Table Of ContentCaring for Madness
The role of personal experience in the training
of mental health nurses
To Pa, who was always concerned about my education
Caring for Madness
The role of personal
experience in the
training of mental
health nurses
PhD, BEd(Hons), MEd, PGCE, CERT Ed, RNT, DNPsych, RMN,
RGN, Department of Mental Health and Learning Disability,
5h eff ield University
W H U R R
P U B L I S H E R S
0 2001 Whurr Publishers Ltd
First published 2001 by
Whurr Publishers Ltd
19b Compton Terrace
London N1 2UN England, and 325 Chestnut Street, Philadelphia
PA 19106, USA
Reprinted 2003
All rights reserved. No part of this publication may be
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photocopying, recording or otherwise, without the prior
permission of Whurr Publishers Limited.
This publication is sold subject to the conditions that it shall not,
by way of trade or otherwise, be lent, resold, hired out, or
otherwise circulated without the Publisher’s prior consent, in
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tion being imposed upon any subsequent purchaser.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British
Library.
ISBN 18615 6 200 4
Printed and bound in the UK by Athenaeum Press Ltd,
Gateshead, Tyne & Wear
Contents
Foreword vii
Glossary ix
Acknowledgements xi
CHAPTE1R 1
Introduction
SECTIONI 9
~
An Historical Approach to the Management of Madness
CHAPTE2 R 11
Historical Background
CHAPTE3 R 13
Madness and Views of the Self in Early Civilization
CHAPTE4 R 49
From the Enlightenment to the Present
SECTIOIN1 57
Experiencing Training: Students’ Accounts of the
Process of Becoming a Registered Mental Nurse
CHAPTE5 R 59
Study Background
V
vi Caring for Madness
CHAPTE6R 61
Method and Presentation of Data
CHAPTE7R 75
Individual Accounts
CHAPTE8R 161
Group Discussions and Student Reflections
SECTIO1N11 177
Developing a Philosophy
CHAPTER 9 179
A Philosophy of Mental Health Nursing
References 201
Index 207
TABLES
Table 6.1 64
Groups of Students taking part in the Research
Table 6.2 65
The Range of Age and Sex Distribution in each Group
Table 6.3 65
Response to Statements
Table 6.4 66
Number of Students in Group who did not answer to the
Appropriate Statement
Table 6.5 70
Educational Background of the Students
Table 6.6 72
Categories and Subcategories used in the Research
t-oreword
This is a significant book in a number of respects. In the first place,
there are relatively few accounts of the experiences of nurses in
training. This neglect is, perhaps, not surprising when one considers
that research in nurse education is still largely influenced by quantita-
tive methodologies, in which the student voice is not heard, but such
approaches are particularly inappropriate in inquiries into the training
of psychiatric nurses given the nature of their role. Such nurses must
necessarily draw upon their own personal resources - their experiences
of coping with the trials and tribulations of life - if they are to deal
effectively with the problems of patients, which are, by their very
nature, expressed within a social context. If the training of these nurses
is to be successful, it must clearly develop students’ personal competen-
cies, but it can only do this, one imagines, if it is based upon a knowl-
edge of ‘where the students are’ in their own personal understanding.
And, as George Kelly said many years ago (Kelly 1955), if you don’t
know what lies in your subjects’ minds, you should ask them to tell you.
This simple but often neglected advice is seriously followed in the
present book, which provides many fascinating insights into students’
perspectives as they are initiated into the profession.
This achievement alone makes this work essential reading for nurse
educators and students alike, but what gives it added value is that the
author places students’ accounts within an historical framework. In the
first part of the book, he shows how concepts of madness and caring for
madness have evolved over the past three thousand years. We see that
the use of models from the natural world in forming our ideas of
cleansing the mindbody in mental illness has a long history and,
arguably, extends inappropriately to the present day. On the other
hand, there is from very early times evidence of the recognition of the
importance of personal insight and development for both carer and
cared-for in the treatment of mental illness. These different, often
contradictory, emphases are of course still pervasive and help to
vii
viii Caring for Madness
determine the incoherent way in which the role of the psychiatric
nurse is defined in practice.
For Dr Ramsamy, the way forward is to develop a philosophy of
personal knowledge that can help us to integrate the personal and
impersonal aspects of psychiatric nursing. Such a philosophy, he claims,
will do justice to the interpersonal context of the nurse-client relation-
ship, and it can form the basis for a curriculum for psychiatric nurse
education. In the final section of his book, he draws upon the thoughts
of authors such as Polanyi and Macmurray to outline his suggestions.
These considerations are, I believe, vital if the curriculum offered to
trainee psychiatric nurses is to be derived from considered judgements
made in the light of theoretical understanding and research evidence.
This book does not provide a ready-made curriculum. Its importance
lies in its directing us to ask the right questions about the nature of
training for psychiatric nurses.
Neil Bolton
Glossary
CFP Common Foundation Programme
CPN Community Psychiatric Nurse
ENB English National Board
MDT Multi-disciplinary Team
RCN Royal College of Nursing
RMN Registered Mental Nurse
RMPA Registered Member of the Psychological Association
SEN State Enrolled Nurse
UKCC United Kingdom Central Council for Nursing, Midwifery
and Health Visiting
ix
Acknowledgements
I would like to give my particular thanks to Professor Neil Bolton, who
encouraged me to undertake this study and guided me with imagina-
tion, patience and affection during the early stage of this thesis.
Without his love and support, phenemonology would have been an
impossible task. A special thanks to my supervisor Dr Peter Clough for
his support.
I am grateful to the students who devoted their time to this
research, and to Chris Lavender for her patience in typing my
handwriting in readable words. I would also like to thank Nat,
Palmeshiven, Kristopher, Di and my parents, Vadarajoo and Lorgambal
Ramsamy .
xi
