Headlines and Hysteria

The media is a double edged sword. While on one hand they do a vital job in keeping us informed about what is going on in the world, sometimes uniting the public on certain issues, on the other hand they can sometimes create hysteria and misinformation. This occurs frequently on the issue of mental health.

Schizophrenic jailed after vicious knife attack

This is a typical example of a headline that occurs in our press with increasing frequency. This kind of headline reinforces an unfair and incorrect stereotype. The stereotype that all schizophrenics are violent and dangerous. This is totally untrue.

But before we address this we must first define the word 'Schizophrenic'. There is a popular notion made apparent in jokes, figures of speech and media that a schizophrenic has a 'split personality.' This is totally untrue.

Schizophrenia is a mental illness that, in it's simplest form, causes its sufferer to hear voices, to believe things that aren't true (such as that people on the television are talking about them), to be convinced that everyone is talking about them (paranoid ideation), and in some cases to see things that aren't there, although this is relatively rare, usually occurring in drug induced psychosis.

Sufferers can experience low mood, disinterest in themselves or their surroundings, lack of concentration, lack of motivation and self neglect. This is by no means an exhaustive list and sufferers may suffer from some or all of these symptoms. Nowhere in this list of symptoms is 'suffering from a split personality'.

Going back to our headline, Schizophrenia sufferers are far more likely to want to hurt themselves rather than hurt anyone else. The suicide rate amongst young male schizophrenics is higher than in any other section of society. They are typically very shy, quiet and may be viewed as a little odd to the people around them, rather than the screaming, axe wielding madmen (and women) that the media has depicted them as.

Another word the media have taken over is the word 'sociopath' (which means the same as psychopath.) It is popularly believed that the word sociopath and serial killer are one and the same thing.

Although the majority of serial killers are indeed sociopaths, it does not necessarily figure that the opposite is true. Sociopathy is a type of what psychiatrists call a 'personality disorder'. People who suffer from it tend to be very charming and manipulative whilst at the same time be incapable of remorse, have no empathy for neither humans nor animals and are unable to learn from their mistakes. While this makes them unpleasant people to be around and, certainly, to be close to, it does not automatically make them killers.

I have nursed a number of sociopaths and they are, without exception, exhausting people to be around. They are very demanding and will take and take whilst giving nothing back. The most exhausting part is that they are so adept at manipulating people and situations that you can never trust anything they say or do.

Statistically less than 2% of murders in Britain last year were committed by people with a mental illness.

Living with schizophrenia is a living hell for some people. They have to deal with so many disabling symptoms, they have to take medication that can cause unpleasant side effects. Many people who suffer from schizophrenia are lonely and isolated, the stigma that surrounds mental illness being such that making friends is difficult.

Sufferers need help and understanding, empathy and support, not to be labeled as violent and dangerous. The media has such power and responsibility in this country. I hope one day they will wield it in a way that helps, rather than harms the people who need the help most.

JOLLY MAD..and glad!

There are many ethical questions involved in nursing that I could spend hours discussing, as ethics is a particularly favourite topic of mine. However this is not the forum for a long academic discussion, instead I will just briefly touch on the ethical question I have in mind, and then give you some examples.

I have always questioned what right we have to force medication on someone. I am not talking about a person who is at risk to themselves and a danger to other people, in that case it is a necessity. I am talking about people who have no idea that they are 'unwell' but who are perfectly happy being totally and utterly stone mad.

I’ll give you an example. I worked with a gentleman, whom I shall call James, a few years ago who was totally sure he was the king of some imaginary country. He was a lovely man. Once a week in most acute psychiatric units the consultant psychiatrists will come to the ward where their patients are being treated to have a ward round, or basically a discussion about that patients care. In some wards it is policy that the patient is there for the discussion, this was one such ward. Now I am not sure if you are aware of this or not but consultant psychiatrists are a BIG deal. Most of them are phenomenally knowledgeable and have a great deal of power and responsibility. I don't know many nurses who are comfortable calling the psychiatrist they work with by their first name, certainly for me it has always been 'Mr'.

So it was time for James turn at the ward round and, as he believed that he was a king he, quite rightly in his mind, believed that his subjects should stand to attention when he walked in a room, he was after all gracing people with his presence. A ward round was no different, so as he walked in the meeting room with social workers, nurses, myself included, junior doctors and the consultant psychiatrist. James stood at the door, paused, then said in a masterful voice, 'Arise'.

Now the rest of us had been nursing James for a while and so we all dutifully rose to our feet. The consultant psychiatrist, however, had never met James before. To give him his due though, after a moments bemused hesitation, he very soberly stood until James entered the room.

There would be some that would argue that by 'rising' for him we were buying into his delusion, however I see it like this: James in, 'real life' was a single 50 year old man who had no money, no hope of ever getting a job and had he been in society he would have been mocked as 'that weird guy'. Which would you rather be? A king or a 'weird guy'. James ruled a country, he was powerful and adored by his subjects and most importantly he mattered. Realistically he was stuck in a psychiatric ward where, to most people he didn't 'matter'.

