The implications of Kristeva's notion of the abject in understanding the significance of therapeutic knowledge and practice in mental health nursing

Abstract

Mental health nursing knowledge is largely excluded in certain key clinical guideline groups despite nursing practice being so important to service users. This exclusion may be because mental health nurses work close to what cannot be spoken of easily, or at all--the abject. Good mental health nursing practice depends on the individual person of the mental health nurse rather than any knowledge frameworks. Education should focus on relational aspects of practice to develop this and to define the core identity of mental health nursing as a therapy. This paper discusses therapeutic knowledge and practice in mental health nursing through Kristeva's notion of the abject as that which is the other side of language, closely linked to the feminine space of the chora. The chora is a provisional, stable space, associated with the mother's body, where the first possibility of signification can take place. Mental health nursing is a therapeutic practice that draws on knowledge that is practical, tacit, empirical, embodied and intuitive, as well as knowledge that is regarded here as beyond the tacit; the latter indicating an encounter with the abject. Mental health nursing as a practice potentially places an extraordinary ethical onus on the individual nurse in his/her relations with patients and indicates that it is the person of the nurse who is therapeutic rather than any knowledge framework, with major implications for education and professional identity. The presence of mental health nursing practice at the heart of the mental health care system, while effectively being ignored as a treatment by the National Institute for Health and Care Excellence, embodies a critique of the currently dominant evidence-based paradigm.

Everyday ordinariness, neglected but important for mental health nurses' therapeutic relationships: An initial exploration for applying Daniel Kahneman's two systems of thinking

“…Secondly, a wide range of ‘constructs, sub‐constructs and attributes’ proposed as characteristic of the therapeutic relationship such as conveying understanding and accepting individuality have been theoretical, complex and difficult to operationalize as MHN applied practice (Browne et al, 2012). For example, self‐reflection (McSherry et al, 2015) or Delaney et al (2017) process of centring yourself—sending intent—empathy—attunement—decoding and crafting a response. This difficulty in operationalizing MHN therapeutic relationships is associated with a lack of quantitative research evidence for their impact.…”