Table of contents for Cynics Guide
- Job Adverts
- Cynics Guide: Psychiatric Hotline Protocol
- Define My Madness ?
- You Don’t Have To Be Mad, But It Helps
- Better Than Butlins ?
- Stop In The Name Of My Law !
- Sectioning Detrimental To Self Esteem
- Avoiding Becoming A Patient
- Cynics Guide: Staff Retention (Part 1)
- [Cynic's Guide: How To Blog]
- Cynic’s Guide: Not Taught At University
- Major And Minor Psychoneurotics
I notice in recent comments both Bloo and Zarathustra have foreshadowed what I intended. I intend to totally steal their ideas.
Intervention: Building A Therapeutic Relationship - One
Action: Ignoring Clients With Challenging Behaviour
“Just ignore him nurse, he is only banging his head off the wall to get attention”
All time classic this one. Generally used with ars people with a diagnosis of personality disorder, or just those who decide to be loudly unwell when it is time for a tea break. The theory is that time spent with nursing staff is such a wonderful experience that clients will do anything to repeat it. If they do something loud and messy (slash wrists, kick doors, take a tiny overdose) they will get time from staff. The untaught response to a client in distress, like this, is to ignore them. Otherwise they will just do it again when they want something. Ignoring them reduces the reward leading to a cessation of the disturbing behaviour. Fabulous lack of intervention. Very person centred and never ever leads to increasingly bad behaviour leading to an admission to IPCU or even more fun discharge ! If nothing else makes the nurses look like a bunch of … to the rest of the ward.
Intervention: Time Management
Action: Using “paperwork” as an entirely spurious excuse for not talking to patients (Zarathustra)
“I will be with you in five minutes just after this paragraph.”
In modern nursing there are two schools of thought. One; there is too much paperwork, preventing quality time to ignore patients. Two; there is not enough papaerwork making it difficult to avoid patients. The best time to do paperwork is just when someone is going to need a fair period of attention coming up to the end of a shift, a tea break, lunchtime or sundowning time. The best way to
do the paperwork is at a desk in the office, with the door half open. Have your side on to the door so you can comfortable give a hard stare to the side when you get disturbed. Be surrounded by piles of papers and folders, contents irrelevant. Use defensive body language, pretend you are newly in D wing and your current paperwork is your first meal. Hug it and protect it. When disturbed say you will be out in five minutes. Use this excuse three times. Then say if you do not get it done you will be in trouble, glance Heavenwards and try to look frightened. Another approach is to say:
“Can you stop hanging around the office door please”
in a suitably condescending manner. (Zarathustra)
Intervention: Looking After Your Own Health
Action: Taking Time Off Sick
“My granny died again. No, the other one this time.”
If you need to go off sick, do so. Be prepared though. Even if you come back with a brand new stoma and an amputation at least one quarter of your colleagues will think you are a malingerer. The rest will just want to feel your stump. Prepare yourself by ensuring you put the worst possible interpretation of another staff’s sick time. Point out that it was a Monday, or a Friday. Suggest they did not seem that unwell when they collapsed in a yellow heap. Nod and make hmm noises. By making others seem bigger wasters you decrease your owned perceived wasterness levels.
Intervention: Maintaining A Safe Environment For One
Action: Unobtrusive Special Observations
“No I am not following you, remember you are paranoid !”
Sometimes patients need to be kept safe. Requiring a member of staff to keep them in sight at all times. It is difficult to avoid some patient contact in this situation. You must be sneaky. Whenever the patient makes eye contact with you whistle, any tune will do, I suggest ‘Always Look On The Bright Side of Life”.
Intervention: Mentoring Student Nurses
Action: Encouraging Self Directed Study
“Why don’t you go and research that yourself, it would be a better learning experience”
Students get taught stuff in University. Often they take this book learning and ask mentors about it. Some mentors have difficulty reading the Nursing Standard without following the words with their finger and moving their lips. We get asked things we have no idea about. The secret nurses code for:
“I have no idea what you are talking about!”
is the above comment. When I did my training we got taught about models of nursing. We got taught a lot about them. I, a bright eyed young thing, asked “What model of nursing do you use on Slow Rehab ward.” did actually meet with the response of “What is a model of nursing?”. Eventually the mentors got wise and told me they used “an eclectic approach combing holistic proactive person centred theories.” I think I know what that means now. It means nothing.