James never hurt a soul and never hurt himself so did we have the right to take away his vastly preferable reality? Studies have shown that some people who hear voices quite like the company and I have personally nursed someone who was forced to take medication to take away the voices that he had. He then got discharged, went home and hanged himself. Without the voices he was lonely. That may be an extreme example, and a particularly tragic and heartbreaking one. But it does raise questions about the power of the medical profession and the choices we make for people.

A Dark Humour and a bowl of fruit.

Anyone who works in professions such as the police and the medical profession has, I suspect, something of a black humour about them. I think that it is a necessary tool in the armoury of anyone who has to work in a job where pain and tragedy are an everyday thing. I have seen and heard of many amusing things but I think one of the funniest is one that involved a member of staff that I worked with. The funniest things are usually to do with amusing things that your colleagues have done I guess!

In the acute admission ward where I was working at the time, we were nursing a lot of very unwell patients. Some of these patients had to be placed on what was called constant observations. A situation where an allocated member of staff had to sit with, follow and basically be within sight or sound of a particular patient at all times. This can be intense work so staff usually do this in hourly rotations. There are a number of reasons for patients being placed on observations, and these determine how closely you observe the patient. If someone is at risk of harming themselves then the staff member has to be within a very close proximity to that patient, for example. This particular patient, who I will call Susie was an absconsion risk, meaning that she basically wanted to run away. And in a ward where people are extremely ill that isn't always a great idea. So a nurse we will call Jane was sitting outside Susie's room, right in front of the door so that there was no way that Susie would be able to leave the room without her knowing. Because Susie was not a suicide or violence risk it was not necessary to watch her for every second. The basic rule in the trust I worked in at the time was that you had to be within either sight or sound of the patient who was an absconder risk. It was accepted practice to sit outside someone's single room with the occasional look through the observation window to make sure that the patient didn't need anything. Now in 12 years of training and practising I never once saw a problem with this policy. A room has one door, windows that don't open and has a member of staff sitting right outside that one door. How could anything go wrong? Well one day it did. Spectacularly and, looking back, hilariously.

Jane, the nurse, was sitting outside the room and decided to have a wee check on Susie to make sure she didn't need a drink or whatever. But when Jane looked through the small observation window, Susie wasn't there. Jane looked again, and then again. No, Susie had disappeared. Poor, poor Jane must have thought that she was going mad, and then all hell broke loose. The keystone cops had nothing on that ward that day! As soon as that alarm was sounded people entered the room to find… a bowl of fruit in place of where Susie's head should have been. Then someone heard a sound from above. They looked up and came to the realisation that Susie was in the roof. In the ward at the time the ceilings were quite easy to move, the ceiling tiles were movable, and that is exactly what Susie had done. Now suggestions started flying around, 'call the fire brigade, phone her husband' what was the unfortunate nurse supposed to say to the husband? 'I am awfully sorry sir, we've lost your wife in the roof'

The other problem and fear the staff had was of safety. What if Susie fell through the roof? So, ever resourceful as nurses tend to be, they grabbed a mattress and started to follow her movements up in the roof from below. The vision of these professionals going, 'left a bit, right a bit' has me crying with mirth whenever I think of it. Of course at the time it wasn't an amusing story, especially not for Janice, the nurse who had been allocated the patient. But now, looking back it has become hospital folklore and poor Janice has never been able to live it down. As it happened the lady’s husband was called and he was able to talk her down, and no one was hurt. Apart from Janice’s pride, which I am sure will take a little longer to repair.

Humour is so important in life as well as nursing, and what is funnier than human nature!

 

A Different Approach

Us nurses are an invaluable tool in our job, especially in my experience as a psychiatric nurse. The way an individual handles themselves and other people is very telling of how effective or otherwise they are as a nurse. Personality traits come into play here, with varying results!

I have worked with a wide variety of care givers with personalities and approaches as varied as the illnesses in the people that they take care off. I would say that to the lay person some approaches may seem harsh, but what one must remember about psychiatric care is that sometimes 'tough love' is required to get the best for the patient. Nurses are not there to be liked, they are there to get the best both for and from their patients and there are no set in stone methods to get it. Sometimes you are just flying by the seat of your pants! (A concept I am quite sure any of us are pretty familiar with!)

One particular sub species of nurse that are always a pleasure to work with are Glaswegian psychiatric nurses. They are the most unflappable people I have ever had the pleasure to meet and work with, some of the funniest and certainly the toughest.

As in most inner city psychiatric hospitals the atmosphere in an acute admissions unit in Glasgow is noisy, frantically busy and occasionally there is a hint of menace, of a pot about to boil over under the surface.

It was on a typical day like this that S/N Martin Franks was at his best. In the office, which was the size of a cupboard there was an irate relative on the phone and a poor first year student had been asked to speak to them, she was getting redder and redder as she tried to get a word in edgeways.

