Nurse training

Mental Health Nursing,  May 1999  by Allen, Cris

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It's an unpredictable passage these days, a career in mental health work. In times past you went off to the asylum as a boy or girl and stayed there as man or woman. Then you retired, hanging up the white coat for the last time, put your feet up and reflected on your life's work as a psychiatric nurse and all that meant, both good and bad.

Your offspring may have donned the hospital suit and gone off to nurse training, too, inheriting your bunch of keys and taken over your stool at the social club bar. They may have had a more varied career with the closure of the hospital, the development of community care and the comings and goings of an array of new-dawn paradigms in the policy and practice of mental health care.

Then there may be grandchildren, now learning the ropes through a PRDN programme, in practice and lecture settings, miles away, metaphorically and logistically, from the closed-down hospital. They are on a very unpredictable path with the horizon laden with present and proposed change.

Old-timers mumble with incredulity about what has gone on and get dewy-eyed reminiscing about the institution, its farm, its sports teams, the grub, the kindly medical superintendent and the happiness of the patients. 'Those were the days; formaldehyde, insulin and electricity had their faults, but we were happy.'

The unpredictable path has led me back to my student stamping-ground. The hospital where I trained is still there, but is empty and awaiting demolition; or, if a recent documentary about one such hospital is to be believed, gentrification and conversion into poncey apartments, available for truckloads of money to rather sad people who seek the companionship apparently built into the developers' vision. Sing-- songs, socials, communal eating and recreational areas, and beautiful grounds to stroll in when it all gets too much or your neighbour across the corridor starts saying peculiar things. A sort of asylum that you actually buy into. Weird really.

I bump into staff who I recall from years ago, transplanted with the clients into new settings. It doesn't take long before the conversation turns to the past: a wicked charge nurse, an infamous patient or drunken conquests allegedly made in the nurses' home. Some former patients are still around, living in accommodation on the peripheries of the hospital campus. Their views, like the staffs, are mixed with regard to the progress mental health care has made - wistful recollections of the institution from some, clear enjoyment of a rather more 'normalised' existence from others.

Branch line

I am here now in a research post, which, in part, means libraries and seeking information. Fiddling among the literature is a process of serendipity, a colleague tells me, and just when you lose all hope, you fall upon the most informative article on whatever it is you are exploring.

In my case, serendipity led me to a piece on local railways. (No, please, you must understand how broadly the novice researcher has to search!) What I learnt from this was that from the now closed local railway, a branch line led off, with the sole purpose of serving the hospital, delivering everything that maintained it: coal, food and, of course, its lifeblood - patients.

Having arrived at the picturesque village station patients would alight from the train on to a chain-fenced, segregated platform, only accessible from one side of the carriage and kept separate from the platforms used by the general public. The asylum's own version of Thomas the Tank would then convey the patients across the fields to the hospital.

I wondered how this might have felt for the travellers, who were possibly distressed, impoverished, morally defective, imbecilic, low-grade, or whatever other enchanting sobriquets were applied to people whom society wanted banged up. Relief perhaps that their hitherto unpredictable life-passage was to become more ordered, if custodial, within the well-- intentioned hospital? Terrorised that despite entering such an ordered system they would face an unpredictable future within equally unpredictable regimes of care? Did they even know where the train was taking them?

The railway line was dismantled in I959, heralding new mental health philosophies, which for clients and staff alike have brought improvement but which have sometimes proven as unpredictable and temperamental as the modern railway network.

Cris Allen is a research nurse

Copyright Community Psychiatric Nurses Association May 1999
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