Journal of Psychiatric and Mental Health Nursing , 2002, 9, 87–94

Blackwell Science, LtdOxford, UK

JPMJournal of Psychiatric and Mental Health Nursing1351-0126Blackwell Science Ltd, 2001
86December 2001
449
Othering and psychiatric nursing
E. J. MacCallum
10.1046/j.1351-0126.2001.00449.x
Original ArticleBEES SGML

Othering and psychiatric nursing

E. J. MACCALLUM bsc(hons) rn(mental health)
Scottish Development Centre for Mental Health, 17a Graham Street, Edinburgh, UK

Correspondence: MACCALLUM E. J. (2002) Journal of Psychiatric and Mental Health Nursing 9, 87–94
E.J. MacCallum Othering and psychiatric nursing
Scottish Development Centre for
Mental Health
This paper is a theoretical exploration of the concept of Othering in relation to psychi-
17a Graham Street
atric nursing. The concept of Othering is examined by working the dualisms of same/
Edinburgh
other in relation to the dualisms of east/west, man/woman and reason/unreason. Oth-
EH6 5QN
UK
ering is also examined in relation to the construction of knowledge and reality. The role
of psychiatry and implications for nursing practice are discussed. Othering is found to be
a complex problem which is an inevitability of nursing practice. Possible solutions to the
problem of Othering are presented.

Keywords: difference, Othering, psychiatric nursing, reality, social knowledge, us and

them

Accepted for publication: 20 November 2000

Accepted for publication : 30 July 2001

will be paid to the role of psychiatry in Othering and the

Introduction implications for nursing practice.
This paper is essentially a theoretical exploration of Oth-
ering and its relevance to nursing practice. The paper is
What is Othering?
therefore situated ‘on the edge’ of theory and practice. The
Other I am interested in is the people who are diagnosed as Some would say that Othering has always existed and is an
‘mentally ill’. My aim is to show how the theoretical prob- intrinsic aspect of human consciousness:
lem of Othering is practically relevant. The category of the Other is as primordial as
Othering is part of the process of talking and writing consciousness itself. In the most primitive societies, in
about patients. However, it is necessary for nurses to talk the most ancient mythologies, one finds the expression
and write about the patients in their care during the course of a duality – that of the Self and the Other (de Beauvoir
of their work. I do not suggest they do not. Rather, I sug- 1972, p. 16).
gest that nurses should consider the effects of these activi- Kitzinger & Wilkinson (1996, p. 8) provide a useful
ties. As nurses we need to recognize difference, and work definition of Othering:
across difference rather than perpetuate it. Who and what Others are . . . is intimately related to
In my exploration of Othering I will attempt to define ‘our’ notion of who and what ‘we’ are. ‘We’ use Other
what Othering is and examine related concepts. I will also to define ourselves: ‘we’ understand ourselves in relation
explore the dualism of same/other in relation to the dual- to what we are not.
isms of east/west, man/woman and reason/unreason before A group is defined not necessarily by those who are in it
examining Othering in relation to the construction of but by those who are excluded from it.
knowledge and the construction of reality. Special attention We forget that the outsiders are part of our definition of
ourselves. To confirm our own identity we push the
outsiders even further away. By reducing their humanity
The Scottish Development Centre for Mental Health is part of the we emphasize our own (Littlewood & Lipsedge 1997, p.
Institute of Applied Health and Social Policy, King’s College London 27).

