This paper has been published as Waggett, N. (2025). Digital transformations: Exploring the human-technology constellation in our entangled organisations. Organisational & Social Dynamics 25(1) 52–72 (2025)
Organisational and Social Dynamics, 25, 52-72. doi: 10.33212/osd.v25n1.2025.52
ABSTRACT
Work, organisations, and society have been transformed by digital technologies. Information and communication technologies are increasingly important to the management and delivery of human services. Significant sums are invested with the expectation that new technology will drive positive changes such as improving service user experience, efficiency, and outcomes. Sometimes the promises of technology are not fully realised. As researchers and practitioners in organisational and social dynamics it is important to understand how these technologies are affecting the ways in which we organise, communicate, and relate.
In this article I explore one aspect of this dynamic, which is that technologies are entangled with the anxieties of human service organisations where the task is caring for people who are ill or in distress. This may lead to structures and processes that are not requisite to the primary task of these services and the technology implementation may fail to meet its aims.
I draw on the work of Kurt Lewin, Isabel Menzies Lyth, sociotechnical systems theory and my own research to explore the entangled nature of contemporary organisations. I suggest ways in which we might develop our concepts and practices to fully account for the role of technologies in organisational process and therefore our ability to consult to those processes.
Introduction
We are in the midst of a technological revolution. Computers, automation, digitalisation, the internet, and information and communication technologies have transformed our organisations, how we work and what can be achieved. Rapid change continues and we are only now beginning to see the possible future that artificial intelligence (AI) may create.
As researchers and practitioners in organisational and social dynamics it is important to understand how these technologies are affecting the ways in which we organise, communicate, and relate. Psychoanalysis and systems-psychodynamics are well placed to assist us in this and to support processes of adaptation and change. In this article I want to suggest some ways in which we might develop and adapt our concepts to these new conditions and dynamics (Krantz, 2015). Although these changes are impacting all sectors, the particular focus of this article is on human services such as health and social care. I will argue that the increasing entanglement of information and communication technologies with human processes may have effects that are counter to the core task of these organisations; that is, the provision of compassionate care. I suggest that, as researchers and consultants, we must fully take into account the role of technologies in these organisational processes.
What is meant by technology?
Technology can be defined as the application of scientific knowledge for practical purposes, and also the tools and equipment developed from that knowledge. Digitisation means to convert analogue information into a digital (i.e. computer-readable) format and digitalisation means changing organisational processes to use digital technologies.
Within the human services there is a particular emphasis on the increased use of information and communication technologies (ICT) and investment in digital transformation. For example, NHS England (2024) has highlighted the importance of technology in the future of healthcare and set out priorities to support a “digital transformation and provide a step change in the way the NHS cares for citizens”. However, there is a well-documented (Stanimirovic, 2024; Wachter, 2016) history of troubled ICT implementation in the NHS and the evidence is that these systems often fail to realise their potential (Waterson, 2014). Similar failings have been documented with the electronic record system for statutory child protection and welfare services (Munro, 2011; White et al., 2010).
Several writers (Eason, 2008; Peltu, Eason, & Clegg, 2008) have examined the introduction, and failings, of the UK National Programme for Information Technology (NPfIT) in the NHS from a sociotechnical systems perspective. The findings from these studies are that the systems were rejected by staff because they were judged to be not fit for purpose, were set up in order to carry out administrative tasks such as achieving targets rather than clinical tasks, and because little consultation had been carried out. These findings point towards a misalignment of technical systems to the tasks of healthcare, such that working practices, including safe and effective care, are hindered rather than enabled. This is exemplified in the following quote:
The way the Stroke Register is set up is primarily around data management. We hope maybe at some stage later we can get something that may help the staff. (Hospital Nurse in Stroke Unit, quoted in Waterson, 2014, p. 157)
One of the key lessons found by the Wachter Report was that there had been a “failure to appreciate that digitalisation completely changes the work—the nature of the work, the tasks to be done, and who does them” (Wachter, 2016, p. 9). This is significant because it suggests that digitisation of health services will, and is perhaps intended to, change the very nature of the work, the tasks, and the workforce of the service. This raises important questions, not only about its achievability, but also the likely effects on patient care, clinical practice and the organisation of services.
