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Helping realise development since 1986

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The ‘Impossibility’ of Working in the Current NHS: Sacrifice to a Primitive God

Mike Chitty · June 20, 2025 · Leave a Comment

by Rachel Gibbons (2025)

Reviewed by Mike Chitty

Rachel Gibbons’ recent contribution to Psychodynamic Practice offers a lucid and unsettling diagnoses of NHS organisational culture. Moving beyond typical accounts of staff burnout, under-resourcing, and institutional inertia, Gibbons draws on psychoanalytic and symbolic frameworks to reveal the deeper currents that trap health professionals in a cycle of sacrifice and despair. Her core thesis is that working in the NHS today is not merely difficult, but psychically impossible, unless one submits to being ritually sacrificed to maintain the illusion of a benevolent, functional system.

The ‘Primitive God’ of Sacrificial Health Work

At the heart of Gibbons’ argument is the symbolic function of sacrifice. She contends that NHS workers, particularly those in caring roles, are not merely overworked, but sacrificed. Their wellbeing, values, and often sanity are consumed in service of an institutional mythology that cannot bear to confront its own incoherence. The “primitive god” in this case is the organisation itself, sustained not by functional governance but by ritual acts of devotion and denial.

Sacrifice is not a metaphor but a defence mechanism. It keeps the wider system stable, even if it means destroying those within it. The sacrificial offering is the emotional and moral integrity of frontline workers, those whose care is most authentic and whose suffering is most repressed.

Psychodynamics: Splitting, Projection, and Denial

Gibbons makes good use of psychoanalytic concepts to explain how this dynamic is sustained:

  • Splitting: Staff and systems alternate between being idealised (“heroes”, “angels”) and denigrated (“troublemakers”, “burnouts”), rather than being seen in their full humanity. This fragmentation protects the system from integrating contradictory truths.
  • Projective Identification: Organisational anxiety is offloaded onto individuals, who are then punished or marginalised for manifesting it. This is particularly visible in the treatment of whistleblowers and dissenters.
  • Denial: Leaders and institutions deny systemic trauma by overemphasising strategy, data, and performance management, mechanisms that conceal emotional and moral breakdowns beneath a veneer of rationality.

The result is an emotionally broken culture that expects moral performance without moral support, a theatre of virtue sustained by suffering.

Implications for Leadership and Organisational Culture

One of Gibbons’ most important contributions is her challenge to prevailing models of NHS leadership. Rather than calling for better metrics or resilience training, she calls for psychic and symbolic honesty. NHS leaders, she argues, must become aware of the unconscious dynamics that animate their institutions: the roles they play in sacrificial rituals, the stories they tell to justify harm, and the fear of confronting institutional grief.

She invites leaders to:

  • Develop emotional literacy, able to name and work with shame, guilt, and projection.
  • Hold spaces for collective reflection, not as a form of managerialism, but as a way of honouring moral experience.
  • Resist the myth of heroic individualism, which feeds the sacrificial logic, and instead embrace relational and collective leadership.

In doing so, she implicitly aligns with broader movements that seek to embed ethics of care and process-relational thinking into public service cultures.

The ‘Impossibility’ Reframed

To call working in the NHS “impossible” is not to suggest it cannot be done, it is to suggest that, under current conditions, it can only be done by engaging in forms of self-abandonment that ultimately dehumanise. Those of us who work with colleagues who have sustained NHS careers will recognise this phenomena. Gibbons reframes this impossibility not as a failure of individuals, but as a systemic indictment. She names the collective delusion: that we can continue to expect quality care, moral integrity, and emotional labour from professionals while denying them the psychic and structural support they need.

Her paper, then, is less a critique and more a call to consciousness, to notice what we have repressed, to question the gods we serve, and to remember that care cannot survive where sacrifice is demanded.

A Leadership Ethic for the Post-Sacrificial NHS

For those working in leadership development, Gibbons’ insights offer an urgent provocation: our leadership paradigms must evolve. The NHS cannot be reformed by better targets, slicker dashboards, or even more compassionate rhetoric if it continues to rely on unconscious rituals of self-sacrifice. Instead, what is needed is:

  • A shift toward collective responsibility, where care is not individualised but shared.
  • A refusal of martyrdom, cultivating leadership that names its limits and honours its own needs.
  • The development of psychodynamic fluency in leadership education, recognising that what is not spoken still shapes what is done.
  • The cultivation of process-relational awareness, where institutions are seen not as machines to optimise, but as evolving fields of relationship to be tended.

