A toxic triangle of destructive leadership at Bristol Royal Infirmary: A study of organizational Munchausen syndrome by proxy

Abstract

Although leadership literature increasingly recognizes that leadership is a complex, co-creational process among leaders, followers, and context, destructive leadership scholarship has only recently embraced this paradigm. This article contributes to the toxic triangle debate by linking destructive leadership theory and disaster research in a case study of Bristol Royal Infirmary, a UK hospital that experienced a crisis in its pediatric cardiology unit resulting in the death of dozens of babies undergoing surgery. Thus, the article expands the literature on organizational failure by offering an assessment of how seemingly good, well-intentioned professionals can nonetheless create destructive leadership dynamics and proposes a new, more nuanced theoretical framework called organizational Munchausen syndrome by proxy as a way to analyze what went wrong.

Intergenerational Conflict at US Airlines: An Unresolved Oedipal Complex?

“…The potential for psychoanalysis to explore emotional conflicts such as these, opening a valuable window into the world of organizations by offering fresh insights with extensive explanatory powers and ample practical implications, has been well documented (Gabriel and Carr, 2002;Fotaki et al, 2012;Gabriel, 1998;Carr, 2002;Paul et al, 2002). By accessing organizational anxieties and revealing unconscious social dynamics, a psychoanalytic lens can shed light into some of the darkest corners of workplace life, exposing employees' competing phantasies (Long, 2008;Fraher, 2004Fraher, , 2016de Swarte, 1998). For example, psychodynamic studies include Barings Bank (Brown, 2005), Lehman Brothers (Stein, 2013), Long Term Capital Management (Long, 2008), NASA (Schwartz, 1987;Feldman, 2004), and the NHS (Fraher, 2011).…”

Münchausen Syndrome – A Question of Medical Ethics?

“…(35,36). MSBP is a special "triangle" relationship which develops between the parent-perpetrator, the child victim and the medical personnel, based on the child's abuse and the parent's deceit, associated with the act of deceiving the physician regarding the impossibility of establishing the diagnosis or finding an effective treatment (10,30,37). Some mothers seem to have a special skill for being impostors, they are able to simulate a medical condition, as well as an unusual concern and care for their sick child.…”

“…All parents exhibit a permanent need for medical attention regarding their children, thus, they are fabricating an illness for them. In all cases, the parents of MSBP victims will "choose" the physician, they will search with perseverance, from a consultation to another, and they will find "that" physician who will satisfy their personal need of assistance and attention (37).…”

“…Although most mothers of MSBP victims are quite the flatterers, they can become aggressive if they fear they will lose the attention of others, if they are threatened to be exposed and unmasked, or when the medical personnel has opposing views and does not consider that further tests are necessary (35,39). These intense reactions of only one person are capable to differently attract the attention of the medical personnel, to convey opinions and contradictory feelings in connection with the mother and her family, thus compromising the medical team's work (29,37).…”

“…Confronting the parent-abuser may lead, for a while, to the disappearance of the child's symptoms, but in most cases, the parents go to other medical units, in another city. The unpleasant element of the confrontation is the permanent damage to the physician-patient-family relationship and completely losing the child from observation (37).…”