Within the field of organisation studies the meaning of technology is contested and there is little agreement on the definition and measurement of technology (Orlikowski, 1992). Whereas early research studies assumed technology to be an objective, external force with deterministic impacts on organisational properties such as structure, later researchers focused on the human aspects of technology, seeing it as the outcome of strategic choice and social action. Technological determinism is the position that, given a set of initial conditions, outcomes related to the introduction of new technologies can be predicted with a degree of certainty (Jackson, Poole, & Kuhn, 2001). For much of the twentieth century organisations were thought of as machines in which people were parts and were expected to fit with the technology of the age (Morgan, 2006). Morgan argues that there is a continuing tendency to fall back on a strictly technical view of organisations where the view is, if you get the engineering right the human will fall into place. At the other end of the ontological spectrum, the social construction of technology (Bijker, Hughes, & Pinch, 1987) starts from the point of view that human action itself shapes technology and that its meaning is dependent on its social context. This challenges the taken-for-granted view that technology has a fixed and stable nature with predetermined properties. In this article I adopt a view of technology that is neither techno-centric nor human-centric, on the basis that neither is well equipped to address the complexities of current information-technology driven, connected, and networked organisations. This position of sociomateriality is defined as follows:
Such an alternative view asserts that materiality is integral to organising, positing that the social and the material are constitutively entangled in everyday life. A position of constitutive entanglement does not privilege either humans or technology (in one-way interactions), nor does it link them through a form of mutual reciprocation (in two-way interactions). Instead, the social and the material are considered to be inextricably related—there is no social that is not also material, and no material that is not also social. (Orlikowski, 2007, p. 1437)
Within systems psychodynamics, the ideas of Kurt Lewin may help us understand this position. As Neumann (2005) has shown, the work of Lewin was fundamental to the formation of the Tavistock approach to studying and consulting to organisations and systems. The central premise of Lewin’s (1997) field theory is that people, their surroundings, and conditions, depend closely on each other. He says, “… to understand or to predict behaviour, the person and his [sic] environment have to be considered as one constellation of interdependent factors” (Lewin, cited in Neumann, 2015a).
Second, Lewin’s dynamic approach rule states that the elements of any situation should be regarded as parts of a system. Neumann (2015b) adds:
In other words, we find it useful as scholarly practitioners to assume that all component parts relate with each other forming a complex whole. We find it useful to assume that all parts connect somehow in ways to be discovered through action and study.
Digital technologies should be considered part of the organisational field and Lewin guides us towards considering the complex whole rather than attempting to reduce a situation to its component parts. Building on this, and Orlikowski’s (2007) suggestion that the social and material are inextricably related, the term human-technology constellation may be a helpful way of theorising the entangled nature of our modern world as it emphasises what humans and technologies do together, rather than defining actions as either human- or technology-led. As practitioners and researchers we should not be making a priori assumptions about the causes of organisational and social dynamics but instead be open to discovering, through action and study, how it is that the component parts of the system are relating and connecting. This approach is key to the sociotechnical systems perspective:
The special contribution of the early Tavistock pioneers lay in their analysis of the interrelation between the technological and the social structures in an organisation and how each influences the other. (Sher & Lawlor, 2022, p. 251)
Sociotechnical systems (STS) theory emerged in response to dominant technocratic models that were technologically deterministic, ignoring human factors (Abbas & Michael, 2023). For example, Trist and Bamforth (1951), in their article on coal mining showed how the introduction of new technology could disrupt the social and psychological aspects of organisations on which efficiency and productivity depended. STS emphasises that an organisation will only function optimally if the social and technological subsystems are “designed to fit the demands of each other and the environment” (Pasmore et al., 1982).
Where I think a position of sociomateriality adds to both field theory and sociotechnical systems theory is in its relational ontology, which sees the social world and the material world as being constituted through their relations with each other. That is, not only interrelating to each other as distinct systems as implied by the Sher and Lawlor (2022) quote above. Law suggests that “This is a thoroughgoing relational materiality. Materials—and so realities—are treated as relational products. They do not exist in and of themselves” (2004, p. 42, emphasis in original). As our entanglement with digital technologies grows in the organisational as well as social context, it becomes harder, and perhaps less meaningful, to attribute particular dynamics to a single cause, whether human- or material-technological. Research and practice therefore need to explore our dynamic relationship with things that, “constitute the very possibility for us to be the beings that we are” (Introna, 2007, p. 25).
