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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
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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
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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
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that deviatesthe educative Strait Islandermay cultures. With thepicture
colonisation
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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
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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
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Erikson’s
capacity ‘I just want
theory, identify whattofactors
be there for her…
impact on a
d perspective
little might
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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
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as
2 Where behaviour?
to speak
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actual orshe turns herconflict
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between the 4 IHow can speak
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person Using
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has alegal
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capacity perspective,
apply Bandura’s
Jennifer
2 code hasThe
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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
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distressed the
and
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explains that with her there
Jennifer is veryto
refuses 3 Using theErikson’s
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c little
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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
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everything concept of self-efficacy
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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
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xiii

Guide to the online resources
FOR THE INSTRUCTOR
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cengage.co.nz/instructors for New Zealand.
INSTRUCTOR’S MANUAL
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• 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
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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
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convenit ut Canonici aut Vicarii ex collegarum suorum
numero aliquem designent Episcopum qui reliquos omnes
magnis impendiis liberali convivio excipiat.’
[1252] W. H. R. Jones, Vetus Registr. Sarisb. (R. S.), ii. 128;
Wordsworth, Proc. 170 ‘Item, annulus unus aureus ad
Festum Puerorum.’
[1253] Constitutiones, § 45 (Jones and Dayman, Sarum
Statutes, 75; cf. Jones, Fasti, 295) ‘Electus puer chorista in
episcopum modo solito puerili officium in ecclesia, prout
fieri consuevit, licenter exequatur, convivium aliquod de
caetero, vel visitationem exterius seu interius nullatenus
faciendo, sed in domo communi cum sociis conversetur,
nisi cum ut choristam ad domum canonici causa solatii ad
mensam contigerit evocari, ecclesiam et scholas cum
caeteris choristis statim post festum Innocentium
frequentando. Et quia in processione quam ad altare
Sanctae Trinitatis faciunt annuatim pueri supradicti per
concurrentium pressuras et alias dissolutiones multiplices
nonnulla damna personis et ecclesiae gravia intelleximus
priscis temporibus pervenisse, ex parte Dei omnipotentis et
sub poena maioris excommunicationis, quam
contravenientes utpote libertates dictae ecclesiae nostrae
infringentes et illius pacem et quietem temerarie
perturbantes declaramus incurrere ipso facto, inhibemus
ne quis pueros illos in praefata processione vel alias in suo
ministerio premat vel impediat quoquomodo, quominus
pacifice valeant facere et exequi quod illis imminet
faciendum; sed qui eidem processioni devotionis causa
voluerint interesse, ita modo maturo se habeant et honeste
sicut et in aliis processionibus dictae ecclesiae se habent
qui ad honorem Dei frequentant quando que ecclesiam
supradictam.’
[1254] Appendix M.
[1255] Jones, Fasti, 299.
[1256] Wordsworth, Proc. 259. The oblationes vary from lvis.
viiid. in 1448 to as much as lxxxixs. xid. in 1456.
[1257] Jones, Fasti, 300; Rimbault, xxviii; Planché, in Journal
of Brit. Archaeol. Assoc. xv. 123. Gregory, 93, gives a cut of
the statue.
[1258] Ordinale secundum Usum Exon. (ed. H. E. Reynolds),
f. 30.
[1259] Archaeologia, l. 446, 472 sqq. (Invent. of 1245) ‘mitra
alia alba addubbata aurifrigio, plana est; quam dedit J.
Belemains episcopo innocentum.... Mitra episcopi
innocentum, nullius precii.... Capa et mantella puerorum ad
festum Innocentum et Stultorum [cf. p. 323] sunt xxviij
debiles et contritae.’ In 1402 there were two little staves for
the Boy Bishop (Simpson, St. Paul’s Cathedral and Old
City Life, 40).
[1260] Statutes, bk. i, pars vi. c. 9, De officio puerorum in festo
Sanctorum Innocencium (W. S. Simpson, Registrum
Statutorum et Consuetudinum Ecclesiae Cathedralis Sancti
Pauli Londinensis, 91).
[1261] ‘Memorandum, quod Anno Domini Millesimo cc lxiij.
tempore G. de fferring, Decani, ordinatum fuit de officio
Puerorum die Sanctorum Innocencium, prout sequitur.
Provida fuit ab antiquis patribus predecessoribus nostris
deliberacione statutum, ut in sollennitate Sanctorum
Innocencium, qui pro Innocente Christo sanguinem suum
fuderunt, innocens puer Presulatus officio fungeretur, ut sic
puer pueris preesset, et innocens innocentibus imperaret,
illius tipum tenens in Ecclesia, quem sequuntur iuvenes,
quocumque ierit. Cum igitur quod ad laudem lactencium
fuit adinventum, conversum sit in dedecus, et in derisum
decoris Domus Dei, propter insolenciam effrenatae
multitudinis subsequentis eundem, et affluentis
improborum turbae pacem Praesulis exturbantis,
statuendum duximus ut praedicti pueri, tam in eligendo suo
Pontifice et personis dignitatum Decani, Archidiaconorum,
et aliorum, necnon et Stacionariorum, antiquum suum ritum
observent, tabulam suam faciant, et legant in Capitulo. Hoc
tamen adhibito moderamine, ut nullum decetero de
Canonicis Maioribus vel Minoribus ad candelabra, vel
turribulum, vel ad aliqua obsequia eiusdem Ecclesiae, vel
ipsius Pontificis deputent in futurum, set suos eligant
ministeriales de illis qui sunt in secunda forma vel in tercia.
Processionem suam habeant honestam, tam in incessu,
quam habitu et cantu, competenti; ita vero se gerant in
omnibus in Ecclesia, quod clerus et populus illos habeant
recommendatos.’
[1262] ‘Die vero solemnitatis post prandium ad mandatum
personae Decani convenient omnes in atrio Ecclesiae,
ibidem equos ascendant ituri ad populum benedicendum.