[WORK IN PROGRESS - posted to allow contributions, comments will be moved into main post -Mental]
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74 Comments
Mental, you must be/have been working in the ward I was talking about. Or there are lots of them about, which is rather scary!
oh, and I would re-check who said what in the comments, as you have mixed up Zed and me. I don’t use words like spurious!!
Ignoring patients, aaaah. I saw this (and had this) when I was in hospital. St. Ann’s, to name and shame. When people flipped out (like the woman who thought her baby was eating her) they were ignored. And when you needed something, you had better bring your magazine because you had to wait outside the office door for about thirty minutes. If you kept knocking, you were told off for being disruptive.
Also, the nurses failed to spot that my 24 hours awake despite Haloperidol and Lorazepam and my pacing up and down corridors, showing my boobs to a patient and shouting my own name over and over again were symptoms of mania. Discharged next day while thinking that people were following me! I wanted to be discharged, I hated it in there, but they wouldn’t give me any more medication to sleep because it would be “admitting that you were ill, then they won’t let you go”.
The day I was discharged was the five month anniversary of my dad’s death. I was told to stop crying.
Mental, it’s a good job I know you don’t actually believe what you type! Well, you believe that it happens, but not that it should actually be that way.
I thought some of Seaneens comments were very accurate:
“And when you needed something, you had better bring your magazine because you had to wait outside the office door for about thirty minutes. If you kept knocking, you were told off for being disruptive.”
And that’s just the visitors. Imagine how the patients were treated.
“The day I was discharged was the five month anniversary of my dad’s death. I was told to stop crying.”
A similar thing happened to Mr Man. The compassion of these nurses leaves me speechless.
I need to go and think about flowers now. I’m experiencing an anger management problem.
I think it’s time to have some examples of good acute nursing to balance out all this cynicism that I fear I may have unleashed. Maybe I should do the post!
Last year I became Guardian to a seventeen year old with Dissociative Identity Disorder. After falling out over her (deliberately created - she admitted later) bad moods she moved into a bed and breakfast but still noted me as her next of kin on every occassion.
Three months later she was on Crack Cocaine (having not been given either the appropriate accomodation or support I had warned the Authorities she needed) and was admitted to a Centre for Mental Health with drug induced Psychosis.
They dosed her up and had no clue who she was - the Police had not passed on my details to them. Two days later I found out where she was and went and saw the Psychiatric Registrar and filled him in on her history and diagnosis. I told him that she would probably state I was her next of kin when she was awake enough. He, bright guy, deliberately underdosed her next day so he could ask and sure enough she said I was her next of kin.
When I visited her on Chrismas Eve the nursing staff wouldn’t let me leave her teddy bear with her as it was “a fire risk”. I asked the Charge Nurse to intervene and change the ward staff minds. He talked to them but refused and said she could have it in a day or two.
Next day: Christmas day: The staff on the ward refused to let me in saying she did not want to see me.
Next day: Boxing day: I returned and the staff tried the same trick. C - as I shall call her - saw me and shouted “Oy you have to let him in he’s my friend”.
They let me in. But first they took me to the nursing station where I was surrounded by three large male African nurses who were shouting in me in turns “you are not her next of kin”, “this must be a supervised visit”, “she needs family now not you who are you to her? EH ? Eh? who are you? You are nothing”. etc etc etc.
They waved a piece of paper under my nose on which C had written in scrawled dribble coated writing “My mother is my next of kin”.
When she was released a month later C told me the nurses had told her they were going to increase her drugs if she didn’t sign the paper.
C was also by then in a “relationship” with a 40 year old fellow inpatient. The nurses decided letting them have a relationship might quieten her “over-active sex drive”.
C had also by then been given an incorrect diagnosis of Schizophrenia and had started seeing her abusive father again (for money).
The family these nurses thought so important to the person in their “care”: a father found in court to have abused her from birth, an alcoholic mother and the father’s manipulative twisted grandmother.
When I became her Guardian it was under three separate agreements with these appalling people who all claimed “ownership” of C in terms of being her “legal” Guardian, so I had to reach private agreements with them all.
So “if you can’t ignore them, threaten them, if you can’t threaten them screw them” seemed to be the policy of this Centre for Mental Health’s.
I don’t understand. Why are nurses so proud of being crappy, cruel and lazy? Do they have no self esteem?
