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Principles of Specialty Nursing
Under the Auspices of the European Specialist Nurses Organisations (ESNO)

José Carlos Santos

John R. Cutcliffe Editors

European
Psychiatric/Mental
Health Nursing in
the st Century
A Person-Centred
Evidence-Based Approach
Principles of Specialty Nursing
Under the Auspices of the European
Specialist Nurses Organisations (ESNO)

Series Editor
Françoise Charnay-Sonnek
ESNO
European Specialist Nurses Organisations
Brussels, Belgium
The role of the specialist nurse in Europe is still not clearly defined. Despite the fact
that there have been formal training programs – e.g. for nurse anaesthetists, operating
room nurses, intensive care and mental health nurses – for years now, the practices,
status, duration and content of training can vary greatly from country to country.
Some other specialist roles, e.g. for Diabetes, Dialysis, Urology and Oncology, have
successfully been established in Europe with the help of professional transnational
collaborations. Moreover, advances in medical technologies and more sophisticated
treatment will not only require specialist nurses in order to ensure quality and safety
of care, but will also call upon them to assume new roles in their professional field
to compensate for physician shortages. Most of the available literature on specialty
nursing practice currently comes from the USA, Canada, and Australia, and
accordingly reflects evidence-based nursing in these countries. Therefore, there was
and is a need to establish European evidence-based practice on the basis of different
clinical experiences. This series, which encompasses books for each specialty, will
shape evidence-based practice in Europe, while also integrating lessons learned
from other continents. Moreover, it will contribute to clarifying the status of the
specialist nurse as an advanced practice nurse.

More information about this series at http://www.springer.com/series/13892

José Carlos Santos • John R. Cutcliffe
Editors

European Psychiatric/
Mental Health Nursing
in the 21st Century
A Person-Centred Evidence-Based
Approach
Editors
José Carlos Santos John R. Cutcliffe
Escola Superior de Enfermagem de Cutcliffe Consulting
Coimbra Kingston
Nursing School of Coimbra Canada
Coimbra
School of Nursing
Portugal
Coimbra
Portugal

ISSN 2366-875X     ISSN 2366-8768

Principles of Specialty Nursing
ISBN 978-3-319-31771-7    ISBN 978-3-319-31772-4 (eBook)
https://doi.org/10.1007/978-3-319-31772-4

Library of Congress Control Number: 2017964372

© Springer International Publishing Switzerland 2018

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita-
tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor-
mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.

Printed on acid-free paper

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The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword I

According to various national mental health-care policies and position statements

regarding contemporary mental health care, the person who uses such services (i.e.,
client, service user) is no longer a passive recipient. The service user is no longer
“reduced” to being little more than a disease or malfunctioning brain. And the care
context should no longer be one dominated by doctors/nurses, wherein the care is
focused on diagnosis, symptomatology, and associated pharmacological responses.
The National Survivor User Network (accessed 30 January 2017), for instance,
highlights how the mental health service user involves the:
active participation of a person with lived experience of mental distress in shap-
ing their personal health plan, based on their knowledge of what works best for him.
These policy statements, which show a large degree of convergence and consis-
tency across international borders, indicate that mental health service users can no
longer be considered as “third parties,” disconnected from their own treatment and
the health system. In contemporary European mental health care, the service user
has to be considered as a “partner,” the cocreator/codesigner of the care pathway,
and, importantly, an expert by experience. And so for someone who is a passionate
advocate for service users, it is so very heartening and reassuring to read a
Psychiatric/Mental Health nursing textbook that encapsulates the values and prac-
tices inherent to these policies and position statements. It is uplifting to read a book
in which the role(s) and the involvement of the service user are addressed through-
out and, simultaneously, reflect innovation and evidence-based practice in
Psychiatric/Mental Health nursing.
Furthermore, one of the defining characteristics of person-centered P/MH nurs-
ing is the desire to form partnerships with service users, work with (alongside)
rather than work “on” such individuals. P/MH nurses wishing to practice with such
a person-centered or humanistic focus regard the service users as experts (and own-
ers) of their own experiences and their own care. Indeed, in such relationships, both
parties are recognized as human beings having the same values and the same rights
in the promotion of their interests. An informed service user will then be able to
choose among the various treatment options and will feel as if he/she is an actor of
its treatment. Similarly, an informed P/MH nurse would consider the whole of the
service user’s situation and challenges, taking intrapersonal, interpersonal, familial,
professional/occupational, and social/environmental factors/experiences into

v
vi Foreword I

account when responding to the service user’s needs and tailoring and planning the
care in line with their needs. This holistic and integrated approach allows for a
greater care consolidation and has a beneficial influence on outcomes like recovery,
user’s satisfaction, and security of care. And so upon reading the book, I took great
comfort and solace from how the editors had integrated these key concepts and used
them as the underpinning for the individual chapters.
Upon reading the book, I was also struck by a further key underpinning for this
book, namely, that of evidence-based or evidence-informed practice. I was also
delighted to see how the editors have linked evidence-informed P/MH nursing prac-
tice with the service user involvement. Evidence indicates that mental health service
user involvement in treatment/policy making can and does have a positive impact. It
enables a greater understanding of the service user’s whole situation, experiences,
background, and “environment” and thus enables services to be shaped to the user’s
need. This increases the quality of the care and the cost-effectiveness. But, as one of
the authors rightly writes, this approach can be only sustainable if users are primar-
ily considered as citizens; this concept of citizenship is central to relation and par-
ticipation in society. This is the first P/MH nursing textbook that I have read that
brings these three key concepts together into one philosophical underpinning for the
book and, importantly, demonstrates that they are not mutually incompatible, far
from it.
The book also highlights how European and occidental mental health care per se
still has a way to go before it can claim to have endorsed and operationalized per-
soncentered, holistic, evidence-informed, and service user-informed mental health
care. To get there, this requires of course that mental health-care professional’s
behavior and culture change fundamentally. For service users and those champion-
ing service user involvement, the care model should be based on the client’s needs
by asking this question: “What matters to you?” Communication styles and patterns
have to become more transparent and explicit at the individual, team, and organiza-
tion level. Education of P/MH nurses, psychiatrists, psychologists, and other mental
health professionals should include a holistic vision of the care as well as the multi-
professional care model in order to remove the barriers between different profes-
sions and specialties. Adopting this configuration of mental health care remains
challenging and contains unanswered questions; however, it represents the mental
health-care system of the future, and this book completely reflects this trend.
As a result, I endorse and recommend this book without hesitation or pause.
For any mental health practitioner, especially P/MH nurses, who wish to adopt a
progressive, emancipatory approach to practice, this book is a must read.