Tenetur autem Decanus Presuli presentare equum, et
quilibet Stacionarius sua personae in equo providere.’
[1263] Statutes, bk. i, pars vii. c. 6 (Simpson, op. cit. 129), a
statute made in the time of Dean Ralph de Diceto (1181-
†1204) ‘Debet eciam novus Residenciarius post cenam die
Sanctorum Innocencium ducere puerum suum cum daunsa
et chorea et torchiis ad Elemosinariam, et ibi cum torticiis
potum et species singulis ministrare, et liberatam vini
cervisiae et specierum et candellarum facere, et ibidem
ministri sui expectare, quousque alius puer Canonici
senioris veniat. Et secundam cenam in octavis
Innocencium tenebit, Episcopum cum pueris et eorum
comitiva pascendo, et in recessu dona dando, et, si diu
expectat adventum illorum nocte illa, ad matutinos non
teneatur venire.’
[1264] Rimbault, xxxii.
[1265] Printed in Rimbault, 1. Duff, Handlists, ii. 5, notes also a
Sermo pro episcopo puerorum by J. Alcock, printed in the
fifteenth century by R. Pynson.
[1266] Concio de puero Iesu pronunciata a puero in nova
schola Iohannis Coleti per eum instituta Londini in qua
praesidet imago Pueri Iesu docentis specie (Erasmi Opera
(1704), v. 599). The English version was printed by W.
Redman (Lupton, Life of Colet, 176). It is not clear that this
Concio was preached by a boy bishop, for Colet’s school
(cf. next note) attended the ‘bishop’ of St. Paul’s song-
school.
[1267] Lupton, op. cit. 175 ‘Alle these Chyldren shall every
Chyldremasse day come to paulis Church and here the
Chylde Bisshoppis sermon, and after be at the hye masse,
and eche of them offre a 1d. to the Childe Bisshopp; and
with theme the Maisters and surveyours of the scole.’
[1268] Lincoln Statutes, ii. 98 ‘Inveniet [thesaurarius] Stellas
cum omnibus ad illas pertinentibus, preter cirpos, quos
inveniet Episcopus Puerorum futurorum [?fatuorum], vnam
in nocte Natalis Domini pro pastoribus et ·ijas in nocte
Epiphanie, si debeat fieri presentacio ·iijum regum.’
[1269] Warton, iv. 224 ‘Ioannes de Quixly confirmatur
Episcopus Puerorum, et Capitulum ordinavit, quod electio
Episcopi Puerorum in ecclesia Eboracensi de cetero fieret
de eo, qui diutius et magis in dicta ecclesia laboraverit, et
magis idoneus repertus fuerit, dum tamen competenter sit
corpore formosus, et quod aliter facta electio non valebit.’
[1270] Warton, iv. 237 ‘nisi habuerit claram vocem puerilem.’
[1271] Warton, iv. 224.
[1272] Appendix M. Cf. Rimbault, xi, for further elucidations of
the Computus.
[1273] Percy, North. H. B. 340.
[1274] York Missal, i. 23. The rubric at the beginning of Mass
is ‘Omnibus pueris in Capis, Praecentor illorum incipiat.’
There are some responds for the ‘Praecentor’ and the
‘turba puerorum.’ After the Kyrie, ‘omnibus pueris in medio
Chori stantibus et ibi omnia cantantibus, Episcopo eorum
interim in cathedra sedente; et si Dominica fuerit, dicitur ab
Episcopo stante in cathedra Gloria in excelsis Deo: aliter
non.’ The Sequentia for the day is
‘Celsa pueri concrepent melodia,

eia, Innocentum colentes tripudia, &c.’
[1275] Rimbault, xvi. The dates are between 1416 and 1537.
[1276] Raine, Fabric Rolls of York Minster (Surtees Soc.), 213
sqq. ( † 1500, the additions in brackets being † 1510) ‘una
mitra parva cum petris pro episcopo puerorum ... [unus
annulus pro episcopo puerorum et duo owchys, unus in
medio ad modum crucis cum lapidibus in circumferenciis
cum alio parvo cum uno lapide in medio vocato turchas]....
Capae Rubiae.... Una capa de tyssue pro Episcopo
puerili ... [duae capae veteres olim pro Episcopo
puerorum].’ Leach, 132, says ‘At York, in 1321, the Master
of the Works gave “a gold ring with a great stone for the
Bishop of the Innocents.” In 1491 the Boy Bishop’s
pontifical was mended with silver-gilt.’
[1277] Lincoln Statutes, i. 290 (Black Book, †1300); ii. ccxxxi.
[1278] Archaeologia, liii. 25, 50; Monasticon, viii. 1282 ‘Item, a
coope of Rede velvett wt Rolles & clowdes ordenyd for the
barne busshop wt this scriptur “the hye wey ys best”.’ The
entry is repeated in a later inventory of 1548.
[1279] Hereford, Consuetudines of thirteenth century (Lincoln
Statutes, ii. 67) ‘Thesaurarius debet invenire ... in festo
Innocencium pueris candelas et ·ijos cereos coram parvo
Episcopo.’
[1280] Lichfield—J. C. Cox, Sports in Churches, in W.
Andrews, Curious Church Customs, 3, quoting inventories
of 1345 and of the fifteenth century. The latter uses the
term ‘Nicholas Bishop.’
[1281] Gloucester—Rimbault, 14, prints from Cotton MSS.
Vesp. A. xxv, f. 173, a Sermon of the Child Bishop,
Pronownysed by John Stubs, Querester, on Childermas
Day, at Gloceter, 1558.
[1282] Norwich—a fourteenth-century antiphonal of Sarum
Use, probably of Norwich provenance (Lansd. MS. 463, f.
16v), provides for the giving of the baculus to the
Episcopus Puerorum at Vespers on St. John’s Day.
[1283] Beverley—the fifth earl of Northumberland about 1522
gave xxs. at Christmas to the ‘Barne Bishop’ of Beverley,
as well as to him of York (Percy, North. H. B. 340); cf. p.