Ariel wrote:
“I don’t understand. Why are nurses so proud of being crappy, cruel and lazy? Do they have no self esteem?”
I wonder if a lot of it comes down to other discussions that have taken place here. The “Mental Health System” is not actually helping many people towards mental health largely because it’s understanding of “mental health” is a bunch of baloney.
The nurses therefore become prison guards at best.
As experiments about “prisoners and guards” undertaken at Stanford University (I believe it was?) have shown the “prison guards” have a tendancy to become more and more aggressive and controlling and vindictive to the prisoners.
In this situation it might be because the nurses who act this way are aware of the complete inneffectiveness of the regimes they are supposed to be policing or because they are bossed around by a bunch of generally very disturbed people called “Psychiatrists” - a friend of mine who is an NHS Psychiatrist has proposed that at least 50% of the colleagues he knows suffer personality disorder - mostly Narcicistic Personality Disorder.
They don’t have any power to help so the only power left is to control. People given power over others often misuse it.
Having said all that I would like to recognise that there are excellent well trained staff and well run units. It’s a postcode lottery though. No good staff want to work in the Area of East London I live in as it can be “death to their career” to have our local hospital on their CV.
Hence we have only recent immigrant nurses who have inappropriate cultural backgrounds to be doing the job they are doing and often arrive from war torn countries, quite possibly with falsified qualifications. Hence the African men bullyingly assuming wrongly (for their own benefit really - i.e an easy time) that C needed her alcoholic Mum and her Dad who trained her for sex from birth more than she needed me.
Woah there. Nurses who are lazy, who are incompetent or who fall short of the ideal I can accept. Nurses who are deliberately cruel and oppressive are a very rare breed in my quite extensive experience. I’m rather disturbed at the way this thread is heading.
I know that in the 8 years my mother spent as an involuntary (in- and out-) patient, there is only one nurse that she now describes as “cruel”. She had countless nurses looking after her- some were empathetic, some were lazy, some were enthusiastic, some were uninterested. But she only described one of them as cruel- and she is rather prone to taking a dislike to people, so I don’t think she’s trying to spare anyone.
Beakie,
Just for a laugh get yourself admitted to the particular Centre for Mental Health I mentioned. You will definitely meet some good caring people. Mostly I am afraid you will not: You will meet cruel oppressive treatment from people who do not give a fig for you.
The area you live in may be a nicer place to work able to attract a better level of well-trained, well-intentioned and caring nursing staff. The area I live in is not one of those.
The attitude is one of oppressive control and vindictive cruelty.
Also bear in mind that being disturbed at the way a thread is heading may have more to do with your own psychology than any other reality.
Matthew
and Beakie you quoted this yourself:
“Moreover, one third of inpatient staff accept that they or colleagues have threatened to use medication or seclusion to control patients.”
If that is not “deliberately cruel and oppressive”, I do not know what is. And, if one third were honest enough to admit it the real figure is probably higher - maybe two thirds?
Irrreverent Buddhist:
I am uncertain why you are using this thread, intended for some light relief after the abuse thread, to launch into an attack on nurses and the psychiatric system. No one here is an apologist for bad nursing practice, no here would defend the treatment you and your ward have received from the system. So when you post these things and they are left unchallenged it tarnishes the image of the good nurses who have done no wrong. If you must launch into these attacks please feel free to start a thread in the forums.
Comment 13 entirely depends on definition of threat and control.
Please move this discussion to the forums, leave a link and let us get back to the light hearted self deprecating humour.
Mental
Mental, if this post was an attempt at ‘light relief’ I think it seriously misfired. Perhaps if you had ever been on the receiving end of the type of behaviour you described you might fail to see the joke too.
Light relief as opposed to child sexual abuse ? Oh yes.
Everyone has been on the receiving end of this kind of behaviour somewhere along the line. The nursing variations may be different on a superficial level, but any professions dealing worth the public will have members that can not be bothered doing their job properly at one time or another.
Would like to think nurses reading this post would grin at some parts. Shake their heads and make sure they do not actually do any of them.
The examples above are significant overstatements of the nursing behaviours I have observed.
The post is a Cynic’s Guide and tagged humour, neither of which are indicators of seriousness.
But I do take your point. Being on the receiving end of any dehumanising behaviours is never going to be funny. Apologies for any offence.
