The Tightrope Walked by Psychiatric Nursing Staff Caring for People with Suicidal Thoughts Between 1920 and 1970

Abstract

Nurses working in psychiatric care in the 20th century faced an ethical dilemma between monitoring and caring for suicidal patients. On the one hand, they had to comply with strict instructions to prevent suicides, but on the other hand, they were not supposed to restrict patients unnecessarily and should still allow them a certain amount of freedom. It was a tightrope walk between control and trust. Combating and preventing suicides was therefore considered to be a very challenging task within psychiatric nursing. An analysis of historical sources, such as textbooks, annual hospital reports, medical records, minutes of the supervisory committee, and interviews with former nurses, gives a broad insight into how the issue was dealt with in the 20th century. Suicide attempts and suicides could be interpreted as actions by patients to free themselves from a life situation that they no longer found bearable. Psychiatric doctrine assumed that suicides could not be prevented altogether. They did not happen very often. Nurses were rarely sanctioned for suicides, but nevertheless felt bad and had feelings of guilt even decades after such serious incidents. The risk of suicide can be minimised if nurses are well qualified and have sufficient resources available for everyday care duties.