© 2002 Blackwell Science Ltd 87

E. J. MacCallum

health worker. She considered that it was problematic for

Concepts related to Othering the staff to care for a person who was both an ‘Us’ and a
‘Them’.
Difference
Our understanding of Other is important for how we
Dualisms – working the distinction
understand difference. It is easy to use Otherness and dif-
ference synonymously but they must be kept separate Our understanding of the dualism of the ‘Self and the
because it is not helpful to our understanding to merge the Other’ can be explored further in relation to the dualisms
two. As Carabine (1996) points out, not all differences are of west/east, man/woman, reason/unreason. Working these
the same. The difference between the One and the Other, dualisms helps cast further light on the dualism of same/
or Self and Other, is oppositional difference rather than other. Othering is essentially about constructing dualisms.
difference as diversity. The Other is attributed a negative Woman is described in relation to man; the insane are
value, and the Same a positive value. The concept of Other defined in relation to the sane.
is deeply implicated in power relations (Carabine 1996). Othering is often discussed in terms of gender and race,
For example, the creation of Others in social sciences i.e. woman as Other, black person as Other. I wish to
involves the privileged researching and representing poor explore the construction of people with mental illness as
people, mentally ill people and other groups who are pow- Other. This contains a different aspect from the discourses
erless in relation to the researchers (Brown 1996). of race and gender, as mental illness is a category that peo-
ple can move in and out of, that is, it is fluid, not fixed. It
is also interesting to note that the dualism of reason/unrea-
Us and Them
son is focussed on reason itself. It is an act of reason to split
The ‘Us’ and ‘Them’ phenomenon is an example of Oth- reason from unreason. Conversely, it is an act of unreason
ering. ‘Them’ are posited as ‘Other’, of less value than ‘Us’. to be unable to do this and this is sometimes referred to as
‘Us’ defines ‘Them’. People do not position themselves as ‘lack of insight’.
Other, or as ‘Them’. Once positioned as Other some people
may seek to maintain and celebrate their Otherness, e.g.
Duality of West/East – Orientalism
Mad Pride.
I became interested in the topic, which I now construe as Colonialism created Others (Kitzinger & Wilkinson 1996).
Othering, during a placement as a student nurse on a psy- According to Littlewood & Lipsedge (1997) there are two
chiatric inpatient ward. I found there to be a culture of ‘Us’ types of outsiders: the mentally ill and non-Europeans. Said
and ‘Them’, staff and patients, who inhabited two very dif- (1978) problematizes this process of Othering, which, he
ferent worlds. I was caught in between the two worlds of says, goes on. He describes the Orient as:
the staff and the patients, neither belonging to ‘Us’ nor to The place of Europe’s greatest and richest and oldest
‘Them’. It was this experience that led me to explore Oth- colonies, the source of its civilisations and languages, its
ering in the literature. cultural contestand, and one of its deepest and most
Davidson (1998) writes of his experience as a student recurring images of the Other (Said 1978, p. 1).
psychiatric nurse and describes reassurance given to a stu- This description immediately sets up the distinction
dent. The reassurance served to invite the student to share between East and West. The West had the power to define
the attitude of the staff group. Shared attitudes contributed the East as the Other. East and West may mean ‘Them’ in
to staff bonding and provided the staff group with cohe- the East and ‘Us’ in the West. Said (1978, p. 3) informs us
sion. Once established, the bond was maintained by that ‘European culture gained in strength and identity by
‘oppressive suspicion’ of the patients. Davidson (1998) felt setting itself off against the Orient.’ Therefore, in defining
caught between the staff world and the patient world. the East, Orientalists were taking part in an exercise that
Rudman (1996, p. 42) ponders: was essentially about defining the West. Orientalism is a
To what extent do we maintain professional power and subject that which teaches more about European power
distance to prove the other person is irrational or sick, over the Orient than it informs about the Orient (Said
and thus maintain our own sense of integrity and sanity? 1978). Therefore, in representing the Orient, the European
The ‘Us’ and ‘Them’ mentality that exists in psychiatric representer conveys more about what it is to be European
care maintains patients as Other, mentally ill, and reasserts than what it is to be Oriental. This is evidence of the posi-
the staff’s ‘sanity’ and also, their power. tional superiority of Europeans and cultural domination.
Hart (1997) raises the issue of the ‘Us’ and ‘Them’ atti- The Orient is positioned as Other. What is more, posi-
tude from the perspective as a patient and also as a mental tioned as Other, the Orient is silenced, disallowed to

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 Othering and psychiatric nursing