357.
[1284] Wordsworth, Proc. 52; cf. Appendix M (1).
[1285] Ottery—Statutes of Bishop Grandisson (1337), quoted
by Warton, ii. 229 ‘Item statuimus, quod nullus canonicus,
vicarius, vel secundarius, pueros choristas in festo
sanctorum Innocentium extra parochiam de Otery trahant,
aut eis licentiam vagandi concedant.’
[1286] Magdalen—see Appendix E.
[1287] All Souls—An inventory has ‘j chem. j cap et mitra pro
Episcopo Nicholao’ (Rock, iii. 2. 217).
[1288] In 1299 Edward I heard vespers said ‘de Sancto
Nicholao ... in Capella sua apud Heton iuxta Novum
Castrum super Tynam’ (Wardrobe Account, ed. Soc. of
Antiq., 25). In 1306 a Boy Bishop officiated before Edward
II on St. Nicholas’ Day in the king’s chapel at Scroby
(Wardrobe Account in Archaeologia, xxvi. 342). In 1339
Edward III gave a gift ‘Episcopo puerorum ecclesiae de
Andeworp cantanti coram domino rege in camera sua in
festo sanctorum Innocentium’ (Warton, ii. 229). There was
a yearly payment of £1 to the Boy Bishop at St. Stephen’s,
Westminster, in 1382 (Devon, Issues of Exchequer, 222),
and about 1528-32 (Brewer, iv. 1939).
[1289] The fifth earl of Northumberland ( † 1512) was wont to
‘gyfe yerly upon Saynt Nicolas-Even if he kepe Chapell for
Saynt Nicolas to the Master of his Childeren of his Chapell
for one of the Childeren of his Chapell yerely vjs. viijd. And
if Saynt Nicolas com owt of the Towne wher my Lord lyeth
and my Lord kepe no Chapell than to have yerely iijs. iiijd.’
(Percy, North. H. B. 343). An elaborate Contenta de
Ornamentis Ep., puer., of uncertain provenance, is printed
by Percy, op. cit. 439.
[1290] St. Mary at Hill (Brand, i. 233); St. Mary de Prees
(Monasticon, iii. 360); St. Peter Cheap (Journal of Brit.
Arch. Ass. xxiv. 156); Hospital of St. Katharine by the Tower
(Reliquary, iv. 153); Lambeth (Lysons, Environs of London,
i. 310); cf. p. 367.
[1291] Louth (E. Hewlett, Boy Bishops, in W. Andrews, Curious
Church Gleanings, 241)—the payments for the Chyld
Bishop include some for ‘making his See’ (sedes);
Nottingham (Archaeologia, xxvi. 342); Sandwich (Boys,
Hist. of S. 376); New Romney (Hist. MSS. v. 517-28),
Yorkshire, Derbyshire, Somersetshire (J. C. Cox, Sports in
Churches, in W. Andrews, Curious Church Customs);
Bristol—L. T. Smith, Ricart’s Kalendar, 80 (1479-1506,
Camden Soc.). On Nov. 24, the Mayor, Sheriff, and
‘worshipfull men’ are to ‘receyue at theire dores Seynt
Kateryn’s pleyers, making them to drynk at their dores and
rewardyng theym for theire playes.’ On Dec. 5 they are ‘to
walke to Seynt Nicholas churche, there to hire theire even-
song: and on the morowe to hire theire masse, and offre,
and hire the bishop’s sermon, and have his blissyng.’ After
dinner they are to play dice at the mayor’s counter, ‘and
when the Bishope is come thedir, his chapell there to
synge, and the bishope to geve them his blissyng, and then
he and all his chapell to be serued there with brede and
wyne.’ And so to even-song in St. Nicholas’ church.
[1292] L. T. Accounts, i. ccxlvi record annual payments by
James IV (†1473-98) to Boy Bishops from Holyrood Abbey
and St. Giles’s, Edinburgh.
[1293] Wilkins, ii. 38 ‘Puerilia autem solemnia, quae in festo
solent fieri Innocentum post vesperas S. Iohannis, tantum
inchoari permittimus, et in crastino in ipsa die Innocentum
totaliter terminentur.’
[1294] Archaeologia, lii. 221 sqq.
[1295] Transactions of London and Middlesex Arch. Soc. vols.
iv, v.
[1296] Athenæum (1900), ii. 655, 692 ‘data Pueris de
Elemosinaria ludentibus coram Domino apud
Westmonasterium, iijs. iiijd.’ Dr. E. J. L. Scott and Dr.
Rutherford found in this entry a proof of the existence of
the Westminster Latin play at ‘a period anterior to the
foundation of Eton’!
[1297] Rimbault, xviii; Finchale Priory (Surtees Soc.),
ccccxxviii; Durham Accounts (Surtees Soc.), iii. xliii, and
passim.
[1298] Hist. MSS. xiv. 8. 124, 157.
[1299] Computi of Cellarer (Warton, ii. 232, iii. 300) ‘1397, pro
epulis Pueri celebrantis in festo S. Nicholai ... 1490, in
larvis et aliis indumentis Puerorum visentium Dominum
apud Wulsey, et Constabularium Castri Winton, in apparatu
suo, necnon subintrantium omnia monasteria civitatis
Winton, in festo sancti Nicholai.’
[1300] G. W. Kitchin, Computus Rolls of St. Swithin’s
(Hampshire Rec. Soc.), passim; G. W. Kitchin and F. T.
Madge, Winchester Chapter Documents (H. R. Soc.), 24.
[1301] Warton, ii. 231 ‘1441, pro pueris Eleemosynariae una
cum pueris Capellae sanctae Elizabethae, ornatis more
puellarum, et saltantibus, cantantibus, et ludentibus, coram
domina Abbatissa et monialibus Abbathiae beatae Mariae
virginis, in aula ibidem in die sanctorum Innocentium.’