Brussels, Belgium Françoise Charnay-Sonnek

Foreword II

Back in 1984, at the tender age of 18, I took a job as a nursing assistant in an acute
male psychiatric ward of a mental hospital outside Bristol in the UK. I only worked
there for a few months—before disappearing off to explore India—but the experi-
ence remains clearly etched in my mind. I particularly remember one young man—
let’s call him Rob—who was admitted shortly after I started, highly agitated, restless
and manic. I’d never seen anyone so unwell. Yet four months and a few interesting
incidents later, Rob walked out of that hospital with a smile, a wave and his head
held high, his mind mended. Since I too was young and had no formal nursing quali-
fications, I spent a lot of time on the ward with Rob and so was able to witness his
journey to recovery on an almost daily basis. At the end of my time working there, I
thought I would be unlikely to find such a rewarding job ever again, and so that has
proved in many ways. Working with numbers and policies and forms is not nearly as
interesting as directly working to help people get better from mental health problems.
I begin with this little account because it speaks to two pivotal issues underlying
the mental health nursing profession (and this book): the value of mental health and
our individual as well as collective need to nurture, protect and—where indicated—
restore it and the potential for and power of recovery from mental health problems,
both in its clinical and personal sense. I don’t know what happened to Rob after that
hospital admission, but at discharge his mental health state was evidently stabilized
and his functional capacities were restored to the extent that he was able to go back
to his course of study.
Our mental health and well-being is a precious but fragile asset, shaped by a
myriad of different factors that may be either protective or harmful. It is therefore
appropriate and reassuring that due place and recognition is given in this new text-
book to the underlying determinants of mental health and the explicit adoption of a
biopsychosocial approach to its understanding. Improved knowledge and awareness
about the many possible factors that may lead to someone becoming ill and coming
into contact with mental health services would seem to be a vital prerequisite for
a more nuanced and holistic response to a person’s needs. The pursuit of a person-
centred approach to mental health nursing is indeed a recurring and deservedly cen-
tral theme of this book and one that resonates strongly with broader (inter)national
agendas to strengthen health systems and workforce development policies.
In this volume, attention is also given to the needs of particular subpopulations,
including refugees and migrants. Europe is witnessing a huge inward movement of

vii
viii Foreword II

people, many of them scarred by conflict, civil unrest, or persecution, which not
only increases the numbers of people who could benefit from decent, responsive
mental health services but also poses new challenges for mental health nurses and
other frontline workers, including issues of cultural sensitivity and language. These
and other issues are nicely picked up in a section devoted to the competencies
required of nurses working in mental health.
A further important challenge and need concerns how to foster effective collabo-
ration or joint working arrangements with other professional groups. There is more
than enough evidence to support the value of collaborative care in its true sense, but
all kinds of real-world barriers seem to get in the way of its proper implementation,
including weak clinical governance, vertical budgeting arrangements and ill-defined
roles and responsibilities. So a further competency need extends to working well
with other health professionals as well as working well with users of services! In
support of this strategic need, the WHO Regional Office for Europe has had the
pleasure of hosting a number of knowledge exchange meetings between lead repre-
sentatives of staff groups active in mental health in the region—including Horatio.
A final critical area of strategic need relates to the inclusion of service users in
the processes and decisions that affect their lives. This is a foundational principle of
the WHO European Mental Health Action Plan 2013–2020 and one given renewed
emphasis in a recent (2017) Report of the Special Rapporteur to the UN on the
right of everyone to the enjoyment of the highest attainable standard of physical
and mental health. Issues around the engagement, involvement and participation
of service users are explored in Chap. 3 of this book, including issues of informed
consent, shared decision-making and legal capacity. This has also been a major area
of developmental work for WHO over the last decade, culminating in the release of
a comprehensive set of QualityRights training and guidance materials for assessing
and improving standards of care and human rights protection across different men-
tal health-care settings and in ways that are fully in line with the UN Convention on
the Rights of Persons with Disabilities. It is incumbent on mental health nurses to
be not only cognizant but also respectful of the human rights of those whom they
are caring for.
I congratulate the editors and authors for putting together this new book and
share the hopes and expectations they have for the translation of a person-centred,
evidence-based and rights-oriented approach to mental health promotion, protection
and restitution into everyday nursing practice.

Dan Chisholm
Programme Manager for Mental Health
Division of NCDs and Promoting Health through the Life-Course
WHO Regional Office for Europe, Copenhagen, Denmark
Preface

Why Another Psychiatric/Mental Health Nursing Textbook?

That is a good place to start.

In our long careers in psychiatric/mental health nursing, neither of the editors has
ever found one textbook that featured the key emphases and elements that we
wanted and needed to see. Sure, some textbooks included some of these desired
emphases and elements; those published during the last ten years or so may have
included material on evidence-based practice. Others have something of a humanis-
tic or person-centred focus. One or two have eschewed the dominant bio-psychiatry,
pharmacologically-skewed, and containment driven (i.e. defensive practice) domi-
nant discourse of most Occidental, contemporary mental health care. And a few
have made some effort to reflect a European emphasis—to a greater or lesser extent
and with mixed results. But no P/MH textbook has brought these emphases
together—up until now. For those involved in leading the writing, editing and pro-
duction of this book, this publication represents the first genuinely European,
Person-centred, evidence-based, P/MH nursing textbook that questions the hege-
mony of bio-psychiatry, places the human connection and therapeutic relationship
as central and sees service users as our partners in care.
The initial idea for the book belongs with Jose, and with apologies to Tolkien,
‘the tale grew in the telling’ once this became a collaborative, co-edited text with the
addition of John. One of our early and easy design decisions was to compile a list of
contributors that genuinely represented and reflected as many European nations as
possible rather than having the more typical, ‘Anglo-Saxon’-heavy author composi-
tion. For a genuinely European P/MH nursing textbook, the Editors felt it should
include contributions emanating from lesser known European authors and often
unrepresented European nations. Further, the editors felt that the book could have
more utility and applicability if we invited a few contributions from non-European
scholars, arguably broadening its appeal and widening the audience that might see
something meaningful and experience a ‘phenomenological ah ha!’
As with most journeys, our path from conceptualisation to realisation was nei-
ther linear nor lacking turbulence. And at the risk of sounding trite, maybe there was
something worthwhile and enabling in such struggles? The destination ‘tastes’ even
sweeter for the challenges encountered en route. And so the project that began in

