(Download PDF) Mental Health Nursing Applying Theory To Practice 1St Edition Gylo Hercelinskyj Full Chapter PDF

Mental Health Nursing: Applying
Theory to Practice. 1st Edition Gylo

Hercelinskyj
Visit to download the full and correct content document:
https://ebookmass.com/product/mental-health-nursing-applying-theory-to-practice-1st
-edition-gylo-hercelinskyj/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Family Health Care Nursing: Theory, Practice, and

Research 6th Edition
https://ebookmass.com/product/family-health-care-nursing-theory-
practice-and-research-6th-edition/
Neeb’s Mental Health Nursing 5th Edition, (Ebook PDF)
https://ebookmass.com/product/neebs-mental-health-nursing-5th-
edition-ebook-pdf/
Lippincott CoursePoint+ for Videbeck’s Psychiatric-

Mental Health Nursing
https://ebookmass.com/product/lippincott-coursepoint-for-
videbecks-psychiatric-mental-health-nursing/
Health Promotion in Nursing Practice (Health Promotion

in Nursing Practice ( Pender)) 7th Edition, (Ebook PDF)
https://ebookmass.com/product/health-promotion-in-nursing-
practice-health-promotion-in-nursing-practice-pender-7th-edition-
ebook-pdf/
Mental Health Disorders Sourcebook Angela Williams
https://ebookmass.com/product/mental-health-disorders-sourcebook-
angela-williams/
Community/Public Health Nursing Practice E Book: Health

for Families and Populations (Maurer, Community/ Public
Health Nursing Practice) 5th Edition, (Ebook PDF)
https://ebookmass.com/product/community-public-health-nursing-
practice-e-book-health-for-families-and-populations-maurer-
community-public-health-nursing-practice-5th-edition-ebook-pdf/
Health Promotion Programs: From Theory to Practice

(Jossey-Bass Public
https://ebookmass.com/product/health-promotion-programs-from-
theory-to-practice-jossey-bass-public/
Clinical social work practice in behavioral mental

health : toward evidence-based practice 3rd Edition
eBook
https://ebookmass.com/product/clinical-social-work-practice-in-
behavioral-mental-health-toward-evidence-based-practice-3rd-
edition-ebook/
Health Behavior: Theory, Research, and Practice

(Jossey-Bass Public Health)
https://ebookmass.com/product/health-behavior-theory-research-
and-practice-jossey-bass-public-health/
Mental
Health
Nursing
Applying Theory to Practice
Gylo (Julie) Hercelinskyj

& Louise Alexander
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
Mental
Health
Nursing
Gylo ( Julie ) Hercelinskyj

& Louise Alexander
Mental
Health
Nursing

& Louise Alexander
Mental health nursing: Applying theory to practice © 2020 Cengage Learning Australia Pty Limited
1st Edition
Gylo (Julie) Hercelinskyj Copyright Notice
Louise Alexander This Work is copyright. No part of this Work may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means without prior
written permission of the Publisher. Except as permitted under the
Head of content management: Dorothy Chiu Copyright Act 1968, for example any fair dealing for the purposes of private study,
Senior content manager: Michelle Aarons / Fiona Hammond research, criticism or review, subject to certain limitations. These limitations
Senior content developer: James Cole include: Restricting the copying to a maximum of one chapter or 10% of this
Senior project editor: Nathan Katz book, whichever is greater; providing an appropriate notice and warning with the
Cover designer: Danielle Maccarone copies of the Work disseminated; taking all reasonable steps to limit access to
Text designer: Norma Van Rees these copies to people authorised to receive these copies; ensuring you hold the
Permissions/Photo researcher: Mira Fatin; Corrina Gilbert appropriate Licences issued by the Copyright Agency Limited (“CAL”), supply a
Editor: Anne Mulvaney remuneration notice to CAL and pay any required fees. For details of CAL licences
Proofreader: James Anderson and remuneration notices please contact CAL at Level 11, 66 Goulburn Street,
Indexer: Julie King Sydney NSW 2000, Tel: (02) 9394 7600, Fax: (02) 9394 7601
Art direction: Nikita Bansal Email: info@copyright.com.au
Cover: Cover image courtesy of Stocksy.com/Lumina Images Website: www.copyright.com.au
Typeset by Cenveo Publisher Services
For product information and technology assistance,
Any URLs contained in this publication were checked for currency during the in Australia call 1300 790 853;
production process. Note, however, that the publisher cannot vouch for the in New Zealand call 0800 449 725
ongoing currency of URLs.
For permission to use material from this text or product, please email
Notice to the Reader aust.permissions@cengage.com
Publisher does not warrant or guarantee any of the products described herein or
perform any independent analysis in connection with any of the product National Library of Australia Cataloguing-in-Publication Data
information contained herein. Publisher does not assume, and expressly ISBN: 9780170387521
disclaims, any obligation to obtain and include information other than that A catalogue record for this book is available from the National Library of
provided to it by the manufacturer. The reader is expressly warned to consider Australia.
and adopt all safety precautions that might be indicated by the activities
described herein and to avoid all potential hazards. Cengage Learning Australia
Level 7, 80 Dorcas Street
By following the instructions contained herein, the reader willingly assumes all South Melbourne, Victoria Australia 3205
risks in connection with such instructions. The publisher makes no
representations or warranties of any kind, including but not limited to, the Cengage Learning New Zealand
warranties of ﬁtness for particular purpose or merchantability, nor are any such Unit 4B Rosedale Oﬃce Park
representations implied with respect to the material set forth herein, and the 331 Rosedale Road, Albany, North Shore 0632, NZ
publisher takes no responsibility with respect to such material. The publisher
shall not be liable for any special, consequential, or exemplary damages resulting, For learning solutions, visit cengage.com.au
in whole or part, from the readers’ use of, or reliance upon, this material.
Printed in Singapore by 1010 Printing International Limited.

1 2 3 4 5 6 7 23 22 21 20 19
v

BRIEF CONTENTS
SECTION 1 CHAPTER 15
UNDERPINNINGS OF MENTAL HEALTH NURSING 1 Neurodevelopmental disorders 299

CHAPTER 1 CHAPTER 16
Mental health nursing – then and now 2 Neurocognitive disorders 317

Theoretical frameworks underpinning practice 16 Obsessive compulsive and related disorders 339
Ethics, law and mental health nursing practice 33 Trauma and stress-related disorders 351
Treatment modalities utilised in contemporary mental health Other disorders of clinical interest 367
service delivery 48
CHAPTER 5 SECTION 3
Mental health nursing as a therapeutic process 68
CONTEMPORARY ISSUES IN MENTAL
CHAPTER 6 HEALTH NURSING 391
Using evidence to guide mental health nursing practice 91
CHAPTER 20
Suicide and non-suicidal self-injury 392
SECTION 2 CHAPTER 21
THE CLINICAL CONTEXT OF PRACTICE 106 Recovery and resilience in mental health 413
Assessment and diagnosis 107 The family’s role in contemporary mental health
CHAPTER 8
service delivery 435
Schizophrenia spectrum and other psychotic disorders 127 CHAPTER 23
CHAPTER 9
The multidisciplinary team 450
Bipolar and related disorders 152 CHAPTER 24
CHAPTER 10
Community mental health context 464
Depressive disorders 171 CHAPTER 25
CHAPTER 11
Cultural context in practice in Australia 482
Anxiety disorders 195 CHAPTER 26
CHAPTER 12
Mental health first aid 497
Personality disorders 211
CHAPTER 13
Eating disorders 235
CHAPTER 14
Substance-related and addictive disorders 258
vii

CONTENTS
Guide to the text x CHAPTER 4

Guide to the online resources xiii Treatment modalities utilised in contemporary
Prefacexiv mental health service delivery 48
About the authors xv Introduction 49
Acknowledgementsxvii Pharmacological interventions 49
Psychosocial interventions 52
Motivational interviewing 52
SECTION 1
Mindfulness-based interventions 57
UNDERPINNINGS OF MENTAL HEALTH NURSING 1 Cognitive behavioural therapy 58
CHAPTER 1 Rational emotive behaviour therapy 60
Mental health nursing – then and now 2 Dialectical behaviour therapy 61
Introduction 3 Structured problem solving 62
Belief in supernatural origins of illness and disease 3 Psychoeducation 63
Asylums of the world 5 Chapter resources 65
History of Australia’s asylums and mental health nursing 6 CHAPTER 5
Treatments throughout history 8
Mental health nursing as a therapeutic process 68
The role and identity of the mental health nurse in
Introduction 69
contemporary service delivery 10
Interpersonal communication within the
Chapter resources 12
nurse–consumer relationship 69
CHAPTER 2 Core elements of the communication process 70
Theoretical frameworks underpinning practice 16 Effective communication skills 70
Introduction 17 The therapeutic relationship 74
Health, mental health and human behaviour 17 Therapeutic use of self 75
Biomedical theories of personality 17 Developing, maintaining and terminating
Psychodynamic theories of personality 18 therapeutic relationships 77
The behavioural/social cognitive orientation 23 The application of therapeutic communication
The humanistic orientation 26 qualities and skills in the clinical context 80
The use of psychological and sociological theories of Chapter resources 86
personality in mental health nursing practice 27 CHAPTER 6
Relevance of psychological and/or nursing theories to
Using evidence to guide mental health
nursing practice 29
nursing practice 91
Introduction 92
CHAPTER 3 What is evidence-based practice? 92
Ethics, law and mental health nursing practice 33 Implementing evidence-based nursing practice 93
Introduction 34 Critical appraisal of research evidence 99
Context of mental health legislation in Australia 34 Translating evidence into clinical practice 100
Legislation facilitating care and treatment of people Mental health outcome measures 101
with a mental health condition 36 Chapter resources 102
Mental health conditions, offending and the law 40
Legal and ethical dimensions of practice for nurses 41 SECTION 2
Compulsory care and treatment from a consumer
THE CLINICAL CONTEXT OF PRACTICE 106
perspective 43
Chapter resources 44 CHAPTER 7
Assessment and diagnosis 107
Introduction 108
The context of practice 108
Assessment in mental health 108
viii Contents
Comprehensive mental health assessment 111 Antisocial personality disorder (APD) 220
Modern diagnostic classification systems in mental Borderline personality disorder 224
health assessment 122 Chapter resources 232
CHAPTER 13
CHAPTER 8 Eating disorders 235
Schizophrenia spectrum and other Introduction 236
psychotic disorders 127 Anorexia nervosa 236
Introduction 128 Bulimia nervosa 246
Aetiology 128 Binge-eating disorder 252
Diagnostic criteria schizophrenia 133 Males and eating disorders 253
Clinical presentation and the mental state examination 136 Chapter resources 254
Treatment 141
CHAPTER 14
Recovery and relapse prevention 146
Other psychotic disorders 147
Substance-related and addictive disorders 258
Introduction 259
The historical context of substance use and misuse 259
CHAPTER 9 Understanding substance misuse, and defining
Bipolar and related disorders 152 illicit and psychoactive substances 259
Introduction 153 Addiction and dependence 260
Aetiology 153 Substance use, misuse problems and substance
Diagnostic criteria bipolar I and II disorder 155 use disorders 264
Clinical presentation and the mental state examination 158 Diagnostic criteria 274
Treatment 163 Biopsychosocial assessment framework 282
Recovery and relapse prevention 166 Clinical presentation and the mental state examination 285
Chapter resources 169 Chapter resources 294
Depressive disorders 171 Neurodevelopmental disorders 299
Introduction 172 Introduction 300
Aetiology and epidemiology 172 Neurodevelopmental disorders 300
Clinical presentation of depressive disorder in the Attention deficit/hyperactivity disorder 300
context of the mental state examination 176 Intellectual disability (intellectual disability disorder) 303
Treatment 177 Autism spectrum disorder 307
Persistent depressive disorder (dysthymia) 184 Risk assessment for people diagnosed
Depression in the perinatal period 185 with a neurodevelopmental disorder 312
Depression and older people 186 The impact of caring for a person with a diagnosis of a
Recovery and relapse prevention 189 neurodevelopmental disorder: who cares for the carers? 312
The family’s experience of depression 189 Chapter resources 313
CHAPTER 16
CHAPTER 11 Neurocognitive disorders 317
Anxiety disorders 195 Introduction 318
Introduction 196 Ageing in Australia today: contemporary
What is anxiety? 196 trends and issues 318
Aetiology 197 Healthy ageing 319
Diagnostic criteria 198 Elder abuse 319
Treatment of anxiety disorders 203 Mental health issues and older people 320
How do mental health nurses assist a person Delirium 321
experiencing anxiety? 207 Major neurocognitive disorders: dementia 323
Chapter resources 208 The impact of neurocognitive disorders on families 333
CHAPTER 12
Personality disorders 211 CHAPTER 17
Introduction 212 Obsessive compulsive and related disorders 339
Defining personality and understanding general Introduction 340
personality disorder 212 Obsessive-compulsive disorder 340
Introducing cluster A, B and C personality disorders 213 Hoarding disorder 344
Contents ix
Trichotillomania 347 CHAPTER 22

Excoriation 348 The family’s role in contemporary mental
Chapter resources 349 health service delivery 435
CHAPTER 18
Introduction 436
What is a family? 436
Trauma and stress-related disorders 351
Theories regarding family structure and functioning 436
Introduction 352
The family’s experience of caring for a loved
Understanding trauma and stress-related disorders 352
one with a mental health challenge 438
Trauma and stress-related disorders 353
Families and resilience 440
Assessment and treatment of trauma and
Mental health nurses work with families 441
stress-related disorders 357
Assessing family structure, function and dynamics 441
Developing an individualised plan of care for a person
Strategies for promoting family resilience 443
experiencing a disorder as a result of trauma/stress 359
Consumers’ views of the family in supporting them
Supporting family and other caregivers 362
through their journey 444
Supporting clients on the recovery journey 363
CHAPTER 23
CHAPTER 19
Other disorders of clinical interest 367 The multidisciplinary team 450
Introduction 451
Introduction 368
The multidisciplinary team 451
Conduct disorder 368
Characteristics of effective teamwork 453
Oppositional defiant disorder 373
Becoming a member of the multidisciplinary
Dissociative identity disorder 375
team: integrating into the team as a student nurse 457
Gender dysphoria 378
Research on consumers’ views on the role of the
Conversion disorder 382
mental health nurse as a member of the
Factitious disorder 384
multidisciplinary team 459
CHAPTER 24
SECTION 3
Community mental health context 464
CONTEMPORARY ISSUES IN MENTAL
Introduction 465
HEALTH NURSING 391
Historical factors of community mental health care 465
CHAPTER 20 Social determinants of mental health 465
Suicide and non-suicidal self-injury 392 Primary mental health care 466
Introduction 393 The roles of the mental health nurse 468
Suicide 393 Specialised community services 471
Theories of suicide 397 Chapter resources 477
Cultural considerations and vulnerable groups 397 CHAPTER 25
The role of the media 399
Cultural context in practice in Australia 482
Assessing risk of suicide 400
Introduction 483
Self-harm/injury (non-suicidal self-injury) 404
Historical and cultural determinants 483
Assessment and collaborative care for consumers
Social determinants 486
who experience self-injuring behaviours 406
Indigenous Australians’ social and emotional well-being 488
Culturally safe practice: racial issues 491
CHAPTER 21 Chapter resources 493
Recovery and resilience in mental health 413 CHAPTER 26
Introduction 414
Mental health first aid 497
Recovery and recovery-oriented practice 414
Introduction 498
Trauma-informed practice 416
Introduction to the MHFA acronym 498
Working with people 420
How to apply MHFA to various mental health problems 500
Be an ‘agent of change’ for recovery-oriented and
Cultural considerations of MHFA within vulnerable groups 509
trauma-informed practices 427
Mental health first aid for carers 511
The peer workforce and recovery 427
Recovery ethics and reflection 429
Chapter resources 431 Appendix 514
Glossary 517
Index 525
x
Guide to the text

CHAPTER
As you read this text you will find a number of features in every chapter
to enhance your study of mental health nursing and help you
2
understand howTHEORETICAL
the theory is applied in the
FRAMEWORKS real world.
UNDERPINNING
PRACTICE
CHAPTER-OPENING FEATURES
Identify the key concepts M E N TA L H E A LT H N U R S I N G – T H E N A N D N O W 7

LEARNING OUTCOMES
that the chapter will cover Upon completion of this chapter, you should be able to:
2.1 Define the terms health, mental health, human behaviour and personality
with the Learning outcomes 2.2 Describe biomedical theories of personality, their application and relevance to mental health nursing
practice and some of the major critiques of these theories
at the start of each chapter.
the control of the medical profession in Australia and nurses by medical staff and a three-year training
2.3 Describe psychodynamic theories of personality, their application and relevance to mental health nursing
at the same time that the first legislation relating
practice and tomajor critiques
some of the program approved by the relevant health authority in
of these theories
CHAPTER 1
Challenge your mental perspective
health was enacted through the 1843
2.4 Describe Lunacy cognitiveVictoria
behavioural/social was introduced.
theories of personality, their applicationHowever,
and relevancethis qualification
to mental
health nursing practice and some of the major critiques of these theories
on mental health Actnursing in Prior to this, the
(Curry, 1989). first superintendent was not recognised outside of Victoria, and nurses and
2.5 Describe humanistic theories of personality, their application and relevance to mental health nursing
had been a layperson, whose approach toandthe
somecare attendants were not registered with the Nurses’ Board
the real world with the practice
2.6 Describe
of the major critiques
how nursing
of these theories
of individuals with a mental health condition wastheorists have of drawn from psychological
Victoria (Reischel,and sociological
1974).theorists to understand
Learning from Practice focused on using psychosocial care
human
as a
behaviour
means
and
for
how this influences the role
Modern
of the mental health nurse
mental
2.7 Reflect on which psychological and/or nursing theories would be relevant to your health nursing education
nursing practice
74 vignette
U N D E Rand
P I N N I reflective
N G Smanaging
O F M E N TAtheir
L H E Abehaviour.
LT H N U R S I N G commenced in the mid-twentieth century (Reischel,
The ideological conflict between proponents of 2001); for example, recognised education and
questions. Then, consider
such models of care and those who LEARNING
supported FROM medicalPRACTICE registration as psychiatric nurses commenced in
how the chapterapproaches has to treatment ‘based in neurophysiology Victoria with the passing of the Victorian Nurses Act
difficulty focusing their thoughts on a broad, open Shelley is a 21-year and skills.
old woman who As livesdescribed
at home with previously, At theinterpersonal
end of the second visit, a registered nurse
impacted your and neuropathology’ (Curry, 1989,
question. However, too many closed questions can
p. 10)
her mother. contributed
Shelley
communication first
has been admitted for the 1958time (Reischel,approached
is the tocornerstone
1974). Rose Parallel
of the as she waswith
therapeutic
these
leaving developments,
the unit. Indicating
SECTION 1
understanding, to the the

with establishment of the Select theCommittee
inpatient unit at the on the
local acute inpatientstatements
mental health regardingthat she waschanges
concerned that to health
Rose appearscare delivery
uncomfortable
make an interaction seem like an interrogation. facility. Shelley’s first 132
relationship.
36 hours in the unit wereT H Eunsettled
C L I N I C A L Cwhile
O N TinEthe
X Tunit
O Fand
P Rthat
A CsheT I Cwas
E very happy to answer any
Lunatic Asylum, Tarban Creek in 1846. The findings of generally, and mental health care in particular, were
Reflection on Learning this committee
as
enabled medicalresisted
she was
practitioners
extremely
efforts by theto
The
suspicious
assume
therapeutic
of the nursing
also
relationship
staff and
being reported.
is
questions a specific
Rose
stiffen andHolland
may type
have, Rose’s
(1978,
ofwhole
p. 16)
body appeared
stated
to
that
The opening word and its effect nurses
helping
to engage with
relationship.
her. Shelley
It is a relationship
with a trembling
where
voice she
the
replied, ‘Why would
fromThe
Practice
opening at word the
the end of
responsibility
chosen for governance
in a conversation did
can and treatment. This
not believe she needed to be in hospital and became you care, my daughter
‘A greater emphasis was emerging on health services is lost to me and places like this don’t
extremely agitated when mental healthtonurse
staff attempted administeror clinician help. Iengages therapeutically
know what these places are like and the sooner she
chapter. development meant that the laythesuperintendentsaying wasthat everyoneoutside
conditions, institutions
schizophrenia such asishospitals’. Since this time,
influence the focus of the response. Consider prescribed medication, with the consumer was trying
or carerto tois assist
out of here to thought
the better
them for her!’
identify, to emerge in the researchers claim psychopharma
following words demoted
in Table to5.3.
the position of senior warden.
poison Curry
her ‘because (1989)
she knew nursing
latestrategies
too much’. Shelley’s teens education
mother into early inadulthood,
all disciplines withhas comeepisode-
a first under the (with atypical antipsychotics) is
plan and evaluate to meet their health-related
SECTION 2
argues that this arrangement established Rose has beenthe in twice to visit her. Nursingcontrol
medical staff have of nursing Following Rose’s abrupt
bodies such departure,
thethe registered Board
nurse
asked several timesneedsto make aor objectives.
time
age-onset
to meet with Rose
for males
Effective
to therapeutic
considered
ofthisthe earlyasWhat
20s,
relationships
interaction.
Nursing
and for femalesof
emotions, feelings and
others believe psychological the
and nursing systems for the asylums discussand was copiedobtain additional Victoria
in the and,
late 20s, in contemporary
and times, the Nursing and
TABLE 5.3 Shelley’s progress
start andwith attitudes information
and values that again
experiences could be
promote inbehind
the
trustpost-menopausal
Rose’s response? How could effective. Some argue a combina
FEATURES WITHIN CHAPTERS
The opening word of everywhere
questions throughout the colonies.
The first facility for individuals
regarding the circumstances leading to Shelley’s
On both occasions, and
with a mental
understanding
staff have
Midwifery
period admission.
observed that Rose avoids
(APA,
between
requirements
condition
Board2013).
varies
the
of Australia.
an understanding
to work
While
mental
for between
accreditation
of the
health
collaboratively
This
psychologicalorganisation
nurse
with Rose
theories assistof
development
and Shelley?
of educational programs
thesets
team the
the What we do know is that any in
WORD CHOSEN IMPLICATION eye contact with them, and saystheveryindividual.
little to Shelley We
and consider
seems the core individuals,
values that it is usually this crucial period will be more
health condition in Victoria wasill at established in 1848
ease in the environment. and
gradual defines the standards
or attenuated with for nursing (and
symptoms midwifery)
emerging as nothing at all (Orygen Youth He
What Implies that we are searching for facts. promote effective therapeutic engagement.
Recognise the core and was DSM V Diagnostic
proclaimed
P E
a ward of
R S O N A L I
Criteria
T y
the NSWfor
D I S O R D E R
asylum at
S 213
Consider practice.
mild, and approaches
The development
culminating to in respectful
of the treatments
significant carefor
distress as formental
the The active phase of schizoph
How UsuallyCreek.relates toItquestions
becamethat ask forknownfeeling as the Merri
specific mental Tarban health conditions withlocally
the Respect clients health
condition
from disorders
progresses.
diverse throughoutThe prodrome
backgrounds history isisdealt with in
considered
with the the prodrome and is characteris
responses.
Creek
16
Lunatic Asylum. Following separationThe from foundationmore the
of an detail
early, in the
emerging
effective following section. is and
stage ofrelationship
therapeutic schizophrenia, Psychosis is a generic term use
Diagnostic
Why criteriaNew boxes.
Usually
South suggests
Wales, we are searching for
it became knownreasonsasor the Yarra respect. Bend Cultural
Respectmay
considerations
can be alikeneddifficulttoconcept‘the warning’
boxes.
to define, or abutsub-threshold of acute symptoms; delusions, h
explanations.
Lunatic Asylum (Reischel, 2001). The first evidence
at the five common it is seenof in the presentation
way that we interact where symptoms with others: do‘Respect
not yet warrant thought disorder, which as you
which trait may When DIAGNOSTIC education CRITERIA
Usually refers
forto‘mental
a period ofnurses’
time. in Victoria wasisnoted
BK-CLA-HERCELINSKYJ_1E-180420-Chp02.indd 16
constructed and CULTURAL
a conclusive
demonstrated CONSIDERATIONS
diagnosis.
in the Duringinteraction’ the prodrome, the
19/03/19 4:11 PM
characteristic of schizophrenia.
CHA P TER 12
enging behaviours. Where in Focuses

