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Delusions of the Workplace (How recession paranoia and projection impact patient care)

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Length: 21 minutes

Melinda Lee Payne, MD

In-Patient hospitalization was at one time, as recently as 1990 a place for safety, respite, and reorganization of the psyche and a person’s life. For the last 15 years in-patient stays have changed and the regressed person is often seen as an irritant rather than a person in pain.

As a child and adolescent psychiatrist working in a Children’s Rehabilitation Hospital, the staff holds the container for the child’s rehabilitation from injury, illness or both.

Add to this complex environment the escalation of employment “lay-offs”, and the dynamics of an already strained setting become wrought with misunderstanding, paranoid projection, resentments and hostile distortions.  There is often an ironic sense of helplessness.

This paradoxical situation hurts the children. As the children emerge from head injury, or trauma they are most vulnerable to the perceptions of those who are working with them, caring for them. The child who is dependent on a nurse, physical therapist, a feeding specialist, a pulmonary specialist and pediatrician for help with staying alive, and retrieving a “self” through mastery of “ADL”s (Activities of Daily Living) can become a target of the staff’s harried perceptions and fears.

How do those of us in the fields of psychological health provide a presence that diminishes the hostility, and promotes hope—without getting caught in the cross-fire?


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ISPS-US