ix
x Preface

earnest in 2016 comes to fruition in 2018. Maybe as the textbook evolved during its
production, it may also be the case that the editors (and authors?) are changed as a
result of their experiences.
In closing, if the contributions from the authors, representing around 20 different
countries, are anything to go by, there remains an international appetite for the
form(s) of P/MH nursing and mental health care featured and focused on in this
book, both in the mental health care providers and the services users—the recipients
and consumers of such care. This is heartening. While the published evidence seems
to suggest that the passion for interpersonally focused P/MH nursing care may have
passed its zenith, the same body of work continues to highlight that desire that ser-
vice users have to receive and engage in such care. And so to see these key ideas
embraced and embedded throughout this book gave the editors hope for the future.
After all, as Peplau (1995, p.x), the so-called Founding Mother of P/MH nurse,
stated:

Despite our current emphasis on medical diagnoses, sophisticated technology, economic

cutbacks and “quick fixes”, what patients need most in the midst of this health care maze is
sensitive and caring individuals who are willing to enter into interpersonal relationships that
foster hope and prevent hopelessness.

Coimbra, Portugal  José Carlos Santos

Kingston, Canada John R. Cutcliffe
November 2017
Acknowledgements

The editors have a number of people and organisations that they need to offer their
profound thanks to, and without whom this book could not have been produced.
Firstly, to each of the publishers that gracefully provided permission to contribu-
tors to reproduce part or all of their previously published works, we extend our
appreciation and thanks. Where such reproductions have occurred, we include
acknowledgments and thanks at the end of these individual chapters. However, the
editors would like to offer our thanks again here to the publishing houses: Taylor
Francis, Elsevier and Wiley.
Secondly, it is perhaps tautological to point out that without the outstanding work
and contributions of our authors, this book would not exist. To each contributor,
whether a sole or co-author—the editors are proud to be associated with each of you
and want each of you to know that your contributions have elevated the overall aca-
demic quality and clinical utility of this book. Thank you.
Thirdly, to the foreword writers, Françoise and Dan; we greatly appreciate your
Forewords and the endorsement of the book, and both of which offer some thought-
ful and interesting insights and comments.
Fourthly, to the publishing team, Nathalie and Madona, and everyone else at
Springer; we know the effort and energy you put into this book. We hope and trust
that you are happy with the finished product and what a way to start a book series.
Thank you.
Fifthly, to our families, Joao Santos and Rita Santos, and to Maryla, Natalia and
Charlotte—we could not have done this without your unfailing support, love and
encouragement. This one is for you!
And lastly to all the clients, family members and significant others that we have
encountered in our respective mental health care careers; we are honoured to have
shared in your journey and hope that, in some small way, we made a difference for
the better.

xi
Contents

Part I Principles and Approaches

1 Introduction: Remembering the Person: The Need for a
Twenty-First-Century, Person-Centred European
Psychiatric/Mental Health Nursing Textbook ��������������������������������������    3
John R. Cutcliffe and José Carlos Santos
2 Oxymoronic or Synergistic: Deconstructing the Psychiatric
and/or Mental Health Nurse ���������������������������������������������������������������������� 13
John R. Cutcliffe, Chris Stevenson, and Richard Lakeman
3 Service User Involvement and Perspectives���������������������������������������������� 29
Marta Ferraz
4 Taxonomies: Towards a Shared Nomenclature and Language������������   37
Carlos Alberto da Cruz Sequeira and Francisco Miguel Correia
Sampaio
5 Theories of the Interpersonal Relationships, Transitions
and Humanistic Theories: Contribution to Frameworks
of Psychiatric/Mental Health Nursing in Europe���������������������������������   49
José Carlos Carvalho and Raul Alberto Cordeiro
6 An Introduction to the Art and Science of Cognitive
Behavioural Psychotherapy������������������������������������������������������������������������ 59
John Swan and Graham Sloan
7 Psychodynamic and Psychoanalytical Theory, Approaches
and Clinical Relevance: Applying the Psychoanalytic
Principles and Practices to Mental Health Nursing������������������������������   75
J. Lopes and John R. Cutcliffe
8 The Biopsychosocial Approach: Towards Holistic,
Person-Centred Psychiatric/Mental Health Nursing Practice������������   89
José Carlos Santos, Marie Bashaw, Will Mattcham,
John R. Cutcliffe, and Kelly Graziani Giacchero Vedana

xiii
xiv Contents

9 Trauma-Informed Care: Progressive Mental Health Care

for the Twenty-First Century�������������������������������������������������������������������� 103
John R. Cutcliffe, Rodger Travale, and Tyler Green
10 Competences for Clinical Supervision in Psychiatric/Mental
Health Nursing ������������������������������������������������������������������������������������������ 123
John R. Cutcliffe and Graham Sloan
11 European and Worldwide Mental Health Epidemiology
and Trends�������������������������������������������������������������������������������������������������� 141
Evanthia Sakellari
12 Mental Health Nurses and Responding to Suffering
in the Twenty-first Century Occidental World: Accompanying
People on Their Search for Meaning�������������������������������������������������������� 151
John R. Cutcliffe, Jan Kare Hummelvol, Arild Granerud,
and Bengt Erikson

