Scapegoating in Healthcare: A Primitive Response to Tragedy.

backgroundIn recent years, a pattern has emerged in healthcare systems where clinicians and organisations are publicly blamed and punished following tragic events such as suicides or homicides. These responses often reflect more than institutional accountability, they reveal unconscious cultural mechanisms of scapegoating rooted in collective anxiety, grief, and the intolerability of uncertainty.

aimsThis paper explores scapegoating in healthcare not merely as an ethical or organisational failure, but as a deep-seated psychological and sociocultural process. It aims to illuminate how blame is mobilised as a primitive defence against psychic pain and systemic dysfunction, and to consider the implications for clinical practice, regulation, and public trust. METHODOLOGICAL APPROACH: This article employs an interpretive narrative approach, synthesising psychoanalytic and sociological theory to illuminate scapegoating in healthcare. It draws on the work of Freud, Bion, Menzies-Lyth, Douglas, and Girard, and integrates contemporary case material from international healthcare refined through peer discussion to illustrate and develop the theoretical analysis.Key Arguments:Scapegoating functions as a symbolic ritual of emotional discharge that obstructs learning and distorts justice. Organisational investigations and media narratives often collapse systemic complexity into linear blame, serving retributive rather than restorative purposes. Those targeted are frequently among the most vulnerable, socially, professionally, or structurally. The paper argues that only by recognising and resisting these unconscious group dynamics can healthcare systems foster genuine accountability, psychological safety, and real learning.