I will next outline my research study before using it as the basis to explore the entangled nature of people and technologies within human services organisations.
Outline of research focus and design
The research (Waggett, 2017) focused on the organisation of child welfare and mental health services as a case study for technology implementation. In considering the relationship between people and technologies it is important to understand the context in which this is taking place. Child and adolescent mental health services (CAMHS) and other child welfare and social care services are the location for powerful human emotions and dynamics, including individual and social anxieties, relating as they do to children and families in situations of distress. Working in the human services means engaging in relationships with people who are suffering and this, “inevitably arouses anxiety, pain and confusion” (Obholzer, 1994, p. 206).
Technology is increasingly seen as essential to the transformation of these services including offering, “the potential to increase the capacity of child and adolescent mental health services (CAMHS), promote greater self-management of health, and enable easier, quicker access to support” (Cliffe et al., 2020, p. 95). However, the same authors note that these technologies have not been widely adopted by child mental health professionals.
Data for the study were gathered via a visual method known as the social photo-matrix (Sievers, 2007, 2008, 2013), which draws on Lawrence’s (2005) social dreaming approach, and was originally used as a consultancy intervention before being developed as a visual research method (Fitzpatrick, 2024; Warren, 2012). A social photo-matrix is a small group of participants who provide, in advance of the group meeting, a photograph or other image on the chosen theme, to which they then respond in the matrix. In the case of this research there were two groups of four people each and the participants were a mix of professionals (psychiatrist, psychotherapist, social worker, mental health practitioner, etc.) working with children and young people, and their carers, with emotional, social, and behavioural difficulties. They were asked to produce an image representing their experience of technology in their organisation. These images were shown anonymously to the group as a whole, who sat facing the projector screen, as the basis for free association to the theme. This produced a powerful range of responses, views, and emotions. In the second part of the matrix the group discuss and reflect upon their associations as a way of making further sense of the theme. This draws on Bion’s (1962a) theory of thinking with the second part of the matrix providing the apparatus to think the thoughts generated by contact with the images in the first part. The method thus combines visual and psychoanalytic methodologies as a way to access the collective unconscious of the research participants. The results were data, gathered via tape recordings, which were transcribed and then analysed using techniques for thematic analysis identified by Ryan and Bernard (2003).
The outcome of the study included findings that information and communication technologies participate in ongoing processes that structure the organisation and the work of the staff within it. In some cases, the resulting structures may not be aligned with the primary task of caring for the users of the human services studied. I conclude that these may be contributing factors in why the implementation of ICT systems in the human services can often fail to meet its promises (Stanimirovic, 2024; Wachter, 2016; White et al., 2010).
In the following sections I will first show how integral ICTs are to working in the human services before providing evidence to support the finding that they contribute to changes in organisational structures and work processes. I will then demonstrate how and why this may not be requisite to the organisational task.
The entanglement of humans and technologies at work
The data support the idea that human services are fully entangled with information and communication technologies. As one participant put it, in response to an image of a computer on a desk (Figure 1):
This says work to me. Very loudly. You know, this is a work station. This is work.
Figure 1.
Participants described different types of technology used at work including various patient record systems, portable laptops for accessing these records while on call, electronic diaries, and mobile phones being used to communicate with service users. The images they produced included computers, screens, keyboards, and tangled wiring (Figure 2).
Figure 2.
The increasing dependency on technology and reliance on it for core functions, such as storing knowledge and making connections, was expressed by a participant:
Reminds me a bit of a life support system. I am just thinking that when our systems go down, I feel completely helpless. I can’t access the notes. I can’t write emails. I can’t correspond with colleagues.
In gaining the greatly increased capacities of technology we also give away our agency to it.
Structures and practices change with technology use
The idea that adopting new technologies leads to important changes in how organisations are ordered and run is supported in an extensive review of literature by Bjørn-Andersen and Raymond which concludes that:
There seems to be overwhelming evidence that the continuous IT development has contributed to the emergence of important organisational models over time regarding the creation of new working situations for workers and management. (2014, p. 191)
I will give three brief examples from my research data to illustrate this.