Part II Settings and Contexts

13 Acute Inpatient Psychiatric/Mental Health Nursing: Lessons

Learned and Current Developments�������������������������������������������������������� 169
Roland van de Sande
14 Community Psychiatric/Mental Health Nursing: Contexts
and Challenges—The Case of Nurse Prescribing
and Recovery-­Focused Interventions ���������������������������������������������������� 183
Steve Hemingway and Neil Brimblecombe
15 Unearthing the Theoretical Underpinnings of “Green Care”
in Mental Health and Substance Misuse Care: History,
Theoretical Origins, and Contemporary Clinical Examples ���������������� 195
John R. Cutcliffe and Rodger Travale
16 Nursing People in Prisons, Forensics and Correctional Facilities �������� 211
Tommy Dickinson, Amrita Mullan, Kirsty Lippiatt,
and Julie Ann Owen
17 eHealth, Telematics and Telehealth���������������������������������������������������������� 223
Nina Kilkku
18 Public Health and Ecological Approaches: The Example
of eHealth for Adolescent Mental Health Support �������������������������������� 235
Anttila Minna, Kurki Marjo, and Välimäki Maritta

Part III Psychiatric/Mental Health Nursing Competencies

and Ways of Working
19 Forming and Maintaining Interpersonal Relationships������������������������ 247
Manuel José Lopes
Contents xv

20 Psychiatric/Mental Health Nursing Core Competencies:

Communication Skills�������������������������������������������������������������������������������� 259
Cândida Loureiro, Helena Quaresma, and José Carlos Santos
21 Group Work in Psychiatric/Mental Health Nursing: The Case
for Psychoeducation as a Means to Therapeutic Ends �������������������������� 269
Evelyn Gordon and Maeve Kenny
22 A Family-Focused, Recovery Approach When Working
with Families When a Parent Has a History of Mental Health
Problems: From Theory to Practice�������������������������������������������������������� 283
Darryl Maybery and Andrea Reupert
23 Psychiatric/Mental Health Nursing and Mental Health
Promotion: An Eight Steps Path�������������������������������������������������������������� 293
José Carlos Rodrigues Gomes
24 Therapeutic Milieu: Utilizing the Environment to Promote
Mental Wellness������������������������������������������������������������������������������������������ 309
Tyler D. Green
25 Psychiatric/Mental Health Nursing Nonphysical Competencies
for Managing Violence and Aggression: De-escalation
and Defusion ���������������������������������������������������������������������������������������������� 319
Hulya Bilgin and Zeynep Ozaslan
Part IV Human Experiences of Mental Health Problems and Psychiatric/
Mental Health Nursing Responses

26 Problems Affecting a Person’s Mood ������������������������������������������������������ 337

German López-Cortacans, Carme Ferré-Grau,
and José Carlos Santos
27 The Person Experiencing Anxiety������������������������������������������������������������ 353
Columba McLaughlin
28 Integrated Care – ‘Schizophrenia’: A Challenge
for Psychiatric/Mental Health Nursing���������������������������������������������������� 371
David González-Pando and Fernando Alonso-Pérez
29 Human Experiences of and Psychiatric/Mental Health Nurses’
Responses to Problems Related to Dementias
and Cognitive Impairment������������������������������������������������������������������������ 385
Helena Quaresma, Cândida Loureiro, and José Carlos Santos
30 Problems Related to Substance and Alcohol Misuse������������������������������ 395
Fatma Yasemin Kutlu and Gul Dikec
xvi Contents

Part V Specific Challenges

31 Problems Related to Eating, Nutrition, and Body Image���������������������� 425

Christopher Modica
32 Suicide and Self-Harm������������������������������������������������������������������������������ 441
José Carlos Santos
33 A Systematic Perspective of Violence and Aggression in Mental
Health Care: Toward a More Comprehensive Understanding
and Conceptualization ������������������������������������������������������������������������������ 453
John R. Cutcliffe and Sanaz Riahi
34 The Withdrawn or Recalcitrant Client���������������������������������������������������� 479
Richard Lakeman
35 Confronting Goffman: How Can Mental Health Nurses
Effectively Challenge Stigma? A Critical View of the Literature���������� 493
L. Bates and T. Stickley

Part VI Special Populations

36 Psychiatric/Mental Health Nursing Care of Children

and Adolescents���������������������������������������������������������������������������������������� 507
António Jorge Soares Antunes Nabais, Lucília Rosa Mateus Nunes,
John R. Cutcliffe, and José Carlos Santos
37 Psychiatric/Mental Health Nursing Care of the Older Adult:
Mental Health in Old Age������������������������������������������������������������������������� 521
Bengt Eriksson and Arild Granerud
38 Psychiatric/Mental Health Nurses Care of the Client Who Presents
with Both Mental Health and Substance Misuse Problems ������������������ 533
John R. Cutcliffe, Rodger Travale, and T. Green
39 Non-European and European Migrants in Acute Adult Inpatient
Mental Healthcare: Dissociation and Identity���������������������������������������� 549
Yasmine Souiah-Benchorab, Stephen Adshead,
and Jean-Manuel Morvillers
40 Working with Individuals Who Are Homeless���������������������������������������� 561
Cheryl Forchuk
41 Mental Health Problems and Risks in Refugees During Migration
Processes and Experiences: Literature Overview
and Interventions �������������������������������������������������������������������������������������� 571
Cossu Giulia, Maura Galletta, and Carta Mauro Giovanni
About the Editors