the Annual Reportresponse
the consumer’s for 1887 of the Kew asylum
on location. (Candlin, in 2011,individual p. 63). Respect experiences
is demonstrated subtle behavioural
verbally changes and the individual loses touch with
General personality
Victoria disorder
(Reischel, 1974). Mental illness and European settlement includes of Australia
ose individuals prone Would/could Encourage an open focus to theThis was the beginning
interaction of a
and non-verbally diminishing
through such functioning.
behavioursThis as being occupational, exhibit strange or odd behaviou
TABLE 12.2 formal training system Prior vocational
to the settlement of Europeans in Australia, mental
he most challenges from and enable the consumer to for
makestaff in asylums. Reischel
a decision genuine, being social, non-judgemental, and
beingpsychological
competent infunctioning. may believe that someone is wa
Diagnostic criteria
(2001) general
regarding observespersonality
their thatdisorder
participation lectures were provided your
in the interaction. by medical Whenillnessexplored
was almost unheard of in Aboriginal
retrospectively and Torres
While most of these role, keeping the consumer’s health-related(i.e. needs after
in diagnosis), house through electronic device
A. An enduringstaff
patternwho also
ofSOURCE:
inner oversaw
experience andOFand
behaviorcontrolled
that deviatesthe educative Strait Islandermay cultures. With thepicture
colonisation
of anofindividual
Australia
s to them, there are AUSTRALIAN INSTITUTE PROFESSIONAL COUNSELLORS, N.D. focus and doingthe noprodrome
harm (Egan, 2014). create the microwave, etc.), and as such, d
potential negative traits markedly from the expectations
process. In 1902, of the individual’s culture.
a number of general This trained nurses who came had disease
manyand the introduction
emerging signs ofofschizophrenia,
many substances supply to their property. It is im
pattern is manifested in two (or more) of the following areas:and several trained previously
becauseunknown to Indigenous cultures (such as
) situation. For example,
A guide1.toCognition
were employed
openand questions
(i.e.,untrained
ways of perceiving
at the Kew
andnurses
asylum
interpreting self,employed in the
Empathy but they were mild, did not merit further the individual may be frightene
female were alcohol). Since European settlement,
investigation rates of mental
seen in the agreeableness
other are
people, and events).
Empathy can be described as(Fleischhacker
both a value that & Stolerman, 2014). The these experiences and therefore
When issues spelled out in terms
main male ward (Reischel, 1974). This was the of the person’s first health challenges in Aboriginal and Torres Strait Islander
ual who is easily taken 2. Affectivity (i.e., the range, intensity, lability, and underpins the prodrome
therapeuticmay last for a period
relationship and a of years, and because sensitivity and validation in rap
experiences, feelings
recorded and behaviours,
occasion the issues
of female staff being involved in the people have increased to an extent that significantly
n an individual presents appropriateness of emotional response). communication it skill
usually thatoccurs
is seen inin adolescence
the mentaland emerges during the nurse. The active phase is w
become clearer.care For of example,
individuals questions
with acould mental focus healthon: condition. passes the ratesand of mental health conditions among stages,
non-
d and maladaptive, 3. Interpersonal functioning. health nurse’s interactions formative social
with consumers, emotional developmental
family is most likely to require hospita
■■ experience: what happened? Indigenous Australians. Currently, rates of psychological
tion to their life, one 4. ImpulseWomen
control. were specifically referred to as nurses now, and carers.
members it can have catastrophic
As a value, empathy impacts on an
is related individual’s come into contact with the men
Identify important client health and safety issues, Highlight Thespecific key aspects of emergence
clinical of
■■ behaviour: what
defining did you do? distress among Indigenous Australians are more than
a personality disorder. B. The enduring pattern isthem inflexibledifferently
and pervasive fromacross their male colleagues
a broad to developing the life.capacity prodrome
to sense mayandincludeacknowledge the untreated, the active phase may
ese traits are not and the appropriate
■ ■ feeling: how did
who were
range of personal
itresponse
and
feel? known
social toattendants
as
situations. critical situations (Reischel, the 1974). feelings presentation twice those
of symptoms
another person.
of non-Indigenous
relevant
listed inisthe
It the to a
‘Clinical
ability
Australians
specific
to
(ABS, 2011).
mental
observations’ box.health months.
■■ here and now: how do you feel now?
to many individuals, with theC.Safety The enduringfirst
Education
pattern boxes.
leads continued to be provided
to clinically significant distress orto attendants understand condition
the consumer withfrom thetheir Clinicalviewpoint observations boxes. Following the active phase (a
when an individual impairment in social, occupational, or other important areas of (Egan, 2014). We consider empathy as a specific of treatment) is the residual pha
stics from these traits, SAFETY FIRST
functioning. communication skill later in the chapter.
CLINICAL OBSERVATIONS often been described as resembl
onality disorder. You D. The pattern isCASEstable and STUDY
of long duration, and its onset can be phase. During this phase, the in
istics of the personality DON’T traced
JUST back at leastON
FOCUS to adolescence
THE PROBLEM! or early adulthood. Unconditional Possible positiveearly regard symptoms of the prodrome withdraw, display a distorted aff
riteria for many of the In the context
E. The of PENNY’S
enduring the
pattern is not‘CALLING’
therapeutic better relationship,
explained as ita can be
manifestation
From a humanistic perspective, unconditional positive
Possible early symptoms are: and may demonstrate some odd
d below. easy to think thatI mental
or consequence completed
of another healthmy
mentalnurse training
disorder.
nurses only listenin theto1970s, back when regard nursesis central soto long that I have been
developing and fortunate
maintaining
■■ strange beliefs, perceptions or bodily sensations
enougha to see the amazing but are no longer classified as ps
problems. But this
F. The enduring
trained
is notisinthe
pattern
a hospital
notcase.
andtoalso
Practising
attributable
lived
within there
the physiologicala too. I guess I sort of therapeutic
positive progression of mental health
relationship. The capacity
■■ issues with maintaining concentration
care, to even to play a part in this... also experience issues with their
der recovery-oriented ‘fell’ into(e.g.,
framework
effects of a substance mental health.
ameans
drug I did aa medication)
of listening
abuse, rotation
for the in the or psychiatricvalueward and respect things weren’tperson
another always great
■■ suspicious thoughts
regardlessin mental of health
how when I first display more negative symptom
nherently conditions andcondition
another strengths,
consumer’s medical thewhat nurse manager
(e.g.,
worked pulled me
headpreviously,
trauma) aside and told me
what behave is started,
I would
they the but we were
essential feature
■■ superstitious beliefs
doingofthe best we could with what we
unconditional psychotic symptoms have subsi
n cognition, affectivity, their hopes are, and be anot good justaddition
what they to their
feelstaff,
wentand I haven’t reallypositive
wrong. looked regard.knew. It■■alsoI really believe I was able
is demonstrated to help many of my patients
through may still experience some issues
SOURCE: APA, 2013 changes to affect
al functioning. These It is by listening inback since. I certainly
framework that mental haven’t
healthregretted
nursesit. I’ve been nursing support
ongoing even and in the early days whereIn
encouragement.
■■ emergence of mild negative symptoms
medications
order to were do limited and For example, while the individu
uous or long-lasting) help to promote a sense of hope, self-determination and this, DeVito (2016) believes we must listen without
■■ social withdrawal. people are watching them throu
irment in the empowerment in consumers and their families/carers. judgement, yet critically. This is a complex idea: they may still be suspicious of p
Copyright 2020 Cengage Learning. All Rights Reserved. May How notcan be copied,
we listen scanned,
without or judgement,
duplicated, inbut whole or in part. WCN 02-200-202
critically,
n successfully in a social,
al manner. They also INTRODUCING CLUSTER A, B AND C and how can this be Youngdonepeople
in practice? who are This difficult to have an
considered
Prognosis
concept is explored in the following sections. It is understood that the earlier
TABLE 9.6 G U I D E TO T H E TE X T xi
Mood stabilisers: dose ranges and side effects
SECTION 2
MEDICATION NAME DOSE RANGE SIDE EFFECTS AND INDICATIONS
Acute: 500–2000 mg Po titrated over side effects are directly related to serum lithium levels. The following symptoms
lithium carbonate
(lithicarb™) approx. 3 days (regular blood testing should resolve once dosage stabilises, and include:
FEATURES WITHIN CHAPTERS required)

Acute mania serum levels
• Gi upset (mild nausea, diarrhoea)
• dizziness
0.6–1.2 mmol/l • muscle weakness.
96 U N D E R P I N N I N G S O F M Therapeutic
E N TA L H E A(maintenance)
LT H N U R S I N G
levels The following are more persistent side effects:
Analyse Case studies that present 0.6–0.8 mmol/lmental health nursing issues
• fine hand tremor in context, encouraging you to
integrate and apply the concepts discussed in the chapter. • fatigue
• thirst
• polyuria
CASE STUDY • anorexia or weight gain (1–2 kg)
SECTION 1
• constipation
A NEW CLIENT • headache
Tomas is a 19-year-old client recently diagnosed with • ECG changes with Tomas and support his mother. You decide to locate and
• skin conditions
review (e.g. acne).current and best evidence to develop your
the most
schizophrenia and living with his mother. He has been
sodium
unablevalproate
to return to his1000–2500 mg/day
study course or Po
findinwork since include: response.
Bd dose
(anticonvulsant)
dropping out of his VET with food the previous semester. He•isnausea;
course
Target serum levels 50–100 mg/l Questions
• diarrhoea
reluctant to accept the diagnosis and struggles to agree with 1 What background questions need to be answered in
• vomiting
a need to take his olanzapine. His mother has expressed • constipationorder to then develop the specific foreground question?
worries that she ‘cannot talk to him any more’ and get him • headache
2 Develop a searchable and answerable foreground
to take his medication. She says he is becoming worse and • sedation or question
fatigue using the PICO format to locate the highest
asks you what she should do. Tomas is a new client and it• muscle twitching. level of evidence to inform your approach to help Tomas
138 THE CLINICAL CONTE X T OF PRACTICE
is not clear howthat
Identify commonalities
lamotrigine to quickly
youdevelop
100–400 may medication
mg/daysee Po inwith adherence
Bd dose consumers experiencing
lamotrigine has efficacy
and a specific
in treating
his mother. mental
Bd where depressive health
episodes have occurred.
(anticonvulsant) Careful titration required as high • life-threatening rash
condition with the Commonalities commencingof the
doses MSE
have section
been related in each chapter
• double-vision (diplopia); of Unit 2.
Levels and types of research
to occurrence evidencerash; • dizziness;
of life-threatening current evidence, an understanding of how to classify
see the ‘safety first’ box. • headache;
the quality of research is needed. Research evidence
Clinicians
COMMONALITIES do not approach research
OFlevels
THE MSE: evidence for the
SCHIZOPHRENIA
serum are not a reliable • loss of is
coordination (ataxia);
SECTION 2
same purpose as thatmeasure of a researcher. frequently depicted in a hierarchy, often called an

of efficacy forResearchers
lamotrigine. pose • nausea & vomiting;
questions as research problems – frequently, for the • fatigue.‘evidence pyramid’, where the top of the pyramid
purpose ofappearance
discovery through represents the highest level may
of research evidence
General
Carbamazepine andmghypothesis
400–1600 behaviour
Po
testing. From
some sidevoices forbe
effects can some individuals
mitigated by commencing abelownegative (‘You
dose and titrating
this perspective, researchers arelevels
interested in thewithbest available.
are worthless, The pyramid in Figure 6.3 depicts six
An individual with schizophrenia
Target serum 4–12present
may mg/l slowly. side effects include: you should kill yourself’) or positive in
way to answer anomalies
the following the research inquestion. Instead, and
their appearance • dizzinessnature (‘You are important and special; this isor
clinicians levels of research-based evidence. The best – whymost you
need to have confidence that they are utilising the • headache trustworthy
have been – evidence
chosen’). Voicesis atcan
thebe top maleof the
or pyramid.
female (and
behaviour:
best currently available
■■ dishevelled evidence about the
(due to disorganisation, issuesspecific
with EF, lessAny
• loss of coordination search
(ataxia)for
frequently, evidence
childlike), for practice
although should
McCarthy-Jones et
clinical problem impacting on their client. Therefore, • sedation start
al. at thenote
(2014) top in of their
the pyramid.
study Clinicians
exploring should
hallucinations
motivation due to negative symptoms, etc.) • fatigue
the only movevoices downwere the levels
more when the evidence
While theis
■■ clinician
uncooperativeasks questions of the (due
with interview current research
to poor insight that male common.
• double-vision (diplopia) at a higher level. Figure 6.3 is divided
not available
evidence that bestandanswers the clinical problem.
into illness belief in the need to require • nausea individual may recognise the voice asA N someone who is
XIE T y dIsORdERs 207
Clinicians seekortosuspiciousness
find the best possible answer • vomiting into
known twotobroad them,layers:
unknown filtered
voicesinformation
are just asand common.
intervention) and paranoia
to clinical questions from databases containing very • fluid unfiltered
retention The information.
following subtypes Filtered
of information
auditory is sources
hallucinations
■■ poor eye contact (due to negative symptoms) or
largeintense of
areresearch evidence in which studies based on similar
Learn about thepools of
eyeresearch.
importance contactof To find the best possible
evidence
(paranoia) and clinical•research dry mouth. common
in nursing with the Evidence-based practice
in schizophrenia:
boxes, which HOW link DO MENTAL HEALTH

■■ movements or gestures may be overt and the
research to nursing NURSES
practice. if
■ command
■ the person hallucinations
is experiencing (‘Quickly!
high levelsETTurn
soURCE: AndREWs of2013;
Al., off
anxiety,the 2018
MiMs onlinE,
individual may present as distracted. butTV, it isthey can see you.

a short-term Hurry!’) In addition, it is
alternative.
C H A P T E R 11
ASSIST A PERSON EXPERIENCING ■ running-commentary
very
■ important to promote hallucinations
the use of deep onbreathing
behaviour
EVIDENCE-BASED PRACTICE
Mood
ANXIETY? and(‘It is interesting
relaxation that you
techniques that have chosen
a person can a red
use pento to
Individuals with schizophrenia who are paranoid may fill out your deposit slip
prevent/manage/reduce the today’)
impact of anxiety. This
Seasons
Nursing and bipolar
approaches disorders?
to assisting a person experiencing Systematic spring; however,voices the same information about hypomania is
be fearful, afraid or distressed. Individuals exhibiting ■■ multipleempowers
reviews knowledge who converse
a person to tobeeach about at
in control the a
anxiety focus
Title of study
significant on supportive
negative symptoms interventions,
may presenttherapeuticas not readily
individualavailable.or other
time when anxiety canthings (male
strip aFiltered
person voice:
of their ‘Hefeeling
will
communication
Seasonal variations
withdrawn and education.
in ratesDue
or depressed. Earlier
of hospitalization in
to suspiciousness, this chapter,
for mania theand Design never amount
of control. When the to anything, is he
personinformationlesswill never provide
anxious, measure
we introduced
hypomania
individual specific
in psychiatric
may refuse to strategies
hospitals
eat food into assist
NSW
that hasanot person
beenwho
Critically appraisedQuantitative
up to our
opportunities
topics dataexpectations’.
collected
for exploring in NewFemale
South Wales
possible voice: from
catalysts‘Exactly,
that he
is experiencing
prepared a panic attack.
by a trustworthy person, so exploration (evidence syntheses
Authors December
increase 1999
is so pathetic;
feelingsto January
of 2014 even
heanxiety
can’t was
andextrapolated
get his hairusing
strategies right!’)
that the
Supportive
ofGordon
appetite interventions
is important. is are
notbased
ItGraham uncommonon principles of
forand guidelines)
Parker and Rebecca ICD ■ classification
person
■ non-verbal
has used labels.
auditory
previously hallucinations
that have been (such as music,
successful.
promoting a sense of emotional and
individuals who have a diagnosis of schizophrenia to physical safety.
sounds,
Working fromwhite noise, humming,
a strengths-based running is
perspective water,
a
Background
Sitting
disconnect withthea consumer,
power to their decreasing
home the dueamount
toCritically appraised Participation
of
paranoia, individual
animal noises).on for
articles powerful
Admission
(article synopses) reinforcer
information 27 255 the individual,
mental health as
patientsit shows
with mania
A number
stimulation of studies
they arehave suggested
encountering
and therefore storage of food items may become that
in individuals
the immediatewith
them
and they
hypomania
Visual do have
in all
hallucinations NSWskills
mental and
healthstrengths theyexplored.
facilities was can draw
bipolar
area, disorder
remaining experience
calm and higher
using
unhygienic and spoiled, rendering them unsafe forrates
clear of hospitalisation
concise language in
Randomised on. Reinforcing and supporting
are anotheracommon person in these
are all ways in Exploration
consumption. which the mental of libido health
is alsonurse cancontrolled trials
important,
Visual (RCTs)
hallucinations
SOURCE: UNIvERSITY OF CANBERRA LIBRARY, 2018
ways are part

perceptual of what is the
phenomenon core business ofVisual
of schizophrenia. mental
assist a person who is experiencing anxiety. The use of
Follow an individual
and may indicate person’s issuescase
with and the process
trustworthiness or of planning healthcare, nursing.
hallucinations
identifying
The following
commonly
problems,
nursing
Unfiltered
occur
performing
care
simultaneously plan draws
PRN (when necessary) medications
significant distractibility, rendering relationships may be indicated
Cohort studies
interventions and evaluating outcomes for that person withalongside the detailed
together aauditory
number Nursing
of these ideas.
hallucinations careinplans.
information over 80% of
difficult to maintain. Sleep may be impacted in
BK-CLA-HERCELINSKYJ_1E-180420-Chp09.indd 164 persons with schizophrenia (Waters et al., 2014). Visual 19/03/19 12:44 PM
times of stress or heightened paranoia, and therefore
Case-controlled studies/case series/reports
NURSINGof CARE
exploration PLANis essential.
sleep patterns
hallucinations are often described as three-dimensional,
solid, both colour and black and white, and can
Background information/expert opinion
Affect last for a few seconds or minutes. Typically, visual
MANAGING PANIC ATTACKS hallucinations may include images of people (including
In individuals who are experiencing increased negative
FIGURE
Consumer6.3 Diagnosis: Panic Attacks tightness in herfairies,
chest and difficulty breathing. She managedorto
symptoms of schizophrenia it is common to see affective God, Satan, ghosts, etc.), animals, shadows
Evidence
Nursingpyramid
Diagnosis: Extreme fear/panic whereby Maeve turn into a andside street, where she continued to experience these
blunting. This can range from restricted affect, where objects, those of a distressing nature may include
experiences feelings of intense dread and anxiety, tightness in symptoms insects, blood for several minutes before
or offensive writing they(Waters
subsided. et Eventually,
al., 2014).
there is some distortion of emotional expression, to a
the chest, palpitations, sweating and difficulty breathing. the symptoms
Perceptual settled down, which
disturbances lessenabled
commonly Maeve to contact
seen in
flat affect, whereby emotional expression is absent. It
Outcomes: Develop strategies to manage any future episodes her partner. She attended
schizophrenia include: the emergency department, where a
is important to consider how congruent the affect is to
of panic. range of tests was performed with all results being within normal
■■ olfactory hallucinations (e.g. smelling rotting food
the individual’s mood. Are they smiling while discussing
parameters.
or gas)Since this first visit, Maeve has experienced several
details of a perceived
Maeve is a 42-year-old woman
BK-CLA-HERCELINSKYJ_1E-180420-Chp06.indd plot
96 to kill them, for example?
who recently presented to the 17/03/19 5:25 PM
more of these episodes. As nothing physiological was identified,
■■ tactile hallucinations (e.g. feeling spiders crawling
emergency department. Maeve was driving to work along a Maeve has been asked to visit her local GP, who has referred her
Perception on skin)
busy arterial road when she suddenly felt faint and experienced for assessment to the practice nurse.
The most common perceptual disturbances in ■■ gustatory hallucinations (e.g. tasting ‘poison’ in food).
schizophrenia are auditory and visual hallucinations.
Thought
Auditory hallucinations
ASSESSMENT DATA EVIDENCE-BASED RATIONALE CONSUMER
Auditory
OBJECTIVEhallucinations
(O) (such RATIONALE
as hearing the voice Content RESPONSE
ofSUBJECTIVE
Copyright God)Cengage
2020 are commonly
(S) Learning.heard at a normal
All Rights Reserved.volume
May not be copied, scanned,are
Delusions or a diagnostic
duplicated, in component of schizophrenia
whole or in part. WCN 02-200-202
(although sometimes reported as whispering or yelling), (and psychosis) and are therefore very common in the
Maeve describes how she feels a Provide psychoeducation that Education provides Maeve with Maeve begins to understand the
insudden,
both severe
ears, for periods longerencompasses
and uncontrollable than a few minutesand
information conversations
information to help herof consumersconnections
understand who havebetween
a diagnosis of
events, her
REFLECTION ON LEARNING FROM PRACTICE
CHAPTER RESOURCES
SECTION 1
Lydia’s experience is not unlike that of others when admitted Mental health nurses need to be aware of their
xii G U I D E TO Tto
H Ea mental
TE X T health unit under the Mental Health Act. While professional, legal and ethical responsibilities in
SUMMARY
the Mental Health Act aims to support people with a providing and supporting care for people with a mental
mental health condition who require treatment, it can be illness. It is the responsibility of the nurse to ensure that
■■ This chapter has explored the legal and ethical contexts for ■■ Law and ethics apply in the context of nursing in Australia
a stigmatising and scary experience for consumers. The care and treatment provided is supportive of the person’s
nurses working in the field of mental health in the context of and all nurses working in health care need to be familiar
challenging aspect of this is for mental health nurses to human rights, and inclusive of their and their primary
mental health legislation in Australia. with local Mental Health Acts and other relevant
END-OF-CHAPTER
■■ Mental health legislation FEATURES
balance legislation whilst maximising choice, promoting
in various jurisdictions of Australia
safety and supporting consumers in their recovery.
carer/’s wishes.
legislation.
is varied. However, commonalities lie in the preservation of ■■ Of supreme importance are the issues of informed consent
dignity,
At the end upholding
of each duty of you
chapter care, will
and providing mentaltools
find several health to helpand
youinvoluntary
to review,or compulsory
practisetreatment, and the
and extend mental
your
care that is in a least restrictive environment. health nurse should adopt a consumer perspective.
knowledge of the key learning outcomes.
■■ Contemporary ethical and legal frameworks facilitate
CHAPTER RESOURCES
Review recovery
your understanding of the key
and promote autonomous chapter
decision with with the Summary.
makingtopics
carer input.
SUMMARY
ONLINE STUDY
■■ This chapter TOOLSthe legal and ethical contexts for
has explored ■■ Law and ethics apply in the context of nursing in Australia
nurses working in the field of mental health in the context of and all nurses working in health care need to be familiar
mental health legislation in Australia. with local
■■ videos andMental Health
video links for Acts and other
the chapter relevant
video cases
Express
■■ Mental health legislation in various jurisdictions of Australia legislation. version of the summary of age trends table
■■ downloadable
Visit http://login.cengagebrain.com
is varied. However, commonalitiesand lie use thepreservation
in the access of Of supreme
■■ for importance are the issues of informed consent
this chapter
code that comes
dignity, upholding withduty
thisofbook forand
care, 12 months
providing access
mentaltohealth
the and involuntary
■■ revision quizzes or compulsory treatment, and the mental
resources
care thatandis instudy tools
a least for this chapter.
restrictive environment. health
■■ and nurse should adopt a consumer perspective.
more!
Test your The CourseMate
■■ Contemporary
knowledge Express
ethical
and and website
legal
consolidate contains:
frameworks
yourfacilitate
learning through the Review questions.
recovery and promote autonomous decision making with
carer input.
REVIEW QUESTIONS
1 Choose the statement that best defines the difference 3 The following requirements are necessary for all patient
ONLINE
betweenSTUDY
law and TOOLS
ethics: consent:
a Ethics dictates behaviour, but law does not a The consent must be voluntary, specific to the
b Law is ‘prescriptive’ videos and video links for theinformed
intervention/treatment, chapter and
videothecases
person must
Express and ethics is ‘guiding’
■■
c Ethics is based on law ■■ downloadable