Such a shift would require leaders not only to learn new skills, but to undergo a kind of moral and emotional reckoning: a willingness to listen to the unspoken, to disrupt sacrificial norms, and to reimagine care as something grounded in shared vulnerability rather than heroic endurance.

Conclusion

Rachel Gibbons has written a rare thing: a paper that is both clinically astute and politically courageous. By drawing attention to the unconscious sacrifices demanded by NHS culture, she gives voice to what so many feel but dare not name. In doing so, she opens the door to a new conversation, one in which care is no longer confused with suffering, and leadership becomes an act of deep, relational responsibility.

Her paper deserves to be widely read, not only by clinicians and psychotherapists, but by health leaders, policymakers, and anyone seeking to restore soul and sanity to public service. For those of us working at the intersection of ethics, process, and leadership, her work is not only insightful, it is indispensable.

If you would like to explore this paper further and its implications for your leaders or leadership please do get in touch.

Between Principle and Power

Mike Chitty · May 4, 2025 · Leave a Comment

How Electoral Tactics Are Separating the Green Party from Its Ethics…

The Green Party was founded not just as a political vehicle, but as a principled response to the intertwined ecological, social, and moral crises of our time. It offered an invitation to reimagine politics, not as a contest for domination, but as a space of stewardship, participation, and care.

Yet in recent years, as electoral ambitions have grown, there are signs that the tactical imperatives of gaining and holding political power are beginning to erode this ethical foundation.

Electoral logic is inherently adversarial. It encourages message discipline, voter segmentation, and the identification of ‘wedge issues’ that can secure marginal gains. Success within this logic often demands strategic ambiguity, image management, and the pursuit of short-term wins over long-term transformation. While such tactics may increase vote share or seats won, they also risk transforming the party into what it once sought to challenge: a political actor driven more by pragmatism than principle, more by reaction than reflection.

Nowhere is this tension more evident than in the increasing willingness of some candidates to downplay radical policies in order to appeal to ‘soft’ voters, or to centre campaigns around local grievances rather than systemic transformation. There is a growing pressure to behave as mainstream politicians do, to speak in soundbites, avoid controversy, and prioritise electability over ecological truthfulness or moral clarity. In doing so, the party risks becoming a parody of itself: advocating for ecological integrity while compromising the deeper cultural and spiritual shifts such integrity demands.

This drift is not simply a matter of strategy; it is a philosophical divergence.

To frame politics as a battlefield where tactical cunning triumphs is to endorse a consequentialist ethic, where ends justify means, and moral considerations are subordinate to electoral calculus. But the ethic at the heart of the Green movement has always been one of care, coherence, and attunement. It calls for right relationship with the Earth, with others, and with future generations; a relationship that cannot be faked, marketed, or delayed until the next election.

Indeed, as Joan Tronto argues, care is not merely a private virtue but a political orientation, an ongoing attentiveness to needs, vulnerabilities, and interdependencies. Similarly, the process philosophy of Whitehead and others reminds us that all systems, including political ones, are dynamic, relational, and co-creative. From this perspective, the means are not separate from the ends. They are the ends, in germinal form. If the Green Party abandons its way of being in the world in order to win, then it has already lost something essential.

The process we use to get to the future IS the future we get.

What is needed perhaps, is not an abandonment of the political field, but a reclaiming of the party’s distinctiveness within it. This means resisting the seductions of slick campaign tactics that flatten complexity and compromise values.

It means crafting a politics that is slower, deeper, and more dialogical; a politics of presence rather than performance. And it means welcoming those willing to stand not just for something, but as something: embodiments of a different ethic, a different culture, a different future.

The choice before the Green Party is not simply between being idealistic or realistic. It is between being ethically alive or tactically undead. If we are to resist becoming yet another party chasing the hollow prize of influence, we must stay rooted in the living soil of our founding values, listening to the Earth, to each other, and to the silence between applause.

Mike Chitty

2025

Wearing Values Lightly or Living Them Deeply?

Mike Chitty · April 29, 2025 · Leave a Comment

The Dance Between Personal and Organisational Ethics

In contemporary organisational life, values have become a kind of currency, to be printed on mission statements, vinyls stuck on to walls, and voiced confidently at induction days. Yet, behind this rhetorical familiarity lies a more complex, unresolved question:

What are values, and how do they operate in the interplay between personal conscience and institutional identity?

To explore this, we might begin by asking: are values like clothes, chosen to suit a setting, or are they closer to a second skin, inseparable from the self, enduring across time and place?