Mental
Mental
Attacking nurses? Not in general and sorry if I gave that impression. …. I shall depart as requested. Bon Adieu. I leave you to your merry fun with this I wrote earlier:
“Having said all that I would like to recognise that there are excellent well trained staff and well run units.”
Not depart. Really. In my defence I was fairly stressed (in real life) when I wrote the above two comments. It is just you have made your feelings on these particular issues very clearly previously.
Really!
As for all professions being the same, I have never met a psychiatrist who didn’t treat me with respect and courtesy - or do his job well.
Then you are very lucky
Not just health professions. I just meant anyone in any job. Particularly those dealing with the public.
Regrettably I have offended IB enough by my public ’slapping down’ that he has departed the site. Am quite genuinely sorry and I will continue to read his blog:
The Irreverent Buddhist
with interest.
Mental, how dare you trespass onto my territory !!. Offending people is entirely within my remit.
FWIW, I`m still in favour a bit of knockabout and some frank exchange of views. After all, that`s why many of us play out on the internet. The weak and woolly liberals won`t accept it but you certainly can`t say what you think at work. If IB`s and Ariel`s experiences of in-patient sevices have been predominantly woeful then they should be able to flag that up. I`ve only ever worked in an in-patient environment and I`m quite happy to take it on the chin.
Rant:
1/ Im not “offended” as such: I feel slapped down and I am not anyone’s bitch: child, ho or patient on here. Mental - I found your way of dealing with me in public really inappropriate. An email and an edit would have done. And that ^^^ appology nor your emailed one take the public bitch-slapping above back in a way that feels real to me.
2/ It was not “my” ward. I spent one night as an inpatient, voluntarily, ten years ago - the total of my personal “inpatient” experience - not something I have related here. I have visited a number of places to see friends in trouble.
3/ I understand the need to let off steam. But you guys could also understand the psychology of what you are doing. When you laugh at something which is painful and wrong you are dissipating important energy in a negative way. This is a habituated reaction to injustice and learned from society.
It ensures in effect that you ignore the injustice and do not do something about it but “have a laugh instead”. It helps keep the world a mess and keep your wards busy in the long term as problems don’t get solved.
4/ Unfortunately “cruel and oppressive” treatment and tactics in MH units is more common than anyone would wish (i.e 0%). Everyone has a different trigger level of stress whereby this sort of reaction may cut in.
It is not, in my humble opinion, “their fault”, any more than someone with “personality disorder” can be blamed when their own confusions lead them to violence. Such systems as “a mental health unit”: comprising buildings, patients staff and procedures, are complex and their problems have multi-causal links. The other feature of such systems is that problems can emerge into view miles from any of the causes…
5/ I do blame the system and the shrinks:
I particularly blame the thinking behind Mental Illness and Health. Knowledge of the true aetiology of “mental illness” has not come on far since Freud faked his thinking and screwed his “service users” to make sure he kept getting his cocaine money.
My other main target is Psychiatrists themselves and their career structure as doctors.
As George Will, a Washington Post columnist who has long suffered from ingrained conservatism, noted, tartly: “The professors have ideas; the rest of us have emanations of our psychological needs and neuroses”. This can be extrapolated to Shrinks. One out of two shrinks you work with, on average, is certifiably nuts, whilst spending their daytimes certifying people as nuts.
Also psychiatrists and medical doctors are God-like in the system which is partly causal of the above. The Public Accounts Committee recently reported that “managers have all the accountability and no power whilst Consultants have all the power and no accountability”.
This power without accountability is the definition of absolute power. We all know the saying “power corrupts and absolute power corrupts completely”. Can you imagine a more corrupted set up than the current NHS one??? I certainly can not.
I don’t know how nurses put up with the worst of the consultants. Were I a nurse I would have decked too many by now to be employable. I’ve seen consultants treat patients and nurses with the respect they treat dog poo. Maybe most of the bad nursing behaviour may be associated with working with consultants who treat you this way. Worth a scientific study that one.
*absolutely
Are you getting out enough, IB ?
Black humour may well be unsavoury but in many scenarios it is little short of essential.
You are quite right to point out that Freud was flawed and that our aetiological knowledge base has made little subsequent progress. There are a hell of a lot of stones still be turned. You might do well to remember that.
Moreover, one third of inpatient staff accept that they or colleagues have threatened to use medication or seclusion to control patients
Controlling patients is an important aspect of the in-patient nurse’s role. On wards where nurses don’t take control, the lack of safety for everyone - patients, visitors and staff - is palpably evident. While I don’t hold with the idea of threatening patients with medication or seclusion, pointing out the consequences of a patient’s behaviour- which might well include medication or seclusion - is part of gaining that control.
