"Does it make any difference that I have had a depressive illness myself?"
"Yes, it does," replied the Chairman of the interview panel. "It means that you will have more understanding of the patients". In the l960s, I had been admitted to a traditional psychiatric hospital which was characterised by an authoritarian system of government, staff hierarchy and custodial care.
Battling with depression, and difficulties with concentration and memory, had left me without energy or motivation. I was panic-stricken at the feeling that I was losing my grip on life. The ward was pleasant and light, and my early days as a patient were spent 'under observation' as I sat, fully dressed, on my dual purpose bedside locker. I was totally passive and had hardly the strength to speak.
Formerly very independent, I found myself relying on a team of kind uniformed nurses to provide my food, supervise my personal hygiene, and carry out the consultant's treatment regime formulated to cure me.
The change of environment made me feel more like a person than a 'patient'.
As my state of mind improved, and I became more responsive, my days were spent in the Occupational Therapy Department. There I joined other people in individually chosen creative activities, and decided to make a small rug.
The change of environment made me feel more like a person than a 'patient'. We had all been through a challenging time, and derived benefit from this period of rehabilitation. I made two or three friends with whom to socialise after we were discharged. In the 1970s, I was fortunate to train and work as a nurse in the first psychiatric hospital to function as a Therapeutic Community.
Its distinctive feature was that treatment took place progressively through daily interaction between all its members, and through scheduled ward meetings and groups. No differentiation was made between patients and staff, or between the hospital and the rest of society. It was a form of social psychiatry.
My experience as a patient enabled me to understand.
I began working as a staff nurse on a long-stay ward, which was the patients' home. They were engaged in all the activities of daily living, and attended ward meetings and occupational therapy as part of their treatment. Some went to work in different areas of the hospital, and they each had a personal account for when a nurse accompanied them to the shops to buy clothes or shoes.
We had to combine respecting their rights with appropriate encouragement of their independence. My experience as a patient enabled me to understand feelings of not being acceptable, not belonging, rejection, and being paranoid about what people might be saying. However, in the interests of the patients, I must not allow empathy to make me over-protective or to become over-involved. I coined for myself the cautionary phrase of 'detached involvement'.
I coined for myself the cautionary phrase of 'detached involvement'.
The qualities demanded of a psychiatric nurse were patience and understanding, the ability to listen and never judge, to be without prejudice, to be reassuring and encouraging, and to know when to suggest behavioural change. Openness and honesty were required in all interactions with patients, their relatives and our colleagues.
There was a decade, and quite a contrast, between my receiving care as a patient and offering care as an autonomous nurse. I had been a passive recipient in a traditional psychiatric hospital at a time when mental illness was more of a social stigma. In the therapeutic community, patients and staff were equal and I had to be prepared to use myself in a treatment relationship with the patients. This was a challenge for everyone.
My book Unrehearsed Journey was suggested and titled by my parents some thirty years before I started writing it. For most of my life, I have been asking two questions: Who am I? and Why am I here? At a privileged 80 years, I want to share the journey to my answers. Knowing who we are can lead to inner peace and fulfilment of our true potential; and it's never too late to start something new.
It was not only the patients who learnt about themselves in the therapeutic community. We all did.
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