Altschul's legacy in mediating British and American psychiatric nursing discourses: common sense and the ‘absence’ of the accountable practitioner

This paper contributes to an archaeology of knowledge in the field of psychiatric and mental health nursing. It focuses on a principal concern of contributors to literature on British psychiatric nursing: the problem of defining psychiatric nursing. Early British writers describing psychiatric nursing accomplished the ‘presence’ of psychiatric nursing as a discursive object, by discursively constructing the ‘absence’ of the psychiatric nurse doing, and being accountable for, ‘appropriate’ work. Altschul's (1972) Patient–nurse Interaction was the key text in this tradition, mediating British and American discourses, setting the methodological and substantive agenda for an important body of subsequent British psychiatric nursing research. The paper examines a number of topics in the American and British discourses mediated by Altschul: the privileging of nurses' presence and language in communication with patients; lay versus professional knowledge, and interaction as gossip; ‘common sense’ as a topic; common sense as different from ‘identifiable perspective’; the problem of accountability and the hierarchy of credibility; accountability, the ‘absent’ nurse, and issues of method. Altschul's later work keeps in tension two potentially conflicting claims – on the one hand, that the practice of psychiatric nursing depends on the ‘kind of person’ the nurse is, and on the other, that specialist discourses have priority in determining the basis for practice. Altschul played a crucial role in establishing the role of research in British psychiatric nursing discipline: locating the accountable individual practitioner, and devising remedies for ‘absence’. In doing so, she anticipated current discourses on nurses' accountability, particularly their inability to demonstrate ‘evidence’ of their ‘effectiveness’.