And no psychiatrist, psychiatric nurse or other mental health professional has “power without accountability”. They are accountable for their actions to patients, to managers, to the institutions of law and to their own professional bodies.
IB wrote: “I’ve seen consultants treat patients and nurses with the respect they treat dog poo. Maybe most of the bad nursing behaviour may be associated with working with consultants who treat you this way.”
I couldn’t agree more.
And OSB wrote: “Black humour may well be unsavoury but in many scenarios it is little short of essential.”
I agree with this too.
Trust me IB, I am still in need of counselling after what I have witnessed on wards and how I was treated - and I wasn’t even a patient! But you know what? Sometimes if you don’t laugh you cry, and there is a place for both. If I thought for one minute that Mental Nurse actually believed that treating people this way was funny I would have stopped reading this blog long ago.
I don’t think it was anyones intention to “slap you down”, but your comments are always highly emotive and this blog is open to anyone to read. Maybe Mental Nurse thought your comments would be more appropriate on the forums where the more “serious” readers/ members go?
IB:
1) Yet the apology was very genuine. I think since starting Mental Nurse in March 2005 that is the first time I have snapped so badly. Yet I did believe we (nurses) were put in a position where we would have to defend the indefensible. We are well aware there are some shocking practices in the mental health system we do not condone them in any way, shape or form. The public slapping was wrong. I did just want the particular subject moved to the forums.
5) Actually I probably go further than you here. Power systems do breed corruption and abuses. But when it comes down to particular bad practices the individual is to blame. Particularly with the terrible examples you give. Doctors are impressively educated and should be able to analyse their own practice. Nurses are taught from day one they are responsible for their own practice. The system can provide the backdrop the people do the actual evil.
(Not in response to IB in particular any more)
The post is satire. The Cynic’s Guides are often a little more so than my regular posts. I was, and still am, hoping this thread will be a little light hearted while making us think seriously about what we do and how we interact with patients, carers and others we come into contact with.
Lets take the second example Time Management. There is not a nurse reading this who has not said at some point they will be with someone in five minutes. This five minutes then becomes a special time where every other patient on the ward chooses to have a higher priority disaster. Probably involving screaming in blood. The person waiting happily is unaware of this and ends up feeling neglected. Even with a later explanation this could end up being a defining memory of their inpatient experience. I have never seen a nurse say they will be with someone in five minutes without genuinely intending to be with that person.
I am also intending to make most of the remaining examples to do with nurse politics as it is normally much funnier
Mental Nurse
Feeling a little bit more my normal self!
Updated post!
Right have got round to setting up a forum topic:
The Psychiatric System Is Very Bad
Please read. If anyone knows of good earlier threads on this topic please post the links into the forum.
Oooh, this really is a tricky subject isn’t it?
Beakie:”And no psychiatrist… has “power without accountability”. ”
Mental: “I have never seen a nurse say they will be with someone in five minutes without genuinely intending to be with that person.”
*Mr Mans Wife quietly whistles a made up tune and edges towards the door*
Maybe not never
But very very rarely 
But the minute you say you will be with somebody by a certain time you invoke The Curse.
It’s quiet in here tonight isn’t it.
*runs*
LOL at Bloo
Beakie:”And no psychiatrist… has “power without accountability”. ”
Sorry Beakie that wasn’t one of my weird and whacky ideas it was the Public Accounts Committee of the House of Commons who said that. And they are right.
Managers are accountable to the politicians but Consultants are medically in charge and effectively accountable to no one - oh except the GMC who are of course principally elected by …. Dcotors.
Would you like it if only Police chiefs could vote people on to the Police Complaints Commission? No its a recipe for disaster.
Sorry Beakie that wasn’t one of my weird and whacky ideas it was the Public Accounts Committee of the House of Commons who said that. And they are right.
They aren’t right. To start off with, the consultants I’ve worked with would balk at the idea that they have “power”. Influence, yes, but power? No. They have responsibilities granted them by law, and that’s it. When it comes to power, that still resides in the government who decide law and the legal limits of the psychiatrist’s role and, increasingly, the Trust managers, who have power over funding and even the ongoing existence of the consultant’s post.