Dr. John R. Cutcliffe is the owner/operator of

Cutcliffe Consulting, a health care/higher educa-
tion/corrections consulting firm that operates in the
USA, Canada, and Europe. He is an esteemed aca-
demic, having held three Endowed Research Chairs;
he also practices as a psychotherapist. He also holds
Adjunct Professor positions at the University of
Ottawa, Canada; the University of Coimbra,
Portugal; and the University of Malta, Malta. Most
recently, John held the ‘Blanke Endowed Research Chair in Nursing Research’/
Director for the Center for Nursing Research at Wright State University, Ohio,
USA. His two previous Endowed Professorial Research chairs were the ‘David
G. Braithwaite Research Chair’ at the University of Texas and the ‘Acadia
Professorship in Psychiatric and Mental Health Nursing’ at the University of
Maine, both in the USA.
John’s clinical background is in nursing, having completed his psychiatric nurse
and then his general nurse education in the United Kingdom. John’s research inter-
ests focus on hope, suicide, and clinical supervision, and he was recognised by the
federal government of Canada and cited as one of the top 20 ‘Research Leaders of
Tomorrow’ for his research focusing on hope and suicidology.
He has published extensively—over 120 peer-reviewed papers, 35 chapters, over
50 professional/editorial/non-peer-reviewed papers, 11 books, and over 90 abstracts/
conference proceedings. As of June 2017, his work has been cited more than 5647
times (according to Google Scholar), his ‘H’ Index is 39; his I-10 index is 100. His
work on suicide and care of the suicidal person has been translated into German,
Japanese, Dutch, Spanish, Mandarin Chinese, Portuguese, Korean, Turkish, and
Italian. He has over $5,000,000 dollars of extra-mural research funding as Primary/
Co-Investigator and his research findings, particularly those pertaining to suicide
and hope, are now found in best practice guidelines in several parts of the world.
John has a track record of successful doctoral student supervision, operationalized
through his primary and Adjunct appointments. As a result, he has a track record of
providing doctoral supervision via distance to his internationally located students.
He has served as the national Canadian Representative for the International
Association of Suicide Prevention and the Director of the International Society of

xvii
xviii About the Editors

Psychiatric Nurses: Education and Research division: he is the Associate Editor for
the highest ranked Psychiatric/Mental Health Nursing Journal as well as serving on
the boards of eight other health or education focused journals. And in 2012 he was
invited by the Director of Medicine at Yale University to join the first international
advisory board on Clinical Supervision.
He retains his interest in clinical work, particularly in psychotherapy and advanc-
ing a more human-focused approach to Psychiatric/Mental Health nursing—in psy-
chiatric facilities, corrections facilities, and substance misuse facilities; care of the
suicidal person, inspiring hope, clinical supervision, and dealing with violence and
aggression.
José Carlos Santos is a Coordinating Professor
at the Nursing School of Coimbra. He has a back-
ground in nursing and experience in general and
psychiatric hospitals. He completed his nurs-
ing degree (1986), mental health specialisation
(1997), and master’s degree (2000) in Coimbra,
and his doctoral degree (2006) at the University
of Porto.
He is a researcher of the Health Sciences
Research Unit: Nursing (UICISA:E), Nursing
School of Coimbra. He coordinates the ‘Prevention
of suicidal behaviours’ project, which has three main
areas: adolescents—prevention of suicidal behav-
iours in schools; families—prevention of suicidal
behaviours with the families; and ­professionals—
guidelines and tools to prevent suicidal behaviours. He is also a researcher at the
Portuguese Observatory on Health Systems.
José is a professor of Mental Health/Psychiatric Nursing in doctoral and master’s
programmes, and in an undergraduate nursing degree. He is currently the coordina-
tor of the master’s degree in Mental Health and Psychiatric Nursing at the Nursing
School of Coimbra.
He is a renowned specialist in suicidal behaviours. He was President of the
Portuguese Society of Suicidology (2011–2013) and Rapporteur for the Portuguese
Suicide Prevention Plan (2013–2020). He supervises both national and international
master’s dissertations and doctoral theses in this field. He also works in the Suicide
Research and Prevention Unit at the Coimbra University Hospital.
José is a member of several health-related organisations where he occupies a
position of responsibility.
He has published extensively in this field. He is the author or coauthor of 5
books, 13 chapters, over 30 peer-reviewed papers, and over 60 abstracts/conference
proceedings in Portuguese and English. He is a board member or referee of several
journals.
His interests focus on suicidal behaviours and their impact on the family, society,
and professionals, liaison psychiatry, and mental health/psychiatric nursing in
general.
Contributors

Stephen Adshead School of Health and Human Sciences, University of Essex

(Southend on Sea), Colchester, UK
Fernando Alonso-Pérez University of Oviedo, Oviedo, Spain
Marie Bashaw Assistant Professor of Nursing, Wright State University, Ohio,
USA
L. Bates Substance Misuse Nurse, Dudley and Walsall Mental Health
Partnership NHS Trust, Dudley, UK
Hulya Bilgin Florence Nightingale Nursing Faculty, Psychiatric and Mental
Health Nursing, Istanbul University, Istanbul, Turkey
Neil Brimblecombe South London and Maudsley NHS Foundation Trust,
London, UK
José Carlos Carvalho Escola Superior de Enfermagem do Porto (Nursing
College of Porto), Porto, Portugal
Raul Alberto Cordeiro Polytechnic Institute of Portalegre, Portalegre, Portugal
Carlos Alberto da Cruz Sequeira Nursing School of Porto, Porto, Portugal
Scientific Pedagogical Unit, “Nursing: Discipline & Profession”, Nursing School
of Porto, Porto, Portugal
Research Group “NursID: Innovation & Development in Nursing” Center for
Health Technology and Services Research (CINTESIS), Porto, Portugal
Portuguese Society of Mental Health Nursing, Porto, Portugal
John R. Cutcliffe Cutcliffe Consulting, Kingston, Canada
School of Nursing, Coimbra, Portugal
Tommy Dickinson The University of Manchester, Manchester, UK
Gul Dikec Nursing Department, Health Science Faculty, Istinye University,
Istanbul, Turkey

xix
xx Contributors

Bengt Eriksson Inland Norway University of Applied Science, Faculty of

Public Health, Hedmark University College, Elverum, Norway
Marta Ferraz Coordinator of the Advisory Commission for User and Caregiver
Participation, National Mental Health Programme, DGS, Director of the Oeiras
Psychosocial Rehabilitation Unit, ARIA, Mira, Portugal
Carme Ferré-Grau Department of Nursing, Rovira i Virgili University,
Tarragona, Spain
Cheryl Forchuk Western University, London, ON, Canada
Maura Galletta Department of Medical Science and Public Health, University
of Cagliari, Cagliari, Italy
Kelly Graziani Giacchero Vedana Ribeirão Preto College of Nursing - PAHO/
WHO Collaborating Centre for Nursing Research Development, University of
São Paulo, Butantã, Brazil
Carta Mauro Giovanni Department of Medical Science and Public Health,
University of Cagliari, Cagliari, Italy
Cossu Giulia Department of Medical Science and Public Health, University of
Cagliari, Cagliari, Italy
José Carlos Rodrigues Gomes Health Research Unit, School of health
Sciences, Polytechnic Institute of Leiria, Leiria, Portugal
David González-Pando University of Oviedo, Oviedo, Spain
Amrita Goomany Sheffield Health & Social Care NHS Foundation Trust,
Sheffield, UK
Evelyn Gordon School of Nursing and Human Sciences, Dublin City
University, Dublin, Ireland
Arild Granerud Inland Norway University of Applied Science, Faculty of
Public Health, Hedmark University College, Elverum, Norway
Tyler Green Clinical Instructor and Psychiatric Nurse Practitioner, Wright State
University Ohio, New York, NY, USA
Tyler D. Green College of Nursing and Health, Wright State University,
Dayton, OH, USA
T. Green Owner/Operator Cutcliffe Consulting, University of Coimbra, Dayton,
Portugal
Steve Hemingway University of Huddersfield, Huddersfield, UK
Jan Kare Hummelvol Inland Norway University of Applied Science, Faculty of
Public Health, Hedmark University College, Elverum, Norway
Contributors xxi