Or perhaps they are something stranger still: half-inherited, half-chosen, and only truly revealed and strengthened in the tension between conviction and circumstance.

The Illusion of Fixed Values

Much of modern leadership discourse assumes that values can be fixed, coherent, and transferable. We’re told that individuals should be “values-led” and that organisations ought to “live their values.” Yet this assumption often masks a deeper truth: values are not stable possessions but are better understood as living commitments that emerge through relation and context. As Charles Taylor (1989) notes, values are embedded in “webs of significance,” always interpreted through cultural and historical lenses.

What’s more, the idea that values can be universally codified, immutable across time, place, or person, can be more coercive than clarifying.

When organisations articulate a set of ‘core values’ as non-negotiable, they risk substituting conformity for integrity. This creates a culture where people wear values like uniforms, suppressing the dissonance that might otherwise lead to growth, questioning, or innovation.

Conformity or Plurality?

This raises a second question: do we really want everyone in an organisation to share the same values? At first glance, the answer seems obvious; surely alignment makes for harmony. But such harmony is often achieved at the cost of diversity, creativity, and ethical depth. Iris Marion Young (1990) warns against what she calls the “ideal of impartiality,” which smooths over difference and silences dissent in the name of common purpose.

Values pluralism, on the other hand, recognises that different people may hold divergent but equally valid commitments. Rather than seeking uniformity, organisations might do better to foster ethical dialogue, a space where conflicting values can be explored without fear. This calls for what Joan Tronto (1993) names as an “ethic of care,” rooted not in abstraction but in attentiveness, responsibility, and responsiveness to others in specific contexts.

Organisational Culture in an Era of Polarisation

These questions become even more urgent at a time when social and political values are increasingly polarised. Whether in debates over immigration, climate policy, or the role of the state, we see a rising tension between values of individualism and selflessness, liberty and security, progress and tradition. Organisations do not exist outside these debates; they are implicated in them, both as actors and as communities of meaning.

In such a landscape, the temptation is to double down on values as boundary-markers, signalling virtue or allegiance. Yet a wiser response might involve cultivating values not as fixed identity claims but as evolving practices of relational negotiation. Values such as honesty, care, courage, and justice are not simply asserted; they are enacted in and through the messiness of lived organisational life.

A Practice-Based View of Values

Perhaps then, values are less like clothes and more like musical instruments: tools of expression that require tuning, care, and skilled use. This analogy invites a shift from “value alignment” to “value attunement”, not everyone playing the same note, but listening closely enough to play in harmony. Minor keys only serving to deepen the melody. Such a shift echoes Alfred North Whitehead’s (1929) process view of reality, in which coherence is not imposed from above but arises through ongoing patterns of relating and becoming.

For leaders and organisations alike, this means resisting the lure of simplistic value statements. Instead, they must foster reflective practice, story-sharing, and the kind of dialogue that welcomes friction as a site of ethical discovery. As values continue to shift across the wider culture, organisations that can live with complexity, rather than retreating into dogma, may be the ones best equipped to contribute meaningfully to the common good.

Conclusion: Living Values Together

Values, then, are not scripts to be memorised or costumes to be worn. They are the living expressions of what we care about, emerging at the intersection of self, other, and world. To ask people to abandon their personal values for the sake of organisational alignment is both ethically suspect and strategically shortsighted. And yet, to ignore the shared values that can bind communities together is equally dangerous.

The challenge is to create organisations that are less like factories of sameness and more like ecosystems of ethical practice, spaces where values are neither imposed nor hidden, but continually explored, negotiated, and lived. In such a space, care might take precedence over compliance, and integrity might mean not agreement, but the capacity to remain in relationship across difference.

References

Taylor, C. (1989). Sources of the Self: The Making of the Modern Identity. Cambridge: Cambridge University Press.

Tronto, J. (1993). Moral Boundaries: A Political Argument for an Ethic of Care. New York: Routledge.

Whitehead, A. N. (1929). Process and Reality. New York: Macmillan.

Young, I. M. (1990). Justice and the Politics of Difference. Princeton: Princeton University Press.

The Fortress of Self: Understanding Donald Trump…and finding a way to respond…

Mike Chitty · April 13, 2025 · Leave a Comment

Donald Trump remains one of the most divisive figures in global public life. For some, he is a truth-telling outsider who challenges elite hypocrisy; for others, a dangerous narcissist whose disregard for truth, decency, and democratic norms undermines the very fabric of civic life. But rather than rehash familiar condemnations or rally around partisan affirmations, we might ask more difficult, potentially healing questions:

What kind of inner world produces such a person, and how might we respond from a place of care rather than condemnation?