T Hhave T i C Aversion
E o R Ecapacity l f R A mofE w
the
o Rsummary
k s u n d Eof
R Page
i n ntrends
i n g P Rtable
ACTiCE 31
Visitdhttp://login.cengagebrain.com
A person can be punished forand use the ethics
breaching access for
b this
Thechapter
consent does not need to be voluntary as long as
2codeWhere
that comes
there is with
an this book
actual or for 12 months
perceived access
conflict to the the
between ■■ revision quizzeshas the legal capacity
the person
resources
code ofand study for
conduct tools for this
nurses andchapter.
the law: ■■ and
c more!
The consent can be considered valid if obtained
The CourseMate Express website contains:
CRITICAL
a The codeTHINKINGtakes precedence through coercion as long as it is in the best interest of
THEoRE TiCAl fRAmE woRks undERPinning PRACTiCE 31
The law takes precedence on and discuss complex issues inthe patient to nursing with the
CHAPTER 2
Challenge b yourself to reflect relation
1 The conflict
c What factors iswould
settled
a with consideration
mental health nurse totake
the code dTheyThe consent
are sleepingmust be voluntary,
in separate rooms cover
and any
she intervention/
will not let
CriticalREVIEW
thinking QUESTIONS
questions.
andaccount
into the law when considering which theoretical himtreatment during admission,
see her undressed. be informed
‘I just want to be there andforthe person
her…
1 dChooseThe conflict
perspective is decided
might
the statement help by
thatthem theto
best Nursing
understand
defines and
the Midwifery
a consumer’s
difference 3 but Themust
she’s have
following capacity
locking me out’, Ivan
requirements arestates. ‘I have
necessary forno-one
all patient
CRITICAL
Board law
behaviour?
between of THINKING
Australia
and ethics: Iconsent:
can speak to.’ Using a psychodynamic perspective,
2 a Jennifer has been
Ethics dictates receivingbut
behaviour, chemotherapy
law does notas part of her how
a The could the nurse
consent mustunderstand
be voluntary, Jennifer’s
specific current
to the
1 b What
breast
Law isfactors
cancer would aand
mental
treatment.
‘prescriptive’ The
ethicshealth
nurse nurse that
notes
is ‘guiding’ takewhen her They are sleeping in separate
behaviour?
intervention/treatment, roomsand
informed andthesheperson
will notmust
let
c into account
husband
Ethics isattends
basedwhen the
on considering
appointment
law which
withtheoretical
her there is very 3 himUsingsee
have her undressed.
Erikson’s
capacity ‘I just want
theory, identify whattofactors
be there for her…
impact on a
d perspective
little might
conversation
A person can help themfor
between
be punished to breaching
them. understand
Whenever a Ivan
consumer’s
ethics tries but she’s
person’s
b The lockingdoes
development
consent me out’,
over
not Ivan
thestates.
need course
to ‘Iofhave
theirno-one
be voluntary life.long as
as
2 Where behaviour?
to speak
therewithis anJennifer
actual orshe turns herconflict
perceived head and will not
between the 4 IHow can speak
thecan theto.’
person Using
mental
has alegal
psychodynamic
thehealth nurse
capacity perspective,
apply Bandura’s
Jennifer
2 code hasThe
lookofatconduct
him.
BK-CLA-HERCELINSKYJ_1E-180420-Chp03.indd been receiving
fornurse
44 asks
nurses andchemotherapy
Ivan privately ifaseverything
the law: part of her how
concept
c The couldof the
consent nurse understand
self-efficacy
can be to support
considered Jennifer’s
consumers current
valid if obtainedin 19/03/19 11:07 AM
a breast
isThe
okay cancer
between
code takes treatment.
him andThe
precedence nurse Ivan
Jennifer. notesbecomes
that when her behaviour?
medication self-management?
through coercion as long as it is in the best interest of
b husband
visibly
The law attends
distressed the
and
takes precedence appointment
explains that with her there
Jennifer is veryto
refuses 3 Using theErikson’s
patient theory, identify what factors impact on a
c little
talk conversation
Theabout
conflicttheiscancer between
settled with them.
diagnosis Whenever
and
consideration treatment.Ivancode
to the tries person’s development
d The consent must beover the course
voluntary, cover of their life.
any intervention/
to
Start your online speak with
and the reading
law Jennifer she turns her head and will
and research using the short list of Useful not 4 How can
treatmentthe mental
websites. health nurse apply Bandura’s
during admission, be informed and the person
d look
The at him. The
conflict nurse asks
is decided by theIvan privately
Nursing andifMidwifery
everything concept of self-efficacy
must have capacity to support consumers in
isBoard
okay of
between
Australia him and Jennifer. Ivan becomes medication self-management?
USEFUL visiblyWEBSITES
distressed and explains that Jennifer refuses to THEoRE TiCAl fRAmE woRks undERPinning PRACTiCE 31
talk about the cancer diagnosis and treatment.
■■ Approaches to Psychology – the humanistic approach: ■■ Hildegard Peplau’s interpersonal relations theory:
https://www.ryerson.ca/~glassman/humanist.html https://nurseslabs.com/hildegard-peplaus-interpersonal-
■■ Australian Psychological Society: relations-theory
USEFUL WEBSITES
USEFUL WEBSITES
https://www.psychology.org.au
CHAPTER 2
■ Approaches to Psychology
BK-CLA-HERCELINSKYJ_1E-180420-Chp03.indd 44 – the humanistic approach: ■ Hildegard Peplau’s interpersonal relations theory: 19/03/19 11:07 AM
Approaches
■■ to Psychology – the humanistic approach:
https://www.ryerson.ca/~glassman/humanist.html
■■ Hildegard Peplau’s interpersonal relations theory:
https://nurseslabs.com/hildegard-peplaus-interpersonal-
Expand your
SEARCH knowledge
ME! NURSING by reading
https://www.ryerson.ca/~glassman/humanist.html
■ Australian Psychological Society:
the Search me! nursing articles or conducting further research in the
https://nurseslabs.com/hildegard-peplaus-interpersonal-
relations-theory
Search
■■ me! nursing
Australian database
Psychological
https://www.psychology.org.au with the suggested key termsrelations-theory
Society: and activities.
Key terms
https://www.psychology.org.au 2 Read the article, ‘The effect of using Peplau’s therapeutic
■■ Hildegard Peplau relationship model on anxiety of coronary artery bypass
SEARCH
■■ Mental health ME! NURSING graft surgery candidates’ (Maghsoodi et al., 2014).
SEARCH ME!
■■ Mental illness NURSING
Expand your knowledge with Search me! nursing. Fast and
a While not specific to mental health, it is interesting
a Research Peplau’s four phases of the therapeutic
■■ Personality
convenient, this resource provides you with 24-hour access to reflect on the utility of the model in other clinical
relationship.
Key terms
■■ Phil 2 Read the article,
contexts ‘The effect
andlike
shows thatthe of
theusing Peplau’s
experience oftherapeutic
anxiety
toBarker
full-text articles from hundreds of scholarly and popular b You might also to review research into the
■■ Hildegard Peplau
■■ Therapeutic
journals and relationship
newspapers, including The Australian and The
relationship
application
model
is experienced
of Peplau’s
on anxiety
in allideas
health of coronary
contexts.
to other healthHow
artery bypass
would
contexts. you
■■ Mental health
KeywordNewactivities
York Times. Search me! allows you to explore topics 2 Readgraft surgery
explain
the article, candidates’
mental healthofto
‘The effect (Maghsoodi ettherapeutic
a nonprofessional?
using Peplau’s al., 2014).
■■ Mental illness
1 Read further
theand find current
article, references.
‘A literature review of the progress of aReadWhile
3 relationshipthe not specific
model
article, on‘Toward to mental
anxiety aofnew health,
coronary it isof
artery
definition interesting
bypass
mental health’
■■ Personality
For access,nurse-patient
the psychiatric go to http://login.cengagebrain.com.au
relationship as describedand by graft to reflect
surgery
(Galderisi on the
candidates’
et al., 2015). utility
Thisofarticle
(Maghsoodithe model al., in
etstarts otherthe
2014).
with clinical
definition
■■ Philfollow
Barkerthe instructions
Peplau’ (Stockmann, 2005). provided on the printed access card a contexts
While not and
specificshows
to that
mental the
health,experience
it is
developed by the WHO and argues for a new definition of of
interesting anxiety
from the front
■■ Therapeutic of this textbook.
relationship toisreflect on the utility
experienced in allof health
the model in otherHow
contexts. clinical
would you
a Research Peplau’s four phases of the therapeutic mental health.
Keyword The following key terms and activity questions can be used
activities contexts
explain and shows
mental that the
health to experience
a of anxiety
nonprofessional?
relationship.
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, a What is your
scanned, own personal
or duplicated, definition
in whole or in of mental
part. WCNhealth?
02-200-202
1 Read for additional
the research.
article, 3 Read is experienced
article,in‘Toward
thewould all healthacontexts.
newthe How
definition would you
of mental health’
You
b Key might
terms also‘Alike
literature review
to review of the progress
the research into theof How
b explain mental you
health incorporate
to a nonprofessional? ideas presented in this
theapplication
psychiatricof nurse-patient relationship as described
Peplau’s ideas to other health contexts. by (Galderisi et al., 2015).
paper into this definition? This article starts with the definition
■
xiii

Guide to the online resources
FOR THE INSTRUCTOR
Cengage is pleased to provide you with a selection of resources that will
help you prepare your lectures and assessments. These teaching
tools are accessible via cengage.com.au/instructors for Australia or
cengage.co.nz/instructors for New Zealand.
INSTRUCTOR’S MANUAL
The Instructor’s manual includes:
• Learning outcomes • Video activities for classroom teaching
• Key words and definitions • Websites and readings
• Cases and case question solutions (including • Search me! key terms and activities.
additional questions for instructors).
• Solutions to end-of-chapter review and critical
thinking questions.
WORD-BASED TEST BANK AND STUDENT REVISION QUIZ

This bank of questions has been developed in conjunction with the text for creating quizzes, tests and exams for
your students. Deliver these through your LMS and in your classroom. An additional bank of questions has been
created to provide direct to students for their own revision and self-assessment.
POWERPOINT™ PRESENTATIONS
Use the chapter-by-chapter PowerPoint slides to enhance your lecture presentations and handouts by
reinforcing the key principles of your subject.
ARTWORK FROM THE TEXT

Add the digital files of graphs, pictures and flow charts into your course management system, use them in
student handouts, or copy them into your lecture presentations.
FOR THE STUDENT

New copies of this text come with an access code that gives you a
12-month subscription to Search me! nursing.
Visit http://login.cengagebrain.com and log in using the access code card.
SEARCH ME! NURSING

Search Me! Nursing is an online research library Plus, 24-hour access means you won’t be limited by
customised to your subject, that puts the information library opening times!
you need right at your fingertips. Log in using the code on the card inside the front
Content is updated daily from hundreds of scholarly cover.
and popular journals, eBooks and newspapers.
xiv
PREFACE
ABOUT THIS BOOK ■■ theory of communication

■■ legal and ethical considerations
Florence Nightingale once said, ‘nursing is an art ■■ extensive exploration of conditions (e.g.,
and a science’. This point perhaps best describes schizophrenia, depression, personality disorders etc.)
the dichotomy for students when entering mental ■■ complements the acclaimed DSM5 (2013)
health. For many students their previous learning has ■■ therapeutic use of medicines
focused on technical psychomotor skill acquisition. ■■ suicide and non-suicidal self-injury
For example, undertaking a physical assessment, ■■ non-pharmacological approaches to intervention
blood pressure, or administration of sub-cutaneous ■■ community mental health
medication. Mental health nursing requires a uniquely ■■ carer and family input
different, and human set of skills that can be very ■■ Indigenous perspectives
challenging for some. Mental health nursing centres ■■ mental health first aid.
on the individual, their needs, their challenges, their One of the most difficult aspects of mental health
hopes and their goals, and nurses require competent nursing for students is applying what they have leaned
therapeutic communication skills to help. into a clinical context. For example, how to undertake
Mental health nursing proficiency is a standard a mental state examination. This text has been
requirement of every nursing graduate. Individuals developed with these issues specifically in mind by:
with a lived experience of a mental health condition ■■ providing examples of common mental state
are understood to experience discrimination, examination presentations specifically according to
stigmatisation and disadvantage that results in the mental health condition
worsening of mental and physical health. While ■■ comprehensive exploration of mental state
mental health nursing is a highly specialised sector examination including provision of questions and
of healthcare, the increasing prevalence of mental definitions
health conditions means that all nurses must be ■■ the use of clinical observation and Safety First
suitably equipped to engage therapeutically with boxes to highlight specific areas of practice that
someone experiencing a mental health challenge. This students must be familiar with.
requires a combination of theoretical understanding This text provides a comprehensive introduction
of mental health and mental ill health, and how the to mental health nursing where the consumer is
person’s lived experience of a mental health condition central to the caring process, and how care is delivered
is central to working collaboratively with them. This by the multidisciplinary team. Core features of
understanding is then applied in practice through the this text will provide students with the foundation
multidisciplinary team by safely applying therapeutic knowledge and skills they can apply during their
skills in interactions with consumers experiencing clinical placement and future nursing career.
a mental health condition. This text provides a
comprehensive exploration of mental healthcare that Gylo (Julie) Hercelinskyj and
enables practical application of skills. Louise Alexander
Areas comprehensively covered in this text include:
■■ historical perspectives of mental healthcare
■■ recovery and trauma informed practice
xv

ABOUT THE AUTHORS
Gylo (Julie) Hercelinskyj is a senior lecturer Principal Lecturer Nursing, Three Counties School
in mental health nursing at Australian Catholic of Nursing and Midwifery, University of Worcester/
University (ACU), Melbourne. Julie’s clinical, teaching Associate Professor (adjunct) School of Nursing and
and research background is in older person’s mental Midwifery, La Trobe University
health, perinatal mental health, interpersonal skills ■■ Chapter 18: Trauma and stressor-related
and psychosocial nursing practice. Julie is a registered disorders, with Louise Ward.
nurse. She completed her original education in general
Glen Collett
nursing and then specialised in mental health nursing.
Ad. Dip Nursing Studies, Facilitating Learning in
Julie has a Masters in Nursing Studies and completed
Clinical Practice, P.Grad Certificate of Nursing, Papers
her PhD in 2011. She has presented at national and
in Alcohol and Drug Rehabilitation and Clinical
international conferences and has published in the
Speciality in Mental Health. Prior Nurse Unit Manager
area of emotional labour in mental health nursing.
for Addictions, Healthscope, Clinical Facilitator
Julie believes that all nurses need to incorporate
■■ Chapter 14: Substance-related and addictive
promoting mental health into their practice. This
disorders, with Desiree Smith
requires a clear understanding of mental health and
mental distress, the impact on the person and their Doseena Fergie
families and how nurses work collaboratively with PhD. FCATSINaM. 2016 Churchill Fellow. Project Lead,
people who have a lived experience mental distress, Indigenous Recruitment and Retention, (Postgraduate
and their families. & Academic), Australian Catholic University
■■ Chapter 25: Cultural context in practice in
Louise Alexander is a lecturer in mental health
Australia
nursing at Australian Catholic University (ACU),
Melbourne. Louise has a background in forensic Terry Froggatt
mental health nursing in acute, subacute and PhD. MSc. BHA (UNSW). RN.CMHN, Head - Faculty
rehabilitation areas. Louise is a registered nurse with of Health and Social Wellbeing, Honorary Fellow
post-graduate qualifications in psychiatric nursing, University of Wollongong, Nan Tien Institute
and professional education and training. She also has ■■ Chapter 3: Ethics, law and mental health nursing
a Masters in Education, and a PhD in Psychology. practice, with Alison Hansen

Louise has presented at conferences both locally and ■■ Chapter 7: Assessment and diagnosis, with Louise
internationally about teaching mental health nursing Alexander

and has a special interest in the use of simulation in ■■ Chapter 26: Mental health first aid, with Nygell
mental health teaching. Topp.

Louise is passionate about students’ developing
Karen Hall
a comprehensive understanding of the theoretical
RN, Dip VET, MMentHlth, PhD (cand.), Swinburne
underpinnings of mental health nursing. In particular,
University.
students’ understanding and ability to undertake a
■■ Chapter 24: Community mental health context
mental state examination, and activities that alleviate
pre-clinical placement anxiety. Louise currently Alison Hansen
oversees mental health nursing within the Bachelor RN, MAdvNursPrac (Mental Health), GCHE, PhD
of Nursing program and is the national course (Cand.), Lecturer, Monash University
coordinator for mental health nursing at ACU. ■■ Chapter 3: Ethics, law and mental health nursing
practice, with Terry Froggatt

Contributing authors
Peri O’Shea
Cengage would like to thank the numerous
PhD, M. Soc. Pol., Psyc. Hon., B. Soc. Sc. Lived
contributors who assisted in this publication.
Experience Researcher and Consultant – xperienhance
Melody Carter ■■ Chapter 21: Recovery and resilience in mental
PhD, MSc (ECON), PGCE(HE), BSc (HONS), RGN, health

DN, Senior Fellow of the Higher Education Academy,
xvi A b o u t t h e au t h o r s
Brian Phillips Louise Ward

DipSc, MSc, PhD, RN, Senior Lecturer in Nursing, PhD, MN (Mental health), PGDip Arts therapy,
Charles Darwin University PGCert ed. BN (Hons), RN, Associate Professor Clinical
■■ Chapter 6: Using evidence to guide mental health practice, School of Nursing and Midwifery, La Trobe
nursing practice University Australia.
■■ Chapter 18: Trauma and stressor- related
Desiree Smith
disorders, with Melody Carter
RN, BHSc (Nursing), GCPNP, MPH, Sessional Tertiary
Educator, Intake Clinician: The Melbourne Clinic Cengage would also like to extend thanks for partial
■■ Chapter 14: Substance-related and addictive chapter contributions to:
disorders, with Glen Collett
Russell Fremantle
Nygell Topp ■■Chapter 15: Neurodevelopmental disorders
RN, B.N, PGD Adult Ed, Accredited mental health first
Scott Truman
aid instructor
■■ Chapter 17: Obsessive compulsive and related
■■ Chapter 26: Mental health first aid, with Terry
disorders.
Froggatt
xvii

ACKNOWLEDGEMENTS
Gylo (Julie): This has been a journey shared with a You are both my biggest motivation, and my proudest
number of people. Thanks to Louise for agreeing to achievement. I love you both very much. Finally, I
go on this rollercoaster ride with me. To my amazing would like to dedicate this book to my nephew James.
husband Peter – your support, love and friendship Never forgotten.
have always been the mainstay in my life. You
Cengage and the authors would like to thank the
are my ‘rock’. Here’s to the future. To my children
following reviewers for their incisive and helpful
Ayisha and Shae and my amazing grandson Ralph,
feedback:
I am immensely proud of the people you are, and
■■ Trudy Atkinson – Central Queensland University
that I get to be your mum and grandma. Mum, your
■■ Rhonda Dawson – University of Southern
indomitable spirit inspires me to be best I can be
Queensland
personally and professionally. To my father, sister and
■■ Cheryl Green – University of Adelaide
brother, I miss you all. This book is dedicated to you.
■■ Phillip Maude – RMIT University
Louise: I would like to thank my family for their ■■ Eddie Robinson – Monash University
support during this journey. You have all had to ■■ Tracy Robinson – University of Canberra
put up with an awful lot of literary suffering, far in ■■ Susan Sumskis – University of Wollongong
excess of the usual undertakings of an academic: ■■ Sione Vaka – Massey University
manuscripts, PhD thesis and this book. In particular, ■■ Philip Warelow – Federation University.
I want to thank my husband Christian, and children

Every effort has been made to trace and acknowledge
Madeleine and Charlotte. Christian, thank you for
copyright. However, if any infringement has occurred,
your support during this process, and for believing
the publishers tender their apologies and invite the
in me. I love you. To my daughters, I know it always
copyright holders to contact them.
seems like mum is always busy ‘doing something’ but
I do hope you understand that I do it for you both.
SECTION
1
UNDERPINNINGS OF MENTAL
HEALTH NURSING
CHAPTER 1 MENTAL HEALTH NURSING –THEN AND NOW 2
CHAPTER 2 THEORETICAL FRAMEWORKS UNDERPINNING PRACTICE 16
CHAPTER 3 ETHICS, LAW AND MENTAL HEALTH NURSING PRACTICE 33
CHAPTER 4 TREATMENT MODALITIES UTILISED IN CONTEMPORARY
MENTAL HEALTH SERVICE DELIVERY 48
CHAPTER 5 MENTAL HEALTH NURSING AS A THERAPEUTIC PROCESS 68
CHAPTER 6 USING EVIDENCE TO GUIDE MENTAL HEALTH NURSING PRACTICE 91
From the days of the asylum and work of attendants through to contemporary mental health
service delivery, mental health nursing has evolved into a discipline that is guided by humanistic
principles and evidence for practice. Practice is founded on a range of theoretical perspectives,
legislative requirements, a variety of treatment and management options and therapeutic
processes. Section 1 explores these foundational ideas in order to set the scene for the
remainder of the book.
To understand the role of the mental health nurse as a member of the multidisciplinary
team in delivering recovery-oriented and trauma-informed care, Chapter 1 provides a
sense of the historical development of the discipline. Chapter 2 introduces some of the key
theoretical frameworks that underpin mental health nursing practice. You will read about
ideas from psychology and medicine as well as key contributions from mental health nursing
theorists. These ideas will be applied to practice and critiqued. Chapter 3 presents essential
knowledge regarding how mental health legislation underpins mental health service delivery,
how recovery has influenced recent legislation and the consumer perspective of compulsory
treatment and nursing practice, as well as key ethical considerations and issues related
to practice and ethical frameworks to identity these issues. Chapter 4 explores the range
of pharmacological and psychosocial treatment options currently used in contemporary
practice. Core to effective practice in mental health is the capacity to listen to, respond and
work collaboratively with consumers and their families. Chapter 5 explores the concept
of mental health nursing as a therapeutic process. The fundamental components of the
communication process, and the application of knowledge and skills to the therapeutic
process are identified and explored. Section 1 concludes with Chapter 6, which looks at how
mental health nurses understand, apply and critique evidence for practice. This includes
consideration of clinical reasoning and decision-making.
1
CHAPTER
1
MENTAL HEALTH NURSING – THEN AND NOW
Louise Alexander and Gylo (Julie) Hercelinskyj
LEARNING OUTCOMES
Upon completion of this chapter, you should be able to:
1.1 Describe early human beliefs in illness and disease that affected how mental illness has been perceived
1.2 Describe factors behind the rise and growth of asylums throughout the world as well as the conditions that
historically prevailed at asylums
1.3 Describe the history of asylums in Australia and the emergence of mental health nursing as a distinct
profession within Australia
1.4 Describe treatments of mental health conditions throughout history, including the improvement of care,
conditions and more humane perspectives on mental health and mental health nursing
1.5 Explore the role and identity of the mental health nurse in contemporary mental health service delivery
LEARNING FROM PRACTICE