Maeve Kenny Principal Clinical Psychologist, St Vincent’s Hospital, Fairview,

Dublin, Ireland
Nina Kilkku School of Health Care, Tampere University of Applied Sciences,
Pirkanmaa, Finland
Fatma Yasemin Kutlu Mental Health and Psychiatric Nursing Department,
Florence Nightingale Nursing Faculty, Istanbul University, İstanbul, Turkey
Richard Lakeman Adolescent Mental Health Nurse Navigator/Clinical Nurse
Consultant, Cairns and Hinterland Health Service District, Queensland Health,
Brisbane, Australia
School of Health & Human Science, Southern Cross University, Lismore, NSW,
Australia
Kirsty Lippiatt King’s College London, London, UK
J. Lopes RN Mental Health Specialist, Psychoanalitic Psychotherapist, School
of Health Care, Polithecnical Institute of Setúbal, Setúbal, Portugal
Manuel José Lopes São João de Deus School of Nursing, University of Évora,
Évora, Portugal
German López-Cortacans Primary Care Center, Catalan Institute of Health,
Barcelona, Spain
Cândida Loureiro Nursing School of Coimbra, Coimbra, Portugal
Välimäki Maritta Department of Nursing Science, University of Turku, Turku,
Finland
School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong
Kurki Marjo Department of Child Psychiatry, University of Turku, Turku,
Finland
Will Mattcham Assistant Professor of Nursing, Cleveland State University,
Ohio, USA
Darryl Mayberry Department of Rural Health and Professor Rural Mental
Health Research, Director School of Rural Health - Monash University, Moe, VIC,
Australia
Columba McLaughlin Ulster University, Coleraine, UK
Anttila Minna Department of Nursing Science, University of Turku, Turku,
Finland
Christopher Modica Wright State University, Dayton, OH, USA
Jean-Manuel Morvillers EPS Maison Blanche, Paris, France
Université Paris 13, Sorbonne Paris Cité, Chaire Recherche Sciences Infirmières,
Laboratoire Educations et Pratiques de Santé (LEPS), (EA 3412), UFR SMBH,
Bobigny, France
xxii Contributors

Amrita Mullan Sheffield Health & Social Care NHS Foundation Trust,
Sheffield, UK
António Jorge Soares Antunes Nabais Centro Hospitalar Lisboa Central,
Hospital D. Estefânia, Lisboa, Portugal
Lucília Rosa Mateus Nunes Nursing Department, Escola Superior de Saúde—
Instituto Politécnico de Setúbal, Setúbal, Portugal
Julie Ann Owen King’s College London, London, UK
Zeynep Ozaslan Nursing Department, Health Sciences Faculty, Kocaeli
University, Kocaeli, Turkey
Helena Quaresma Nursing School of Coimbra, Coimbra, Portugal
Andrea Reupert Faculty of Education, Krongold, Monash University, Clayton,
VIC, Australia
Sanaz Riahi Clinical Information and Adolescent Services, Ontario Shores
Mental Health, Whitby, ON, Canada
Evanthia Sakellari Department of Public Health and Community Health,
Athens University of Applied Sciences, Athens, Greece
Department of Nursing Science, University of Turku, Turku, Finland
Francisco Miguel Correia Sampaio Nursing School of Porto, Porto, Portugal
Research Group “NursID: Innovation & Development in Nursing” Center for
Health Technology and Services Research (CINTESIS), Porto, Portugal
Psychiatry Department, Hospital de Braga, Braga, Portugal
Roland van de Sande Institute of Nursing Studies, Utrecht University of
Applied Sciences, Utrecht, The Netherlands
Parnassia Psychiatric Institute, The Hague, The Netherlands
José Carlos Santos Escola Superior de Enfermagem de Coimbra,
Nursing School of Coimbra, Coimbra, Portugal
Graham Sloan Consultant Nurse in Psychological Therapies, Psychological
services, NHS Ayrshire and Arran, Ayr, Scotland, UK
Psychological Therapies Training Coordinator, NHS Education for Scotland, NHS
Ayrshire and Arran, Ayr, Scotland, UK
Yasmine Souiah-Benchorab EPS Maison Blanche, Paris, France
Chris Stevenson Formerly Head of School of Nursing and Professor, Dublin
City University, Dublin, Ireland
Contributors xxiii

T. Stickley Associate Professor, School of Nursing, Midwifery and Physiotherapy,

University of Nottingham, Nottingham, UK
John Swan Division of Neurosciences and Medical Education Institute, College
of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK
Rodger Travale Healthcare Manager, Chiron Health Services, Prince George
Regional Correctional Centre, British Columbia, Canada
 Part I
Principles and Approaches
Introduction: Remembering the Person:
The Need for a Twenty-First-Century, 1
Person-Centred European Psychiatric/
Mental Health Nursing Textbook

John R. Cutcliffe and José Carlos Santos

1.1  he Need for a Contemporary European Psychiatric/

T
Mental Health Textbook

Anyone who has paid even only cursory attention to the global news over the last
decade or so should be well aware that Europe has endured, and in many ways is still
enduring, significant upheaval, major socio-economic and geopolitical changes/chal-
lenges.1 These challenges and developments can have a direct and indirect impact on
mental health-care policy (Santos and Cutcliffe 2013), on mental health service user
outcomes and experiences (Simou and Koutsogeorgou 2014) and on psychiatric/men-
tal health nursing practice, education and research (WHO 2012). According to the
World Health Organisation—European Regional Office (2017)— mental health prob-
lems account for almost 20% of the burden of disease in the WHO European Region
and now affect one in four people in Europe at some time in their life. Additionally,
according to the findings of several significant studies (see, e.g. European College of
Neuropsychopharmacology 2011), results reveal that (so-called) mental disorders
have become Europe’s largest health challenge in the twenty-first century. To further

1
See, for example, major economic meltdown; Syrian refugee crisis, rise of anti-establishment and
the nouveau right, Britain’s decision to Brexit.