1) Electronic patient record systems and widespread use of laptops have led to the closure of medical record departments and the transfer of responsibility for record keeping onto clinical staff. By enabling staff to access records and write up notes from home (or in their car as one participant said) and out-of-hours, technology transports work across boundaries (both physical and temporal) and onto individual practitioners. The double-edged nature of this is apparent in this statement by a participant:
I love the fact that I can get home in time for tea sometimes and then I can do my notes at home.
2) The data demonstrate how advances in technology have facilitated changes in the physical estate and infrastructure of services, and that this impacts on working practices. Even before the pandemic, there were fewer fixed bases from which to see clients and more mobile or agile working facilitated by new technologies. A participant expressed how this had affected team dynamics:
And also it really does murder teams as a kind of physical basis for what you’re doing, so that sense of this is my desk, therefore that’s your desk and that’s your desk and we get to know each other.
3) Technology is now integral to practitioners’ relationships with clients, just as it is increasingly part of the workplace. As Boxer (2013) says, “Digitalisation and the internet lead every client to expect more dynamic interaction with their particular situation, context and timing”. There are many potential benefits to this but also challenges. Staff can be contacted anytime, anywhere and, whilst for service users this may be empowering, for the practitioner it is felt to be intrusive. As with patient records, the responsibility for managing the boundaries of the relationship with distressed patients and families, and the anxiety associated with that, is transferred to the individual practitioner.
The transformation of services is often the intended outcome of introducing new technology and new models of practice, and may be necessary if we are to achieve service improvement. However, these initiatives may fail if they do not relate realistically to the conditions of the system including anxieties associated with the provision of services to people who are in situations of distress.
Technology as a generator of abstractions
In the following examples technology is shown to connect with organisational anxieties to generate simplified representations of complex human processes and interactions. These are abstractions from concrete experience. It is argued that this can be necessary and helpful, but may also entail an emotional distancing from the work which may lead to an orientation of services towards the simple and away from the complex.
4) An example of abstraction from my research is an image of a photograph being taken of a collage made by young people in a group therapy session (Figure 3).
Figure 3.
The photograph is a snapshot of a multi-layered experience taking place over a period of time which is reduced to one moment. The suggestion is that this was done to provide evidence of the intervention and that “there’s got to be evidence of an experience rather than just the experience”. The technology of the mobile phone enables this but at the same time reduces the event to a single moment; only one aspect of the reality of the experience.
5) Both electronic patient record systems and patient reported outcome measures (PROMs) can be seen to produce a simplified representation of the service user, their condition, and the practitioner’s experience of them. Whilst participants describe some positive developments, such as the ability to access patient records remotely, there were also examples of the reductive capacities of these technologies.
In the same way that I can see a note that my colleague has written four months ago in a blink of an eye, there’s an idea that all of the complexity could be reduced to something as easy as that.
The sense given was that the client/practitioner experience is reduced and devalued by these systems:
The fact of actually doing this piece of work with the young people in itself wasn’t the value, it had to be in some way recorded, a bit like “if it’s not in the diary it doesn’t count”.
I couldn’t help thinking about the three dimensional going to two dimensional and then if it’s then made into a file that goes on an electronic record, is that the value of it, do you lose value as it’s going through that process, as it gets less dimensional?
Another participant made a link to how outcome measures require something human to be fitted into the form and the distorting effect of that action:
… it makes me associate to outcomes … I think it goes with things like distortion and making human things fit into shapes like that. And what gets lost and distorted. Potentially.
The argument is not that these are deterministic outcomes of the technology but that the technology-in-use is interacting with and mediating human processes. This view is supported by other research. Berg defines the electronic medical record (ERM) as a “formal tool”, that is, “those tools that operate on circumscribed inputs using rules and that contain a model of the workplace in which they are supposed to function” (1997, p. 403). Embedded in the rules for using the ERM—what can or can’t be entered and in what way—is an abstract model of the workplace. For example, the ERM studied by Berg (ibid.) in an intensive care unit in a hospital in the Netherlands contained a medical progress note which indicated what had to be investigated, in what sequence, and defined how the findings were to be described. He argues that in so doing the formal tool is attributed a central role in organising the work of the unit. This is problematic because of the fundamental poverty of the formal in comparison with the richness of the empirical world:
A rule- or formula-based model cannot but delete the details of what it represents. This creates inflexibility and will inevitably result in improper functioning when the formal tool is “set free” in the complex world it supposedly models. (Berg, 1997, p. 406)
6) One of the images provided for the social photo-matrix was of a computer on which could be seen an electronic diary being used to plan appointments (Figure 4).
