Academic journal article Research and Theory for Nursing Practice

"Only a Manic Depressive!": The Zone of the Untouchable and Exceeding Limits in Acute Psychiatric Care

Academic journal article Research and Theory for Nursing Practice

"Only a Manic Depressive!": The Zone of the Untouchable and Exceeding Limits in Acute Psychiatric Care

Article excerpt

This article addresses psychotic patients' fragile boundaries and need for professional help to restore their personal untouchable zone. We examine how nurses move into this inviolable zone and re-establish limits. Empirical data are drawn from an acute psychiatric setting and focus on one patient in different situations and on her relationships with nurses. Data from nurses' discussions and the researcher's experience are also included. The concept of the zone of the untouchable, by the Danish theologian and philosopher K. E. Løgstrup, guides interpretation. Analysis shows how and with which critical and constructive consequences the diagnosis-oriented understanding affects the patient-nurse relationship. Conclusions include premises that can guide nurses moving into the patient's untouchable zone.

Keywords: zone of the untouchable; setting limits; psychotic patients; psychiatric nurses; acute psychiatry

Acute psychiatric care involves limits in several ways. Psychotic patients who are admitted to an acute psychiatric department have fragile boundaries that are easily breached. These can be seen through the patients' painful lack of clarity in their understanding of who they themselves are and who others are. Crossing boundaries of cultural and social norms often creates problems for psychotic persons and their surroundings. Limit-setting measures are both important and difficult when caring for these patients. Although psychiatric patients may perceive limits intended to help them regain self-control as necessary and reassuring, the opposite may also be the case; they may perceive attempts to impose limits as an invasion of their zone of the untouchable and as an offense against their integrity.

In our daily contact with each other we all have an intuitive understanding of where the limits between us are set. These are natural limits that help preserve respect and integrity. We readily accept each other's social camouflage-or what we will define in this article as the zone of the untouchable. How is this general code of behavior put into effect in professional therapeutic care? How can and should nurses use their professional skills to restore the patient's unstable boundaries? How is setting and exceeding limits perceived by the involved parties? These are questions this article will clarify.

We present and analyze part of a larger body of empirical material from a locked ward in an acute psychiatric department in a city in Norway. 1 Patients on the ward have often been involuntarily hospitalized. Our point of departure is the experience of a young woman who has been committed to such a ward. We have combined data from various situations and positions; data from interviews with the patient are viewed in connection with observations of daily life on the ward and with data retrieved from discussions about the patient between nurses and other staff. We also bring in the researcher's own experience of relating to the young psychotic woman. When interpreting the material we use the Danish theologian and philosopher Løgstrup's (1997b) concept of what he calls "the zone of the untouchable." We start with this inviolable zone.

THEORETICAL FRAMEWORK: THE ZONE OF THE UNTOUCHABLE

Much of the literary work of Knut Ejler Løgstrup (1905-1981) was dedicated to analyzing basic features or conditions of human coexistence (1997a, 1997b). He used the concept of "the zone of the untouchable" to express the phenomenon that everybody has the need to impose a protective limit between themselves and their surroundings (Løgstrup, 1997b, p. 176). However, the zone does not represent a permanent filter intended to hold the surroundings out or to be an innate protection against invasion. On the contrary, it describes human vulnerability. Respect and awareness of each other's inviolability is crucial for preserving integrity. Løgstrup referred to this respectful reluctance to lay bare others' motives as spiritual modesty, which prevents others from feeling mentally invaded. …

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