To be honest, when I started nursing, I didn’t even realise But when I told my parents of my decision my father’s
there was an area of practice dedicated to working in response was: ‘Why can’t you be a normal nurse and work
mental health. But even in the beginning of my education, with babies?’
I was always drawn to those ideas and concepts that Even now many years later, when I say I am a mental
explored the person’s response to both health and illness. All health nurse I wait for what seems to be the inevitable
the science was important, but it was learning about people reaction from people. I watch their eyes widen, their jaw
that interested me the most. Having a clinical placement drop ever so slightly and then they say: ‘But what do psych
at a community mental health facility provided my first nurses actually do?’, ‘You’re a mental health nurse? That
experience of a positive learning opportunity. I loved the must be so hard’, ‘You deserve a medal’ or ‘Why did you
learning, the teamwork, and seeing the way consumers choose that?’ So, I tell them my story and hope they take
experienced their recovery journey. I wasn’t made to feel even a small level of understanding away.
small or insignificant and no-one made me cry. But even JD, mental health nurse
then, I still did not see myself as a mental health nurse. I
was going to be a midwife and thought completing mental JD has described her journey into mental health nursing,
health nursing after graduation would be useful in that work. one she herself admits she was surprised to have enjoyed.
I never became a midwife. The closest I came to holding You may find yourself in a similar position – contemplating
an infant was the time spent working in paediatrics. My your future as a nurse, and finding certain areas challenge
postgraduate year had clearly shown me that I wanted to your preconceived ideas. What is your understanding of
be a mental health nurse. It was there that I felt I could mental health nursing? Reflect on how you feel about your
contribute and make a difference as a registered nurse. upcoming mental health studies.
2
M E N TA L H E A LT H N U R S I N G – T H E N A N D N O W 3
INTRODUCTION The following terms were all socially appropriate and,

in fact, diagnostic labels of early mental health conditions:
CHAPTER 1
To understand where we are going in the profession of ■■ lunatic
mental health nursing, it is important to consider where ■■ idiot
we have come from. Often the history of mental health, ■■ raving mad
or psychiatry as it has been referred to historically, ■■ feebleminded
is understood in terms of its historical development, ■■ insane
treatment of people with a lived experienced of mental ■■ incoherent
illness and the plethora of iconic or infamous events ■■ intemperate
and images that surround it. Mental health nursing ■■ hysterical.
has been largely ignored, and seen only in relation to The institution that housed the mentally ill of
psychiatry and promulgated through literature, art, yesteryear was commonly called an ‘insane asylum’ or
film and television in ways that perpetuate many of a ‘lunatic asylum’.
the myths that surround mental health. Mental health
nursing has been overlooked by historians in terms of
the contribution it has made to the care of people with a BELIEF IN SUPERNATURAL ORIGINS OF
mental health condition in Australia, with only fleeting
ILLNESS AND DISEASE
references to mental health nursing in their work
(Maude, 2002). Nolan (1993) also believes much of the In today’s modern and civilised society, it seems
literature that does exist relates primarily to the history abhorrent to consider that disease and ill health have
of psychiatric services, with nursing only considered in a basis in any realm outside modern medicine. This was
a marginal capacity. For example, the image of nursing not the case in the fourteenth century, however. We
is inevitably viewed through the lens of Florence consider a time where preoccupation with witchcraft,
Nightingale’s exploits in the Crimea, her establishment sorcery and demonology was a common justification
of the first formalised nurse training school and the for regular occurrences of that era: plagues, famine and
publication of her text ‘Notes on nursing’ in 1859. general social unrest. By trusting in such supernatural
It is most likely that mental health nursing evolved concepts, believers of those times had something
from what was historically a correctional or custodial tangible on which to project their anger, fear and blame.
position within an asylum. Asylums were notoriously
inhumane places to reside and a significant portion of Witches
the history of mental illness encompasses this suffering. Witches and witchcraft were blamed for many events of
Workers within asylums monitored the whereabouts and the early and Middle Ages, ranging from simple misfortune
cared for the inhabitants confined there. From around (such as the death of a child, crop blighting or adverse
the mid-nineteenth century, the acceptable term for weather events) to the bizarre that had no basis in fact
attendants was ‘nurse’ and this included both male and (such as riding on a broomstick or changing form from
female attendants. This chapter explores some main human to animal). It is perhaps human nature to seek an
historical perspectives of the causes of mental illness, understanding of why ‘bad’ things occur, and for many
historical mental health rituals, the establishment of people ascribing blame to an evil, mythological being made
asylums throughout the world and then in Australia, sense. While there were varied and numerous reasons why
and the development of mental health treatments women were ultimately tried as witches, many of which
throughout human civilisation. In this chapter, we argue were purely matters of politics or the result of religious
that to understand and value the role of mental health differences, it is understood that some of those who were
care and nursing practice today, it is essential to see how persecuted were mentally unwell individuals who were
it evolved over the course of history. We approach this probably suffering psychosis. In the majority of cases, there
task by first looking at the history of mental health and was no treatment offered to the suspected guilty party, and
then introducing the role of the mental health nurse in ‘confessions’ were obtained under torture or other duress;
contemporary mental health service delivery, including usually to make a deliberate example of the victim. Witches
introducing recent debates on the professional identity of were burned at the stake (see Figure 1.1) or suffered what
the contemporary mental health nurse. is known as the ‘dunking test’. In this ultimate no-win
situation (see Figure 1.2), the witch was tied to a chair and
Historical terms lowered into a body of water such as a river or lake. She
While today it is unacceptable to refer to individuals was dunked in the water repeatedly, and if she died it
experiencing a mental health challenge as ‘mad’ or was determined that she was not a witch. If she managed
‘insane’, historically such terms were widely acceptable to survive the dunking, this meant that she was a witch,
and originated from actual medical diagnoses. Unlike and she would be outed as a devil and killed regardless.
their usage today, they were not intended to be Alternative recollections of this historical perspective also
derogatory. suggest that if she sank, she was deemed innocent (yet was
4 U N D E R P I N N I N G S O F M E N TA L H E A LT H N U R S I N G
now dead) and if she floated, she was guilty and was killed with us in the shape of a deer or any other shape that
anyway. It is unknown how many women and clergymen he would be in. We would never refuse him’ (Zacks,
SECTION 1
died under the pretence of supernatural and/or spiritual 1994). Isabel described in great detail the intimate
causes of civil unrest, but it has been suggested that knowledge of her sexual encounters with the devil:
hundreds of thousands of people were killed due to
And within a few days, he came to me, in the
such beliefs throughout the centuries (Elmer, 2016).
New Ward’s of Inshoch, and there had carnal
copulation with me. He was a very huge, black,
rough man, very cold; and I found his nature
SOURCE: IMAGE FROM ALT- UND NEU-WIEN. GESCHICHTE DER KAISERSTADT UND IHRER UMGEBUNGEN, ETC BY MORIZ BERMANN (1880), BRITISH LIBRARY
[semen] within me all cold as spring well water.

He will lie all heavy upon us, when he has carnal
dealing with us, like a sack of barley malt. His
member is exceedingly great and long; no man’s
member is so long and big as his. He would be
among us like a stud horse among mares.
The youngest and lustiest women will have
very great pleasure in their carnal copulation
with him, yea much more than with their own
husbands; and they will have an exceedingly great
desire for it with him, as much as he can give
them and more, and never think shame of it. He is
abler for us that way than any man can be (Alas!
that I should compare him to any man!) only he
is heavy like a sack of barley malt; a huge nature
[outpouring of semen], very cold as ice.
Source: Zacks, 1994
Given the content of this extract, it is possible that

Isabel was experiencing psychosis in the context of
mania or schizophrenia. Her plight was met with the
response that was common for the ‘witches’ of the
Middle Ages: she was killed.
FIGURE 1.1 Exorcisms and spirit possession

Witch being burned at the stake Most religions have a history of exorcism and the
history of such practices goes back thousands of
years. Exorcism has a place in the management of
SOURCE: IMAGE FROM CHAP-BOOKS OF THE EIGHTEENTH CENTURY BY JOHN ASHTON (1834)
the mentally ill in some countries even to this day,

and demonic possession has been attributed to many
strange beliefs or behaviours that now are commonly
associated with psychosis or schizophrenia (Craig,
2014). In the Middle Ages countless people suffered
painful treatments at the hands of clergymen seeking
to exorcise spirits from their inhabitant and these
frequently resulted in death (McNamara, 2011). Figure 1.3
depicts St Francis Borgia providing the last rites to a
dying man who appears haunted by demonic spirits.
While exorcism is predominantly associated
with Catholic practices throughout history, there are
many other historical examples in other cultures.
FIGURE 1.2 Aboriginal Australians have an embryonic history of
The dunking test spiritual Dreamtime dating back 50 000 years, which
includes entering spiritual dreamlands that have
In Scotland in 1662, Isabel Gowdie was accused of included possession (McNamara, 2011). Spirit possession
being a witch and she readily confessed to this crime is also recounted in the histories of Native America,
without requiring any torture. During her trial, Isabel pre-Columbian South America, West African Yoruba, Islam
was quoted as saying, ‘He would have carnal dealing and Northern and Southern Asia (McNamara, 2011).
became colloquially known as institutionalisation.

Asylums tended to be large buildings with dorms or
CHAPTER 1
rooms (which were locked) under the proviso that
they were providing specialised care for people with
mental illness. In reality, they were places of disease,
distress and depravity (Arnold, 2009). The world’s
first hospital for the mentally insane was opened in
Baghdad in 792 CE, and Europe soon followed suit,
but prior to this, families were generally responsible
for the keeping of mentally ill people, much to their
immense shame and embarrassment.
The superstitions associated with mental illness
SOURCE: ST. FRANCIS BORGIA HELPING A DYING IMPENITENT BY GOYA (CIRCA 1788), PUBLIC DOMAIN
rendered many families with disturbed family

members deemed to be unlucky and cursed, thus
resulting in them being isolated and ridiculed.
Lunatic asylums began to emerge in the sixteenth
century. These were not places of healing, but were
locked penal colonies where the mentally ill could
be abandoned by their long-suffering families,
often never to be seen again. Conditions were
appalling – vermin and disease were rife, the food
insufficient, sanitation grossly inadequate and the
caretakers sadistic – and overcrowding resulted in
inmates being unable to lie down or move around
(as they were almost always chained up anyway)
(Arnold, 2009). Individuals with an intellectual
disability were also housed in asylums in the same
FIGURE 1.3 horrendous conditions, and this is hypothesised as
St Francis Borgia (1510–72) helping a dying impenitent Francisco José being one of the more common reasons why many
De Goya people wrongly think even today that those with a
mental health condition are of lower intellect. These
ASYLUMS OF THE WORLD horrendous conditions continued worldwide until
An asylum was an institution where people with a around the 1850s, although in some countries they
mental health condition were housed. This process continued well into the 1900s.
CASE STUDY
THE ROSENHAN EXPERIMENT
The Rosenhan experiment is a further example of subjectivity Questions
within psychiatry. David Rosenhan was a psychologist, and in 1 The participants of the Rosenhan experiment were
1972 he and seven colleagues presented to various hospitals trying to make a point about diagnostic subjectivity in
across America fabricating mental illnesses of varying degrees. psychiatry. What do you think this means?
All were admitted to hospital for periods ranging from seven to 2 Reflect on your understanding of general medical
52 days, given invasive treatments against their will, and despite conditions. Is psychiatry unique to such ambiguity in
trying to convince doctors they were undertaking an experiment, diagnosis?
they were only released when they appeared to comply with
their diagnosis and subsequent treatment (Fontaine, 2013).
Bedlam Locals were encouraged to come and view the

One of the most notorious and infamous asylums in ‘lunatics’ of Bedlam as entertainment, and on the
the world was Saint Mary of Bethlehem, located in first Tuesday of the month people could peer through
London in the mid-sixteenth century (see Figure 1.4). holes in the stones for free. On other days, this outing
This asylum was quickly named ‘Bedlam’ and is would cost a penny. Around 100 000 people visited the
in fact the origin of the moniker itself. Bedlam has site every year, and Bedlam remained a popular tourist
a dark, well documented and researched history. attraction into the nineteenth century (Arnold, 2009).
to hold the powerful and authoritarian roles in historical

WELLCOMECOLLECTION.ORG/WORKS/K2S5CH9Q. RELEASED UNDER CC BY 4.0.
psychiatry; many women remained institutionalised for

SECTION 1
mere convenience (Toy, 2014).

LINK TO LICENSE: HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/
SOURCE: ENGRAVING BY B. COLE, WELLCOME COLLECTION, HTTPS://
Mental health nursing in Australia

Formerly custodial attendants, mental health nursing
emerged as a distinct profession in Australia around
1890 with the increased medicalisation of mental
health (Sands, 2009). Generally, men were responsible
for the care of the mentally insane, until women were
employed in the early twentieth century (Happell,
2007). Identification of nursing as a profession
emerged in the mid- to late twentieth century
FIGURE 1.4 and this resulted in the notion of specialisation in
Saint Mary of Bethlehem, or ‘Bedlam’
the field of psychiatry. With the development of
psychotropic medication in the 1950s, psychiatry
HISTORY OF AUSTRALIA’S ASYLUMS experienced changes in credibility and further
interest in psychiatry as a nursing specialisation. The
AND MENTAL HEALTH NURSING deinstitutionalisation of people with a mental
The first lunatic asylum to operate in Australia was New health condition in the late 1980s saw a move from
South Wales’ Castle Hill Asylum, which opened in 1811. institutionalised care to community-based care, and
Like many asylums of its time, Castle Hill has a dark thus the role and expertise of the psychiatric nurse
history. Treatment of mental illness did not usually serve also adapted (Happell, 2007).
as part of the purpose of such asylums, and if it did,
many ‘treatments’ were both inhumane and barbaric Mental health nursing history and education
when they were instituted in similar asylums in Europe. The history of psychiatry, or mental health as it is
A vast majority of the treatments of mental illness were now referred to, has had a considerable impact on
experimental, and often formed the basis of a speculated the development of nursing practice. The history
theory. The purpose of these institutions was to contain of (psychiatric) mental health nursing differs
the uncontainable – to control the uncontrollable. significantly from that of other branches of nursing
This included restricting (or preventing) access to the (Happell, 2007), where the influence of iconic figures
community (and thus eliminating perceived threats), as such as Florence Nightingale and Lucy Osborne on
well as cohabitation of prisoners, those suffering dissolute the development of nursing services in the Colonies
or intemperate habits (such as alcoholism or sexual is clear and has been extensively documented
promiscuity) and intellectually disabled individuals. (Bessant, 1999). Prior to the establishment of the
The gold rush of the 1850s resulted in both an first asylums in Australia, individuals with a mental
influx of migrants and serious increases in mental health condition were confined to jails or cared for
illness exacerbated by the use of alcohol and drugs privately. There was no distinction between those
such as opium. By the 1880s, more than 3% of individuals experiencing mental illness and those
Australia’s population were identified as lunatics (this who were intellectually disabled (Happell, 2007). Jails
figure was more than three times higher than just 30 were always custodial rather than treatment oriented,
years prior) and services were ill-equipped to manage so incarceration of individuals with a mental health
them. As a result, between 1811 and 1912 close to 30 condition was obviously ineffective.
asylums were opened across Australia. Despite this, The introduction of the first Australian asylum
it seemed nothing could keep up with the influx of at Castle Hill in 1811 failed to provide a feasible
those afflicted with ‘diseases of the soul’, and most alternative to existing options in the lives of the
asylums filled beyond capacity quickly, adding to the mentally ill. Although the philosophy underpinning
despair inhabitants were already experiencing. care was based on humane treatment, the day-to-day
While the personal tolls of drugs and alcohol reality of caring for patients was primarily about
provide a justifiable rationale for the increases in people containment. While this could partly be a
committed to asylums across Australia, they are not the consequence of the overcrowded conditions at Castle
only cause. In fact, a more sinister reason exists. Being Hill (Curry, 1989), it also reflected the prevailing
committed to an asylum was a seemingly easy task if you attitude that mental illness was incurable (Sands,
were a woman, married to a man who wanted to be rid 2009). The people who managed and cared for
of you. Getting out of such a facility was much harder (or individuals with a mental health condition were
seemingly impossible), and given the penchant for men referred to as ‘attendants’ and their work came under
the control of the medical profession in Australia and nurses by medical staff and a three-year training
at the same time that the first legislation relating to program approved by the relevant health authority in
CHAPTER 1
mental health was enacted through the 1843 Lunacy Victoria was introduced. However, this qualification
Act (Curry, 1989). Prior to this, the first superintendent was not recognised outside of Victoria, and nurses and
had been a layperson, whose approach to the care attendants were not registered with the Nurses’ Board
of individuals with a mental health condition was of Victoria (Reischel, 1974).
focused on using psychosocial care as a means for Modern mental health nursing education
managing their behaviour. commenced in the mid-twentieth century (Reischel,
The ideological conflict between proponents of 2001); for example, recognised education and
such models of care and those who supported medical registration as psychiatric nurses commenced in
approaches to treatment ‘based in neurophysiology Victoria with the passing of the Victorian Nurses Act
and neuropathology’ (Curry, 1989, p. 10) contributed 1958 (Reischel, 1974). Parallel with these developments,
to the establishment of the Select Committee on the statements regarding changes to health care delivery
Lunatic Asylum, Tarban Creek in 1846. The findings of generally, and mental health care in particular, were
this committee enabled medical practitioners to assume also being reported. Holland (1978, p. 16) stated that
the responsibility for governance and treatment. This ‘A greater emphasis was emerging on health services
development meant that the lay superintendent was outside institutions such as hospitals’. Since this time,
demoted to the position of senior warden. Curry (1989) nursing education in all disciplines has come under the
argues that this arrangement established the medical control of nursing bodies such as the Nursing Board of
and nursing systems for the asylums and was copied Victoria and, in contemporary times, the Nursing and
everywhere throughout the colonies. Midwifery Board of Australia. This organisation sets the
The first facility for individuals with a mental requirements for accreditation of educational programs
health condition in Victoria was established in 1848 and defines the standards for nursing (and midwifery)
and was proclaimed a ward of the NSW asylum at practice. The development of the treatments for mental
Tarban Creek. It became locally known as the Merri health disorders throughout history is dealt with in
Creek Lunatic Asylum. Following separation from more detail in the following section.
New South Wales, it became known as the Yarra Bend
Lunatic Asylum (Reischel, 2001). The first evidence of
education for ‘mental nurses’ in Victoria was noted CULTURAL CONSIDERATIONS
in the Annual Report for 1887 of the Kew asylum in
Victoria (Reischel, 1974). This was the beginning of a Mental illness and European settlement of Australia
formal training system for staff in asylums. Reischel Prior to the settlement of Europeans in Australia, mental
(2001) observes that lectures were provided by medical illness was almost unheard of in Aboriginal and Torres
staff who also oversaw and controlled the educative Strait Islander cultures. With the colonisation of Australia
process. In 1902, a number of general trained nurses came disease and the introduction of many substances
were employed at the Kew asylum and several trained previously unknown to Indigenous cultures (such as
and untrained female nurses were employed in the alcohol). Since European settlement, rates of mental
main male ward (Reischel, 1974). This was the first health challenges in Aboriginal and Torres Strait Islander
recorded occasion of female staff being involved in the people have increased to an extent that significantly
care of individuals with a mental health condition. passes the rates of mental health conditions among non-
Women were specifically referred to as nurses now, Indigenous Australians. Currently, rates of psychological
defining them differently from their male colleagues distress among Indigenous Australians are more than
who were known as attendants (Reischel, 1974). twice those of non-Indigenous Australians (ABS, 2011).
Education continued to be provided to attendants
CASE STUDY
PENNY’S ‘CALLING’
I completed my nurse training in the 1970s, back when nurses so long that I have been fortunate enough to see the amazing
trained in a hospital and also lived there too. I guess I sort of progression of mental health care, to even play a part in this...
‘fell’ into mental health. I did a rotation in the psychiatric ward things weren’t always great in mental health when I first
and the nurse manager pulled me aside and told me I would started, but we were doing the best we could with what we
be a good addition to their staff, and I haven’t really looked knew. I really believe I was able to help many of my patients
back since. I certainly haven’t regretted it. I’ve been nursing even in the early days where medications were limited and
care was almost custodial. It didn’t feel like that at the time nurse? Don’t disregard mental health nursing… maybe it’s
SECTION 1
though. We thought we were cutting edge! Helping patients your calling too.
and their families has always been my motivation for staying in Penny, registered nurse
mental health nursing. Mental illness is so destructive, and the Question
suffering and pain it causes is immense. To play a part in easing Penny has described the types of transitions that
someone’s distress is my calling. someone who has worked in health care for a long time
I’ve seen deinstitutionalisation firsthand, and the will encounter. Her experience of change was welcomed
benefits and challenges that this created. One of the big and she was able to embrace it. Not everyone embraces
changes in my career was the move from hospital-based change, however. Consumers in the mental health
training to university-educated nursing. I remember system also experience great adjustments during times
there was a lot of resistance from some nurses when this of hospitalisation, diagnosis and treatment, and may be
happened. But I embraced it; change is inevitable, and resistant to such change. How do you think you can support
I have had the firsthand experience of seeing a student someone experiencing change?
realise their ‘calling’. What advice would I give a student
TREATMENTS THROUGHOUT HISTORY Recovery-oriented models of practice now place the

person with a lived experience of a mental health
The term ‘consumer’ is used to describe a person who condition at the centre of their care. It is understood that
identifies as having a lived experience of a mental health they are the experts on their lives. This, however was
condition (Fuller Torrey, 2011). This experience may not always the case, and while consumers today have
be past or current. The term consumer is preferred to a central voice in how they are treated, patients of the
‘patient’, and throughout this book, you will see this past were exposed to brutal and barbaric ‘treatments’.
term used frequently, and interchanged with other Some earlier treatments focused on Hippocrates’ belief
terms such as ‘individual’ or ‘person’. Consumers of in the four ‘humours’ (blood, yellow bile, black bile and
today are afforded a range of management options phlegm) and their imbalance as a precursor for all types
such as medication and talking therapies that have of illness, including psychiatric illness. Table 1.1 outlines
benefited from extensive testing prior to their use in many of the treatments for mental illness throughout
human populations, and this is a strictly regimented history.
requirement of pharmaceutical companies.
TABLE 1.1
Timeline of treatment of mental disorders through history
TREATMENT TIME OR ERA PERCEIVED BENEFITS
Trephination – the drilling of a small hole into the skull 8000 BCE to 600 It was believed that this process would allow evil spirits to
BCE exit the mind.
Fumigation of vagina – alleged to encourage the vagina to Ancient Egyptian Fumigation of the vagina was thought to cure a ‘wandering
realign to its correct positioning and Greek uterus’, which was commonly associated with hysteria in
women.
Imbalance of humours – use of leeches, laxatives and Middle Ages This process purged the individual of melancholy and
substances to induce vomiting rebalanced their ‘humours’.
Bloodletting or scarification – of brain, rectum, large leg Middle Ages It was believed that this resulted in the drawing away of
veins poison from the brain.
Flogging – beating, sometimes in public Middle Ages People believed that poor behaviour could be ‘beaten’ out of
the person.
Freezing or scalding – being immersed in hot or cold Middle Ages This process was believed to shock the person back to sanity.
water, or throwing it at the individual
Gyrating chair – a chair that spun around widely until the Mid-1700s The spinning and gyrating was believed to result in mixing
strapped patient lost consciousness (see Figure 1.5) blood and tissues and re-establishing balance.
Straight jacket – a confining garment where the patient’s 1700s Deemed to be a ‘humane’ treatment for a patient who needed
arms were strapped securely across their body to be restrained, as it permitted the individual to move about
freely (from waist down) while preventing them from harming
themself and others.
TREATMENT TIME OR ERA PERCEIVED BENEFITS
CHAPTER 1
Tranquillising chair – a movement-restricting chair that Late 1700s Used the premise that agitation was a form of inflammation
included a box held over the person’s head to keep them of the brain, exacerbated by movement. By preventing
immobile movement, the inflammation would diminish and the madness
would be cured.
Rotary chair – a chair that turned on its axis and was 1850s The chair resulted in feelings of terror, nausea, a sense of
propelled at high velocity, resulting in fright and painful suffocation and distress and some believed that it would
cranial pressure restore balance in the brain.
Utica crib – a fully enclosed ‘cot’ or crib where the opening 1860s Resulted in containment and some perceived therapeutic
was also sealed with bars calming benefits.
Shock treatments: 1920s to 1950s Insulin shock was believed to effectively treat schizophrenia
Insulin – large doses of insulin injected over a period of and the resulting coma and seizures were believed to reset
weeks resulting in coma the brain.
Fever – malaria was injected into the patient to induce fever It was believed that a severe episode of fever could restore a
previously insane person, to calm and sanity.
Medicine – induced seizures Seizures were induced with a variety of medicines (including
metrazol) in persons with schizophrenia as it was falsely
believed that schizophrenia and epilepsy could not coexist.
Lobotomy – prefrontal lobe lobotomy is a surgical 1935 Usually reserved for those experiencing depression (and
intervention that severs the pathways between frontal lobes schizophrenia), the lobotomy was a highly invasive procedure
and lower regions of the brain. The physician would often that rendered the individual calm and compliant, and more
gain access to the brain via the tear duct of the eye, or frequently cognitively impaired. It was often used on patients
through the nose who were violent, highly emotive and deemed too difficult to
manage.
SOURCE: ADAPTED FROM VALENSTEIN, 2010
In the mid- twentieth century, the emergence of

psychotropic medication resulted in a revolution in
both the treatment and care of persons with a mental
health condition, and in part helped facilitate the
eventual deinstitutionalisation of people with a lived
experience in the late 1980s. Table 1.2 outlines the
emergence of psychotropic medications in psychiatry.
TABLE 1.2
Timeline of psychotropic medications
YEAR MEDICATION USES
1952 Chlorpromazine (typical First antipsychotic used to
antipsychotic) treat schizophrenia
SOURCE: SCIENCE PHOTO LIBRARY
1952 Lithium Bipolar disorder

