Damaging dichotomies and confounding contradictions in mental health inpatient nursing: Lessons learned from Orwell’s 1984

Abstract

Purpose: Our discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk.
Approach: Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears.
Findings: Drawing upon Orwellian themes of power, social control, and digital surveillance from 1984, we highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges.
Originality/value: We use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.
Implications: To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, we make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care.