Where Only Bones Remain: Recovering from the Death Mother in NHS & Social Care

It has long been debated in clinical literature that children suffer not from hostility but from neglect. Winnicott suggested that the psychological wounds of neglect can cut deeper than the pain of conflict. The absence of protection, comfort, or containment creates a void that shapes the child’s developing self. The hopeful child protests, the hopeless child performs compliance.

In psychodynamic terms, protest is often a sign of vitality. The hopeful child still believes their voice might matter, that rupture can be repaired, that someone might respond.

Humans are inherently social and hive animals. To survive, we must hold others in mind. As such, compliance can be a sign of social maturity - we recognise that the world does not revolve around us and that we must conform to keep others safe. As such, compliance is often viewed as a measure of maturity or resilience. However, compliance for the neglected child or the neglected group can also be a signal of a collapse of connection. The child does not protest because they have learnt that there is no point and energy is best spent elsewhere.

James Hillman further developed this idea, suggesting that perhaps the greatest parental failure is not a lack of emotional regulation, but rather a lack of imagination. To fail to dream about a child: to see no potential, no future, no struggle worth having. This leaves the child in a barren climate where nothing can grow. Even flawed aspirations are better than none; at least they give the child something to wrestle with, a shadow to resist or reimagine.

Dostoevsky, too, saw imagination as integral to love. A commitment to seeing someone not just as they are now, but as someone capable of growth, change, and transformation. Without this kind of imagination, children (and adults) risk becoming detached, untethered, unable to feel alive in the present or hopeful for the future.

Yet, as Robert Bly suggests, this imaginative holding requires a template. Someone must know what growing up looks like. Too many have never experienced what it means to be held in mind: not as a problem to fix, a cause to champion, nor a mirror to flatter, but as a person to be dreamt into being.

You cannot offer what you have never received. You cannot hold another in mind if you have never been held yourself. Instead of imagination, what is often offered is in its place is affirmation, which might also be named pity or envious attack. Misery loves company. In this light affirmation is not an act of imagination. It is just an echo of absence.

When the NHS Withdraws

For staff in the NHS, this perspective resonates painfully. Many experience the organisation not as a strict or nurturing parent, but as something colder: indifferent, withdrawn, absent. Policies, checklists, and efficiency targets often replace human recognition. Staff can feel unseen, unsupported, and emotionally skeletal.

Here, the NHS takes on the archetype of the death mother, not actively cruel, but withdrawn, unable to contain or sustain. A nurse works late into the night on a patient advocacy proposal, only to be met with silence. Meetings focus on attendance records and waiting times, with no space to process strain or grief. Compassion goes unrecognised. Like a child seeking acknowledgment from a disengaged parent, staff are left to their own devices with their questions and wonderings, their passion for work stripped to the bone.

The Skeleton Woman

The Inuit tale of the Skeleton Woman captures this dynamic with haunting clarity.

A young woman, cast into the sea by her father, is gnawed to the bone by fish. Years later, a fisherman hooks her skeleton. Terrified, he flees but she remains tangled in his line, following him to his igloo.

There, in the lamplight, he begins to see differently. Untangling her bones, wrapping her in furs, he sheds a tear of compassion. She drinks this tear and is restored to life: hair, flesh, libido. Together, they move to a place where the sea provides for them.

Her revival is not a miracle of technique, but of imagination and tenderness. She is brought back to life because she is thought about and her existence is imagined.

Containment and the Group Matrix

This story carries profound lessons for the NHS. Staff stripped to their skeletal form can only be restored through recognition and imagination. Bion’s concept of containment illuminates this: the act of holding raw emotions, metabolising them into something bearable. In teams, containment extends into the group matrix, where colleagues can process anxieties together rather than leaving one another skeletal and unseen.

In group analytic terms, this matrix is not simply a backdrop but a living organism. The web of reverberations where one person’s despair can echo through the whole. Neglect is not only intrapsychic but intersubjective: the absence of containment in the group field shapes psychic structure just as surely as the absence of a responsive parent. The matrix holds, or fails to hold, and in doing so, it either sustains vitality or strips it to the bone.

Compliance, too, deserves a more layered reading. While it may signal collapse in the neglected child, it can also reflect unconscious group adaptation a relational defence that preserves cohesion when protest feels too risky. In this light, pseudo-mutuality and false harmony may emerge, not from resilience, but from a collective fear of rupture.

Reflective spaces, rituals of acknowledgement, and simple acts of sibling-like recognition can function as the fisherman’s tear. They reanimate passion, allowing staff to feel human again. These gestures are not merely interpersonal; they are matrixal. Restoring the rhythm of resonance and the possibility of shared meaning.

But the opposite is also true. Gottman’s “Four Horsemen”: criticism, contempt, defensiveness, stonewalling also echo through organisational life. These dynamics, though borrowed from couple therapy, find powerful analogues in group analytic theory. They resemble Bion’s basic assumption behaviour, where anxiety disrupts the group’s capacity to think. When policies dismiss staff concerns (contempt), when individuals are blamed for systemic failings (criticism), when silence meets advocacy (stonewalling), the matrix collapses. Staff are left to fend off despair alone, caught in a field that resists cohesion and metabolisation.

But reanimation is rarely gentle. As groups come into consciousness of their neglect, what often emerges first is not gratitude, but rage. That which has been left unmetabolised, unacknowledged, and long held in the body. This rage is not a failure of professionalism, but a sign of vitality. It marks the shift from skeletal compliance to psychic protest. In group analytic terms, it reflects the surfacing of the social unconscious: the shared pain that could not be spoken, now demanding recognition. If held with care, this rage can be transformative a force that reclaims agency, restores dignity, and reanimates the group matrix.

From Survival to Presence

The Skeleton Woman reminds us that neglect wounds deeply but also that revival is possible. To bring imagination back into the NHS means to hold staff in mind, not only as functionaries but as human beings with potential, passion, and needs.

• MDTs as fishermen: teams can notice the skeletal remains, hold them, and offer care.

• Colleagues as siblings: a horizontal web of recognition where mutuality restores life.

• Rituals of gratitude: celebrating small successes, naming strengths, sharing tears that acknowledge strain and loss.

These small but imaginative acts shift the culture from survival to presence. They resist the barren withdrawal of the death mother and breathe life back into the workforce.

The fisherman’s tear is not a policy or a checklist. It is a relational act of imagination — the capacity to see life where only bones appear. For the NHS, this may be the most vital act of all.

A Defence of the Bones

This concept defies the logic of social construction, which claims that only what is affirmed, felt, or named can be considered life. It recognises life beyond construct. That which constructs edit out, persists even when the meat of our conversations is gnawed into annihilation. The bones remain.

Painful things hurt. Even when unacknowledged. Even when unnamed. Even when compliance masquerades as care.

Truth is beauty. Not because it is affirmed, but because it endures. Not because it is seen, but because it insists.

This is not a denial of social construction, just a refusal to let it be the final arbiter of reality. It is a protest from the hopeful child, and a lament for the hopeless one. It is the Skeleton Woman, tangled in the line, insisting on being seen.

Should you wish for more support and space to think through the dilemmas of group life in complex institutional life, do consider attending the Recovering from the Death Mother: Reclaiming Life in NHS & Social Care Work on Fri, 17 Oct 2025 13:30 - 16:00 BST. It offers a reflective forum for those navigating the symbolic, ethical, and relational dimensions of professional practice. Wishing to move beyond the self-sacrificing archetype, embracing rest, support, and community to reclaim a balanced life.

https://www.eventbrite.com/e/1554933109789?aff=oddtdtcreator