Consultants are not free to do what the hell they like, to whom they like without any fear of reprimand. To suggest they are is nothing but scare-mongering nonsense.
Beakie, I would agree with you that most consultants would balk at the idea that they have power, but “most” is not “all”.
We had a very bad experience with a consultant who kept Mr Man on medication that was making him ill just because he could. When I challenged him he smirked. There were other things he did as well and after a very stressful complaints procedure there was no reprimand as the whole thing was swept under the carpet.
Of course we were both very new to the mental health system then and didn’t understand what our rights were, and he knew that. This is not scare mongering, this is how it was. It won’t ever happen again though. Thankfully he was the only one of his kind that we have come across.
Comment moved to this thread.
Mental Nurse
Please just delete every comment and/or article I ever wrote on the site
I see your actions: slapping me down, false appology, failure to withdraw the slapping down , creation of a separate thread and moving of my post there all as part of the denial you are in.
Too insulting for words. Why move my comment and not MMW’s >?????? it makes no sense … ahhh ,..,… I forgot to wait QUIETLY at the nursing station .. of course.
IB
Are you having a bad day?
Mr Mans Wife’s was a specific and focused comment. Also she has a long history of posting well balanced comments. Yours went over into a more general rant against the system which is why the new thread was set up.
Apparently not.
IB seems to be very, very angry at the system, there is no disputing that. Unfortunately, being angry at the people on this forum helps no one. Challenging banter is welcomed, but not flaming, and it appears to me, that is what IB has been doing.
To be fair to IB, I waited a few days before commenting, to allow myself time to calm down and enable me to comment in a more balanced way. I carry a lot of anger too. Even though Mr Man and I have had good experiences with mental health services since the time mentioned above, the anger remains. How can you let go of something like that when there was no justice? Maybe IB’s experiences were more recent than my own?
I suppose the important thing is to remember that none of the people on here were responsible for what happened. All our experiences will be different, and we will each have a different perspective on those experiences due to our different roles - some as service users, some as mental health professionals, myself as a carer.
Anyway, I talk too much…
That is a very fair point MMW. You don’t talk too much. Talking is good for you - so I hear!
Mr Man’s Wife said: Anyway, I talk too much…
No, not at all. I always enjoy reading your comments.
Mr Man’s Wiife Said: All our experiences will be different, and we will each have a different perspective on those experiences due to our different roles - some as service users, some as mental health professionals, myself as a carer.
Which is what makes this site so interesting. However, I think it’s important to have respect for eachother, and IB wasn’t doing that in his recent comments.
Thanks Lou and Bloo.
I stopped at that point because I could feel that I was going to start getting deep!
I mean, this perspective thing - although the consultant I mentioned treated Mr Man disgracefully, everyone had a different view of him. One nurse argued with the consultant over his decisions; one nurse apathetically stated that the consultant “doesn’t care about the patients because he’s leaving soon” but chose not to challenge him; and another nurse supported him unquestioningly. Which one was right?
bloo
I’m not angry at “the system”.
I’m angry at the appologists for the inexcusable, the people who would rather bury their heads than see the shit they are in, and people who treat me like a naughty little boy for trying to express these very understandable feelings.
The post Mental moved from this thread was not a “long rant against the system” (there are good examples of long rants left above as it happens for comparison). It answered/responded to specific points from several different people.
It was moved as an act of Power (Mental’s) over me (a user of this “service”) and it was an abuse of power. Absolute power corrupts and on this weblog Mental has absolute power. I was starting to piss Mental off so I got a slap accross the leg, a warning.
As Mental so rightly put it elsewhere:
“… Though these have shown me that I am losing my balance a little bit.”
Yes. Well said.
I am sorry that I bring a dimension to the discussions here that people do not want to hear. It is the same dimension people have been trying to ignore since freud: it’s being ignored is the reason the mental health of the nation and the mental health system are both in such a mess.
However, no matter how far away you push me, those truths you don’t yet feel able to hear will remain just what they are: True.
IB - as I understand it, this is a moderated site, not a free for all and sometimes decisions have to be made as to whether someone’s comment is acceptable or not. This is not about “power” and its irresponsible exercise, this is about making this site a pleasant and productive place for all contributors. For all you know, there might be people out there reading this site who have serious mental health problems and will be frightened off from seeking help by endless scary tales of dreadful nurses and doctors. That’s not to say that bad practice shouldn’t be spoken about, but that’s not best done by tarring everyone with the same brush.
earlier Beakie wrote:
‘And no psychiatrist, psychiatric nurse or other mental health professional has “power without accountability”’
You are not adverse to “tarring everyone with the same [rose-tinted in your case] brush”.