Figure 4.
The electronic diary is a simplified representation of the complex relationships with service users. This is necessary as it enables administrators and managers to organise the service in terms of numbers of time slots, clinicians, rooms, and patients. However, the service viewed at this level is abstracted from the emotional experience of working with disturbed and disturbing patients. A participant described this as:
And there’s maybe a little sense of that here—that maybe out there, well it’s not at all cut and dried, but in here it’s all colour coded in nice blocks and it stands instead of reality rather than representing it. Perhaps.
The diary isn’t intended to reflect the emotional and dynamic complexity of the service but, what the research participant is indicating, is that this simplified version is viewed as if it is in fact the same as the service itself and therefore “stands instead of reality rather than representing it”.
And it kind of presumes that everything we do is the same doesn’t it? … And you just think these slots are okay but what if the patients don’t fit in the slots, then you get stuck. Because if this is a fixed system and the green is your appointments, the blue is your write up time, or whatever, they have a meaning.
As a result, the service is orientated to the abstract version represented by the diary and the research participants discussed how this does not afford the time and spaces necessary for the processing of the emotional content of the work such as informal meetings or time to reflect between difficult sessions. As another participant put it:
Like what colour is a conversation with a colleague? All those bits that might not be reflected in the diary.
It might be argued that it is a management choice to not have a colour code for “conversation with a colleague”. However, if we think of it as an action within the human-technology constellation then what is recorded is determined, to some extent, by the limitations of the system and partly by the needs of managers to have a well-ordered service. These two things acting together squeeze out informal spaces for processing the anxieties of the work.
7) A different kind of example of technology contributing to the generation of an alternate, or as if, reality is seen in videos made with young people to represent the work of CAMHS. These are highly selective as only a small proportion of service users are likely to be willing and able to talk on camera about their experience of mental illness and of services. The process is likely to exclude a whole range of children and young people who are either more seriously ill or otherwise unable to speak about themselves in that way. What gets produced as a result is a narrow representation of the reality of services, and only one part of the wide spectrum of work is made visible and therefore available for public endorsement. As a participant said:
You have to wonder about teenagers who lend their help to developing CAMHS services, I always think, I wonder if what gets produced is a very, very narrow scope of the field.
Again, choices are being made by people but the technologies (recording equipment and website) afford some options and constrain others. As Zammuto et al. say, “An affordance perspective recognises how the materiality of an object favours, shapes, or invites, and at the same time constrains, a set of specific uses” (2007, p. 752). The argument is that, in the entangled human-technology relationship, the coming together of human anxieties, such as the need for a positive representation of the experience of young people in the service, and the affordances and constraints of technologies, result in particular representations of the world, and ones that are often simplifications of the complexity of the lived experience. This in turn reduces the visibility of, and therefore the valuing of, the more complex and difficult aspects of the service that are harder, if not impossible, to capture through the technologies described.
I will next explore the nature of anxieties in the system and how these may be interacting with technologies and the function of abstracting from concrete experience.
Technology as a (failed) container of anxieties
The research data indicated that the practitioners experienced feelings of risk and anxiety and sought ways to manage them including by projecting into the technologies which were as much part of their work as was time spent with service users. As one participant stated:
… maybe, sometimes, for me at least, the technology holds some of my anxiety because I’ve recorded it.
Another indicated that it may also function to contain anxiety for the wider system:
Because the image with the diary, it can be lots of different things, but one of the things it might be used for is by the system itself, to contain some of the anxiety that’s going on.