Early 1950s Monoamine oxidase Depression
inhibitors (MAOIs)
1958 Haloperidol (typical Schizophrenia
FIGURE 1.5 antipsychotic)
Dr Herman Boerhaave’s gyrating chair 1958 Tricyclic antidepressants Depression
1960s Benzodiazepines Anxiolytics and hypnotics
In the late eighteenth century, conditions began to
1970s Clozapine (atypical Treatment-resistive or
improve in many asylums. Treatments became more
antipsychotic) refractory schizophrenia
focused on improving mental illness through humane
1990s Atypical antipsychotics Schizophrenia and mania
treatment, fresh air and interaction. A number of talk
therapies were developed in an effort to explore an 2000+ Novel agents Schizophrenia and mania
individual’s past experiences and consider the impact
of these experiences on the person’s current mental While the history of mental illness may make some
health. Pioneers of modern psychiatry included believe that psychiatrists and nurses were motivated
physicians such as Sigmund Freud and Carl Jung. by experimenting on and hurting vulnerable people,
the vast majority were working in a field that was et al., 2006). Some of the perceptions of nursing
highly criticised and even stigmatised by the medical include:
SECTION 1
profession as a whole. With the benefit of hindsight, ■■ nurses are less powerful, and they are dependent
we can now see how destructive many practices on medical officers

were; however, at the time it is likely that people ■■ it is a ‘good’ career choice for women
were motivated to help ease suffering and improve ■■ it is an occupation that requires patience, virtue
people’s lives. The next section explores the role of and physical strength
contemporary mental health nurses. ■■ nurses are self-sacrificing
■■ it is a low-status career.
Some researchers have hypothesised that these

THE ROLE AND IDENTITY OF social perceptions, media representations and
THE MENTAL HEALTH NURSE IN professional attitudes converge and stigmatise the role
of mental health nurses through a negative association
CONTEMPORARY SERVICE DELIVERY with mental health (Halter, 2002).
Mental health nurses play a central role as clinicians, Discussion about the role of the mental health nurse
case managers, clinical nurse specialists and nurse is not new. Sheehan’s (1998) study reported on the role
practitioners in mental health care settings. They and rewards of asylum attendants at a West Yorkshire,
are increasingly involved in a range of psychosocial England, asylum from 1852 to 1889. Defining their role
interventions and work within recovery-based models as the list of functions an individual performs, Sheehan
of care with consumers and carers. identifies those specific tasks that were prescribed for
Interventions include the development and attendants. These functions included qualities such
implementation of psychosocial therapies for as kindness, gentleness and firmness. Attendants were
psychological distress, consumer participation in expected to promote the safety, comfort and recovery
the development, implementation and evaluation of patients and every effort was to be made to secure
of mental health services, and the development and the goodwill of the patient and friendship. Physical care
coordination of aggression management programs was to be provided through maintaining good hygiene
in acute inpatient facilities (Sinclair et al., 2007). and good nutrition. There was also a large emphasis
Recently, mental health nurses have also renewed on preventing the patient from absconding (running
their skills in the more traditional areas of medication away).
administration and education (Hemingway, 2004, Table 1.3 charts the degree to which the role
2005; Hemingway et al., 2008). In 2001, the World expectations of the nineteenth-century mental health
Health Organization (WHO) stated that nurses, as nurse identified in Sheehan’s study are similar to
part of the multidisciplinary team, are especially current ideas about the role of the mental health
relevant in the management of mental illness nurse in contemporary scholarly literature. Some
(WHO, 2001). immediate comparisons can be seen in concepts such
Furthermore, population health approaches have as the therapeutic relationship, therapeutic use of self,
identified that mental health nurses take up the bulk therapeutic milieu, professional boundaries and risk
of the work with consumers in both community and assessment.
inpatient settings (Raphael, 2000). This is verified by
moves towards expanded practice roles for mental TABLE 1.3
health nurses, particularly in the area of community Comparison between historical and contemporary roles of the mental
health nurse
mental health, which have occurred over the past
decade (Elsom, Happell & Manias, 2005, 2007, 2009). HISTORICAL ROLE DEFINITION
It is informative to consider how the role of the PERIOD
mental health nurse has evolved historically in line Role of the attendant • Kindness, gentleness and firmness
with the development of care and treatment options 1852–89 (Sheehan, • Securing the goodwill of the patient and
for consumers and carers, as well as changes in public 1998) friendship
• Maintaining safety and comfort
expectations of the role of the mental health nurse.
• Prevent patient from absconding
According to numerous authors, the public does hold • Physical care/nutrition/hygiene
perceptions about who nurses are and what they do
Contemporary role • Limit setting and boundaries
(see Aber & Hawkins, 1992; Bridges, 1990; Brodie
functions (Crowe & • Therapeutic relationship/therapeutic use
et al., 2004; Fiedler, 1998; Gordon, 2001; Gordon & Carlyle, 2003; Hewitt, of self
Johnson, 2004; Kalisch, Kalisch & McHugh, 1980; 2009; Scanlon, 2006) • Therapeutic milieu
Takase, Maude & Manias, 2006). This holds true • Risk assessment/supervision
also – although to a lesser degree – for mental health • Support activities of daily living
nurses (Kalisch & Kalisch, 1981; Rungapadiachy SOURCE: ADAPTED FROM CROWE & CARLYLE, 2003; HEWITT, 2009; SCANLON, 2006; SHEEHAN, 1998.
Contemporary debates on the professional on the identified needs of the individual consumer
through partnership and collaboration.
roles and identity of the mental health nurse
CHAPTER 1
Hildegard Peplau (1962), considered by many to
One debate that surrounds the knowledge and skills
be the founder of modern mental health nursing,
required for mental health nurses to carry out their
viewed mental health nursing as an interpersonal
role is centred on whether mental health nurses work
and interactive process between the nurse and
within a biomedical or an interpersonal framework
consumer. She described the nurse–consumer
(Barker et al., 1997; Gournay, 1995; Peplau, 1962).
relationship as being the crux of mental health
Both of these approaches are explored in Chapter 2.
nursing. Through this relationship the nurse uses
The biomedical approach emphasises the diagnosis
him/herself as the therapeutic facilitator of growth
of an illness based on a set of signs and symptoms.
and development within collaborative engagement;
Treatment is focused on removing or at least
that is, the nurse engages with consumers through
reducing these signs and symptoms. Mental health
a variety of psychosocial interventions to facilitate
nursing practice is located in the administration of
personal growth on the part of the consumer. Peplau
medications, education and symptom management.
(1962) also proposed the therapeutic relationship
The interpersonal approach views the relationship
passed through several phases that evolved from the
that develops between the nurse and consumer as
initial contact through to discharge. These phases are
the central feature of mental health nursing. It is
the orientation, working and resolution (Forchuk,
through this relationship that the mental health
1994) and it is during each of these phases that the
nurse uses the therapeutic process to facilitate the
nurse will take on various roles in response to the
consumer’s change and growth and interventions are
emerging and identified needs of the consumer.
usually psychosocial rather than medicalised. The key
These roles involve various strategies such as
questions are whether it is possible or even desirable
risk assessment, therapeutic engagement or support
to separate these two approaches to practice, or
with activities of daily living and promoting
whether it is necessary to understand the role of
healthy lifestyles. Research also highlights the
the mental health nurses as encompassing both
importance that consumers place on the therapeutic
approaches.
relationship, with communication, trust and respect
Some researchers argue that describing the role
being highly valued. Having time to develop positive
of the mental health nurse is difficult. This difficulty
relations, not holding stigmatising views and being
lies in part with what is referred to as the ‘invisibility’
non-judgemental, assisting consumers to find the
of the core skills of mental health nursing; that is,
balance between independence and the need for
the nurse–consumer relationship rather than the
support are examples of ways in which the role of
execution of specific technical skills (Bray, 1999;
the mental health nurse is enacted (Gilburt, Rose &
Forchuk, 1994; Hamilton & Manias, 2007; O’Brien,
Slade, 2008; Johansson & Eklund, 2003). We consider
1999; Peplau, 1962; Welch, 2005). Hamilton and
the therapeutic relationship in depth in Chapter 5,
Manias (2007) believe that the invisibility of mental
and learn more about Peplau’s ideas in Chapter 2.
health nursing interventions, such as focused
observation, has negative consequences for the The role of the mental health nurse and
capacity for mental health nurses to describe their professional identity
role. When a person asks you, ‘What do you do for a
How do mental health nurses understand and living?’, you may say, ‘I am a student nurse’, ‘I
explain their role? Work by Hercelinskyj et al. (2014) am a parent’ or ‘I work part time at a chemist’.
shows that mental health nurses do not define their Explaining what you do as a student nurse usually
role in one particular way. Mental health nurses work will be described in terms of where you study, what
in increasingly diverse roles and clinical contexts that is expected of you, the specific tasks or functions
enable them to engage according to the needs of the you have to fulfil, who you study with and perhaps
consumers with whom they work. The role of the examples of what you are currently doing. What you
mental health nurse is seen through the therapeutic are actually describing is your role. It is this process
relationship they engage in with consumers. Mental that is part of establishing your professional identity
health nursing practice is grounded in the structures as an emerging nurse. The ‘Evidence-based practice’
of knowledge and skills through which nurses provide box details some further ideas around the concept of
a supportive, empowering and recovery-oriented professional identity in mental health nursing.
environment. The degree of support given is based
EVIDENCE-BASED PRACTICE
SECTION 1
Professional identity in mental health nursing Results

Title of study Three main themes emerged from the data. These were
Perceptions from the front line: Professional identity in the challenges to the role of the mental health nurse, the
mental health nursing challenges in attracting the next generation of mental health
nurses and describing their work to others.
Authors
Gylo Hercelinskyj, Mary Cruickshank, Peter Brown and Brian Conclusions
Phillips The role of the mental health nurse is multifaceted,
reflecting the diversity of clinical practice in contemporary
Background society and the diverse needs of consumers. Professional
In the context of a growing population of people identity is contextualised within the primacy of the
experiencing mental illness worldwide, mental health nurses therapeutic relationship.
are a crucial workforce. This paper explored experienced
mental health nurses’ perceptions of their role and the Implications
impact on their professional identity. In order to recruit and retain nurses in mental health, it is
essential to develop strategies that promote mental health
Design nursing as a discipline with a distinctive role in the delivery
This naturalistic study used a qualitative explorative descriptive of mental health services.
design to explore participants’ understanding of their role as SOURCE: HERCELINSKYJ, G., CRUICKSHANK, M., BROWN, P. & PHILLIPS, B. (2014).
mental health nurses and the impact of this on their professional PERCEPTIONS FROM THE FRONT LINE: PROFESSIONAL IDENTITY IN MENTAL HEALTH NURSING.
INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, 23(1), 24–32. DOI:10.1111/INM.12001
identity within the theoretical framework of role theory.
Participants
Eleven participants were interviewed using semi-structured
interviews.
REFLECTION ON LEARNING FROM PRACTICE

As JD reflected at the beginning of this chapter, it can be The history of mental health (psychiatry) is replete
challenging to accurately and clearly represent the role with stories of ignorance and inhumane treatment. But
of the mental health nurse to people who have little to no this chapter also highlights the way in which mental health
understanding of mental health and mental illness generally, nursing education and practice has evolved and represents
or who are only familiar with the images and stories of mental new and diverse methods of practice. In the chapters
health practice from past years. JD’s own journey illustrates the that follow, we explore in greater detail how nurses
level of invisibility that mental health has and the narrow view contribute to and collaborate with consumers, carers and
that people have of the type of work that nurses undertake, and the multidisciplinary team in the delivery of contemporary
what even constitutes proper nursing work. mental health care.
CHAPTER RESOURCES
SUMMARY
■■ Historically humankind has attributed many adversities to ■■ Changes to nursing education and practice coincided with
supernatural origins. However, with the benefit of hindsight, changes to the understanding of mental illness and its
we can safely assume that many of these experiences lay in subsequent treatment.
mental illness. ■■ As future nurses, we need to ensure that we practise in an
■■ Asylums were erected in response to a need to contain and evidence-based environment and that this information is
segregate people with mental illness, rather than treat them. applied to our practice rigorously.
■■ The history of mental health nursing in Australian is closely
linked to the development of psychiatry as a discipline.
Education was historically controlled by medicine.
REVIEW QUESTIONS
CHAPTER 1
1 How accurate do you believe the public perceptions of services and improvements for consumers. Describe the
mental health nursing are? Discuss the factors that might many different benefits of moving from institutionalised
contribute to these perceptions. care.
2 What do you consider to be the key attributes and qualities 4 How does the role of the mental health nurse differ from
of a mental health nurse? other disciplines of nursing?
3 The deinstitutionalisation of mental health facilities in the 5 How would you explain the role of the mental health nurse
1990s in Australia has seen major changes to mental health to a fellow student?
CRITICAL THINKING
1 How has the education of nurses changed during the 2 You are currently attending a clinical learning placement at
past 30 years? What impact do you believe this has had a mental health facility. How would you describe the role
on mental health nursing? of the mental health nurse to a friend who is not studying
nursing?
USEFUL WEBSITES
■■ Australian College of Mental Health Nurses: ■■ History of Psychiatry: http://journals.sagepub.com/home/hpy
http://www.acmhn.org
SEARCH ME! NURSING

Expand your knowledge with Search me! nursing. Fast and Key terms
convenient, this resource provides you with 24-hour access ■■ Mental health nursing education
to full-text articles from hundreds of scholarly and popular ■■ Professional identity
journals and newspapers, including The Australian and The Keyword activities
New York Times. Search me! allows you to explore topics Read the article, ‘Let the buyer beware! Loss of professional
further and find current references. identity in mental health nursing’ (Happell, 2014).
For access, go to http://login.cengagebrain.com.au and 1 What contributions have mental health nurses made to
follow the instructions provided on the printed access card mental health service delivery?
from the front of this textbook. 2 Why is it essential to consider how identity impacts on the
The following key terms and activity questions can be used role of mental health nurses in service delivery?
for additional research. 3 Use the key term to find additional journal papers or news
items covering this topic.
REFERENCES
Aber, C.S. & Hawkins, J.W. (1992). Portrayal of nurses in Bray, J. (1999). An ethnographic study of psychiatric nursing. Journal
advertisements in medical and nursing journals. IMAGE Journal of of Psychiatric and Mental Health Nursing, 6(4), 297–305. doi:10.1046/
Nursing Scholarship, 24(4 winter), 289–93. j.1365-2850.1999.00215.x
Arnold, C. (2009). Bedlam, London and Its Mad. London: Simon & Bridges, J.M. (1990). Literature review on the images of the nurse and
Schuster. nursing in the media. Journal of Advanced Nursing, 15(7), 850–4.
Australian Bureau of Statistics (ABS). (2011). 4704.0 – The Health and Brodie, D.A., Andrews, G.J., Andrews, J.P., Thomas, G.B., Wong, J. &
Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples, Rixona, L. (2004). Perceptions of nursing: Confirmation, change and
Oct 2010. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@. the student experience. International Journal of Nursing Studies,
nsf/lookup/4704.0Chapter715Oct+2010. 41(7), 721–33.
Barker, P.J., Reynolds, W. & Stevenson, C. (1997). The human science Craig, L.A. (2014). The history of madness and mental illness in the Middle
basis of psychiatric nursing: Theory and practice. Journal of Ages: Directions and questions. History Compass, 12(9), 729–44.
Advanced Nursing, 25(4), 660–7. Crowe, M. & Carlyle, D. (2003). Deconstructing risk assessment
Bessant, B. (1999). Milestones in Australian Nursing. Collegian, 6(4), and management in mental health nursing. Journal of Advanced
suppl. 1–3. Nursing, 43(1), 19–27.
Curry, G. (1989). The Select Committee on the Lunatic Asylum, Tarban health nursing. International Journal of Mental Health Nursing,
Creek, 1846: The Medicalisation of Mental Nursing in NSW. 23(1), 24–32. doi:10.1111/inm.12001
SECTION 1
Lindfield: Kuring-gai College of Advanced Education. Hewitt, J. (2009). Redressing the balance in mental health nursing
Elmer, P. (2016). Witchcraft, witch-hunting, and politics in early education: Arguments for a values-based approach. International
modern England. Oxford Scholarship Online. doi:10.1093/ Journal of Mental Health Nursing, 18(5), 368–79.
acprof:oso/9780198717720.001.0001. Holland, J. (1978). New health body to take over. The Age, 6 December.
Elsom, S., Happell, B. & Manias, E. (2005). Mental health nurse Retrieved from Google News.
practitioner: Expanded or advanced. International Journal of Mental Johansson, H. & Eklund, M. (2003). Patients’ opinion on what
Health Nursing, 14(3), 18–186. constitutes good psychiatric care. Scandinavian Journal of Caring
Elsom, S., Happell, B. & Manias, E. (2007). Exploring the advanced Science, 17, 339–46. Retrieved from http://web.ebscohost.com.
practice roles of community mental health nurses. Issues in Mental ezproxy-m.deakin.edu.au/ehost/pdf?vid=3&hid=7&sid=0d5a034d-
Health Nursing, 28(4), 413–29. d286-4358-885b-67dcfe6b61fc%40sessionmgr2.
Elsom, S., Happell, B. & Manias, E. (2009). Australian mental health Kalisch, B.J., Kalisch, P.A. & McHugh, M. (1980). Content analysis
nurses’ attitudes to role expansion. Perspectives in Psychiatric of film stereotypes of nurses. International Journal of Women’s
Care, 45(2), 100–7. Studies, 3(6) 531–58.
Fiedler, L.A. (1998). Images of the nurse in fiction and popular culture. Kalisch, P. & Kalisch, B.J. (1981). The image of psychiatric nurses
In A.H. Jones (ed.), Images of Nurses, Perspectives from History, Art in motion pictures. Perspectives in Psychiatric Care, XIX(3 & 4),
and Literature. Philadelphia, PA: University of Pennsylvania Press. 116–24.
Fontaine, M. (2013). On being sane in an insane place – the Rosenhan Maude, P. (2002). Historians overlook the role of nurses. Mental Health
experiment in the laboratory of Plautus’ Epidamnus. Current Practice, 6(4), 5.
Psychology, 32(4), 348–65. McNamara, P. (2011). Spirit Possession and Exorcism: History,
Forchuk, C. (1994). The orientation phase of the nurse–client Psychology, and Neurobiology: Mental States and the Phenomenon
relationship: Testing Peplau’s theory. Journal of Advanced Nursing, of Possession. Westport, CT: Greenwood Publishing Group.
20(3), 532–7. New South Wales Health. (n.d.). The Lunatic Asylums. Retrieved from
Fuller Torrey, E. (2011). Patients, clients, consumers, survivors et al: http://www.health.nsw.gov.au/about/history/Publications/h-asylums.
What’s in a name? Schizophrenia Bulletin, 31(3), 466–8. doi:10.1093/ pdf.
schbul/sbq102 Nolan, P. (1993). A History of Mental Health Nursing. London: Chapman
Gilburt, H., Rose, D. & Slade, M. (2008). The importance of relationships & Hall.
in mental health care. A qualitative study of service users’ O’Brien, A.J. (1999). Negotiating the relationship: Mental health nurses’
experiences of psychiatric hospital admission in the UK. BMC perceptions of their practice. Australian and New Zealand Journal
Health Services Research, 8(92). Retrieved from http://www. of Mental Health Nursing, 8(4), 153–61.
biomedcentral.com/1472-6963/8/92. Peplau, H.E. (1962). Interpersonal techniques: The crux of psychiatric
Gordon, S. (2001). Nurses speaking out about what they do. Australian nursing. American Journal of Nursing, 62(6), 50–4.
Nursing Journal, 9(3), 46–7. Reischel, H.J. (1974). Nurse education in mental health, Victoria past,
Gordon, S. & Johnson, R. (2004). How Hollywood portrays nurses. present and future. UNA Nursing Journal, 72(2), 14–17.
Report from the front row. Revolution, March–April, 15–21. Reischel, H.J. (2001). The Care that Was. Ebookland/Zeus Publications.
Gournay, K. (1995). Training and education in mental health nursing. Rungapadiachy, D.M., Madill, A. & Gough, B. (2006). How newly
Mental Health Nursing, 15(6), 12–15. qualified mental health nurses perceive their role. Journal of
Hamilton, B.E. & Manias, E. (2007). Rethinking nurses’ observations: Psychiatric and Mental Health Nursing, 13(5), 533–42. doi:10.1111/
Psychiatric nursing skills and invisibility in an acute inpatient j.1365-2850.2006.00976.x
setting. Social Science and Medicine, 65(2), 331–43. Retrieved from Sands, N. (2009). Round the bend: A brief history of mental health
ScienceDirect Database. nursing in Victoria, Australia 1848 to 1950s. Issues in Mental Health
Happell, B. (2007). Appreciating the importance of history: A brief Nursing, 30(6), 364–71.
historical overview of mental health, mental health nursing and Scanlon, A. (2006). Psychiatric nurses’ perceptions of the constituents
education in Australia. International Journal of Psychiatric Nursing of the therapeutic relationship: A grounded theory study. Journal of
Research, 12(2), 1439–45. Psychiatric and Mental Health Nursing, 13, 319–29.
Happell, B. (2014). Let the buyer beware! Loss of professional identity Sheehan, J. (1998). The role and rewards of asylum attendants in
in mental health nursing. International Journal of Mental Health Victorian England. International History of Nursing Journal, 3(4),
Nursing, 23(2), 99–100 25–33.
Hemingway, S. (2004). The mental health nurse’s perspective on Sinclair, E., Townsend, J., Keith, R., Hazelton, M. & Constable, J. (2007).
implementing nurse prescribing. Nurse Prescribing, 2(1), 37–44. Development, implementation and evaluation of a nursing delivered
Hemingway, S. (2005). An emerging picture of mental health nurses as psychosocial intervention for psychological disease. Paper
non-medical prescribers. Nurse Prescribing, 3(6), 257–62. presented at the Nursing Innovations Showcase. NSW Department
Hemingway, S., White, J., Turner, J., Maginnis, R. & Gray, J. (2008). of Health: Nursing and Midwifery Office.
Medicines with respect. Collaboratively establishing the art and Takase, M., Maude, P. & Manias, E. (2006b). Role discrepancy: Is it a
science of medicines administration. International Journal of common problem among nurses? Journal of Advanced Nursing,
Mental Health Nursing, 17, suppl. 1(A14). 54(6), 751–9.
Hercelinskyj, G., Cruickshank, M., Brown, P. & Phillips, B. (2014). Toy, M. (2014). Victorian psychiatric patients’ grim fate in hellish
Perceptions from the front line: Professional identity in mental 1800s hospitals. Herald Sun, 9 December. Retrieved from https://
www.heraldsun.com.au/news/victoria/victorian-psychiatric- World Health Organization (WHO). (2001). The World Health Report
patients-grim-fate-in-hellish-1800s-hospitals/news-story/ 2001: Mental Health – New Understanding, New Hope. Geneva:
CHAPTER 1
c7928ebe8a9f527a941cce86e0990fef. WHO. Retrieved from http://www.who.int/whr/2001/en/whr01_
Valenstein, E.S. (2010). Great and Desperate Cures: The Rise and en.pdf.
Decline of Psychosurgery and Other Radical Treatments for Mental Zacks, R. (1994). History Laid Bare: Love, Sex and Perversity
Illness. New York: Basic Books. from the Ancient Etruscans to Warren G. Harding. New York:
Welch, M. (2005). Pivotal moments in the therapeutic relationship. HarperPerennial.
International Journal of Mental Health Nursing, 14, 161–5.
Wikipedia. (2017). List of psychiatric hospitals in Australia. Retrieved
from https://en.wikipedia.org/wiki/List_of_Australian_psychiatric_
institutions.
CHAPTER
2
THEORETICAL FRAMEWORKS UNDERPINNING
PRACTICE
LEARNING OUTCOMES
Upon completion of this chapter, you should be able to:
2.1 Define the terms health, mental health, human behaviour and personality
2.2 Describe biomedical theories of personality, their application and relevance to mental health nursing
2.3 Describe psychodynamic theories of personality, their application and relevance to mental health nursing
2.4 Describe behavioural/social cognitive theories of personality, their application and relevance to mental
health nursing practice and some of the major critiques of these theories
2.5 Describe humanistic theories of personality, their application and relevance to mental health nursing
2.6 Describe how nursing theorists have drawn from psychological and sociological theorists to understand
human behaviour and how this influences the role of the mental health nurse
2.7 Reflect on which psychological and/or nursing theories would be relevant to your nursing practice
LEARNING FROM PRACTICE

