PsychoPathology: Space, Social Perception, and Mental Disorders ...

In the Philos-L "The Liverpool List" I noticed this (online) issue of Psychopathology and was drawn to its themes, especially that of space.

TABLE OF CONTENTS

129. Space, Social Perception, and Mental Disorders: Phenomenological and Empirical Approaches
Bader, O.; Bizzari, V.; Fuchs, T.
https://www.karger.com/Article/FullText/524754 (Open Access)

132. Scale for Space and Time Experience in Psychosis: Converging Phenomenological and Psychopathological Perspectives
Arantes-Gonalves, F.; Wolman, A.; Bastos-Leite, A.J.; Northoff, G.
https://www.karger.com/Article/FullText/519500

143. Alterations in the Experience of Time, Space, and Intersubjectivity and the Interaction with Pre-Existent Psychopathology during the COVID-19 Pandemic
Lau, I.; et al.
https://www.karger.com/Article/FullText/522345

156.  Reopening Selves: Phenomenological Considerations on Psychiatric Spaces and the Therapeutic Stance
Thoma, S.; Schwnzl, I.; Galbusera, L.
https://www.karger.com/Article/FullText/517888

168. Borderline We-Space? The Phenomenology of the Background of Safety in Borderline Personality Disorder
Van Duppen, Z.; Schmidt, P.; Lowyck,B.
https://www.karger.com/Article/FullText/520860

179. Borderline Personality Disorder, Lived Space, and the Stimmung
Lo Monte, F.; Englebert, J.
https://www.karger.com/Article/FullText/521182

190. Background Feelings of Belonging and Psychological Trauma
Wilde, L.
https://www.karger.com/Article/FullText/518327

201. Interpersonal and Intersubjective Alienation in Social Stigmatization and Depression
Paskaleva-Yankova, A.
https://www.karger.com/Article/FullText/519253 (Open Access)

211. Gestalt Perception and the Experience of the Social Space in Autism: A Case Study
Bader, O.; Fuchs, T.
https://www.karger.com/Article/FullText/524562 (Open Access)

Edited - removed active links, affiliations, spurious text codes/line breaks, added one et al.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

psycho- space Intra- Interpersonal Intersubjective	-pathology space empirical
social perception 'We-space'?	space 'We-space'?

High Intensity Networks - serenity integrated mentoring SIM model of care

individual
| 

 INTERPERSONAL : SCIENCES 

 humanistic ----------------------------------------------- mechanistic 

SOCIOLOGY : POLITICAL

| 

 group

'Serenity' a humanising term? TRAUMA informed? Expressing distress Poor coping skills Suicidal ideation, Plans, Intent Self-harm Personal Responsibility -  Serenity Practitioner values? Therapeutic modality Access to Therapy - DBT ...? Active research in this field - Parity? Chaotic presentation [Define] High Intensity: Needs highly personalised care 'person-centred care' 'This' is why I became a MH Nurse: Values

High Intensity Network# and “serenity integrated mentoring” (SIM) model of “care” Nursing theory: 'patiency' Integrated Recovery Programme - IRP [Define] High Intensity: Attempted suicide, Frequency, Nos. of services, Nos. of A&E attendances, Dual, n-diagnosis, Data Evidence-base Independent review Mare Serenitatis: Peace on the Moon? Resource allocation: Framing the problem* 'Clinically'

Language & Terminology 'High Intensity' Education of students: 'committed' - 'completed'? Care in the Community (Social) Serenity Social Justice Community - MH Nursing - of Practice Therapeutic relationships Historical artefact: The therapeutic alliance

Policing, Law & Enforcement “high intensity users” (HIUs) of emergency services Mental Health [Police officers] Teams Criminalisation Decriminalisation of Suicide 1961 (Organisational) Serenity? High Intensity (Service-centred) Cost, Time, Personnel, Services involved Commissioning, Policy Outcomes - Cost Savings? NMC MH Nursing Standards MH Nursing Curricula

^#Website not provided: "Service Temporarily Unavailable" 

*There is a 'problem' here. Is the main symptom and sign however, evidence of an ongoing lack of parity of esteem?

My source: Twitter - various

 

Stranger in a strange land: 'Adult' CMHT

I've started working in an 'adult' community mental health team. This is a change in character from older adults and in Hodges' model we can draw the discussion on this out in several directions.

The 'adult' - 'older adult' distinction on one hand may seem discriminatory. So, once you are aged 65 you move to another service? On the other hand there are many scholars / professionals who have over many decades fought to have older people's needs recognised, represented and funded as a distinct speciality. There are protocols accepted and practiced that should - must also take into account the patients (carers) wishes allied with needs and circumstances.

The 'character' is also different between adult - older adult, but both carry unique challenges*. This must always be the case if the patients and their situation are viewed as unique.

3.5 days in - I'm already aware of changes in community mental health provision. My previous experience 16-65 goes back to 1995, apart from having some patients during studies in psychosocial intervention in psychosis.

There seems to be more chronicity and I have a sense that suddenly 'nursing' has a welfare and benefits problem solving flavour to it.

The summit I've just posted about is invaluable learning, as I have inherited a caseload of people living with varying forms of diagnosed personality disorder. I'll expand on this experience over the next few weeks. This is timely as I have re-validation next year.

Over many years I have heard of Paris the clinical record system. Now I will be having training and become a 'user'. Looking forward ...