There is a recurring metaphor in the data connected to “mess, chaos, pandemonium” and their opposites in “tidy, cut and dried, neat”. Tidying the chaos may represent the managing of powerful emotions; of finding ways to keep anxiety under control in a chaotic, disturbing world. The ever-present familiarity of computer equipment is seen by one participant to provide an “anchor” in an otherwise turbulent environment:
The keyboard can offer a bit of an anchor, though. In that you know what’s where. Like I know where the Q is and the W. And you know what to do. You know how to do it. You know? A lot of our … the work is a bit … in unknown territory. But with that it’s a bit of an anchor sometimes. At least you know how to do that.
The suggestion is that the technology is used, in phantasy, as an object into which anxiety is projected as a way of seeking containment for those anxieties. As Western argues:
… psychic objects and part objects, are not only projected into other humans but also into the machines and technologies in our networks. In return we introject not only from other humans, but also from material objects from the natural and non-animate network. (2009, p. 9)
The evacuation of anxiety may provide temporary relief in some circumstances, such as sending an angry reply-all email to colleagues or making a data entry, but it is should be clear that information technologies cannot process and modify projected anxiety in the way that people do, such as in the supervisory relationship or in a conversation with a colleague. It may be obvious, but as psychoanalytic practitioners we would note that technology does not have the capacity Bion (1962a) called “maternal reverie” in which the mother receives the infant’s projections of fear, discomfort, and anxiety and modifies them so that the infant can introject the anxiety in a detoxified, bearable form. Technology has no way of processing the projections; it is a failed container. As a result, staff have to take back what they have projected outwards and introject it in a raw, unprocessed form that serves to increase their distress. I believe a participant was describing the failed containment of computers when they said:
The mess. All these wires behind the desks. That don’t get seen. Because often they’re falling down behind the desk. So uncontained, in a way. Crossing over and hidden and …
This may be a reference to unconscious fears and anxieties “that don’t get seen”, that is, not subject to reverie. In the absence of containing structures—and we have seen the role that technology may play in this—the staff undertaking complex emotional tasks unconsciously seek containment from the technologies that are the very stuff of their work, but this is not effective. Therefore, rather than acting as containers for anxiety, technologies may become incorporated into structures that defend against that anxiety.
The human-technology constellation as a defence against anxiety
A central focus of the psychoanalytic understanding of organisational processes relates to the role of anxiety and socially structured defences against it (Armstrong & Rustin, 2015). Where containment is inadequate, individuals may employ primitive defences such as splitting and projective identification in order to manage the distress and for self-preservation, but this can easily become dysfunctional and interfere with the organisational task: “Excessive anxiety can inhibit, erode and even paralyse our capacity to function effectively” (Gutman, 1989, p. 5). What Menzies Lyth (1960) found in her study of nursing systems in a teaching hospital was that these defences can become socially organised. Building on Jaques’ (1955) work on social systems as a defence against persecutory and depressive anxiety, Menzies Lyth showed how the running of the hospital, its procedures, systems, roles, and culture, was structured as a way of evading the anxieties of caring for patients (Bain, 1998). Crucially, Menzies Lyth also found that, “the social defense system in the nursing service was ineffective in containing anxiety in its members. It did not help them work it through” (1960, p. 460).
Whilst Menzies Lyth does give some consideration to the role of materiality, such as uniforms and insignia, in social defences, her central argument is that, “the culture, structure and mode of functioning are determined by the psychological needs of the members” (1960, p. 443). One implication of adopting a position of sociomateriality (Faulkner & Runde, 2012) is to recognise that agency is not the exclusive property of humans but that “objects too have agency” (Latour, 2005, p. 63). By challenging the dualism that gives the capacity for agency (i.e. making things happen) only to humans, the entanglement with non-human actors, such as digital technologies, can be fully explored: “Objects are approached as agents, that is, as entities with the capacity to do something” (Humphries & Smith, 2014, p. 479).
The incorporation of technologies into socially structured defences is explored by Krantz (2015). He recognises that institutions that are created to satisfy human needs can then take on enduring, impersonal, and independent characteristics and thus the need is to understand, “the aspects of the new organisations that are more than just the people who animate them” (ibid., p. 61). He argues that social defences theory shows,
how the non-human aspects of organisational life … can be incorporated into the cycle of projection and introjection in a way that reinforces people’s defences against task-related anxiety by functioning as containers of psychotic anxiety. (ibid., p. 61)
Understanding these processes is what Western (2009) described as a key question of our times, that is, “How non-animate objects and psychic objects interact in complex networks to create the social world”.
