Searching for a Psychoanalytically Informed Nursing
I wish to speak to the conceptual insulation of clinical psychoanalytical thought as identified in Metabola’s original Editorial by inviting an interaction with the discipline of nursing. In this textual space I wish to further encourage nursing philosophy’s generative mission1 and promote a rhizomatic association towards psychoanalysis. This is an invitation to a metaphorical holiday destination' for psychoanalytically informed thought, one that necessitates the translation of thinkers, concepts, approaches into an alternative culture of health/care – nursing.
On the vast cartographic atlas of humanity whereby we categorise our epistemic findings and organise the ensuing cognitive, physical, and emotional labour to ontologise that which we believe we know, one may suggest that these two discipline are not so distinct. In terms of clinical proximity, the primary subject of focus is that of a patient, or service user, or client. The professional practices concerned with such individuals have, ostensibly, similar trajectories, though this is considered in the widest possible formulation of health. For this, I consider such labour to be in the promotion of one’s affective capacities to make, resist, or transform. With this un/certainty regarding both outcome and means, why are my hands pressed against the glass of psychoanalysis, my gaze filled with both desire and longing?
You see, a primary concern within nursing is the difficulty of manifesting theory into application. A secondary concern, prudent here, is the academic discipline of nursing’s reluctance to engage with theory that has not been generated or suitably naturalised within the field. There are historical reasons for this disciplinary defence mechanism. Nursing, from its inception as professional, academic occupation within the world of healthcare in the 1950s, has needed to justify itself across three primary vectors. 1) Personal validation; the noble eschewing of the gendered and power-laden relationship of nurse-doctor. 2) Professional validation; the solidification of role and purpose, by conceptualising what a nurse is and what a nurse does. 3) Academic validation; the requirement to institutionalise the metatheoretical directions of nursing knowledge, so to guide the development of subsequent knowledge generation and clinical practice in a manner distinct to nursing. That is, the desire for a Kuhnian2 metaparadigm which indicates both disciplinary coherence and separation from others.
It is for these reasons unique to nursing that it is afraid of psychoanalysis. The fraught history of psychoanalysis and psychiatry has its own battlefield that I sidestep here.
You; the psychoanalytically informed, the training practitioner, and your canonised forebears. You are onto-epistemically foreign to us. Your work does not speak to us so and so, in turn, we shall not listen. Where the analyst follows the retreating patient into the world of the symbolic, the nurse resolutely remains – and seeks to reimpose – all that is concrete. The psychological discourses that nursing most commonly interfaces with, so entwined with the neoliberal demands of cost/benefit, mostly serve to only perpetuate this position.
So, I reiterate my invitation to cross thresholds, to resist the boundaries which offer security at the expense of alternative forms of knowing and doing. To be clear, nursing as a profession deals with some of the sharpest points of human suffering, so an element of conservativism is to be expected within a profession governed by risk. However, exemplary medical care, outside of biomedical directives, should not exclude any opportunity to seek improvements in the outcome of their patients. One should look upon such rigid disciplinary boundaries with distain. Such essentialism tends towards totalising epistemic structures, and, within nursing, this has been proclaimed proudly.3 The prospect of building the psychoanalytically informed nurse is a delightfully uncomfortable experiment. It would involve reflecting inwards and generating something else; a new configuration of the nurse-assemblage. It would be differential proposition as to what the nurse is and what they do. It would be an act of deterritorialization, a destabilisation of the rigid conceptual formations nursing has built yet has found, ironically, limited utilisation in day-to-day clinical practice. So, let us find spaces of novelty and play.
Psychoanalysis does not fix nursing, nor does it guarantee answers to questions that go unsolved in the discipline. Indeed, such uncertainties are the driving force behind all intellectual endeavours, including this humble collection of words. What is wished, however, is a transversal linkage between nursing and all other bodies of thought which concern the ecology of humanity. Any attempt to appreciate the human subject holistically,4 as post-humanist theory would suggest, demands the rhizomatic association between those who examine the deepest depths of the psyche to those who monitor atmospheric composition. You too, psychoanalysis, require participation in this ethics of interdependence.
With this, I long for a gradual shift – a glacial shift, if one wishes a slice of morbid sardonicism with their metaphorical holiday – in openness within nursing and those who collaborate with them as academic and clinical colleagues. There are several means by which this may manifest. Of course, it wouldn’t rhizomatic otherwise, now, would it? I elect here for a manner echoing Braidotti’s call for a shift from doxa to praxis5 - a shared project that is realised through a consideration of our mutual relatability. Only with such understanding can we then drive towards a better ecology of health.
I conclude with a clinical vignette which I hope elucidates the tensions of the concrete and symbolic that reside in the potential of the nurse.
“A patient, who had been convicted of multiple criminal offences by a British court, was detained under a particular section of the Mental Health Act. These relevant portions of the Act constitute the formal codification of the messy relationship between criminality and psychiatry. His whole being had been judged, evaluated, and organised by the judicial and medical systems, who form a productive vector in the control of such individuals, and now he involuntarily resided on a forensic ward in a psychiatric hospital.
It was early in the morning, as the day staff exchanged their customary hello/goodbyes with the passing night shift, when this patient approached the nursing station – a semi-circular desk that sits at the intersection of the ward. He politely addressed the nurse standing behind the desk and candidly made the comparison that the nurses at the hospital were like the wardens at the prison: they both played a role in the deprivation of his liberty. He wished to leave and we, of course, would not let him do so.
It was the sound of keys that reminded him, as the two groups of staff noisily entered and exited the ward as a part of the morning’s handover, he said. It was the sound of the key bunches, prominently displayed on our belts, which constantly reverberated throughout the white, spacious corridors of the ward as we went about our business of care. Bright and wide, purposefully designed to promote a panoptic visibility and reduce potential sites of physical altercation - this was the space he was not allowed to depart from. This was the space of his treatment.
He, so I the student thought, sought connection, confirmation, affirmation. Instead, he received a dialogue of defensiveness from the nurse, who called upon a colleague to help stress to the patient the differences of those who minded him across the two locations. They kept him in a different place for a different purpose, yes, but they were keeping him here all the same. Their circular conversation continued for some time. I recall most keenly the second nurse’s initial response:
“You are not a prisoner; you are a patient, and we are nurses.”
About the Author
Liam Simmonds is a graduate of International Relations BA, Sociology MPhil, and now a postgraduate student in Mental Health Nursing MSc. He strives in the collating of multidisciplinary resources to better explore post-human psycho-social phenomena. He is based in London, United Kingdom.
Zahra Sharifi-Heris & Miriam Bender (2003) What constitutes philosophical activity in nursing? Toward a definition of nursing philosophy based on an interpretive synthesis of the recent literature in Nursing Inquiry (30:4)
Thomas Kuhn’s (1962) The Structure of Scientific Revolutions was an oft-cited basis within this process of “academic validation”
See the ‘holarchy’ constructed and promoted by influential nursing theorists such as Jacqueline Fawcett i.e. Contemporary Nursing Knowledge, 2nd Ed. (2005)
The notion of “holistic care” is, in the UK at least, a leading discursive concept driving the organisation and delivery of care by accounting, supposedly, for all facets of the individual within treatment.
Rosi Braidotti (2013) The Posthuman