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Seeing
the person behind the symptoms
February
9, 2001
Psychiatric
nurse Ian Murray's method of helping people who self-harm is innovative
- and some say controversial. He spoke to Adam
James
.....
Ian Murray first
encountered self-harm 21 years ago.
He was in charge of a community-based hostel for people with mental
health problems when, one evening, there was an urgent knock at
his door.
It was a 19-year-old
girl who asked Murray, a registered mental nurse, to attend to her
18-year-old friend who had locked herself in a bathroom.
On arrival,
Murray saw a pool of blood seeping from underneath the bathroom
door, behind which cowered the distraught teenager. She had cut
her wrist.
To Murray's
alarm he realised the other young woman who had come to his door
had also cut herself.
Murray, who
had by then worked eight years in psychiatric nursing, faced two
choices. Either to bundle both of them in his car and drive them
to the nearest psychiatric ward. Or take them to a casualty ward
to have their wounds stitched.
Murray chose
the latter - a decision which he believes helped prevent the vulnerable
teenagers becoming "career" psychiatric patients.
"Rather
than making a huge fuss about what had happened, the three of us
later discussed what had happened informally and made a commitment
to get their problems sorted," remembers Murray.
"It just
did not make a lot of sense for me to go down the medical route
and ship them off to psychiatric hospital. I think I did the right
thing. Later, in what was a reciprocal act, the girls cleaned my
front door step for me to remove the blood."
This is just
one example from Murray's 29-year mental health nursing career documenting
his working philosophy towards people who self harm.
He is scathing
of traditional psychiatric hospitals which he refers to as "bins".
"I would never return to work in one," he vows.
The 46-year-old
Belfast man is disdainful of the medicalisation of distress, and
the coercion and dehumanisation of patients which psychiatric care
is, sadly, often criticised for.
An opportunity
for Murray to practise his more "humanistic" nursing of
self-harming patients came in March 1993 when for three years he
was nursing manager at Dryll y Car Support Bed Unit in Barmouth,
North Wales.
The unit, which
over the years developed a reputation for its innovative care, attached
less importance to a patient's diagnosis and the treatment of symptoms.
Instead more
emphasis was put on relating to and engaging with the person behind
the distress. This often involved finding ways of attending to traumatic
life events, such as abuse, which lay behind self-harm and admittance
to hospital - a fact supported by research at Dryll y Car which
suggested 50% of its patients had been sexually abused.
During his time
at the eight bed unit Murray supervised a change of role for psychiatric
nurses - from less of a depot injector to more an "ally"
of self-harming patients.
"The lesson
I have learnt is that there is a human component [to self-harm]
that must be taken into consideration," he says.
For Murray this
involves finding a "common language" to support patients.
One of Murray's examples is that of a 19-year-old who carried out
extreme acts of self-harm. The teenager once revealed to Murray
that it was his inability to express his experience in a meaningful
way which caused him so much pain.
Later, Murray
and the young man discovered they were both fans of American poet
Ron McKuen. "The lad started to write poetry which we used
to share together. It became a means of expression and started him
on the road to recovery," recalls Murray. "Later he no
longer self-harmed."
A second innovation
at Dryll y Car was the inclusion of user volunteers into Murray's
team. This led Murray to establish a network with those from the
mental health user movement who appreciated the change of practice
Murray was introducing into mental health nursing.
Subsequently,
Murray worked with Ron Coleman of Action Consultancy and Training
and the Hearing Voices Network, to produce training material for
nurses.
Yet what may
be innovation to some, is controversy to others - demonstrated by
Murray's decision to work with Sharon Lefevre, a former self-harming
Dryll y Car patient and author of Killing me Softly, a gruelling
subjective account of self-harm.
Together they
ran training workshops for nurses and other professionals examining
the connection between voice-hearing and self-harm. The workshops
featured Lefevre, a dramatist, simulating sex with a doll. While
the performance was designed to reveal to professionals the sexual
abuse which can underlie self-harm, critics said it was an extension
of Lefevre's pathology.
Some, mainly
psychiatrists, were so incensed they stormed out of some workshops.
But, for Murray, his participation was consistent with his philosophy.
"The thrust
of what we were trying to get across was how, as professionals,
we view our clients. Too often we look for bad behaviour and symptoms.
So often we refuse to see the person."
Yet Murray,
now a CPN in Meirionnyd also in North Wales, remains dedicated to
changing psychiatric nursing. He prefers to do this "from within"
by adhering to the "basic principles of empowerment and support."
"Medication does have a place but giving support to people
is the significant thing that happens in normal society," he
says. "In society we support each other to recover in reciprocal
ways. That is what we should try and do in nursing"
Murray's workbook
for working with self-harm patients is available from Handsell Publishing.
Tel: 01452 380319
© Copyright
Psychminded, Feb 2001
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