What kind of society elects such a person as its leader?

To look for clues, I turn to two frameworks: personal construct psychology (Kelly, 1955) and the ethic of care (Gilligan, 1982; Noddings, 1984; Tronto, 1993). Together, they help me interpret Trump’s behaviour not merely as aberrant, but as the outcome of a particular configuration of personal meaning, and to consider a form of resistance that retains ethical integrity.

The Winner-Loser Binary: A Core Construct

At the centre of Trump’s personality appears to be a rigid binary construct: “winner vs. loser.” This is not just rhetorical flourish, it functions as a core psychological filter through which people, situations, and events are understood and evaluated. And in which identity as ‘a winner’ must be conserved. In business, golf, media, politics, and even family life, success and dominance are equated by Trump with worth, and loss or compromise with irrelevance or contempt. And when there is a loss, it is portrayed as a ‘steal’.

Personal construct psychology, developed by George Kelly, helps us see how such binaries operate. We do not simply observe reality; we interpret it through personal templates and filters shaped by past experiences. If Trump’s formative world taught him that only the dominant survive, then his worldview, however distasteful or destructive to others, has internal coherence. It explains his allergy to humility, his need for applause, and his inability to accept defeat without declaring fraud.

Business Failures, Risk-Taking, and Narrative Control

Trump’s business record is strewn with failed ventures, multiple bankruptcies, lawsuits, unpaid workers, and exaggerated claims. Yet these rarely damage his self-image or standing with loyal supporters. He reframes failures as strategic exits, deflects blame onto others, and doubles down on grandiosity.

This is what Kelly calls “construct protection“: the re-making of events to preserve the integrity of core meanings. In Trump’s case, the identity of “winner” must be protected at all costs, even if that means denying apparently obvious facts. And from within that system, truth is always subordinate to controlling the narrative.

His high tolerance for risk, legal, financial, sexual, political, is also shaped by this construct system. Risk-taking, even cheating, can be interpreted as strength, cleverness, or dominance. In such a worldview, ethical boundaries are soft, non-existent, or invisible, if crossing them reinforces self-image.

Sexual Promiscuity and the Politics of Entitlement

Trump’s sexual conduct, his affairs, boastful misogyny, and serial objectification of women, cannot be dismissed as merely private matters.

They reflect more than mere libido. They suggest a worldview in which other people, especially women, exist as instruments of gratification and affirmation. The pursuit of sexual conquest becomes another arena for dominance, a performance of virility and power, tinged with risk and reward. Those harmed by it are made invisible.

This is not incidental to Trump’s political ethos; it mirrors it. In both realms, the ethic is not mutuality but utility. What use is this?

What Kind of Ethics Are at Work?

The ethics at play in Trump’s world are perhaps best described as utilitarian self-centredness with a Darwinian accent. There is little sense of moral responsibility beyond the self, and no ethic of interdependence. This worldview celebrates not virtue but efficacy; the ability to win, persuade, extract, or dominate.

This is an ethic in which cheating is clever, truth is flexible, loyalty is instrumental, and empathy is weakness. It is amoral, structured by spectacle and driven by survival.

Attending with Care: A Difficult Discipline

How should we respond to this?

Not with indulgence. Trump has done harm, and care does not mean looking away. But nor should we respond with scorn or dehumanisation. An ethic of care begins not with outrage but with attentiveness.

  • What is this person defending?
  • What fear lies beneath this performance?
  • What relational wound cries out through these public acts?

Care, as Tronto reminds us, is a political practice rooted in moral clarity. It is not naĂŻve. But it refuses to surrender to cynicism. It holds the tension between accountability and empathy.

The Trump in All of Us

To speak meaningfully about Donald Trump requires more than analysis. It requires self-examination. His prominence may reflect not just a cultural sickness, but a psychic one, a shadow made visible.

  • Where do we ourselves cling to power, status, or control?
  • Where do we treat others as means to ends?
  • Where do we fear irrelevance, shame, or failure?

Trump does not arise from a vacuum. He is a projection of something latent in the culture, something latent in all of us, perhaps?

Resisting Trumpism is not just a political act, it is a spiritual one. It asks us to do our own inner work, to resist the binaries and ego-structures that shape us too. To meet force not with force, but with a stronger fidelity to truth, humility, and relationality.

