Missing Pieces: The presentation of mental health nursing in narrative fiction and the role of the practitioner/writer by Henry James Murray Bladon A thesis submitted to the University of Birmingham for the degree of DOCTOR OF PHILOSOPHY Department of Film and Creative Writing School of English, Drama and American and Canadian Studies College of Arts and Law University of Birmingham August 2017 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT Missing Pieces is a novel about mental health nursing and the difficulties faced by the profession as Ron seeks an understanding of his personal and professional world. The novel challenges traditional stereotypes, offering a greater range of character depictions. The critical discussion asks why mental health nursing is represented in fiction like it is. By first contextualizing the argument within the sphere of fictional representations of other health professions, it then examines the stereotypes of mental health nursing in fiction and argues that, while literary shortfalls are in part supported by clinical evidence, existing novels fail to accurately depict the experience of the profession. With reference to the nursing theory of Peplau and others, we not only see the failures of fiction writers, but realise that mental health nursing must assume some culpability, by failing to disseminate its identity with sufficient clarity. Looking at the work of Freya Barrington and Monica Starkman in other health disciplines, it asks how fictionalised accounts of mental health practitioner/writers can integrate into health education programmes, and looks at the professional benefits of writing fiction including continuing professional development. Finally, it points to potential areas for further investigation. ii ACKNOWLEDGEMENTS My first thanks must go to my wife, Jane, who, over the past three years (and more), has had to listen to endless ideas, plot lines, character developments, and other ramblings in the development of this work. My thanks also to my supervisors, Dr Richard House and Dr Dan Vyleta, for their academic and creative guidance. I should acknowledge my fellow students with whom I shared many afternoons in Birmingham discussing the merits of relevant submissions, especially Rachel New, for her helpful comments and mutual support. I am also grateful to those mental health nurses who were generous enough to discuss the project and help inform the content. A special mention to all the writers, practitioner/writers and health care professionals who gave me their time and were kind enough to respond to emails, phone calls and requests for interviews. Specifically, and in no particular order: Paul Sayer, Nathan Filer, Paul Crawford, Femi Oyebode, Mark Radcliffe, Clancy Sigal and Felicity Stockwell. iii To Jane, for whom this journey has been infinitely more painful iv Table of Contents The Novel: Missing Pieces ...................................................................................................... 1 Critical Thesis ..................................................................................................................... 303 Introduction ....................................................................................................................... 304 Mental health nursing image in fiction: Is it worth writing about? ............................................ 305 The Evolution of Missing Pieces ................................................................................................. 310 Chapter One ....................................................................................................................... 315 The Impact of media representations on attitudes to mental health and the effect on mental health nurses .............................................................................................................................. 315 Health and social care professionals in fiction ............................................................................ 317 Social Workers ........................................................................................................................ 317 Psychiatrists ............................................................................................................................ 319 General Nurses ....................................................................................................................... 323 Chapter Two ....................................................................................................................... 326 Myth surrounding Mental Health Nursing .................................................................................. 326 Mental health nurses in fiction................................................................................................... 327 The Portrayal of Power ........................................................................................................... 340 Contemporary Relevance ........................................................................................................ 350 On Writing Character ................................................................................................................. 353 Another way ........................................................................................................................... 358 Chapter Three .................................................................................................................... 365 Where’s the thread?................................................................................................................... 366 The invisible bond: The therapeutic relationship as mental health nursing’s greatest asset ..... 367 Identity and Voice ................................................................................................................... 370 Closing the gap ........................................................................................................................... 377 Chapter Four ...................................................................................................................... 378 Positive Outcomes from Fiction ................................................................................................. 378 The role of the Practitioner/Writer ............................................................................................ 379 How Missing Pieces addresses the issues in this thesis .............................................................. 387 Character detail ...................................................................................................................... 387 Realistic portrayal of the nursing role ...................................................................................... 389 What do such works potentially achieve for Mental Health Nursing? ........................................ 395 How fiction can benefit professionals and end-users alike ......................................................... 400 Summary ............................................................................................................................ 402 Conclusion .......................................................................................................................... 406 Bibliography ....................................................................................................................... 409 Appendices......................................................................................................................... 435 ‘Big Nurse’ Ratched: An Alternative Take ................................................................................... 435 The Evolution of Mental Health Nursing in Britain ..................................................................... 444 Other Recurrent Themes in Narrative Fiction ............................................................................. 448 Pitfalls for practitioner/writers .................................................................................................. 452 v The Novel: Missing Pieces 1 ‘I’m an addict, working with the mad is the only sane thing I’ve found in this mad, mad world’ (Mental health nurse Les O’Brien in Clancy Sigal’s Zone of the Interior). 2 Chapter 1 A patient in a green cardigan was shouting at a bench. She turned when she heard his footsteps and their gaze met. She paused and her words suddenly became lucid. She said, ‘I know when I’m mad.’ Ron watched her shuffle off and he started back up the drive. Cars coughed their way past him in the early morning gloom. He stared through the darkness at the hospital view he knew so well. He could only see the outline, but it didn’t matter, because the panorama of the place was stored in his head. The sweep of the male long-stay ward, the female geriatrics, the alcoholic unit that was the old TB isolation ward, the admin department with and all that paper. Then there was the chapel,