[1302] Harpsfield, Hist. Eccl. Angl. (1622), 441, citing
Peckham’s Register. He says the mandate was in French.
[1303] Visitations of Diocese of Norwich (Camden Soc.), 209
‘Domina Iohanna Botulphe dicit ... quod ... habent in festo
Natalis Domini iuniorem monialem in abbatissam
assumptam, vocandi [? iocandi] gratia; cuius occasione
ipsa consumere et dissipare cogitur quae vel elemosina vel
aliorum amicorum largitione acquisierit ... Iniunctum
est ... quod de cetero non observetur assumptio abbatissae
vocandi causa.’
[1304] Gregory of Tours, x. 16 (M. G. H. Script. Rerum
Meroving. i. 427), mentions among the complaints laid
before the visitors of the convent of St. Radegund in
Poitou, that the abbess ‘vittam de auro exornatam idem
neptae suae superflue fecerit, barbaturias intus eo quod
celebraverit.’ Ducange, s. v. Barbatoriae, finds here a
reference to some kind of masquing, and Peter of Blois,
Epist. 14, certainly uses barbatores as a synonym for mimi.
The M. G. H. editors of Gregory, however, explain
‘barbatoria’ as ‘primam barbam ponere’ the sense borne by
the term in Petronius, Sat. lxxiii. 6. The abbess’s niece had
probably no beard, but may not the reference be to the
cutting of the hair of a novice when she takes the vows?
[1305] Ducange, s. v. Kalendae (‘de monialibus Villae-Arcelli’),
‘Item inhibemus ne de caetero in festis Innocentum et B. M.
Magdalenae ludibria exerceatis consueta, induendo vos
scilicet vestibus saecularium aut inter vos seu cum
secularibus choreas ducendo’; and again ‘in festo S.
Iohannis et Innocentium mimia iocositate et scurrilibus
cantibus utebantur, ut pote farsis, conductis, motulis;
praecepimus quod honestius et cum maiori devotione alias
se haberent’; Gasté, 36 (on Caen) ‘iuniores in festo
Innocentium cantant lectiones suas cum farsis. Hoc
inhibuimus.’ In 1423, the real abbess gave place to the little
abbess at the Deposuit. Gasté, 44, describes a survival of
the election of an ‘abbess’ from amongst the pensionnaires
on the days of St. Catherine and the Innocents in the
Abbaye aux Bois, Faubourg St. Germain, from the
Mémoires of Hélène Massalska. This was about 1773.
[1306] Howlett, Monumenta Franciscana (R. S.), ii. 93
‘Caveant fratres in festo Sancti Nicolai seu Innocentium,
vel quibuscunque aliis festis vestes extraneas religiosas
seu seculares aut clericales vel muliebres sub specie
devotionis induere; nec habitus fratrum secularibus pro
ludis faciendis accommodentur sub poena amotionis
confusibilis de conventu.’
[1307] Denifle, i. 532. It was forbidden ‘in eisdem festis vel aliis
paramenta nec coreas duci in vico de die nec de nocte
cum torticiis vel sine.’ But it was on Innocents’ Day that the
béjaunes or ‘freshmen’ of the Sorbonne were subjected to
rites bearing a close analogy to the feast of fools; cf.
Rigollot, 172 ‘1476 ... condemnatus fuit in crastino
Innocentium capellanus abbas beiannorum ad octo solidos
parisienses, eo quod non explevisset officium suum die
Innocentium post prandium, in mundationem beiannorum
per aspersionem aquae ut moris est, quanquam solemniter
incoepisset exercere suum officium ante prandium
inducendo beiannos per vicum super asinum.’
[1308] Denifle, iii. 166.
[1309] ‘Verbis nedum gallicis sed eciam latinis, ut ipsi qui de
partibus alienis oriundi linguam gallicam nequaquam
intelligebant plenarie.’
[1310] S. F. Hulton, Rixae Oxonienses, 68. There had been
many earlier brawls.
[1311] Statute xxix (T. F. Kirby, Annals of Winchester College,
503) ‘Permittimus tamen quod in festo Innocencium pueri
vesperas matutinas et alia divina officia legenda et
cantanda dicere et exsequi valeant secundum usum et
consuetudinem ecclesiae Sarum.’ The same formula is
used in New College Statute xlii (Statutes of the Colleges
of Oxford, vol. i).
[1312] Cf. Appendix E. Kirby, op. cit. 90, quotes an inventory of
1406 ‘Baculus pastoralis de cupro deaurato pro Epõ
puerorum in die Innocencium ... Mitra de panno aureo ex
dono Dñi. Fundatoris hernesiat (mounted) cum argento
deaurato ex dono unius socii coll. [Robert Heete] pro Epõ
puerorum.’
[1313] The Charter of King’s College (1443), c. 42 (Documents
relating to the Univ. of Camb. ii. 569; Heywood and Wright,
Ancient Laws of the Fifteenth Century for King’s Coll.
Camb. and Eton Coll. 112), closely follows Wykeham’s
formula: ‘excepto festo Sti Nicholai praedicto, in quo festo
et nullatenus in festo Innocentium, permittimus quod
pueri ... secundum usum in dicto Regali Collegio hactenus
usitatum.’ The Eton formula (c. 31) in 1444 is slightly
different (Heywood and Wright op. cit. 560) ‘excepto in
festo Sancti Nicholai, in quo, et nullatenus in festo
Sanctorum Innocentium, divina officia praeter missae
secreta exequi et dici permittimus per episcopum puerorum
scholarium, ad hoc de eisdem annis singulis eligendum.’
[1314] Warton, ii. 228; Leach, 133. The passage from the
Consuetudinarium is given from Harl. MS. 7044 f. 167
(apparently a transcript from a C. C. C. C. MS.) by
Heywood and Wright, op. cit. 632; E. S. Creasy, Eminent
Etonians, 91 ‘in die Sti Hugonis pontificis solebat Aetonae
fieri electio Episcopi Nihilensis, sed consuetudo obsolevit.