describe the Orient. As Other, their words are powerless put them’. In this context, ‘Other’ can be seen to be a vague
and meaningless. ‘. . . Only the Orientalist can interpret the residual category.
Orient, the Orient being radically incapable of interpreting The dualism of mind/body is essentially a Western con-
itself’ (Said 1978, p. 289). struction. The labelling of women as mad continued into
A comparison may be made with this last statement and the Victorian era and, at that time, women were confined
the situation of psychiatric patients. It could be said that to the home (Ussher 1991). Also, at that time science began
only the psychiatrist or psychiatric nurse can interpret the to dominate and had the power to define reality. Madness
mentally ill. Representations of the mentally ill appear in became synonymous with femininity even when experi-
medical and nursing notes, the notes of other professionals enced by men. This can be explained by the dualisms that
involved in their care and in the representations of writers characterise Western thought (Longhurst 1997). Feminists
and researchers. The mentally ill have been assumed to be argue that this dualism is gendered; male characteristics are
incapable of interpreting themselves and speaking for associated with the mind and female characteristics with
themselves. Unable to recognize the truth of their being, the body. Mind is privileged over body. Men are thought to
their condition, the mentally ill are said to ‘lack insight’. be rational, able to transcend their bodies, reason and this
This implies that the mentally ill are doubly irrational; they allows them to ‘speak universal knowledge’ (Longhurst
are irrational because they are mentally ill and they are 1997, p. 491). Women are associated with their reproduc-
doubly irrational because they are mentally ill and they tive body, tied to nature and the instincts, rhythms, desires
don’t recognize it. of their body, incapable of rationality (Longhurst 1997).
Rationality identifies masculinity and, conversely, feminin-
ity is associated with the non-rational, hysterical, Other.
Duality of man/woman
So, even when men experience madness it is associated with
The concept of the Other has been discussed in relation to femininity. Men are rational; women are not.
woman as Other and can be found in feminist discourse. de The focus on women’s sexuality and menstruation was
Beauvoir (1972) makes the point that Others do not define such that evil and madness also became synonymous in the
themselves as Other, rather it is the person with power who literature of the nineteenth century. Mad women were
sets himself up as the One by defining the Other. Men incarcerated in asylums or ‘inside their own “weak and
define women as Other in the same way that psychiatrists afflicted” bodies, which were treated with leeching, solitary
define the mentally ill as Other. confinement, clitoridectomy, frequent intercourse, or a
Constructed as Other, women are relegated to the good beating from a “concerned” husband’ (Ussher
position of mere objects of male knowledge and our 1991, p. 88). From the time of witches to the Victorian era,
own knowledge and experience are routinely obliterated the discourse of madness changed and, hence, the language
(Kitzinger & Wilkinson 1996, p. 4). used changed but madness remained a problem of women.
Constructing people as mentally ill positions them as This represents the loss of power of the churches to science,
Others and relegates them to the position of passive objects which had become equated with the truth. ‘Much of the
of psychiatric knowledge and their own knowledge and therapeutic discourse is still tied to science, and thus to
experiences are routinely obliterated. power, to prestige and to patriarchy’ (Ussher 1991, p. 109).
The powerful patriarchal and medical discourses subju- Madness is a label to mark as Other and prevents challeng-
gate the less powerful knowledge of women and of ethnic ing the One (Ussher 1991). The account of the labelling of
minority groups (Coyle 1999). According to Ussher women as mad in the time of witch hunts and the Victorian
(1991), misogyny makes women mad through naming era, and the ‘treatment’ for women’s madness, reveals as
women as the Other or by depriving women of power. Or, much, if not more, about male fantasies and perversions
misogyny causes women to be named as mad and thereby than it does about women’s madness. Othering is unin-
silences women’s voice. ‘For madness acts as a signifier, tended by those constructing women as witches, as mad. It
clearly positioning women as the Other’ (Ussher 1991, p. is only by standing back that this can be seen. An important
11). aspect of Othering is that it is not considered as such.
Historically, the mentally ill were considered to be Those writing about the mentally ill, do not intend that
witches. In reality, and in imagination, witch equals what they write reveals as much about them:
woman therefore women were mentally ill (Ussher 1991). Accounts of the social world, no matter how much they
Szasz (1971, cited by Ussher 1991, p. 55) suggests that are animated by a sincere desire for truth, are never
‘witchcraft and mental illness are imprecise and all- more than stories we tell whose themes and meanings
encompassing concepts, freely acceptable to whatever uses express the social positioning of the story teller
the priest or physician (or lay “diagnostician”) wishes to (Seidman 1994, p. 117).