J.R. Cutcliffe (*)

Cutcliffe Consulting, Kingston, Canada
School of Nursing, Coimbra, Portugal
e-mail: [email protected]
J.C. Santos
Escola Superior de Enfermagem de Coimbra, Nursing School of Coimbra,
Coimbra, Portugal
e-mail: [email protected]

© Springer International Publishing Switzerland 2018 3

J.C. Santos, J.R. Cutcliffe (eds.), European Psychiatric/Mental Health Nursing
in the 21st Century, Principles of Specialty Nursing,
https://doi.org/10.1007/978-3-319-31772-4_1
4 J.R. Cutcliffe and J.C. Santos

compound and complicate the situation, the clinical focus and indeed very nature of
mental health problems and resultant responses to mental health-care needs have been
annexed by those who would seek to locate the discourse firmly within biological
psychiatry.2 For instance, the relevant literature draws attention to:

• The creeping encroachment of the medicalisation of everyday life (see Szasz,

2007; Cutcliffe and Lakeman In Press; Whittaker 2010, 2012; Lakeman and
Cutcliffe 2009, 2016)
• The continuing acceptance and pushing (some use the term ‘marketing’) of the
biological hypothesis of mental health even in the face of an absence of convincing
or compelling scientific evidence (Deacon 2013; Lakeman and Cutcliffe 2016)
• The exponential expansion of so-called psychiatric diagnoses in the various iter-
ations of the DSM, both in terms of scope and sheer number,3 despite the fact that
such diagnoses represent a consensus of opinion within certain American
Psychological Association members and are, in no way, scientific constructs (see
also Phillips et al. 2012)

Furthermore, P/MH nurses and all mental health-care practitioners are now
firmly embedded in and have to operate within the epoch of evidence-based practice
(see, e.g. Buccheri et al. 2010). While the editors are more comfortable with and
prefer to use the term ‘evidence-informed’,4 we nevertheless wholeheartedly
embrace the concept of evidence-informed care and practice and, accordingly, all
contributing authors to this book we asked to write their chapters in this context. For
some people, there is a trend to delegitimise independent facts and create a climate
of epistemological relativism,5 resulting in situations where opposing parties rely on
their own facts. For the editors of this book, we deliberately eschew ‘Alt’ news and
other non-peer-reviewed sources of information. All authors and contributors to this
book were required to use sources of information that, where possible and
appropriate,6 were subject to the common scientific academic practices of falsifi-
ability, verifiability, empirical tests, peer review and independent verification/repro-
ducibility. As a case in point, the editors draw attention to the thorny issue of
biological psychiatry and the paucity of evidence.

2
And with this the almost automatic response to mental health problems being the prescription of
pharmaceuticals.
3
According to Spitzer et al. (1978), the DSM I had about a dozen separate diagnoses, whereas now
this number has grown to 265 in DSM V (Ghaemi 2013).
4
Given that even the most modest estimates suggest that the amount of practice that can accurately
claim to be evidence based is about 40%—with other studies suggesting even lower numbers, it is
something of an overreach to adopt the term ‘evidence-based practice’.
5
Indeed the Orwellian term ‘alternate facts’ has been advanced recently by a senior advisor to
Donald Trump (i.e. Kellyanne Conway). See http://www.cbsnews.com/news/kellyanne-
conway-alternative-facts-internet-memes/.
6
Not all research paradigms or methods see reproducibility as possible or necessary to establish
credibility, truth value or validity of findings; readers are referred to the vast literature available on
qualitative research methodology and the various underpinning philosophical views.
1 Introduction: Remembering the Person 5

As Cutcliffe and Lakeman (In Press) highlighted in a paper that was accepted for
publication in Skeptic (http://www.skeptic.com/):

Senior Lecturer at Harvard Medical School and the former Editor in Chief of The New
England Journal of Medicine) Marcia Angell draws together the findings and arguments of
Kirsch (a psychologist), Whittaker (a journalist) and Carlat (a psychiatrist) pertaining to the
biological causation hypothesis. She asserts, “but the main problem with the theory is that
after decades of trying to prove it, researchers have still come up empty-handed. All three
authors document the failure of scientists to find good evidence in its favor. Neurotransmitter
function seems to be normal in people with mental illness before treatment.” Angell high-
lights how Carlat refers to the chemical imbalance theory as a “myth”, and how Kirsch
concludes “It now seems beyond question that the traditional account of depression as a
chemical imbalance in the brain is simply wrong.

Accordingly, if operating judiciously within the evidence-informed approach,

then P/MH nurses ought to be aware of the biological hypothesis but treat it with a
healthy degree of scepticism—given the lack of evidence supporting (for a recent
review, please see Cutcliffe and Lakeman In Press; Lakeman and Cutcliffe 2016). At
the same time, accepting and operating within the boundaries of a genuinely scien-
tific discipline requires P/MH nurses to retain an open mind to the possibility that
the biological hypothesis may indeed turn out to be accurate; one does not close
down the possibility of having to accept this hypothesis in the face of new and com-
pelling evidence. Thus, throughout the book, the reader will find that the editors
eschew certain terms, preface some terms with the expression ‘so-called’ and/or
place such terms in ‘scare, shudder or sneer’ quotation marks as a way to illustrate
their unconfirmed nature.