Shelley is a 21-year old woman who lives at home with At the end of the second visit, a registered nurse
her mother. Shelley has been admitted for the first time to approached Rose as she was leaving the unit. Indicating
the inpatient unit at the local acute inpatient mental health that she was concerned that Rose appears uncomfortable
facility. Shelley’s first 36 hours in the unit were unsettled while in the unit and that she was very happy to answer any
as she was extremely suspicious of the nursing staff and questions Rose may have, Rose’s whole body appeared to
resisted efforts by nurses to engage with her. Shelley did not stiffen and with a trembling voice she replied, ‘Why would
believe she needed to be in hospital and became extremely you care, my daughter is lost to me and places like this don’t
agitated when staff attempted to administer prescribed help. I know what these places are like and the sooner she
medication, saying that everyone was trying to poison her is out of here the better for her!’
‘because she knew too much’. Shelley’s mother Rose has
been in twice to visit her. Nursing staff have asked several Following Rose’s abrupt departure, the registered nurse
times to make a time to meet with Rose to discuss Shelley’s considered this interaction. What emotions, feelings and
progress and obtain additional information regarding the experiences could be behind Rose’s response? How could
circumstances leading to Shelley’s admission. On both an understanding of psychological theories assist the team
occasions, staff have observed that Rose avoids eye contact to work collaboratively with Rose and Shelley?
with them, says very little to Shelley and seems ill at ease in
the environment.
16
T he o ret i ca l f ra m e w o r k s u n d erp i n n i n g pract i ce 17
INTRODUCTION factors that impact health in general and mental

health specifically. This critique is important to
CHAPTER 2
This chapter explores the theoretical frameworks framing our understanding of what constitutes mental
common within nursing practice. Such theoretical health and mental illness.
frameworks permit the nurse to provide care that What makes a person mentally healthy? Frisch and
is evidence-based and provide a sound base that Frisch (2006) believe there is no clear single definition
guides the nurse’s practice and reflection. Working of mental health. While this might be so, we make
collaboratively with consumers and carers requires judgements about a person’s mental health from their
mental health nurses to understand: behaviour. Using this framework, characteristics of
■■ how people understand health
mental health might include:
■■ how their understanding of health impacts on
■■ self-determination and autonomy
their health choices and health behaviours. ■■ self-actualising and goal-directed behaviour
There are multiple ways to explain or predict ■■ flexibility and tolerance of uncertainty
personality or human behaviour. For example, perhaps ■■ awareness of strengths and limitations to build
we want to understand why some consumers agree to self-esteem
take regular medications and others will not. Where ■■ ability to maintain relationships and communicate
would we start? There are a variety of ways in which directly with others
to understand this behaviour, and disciplines such as ■■ respect for others
nursing psychology have philosophical assumptions ■■ actions grounded in reality
and focus on different aspects of human existence and ■■ managing stress appropriately
experience (Bernstein, Penner, Clarke-Stewart & Roy, ■■ capacity to meet basic needs (adapted from Frisch &
2012). Theories comprise a range of concepts about Frisch, 2006).
a phenomenon studied within a discipline. They are As can be seen from this list, the process of defining
based upon what has been observed and researched what mental health is and ascribing this term to a
across larger populations. No theory is perfect, but person is far more complex than the WHO’s original
a useful theory will give clinicians a structure that definition. The remainder of this chapter looks at the
enables them to understand people’s behaviour and different ways in which personality development is
health-related decisions and to plan strategies to viewed and how this impacts on mental health.
implement in practice (Bernstein et al., 2018; Burger,
2011; Weiten, 2011). In this chapter, we consider Definitions of personality
foundational ideas regarding health, mental health, Before we explore different theories of personality, it
human behaviour and personality. is important to have a working definition of the term.
When we think of the term ‘personality’, different ideas
HEALTH, MENTAL HEALTH AND come to mind, such as ‘they have a great personality’
or ‘they have a really quirky way of behaving’. People
HUMAN BEHAVIOUR differ in the ways they think, feel and behave – in
The word ‘health’ in its broadest sense holds different short, everyone has a unique personality.
meanings for different people at different times in Personality can be defined as the set of
history, in different cultures, in different social classes cognitions, emotions and feelings that a person brings
or even within the same family. Our understanding of to their interactions with the total environment. It is
health is therefore an evolving and dynamic process. the interaction that will influence the way in which
Traditional definitions of health have tended to an individual thinks, feels and subsequently behaves.
have a biomedical focus where health was viewed as the These patterns of thinking, feeling and behaving in
absence of disease or pathology and health was achieved different circumstances are seen to be consistent or
through the physical process of homeostasis. Illness enduring over time and across situations. This means
was caused by the body being subjected to a range there will be distinct differences in the way people can
of factors (e.g. pathogens such as infections, trauma, respond to the same situation (Burger, 2011; Cervone &
biochemical changes or degenerative processes) that Pervin, 2013; Weiten, 2011).
disrupted homeostasis. The World Health Organization
(WHO) produced a seminal definition of health when
it stated that health was a ‘State of complete physical,
BIOMEDICAL THEORIES OF
mental and social well-being and not merely the absence PERSONALITY
of disease or infirmity’ (WHO, 1946). Any discussion that focuses on understanding
However, these understandings of health fail to personality and its relationship to human behaviour
acknowledge the broader cultural, psychological, would not be complete without a review of what
sociological, political, economic and environmental
18 UND E R P INNINGS OF M E N TA L H E A LT H NU R SING
must be considered the predominant approach to biological model. However, according to Norman
mental health; that is, the identification of mental and Ryrie (2009), it is not possible to classify mental
SECTION 1
illness. health nursing in such a distinct way, because the

The fundamental premise of the biomedical model complexity of mental health nursing means there is a
of health and illness is that behaviour is the result diversity of clinical contexts that mental health nurses
of maintaining an internal (physiological) balance work in and the role of expectations in these areas of
(or equilibrium). Normal behaviour represents practice.
this balance and abnormal behaviour represents a
dysfunction (either pathological or neurological).
A biomedical view of mental health and mental CULTURAL CONSIDERATIONS
illness is fundamentally concerned with providing
a physiological explanation of health, illness and Are Western theoretical perspectives universally
resulting behaviour. Changes can be assessed by a valid?
clinician observing a series of signs and symptoms. As mentioned above, the theoretical perspectives
The clinician then takes this constellation of reviewed in this chapter were developed within a Western
signs and symptoms and classifies them as a context. They also represent the social, economic and
diagnosis. Recovery from mental illness (discussed personal stories of each person who developed the theory.
in greater detail in Chapter 21) traditionally has In today’s culturally diverse world, there is ongoing debate
been conceptualised in terms of the elimination of regarding the utility of such models for people (a one-size-
symptomatology (Nye, 2003). fits-all approach) as opposed to exploring and utilising a
variety of models to best meet the needs of the individual
Relevance of the biomedical orientation to person.
mental health nursing practice
The biomedical orientation to mental health
nursing practice allows clinicians to make sense of
the range of symptoms a consumer can experience PSYCHODYNAMIC THEORIES OF
and their unique response to those signs and
symptoms. Research into mental health and mental
PERSONALITY
illness has paved the way for the development of There can be no discussion of Western models of
specific treatment approaches, particularly in the personality without considering the psychodynamic
area of psychotropic medication. The biomedical approach and in particular the work of Sigmund
model also provides a clear framework for the Freud (1865–1939). Freud produced the first structured
mental health nurse to use when working with and formalised attempt to understand personality
consumers and families, particularly in the area of and human behaviour. While there is intense debate
psychoeducation. regarding the contemporary usefulness of his original
ideas, all subsequent theory development, research
Critique of the biomedical orientation to mental and clinical application has developed from these core
health nursing practice ideas. The core assumption of the psychodynamic
From a Western cultural perspective, the biomedical orientation is that abnormal behaviour reflects
orientation could be seen to be the dominant focus unconscious conflicts within the person.
of clinical practice, research and education in mental Key areas of Freud’s theory relate to the
health service delivery. The outcome has been the psychosexual stages of development (human
advent of drug therapies to treat mental illness. This mind) psyche, the structure of personality and the
focus on the use of drugs has led to the idea that it use of defence mechanisms. We consider Freud’s
is possible to ‘cure’ mental illnesses. One critique of theory and then look at the key neo-Freudians who
the biomedical orientation is that, as the dominant challenged and extended many aspects of Freud’s
(Western) approach to understanding mental theory.
health and illness, it limits the capacity for other
(non-biomedical) interventions or reduces their use to Freud’s theory
an adjunct status at best. Freud (Figure 2.1) believed that all behaviour is
There has been an increasing emphasis on the purposeful. An individual’s behaviour is determined
role of the nurse in the treatment of mental illnesses by irrational forces, unconscious motivations, and
to focus increasingly on areas such as assessment biological and instinctual drives that develop through
and diagnosis, medication-prescribing privileges and various psychosexual stages in the first six years of
educating consumers and carers about mental illnesses life. The childhood of a person was seen as crucial to
that are largely defined by and constructed on the
The notion of drives or instincts was central to

Freud’s ideas. These instinctual drives were Eros, which
CHAPTER 2
was described by Freud as the life drive, and Thanatos,
which referred to the death/aggressive drive people
held. These instincts served to assist the survival and
growth of individuals and were oriented towards
development and creativity. Libido was the term used
to describe an individual’s emotional energy derived
from underlying instinct of Eros.
Libido (emotional energy) is invested in different
parts of a child’s body as they pass through a rigid
developmental stage. These stages were referred to
SOURCE: ALAMY STOCK PHOTO/GL ARCHIVE

by Freud as the psychosexual stages of development.
Table 2.1 provides an overview of the psychosexual
stages of development.
Freud argued that an individual’s psyche
contained all their conscious and unconscious desires
(e.g. wishes, fantasies, fears and intentions). It is
FIGURE 2.1 the capacity of the psyche to maintain a balance
Sigmund Freud (1865–1939) between these conscious and unconscious forces
that determines an individual’s personality. Freud
the development of the adult personality. Abnormal was specifically interested in how the mind (human
behaviour in Freud’s view resulted from anxiety due to psyche), especially the unconscious part of the human
unconscious conflicts. Behaviour was seen as a result mind, is responsible for everyday behaviour.
of unconscious drives and needs and the mechanisms Freud argued that behaviour was dictated by a
developed to satisfy or control them. An individual person’s personality, which was composed of three
must repress or modify these basic drives when they parts (in which the instinctual drives of Eros and
come into conflict with socially developed cultural Thanatos originate). According to Freud, these three
restraints. These mechanisms of control are developed components are distinct yet interrelated.
in early childhood. The id is the original system of personality. At
Freud believed these basic drives within the birth, an individual is all id. The id operates at an
unconscious mind and past psychological events unconscious level, is amoral and is governed by
determined behaviour; that is, his theory of human the pleasure principle in which the individual
personality and behaviour was a deterministic theory. seeks to gratify their desires. These needs and their
This means that events from childhood can determine fulfilment might be in conflict with societal values
adult behaviour. and mores; that is, its aim is to gain pleasure and
TABLE 2.1
Freud’s stages of psychosexual development
STAGE AGE FEATURES
Oral Birth to 18 months Behaviour is governed by the id. The child seeks immediate gratification. This gratification is
achieved through the mouth, lips and tongue.
Anal 18 months to three With the advent of toilet training, children begin to perceive the impact their behaviour has on
years others. For example, praise and rewards for successfully using the toilet and expressions of
disappointment if they wet the bed. It is at this time that children begin to modify their behaviour to
achieve a positive response from others.
Phallic Three to six years In this phase the penis or clitoris becomes the focus of attention of the libido. The Superego also
begins to develop. It is at this stage that all children go through the Oedipus complex whereby
the child represses their desire for the parent of the opposite gender and identifies with the same
sex parent in order to avoid the same gender parent discovering their incestuous feelings towards
the same sex parent. Freud argued that this process enabled children to develop those socially
sanctioned behaviour attributes of male and female and it is also the time during which the
Superego emerges.
Latent Six years to puberty There is little sexual motivation during this stage.
Genital Puberty onwards The focus of the libido is on the adult genital region.
SOURCE: ADAPTED FROM BURGER, 2011; RANA & UPTON, 2013; WEITEN, 2017
avoid pain. The id operates to meet immediate needs from anxiety. Much of our personality is unconscious,
for satisfaction. Think of a baby who is picked up consisting of repressed memories not easily accessed
SECTION 1
by a person wearing brightly coloured glasses or by the ego. So when the ego uses the reality principle,
perhaps a hair accessory. Their immediate response it is attempting to adapt to the real world while still
will be to reach for the object and grab it. This is satisfying the psychic forces of both the id and the
the id in operation. It does not matter to the baby superego.
that the object belongs to someone else or that the
infant may hurt the other person. Freud identified Defence mechanisms
the concept of wish fulfilment to explain how the If, as described earlier, behaviour results from the need
individual meets the needs of the id in a socially to satisfy or modify needs, then it becomes easier to
acceptable way. The instinctual drives of Eros and see how behaviour, in Freud’s view, is goal directed. In
Thanatos are said to be housed in the id. Therefore, essence, an individual experiences a need, which they
if a person is unable to meet the demands of the id, seek to satisfy. This can be achieved in two ways:
■■ conscious mental processes: by direct
they must find a way to manage this that is socially
acceptable, or they may find themselves in conflict methods
■■ unconscious mental processes: by the use of
with society.
The next component of a person’s personality ego defence mechanisms.
is the superego. The superego develops as a child Ego defence mechanisms are specific intra-
begins to internalise parental demands for socially psychic adjustments used to resolve emotional
acceptable behaviour. It is the ‘moral guardian’. It conflict, reduce anxiety and prevent the ego from
strives for perfection. As Corey states, it is the ‘judicial being overwhelmed when it unsuccessfully attempts
branch of the personality’ (Corey, 2013, p. 65). Recall to meet an unresolved need. Essentially, defence
an instance where you have told someone (or even mechanisms are coping mechanisms of the ego to
yourself) that something is right or wrong, or good or protect the person from feelings of anxiety. They are
bad. These are two examples of what Freud saw as the unconscious and involve a degree of self-deception
superego. The easiest way to think of the superego is and reality distortion (Weiten, 2011).
to think of it as the moral component of one’s psyche; While the use of defence mechanisms was
it operates using the morality principle. The traditionally seen as unhealthy, more contemporary
superego represents society’s views on what is right work views the use of defence mechanisms as part
and wrong. Clearly, the superego develops through a of an individual’s coping style when they attempt
child’s interactions with people. The most significant to address an emotional conflict or stressor. It is
people in a child’s life in their developing years are, in when defence mechanisms are overused and/or
Freud’s view, the parents. ineffective that they become maladaptive and can
The ego emerges to deal with the real world; it result in mental/emotional dysfunction. Defence
operates on the reality principle. It acts as the mechanisms have two common features: they deny
mediator between the demands of the id and the or distort reality, and they operate at an unconscious
moral expectations of the superego. It is viewed as level (Corey, 2013; Rana & Upton, 2013; Weiten,
the ‘executive that governs, controls and regulates 2011). Freud identified a number of ego defence
the personality’ (Corey, 2013, p. 65). The ego controls mechanisms. Some of the key ones are listed and
perception, memory, thought and actions, and suffers described in Table 2.2.
TABLE 2.2
Key ego defence mechanisms
DEFENCE MECHANISM DESCRIPTION EXAMPLE/COMMENTS
Repression Seen as the primary defence mechanism used by Memories of childhood abuse.
the ego to push memories that are unacceptable/ Freud believed that repression was perhaps the most
threatening to the ego into the unconscious. It is important defence mechanism. While these painful
said that this process is unconscious events are submerged in unconsciousness, they can
continue to influence behaviour later in life.
Projection Attributing personal impulses or desires that are Socially unacceptable impulses such as lust,
socially unacceptable onto another person aggression or greed are seen as being held by others,
not the person themselves.
DEFENCE MECHANISM DESCRIPTION EXAMPLE/COMMENTS
CHAPTER 2
Displacement Transferring a strong emotion from the original A person who is being bullied and feels unable to
object/person that would be unacceptable to address this behaviour with the person concerned goes
express to another more socially acceptable (or home and ‘kicks the cat’.
‘safer’) object or person
Denial Refusal to accept the reality of a situation that the Being charged with drink driving offences repeatedly
ego would find threatening but not accepting that there is an alcohol dependence
issue.
Regression Reverting back to an earlier developmental level of Throwing a temper tantrum.
responding to a situation or event
Rationalisation Constructing plausible reasons/excuses to try and A person who binge drinks argues that they do not
explain unreasonable behaviour have an alcohol dependence as they do not drink every
day.
Sublimation A socially acceptable substitute replaces a socially Sport or art are socially acceptable ways of replacing
unacceptable impulse socially unacceptable impulses such as aggression or
sexual energy.
Reaction formation Expressing the opposite impulse to the socially A person goes out of their way to be friendly to a work
unacceptable impulse being experienced and colleague they actually dislike intensely.
which is threatening to the ego
SOURCE: ADAPTED FROM BARKWAY, 2013; BURGER, 2011; RANA & UPTON, 2013
The neo-Freudians Erikson theorised that there are eight psychosocial

As with many ideas, evolution is not only inevitable stages in human development. Erikson was influenced
but desirable. Carl Jung (1875–1961) and Alfred Adler by the ideas of Freud. However, instead of seeing a
(1870–1937) developed psychoanalytic theories that rigid series of stages that all people go through and
disagreed with important aspects of Freud’s work. with ongoing development stopping at adolescence,
There was less emphasis on biological drives such as Erikson’s ideas focused on a series of life conflicts
sex and aggression and a much greater emphasis on or tasks that were faced, and addressed, by people
social relationships. at different ages. Erikson was particularly interested
Another person who developed his ideas from in the development of identity. He saw each stage
Freud’s original theories was Erik Erikson (1902–94; as characterised by a different conflict that must be
Figure 2.2). Emerging from his initial training within resolved by the individual. When the environment
the psychodynamic orientation, Erikson developed makes new demands on people, the conflicts arise.
a number of ideas that contributed to the ongoing The individual can respond to this crisis in an adaptive
development of the psychodynamic approach. (confidence) or maladaptive (feelings of failure) way.
If a person does not successfully achieve the required
task they will experience challenges in achieving
subsequent task phases and they will need to resolve
the earlier stage at some point in the future. The eight
stages that Erikson identified should not be viewed as
strictly linear, but as a framework that conceptualises
a person as able to move back and forth as challenges
are met and crises overcome, leading to further
development (Hoffnung et al., 2013; McLeod, 2013).
The eight development stages are outlined in Table 2.3.
Harry Stack Sullivan (1892–1949)

SOURCE: DIOMEDIA/SCIENCE SOURCE/JON ERIKSON
Within the psychodynamic perspective, a number of

theorists veered away from traditional Freudian ideas
and focused more strongly on how interpersonal
interactions between people influenced personality
development (Cervone & Pervin, 2013), which was in
line with the developments of Freudian theory proposed
by Alfred Adler (Corey, 2017). Harry Stack Sullivan was
one of those theorists, and argued that the emotional
FIGURE 2.2 experiences from infancy were not biologically driven
Erik Erikson (1902–94)
TABLE 2.3
Erikson’s developmental stages (some stages overlap)
SECTION 1
ERIKSON’S AGE DESCRIPTION