Other Ways of Seeing: From Myth to Metaphysics

Trump may also be seen mythically, as a figure not merely of politics but of archetype. He resembles the Trickster of mythology: disruptive, rule-breaking, both generative and dangerous. Like Hermes or Loki, he reveals what polite society hides.

From a Jungian perspective, Trump might represent a collective shadow, a figure who externalises our cultural fears, disowned desires, and unintegrated drives. He carries our daemonic energy, but unredeemed unabsorbed.

From a process philosophy lens Trump represents a resistance to relational becoming. Where process thinkers see reality as interwoven, dynamic, and co-creative, Trump stands for stasis, control, and separation. MAGA longs not for a future of emergence, but a return to an imagined past of dominance and simplicity.

To deepen our response, then, is to enter these alternative logics, not merely to diagnose, but to see differently. To resist not only what Trump does, but what Trump means, in myth, in psyche, in system.

Conclusion: A Different Kind of Strength

To be Donald Trump, it seems, is to live inside a fortress of constructs;

  • winner vs. loser,
  • strong vs. weak,
  • loyal vs. disloyal.

These protect a self that cannot risk doubt, vulnerability, or interdependence. Yet in defending this self, Trump closes off the very qualities, love, truth, connection, that make life meaningful.

But Trump is also a mirror. He reveals the shadow of a culture built on performance and power. He shows us what happens when we lose our capacity to relate, reflect, and repent.

Our task is not merely to oppose him, but to become different, to resist with care, to hold truth with tenderness, to make room for a future not built on winners and losers, but on participants and co-creators.

Care is not weak. It is the quiet strength that endures beyond applause. It is the ethic that survives when the spectacle has faded.

And it may be, in the end, our only way home.

If this post resonates please do share it and consider visiting my substack freshthinking.substack.com

References

  • Carroll, E. J. (2019). What Do We Need Men For? St. Martin’s Press.
  • Forbes. (2016). Donald Trump’s Business Failures Are Very Real.
  • Gilligan, C. (1982). In a Different Voice. Harvard University Press.
  • Jung, C. G. (1959). Aion: Researches into the Phenomenology of the Self. Princeton University Press.
  • Kelly, G. A. (1955). The Psychology of Personal Constructs. Norton.
  • Noddings, N. (1984). Caring: A Feminine Approach to Ethics and Moral Education. University of California Press.
  • Tronto, J. C. (1993). Moral Boundaries: A Political Argument for an Ethic of Care. Routledge.
  • Washington Post Fact Checker. (2021). Trump’s false or misleading claims total 30,573 over 4 years.
  • Whitehead, A. N. (1929). Process and Reality. Macmillan.

A Sonnet Cycle: The Forgotten Knowing

Mike Chitty · April 4, 2025 · Leave a Comment

A Sonnet Cycle: The Forgotten Knowing

I. The Silence of the Old Beliefs

Once whispered truths now linger out of reach,
A world once known, now lost to silent air.
The trees still speak, the rivers still beseech,
Yet ears grow deaf, and hearts forget to care.

The stars once wove their stories in the night,
Their glimmers traced a meaning we could trust.
Yet now we weigh them, measure out their light,
And turn their whispers into cosmic dust.

What once was sacred, now is named profane,
For mystery defies the rule of mind.
Yet in the margins, shadows still remain,
And truths half-sensed refuse to stay confined.

The earth still breathes, though we no longer know
A presence lost, yet felt in moonlit glow.


II. The Cost of Knowing Too Much, Yet Not Enough

We chart the heavens, name the winds and tides,
Unweave the rainbow, split the atom’s core.
Yet what is lost when only mind decides
That life is but the sum of things it stores?

A sacred hush once held the dawn in awe,
A whispered voice within the morning’s breath.
Now nature bends beneath the human law,
Its spirit ground beneath the wheels of death.

No god commands, no spirits weave the thread,
No sacred fire burns within the stone.
Yet something calls us still, though long thought dead,
A truth half-seen, a knowing still our own.

For all our grasping, something slips away
An ancient song the world still longs to play.


III. The Return of the Whispered Truths

Yet who decreed that all must be explained?
That measured truth is all that we may trust?
What if the soul of things remains unchained,
Still breathing ‘neath the weight of time and dust?

What if the river sings, though none may hear,
Its waters whispering of deeper grace?
What if the wind still speaks, though we draw near
With instruments, yet fail to see its face?

Not all is lost, though much has been denied.
The stars still burn, though stripped of myth and name.
A world unseen still beckons from the tide,
Still waits for us to hear its voice again.

For truth is not just that which we ‘command’
It dwells in all, if we but take its hand.


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