Olim episcopus ille puerorum habebatur nobilis, in cuius
electione et literata et laudatissima exercitatio, ad
ingeniorum vires et motus excitandos, Aetonae celebris
erat.’
[1315] Eton Audit Book, 1507-8, quoted by H. C. Maxwell-Lyte,
Hist. of Eton (ed. 1899), 149 ‘Pro reparatione le rochet pro
episcopo puerorum, xjd.’ An inventory of Henry VIII’s reign
says that this rochet was given by James Denton (K. S.
1486) for use at St. Nicholas’ time.
[1316] Maxwell-Lyte, op. cit. 450.
[1317] Hearne, Liber Niger Scaccarii, 674 ‘Item, unam Mitram
de Cloth of goold habentem 2 knoppes arḡ. enameld, dat.
ad occupand. per Barnebishop.’
[1318] John Stone, a monk of Canterbury, records in his De
Obitibus et aliis Memorabilibus sui Coenobii (MS. C. C. C.
C., Q. 8, quoted Warton, ii. 230) ‘Hoc anno, 1464, in festo
Sancti Nicolai non erat episcopus puerorum in schola
grammatica in civitate Cantuariae ex defectu Magistrorum,
viz. I. Sidney et T. Hikson.’
[1319] J. Stuart, Extracts from Council Registers of Aberdeen
(Spalding Club), i. 186. The council ordered on Nov. 27,
1542, ‘that the maister of thair grammar scuyll sell haf iiijs
Scottis, of the sobirest persoun that resauis him and the
bischop at Sanct Nicolace day.’ This is to be held a legal
fee, ‘he hes na uder fee to leif on.’
[1320] Wilkins, Concilia, iii. 860 ‘And whereas heretofore
dyverse and many superstitious and childysshe
observations have been usid, and yet to this day are
observed and kept in many and sondry parties of this
realm, as upon sainte Nicolas, sainte Catheryne, sainte
Clement, the holye Innocentes, and such like; children be
strangelye decked and apparelid to counterfaite priestes,
bysshopps, and women; and so ledde with songes and
daunces from house to house, bleasing the people, and
gatherynge of monye; and boyes doo singe masse, and
preache in the pulpitt, with suche other unfittinge and
inconvenyent usages, rather to the derision than to any
true glory of God, or honour of his saints; the kyng’s
majestie therefore mynding nothing so moche, as to
avaunce the true glorye of God without vayne superstition,
willith and commaundeth, that from henceforth all suche
superstitions be loste and clyerlye extinguisshed
throughowte all this his realmes and dominions,
forasmoche as the same doo resemble rather the unlawfull
superstition of gentilitie, than the pure and sincere religion
of Christe.’ Brand, i. 236, suggests that there was an earlier
proclamation of July 22, 1540, to the same effect. Johan
Bale in his Yet a Course at the Romyshe Foxe (1542), says
that if Bonner’s censure of those who lay aside certain
‘auncyent rytes’ is justified, ‘then ought my Lorde also to
suffer the same selfe ponnyshment, for not goynge
abought with Saynt Nycolas clarkes.’ Thomas Becon,
Catechism, 320 (ed. Parker Soc.), compares a bishop who
does not preach, a ‘dumb dog,’ to a ‘Nicholas bishop.’ The
Articles put to bishop Gardiner in 1550 required him to
declare ‘that the counterfeiting St. Nicholas, St. Clement,
St. Catherine and St. Edmund, by children, heretofore
brought into the church, was a mockery and foolishness’
(Froude, iv. 550).
[1321] Machyn’s Diary, 75 ‘The xij day of November [1554]
was commondyd by the bysshope of London to all clarkes
in the dyoses of London for to have Sant Necolas and to go
a-brod, as mony as wold have ytt ... [the v day of
December, the which was Saint Nicholas’ eve, at even-
song time, came a commandment that St. Nicholas should
not go abroad, nor about. But, notwithstanding, there went
about these Saint Nicholases in divers parishes, as St.
Andrew’s, Holborn, and St.] Nicolas Olyffe in Bredstret.’
Warton, iv. 237, says that during Mary’s reign Hugh
Rhodes, a gentleman or musician of the Chapel royal,
printed in black letter quarto a poem of thirty-six octave
stanzas, entitled The Song of the Chyldbysshop, as it was
songe before the queenes maiestie in her privie chamber
at her manour of saynt James in the Feeldes on Saynt
Nicholas day and Innocents day this yeare nowe present,
by the chylde bysshope of Poules churche with his
company.’ Warton apparently saw the poem, for he
describes it as ‘a fulsome panegyric on the queen’s
devotion, in which she is compared to Judith, Esther, the
Queen of Sheba, and the Virgin Mary,’ but no copy of it is
now known; cf. F. J. Furnivall, The Babees Book (E. E. T.
S.), lxxxv.
[1322] Machyn’s Diary, 121 ‘The v day of Desember [1556]
was Sant Necolas evyn, and Sant Necolas whentt a-brod in
most partt in London syngyng after the old fassyon, and
was reseyvyd with mony good pepulle in-to ther howses,
and had myche good chere as ever they had, in mony
plasses.’ Foxe, Acts and Monuments, viii. 726, celebrates
the wit of a ‘godly matron,’ Mrs. Gertrude Crockhay, who
shut ‘the foolish popish Saint Nicholas’ out of her house in
this year, and told her brother-in-law, Dr. Mallet, when he
remonstrated, that she had heard of men robbed by ‘Saint
Nicholas’s clerks.’ This was a slang term for thieves, of
whom, as of children, St. Nicholas was the patron; for the
reason of which cf. Golden Legend, ii. 119. Another
procession forbidden by the proclamation of 1541 was also
revived in 1556; cf. Machyn’s Diary, 119 ‘[The xxiv day of
November, being the eve of Saint Katharine, at six of the
clock at night] sant Katheryn(’s) lyght [went about the
battlements of Saint Paul’s with singing,] and Sant
Katheryn gohying a prossessyon.’