© 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94 89
E. J. MacCallum

Similarly, the position of the writer is expressed in communicated with. Boyce (1998) was prevented from
accounts of patients written by psychiatrists, nurses or using her knowledge of what it means to be black in a
others involved in their care. white institution to engage with the patient. She related to
the patient as a black person and as a woman and on those
accounts she recognized a shared Otherness as defined by
Dualism of reason/unreason
the institution. However, she was considered sane, and
The dualism of reason/unreason can be explored through a therefore the ‘same’ as staff, and this was used to position
Foucauldian discussion of psychiatry. This is relevant to her against the patient. Therefore, to different people, in
psychiatric nursing, as psychiatric nurses generally care for different contexts, different things mark a person as
those whose ‘unreason’ results in them being segregated ‘Other’. In this situation the staff considered her as one of
from society and named as Other, diagnosed as mentally ill them, when she may have related more closely with the
by psychiatrists. Psychiatry performs a powerful social con- patient. By not allowing her to use her knowledge of what
trol function. Part of Foucault’s work has been the study of it is to be a black woman in a white institution the staff,
‘dividing practices’. ‘The subject is either divided inside and the institution, disregarded fundamental aspects of her
himself or divided from others. This process objectivises being.
him’ (Foucault 1982). As an example of this, Foucault pre- Mental health nurses need to make a commitment to
sents the division of the mad and the sane. To understand recognising difference and accepting alternative and
the dualism of reason and unreason we need to understand competing cultural values in the course of their practice,
the ‘cultural production of the rational as a “good thing” despite pressure to homogenise care (Walsh 1997, p.
and the irrational as something which needs not only to be 173).
excluded but also to be rigorously policed’ (Parker et al. Walsh writes from experience of working in New
1995). Zealand as a psychiatric nurse. In her work with Maori
Psychiatry is the profession with the claims to knowl- people she stresses that it is important to acknowledge cul-
edge and science that has charge of the social control of the tural differences and the power structures between her and
mentally ill. ‘Two words sum up everything: power and them (Walsh 1997). ‘Central to human interaction is the
knowledge’ (Foucault 1981, p. 293). Foucault (1981, p. idea of locating the “other” ’ (Weedon cited by Walsh
293) asks the rhetorical question: ‘Cannot the intertwining 1997). We locate the Other in order to define our bound-
of the effects of power and knowledge be grasped in the aries. When a person is mentally ill they need help to locate
case of a science as contestable as psychiatry?’ In Madness the boundaries. If a person is mentally ill and considered
and Civilization, Foucault charts the Great Confinement. ‘different’ they need skilled intervention to help identify
From the time of the Enlightenment onwards there who they are and who others are (Walsh 1997).
emerged a spirit of capitalism, which promoted rationality. Lyth (1988) suggests that a close relationship between
Reason became separated from unreason, and madness patient and nurse is likely to cause anxiety in the nurse.
was viewed as a lack of reason. Foucault calls the period This results in the inhibition of the ‘development of a full
when the segregation of the mad took place (1650–1789), person-to-person relationship between nurse and patient,
the ‘Age of Reason’. This is when madness was excluded with its consequent anxiety’ (Lyth 1988, p. 52). Devices
from society in the Great Confinement. The mad and the to inhibit the development of a full person-to-person
‘socially useless’ were segregated into an ‘other world’ relationship operate structurally and culturally. Lyth
(Foucault 1986). (1988, p. 52) states that ‘there is an almost explicit
“ethic” that any patient must be the same as any other
patient’; therefore, it should not matter to the nurse who
Shared Otherness
she nurses and conversely it should not matter to the
Karla Boyce (1998) reflects on her experience as a black patient who nurses them. If we follow this argument to
woman and a psychiatric nurse and provides an example its logical conclusion, it is necessary to construct patients
of shared Otherness where she identifies herself as more as Other in order for the nurse to nurse without suffer-
alike than different from someone constructed as the ing from the anxiety of emotional involvement in the
Other. Boyce (1998) highlighted the difficulty of retaining nurse–patient relationship. This contradicts Barker’s argu-
her sense of being in a system that expected her to conform ment that nurses need to be emotionally involved to nurse
to the dominant culture. Boyce (1998) presents a case the patient (Barker 1991).
study of the care given to a black Afro-Caribbean woman Barker et al. (1998) discuss the ‘Us’ and ‘Them’ mental-
whose behaviour was interpreted as madness, rather than ity, recognizing the distinction made between ‘Us’ (men-
being understood as frustration at being secluded, not tally healthy) and ‘Them’ (mentally ill). They suggest that if

