Over the past 20 years I have enjoyed teaching postgraduate and undergraduate students from a wide range of health and allied health professions, and at several different universities. I have marked or moderated thousands of pieces of work and learned a lot from diverse perspectives on the experience of life, health, and illness. But despite the passage of time, one assignment remains at the forefront of my mind.
This was a reflective account written by a student approaching the end of their first year as an undergraduate healthcare professional. In it, the student explored their first experiences in clinical placement with a focus on one particular patient; although this person had presented with a physical condition – let`s say appendicitis – they also had a known diagnosis of schizophrenia.
As I read through the student`s introduction to their work, one sentence leapt out at me; the student described their fear and trepidation of approaching this patient because “it was my first psychiatric and I know that they can be violent”.
There was no evidence in anything that the student had written that the patient was behaving differently to any other patient experiencing acute and severe abdominal pain, but their account conjured up an image of a lion tamer approaching a particularly agitated and angry animal.
Before deciding how to respond, I had to take a break from marking to enable the thoughts swirling in my mind time to settle down. My first feeling was disappointment that even after more than 6 months on the course the student considered this comment to be appropriate; to me at best it demonstrated a lack of compassion and empathy for an individual likely to be experiencing significant distress. I then reflected on the fact that not only did the person marking their work (me) have a known psychiatric condition, but that other members of the teaching team had also had their own experiences of mental ill health.
Was this student`s reaction to their encounter with a patient diagnosed with a psychiatric condition the reason several the academics involved with their professional education so closely guarded the secret of their own diagnosis, or vice versa?
All I knew at that point was an irrational fear of what the student`s response would be if they found out that their work had been marked by a ‘psychiatric’, and for much longer than a moment I actually questioned my ability to mark this work. This despite having three degrees (including a PhD); being a registered nurse; being Called to the Bar; having qualified teacher status; being a PhD supervisor and examiner; having Fellowship of the Higher Education Academy (and since then - Senior Fellowship) and many years’ experience as a lecturer and external examiner. The thought actually entered my mind and sat there for a good while before I was able to justify to myself that yes, I was qualified to mark this first-year undergraduate assignment.
There is a well known saying that “sticks and stones may break your bones, but names will never hurt you” but I really cannot agree with it. Although I tried very hard to protect my own children from the pain unkind words brought them, I felt that it was my responsibility to make them understand that what they said to people could, in fact, be very hurtful. Because it is not necessarily the words themselves that are so damaging, but what they represent.
For me, “it was my first psychiatric and I know that they can be violent” brought to mind images of the enormous, dark and forbidding Victorian psychiatric hospitals – the latter day ‘lunatic asylums’ – that I had visited on my ‘mental health’ placement as an undergraduate nurse in the late 1980s. These were places where the mentally ill were locked safely away ostensibly for their own protection, but likely more so for the benefit of the wider community. Even in the more recent days of ‘care in the community’ my experience is that this ethos is perpetuated; my own psychiatric outpatient care has been provided in a unit tucked away in a corner away from the main general hospital buildings.
So, I think I will continue to play my own small part in challenging long held views and misconceptions about ‘psychiatrics’ and our place in contemporary society.
Until next time,