[1323] At Exton in Rutlandshire, children were allowed at the
beginning of the nineteenth century to play in the church on
Innocents’ Day (Leicester and Rutland Folk-Lore, 96).
Probably a few other examples could be collected.
[1324] At Mainz, not only the pueri, but also the diaconi and
the sacerdotes, had their episcopus (Dürr, 71). On the
other hand at Vienne the term used at all the feasts, of the
triduum and on January 1 and 6, was rex (Pilot de Thorey,
Usages, Fêtes et Coutumes en Dauphiné, i. 179). The Boy
Bishops received, for their brief day, all the external marks
of honour paid to real bishops. They are alleged to have
occasionally enjoyed more solid privileges. Louvet (Hist. et
Ant. de Beauvais, cited Rigollot, 142), says that at
Beauvais the right of presentation to chapter benefices
falling vacant on Innocents’ Day fell to the pueri. Jean Van
der Muelen or Molanus (De Canonicis (1587), ii. 43) makes
a similar statement as to Cambrai: ‘Immo personatus hic
episcopus in quibusdam locis reditus, census et capones,
annue percipit: alibi mitram habet, multis episcoporum
mitris sumptuosiorem. In Cameracensi ecclesia visus est
vacantem, in mense episcopi, praebendam, quasi iure ad
se devoluto, conferre; quam collationem beneficii vere
magnifici, reverendissimus praesul, cum puer grato animo,
magistrum suum, bene de ecclesia meritum, nominasset,
gratam et raram habuit.’ At Mainz lost tradition had it that if
an Elector died during the tenure of office by a Boy Bishop,
the revenues sede vacante would fall to him. Unfortunately
the chapter and verse of history disprove this (Dürr, 67,
79). On the other hand it is certain that the Boy Bishops
assumed the episcopal privilege of coinage. Rigollot, 52
sqq., describes and figures a long series of fifteenth-and
sixteenth-century coins or medals mostly struck by
‘bishops’ of the various churches and monastic houses of
Amiens. They are the more interesting, because some of
them bear ‘fools’ as devices, and thus afford another proof
of the relations between the feasts of Boys and Fools. Lille
monetae of the sixteenth century are figured by Vanhende,
Numismatique Lilloise, 256, and others from Laon by C.
Hidé, in Bull. de la Soc. acad. de Laon, xiii. 126. Some of
Rigollot’s specimens seem to have belonged, not to Boy
Bishops, but to confréries, who struck them as ‘jetons de
présence’ (Chartier, L’ancien Chapitre de N.-D. de Paris,
178); and probably this is also the origin of the pieces
found at Bury St. Edmunds, which have nothing in their
devices to connect them with a Boy Bishop (Rimbault,
xxvi).
[1325] Ivo Carnotensis, Epist. 67, ad papam Urbanum (P. L.
clxii. 87)
‘eligimus puerum, puerorum festa colentes,

non nostrum morem, sed regis iussa sequentes.’
Cf. Rigollot, 143.

[1326] Lucas Cusentinus (†1203-24) Ordinarium (Martene, iii.
39): ‘Puero episcopello pontificalia conceduntur insignia, et
ipse dicit orationes.’
[1327] The Ritual ( † 1264) of St. Omer (Mém. de la Soc. des
Antiq. de la Morinie, xx. 186) has the following rubric for St.
Nicholas’ Day ‘in secundis vesperis ... a choristis incipitur
prosa Sospitati dedit egros, in qua altercando cantatur iste
versus Ergo laudes novies tantum, ne immoderatum
tedium generet vel derisum.’ The same rubric recurs on St.
Catherine’s Day. At St. Omer, as at Paris (cf. p. 363), these
were the two winter holidays for scholars. Cf. also p. 289,
and A. Legrand, Réjouissances des écoliers de N.-D. de
St. Omer, le jour de St.-Nicholas, leur glorieux patron
(Mémoires, ut cit. vii. 160). The St. Omer Episcopus
puerorum also officiated on Innocents’ Eve and the octave.
Dreves, Anal. Hymn. xxi. 82, gives various cantiones for St.
Nicholas’ Day; e.g.
‘Nicolai praesulis
Festum celebremus,
.....
In tanto natalitio
Patrum docet traditio
Ut consonet in gaudio
Fidelium devotio,
Est ergo superstitio
Vacare a tripudio.’
In England it is probable that the Beverley Boy Bishop also
officiated on St. Nicholas’ Day. A chapter order of Jan. 7,
1313, directs the transfer of the ‘servitium sancti Nicholai in
festo eiusdem per Magistrum Scholarum Beverlacensium
celebrandum’ to the altar of St. Blaize during the building of
a new nave (A. F. Leach, Memorials of Beverley Minster,
Surtees Soc. i. 307).
[1328] Tille, D. W. 32; Leach, 130. The connexion of St.
Nicholas with children may be explained by, if it did not
rather give rise to, either the legend of his early piety, ‘The
first day that he was washed and bained, he addressed
him right up in the bason, and he wold not take the breast
nor the pap but once on the Wednesday and once on the
Friday, and in his young age he eschewed the plays and
japes of other young children’ (Golden Legend, ii. 110); or
the various other legends which represent him as bringing
children out of peril. Cf. Golden Legend, ii. 119 sqq., and
especially the history of the resurrection of three boys from
a pickle-tub narrated by Mr. Leach from Wace. A. Maury,
(Croyances et Légendes du Moyen Âge (ed. 1896), 149)
tries to find the origin of this in misunderstood iconographic
representations of the missionary saint at the baptismal
font.
[1329] Leach, 130; Golden Legend, ii. 111.