90 © 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
 Othering and psychiatric nursing

mental health professionals believe that those with mental 1996, p. 15). This text conveys the understanding that
health problems and those without can be easily distin- most people in society do not theorize, but rather that they
guished, they are failing to recognize their own wounds. live in a world; therefore the sociology of knowledge must
concern itself ‘with what people “know” as “reality” in
their everyday, non- or pre-theoretical lives’ (Berger &
Othering and knowledge Luckman 1996, p. 27). This notion places importance on
the lay perspective and is concerned with understanding
Construction of Others through the construction of
reality as it is experienced. The lay perspective is common-
social knowledge
sense knowledge. Berger and Luckman ‘approached social
Seidman (1994) charts the progress of social theory from life as produced and reproduced in individual interaction’
the time of the enlightenment to the present. The Enlight- (Seidman 1994, p. 128). Individuals are socially con-
eners pioneered the new science of society, breaking away structed through interaction; a requirement of self-
from Roman and Christian traditions of social thought, consciousness is the presence of an ‘other’ (Gerber 1997).
with their belief that true knowledge can only rest on sci-
entific method. Humans create society and form a world of
institutions that shape us. By breaking away from Roman
Implications for practice
and Christian traditions of social thought, reason could Othering steals the voice of the person/people constructed
triumph over prejudice, and science was wedded to liberal as Other. Talking and writing about the Other steals the
humanistic world views. Seidman (1994) questions whe- authority of their lives. Nurses, in the course of their work,
ther science today remains wedded to liberal humanistic talk about and write about their observations and interpre-
world views, citing evidence of scientific abuse and control tations of patients.
through medicine and psychiatry (Seidman 1994). An
example of this comes from the former USSR where polit-
Talking with the Other
ical dissidents were forcibly detained and ‘treated’ in psy-
chiatric hospitals in an attempt to maintain political Madness transcends the boundaries of the reality of every-
control by claiming it was the individual’s psyche that was day life: it points to a different reality (Berger & Luckman
in need of repair and not the political system (Adler & 1996). Tilley (1995) claims that psychiatric nurses’ work
Gluzman 1993). This example illustrates that people can be involves ‘reality maintenance’. This involves talking of
categorized as Other to prevent them challenging the dom- ordinary things in which nurses and patients share/con-
inant social order. struct the same reality (Tilley 1995). The terms that nurses
and patients use reveal distinctions in the social reality
meaningful to them. Tilley’s (1995, p. 169) stance is that
Othering in the production of knowledge
‘differences in knowledge constituted differences in reality’.
Sociology became institutionalized as white, male and mid- Nurses claim that their reality makes sense and they expect
dle class and this served to exclude perspectives that were patients to ‘come round’ to their claims of reality (Tilley
threatening to this dominant body of knowledge (Seidman 1995). For example, if a patient holds different understand-
1994). Dorothy E. Smith has challenged the absence of ings from the nurses, he is said to ‘lack insight’. Tilley
women’s perspective in sociology. Smith (1988) claims that (1995, p. 216) has ‘argued that the differences between
women have been excluded from the making of knowledge nurses’ and patients’ knowledge provided the occasions for
and that women’s experiences and ways of knowing have assessment and treatment intended to restore the patient to
not been represented. The reason for this is that men have common sense.’ Peplau (cited by Tilley 1999), writing
written history with their interests in mind, and women about nurse–patient interaction, said that:
have been excluded from ‘participating in creating the cul- The interaction of nurse and patient is fruitful when a
ture of society’. ‘Its general culture is not ours’, i.e. it is method of communication that identifies and uses
men’s, not women’s (Smith 1988, p. 36). This is because, common meanings is at work in the situation.
historically, the opinions of women have not had an arena If by common meanings we mean common sense, then
in which their opinions could be heard (Smith 1988). Altschul disagrees with this basis of interaction. In Alts-
chul’s discourse ‘common sense was constructed as an
inadequately accountable basis for practice’ (Tilley
Othering and the social construction of reality
1999, p. 23). Rather, Altschul’s discourse values theoretical
‘The sociology of knowledge is concerned with the analysis knowledge, while common sense is considered a ‘residual
of the social construction of reality’ (Berger & Luckman category’ of knowledge (Tilley 1999).