DEVELOPMENTAL STAGES
Stage 1: Oral-sensory Birth to 18 months Trust vs mistrust
Children are dependent on parents for survival physically and emotionally
Trust develops when an infant’s physical and emotional needs are met in a
consistent, predictable and emotionally safe way. If an infant receives insufficient,
inconsistent care and poor emotional attachment, mistrust can develop.
Stage 2: Muscular-anal 1.5 to three years Autonomy vs shame/doubt
Autonomy is seen in the child’s capacity to develop independence in skills such
as toileting and feeding. Autonomy develops through mastery where the child is
provided with opportunities to attempt a task and retry after failed attempts. Shame/
guilt occurs through failed efforts to achieve tasks because caregivers do not provide
opportunities or deride efforts to achieve them.
Stage 3: Locomotor Three to six years Initiative vs guilt
Initiative develops through opportunities for the child to use their imagination,
engage in play and ask questions. Caregivers actively promote and support these
opportunities. When these conditions and opportunities are not provided, feelings of
guilt can develop.
Stage 4: Latency Six to 12 years Industry vs inferiority
A sense of industry is developed when children receive recognition from others
such as parents and teachers in completing productive accomplishments. If the child
receives repeated criticism, feelings of inferiority can be internalised.
Stage 5: Adolescence 13 to 18 years Role identity vs role confusion
The transition between childhood and early adulthood is where a child experiences
physical, emotional and social developmental changes and expectations. This stage
is centred on the question ‘Who am I?’. If an adolescent is unsure about their identity
and future pathway, role confusion can ensue.
Stage 6: Young adulthood 19 to 40 years Intimacy vs isolation
The stage where adults begin to share themselves with others and to experience
feelings of caring for others. If a person does not experience this sense of caring,
emotional and social isolation can ensue.
Stage 7: Middle adulthood 40 to 65 years Generativity vs stagnation
Generativity represents the capacity to share experiences, mentor and lead others
to be active participants, contributors/leaders in society, particularly younger
generations. When an individual remains focused on meeting their own needs and
desires, they are seen to be stagnating.
Stage 8: Maturity 65 to death Ego integrity vs despair
Ego integrity represents the idea of a life well lived. The older person has a sense of
self-respect through understanding they have lived a life that is ethically and socially
responsible, they have recognised and owned both the positive aspects and mistakes
made and still contribute their experience and wisdom to younger generations.
SOURCE: ADAPTED FROM COON, MITTERER & MARTINI, 2019; HTTP://FACULTYWEB.CORTLAND.EDU/ANDERSMD/ERIK/SUM.HTML
but were the results of interactions and relations with the unconscious part of the human mind, impacts on
others. This will ultimately affect the view the child has everyday behaviour. Freud’s theories also demonstrate
of themselves, because a sense of self emerges as a result how events in a person’s childhood may influence
of interactions with others. Relationships with others their personality, even if they are not consciously
during infancy, childhood and early adolescence are aware of this. Understanding the role of defence
characterised by significant social relationships that will mechanisms as the ego’s way of managing internal
impact on the young person’s developing sense of self conflict can provide mental health nurses with a
(Cervone & Pervin, 2013). means to understanding consumers’ reactions to
health problems they are experiencing. Examples of
Relevance of psychodynamic orientation to such reactions include anxiety and anger.
mental health nursing practice Anxiety, for instance, can be thought of as the
Understanding Freud’s ideas can help mental health consequence of the ego being unable to cope with
nurses understand how the human psyche, especially the demands of the id and superego. As such, anxiety
represents ego dysfunction. Defence mechanisms
provide a good description of behaviours that can be Critique of the psychodynamic orientation
observed in Freud’s work, which also highlighted the Various criticisms have been made about Freud’s
CHAPTER 2
importance of childhood experiences in personality theories. A number of concepts are seen to be poorly
development. Erikson’s stages of development provide defined and hard to measure, and therefore lacking in
a useful framework to understand people’s responses scientific rigour. The role of the environment also does
to health events at different points in their lives. This not feature in his theories. Unlike humanistic theories,
enables collaborative strategies to be developed that Freud’s ideas do not account for personal choice or
are developmentally relevant to the individual free will. Instead, they position a person as a passive
(Halter, 2014). responder to forces outside their control.
CASE STUDY
DEFENCE MECHANISMS IN PRACTICE
Samantha is a 46-year-old woman, married and with two says she must have it checked out. Samantha insists that there
school-age children. She has been married for 20 years to Jeff, is nothing to worry about as there is no history of breast cancer
who works in information technology. Three months ago Jeff in her family and she is too young to have such a condition. She
was retrenched from his position with a large multinational refuses to get a mammogram and instead focuses on Jeff’s
computer company. Samantha, who has not worked full-time search for work and looking for additional work herself.
since her children were born, has been unable to increase Questions
her hours of employment at the local university due to budget 1 What defence mechanism is Samantha using?
restrictions. While they have a small amount of savings, she 2 In what way could this defence mechanism be useful for
and Jeff are concerned about their capacity to meet mortgage Samantha at this time in her life?
repayments, school fees as well as daily living expenses 3 What are the possible negative outcomes of continued
for more than the next few months. One day in the shower, use of this defence mechanism by Samantha?
Samantha notices a lump in her right breast. She tells Jeff, who
THE BEHAVIOURAL/SOCIAL Ivan Pavlov

Pavlov (1849–1936) was interested in the effect of the
COGNITIVE ORIENTATION relationship between a stimulus and the response it
Behaviourists are interested in how people learn. The produced. Pavlov discovered that dogs could learn to
behavioural orientation argues that a person’s salivate (respond) to a non-food stimulus (bell or light)
behaviour can be objectively observed and studied and if the stimulus was simultaneously presented with food.
that personality is determined by prior learning. This is This work led to the process of classical conditioning.
distinctly different from the psychodynamic orientation, Pavlov asked why the dogs salivated when there was
where the emphasis is on exploring the unconscious no food present, but only the laboratory assistants
processes occurring in a person’s mind. The behaviourist (Figure 2.3). The four essential features of classical
orientation stresses the importance of the environment conditioning, as outlined in Table 2.4, are:
in shaping behaviour. The key term in the behaviourist 1 unconditioned stimulus
orientation is conditioning. Conditioning occurs in two 2 neutral stimulus
ways. The first of these is the concept of classical 3 conditioning process
conditioning developed by Russian physiologist Ivan 4 conditioned response.
Pavlov, who showed how animals could be made to
respond to a stimulus when it was paired with an event
that had previously produced the response.
SOURCE: ALAMY STOCK PHOTO/GRANGER HISTORICAL
The second type of conditioning is known as

operant conditioning. Depending on the type of
reinforcement a person receives, behaviours may be
more, or less, likely to be repeated. It can be positive
reinforcement or negative reinforcement –
either form makes a certain behaviour more likely
PICTURE ARCHIVE
(Weiten, 2011). The behaviourist approach argues that

conditioning allows behaviour to be changed (Coon &
Mitterer, 2012).
FIGURE 2.3
Pavlov’s classical conditioning theory
TABLE 2.4
The essential features of classical conditioning
SECTION 1
ESSENTIAL FEATURES OF CLASSICAL EXPLANATION EXAMPLE

CONDITIONING
Unconditioned stimulus A stimulus that produces an instinctive response. Unconditioned stimulus (food) and
No learning is required response (salivation) is instinctive and no
learning is required
Neutral stimulus A stimulus that does not cause an Neutral stimulus (bell) that does not evoke
unconditioned response salivation
Conditioning process The unconditioned response becomes Conditioning process pairing neutral
conditioned to the neutral stimulus (which is now stimulus (bell) with unconditioned stimulus
referred to as the conditioned stimulus) (food)
Conditioned response The unconditioned response becomes Conditioned stimulus
conditioned to the neutral stimulus (which is now (neutral stimulus – bell) presented after
referred to as the conditioned stimulus) conditioning process, which evoked a
conditioned response (salivation) (Weiten,
2011).
John Watson (1878–1958; Figure 2.4) believed view, reconditioning was necessary to change these
that to understand human behaviour it was maladaptive responses.
necessary to understand how people learn. Building Watson’s ‘Little Albert’ experiment is a
on the work of Pavlov, Watson argued that people well-known example of classical conditioning. In this
are conditioned to respond to an event in more or experiment, Watson elicited a fear of white rats in an
less predictable ways (Bernstein et al., 2018; Burger, 11-month-old infant, Albert. He achieved this by first
2011). Maladaptive responses to events are viewed eliciting a fear response (unconditioned response)
as the result of ‘faulty conditioning’. In Watson’s from Albert whenever he made a loud noise (the
unconditioned stimulus). He then introduced a white
rat (conditioned stimulus) to Albert and whenever he
did this he paired it with the loud noise. After several
pairings, Albert displayed a fear response to the white
rat in the absence of any loud noise (conditioned
response).
SOURCE: CORBIS VIA GETTY IMAGES/HERITAGE IMAGE PARTNERSHIP LTD
SOURCE: JOHN B. WATSON
FIGURE 2.5
Little Albert’s classical condition experiment by J.B. Watson
FIGURE 2.4
J.B. Watson
B.F. Skinner conditioning (also known as instrumental conditioning),

Developing his ideas from the work of Edward which involved the process of increasing or decreasing
CHAPTER 2
Thorndyke, B.F. Skinner (1904–90) believed that people the likelihood that an individual will produce an active
do have such a thing as a mind (this was in direct behaviour (an operant) as a result of interacting with
contrast to Watson’s position), but that it is simply the environment. Skinner’s idea of reinforcement
more productive to study observable behaviour than is central to operant conditioning. Reinforcement
internal mental events. Skinner’s work was premised occurs when a stimulus increases the probability of
on the idea that the best way to understand human a particular response that occurs in response to it
behaviour is to look at the causes of an action and (Upton, 2012). The process of reinforcement can be
its consequences. He called this approach operant seen in Figure 2.6.
Operant Conditioning
Reinforcement Punishment
Increase Behaviour Decrease Behaviour
SOURCE: CURTIS NEVEU. RELEASED UNDER CC BY-SA 3.0. LINK TO LICENSE: HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY-SA/3.0/
Positive Negative Positive Negative
Add appetitive stimulus Add noxious stimuli Remove appetitive stimulus
following correct behaviour following behaviour following behaviour
Giving a treat when the dog sits Spanking a child for cursing Telling the child to go to
his room for cursing
Escape Active Avoidance

Remove noxious stimuli Behaviour avoids noxious
following correct behaviour stimulus
Turning off an alarm clock Studying to avoid
by pressing getting a bad grade
the snooze button
Positive presence of a stimulus
Negative absence of a stimulus
Reinforcement increases behaviour
Punishment decreases behaviour
Escape removes a stimulus
Avoidance prevents a stimulus

FIGURE 2.6
Operant conditioning and types of reinforcers
Albert Bandura 2013). Bandura emphasised observational learning

In contrast to the behaviourist position, which argues and modelling and coined the phrase ‘reciprocal
that internal events merely act as a go-between determinism’.
environment and behaviour, the social cognitive
orientation posited that learning occurs by observing Relevance of the behavioural/social cognitive
the behaviour of others, as well as by observing any orientation to mental health nursing practice
environmental outcomes of the behaviour. Albert If you have tried to give up smoking and rewarded
Bandura (1925–) argued that personality development yourself with a treat for each day that you did not
occurred as a result of the individual’s interaction smoke, been given extra pocket money because you
within the environment and the individual’s did an additional household task without being asked,
perception and thinking. Self-efficacy is the key to or seen a parent in the supermarket ignore their child’s
successful learning in Bandura’s terms and is defined crying for a sweet at the check-out, then you have
as the individual’s belief that they can achieve a used and/or seen others using principles of operant
certain goal or master a particular situation (Corey, conditioning. In the context of mental health practice,
operant conditioning has a number of applications; Carl Rogers

for example, it can be a way of understanding the Perhaps one of the best-known exponents of the
SECTION 1
development of phobias. humanistic orientation is Carl Rogers (1902–87;

If a person finds themselves experiencing Figure 2.7). Rogers’ theory embodies the tenet of
increasing anxiety when confronted with a particular hope and an optimistic view of people. Central to his
object (e.g. a bird), any intervention that removes ideas was the belief that each person has the innate
the object and leads to a reduction in anxiety will capacity to enjoy healthy relationships and positive
be more likely to be repeated if the individual is creative growth. He referred to this as the ‘actualising
faced with the same situation again. Because of its tendency’ of people (Bernstein, Penner, Clarke-Stewart
emphasis on observation, the clear evidence for the & Roy, 2013). In his theory of personality, Rogers
behaviourist/social cognitive approach is provided identified the idea of self-concept (or self) as the
through empirical research. This has led to the fundamental component of personality; that is, the
development and validation through research of a part of the personality each person sees as ‘me’ or ‘I’
range of therapeutic interventions such as behaviour makes up the self. The self represents an organised
modification techniques, systematic desensitisation set of perceptions that are available to awareness.
and a range of combined cognitive–behavioural Personality is shaped by both the actualising tendency
approaches such as cognitive behavioural therapy. of the individual and the evaluations of others.
Therefore, relationships are key to Rogers’ ideas of
Critique of the behavioural/social cognitive personality, well-being and emotional dysfunction
orientation to mental health nursing practice (Rogers, 1951, 1961).
The behavioural/social cognitive orientation is primarily To achieve one’s capacity to self-actualise or
concerned with behaviour that is observable and achieve one’s potential (or become what Rogers
measurable, which means it fails to give sufficient referred to as a ‘fully functioning person’ (Burger,
acknowledgement to the human element of behaviour; 2011, p. 279), people need unconditional positive
that is, how thoughts and feelings influence behaviour. regard, and empathy in their relationships with
This approach has been critiqued for its reliance on others from childhood and genuineness.
animal studies and the extrapolation of the results to
human behaviour, with the argument that human
beings are far more complex than animals (Burger, 2011).
THE HUMANISTIC ORIENTATION

The humanistic perspective stresses the importance of
free will and self-determination and the positive role of
life-affirming emotions such as joy, love and hope in
coping with life’s problems. Humanistic understandings
SOURCE: ALAMY STOCK PHOTO/EVERETT COLLECTION INC

of personality and behaviour were seen by many as a
reaction to the ideas of people such as Freud, Skinner
and Watson. Unlike the behaviourist perspective,
which was seen as too mechanistic and viewed people
as having only a passive role in their development, and
the psychodynamic approach that viewed people as
victims of the unconscious, the humanistic perspective
of personality and behaviour argues that people
possess an innate capacity to develop and grow. The
humanistic perspective is a more optimistic and person- FIGURE 2.7
oriented view, where a person cannot be reduced into Carl Rogers
component parts. Rather, humanistic theories look
at people in a holistic sense and see people as unique Abraham Maslow
in their humanness. Burger (2011) outlines four Abraham Maslow (1908–70) is another central figure
elements that are considered central to the humanistic in the development of the humanistic orientation.
orientation: His research focused on ‘self-actualising people’
1 personal responsibility (Corey, 2013, p. 177). Maslow (1954, 1970) argued
2 being focused on the here and now that a self-actualising person was different from
3 the concept of the phenomenology of a person someone who would be referred to as a ‘normal
4 an emphasis on personal growth. person’. For Maslow, a self-actualising person was
Another random document with
no related content on Scribd:
effects of the liquor, and were all quiet in the forecastle.
The next morning we were aroused at daylight, and for once found
the captain on deck as early as any one. Jim and I were sent off at
once in the dingey to bring Captain Edson on board, who came,
bringing with him a mysterious package of something that smelled
very much like matches.
Captain Gay received him at the gangway; and after they had
drunk a cup of coffee, they both went forward with the mates and the
carpenter, who to his and our surprise was ordered to bring: his
broad-axe with him. The captain then looked about carefully, and at
last directed the carpenter to cut a hole through the deck planks
something more than a foot square, between the beams. The
carpenter was rather astonished, but obeyed orders, and the chips at
once began to fly.
The captain then went to the galley and returned with an iron pot,
to which he attached a line, and Captain Edson poured the contents
of his package into the kettle. By this time the hole was cut through
the deck.
“Stand by to open the scuttle, Mr. Bowker,” said the captain. “Now,
men,” he called down, as the hatch was opened carefully, “are you
coming up like men, or shall I make you come up like sheep?”
The crew greeted this request with shouts and oaths. Many of
them had waked and were again drinking the liquor.
The captain closed the hatch and called out, “Cook, bring me a
shovelful of live coals here!”
The cook came with the hot coals, which he put, as directed, into
the pot.
As the dense white smoke of the burning brimstone in the vessel
curled up, the captain lowered the pot through the hole in the deck,
keeping it close up to the beams and out of reach of the men below,
and then placed two wet swabs over the hole, so that none of the
fumes could escape above.
Flesh and blood could not endure the suffocating vapors that
immediately filled the forecastle. In less than five minutes there was
a terrific rush up the ladder, and a violent effort was made to raise
the hatch, which was prevented by the lashings and the heavy kedge
anchor.
“Stand by, now, all of you!” cried the captain to the mates, “and
clap the handcuffs on them as I let them through, one at a time!”
He opened one door of the scuttle, through which the first man
precipitated himself. He was at once secured and the door was
closed. Then it was re-opened, and the crew were let out one by one
until the whole twelve lay handcuffed on the deck in a row. The last
men were scarcely able to crawl up, so dense were the noxious
fumes in the forecastle.
When the work was completed, Captain Gay walked up and down
the deck in a high state of glee at the entire success of his
experiment, and addressed the captives as he passed:
“Oh, you are a precious lot of scoundrels, aren’t you? You thought
you had the weather-gage of me, did you? I think you will sing a
different tune when you find yourselves in the calaboose! I have
more than half a mind to give you a round dozen apiece before I
send you there, just to warm myself up this morning! But I won’t soil
my fingers with you, you drunken brutes, much as I should enjoy it!
Mr. Bowker, signal for the police boat, and send these fellows off as
quickly as possible and let us be rid of them!”
He turned aft, and went down to breakfast with Captain Edson.
When the police boat came, the officer was greatly surprised at
finding so large a number of prisoners awaiting him. They were taken
on shore; and after remaining in the city prison until we sailed, they
were, as we subsequently learned, released, and were shipped by a
whaler who came in short of hands.
Our captain picked up another crew without much difficulty, and we
went on unlading. We then took on board a cargo of coffee and
carried it to New Orleans, where we loaded with cotton for Liverpool.
CHAPTER IV
NOT BORN TO BE DROWNED
The next voyage of the Bombay was to Mobile for a cargo of

cotton, to be carried to Liverpool. It was the custom in those days for
ships of any great size to discharge and take in their cargoes in the
lower bay. The city is on the Mobile River, fully twenty-five miles
above the entrance to the lagoon-like bay, cut off from the Gulf of
Mexico by a narrow isthmus, upon the point of which the lighthouse
stands.
The Bombay came to Mobile in ballast, so there was no cargo to
discharge, very much to our satisfaction, as everything had to be
loaded into large lighters, which made hard work for the crew.
Captain Gay, as was the custom, went up to the city as soon as
the ship was safely anchored, to superintend the work of the brokers
in obtaining freight, and to forward the cotton to the ship with all
possible expedition. The chief mate remained on board in charge of
the ship.
Of all the dismal holes I had ever seen, the lower bay of Mobile
was the worst. The low shores are either alluvial mud or clear sand;
there were no trees, no inhabitants but a very few ignorant
fishermen, and absolutely nothing to relieve the monotony of life on
shipboard, divested even of the excitement that is found when at sea
in the changes of wind and weather, and the making and taking in
sail that follows calm or storm.
We were supposed to be in port, and Jack dearly loves his
“Sunday liberty,” with its attendant run ashore; but here no one cared
to go on shore on Sundays or any other day, merely to wander about
in the sand, half devoured by mosquitoes, and without a living soul to
exchange a word with. Then, to make it even more disagreeable, as
the bay is unprotected, and it was in the winter season, we were
compelled to stand anchor watches at night, and keep our sails bent
in readiness to slip our anchors and work off shore if a norther
should strike us.
I have since lain at anchor off some very inhospitable and
uninteresting shores, but I do not remember anything more
detestable than life in Mobile Bay in 1844, unless, indeed, it was my
blockading experience outside of that same bay in 1862, of which
you will hear before you finish this volume.
Our only relaxation was crabbing. For this sport we took old iron
hoops and wove upon them coarse nets of heavy twine, the meshes
being very open. In these nets we fastened three or four pounds of
the most ancient and malodorous salt beef we could find in the
harness casks,—and these pieces could be scented the length of the
ship. At night, the nets, heavily weighted, were thrown overboard
with a stout line attached to them, and allowed to sink to the bottom.
The next morning we hauled the nets in, and rarely failed to find
from one to half a dozen enormous hard-shelled crabs entangled in
the meshes of each net and viciously fighting with each other. The
result of these contests was frequently seen in an unfortunate crab
minus half of his legs.
But the pleasure of crab-fishing soon palled upon us, and not even
a hardened sailor’s stomach could endure a steady diet of these
crustaceans. So, after the first week the crab nets were neglected,
and we were forced into spending our few hours of leisure in sleep,
an unfailing resource for a sailor.
However, the first lighter laden with cotton soon came down from
Mobile, and with it a gang of stevedores who were to stow this
precious cargo. At that time freights to Liverpool were quoted at
“three half-pence a pound,” which represented the very considerable
sum of fifteen dollars a bale. So it was very much to the interest of
our owners to get every pound or bale squeezed into the ship that
was possible.
The cotton had already been subjected to a very great
compression at the steam cotton presses in Mobile, which reduced
the size of the bales as they had come from the plantations fully one
half. It was now to be forced into the ship, in the process of stowing
by the stevedores, with very powerful jackscrews, each operated by
a gang of four men, one of them the “shantier,” as he was called,
from the French word chanteur, a vocalist. This man’s sole duty was
to lead in the rude songs, largely improvised, to the music of which
his companions screwed the bales into their places. The pressure
exerted in this process was often sufficient to lift the planking of the
deck, and the beams of ships were at times actually sprung.
A really good shantier received larger pay than the other men in
the gang, although his work was much less laborious. Their songs,
which always had a lively refrain or chorus, were largely what are
now called topical, and often not particularly chaste. Little incidents
occurring on board ship that attracted the shantier’s attention were
very apt to be woven into his song, and sometimes these were of a
character to cause much annoyance to the officers, whose little
idiosyncrasies were thus made public.
One of their songs, I remember, ran something like this:—
“Oh, the captain’s gone ashore,

For to see the stevedore.
Chorus: Hie bonnie laddie, and we’ll all go ashore.
“But the mate went ashore,

