Leiba, Patrick Anthony.; (1997) Caretakers and the rights of the insane : an historical sociology. Doctoral thesis , Institute of Education, University of London.

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Abstract

This investigation grew out of my experiences while working as a mental nurse with people deemed to be insane. The behaviours which they presented and the medical and legal control exercised over them became of concern to me because I felt their rights were not being respected. A primary issue is the extent to which adherence to the medical-somatic view of insanity held by psychiatrists, lawyers and politicians has led to the exclusion of viable custody and treatment alternatives. The purpose of this research is to question the role and functions of mental nurses. It suggests that 'caretakers' might be a more suitable title for such workers with the insane. The hypothesis underlying the research links the work of 'caretakers' of the insane to changes in government policies and legislation; the thesis examines this hypothesis in the light of changes in the roles and functions of 'caretakers' over the period from 1890 to 1990. Research activities included the examination of primary sources, Hansard, newspapers, and professional journals. Interviews were also carried out with nine contemporary caretakers who have worked with the 1959 and the 1983 Mental Health Acts. These research methods provided an historical background to the debates in the Houses of Parliament when mental health legislation was discussed; information from the writings of the professionals who worked with the insane at the times of new mental health legislation; data on the public and media debate of these issues; and information on the perceptions and duties of caretakers working with the insane at the times of new mental health legislation. The research findings show that both those who cared for the insane and the insane themselves have been subjected to changes brought about by mental health legislation since 1890. These changes affected the working conditions of the caretakers and the social control and rights of the insane. The changes in the work of caretakers led to new directions in their education. Workers with the insane became a part of nursing by adopting the somatic approach to care. When this occurred, many of the care activities of keepers, attendants and mental nurses became redundant. Over time, there has been a move to, and then away from, the clinical-somatic model of nursing towards caretaking skills such as group work, therapeutic community skills, counselling skills and psychotherapy skills. These caretaking skills are seen by contemporary caretakers as going beyond their custodial and social control functions, towards providing a space in which people can be respected, encouraged, supported and be open to new insights.

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