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E. J. MacCallum

Writing the Other The sociology of deviance and labelling theory as

related to Othering in psychiatry
Research and knowledge have limitations. ‘All representa-
tions are embedded first in the language and then in the cul- In order to understand the process by which a person
ture, institutions, and political ambience of the representer’ becomes the mad Other, it is useful to look at the sociology
(Said 1978, p. 272). There is a case to argue that qualitative of deviance and labelling theory. A complex web of social
research texts can be compared with nursing notes that are rules constructs society. A person who breaks those rules is
written about patients. The policy of open access to nursing considered deviant, Other. Those who respond to a differ-
notes permits the patient to read what has been written. ent reality from the ‘reality of everyday life’ may transgress
However, this does little to address what the patient may social rules and be considered deviant. ‘Social groups create
believe to be misrepresentation unless the patient is permit- deviance by making the rules whose infraction constitutes
ted to contribute to the notes. Opie (1992) is concerned deviance’ (Becker 1963, p. 9). The rules are not always
with ‘the control of interpretation’. In qualitative research clear and it may not be until they have been broken that we
it has become practice to give research participants a copy are aware of their existence. Deviant behaviour can be said
of the written report and to ask for their comments (Opie to be a social construct. Whether behaviour is regarded as
1992). Opie (1992) suggests it is unclear how the final ver- deviant is dependent upon the social context in which that
sion is reached. Similarly, with open access nursing notes it behaviour is exhibited.
is unclear as to whose version is represented when there is Some people think deviance is a product of mental ill-
disagreement. ness (Becker 1963). Other people think mental illness is a
Parkes (1999) acknowledges that what is written about label for deviance. Ussher (1991) argues that deviance has
Others often reiterates and reinforces what has been writ- been medicalized for social control purposes. A psychiatric
ten before. diagnosis is a label to deviancy (Ussher 1991). If mental ill-
ness is a label to deviancy, and deviancy is dependent on
social rules, then mental illness must similarly be dependent
Othering and psychiatry
on social rules and, as such, cannot be diagnosed by scien-
Ussher (1991, p. 140) provides a useful definition of Oth- tific objectivity.
ering in psychiatry: It is psychiatry’s claim to scientific knowledge that places
Outsiders and aliens maintain the cohesion of social psychiatry, as a profession, in power. Labelling can be seen
groups and play an important part in defining the as a practice of power. The sociology of deviance implies
identity of the in-group, defining what is normal that psychiatric power is based on false claims.
behaviour. The ‘Other’ is needed to define the ‘One’. Gomm (1996) proposes that the labelling of deviant
Through defining what is mad, we denote what is sane, behaviour as mental illness reflects the interests of psychi-
what is ‘normal’, a process carried out by psychiatrists atrists and mental health professionals because labelling
and other social control experts, who negotiate reality people as mentally ill creates work for them. The label
on behalf of the rest of society. overrides a person’s status in other areas, for example, par-
Foucault did research work at Hôpital Saint Anne in ent, partner, employee, friend and, once labelled, the per-
France and in observation he ‘felt very close to and not son may be rejected by family and friends (Becker 1963).
very different from the inmates’ (Miller 1994, p. 62). Fou- Those labelled as ‘mentally ill’ become part of a deviant
cault observed ‘the man of madness and the man of rea- subgroup (Ussher 1991). The group is homogenized, yet
son’ though ‘moving apart are not yet disjunct’ (Miller the only thing they may share in common is the label (Per-
1994, p. 106). The central argument of Madness and Civ- kins & Repper 1998). This scapegoats the outsider and
ilization is that ‘Madness only exists in society’ (Miller maintains the evidence of the Other (Ussher 1991).
1994, p. 98). It is an invention, a product of social rela- Scheff (1996) suggests that stereotypes of mental illness
tions (Miller 1994). Foucault’s stance can be compared are learned early in life and that these stereotypes are con-
with Said’s (1978) work on Orientalism where the West tinually reaffirmed in ordinary social interaction. By per-
only exists in relation to the East. We need to redirect the mitting a person labelled mentally ill to behave in ways
focus from the mad to the cultures, institutions and lan- that conform to stereotyped notions of mental illness, the
guage practices that make it an issue (Parker et al. 1995). person is maintained at a distance and is constructed as
It is practices of power that hold the oppositions of sane/ Other.
insane in place. According to Foucault, we live with an Rosenhan’s (1996) well-known study of eight sane peo-
ingrained predisposition to view madness as essentially ple who gained admission to 12 different psychiatric hos-
‘other’ (Pilgrim & Rogers 1993). pitals demonstrates the power of labelling. When they were