And got his breeches tore,
Hie bonnie laddie,” etc.
As Mr. Bowker had returned to the ship the day before, after a visit
to the lighthouse, with his best broadcloth trousers in a very
dilapidated condition, this personal allusion to the unfortunate
incident, shouted out at the top of their hoarse voices by “Number
One” gang was, to say the least, painful. We boys, however, thought
the sentiment and the verse equally delightful.
The second lighter of cotton was towed down to us by quite a large
high-pressure steamer, the Olive Branch, that was going on to Pass
Christian with passengers. After dinner that day, Mr. Bowker, who
was in an unusually amiable mood, called out, “You, Bob, take
Charlie with you in the dingey, and go on board that steamer, and
see if you can’t get me some newspapers.”
Charlie was the new boy, the successor to Jim, who had
unostentatiously departed from the ship, “between two days,” in
Liverpool, last voyage. As Charlie was my junior, I took a great and
not unnatural pleasure in making him as uncomfortable as possible
when an opportunity presented. So I hauled the dingey up at once to
the gangway, and, rousing Charlie up from his unfinished dinner,
started off for the steamer.
I had already become quite a good boatman, but this was a novel
experience for me, and indeed it was quite a delicate matter to lay a
small boat safely alongside one of those great side wheel steamers
while she was still in motion,—for the Olive Branch had not
anchored, but had only stopped her engines and was slowly drifting.
As I approached the steamer I saw a man standing well forward of
the wheel-house with a line ready to throw to us, and I headed the
boat for him. As we came within good distance we tossed in our
oars, the line was thrown, Charlie caught it, but stumbled and fell,
and in a moment the dingey had capsized, and we were in the water
and under the wheel of the steamer!
Unfortunately I had never learned to swim; and as I was heavily
clad I went down in the cold salt water of the bay like a stone, and for
a few seconds experienced all the agonies of drowning!
Then I rose and, as I came to the surface, found myself among the
“buckets” of the great wheel of the steamer, which were green and
slimy with river moss, and as slippery as ice. By a tremendous
physical effort I succeeded in getting astride of one of these buckets,
and obtained a precarious position of comparative safety, as I
thought at first.
But, to my horror, I was scarcely out of the water when the wheel
commenced very slowly revolving. The terror of that moment I shall
never forget. The recollection of it returns to me now, after all these
years, and in my bad attacks of nightmare I sometimes fancy myself
clinging again with desperation to a slowly revolving wheel,
drenched, shivering with cold, and expecting each moment a horrible
death!
In my agony I shouted aloud; but, inclosed on all sides as I was by
the wheel-box, I felt sure that my cries could not be heard. In the
darkness of this prison box the wheel slowly, very slowly revolved,
carrying me up toward the top of the cover, where I fully expected to
be ground to pieces; or if perchance I escaped that fate, I knew that I
would be drowned when I was drawn under the water in the fearful
suction beneath the wheel.
Escape seemed impossible, but frantic with fear I again shouted at
the top of my shrill young voice till my lungs seemed ready to burst.
Then the wheel stopped. There was a pause; I heard the noise of
hurried feet upon the wheel-box above me, a trap door was opened,
and the blessed light of day came struggling in.
I saw a man looking earnestly down into the darkness of the space
beneath him, and I tried to call out, but my voice seemed paralyzed,
and, for the moment, I could not make a sound.
Neither seeing nor hearing anything, the man rose from his knees
and was about to close the trap-door, when I made another effort,
and, thank God, a faint cry burst from my parched throat.
The man paused, then sprang upon the wheel, picked me up in his
arms, and I fainted dead away!
After what seemed a long time, although, as I was told, it was but
a few minutes, I recovered consciousness to find myself stretched
out on a mattress, covered with a blanket, and surrounded by a
number of kind-hearted women. The passengers had seen the boat
upset and noticed my sudden disappearance. Charlie, who could
swim like a fish, was picked up, and declared that I was drowned.
Indeed, he “saw me go down and never come up again.”
By the merest chance the captain had not started the steamer
ahead. If that had been done I should, of course, have been killed.
My clothes were soon dried in the engine-room, the dingey and
her oars had been recovered, a generous bag of fruit and cake was
packed for me by the sympathetic ladies, and we returned to the
Bombay.
As I came up over the side, Mr. Bowker greeted me with, “Where
have you been all this time, Bob?”
I explained to him my narrow escape from a dreadful death, to
which he cheerfully responded:—
“Well, Bob, you certainly were not born to be drowned; look sharp
to it, lad, that you do live to be hanged!”
CHAPTER V
A “SHANGHAEING” EPISODE
The next three years of my life at sea were but a repetition of the
first three months of my experience, with a slight change in the
scene of the incidents and a natural increase in my knowledge of
seamanship. For when I returned to Boston in the Bombay from
Liverpool, at the end of my first year of probation, and the opportunity
was again presented to me of going into the navy as midshipman, I
declined the offer of my own free will.
My views had changed during the past year, for I had learned how
slow promotion was in the naval service, and I had seen in our
squadron in Brazil gray-haired lieutenants who were vainly hoping for
one more step before going on the retired list. In fact, Farragut, who
entered the navy as a midshipman in 1810, had passed through the
War of 1812, and after thirty-one years’ service was still a lieutenant
in 1841.
During my year at sea my dear mother had died, my home was
broken up, and when my cousin, who owned the Bombay, promised
me that I should have the command of one of his ships when I was
twenty-one, if I proved myself competent, I decided to stay where I
was.
I received my first promotion to the position of second mate, when
I was barely seventeen years of age, and a very proud youngster I
was when I heard myself called “Mr.” Kelson, for the first time on the
quarter-deck of the old Bombay, where less than four years before I
had made my appearance as a green boy.
We were lying at this time at the levee in New Orleans, not far
from Bienville Street, and abreast of the old French Market. The
Bombay was the inner vessel of three in the tier, and formed a
portion of the tow just made up by the tugboat Crescent City, and we
were only waiting for our crew, soon to be brought on board by the
boarding-house runners and the shipping-master.
There was a fine old custom that prevailed in New Orleans in
those days of bringing the crew on board at night, at the last
moment, comfortably drunk, counting them as received, and
bundling them into their berths in the forecastle, to sleep off the
fumes of their debauch. And by the next morning, when the ship
would be down the river at the Belize, the tugboat was cast off, and
then, and not until then, would the ship’s crew be needed to make
sail and clear up the decks for sea.
It was the duty of the junior officer to receive and count the men as
they came on board ship in every stage of intoxication. Some were
brought over the gangway, absolutely helpless, by two stalwart
runners; and when the ship’s quota had been duly delivered in the
forecastle the shipping and boarding-house masters received a
month’s advance pay for each man.
Whatever else might be said against this system, it certainly had
the merit of simplicity; for as the voyage to Liverpool rarely exceeded
thirty or thirty-five days, it was quite customary for the men to “jump
the ship” in Liverpool as soon as she was docked, and, having little
or no wages due them, they were cared for by another set of
boarding-house sharks, who kept them during a very brief carouse in
the “Sailor’s Paradise,” as Liverpool was then called, and then
quietly bundled them on board of another ship, bagging their
advance pay, after the fashion of their New Orleans brothers in
iniquity.
All this, however, is but the prelude to my little story. That
Christmas eve in 1845 I, as second mate, stood at the starboard
gangway of the old Bombay, crammed to her upper deck beams with
cotton, and with a deck load beside, and had checked off thirteen
men drunk and semi-drunk, as they came on board in squads of two
and three.
“Now then, Mr. Kelson,” said the chief mate, as he came up from
the cabin, “have we got these men all aboard yet?”
“Only thirteen yet, Mr. Ackley,” I responded, looking at my list by
the light of the lantern hanging in the main rigging. “But here comes
the shipping-master, sir.”
“Where in thunder is that other man, Thompson?” said the mate.
“The old man is as savage as a meat-axe down in the cabin, and you
had better not see him till we have got our full complement on
board.”
“Oh, that’s all right, Mr. Ackley,” replied the shipping-master.
“Here’s Dago Joe, now, coming with his man. Well, Joe, you almost
missed your chance. They are just ready to cast off the breast lines.
What have you got in your handcart?”
“Oh, Mis’ Thompson, he reglar ole’ shellback, he is. He boad wid
me six week. Came here bossun of de Susan Drew. You’ll ’member
dis feller soon’s you see him. He say he won’t ship less’n sixteen
dollar mont’. Dat’s de advance I giv’ him, ’cos I know Mis’ Ackley like
good sailor man.”
“Why, he looks as though he were dead,” said I, peering at the
prone body in the cart.
“Who, he? Oh no, sir; he been takin’ lil’ drop too much dis evenin’,
but he be ol’ right ’fore mawnin’. Oh, he sober fust-class sailor man.
’Sure you of dat, Mis’ Ackley!”
At this moment our towboat gave an impatient whistle, and
Captain Gay came up from the cabin, two steps at a time.
“Mr. Ackley, what are we waiting for? The tow has been made up
for an hour, and we ought to have been a dozen miles down the river
by this time!”
“The last man has just come on board, sir,” replied the mate, “and I
shall cast off at once.”
“Be sharp about it then, sir!”
“Aye, aye, sir. Go forward, Mr. Kelson, and see to those head
lines; take the cook, steward, and carpenter with you to haul them in.
You, Joe, tumble that man of yours into the forecastle and get ashore
yourself, or you’ll have a chance to take a trip down to the Southwest
Pass! Let go the breast lines! Stand by forward!”
We cast off, the tugboat steamed ahead, the strong current struck
us on the starboard bow, we slowly turned, and went on our way
down the river, leaving the long line of twinkling lights of the Crescent
City behind us.
The next morning at daylight the chief mate and I, after serious
difficulties, succeeded in “rousing out” our befuddled crew, and then
commenced clearing up decks and getting ready for making sail, for
we were nearly abreast of Pilot Town, and would soon be over the
bar.
Thirteen hard-looking subjects presented themselves from the
forecastle, after some little time, but where was the fourteenth? A
diligent search of the men’s quarters was at last rewarded by the
discovery of the missing man—but such a man! A wretched-looking,
frowsy-headed little creature, bandy-legged and narrow chested, a
most unmistakable landsman, dressed in thin, blue cottonade
trousers with a long-skirted, threadbare alpaca coat, buttoned over a
calico shirt; with no waistcoat, or hat, and with well-worn lasting
shoes on his feet. Trembling, blear-eyed, wild with evident
astonishment at his surroundings, this unfortunate wretch was haled
up before the mate by the carpenter, who had found him still asleep
under one of the berths, hidden behind a large sea chest.
“Who the devil are you?” said Mr. Ackley roughly, looking
contemptuously at the man, shivering in the chill of the early
morning.
“Vere you vos takin’ me?” inconsequently replied the man, staring
about him. “I want to go by my home. Lisbeth must ogspect me.
Please stop the boat, lieber Herr; I must go home!”
“He’s got ’em bad, sir,” said the carpenter; “that New Orleans
whiskey is mean stuff, sure. He’s got the ’trimmins, sir!”
“Who shipped you, you measly dog?” shouted the mate, paying no
attention to the carpenter. “Come, speak up, or I’ll lather the hide off
of you! Who shipped you I say?” raising a rope in a threatening
manner.
“Please, goot gentleman, don’t strike me! I vant to go home.
Lisbeth must ogspect me long ago. Why did you bring me here, goot
gentleman?”
“I’ll ‘goot gentleman’ you! Here, Chips, take this fellow and put him
under the head pump. Freshen him up a bit, and then I’ll warm him
with a rope’s end and see if I can’t get some sense into him!”
The carpenter and one of the crew dragged the struggling man
forward, and held him while one of the boys, delighted at the
opportunity, pumped the cold river water over the poor creature,
whose screams were drowned in the rough merriment of the sailors.
I look back at this scene now, as I record it, and at many others,
even worse, that followed during the next month, and wonder if we
were all—officers and men—brutes, in “those fine old days” of the
Black Ball liners and the Liverpool trade!
Poor Shang—that was the name that fell to him in playful allusion
to the fact that he had been made a victim to the “Shanghaeing”
process, as it was called—had been drugged and brought on board
helpless by Dago Joe to make up our full complement.
When we came to choose watches that evening Shang fell to me;
he was left until the last, and Mr. Achley said, “Well, Mr. Kelson, you
allowed Joe to bring this duffer on board, and its only fair that you
should take him in your watch. I don’t want him!”
Shang, as I found out by questioning him, had gone out that
Christmas Eve in New Orleans to buy a few little presents for their
Christmas-tree. He was a poor journeyman tailor, a German who had
come to this country from his native village of Pyrmont, several years
ago, had married a fellow-countrywoman, Lisbeth, and they had one
child,—a crippled girl, Greta,—whom the little man loved with his
whole heart; and for her he had gone out to purchase something with
his scanty, hard-earned wages, paid him that day.
He had stepped into a beer saloon for “ein glas bier,” as he said,
had drunk it, felt drowsy, and—“Gott in Himmel, gnädiger Herr,
nothing more know I more till I find myself in this strange ship! When
think you, sir, we will get there—where we go—is it perhaps far?”
When I told poor Shang the real facts of the case, and that it would
be months before he could again see his Lisbeth and Greta, the poor
fellow was dumb with horror, and I almost feared he would make
away with himself.
I did the best I could to make life endurable for the poor wretch. An
old thick suit of mine he deftly made over for himself, and some of
his shipmates helped him out with a few other clothes. But, even with
the best intention, I could not make a sailor of poor Shang,—it was
not in him, for he was a most helpless lubber,—and that was the
misery of it.
He had been shipped and entered on our ship’s articles as an able
seaman, and Joe had received sixteen dollars of monthly wages on
his account. Our crew was short, at best, the winter voyage was a
stormy one, and poor Shang could not be favored.
Mr. Ackley seemed to have taken an unconquerable dislike to the
man from the first, and led him a dog’s life, beating him unmercifully
several times for his shortcomings. Aloft he must go, though he clung
helplessly to the ratlines in an agony of terror.
“You alone are goot to me, lieber Herr,” said the poor fellow. “I
know you cannot help me more, but how can I live it? I know that I
shall perish before we get there! Ach, lieber Gott, vot become of my
lieblinge! Aber des Himmels Wege; sind des Himmels Wege!”
At last the long voyage was nearly at an end. Cape Clear was in
sight one night as I came up to take the watch at midnight, and a
very pleasant sight it was to all of us. There was a stiff all-sail breeze
from the southward, and we were laying our course fairly up channel.
I was looking over the quarter-rail at the light, now well abeam, as
Shang came aft and drew near me.
“Is it then true, mein Herr, as they say, that we are almost there?”
“Yes, Shang, we are now almost there. If this breeze holds we will
be in Liverpool day after to-morrow. And then,” I added, as I saw how
anxiously he listened to me, “you can ship as a landsman, perhaps,
and get back to Lisbeth and little Greta.”
“Gott sei dank,” he murmured, as he reverently lifted his hat, “if
they have but live all this time.”
I endeavored to reassure the poor fellow, and then, as the breeze
was freshening, I took in the topgallant sails, and later, finding the
wind still increasing, called Captain Gay, who ordered all hands
called and a single reef put in the topsails.
The watch below tumbled up, the yards were clewed down, reef-
tackles hauled out, and both watches went aloft to the fore-topsail.
As my station as second mate was at the weather earing, I was, of
course, first aloft, and had just passed my earing and sung out, “Haul
out to leeward,” when I noticed, to my great surprise, that the man
next inside of me on the yard was Shang, who usually on such
occasions was discreetly found in the bunt.
“Why, Shang,” said I, “you are really getting to be a sailor.”
“Ach, mein Herr,” said he cheerfully, “ich bin so glücklich und so
frölich, now that I am really so near there and that I shall so soon see
Lisbeth”—
A strong gust of wind struck us; there was a vicious slat of the sail
that sent the heavy canvas over our heads; the ship made a
desperate roll and a plunge into the rising sea, and then, as we all
clung closely for our lives, the sail bellied out and filled again,—but
the man next me was gone from the yard!
In the pitchy darkness of the moonless night he had fallen into the
sea, and without a cry he was swept into eternity.
Poor Shang’s earthly troubles were forever ended!
CHAPTER VI
TO CALIFORNIA BEFORE THE GOLD
DISCOVERY
In 1846, while the Mexican War was in progress, it was decided by

President Polk, acting upon the advice of Secretary of the Navy
George Bancroft, to send a volunteer regiment around Cape Horn to
California for the occupation of that country, then a province of
Mexico. In pursuance of this scheme a commission as colonel was
given to a Mr. Thomas Stevenson, a well-known New York politician
and a stanch Democrat, and he was authorized to raise and equip a
full regiment of one thousand men, to be known as the First
Regiment of California Volunteers.
It was found that three ships would be required to transport the
regiment with its commissary stores and ammunition; and the
Thomas H. Perkins, of which I was at the time second mate, was one
of the three vessels chartered for the purpose. Accordingly we
hauled into a berth at the Brooklyn Navy Yard in September, 1846,
and commenced taking in a cargo of military stores in the lower hold,
while the between decks were fitted up with berths to accommodate
three hundred and fifty men.
Having completed this work, we were towed into the East River,
and there three full companies, H, I, and K, with a portion of
Company F, were sent on board from their camps on Governor’s
Island. We were also notified that Colonel Stevenson and his
headquarters staff would take up their quarters on board our ship for
the voyage out, which gave us the distinction of being the flagship.
The men of the regiment were a tough lot of fellows. “Stevenson’s
Lambs,” as they had been nicknamed, were recruited in and about
the Five Points and the worst purlieus of the notorious Fourth Ward,
and from the very first they gave their officers no end of trouble.
The officers, moreover, were but a shade better; for with the
exception of the colonel’s son, Captain Matthew Stevenson, who
was a West Pointer, and the staff officers, who were of the better
class, the great majority of the company officers were mere ward
politicians, elected by their men to their positions, and having little
idea of military discipline.
The colonel had to come on board secretly at night to avoid arrest
for debt, and one energetic deputy sheriff actually chased us down
the harbor in an ineffectual attempt to serve a writ upon this
impecunious officer.
We sailed, after many delays, very suddenly at last, under
imperative orders from Washington, on the last day of September, in
company with the ships Loo Choo and Susan Drew, carrying the
remainder of the regiment, and all of us under the convoy of the
United States sloop-of-war Preble. As she was a very dull sailer,
however, we never saw her after the first day, as we ran her out of
sight that night.
We had a pleasant run down to Rio Janeiro, where we put in for
water and fresh provisions. Here one of the wild freaks of the Lambs
was displayed.
Captain Lippitt, of Company K, was, in contrast to the other
officers, quite a disciplinarian. He was not a New Yorker, but came
from Vermont, where he had superintended a military school; and
neither of these facts commended him to the consideration of his
men, with whom he was very unpopular. His company had abused
their uniforms shamefully during the voyage, and had been
especially careless in losing their dress hats overboard.
These hats were not so comfortable as the fatigue caps, and there
was little doubt that, in many instances, the men lost the hats with
intent. In preparation for making a suitable appearance in Rio,
Captain Lippitt had found a couple of hatters in the regiment, and
with infinite labor had managed to have ninety new dress hats made
for his company, and they had been served out a few days before we
made the land. He took great pride in the success of this effort, and
bragged in a mild manner to his brother officers of the fine
appearance his men would make.
The day we entered the bay of Rio the entire company appeared
on deck in their new headgear, rather to the surprise of the captain,
who had not given orders for full dress; but, attributing it to a desire
on the part of his men to appear well, he made no comment.
As we passed under the walls of the fort which guards the
entrance to the bay, where all ships are hailed as they come in,
Company K at a concerted signal sprang into the rigging or upon the
rail, and, giving three wild cheers, every man threw his new hat
overboard!
The Bay of Rio de Janeiro was alive with nearly one hundred
military hats bobbing about in a most absurd manner, while the walls
of the fort were at once crowded with Brazilian soldiers attracted by
this most astonishing performance.
Captain Lippitt was speechless with rage and amazement, the
colonel and the other officers could not restrain their laughter; and as
they could not very well punish an entire company for a bit of fun, the
matter was allowed to pass with a reprimand and a stoppage of the
value of the hats from the men’s pay. But Captain Lippitt was not
permitted to hear the last of the “battle of the hats” for the remainder
of the voyage.
In Rio the three ships of our fleet met for the first time since we
had parted company after leaving New York. One company of the
regiment from each ship was given liberty on shore daily, and the
Brazilian police probably never had such severe duty before in their
lives. Fancy three hundred New York Fourth Ward roughs adrift in a
quiet foreign city, entirely unprepared for their proper reception!
It was little wonder that at last a formal protest was entered with
the American Minister, Mr. Wise, against the depredations of these
reckless fellows, and a request was made that no more shore liberty
be granted them. It was doubtless an immense relief to the
authorities, who afforded us every facility for expediting our work,
when the supplies were all on board and they had seen the last of
the “Soldados Norte Americanos.”
We parted company with our consorts with the understanding that
we should rendezvous at Valparaiso. Off the Rio de la Plata we had
a very heavy blow, but after that enjoyed unusually pleasant weather
until we got into the latitude of Cape Horn, where, although it was

(Download PDF) Mental Health Nursing Applying Theory To Practice 1St Edition Gylo Hercelinskyj Full Chapter PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

(Download PDF) Mental Health Nursing Applying Theory To Practice 1St Edition Gylo Hercelinskyj Full Chapter PDF

Uploaded by

Copyright:

Available Formats

Mental Health Nursing: Applying

Theory to Practice. 1st Edition Gylo

Family Health Care Nursing: Theory, Practice, and

Neeb’s Mental Health Nursing 5th Edition, (Ebook PDF)

Lippincott CoursePoint+ for Videbeck’s Psychiatric-

Health Promotion in Nursing Practice (Health Promotion

Community/Public Health Nursing Practice E Book: Health

Health Promotion Programs: From Theory to Practice

Clinical social work practice in behavioral mental

Health Behavior: Theory, Research, and Practice

Gylo (Julie) Hercelinskyj

Gylo ( Julie ) Hercelinskyj

Gylo (Julie) Hercelinskyj

Printed in Singapore by 1010 Printing International Limited.

UNDERPINNINGS OF MENTAL HEALTH NURSING 1 Neurodevelopmental disorders 299

Mental health nursing – then and now 2 Neurocognitive disorders 317

Guide to the text x CHAPTER 4

Trichotillomania 347 CHAPTER 22

Guide to the text

Identify the key concepts M E N TA L H E A LT H N U R S I N G – T H E N A N D N O W 7

understanding, to the the

enging behaviours. Where in Focuses

FEATURES WITHIN CHAPTERS required)

same purpose as thatmeasure of a researcher. frequently depicted in a hierarchy, often called an

boxes, which HOW link DO MENTAL HEALTH

individual may present as distracted. butTV, it isthey can see you.

ways are part

c Ethics is based on law ■■ downloadable

WORD-BASED TEST BANK AND STUDENT REVISION QUIZ

ARTWORK FROM THE TEXT

FOR THE STUDENT

SEARCH ME! NURSING

ABOUT THIS BOOK ■■ theory of communication

■■ recovery and trauma informed practice

a Masters in Education, and a PhD in Psychology. practice, with Alison Hansen

internationally about teaching mental health nursing Alexander

mental health teaching. Topp.

practice, with Terry Froggatt

PhD, MSc (ECON), PGCE(HE), BSc (HONS), RGN, health

Brian Phillips Louise Ward

excess of the usual undertakings of an academic: ■■ Sione Vaka – Massey University

I want to thank my husband Christian, and children

Louise Alexander and Gylo (Julie) Hercelinskyj

LEARNING FROM PRACTICE

INTRODUCTION The following terms were all socially appropriate and,

[semen] within me all cold as spring well water.

Given the content of this extract, it is possible that

FIGURE 1.1 Exorcisms and spirit possession

the mentally ill in some countries even to this day,

became colloquially known as institutionalisation.

rendered many families with disturbed family

Bedlam Locals were encouraged to come and view the

to hold the powerful and authoritarian roles in historical

psychiatry; many women remained institutionalised for

mere convenience (Toy, 2014).

Mental health nursing in Australia

TREATMENTS THROUGHOUT HISTORY Recovery-oriented models of practice now place the

TREATMENT TIME OR ERA PERCEIVED BENEFITS

In the mid- twentieth century, the emergence of

1952 Lithium Bipolar disorder

we can now see how destructive many practices on medical officers

Some researchers have hypothesised that these

Professional identity in mental health nursing Results

UNDERPINNINGS OF MENTAL HEALTH NURSING 1 Neurodevelopmental disorders 299

Mental health nursing – then and now 2 Neurocognitive disorders 317

Guide to the text x CHAPTER 4