*With challenges also come rewards!

'Problem patients?' 2 - Appease me do (not)

Many of the aspirations of nursing are just that - aspirational.

Appeasement and other similar 'power' associated concepts helps explain some of the appeal of Hodges' model - with its inclusion of a POLITICAL care domain. The needs of the ONE (interpersonal care domain) are diagonally opposed by the needs of the MANY (political care domain).

Just because I may approach someone (*evidently*) abusing medication / alcohol, over-eating, risk taking ... does not mean I am prepared to continue to nurse them and hence support them in that behaviour. Attempts to engage can be made and (must be) documented, as subsequent referrals and care will build on those care encounters. There is a marked difference between those individuals above who are often socially excluded, risk takers and people who are preoccupied with their health and mental health state. (Are such people stuck in the 'sick role?) Such patients may well seek new drugs and then instantly question the medication they are taking, never satisfied, they may query their care record and care while in hospital by virtue of their personality and anxieties.

I can reject negative behaviours and attitudes, but not the person. As a member of the health care team I can explain clear terms for future engagement should the patient wish. At the end of the day we constantly review: do they have mental capacity and to what extent does their behaviour present a risk to themselves, or others...? There is also a role for specific care management to be effected, to screen and prevent people reaching emergency services when this is repeated and unnecessary. The combination of some conditions such as long term respiratory problems and anxiety can create acute management problems, both for the individuals concerned, their family carers and care providers.

People do have choices to make, and so must take responsibility for how they exercise those choices.

Crucially this also needs to be explained to referrers - e.g. general practitioners / family physicians. For effective care management the inclusion of paramedic, crisis, social and intermediate care services in care management communication and coordination is also essential.

So, there is absolutely no need for a "current model of appeasement based care".

(This is a wind-up - surely? If not I am available for career advice.)

Yours truly and the patient's (even if it hurts),

Peter Jones

'Problem patients?' 1

Nurse Philosophy list

'Problem patients?' 1 - Wimps and space to care

I responded to a mail list discussion around 'problem patients' which began with the following main points:

• a relatively new nurse
• surprise that a significant minority of (my) patients are pathological wimps;
• even prior to seeing them they can often easily be spotted by examining their medical records;
• for example, I frequently notice that wimps have an obscene (and often downright odd) amount of special meal requests;
• current nursing philosophy encourages nurses to be endlessly supportive of wimps. i.e. to follow the often demonstrably wrong idea that "the patient is always right.";
• IMO nurses who claim they benefit such patients using the current model of appeasement based care are co-dependent personality types who enjoy feeling needed more than they enjoy actually helping people.

My first response is copied below with some additional points a further post will follow:

Patients are always a challenge in that they come in lots of 'varieties'. This is why we recognise the need for individualised, person-centred care. One variety is physical trauma laden to which the full-complement of the multidisciplinary team must respond. These patients and *their* crises bring out the best in us in terms of the skills and knowledge, team work they force us to exercise.

Among the plethora of other varieties there are those who are viewed as 'problems'. Like the Pepsi ad of decades ago they are variously and pejoratively described as -

multiattendin, attentionseekin, patiencesappin, bedblockin,
buzzabuzz-buzzin, heartsinkin, timewastin,
symptomfindin, carenumbin
.... patients!

If I receive referral information or heads up information on diagnosis of a 'tci' (to come in) that suggests the above is on the way, has arrived or worse "is on your caseload" - what do I do?

• Brace myself for impact?
• Go off sick (suffering loss of job satisfaction)?
• Become purely task or disease focussed, give up on effecting +ve change and improved outcome?
• Share collective anecdotes in the office - staff changing as a way to cope, de-stress, inject some humour?

OR do I -

• Avoid labelling them, or use these labels in a re-constructive way?
• Ask why are they 'who' they are?
• Gaze into their 'life history' and help them learn from it?
• Refuse to make gross assumptions, even based on previous experience with client - patient?
• Look at the individual wholistically - socially, educationally, behaviourally?
• Believe you can still make a difference (be the fly-half you can be and play ball)?
• Side step being tripped by foibles, behaviours and blatant displays of -ve obstructive ...... attitude that offend 'me'?
• Enter their space and do my utmost to find room for manoeuvre (this is the hardest test)?
• Speak to my manager(s) very tersely about protecting 'me' as a scarce resource and shout "OK where the hell is the gate keeper!"
• Or, as a nurse do you boldly go and seek out new strengths and new opportunities in the same way that Kirk, McCoy, Spock et al. (2264) go and seek New Life, New Civilizations...?

You may have an impossible lock to pick (in its most severe form this has become known as 'personality disorder'), but the nursing challenge is there in all its personal and professional glory. Address this personal - under-the-skin - slant - seek supervision. Be aware of the pit that some people fall into. The trap for some people with life chances they may have completely:

missed, never had, were stolen, denied,
took for granted, spurned,
totally - wasted.

Around the pit is the zone of judgement, but beware it is a singularity (no perspective) and very slippery.

• Otherwise go do your job: Nurse.

Nurse Philosophy list

Reference:

Kirk, McCoy, Spock et al. (2264) The Caring Imperative, To Boldly Go..., Four Quadrant Galactic Care Journal, Integrated Galactic Care Publishing Inc. itess-cube: 1701u-care4mesafelyandnicely