Finding the plot


  • T. STICKLEY ma dipn dipcouns rmn

    Lecturer in Mental Health
    1. School of Nursing, University of Nottingham Duncan MacMillan House Porchester Road Nottingham NG3 6AA UK
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Welcome to this special edition of JPMHN focusing on the arts and mental health. In this edition we are seeking to ‘find the plot’ through creativity in mental health nursing. The term ‘losing the plot’ (a possible allusion to madness) implies that we had one in the first instance, and, somehow, perhaps over time we have lost it. In this special edition, we are proposing that the plot that we once had was human creativity for well-being, and the plot we are rediscovering is a return to human-centred approaches in mental health nursing philosophy, practice and research, which relies a lot upon good human relationships and a fundamental belief that creativity is intrinsic to being human. If there is an art to mental health nursing, this edition is intended to promote the development of that craft. Such a common sense approach has become compromised with complicated theories, science vs. art arguments, evidence-based medicine, political debates, emerging socially inclusive policies and so on. So, first, to history  . . . 

While treatment in the 18th century asylums might have been considered appalling (Scull 1993, Porter 2002), the subsequent ‘moral treatment’ of the insane brought with it humane approaches that included (to some extent) engagement with the arts. It is Hogan (2001) who points out that this fact is often omitted from historical accounts of the arts and health care, and challenges the popular idea that art therapy originated in psychoanalysis. The reformer Pinel (1745–1826), who has been attributed as the father of modern psychiatry, also gave attention to the patient's story. The arts and narrative approaches in mental health care therefore have a long history. The York Retreat, founded in 1796 under the leadership of William Tuke, has become the best-known example of providing moral treatment, although as Digby (1985) observes, it was not so much the activities that were provided and were considered curative, but the provision of such by people who genuinely cared and provided good therapeutic relationships and who willing to not only ‘treat’ the patient, but listen to their life-stories.

Thus, creative approaches are associated with narrative and good human relationships and go back a long way (we could go on about Aristotle and Plato but we shall leave more in-depth discussion to the contributors). The ‘good human relationships’ concept is repeated in mental health nursing theory ever since Peplau (1952) published her seminal work ‘Interpersonal Relations in Nursing’. However, the centrality of narrative in good mental health practice has received little attention in mental health nursing research.

It would be remiss of me to not point out, at this juncture, that the editor of JPMHN has recently co-authored a book on narrative approaches in nursing (Holloway & Freshwater 2007); and a very good book it is, too! So, in this special edition, we are focusing not only upon the arts and mental health practice but also upon narrative in mental health research, and the significance of people's stories in both research and practice. With this in mind, we have included in this edition narrative accounts from researchers and artists and some poetry written by people who use mental health services. In their theoretical paper, Biley and Galvin document the growing evidence for the arts and humanities in nursing research and offer the ‘lifeworld’ as a philosophical framework for ‘re-humanising’ health and social care. Short et al. beautifully merge narratives from several voices and in this ‘true story’ performance; the reader becomes uncomfortable with the indistinct roles of the actors who appear as mental health nurses who become people experiencing distress. Clearly, not everything in the creativity garden, however, is rosy: Louise Pembroke reminds us that creative expression is not always healthy and good for us. Current research continues to identify that there is a constructive place for the arts in contemporary mental health practice. We have pleasure in presenting a paper that includes findings of a British government-sponsored research project into social inclusion and the arts that confirms the benefits of engagement in community arts projects by way or promoting recovery (a concept Pembroke finds repugnant!). The French have adopted culture and health as a political priority for many years now, and Polly Moseley shares with us an example of a flagship project in Paris, La Maison de Solenn ou La Maison des Adolescents.

The social science research world is replete with narrative-based literature and methods, and, as mentioned, is growing in the nursing literature, too. This narrative turn, as it has been called, may be first attributed to the work of Roland Barthes (1977) who first proposed that the social sciences should employ narrative methods. Although originating in the arts and humanities, narrative inquiry has more recently emerged in medicine and nursing under the umbrella term of ‘illness narrative’. Frank (1995) identifies three fundamental illness narratives: restitution, chaos and quest. Restitution narratives are those of the person anticipating recovery; chaos narratives are enduring with no respite; quest narratives are those where people discover that they may become transformed by their illness. What is common to all types of illness narratives is the focus upon the centrality of the telling of the patient's experience. This is for both epistemological and sense-making functions (Gabriel 2004). The epistemological concerns itself with furthering knowledge of a disease from first-hand experience and the sense-making are more to do with making sense of illness, or extracting meaning from the experience, thus infusing hope and subsequent recovery.

Furthermore, there are those who have combined discourse approaches with narrative inquiry in various disciplines. Naturally, there are those who are ‘discourse analysts’ and others who are ‘narrative analysts’, ultimately however, there is no conflict in bringing the two together as narrative constructs discourse and (some would argue) a discourse is a narrative. This multiple lens, multiple voice approach (Chase 2005), has been said to begin to generate new forms of consciousness in research approaches (Gergen & Gergen 2003). So, in this edition of the JPMHN, we are sharing in this ‘consciousness’ and hoping that future editions will carry more reports of the arts in mental health, together with more narrative approaches in research.