A female patient was being bundled up the corridor to put some clothes on as she was in the middle of a manic episode and had run naked down the corridor. A young male patient was standing just out of the office door shouting that he hadn't got his medication and that he needed his, ‘drugs’. I was attempting to speak to a MHO (Mental health officer) on the phone. In the middle of all this sat Martin, quietly reading a file. I briefly had time to wonder how on earth he managed to read anything in all that racket. The patients' indignant shouts were getting louder and began to have an edge of aggression to them. Still Martin kept on reading, and did not appear even slightly disturbed by the chaos all around him, that is until it got personal.

During a brief lull in all the noise the male patient was heard to yell, 'Bitch'. I assume this was directed at either me or my female colleague. Martin, however looked up from his file, stood up and walked in an unhurried fashion over to the male patient. By this point we were all watching to see what would happen, expecting fireworks, a confrontation. But Martin just walked up to him, gave an imperceptible shake of the head and laid a hand gently on his shoulder, at this the patient simply shrugged and walked off. Martin just came back in the office and sat down to read his file again.

This is not an unusual situation. I am sure most nurses know of someone who appears to have this instant soothing manner that quell tempers and make everyone’s job easier. Of course not everyone responds to this approach. I worked with a fantastic nurse called Janice, she had worked in the prison service for years, was about 4' 11'', blond and pretty, but she certainly wasn't a push over! In fact, she was utterly terrifying. I witnessed grown, tough drug dealers cower under her rage. She reminded me of a sister in an old fashioned private school, all the boys were frightened of her but at the same time adored her, and probably had a crush on her.

These are, of course, opposite extremes and there are many approaches to nursing. It doesn't matter what approach you end up taking. It isn't usually a deliberate decision, rather you find what approach suits the rest of your personality and if it works for you and the patient and it’s within the bounds of professionalism then it’s right. A lot of time is spent during modern training talking about the ‘right’ way to approach patients. In my opinion what differentiates a good nurse from a fantastic one is the ability to judge each situation in a split second and decide on the best course of action for that patient.

People don’t come with a guide book about how to approach them, and neither should nurses. That is surely the intuitive skill of nursing.


#all names have been changed to protect identities#

The first day

In my career as a psychiatric nurse I have experienced intense highs, heart breaking lows, life changing moments and days when the pressure was so intense that I wanted to throw in the towel. But what has never waned has been my passion and dedication to the job. It is full of memorable moments quite out of the range of most people's daily experiences. Some of them sad, some tragic, some extremely funny but all of them I will never forget. I don't feel that anything prepares you for that first day of being a proper 'fully fledged' nurse and I am sure that many of you will identify with some of the feelings mentioned in this story!

My first day as a psychiatric nurse is one I will never forget. As I stood outside the imposing grey stone building I felt sick with nerves and as if I was about to pass out with something akin to terror. If I could have done I would have turned tail and fled back to the train station and boarded a train to pretty much anywhere but where I was supposed to be! Having just completed a 3 year student nursing course I naively believed that I knew a thing or two about nursing. I realised at that moment that I knew nothing.

As I walked through the doors I was assailed by what felt like a wall of noise. Phones ringing, eerie screams and the clatter of unspecified metal. I couldn't differentiate between people, they all appeared like an overwhelming homogenous mass I involuntarily took a step back and at that moment I saw a woman bearing down on me with the most inhuman screeching noise emitting from her mouth,

I froze as her screech turned to a cackling noise that sounded totally unearthly. I am not ashamed to say that that I was utterly terrified! Then I heard a gentle, calm and very Glaswegian voice behind me, ‘Claire, stop frightening people'. I swung round and saw a man leaning against a door frame, smiling slightly. The effect on the woman was instantaneous. She seemed to deflate to about half her size and no longer looked like the harridan of a couple of minutes ago; instead she looked like a rather dejected older lady.  ' Would you like a ciggie? ', he said. She considered this for a minute and then she broke into a crooked smile that showed brown broken teeth, grabbed the proffered cigarette and, with a last glare at me she shuffled of down the corridor.

I realised at this point that I hadn't breathed since the incident began. I turned to the man who had spoken and he put out his hand, ' Hello,' he said,' welcome to the madhouse!' at that he turned and went back into the room that he had emerged from.

I learned a very important, and very early lesson from this experience. Nursing is about so many varying skills, among the most important is knowing your patient, knowing what their triggers are, what makes them tick. This can often make the difference between a major incident and an amusing anecdote.

This skill cannot be learned through textbooks or through sitting in lectures. It can only be learned through experience, observation and utilisation of the sixth sense that I believe all excellent nurses have. At this very early stage in my career I hoped that I would be able to gain this skill in my future. Of course I was to meet many shall we say ‘challenging' people over the course of my career an sometimes I got it right. Sometimes horribly wrong!