nursingforsocialjustice

Does everything get commodified? It’s strange sometimes, how something like a journey of self-discovery intended to contribute to the greater good can turn into a journey of self-indulgence and self-promotion. Academia feels f-ed up sometimes. Do you ever feel like you get a bit too caught up in a metaphorical pat on the head and a “good job”?

I cannot stop thinking about the connection between psychiatry and mental health nursing (we also call it psychiatric nursing, and it is debatable if they are the same thing). I cannot stop thinking about the harms we do, the harms that most often fall on the shoulders of nurses. And I wonder, why it is so hard to talk about the pain we feel as nurses when we do things like forcing someone to take medication they are telling you they do not want to take, or not letting them outside, or locking someone in a room? And the pain we feel when we say things like, “because it’s the rule and it’s the same for everyone” when we know the “same for everyone” is an outcome of the stigma that we are fighting against?

It’s easier if we have rules to defer to, and we can distance ourselves from being the makers of the rules, we are just the enforcers of them. But sometimes these larger structures that we work within do not match up with these smaller frameworks that we build within that larger structure. For example, how does a framework that consists of trauma-informed practice, strengths-based care, individualized care, cultural humility, recovery, within the larger structure of the same rule for everyone, risk-aversion, prioritizing diagnosis, focus on problems, safety strategies that include locked doors and locked room, systemic racism, and involuntary treatment really work? And we don’t talk about it.

I cannot even remember the number of times I have brought up something like the harms of seclusion rooms that have been met by: “well what else can we do?” The larger systemic issue boiled down to: what could we have done in this moment, right now, within these constraints within this system that already exists? And no, maybe there was nothing that could have been done in that moment. But, if each moment is taken as separate incidents that are justified by doing the best that we had at the time and ignore the larger issue of continued and ongoing harm, then what are we doing? What are we doing? And, why are we doing it?

Have you read the book Stigma by Erving Goffman? This illness narrative of mental illness, is it helping us or hurting us? What does it erase and obscure?

Why don’t we use self-esteem scales, quality of life scales, self-perceptions of stigma, symptom management scales as outcomes measured for people in mental health services if we identified some constellation of problems? Or why don’t we talk to patients about what they want to measure as outcomes? Why don’t we collect before and after narratives and self-reflections about their experiences if we are so concerned about things like the patient voice? Why don’t we let patients write a something about themselves and include it in their health record? Does this somehow erode the integrity of the professional stature of something? Sometimes (maybe often) I wonder, the way we do things now, who and what are we doing any of this for? We say things like, “the service is so dynamic and responsive” but…to what? To who? And how? Do you ever read something and think: what does any of this actually mean to the person, people, communities that are seeking help? Is this just brainstorming and a fresh re-brand of an old set of ideas and understandings? Maybe I’m just having another existential crisis, but maybe these ideas are something.

Peace,

Michelle D.