Whereas even when making statements about negative aspects of the system I repeatedly point out things such as:
‘Having said all that I would like to recognise that there are excellent well trained staff and well run units.’
Beakie I suggest you meditate on the relationship between “Power and Responsibility”. I suggest this because your earlier posts suggest to me you do not understand this relationship. Your last post re-inforces that impression strongly.
The relationship between “Power” and “Responsibility” as I have described it to Mental in the “things I’d rather not hear” forum thread:
‘You can not just rename “powers” as “responsibilities” and make them NOT powers. The whole point of responsibility is that the need for it comes with the existence of power: i.e. there would not be any “responsibilities” if there were no “powers”: thus responsibilities are DEFINED by the powers they are employed in relation to. This is basic.’
Please do not patronise me IB. I have treated you with respect and I expect the same in return. While I admire greatly your passion and your commitment, and while I also agree with you that a great deal of child abuse goes unrecognised by mental health services, I understand fully the difference between power and responsibility, and am merely stating fact that no [psychiatric professional has untrammeled power over others.
Beakie. I have not treated you with anything other than respect, though I have little respect for much of what you say.
I am not trying to patronise you. In my opinion your thinking about power and responsibility is very fuzzy and you aren’t aware of it. I was proposing a useful excercise in self-education.
I haven’t mentioned child abuse in a while. You are the one raising that again and I am unsure as to why.
You are stating your opinion about the real nature of the power dynamics of Mental Health environments. It is your opinion not a fact. The laws in hand and the situation on the ground are not the same thing. And opinions aren’t facts however strongly you express them, as I am sure you would be the first to point out to me.
I haven’t mentioned child abuse in a while. You are the one raising that again and I am unsure as to why
To offer at least part of your view my support, no other reason.
I don’t think it is my thinking about power and responsibility that is at fault here. I suspect it is a lack of a mutual understanding about terms. Please correct me if I’m wrong, but you seem to be of the view that a psychiatrist has unlimited power over the lives of his patients.
But a psychiatrist’s “power” is circumscribed by law. Even if you doubt that he is accountable to his patients, he is certainly accountable to the law, he is accountable to his professional body and he is accountable to such bodies as the Mental Health Act Commission. Not to mention his accountability to his employing Trust and its managers.
Me: Sorry Beakie that wasn’t one of my weird and whacky ideas it was the Public Accounts Committee of the House of Commons who said that. And they are right.
Beakie: They aren’t right. To start off with, the consultants I’ve worked with would balk at the idea that they have “power”. Influence, yes, but power? No. They have responsibilities granted them by law, and that’s it.
“They have responsibilities granted them by law and that’s it” ..though your later “But a psychiatrist’s “power” is circumscribed by law.” … at least admits they do have power - though you deny it… and no, we’re not just suffering a problem of linguistics here either. You originally stated they have no power - this was not and is not correct. The very law you state in defence of that statement actually DEFINES those powers.
Laws define powers and the limits of those powers. In reality though it is a complex web of written law, personal dynamics, instiututional morale and ethics and a number of other factors that limits or otherwise the power of any Psychiatrist or other doctor in any particular situation.
Psychiatry is probably, in my opinion, better regulated than most forms of medicine, by which I mean, less prone to abuse, more oversight built in, more layers of audit, more external audit and simply more laws.
However no audit regime effectively works 100% of the time.
I stand by my statement that they have no power, hence the quote marks around “power” in my previous post. Psychiatrists are just cogs in the machine, same as all of us, and the people with the real power reside in Whitehall just like they’ve always done.
Beakie
It is absurd to say that Psychiatrists have no power. For a start they sometime confine people and medicate them against their will. These actions require power. The terms in which that power is delegated and excercised are technically dictated by the law.
In practice however a number of other factors help determine the real excercise of power. What side of the bed Gordon Brown got out of has little to do with the on the ground excercise of power in Mental Health units as far as I can see.
I don’t believe you wish to maintain the proposition that Psychiatrists have no power. Even if we only confine it to the legal intention and ignore practice. Search the mental health bill for the words “power” and “authority” (synonymous in the context of the bill). You’ll have a long list.