In the empirical examples given, technology is seen as being used as a defence against anxiety in that it allows administrators and managers to maintain a distanced position from the raw emotions of the service by managing it at the level of abstraction. Whilst helpful for them, my argument is that this orientates the service to a dispassionate model which is useful at the level of managing the service, but which leaves the emotional complexity, disturbance, and anxiety with the frontline practitioners whilst squeezing out mechanisms for processing it. The staff, in turn, project anxiety into technology which is unable to provide containment and the anxiety is returned unprocessed as, what Bion (1962b) called “nameless dread”, and there are repeated references to “dread” in the data that demonstrate this is happening. The key point is that, even though ineffective, the defence system has resulted in an organisation that has taken on the enduring, impersonal, and independent characteristics referred to by Krantz (2015). I will next describe how this process of reification occurs, and technology’s part in it.
Technology and misplaced concreteness
A function of technology identified within the study is to abstract from the lived experience of services to a simplified representation such as the patient record, meeting schedule, outcome measure, or video. These are helpful processes that greatly enhance our capacity to capture, understand, and manipulate the world around us. The experiences and circumstances of a mental health patient or a child in care are complex and unknowable in their entirety so we increasingly turn to technology to assist us. Hernes says that, “The totality of what we are trying to describe escapes our conceptual abilities” (2014, p. 194) and that creating abstractions is essential to help us to understand our experiences.
Whilst necessary, models and representations may also be deceitful as we have a tendency to forget that they are abstractions from experience, and not the actual experience itself. This is the danger that Whitehead (1929) referred to as the fallacy of misplaced concreteness, in other words to allow abstract ideas to become reified, fixed, or rigid so that the concepts behind them are forgotten and they are mistakenly thought of as a true and accurate representation of reality (Wood, 2005). For Whitehead the key point is that “abstractions have a nasty way of taking over from concrete experience, in the sense that they may be mistaken for concrete experience” (Hernes, 2008, p. 6).
The error of misplaced concreteness parallels the process of reification that is central to the social defences thesis. Menzies Lyth showed how a service is organised in order to defend against anxiety, but the resulting structures and ways of working are related to as if they were in the service of the primary task, that is the provision of care. She notes that, for the nurse entering the service, “the social defence system at the time of entry is a datum, an aspect of external reality to which she [the nurse] must adapt and react” (Menzies Lyth, 1960, p. 459). Young (1994) specifically links Whitehead and Menzies Lyth in saying that social defences are the “institutional equivalent” of misplaced concreteness:
… whereby abstractions are created for a quite distinct purpose, but that purpose is forgotten and one becomes stuck with them and equates them with reality, substituting them for direct experience, which comes to be experienced in terms of the equation between that set of abstractions and reality itself. (Young, 1994, p. 167)
Young is suggesting here that both social defences and misplaced concreteness involve a “symbolic equation”. The ability to form symbols is a developmental achievement involving the substitution of a symbol for the thing it represents. Building on Klein’s (1946) analysis, Segal (1957) identified that an attribute of paranoid–schizoid functioning is the inability to distinguish between the symbol and the thing symbolised; the two are equated. Young makes the point that the loss of the symbolic function is a serious deficiency:
Patients who experience things concretely and equate the symbol with the thing are considered to be in a very primitive, regressed state […] so are people under stress in groups and institutions. (1994, p. 17)
That is, people under stress in groups and institutions are more likely to respond concretely to aspects of their organisation, including its technologies and technology-derived abstractions, and relate to the symbolic representation of reality as if it were reality itself. A feature therefore of the human-technology constellation is both the increased abstraction away from the reality of the emotionally demanding task of these services and the increased likelihood of these abstractions being mistaken for reality itself because of the reduced containment of anxiety.
One consequence of symbolic equation is that the anxiety aroused by the original event, sensation, or object may be experienced in full in relation to the symbol (Waddell, 1998). So, although the process of abstraction may, in part, be a defensive distancing from raw experience, this defence fails if the symbol cannot be held in mind separately. This may account for Menzies Lyth’s finding of “the high level of tension, distress and anxiety among the nurses” (1960, p. 460).