[1330] Cf. ch. xi. The position of St. Nicholas’ Day in the
ceremonies discussed in this chapter is sometimes shared
by other feasts of the winter cycle: St. Edmund’s (Nov. 20),
St. Clement’s (Nov. 23), St. Catherine’s (Nov. 25), St.
Andrew’s (Nov. 30), St. Eloi’s (Dec. 1), St. Lucy’s (Dec. 13).
Cf. pp. 349-51, 359, 366-8. The feast of St. Mary
Magdalen, kept in a Norman convent (p. 362), was,
however, in the summer (July 22).
[1331] Specht, 229; Tille, D. W. 300; Wetze and Welte, iv.
1411. Roman schoolmasters expected a present at the
Minervalia (March 18-23); cf. the passage from Tertullian in
Appendix N (1).
[1332] Martin Franc, Champion des dames (Bibl. de l’École
des Chartes, v. 58).
[1333] Du Tilliot, 87.
[1334] Julleville, Les Com. 241.
[1335] Julleville, Les Com. 193, 256; Du Tilliot, 97. The chief
officers of the chapel fous were the ‘bâtonnier’ and the
‘protonotaire et procureur des fous.’ In the Infanterie these
are replaced by the emblematical Mère Folle and the
‘Procureur fiscal’ known as ‘Fiscal vert’ or ‘Griffon vert.’ Du
Tilliot and others have collected a number of documents
concerning the Infanterie, together with representations of
seals, badges, &c., used by them. These may be
compared in Du Tilliot with the bâton belonging to the
Chapel period (1482), which he also gives. The motto of
the Infanterie is worth noticing. It was Numerus stultorum
infinitus est, and was taken from Ecclesiastes, i. 15. It was
used also at Amiens (Julleville, Les Com. 234).
[1336] At Amiens the ‘feste du Prince des Sots’ existed in
1450 (Julleville, Les Com. 233), but the ‘Pope of Fools’ was
not finally suppressed in the cathedral for another century.
But at Amiens there was an immense multiplication of
‘fool’-organizations. Each church and convent had its
‘episcopus puerorum,’ and several of these show fous on
their coins. Rigollot, 77, 105, figures a coin with fous, which
he assigns to a confrérie in the parish of St. Remigius; also
a coin, dated 1543, of an ‘Evesque des Griffons.’
[1338] The term cornard seems to be derived from the ‘cornes’
of the traditional fool headdress. Leber, ix. 353, reprints
from the Mercure de France for April, 1725, an account of a
procession made by the abbas cornardorum at Evreux
mounted upon an ass, which directly recalls the Feast of
Fools. A macaronic chanson used on the occasion of one
of these processions is preserved:
‘De asino bono nostro,

Meliori et optimo,
Debemus faire fête.
En revenant de Gravignariâ,
Un gros chardon reperit in viâ;
Il lui coupa la tête.
Vir monachus, in mense Iulio,
Egressus est e monasterio,
C’est dom de la Bucaille.
Egressus est sine licentiâ,
Pour aller voir donna Venissia,
Et faire la ripaille.’
Research has identified Dom de la Bucaille and Donna

Venissia as respectively a prior of St. Taurin, and a prioress
of St. Saviour’s, in Evreux.
[1339] A coquille is a misprint, and this société was composed
of the printers of Lyon.
[1340] Conc. of Avignon (1326), c. 37, de societatibus
colligationibus et coniurationibus quas confratrias appellant
radicitus extirpandis (Labbé, xi. 1738), forbids both clerks
and laymen ‘ne se confratres priores abbatas praedictae
societatis appellent.’ The charges brought against the
confréries are of perverting justice, not of wanton revelry,
and therefore it is probably not ‘sociétés joyeuses’ that are
in question; cf. Ducange, s. v. Abbas Confratriae, quoting a
Paris example. Grenier, 362, however, mentions a
‘confrérie’ in the Hôpital de Rue at Amiens ( † 1210) which
was under an ‘évêque’; cf. the following note.
[1341] I find an ‘évesque des folz’ at Béthune, a ‘M. le
Cardinal’ as head of the ‘Joyeux’ at Rheims (Julleville, Les
Com. 242; Rép. Com. 340), and an ‘évesque des Griffons’
at Amiens (Rigollot, 105). Exceptional is, I believe, the
Société des Foux founded on the lines of a chivalric order
by Adolphe, Comte de Clèves, in 1380 (Du Tilliot, 84).
[1342] Julleville, 236; Guy, 471.
[1343] Julleville, 88, 136. The Paris Basoche was a ‘royaume’;
those of Chambéry and Geneva were ‘abbayes.’
[1344] Cf. p. 304.
[1346] Bulaeus, Hist. Univ. Paris, v. 690; Julleville, Les Com.
297; Rashdall, Universities of Europe, ii. 611. It was
probably to this student custom that the Tournai rioters of
1499 appealed (cf. p. 301). In 1470 the Faculty of Arts
ordered the suppression of it. Cf. C. Jourdain, Index
Chartarum Paris. 294 (No. 1369). On Jan. 5 they met ‘ad
providendum remedium de electione regis fatuorum,’ and
decreed ‘quod nullus scolaris assumeret habitum fatui pro
illo anno, nec in collegio, nec extra collegium, nisi forsan
duntaxat ludendo farsam vel moralitatem.’ Several scholars
‘portantes arma et assumentes habitus fatuorum’ were
corrected on Jan. 24, and it was laid down that ‘reges vero
fatuorum priventur penitus a gradu quocumque.’
[1347] Grenier, 365; Ducange, s. v. Deposuit, quoting Stat.
Hosp. S. Iacobi Paris. (sixteenth century), ‘après le diner,
on porte le baton au cueur, et là est le trésorier, qui chante
et fait le Deposuit.’ Stat. Syn. Petri de Broc. episc. Autiss.
(1642) ‘pendant que les bâtons de confrérie seront
exposez, pour être enchéris, l’on ne chantera Magnificat, et
n’appliquera-t-on point ces versets Deposuit et Suscepit à
la délivrance d’iceux; ains on chantera quelque antienne et
répons avec l’oraison propre en l’honneur du Saint, duquel
on célèbre la feste.’