IB
You are being an arse.
For a start they sometime confine people and medicate them against their will. These actions require power. The terms in which that power is delegated and excercised are technically dictated by the law.
Which clearly indicates that power does not lie in the hands of the psychiatrists, but in the hands of the government. The ability to detain and medicate people against their will is a responsibility handed to psychiatrists under the law, a responsibility that is boundaried by the law.
Beakie
All state power is ultimately excercised on behalf of government. Yes.
A question? On a ward is it more likely to be a) 2 Doctors b) 2 Politicians or c) 2 Ladies called Agnes, who sign the papers sectioning someone and confining them to a MH unit for observation?
Keep the answer simpe. The ones who do that (a - for anyone struggling to keep up) are excercising powers on the spot.
They may have been enshrined in laws by the politicians but you will never find a politician excercising those powers, weilding them, using them, because the law DOES NOT EMPOWER POLITICIANS to use this law. It empowers psychiatrists to use this law and these powers.
Beakie the stance you are taking is clearly absurd. If you really believe it and it is true you teach nurses I for one am worried.
Lou, by the by, you are being an arse**** … if you dont have something concrete to add and just want to flame people like that ^^^ just shut it instead?
“Lou wrote:
IB
Are you having a bad day?”
“Lou wrote:
…it’s important to have respect for eachother, and IB wasn’t doing that in his recent comments.”
“Lou wrote:
IB
You are being an arse.”
….
practice what you preach Lou.
You might not like what I say but I am not and have never resorted to personal insults as a form of argument and I was not being disrespectful to anyone. YOu have namecalled me more than onvce in this thread. I don’t appreciate it. If you have a dislike for what I write I suggest you don’t read it.;
IB - this discussion has moved away from your initial claim: that psychiatrists have power without accountability. They clearly don’t, and you seem to have shifted somewhat towards this view.
What is happening now between us is a circular discussion about the nature of power wherein I point out where the real power lies and you talk about the exercise of legally-granted and strictly circumscribed “powers”. I suggest we drop this, as it’s going nowhere. I seem to be taking a more “meta” view of power, whereas you are focussing on the particular, the “micro” view.
In terms of the relationship between a psychiatrist and his patient, then it is true to say there is an imbalance in the amount of control or influence one person has (the patient can’t detain the psychiatrist, for instance). However, the patient is not a totally powerless pawn in the psychiatrist’s hands, and nor is the psychiatrist free from being under the control of any other more powerful influences.
For instance, the fear of public inquiries means that defensive practice is often the dish of the day.
I would appreciate it if you didn’t make snide insinuations about my ability to do my job based on my contributions here. It’s unhelpful, offensive and unlikely to lead to constructive dialogue.
Beakie it was not a snide insinuation but a genuine concern stated blatantly.
I stated quite plainly that if you really believed what you were saying I was worried about the quality of education new nurses are getting. And I meant it.
Having said that, my concern is lessened somewhat by your last post in which you clearly recognises the truth is not as you have previously claimed: on the ground the Psychiatrist has powers given to him, and circumscribed, by politicians in parliament.
At the same time as changing your argument you suggest we drop the subject. I’m quite happy to drop it now you have dropped the impossible to defend line you were formerly trying to take. In fact there is no argument any more.
Except to say you were not taking a “meta” point of view, you were taking an abstract reductionist point of view that meant your arguments were absurd. I was taking a meta point of view and your attempt to confine it with your abstract reduction was always destined to fail.
I give up. You win. Happy now?
I’ll take my savaged olive branch and go home.
You already gave up. I “won” before we started. You were being silly.
I hope that makes you very content, IB, but I’m now extremely reluctant to discuss anything with you in future.
Withold your love :O —- ooh I am scared —
Next time just don’t try and hold up a piece of patent nonsense as “fact” for so long then discussing anything with me will be less problematic for you.
My intention wasn’t to scare you, IB, but to indicate that perhaps your debating style is a little oppressive and bullying. Go on - have the last word, I know you can’t resist it.
Phew is it over?
*passes Slurry a piece of shortbread*
*smiles at Lou*
Can I have a bourbon?
*Passes Beakie a bourbon* Shhh Dont tell Dr Crippen
*passes Beakie a nice cup of tea*
*passes Mental a biscuit*
P.S. I can’t comment on the live chat ????
Had that earlyer on, just refresh the page.