Table Of ContentDangerous and Severe Personality Disorder
People with personality disorders are to be found in all branches of psychiatric services,
as outpatients, as acute inpatients, and in the community. Their behaviour can be
manipulative and threatening and they are hard to manage in institutional settings.
Dangerous and Severe Personality Disorder is based on a unique research study
conducted in the three English High Security Hospitals-Ashworth, Rampton and
Broadmoor. Through in-depth analysis of an extensive questionnaire survey followed by
personal interviews, Len Bowers shows how positive or negative attitudes to PD patients
arise and are maintained over time, discusses what impact these attitudes have upon
nurses and the care they provide to patients, and draws some practical conclusions.
The difficulties facing staff who care for and treat PD patients are enormous and
constitute a significant personal challenge for the psychiatric professional of any
discipline. For the first time this book provides details of the most effective ways of
creating a positive context for working with Personality Disorder and offers a blueprint
for training and organizational structures across the professional spectrum.
Len Bowers is a psychiatric nurse with a broad experience of inpatient and community
psychiatric care. He is Professor of Psychiatric Nursing at the St Bartholomew School of
Nursing and Midwifery, City University, London.
Dangerous and Severe Personality
Disorder
Response and role of the psychiatric team
Len Bowers
London and New York
First published 2002
by Routledge
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
Routledge is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or
Routledge's collection of thousands of eBooks please go to
www.eBookstore.tandf.co.uk.”
© 2002 Len Bowers
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval
system, without permission in writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book has been requested
ISBN 0-203-99512-0 Master e-book ISBN
ISBN 0-415-28237-3 (hbk)
ISBN 0-415-28238-1 (pbk)
To Jessica, Sam and George
Contents
Acknowledgements vii
1 ‘Welcome to the world of PD’ 1
2 ‘Special Hospital country’ 18
3 Trials and tribulations 32
4 Staying positive 57
5 A supportive organization and team 80
6 Effects and impacts 101
7 Us and them 125
Bibliography 141
Index 146
Acknowledgements
First thanks go to the two research assistants who worked with me on this project, Linda
McFarland and Frank Kiyimba. Their cheerfulness, skill, perseverance and enthusiasm
were essential to the final result. Their ideas and thoughts have become so mixed with the
development of my own on this topic that they should receive some credit for the
contents of this book. As should the rest of my research team, past and present, who have
discussed the issues with me, challenged my thinking when necessary, and encouraged
me to overcome various obstacles or apparent dead ends. They are: Jane Alexander,
Patrick Callaghan, Paola Carr-Walker, Nicola Clark, Neil Crowhurst, Sarah Eales,
Catherine Evers (who also carried out the inter-rater reliability exercise), Stuart Guy,
Manuela Jarrett, Eddie McCann, Carl Ryan and Alan Simpson. My partner, Eleanor
Marshall, was also important in extending my ideas, as well as in giving me consistent
and steadfast support throughout the years this work went on. Much support and detailed
advice, for which I am most grateful, was also received from my father-in-law, Professor
Peter Marshall.
Many others with whom I also discussed the work and exchanged ideas are also
deserving of my gratitude, especially Hillary Bradshaw and Jo Paton, and the Steering
Group of the research: James Hampton, David Ndegwa, Victoria Hyams, Tony
Thompson, Leeanne McGee, David Robinson, Lezli Boswell, Kevin Barron. Christine
Hogg of Salford University was helpful in extending my thinking about self-mutilation,
Morgan McFarland provided invaluable advice and many superb examples of writing
skill, and Lynne Holmes gave me much support during a difficult phase of the data
analysis. My thinking was also further developed by the many nurses who asked
questions and gave feedback at conference presentations of the findings, within and
outside of the High Security Hospitals.
Support from each of the three English High Security Hospitals was enormous. Each
devoted time and considerable resources into providing site visits for the induction of the
research team. The opportunity for the research team to meet senior staff and nurses on
the wards has been absolutely invaluable. Everywhere my team of researchers and I went,
we were met with openness and interest. All three hospitals appointed liaison staff to the
project, namely Tony Hopkins, Martin Coupland and Peter Melia. They devoted time to
ensuring that the research assistants could access staff for interviews at appropriate times
and places. In addition, POA and RCN representatives at the Hospitals gave the project
their backing and endorsement. Without this level of support, carrying out the research
would have been much more difficult, if not impossible.
The research was funded by the National Programme for Forensic Mental Health
Research and Development, who were at every stage supportive and helpful in the
execution and reporting of the research. Dilys Jones of the Department of Health was
especially encouraging and helpful.
Lastly, but most importantly, I have the highest regard for the psychiatric nurses who
work in the High Security Psychiatric Hospitals. In caring for people who have
committed serious crimes, they embody and express some of the highest values of our
civilisation and culture. The work they do is atrociously difficult, demanding and
psychologically pressurised. I have the deepest respect for all of them, even those that fail
in their task. They do not receive one-tenth of the public respect and sympathy they
deserve. In many ways what I have to present in this book is a summary of their wisdom,
experience and knowledge. Without their support and cooperation, there would have been
no book at all. The work is therefore largely theirs, and I hope that they feel that I have
gone some way towards explaining what it is really like to do the work they do.