If we lose our capacity to symbolise, we lose our ability to understand, that is, to make sense of our concrete experience and the emotions it generates. This is significant for anyone involved in organisational development and change processes as it means that staff are less able to respond thoughtfully and flexible to the changes in their situation. This includes the introduction of new ICT systems, and the foregoing discussion gives a new flavour to the term digital transformation. The digitalisation of health and social care may produce organisational structures and systems that are not requisite to the primary task of caring for patients and service users because they reduce the very humanity most needed for those people. As the role of technology in these organisations is increased so the equilibrium of the human-technology constellation shifts, and the risk is that their humanness is diminished. As a participant in the research said:
And they used to bang on about investing in people in the NHS, and now it feels like everything is invested in technology.
Summary and conclusion
What I have tried to show in this article is how integral information and communication technologies are to the work of contemporary human services, and how this leads to changes in organisational structures and practices. I suggested that the outcomes of this process may not always be as intended by system designers and leaders, and that one reason for this is that technologies connect and interact with individual and organisational anxieties. These anxieties are especially powerful in the human services, and it was seen that some of the new technology-dependent structures and practices may reduce containers of anxiety as they are orientated to the needs of technology more than people. As a result, both frontline staff and management may project their anxieties into the material world around them including information and communication technologies, but these are not effective containers of that anxiety in the sense that they do not help people work it through. Uncontained anxiety leads staff to seek ways to defend against it.
I went on to explore how technologies contribute to a reorientation of structures and processes towards defending against anxiety and away from the primary task of relational care for children and young people with complex needs. One of the powerful attributes of the human-technology constellation was seen to be abstracting from lived experience to simplified representation. These abstractions are divorced from the complex emotional dynamics of caring for patients and service users and, as such, may be seen as a way of defending against the anxiety of that task. The structures and processes generated through these abstractions fail to contain anxiety and, as a result, it is harder for staff to hold in mind the model or abstraction as being only a simplified representation of reality, and not reality itself. The error of misplaced concreteness leads to the abstraction being treated as if it is reality and so further changes are made to structures and processes to align to the technology-dependent model which becomes increasingly misaligned to the task of caring for ill and distressed service users, and of supporting staff in that task. This supports my assertion that the increasing entanglement of information and communication technologies with human processes may have effects that are counter to the fundamental task of the human services; that is, the provision of compassionate care.
Implications for practice
How people respond to new technologies is driven by a complex interaction of conscious and unconscious factors. Technology may be taken up and used in ways that are as much about managing anxiety as they are about service development. To plan technological change without considering human factors would appear to be a return to technological determinism and scientific management. Equally unhelpful is the view that it is only human dynamics and relations that are the concern of the organisation researcher and consultant. The material world, nature, and technologies are also significant actors in our organisations and societies. They make things happen and these may not always be as intended or in our best interests.
As organisational researchers and consultants we must be alert to the dynamics of the present moment and to the changing context in which we work. The power of new and emerging technologies may make these dynamics especially dynamic. This is a challenge for leaders and consultants in supporting adaptive change in complex systems amid pressure towards certainty and away from risk and innovation. Those supporting these processes must be open to discovering how and where connections are made between people and technology, and how these are affecting organisational processes and structures. A degree of agnosticism about the source of forces acting on a situation is a healthy position to hold.
Acknowledgement
I would like to thank the anonymous reviewers for their comments on an earlier version of this article and Dr Louisa Diana Brunner for her support in developing the revised text.
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ABOUT THE AUTHOR
Nick Waggett leads the professional doctorate in advanced practice and research: consultation and the organisation at the Tavistock Clinic. He has a Masters in health service studies, a Masters in consultation and the organisation: psychoanalytic and systemic approaches, and completed the professional doctorate in consultation and the organisation in 2018. His thesis investigated the impact of new technologies on organisational processes and the implications for consultancy practice. Nick was chief executive of the Association of Child Psychotherapists, has taught on several academic programmes, and provides consultancy in the public sector. He is an associate editor of Organisational and Social Dynamics.
Email: nwaggett@gmail.com
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