[1348] Cf. ch. iii and Appendix F; and on the general character
of the puys, Julleville, Les Com. 42; Guy, xxxiv; Paris, 185.
Some documents with regard to a fourteenth-century puy in
London are in Riley, Liber Custumarum, xlviii. 216, 479
(Munim. Gildh. Lond. in R. S.); Memorials of London, 42.
[1349] Julleville, Les Com. 92, 233, 236, 241.
[1350] Clément-Hémery, Fêtes du Dép. du Nord, 184, states
on the authority of a MS. without title or signature that this
fête originated in a prose with a bray in it, sung by the
canons of St. Peter’s. The lay form of the feast can be
traced from †1476 to 1668. Leber, x. 135, puts the (clerical)
origin before 1282.
[1351] Julleville, Les Com. 92, 204, 247.
[1352] F. Guérard, Les Fous de Saint-Germain, in Mélanges
d’Hist. et d’Arch. (Amiens, 1861), 17. On the Saturday
before the first Sunday in May children in the rue St.
Germain carry boughs, singing
‘Saint Germain, coucou,

Ch’est l’fette d’chés fous, &c.’
In the church they used to place a bottle crowned with yellow

primroses, called ‘coucous.’ The dwellers in the parish are
locally known as ‘fous,’ and an historical myth is told to
account for this. Probably May-day has here merged with
St. Germain’s Day (May 2) in a ‘fête des fous.’ Payments
for decking the church appear in old accounts.
[1353] Guérard, op. cit. 46.
[1354] Leber, x. 125, from Mercure de France for April, 1726;
Gasté, 46.
[1355] ‘ludunt ad quillas super voltas ecclesiae ... faciunt
podia, choreas et choros ... et reliqua sicut in natalibus.’
[1356] Leber, ix. 261.
[1357] Julleville, Les Com. 233, quotes a decree of the
municipality of Amiens in 1450, ‘Il a esté dit et declairié qu’il
semble que ce sera tres grande recreacion, considéré les
bonnes nouvelles que de jour en jour en disoit du Roy
nostre sire, et que le ducée de Normendie est du tout
reunye en sa main, de fere la feste du Prince des Sots.’
[1358] Ibid. 214.
[1359] Cf. ch. vii.
[1361] Leber, ix. 150, reprints the Recueil de la Chevauchée
faicte en la Ville de Lyon le dix septiesme de novembre,
1578. Another Lyon Recueil dates from 1566. Cf. Julleville,
Les Com. 234 (Amiens), 243 (Lyon), 248 (Rouen).
[1362] Cf. chs. xiii, xiv. The theatrales ludi of Pope Innocent
III’s decree in 1207 probably refers only to the burlesque
‘offices’ of the feasts condemned; and even the terms used
by the Theological Faculty in 1445—spectacula, ludi
theatrales, personagiorum ludi—might mean no more, for
at Troyes in the previous year the ‘jeu du sacre de leur
arcevesque’ was called a ‘jeu de personnages,’ and this
might have been a mere burlesque consecration. However,
‘jeu de personnages’ generally implies something distinctly
dramatic (cf. ch. xxiv). It recurs in the Sens order of 1511.
The Beauvais Daniel was possibly played at a Feast of
Fools: at Tours a Prophetae and a miraculum appear under
similar conditions; at Autun a Herod gave a name to the
dominus festi. At Laon there were ‘mysteries’ in 1464 and
1465; by 1531 these had given way to ‘comedies.’ Farces
were played at Tournai in 1498 and comedies at Lille in
1526.
[1363] Cf. ch. xv. The Toul Statutes of 1497 mention the
playing of miracles, morals, and farces. At Laon the playing
of a comedy had been dropped before 1546.
[1364] Julleville, Rép. Com. 321 (Catalogue des
representations), and elsewhere, gives many examples.
The following decree (†1327) of Dominique Grima, bishop
of Pamiers, is quoted by L. Delisle, in Romania, xxii. 274:
‘Dampnamus autem et anathematizamus ludum cenicum
vocatum Centum Drudorum, vulgariter Cent Drutz, actenus
observatum in nostra dyocesi, et specialiter in nostra
civitate Appamiensi et villa de Fuxo, per clericos et laycos
interdum magni status; in quo ludo effigiabantur prelati et
religiosi graduum et ordinum diversorum, facientes
processionem cum candelis de cepo, et vexilis in quibus
depicta erant membra pudibunda hominis et mulieris.
Induebant etiam confratres illius ludi masculos iuvenes
habitu muliebri et deducebant eos processionaliter ad
quendam quem vocabant priorem dicti ludi, cum
carminibus inhonestissima verba continentes....’ The
confrates and the prior here look like a société joyeuse, but
the ‘ludus cenicus’ was probably less a regular play than a
dramatized bit of folk-ritual, like the Troyes Sacre de
l’arcevesque and the Charivaris. The change of sex-
costume is to be noted.
[1365] Cf. ch. xx.
[1366] Julleville, Les Com. 33; La Com. 73 ‘Le premier qui
s’avisa, pendant l’ivresse bruyante de la fête, de monter
dans la chaire chrétienne et d’y parodier le prédicateur
dans une improvisation burlesque, débita le premier
sermon joyeux. C’est à l’origine, comme nous avons dit,
“une indécente plaisanterie de sacristain en goguette.”’ A
list of extant sermons joyeux is given by Julleville, Rép.
Com. 259.
[1367] Julleville, Les Com. 32, 145; La Com. 68; E. Picot, La
Sottie en France (Romania, vii. 236). Jean Bouchet,
Épîtres morales et familières du Traverseur (1545), i. 32,
thus defines the Sottie:
‘En France elle a de sotie le nom,

Parce que sotz des gens de grand renom
Et des petits jouent les grands follies

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