92 © 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
 Othering and psychiatric nursing

eventually discharged, it was with a diagnosis of schizo- between Self and Other, Church reached a point in her
phrenia ‘in remission’, not as sane people. This experiment work when she became neither professional nor survivor
showed how unreliable the diagnostic process is and that, and was in an uncomfortable place in between. Church had
once labelled, the schizophrenic cannot overcome the label. to unlearn professional and academic ways of being and of
The label ‘colors others perceptions of him and his behav- writing in order to relearn and, thereby, enable her to
iour’ (Rosenhan 1996, p. 75). An example of this is that the ‘work the hyphen’. She sees the need for the development
pseudopatients openly wrote their research notes on the of specific practices ‘which would enable consumers/survi-
ward and this was documented as ‘patient engages in writ- vors and mental health professionals to work together
ing behaviour’ (Rosenhan 1996). across difference’ (Church 1995).
Church’s (1995) work involved her in relating to users
of psychiatric services as consumers and survivors. In aca-
Working with ‘Others’
demic literature, users are generally presented as patients.
Often, Self and Other are presented as discrete categories, This emphasizes their illness and obscures other aspects of
oppositions. Fine (1994, p. 72) suggests that ‘Self and their being. They are objectified under the clinical gaze of
Other are knottily entangled’ and proposes that those rep- mental health professionals (Pilgrim & Rogers 1993).
resenting Others ‘work the hyphen’. That is, to explore From this position as objectified patients, users are denied
the relation between Self and Other and work with a voice. They are madness personified, the Other.
Others:
Working the hyphen means creating occasions for
researchers and informants to discuss what is, and is Conclusion
not, ‘happening between’, within the negotiated
Othering intersects a number of disciplines, of which I have
relations of whose story is being told, why, to whom,
only been able to study a few. The topic of Othering is so
with what interpretation, and whose story is being
broad that various disciplines are able to use it to relate to
shadowed, why, for whom, and with what consequence
the development of specific interests. Likewise, I have
(Fine 1994, p. 72).
embraced the topic of Othering in relation to my interest in
Fine (1994) is writing specifically about Self and Other
psychiatric nursing.
in qualitative research. However, her proposal is relevant to
The problem of Othering is that it is oppressive and
all those who represent and interact with the Other:
results in misrepresentation of peoples. However, Othering
It has been argued that the relationship between the
seems inevitable and, on reflection of Rosenhan’s study, all-
researcher and his subjects, by definition, resembles
powerful. Othering, in relation to psychiatric nursing, may
that of the oppressor and the oppressed, because it is
appear to be simply the distinction between the ‘mad’ and
the oppressor who defines the problem, the nature of
the ‘sane’; ‘them’ and ‘us’. However, in exploring Othering,
the research, and to some extent, the quality of
it has become apparent that it is more complex than ‘us’
interaction between him and his subject (Fine 1994, p.
and ‘them’ and that it is in fact an inevitability of nursing
73).
practice and something of which nurses should be aware.
If we compare this to the work of mental health profes-
Walsh (1997) and Boyce (1998) illustrated the difficulties
sionals we recognize that they too may be oppressors and
posed by the problem of Othering in psychiatric nursing
researchers who have the specific task of defining the
practice. The work of Peplau, Tilley, Walsh, Fine and
oppressed as mentally ill and investigating their illnesses. In
Church offer suggestions to nurses such as ‘sharing com-
viewing the relationship between nurse and patient as that
mon meanings’, ‘reality maintenance’, ‘working together
of Self and Other, we obscure the many relations between
across difference’ and ‘working the hyphen’. These possible
the two and the quality of interaction is affected and
solutions, discussed earlier, advocate bridging the gap
becomes inhibited.
between the One and the Other and point to a place in
Early in the century, ‘twas noble to write of the Other
between where people can just ‘be’.
for the purposes of what was considered knowledge.
Perhaps it still is. But now, much qualitative research is
undertaken for what may be a more terrifying aim – to
Acknowledgments
‘help’ them (Fine 1994, p. 79).
Church (1995), in her work with psychiatric survivors, The author wishes to acknowledge the advice and feedback
aimed to ‘help’ them. This involved her in ‘working the on earlier drafts of this paper given by Dr Steve Tilley,
hyphen’ (I have borrowed the term ‘working the hyphen’ University of Edinburgh and Dr Allyson McCollam,
from Fine 1994). In her exploration of the relationship Scottish Development Centre for Mental Health.

© 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94 93
E. J. MacCallum

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