1.2 A Different Psychiatric/Mental Nursing Textbook

When one acknowledges and accepts the actuality of the mental health challenges
facing Europe, the need for a P/MH nursing textbook that both acknowledges the
existence of and is contextualised by these challenges, becomes clear. There is a need
for P/MH nursing textbook that includes contemporary material on recently discov-
ered key aetiological findings and resultant policy/practice shifts, for instance, the
overwhelming and compelling evidence that links childhood trauma with the devel-
opment of mental health problems in adult life (see Chap. 9 on Trauma-Informed
Care). There is a need for a textbook that reflects the more contemporary global shift
in drug/substance misuse policy—not least the massive and significant shift from a
criminal justice-driven response to a treatment-driven response to substance misuse
(see Chaps. 30 and 39). Furthermore, there is a need for a P/MH nursing textbook
that adopts and promotes a person or client-centred approach as essential and one
that adopts a more critical stance on biopsychiatry and pharmacological responses as
the mainstay of our care responses and interventions. That is not to say that such
views have no place in our practice (or in this book for that matter). But it is to say
that there are already plentiful examples of textbooks that adopt and embrace the
biological view of psychiatry and see pharmacological intervention as the mainstay
6 J.R. Cutcliffe and J.C. Santos

of mental health care. Yet what are noticeably absent or at least spartan in this body
of literature are P/MH nursing textbooks that emphasise the interpersonal use of self
and that identify, illustrate and expand the multiple ways that P/MH nurses might
offer help and care for/with clients without relying predominantly on psychotropic
drugs, defensive practices and/or containment measures.
Consequently, this book has been designed, written and edited with a deliberate
focus on interpersonally focused ways of working as a P/MH nurse. It was designed
and constructed with a specific intent to identify, explain and explore the various
(multiple) ways that P/MH nurses might enact the full and wide range of skills and
interventions that they have available to them, rather than limiting, curtailing and
kerbing their therapeutic potential. The book was conceived as a deliberate counter-
point to the many P/MH nursing textbooks (in the view of the editors at least) that
emphasise defensive practices, containment measures, risk aversion, risk preoccu-
pation and litigation avoidance: to paraphrase P/MH nursing textbooks that empha-
sise the Psychiatric or Yang at the expense of the Mental Health or Yin (Cutcliffe
2000). And the book was conceptualised as a conduit for reinforcing the critical (for
the editors at least) shift in policy that sees mental health service users as partners in
their own care and that sees such individuals as experts by experience and very
often, according to the epidemiological evidence, as individuals trying to come to
terms with and find ways to cope with their own traumatic past. For the editors of
this book, one of the defining characteristics of person-centred P/MH nursing is the
desire to form partnerships with service users, work with (alongside) rather than
work ‘on’ such individuals.7 Such P/MH nurses see the service users themselves as
experts (and owners) of their own experiences and their own care. We wholeheart-
edly endorse and support the views expressed by the National Survivor User
Network (2017), namely, that mental health service user involvement is the active
participation of a person with lived experience of mental distress in shaping their
personal health plan, based on their knowledge of what works best for them (empha-
sis added). The editors concur with the stated view:
Service user involvement is about making sure that mental health services, organisations
and policies are led and shaped by the people best placed to know what works: people who
use mental health services. They are experts by experience.

And that:

Service-user leadership is fundamental to designing, delivering and checking services that

support people to fulfil their potential. Only by transforming services in the way that the
people who use them want us to can better outcomes be achieved at a time of real budget
constraint.

A further design decision for this textbook involved the editors wanting to
acknowledge the existence of certain unresolved issues and debates that are relevant

7
As this suggests a power differential between service user and P/MH nurse people with mental
health problems
1 Introduction: Remembering the Person 7

to P/MH nurses and nursing, and moreover, the editors wished to ensure that the
book included chapters on some issues that, while significant and important, hith-
erto have remained under-examined and under-discussed. Such issues include:

1. Expose/explore multiple meanings, inconsistencies, contradictions and hidden

agendas in the texts ‘psychiatric/mental health’ nursing.
2. Address the lack of a consistent nomenclature in mental health care.
3. And by no means least, consider the very nature of our responses to people expe-
riencing mental health problems and challenges.

1.3 The Structure of the Book

The book is composed of six sections: (1) Principles and Approaches, (2) Settings
and Contexts, (3) Psychiatric/Mental Health Nursing Competencies and Ways of
Working, (4) Human Experiences of Mental Health Problems and Psychiatric/
Mental Health Nursing Responses, (5) Specific Challenges and (6) Special
Populations.
The first section focuses on cross-cutting and/or overarching principles that have
relevance and application to all areas of mental health care and on principle, inter-
personal theoretical approaches. The second section focuses on the wide range of
different settings and contexts that mental health is delivered and in which P/MH
nurses operate. The editors further wished to include chapters in the book on histori-
cally atypical and/or nontraditional settings where P/MH nurses now work. While
various models or approaches to mental health-care delivery are (and have been
historically) evident across Europe,8 significant quantities of mental health care in
Europe traditionally involved large asylums and institutionalised care (see WHO—
ROE 2017). Indeed, reflecting the fundamental shift away from such care delivery
approaches, the WHO—ROE (2017) states:
The commitment to deinstitutionalization and the development of community-based mental
health services has continued, although progress is uneven across the Region. The consen-
sus is that care and treatment should be provided in local settings, since large mental hospi-
tals often lead to neglect and institutionalization. Thus, a focus on the expanding role of
primary care, working in partnership with multidisciplinary mental health staff in
community-­based facilities, has become central. (WHO—ROE 2017)

Accordingly, the editors wanted to ensure that a twenty-first-century P/MH nurs-

ing textbook includes chapters that accurately reflect the variety of ‘new’, contem-
porary and/or nontraditional settings and contexts in which European mental health
care is delivered. Accordingly, in addition to focusing on inpatient and community
care settings, the editors also commissioned chapters on mental health care in

8
Not least the examples of the exciting service delivery developments associated with Psychiatrica
Democratica in Italy (Crossley 2006) and mirrored in Spain (Ferre Navarete and Palanca 2005).
Exploring the Variety of Random
Documents with Different Content
taken via the lagoons to Lagos. The port is 4279 m. from Liverpool,
1203 from Freetown, Sierra Leone (the nearest safe port westward),
and 315 from Cape Coast.

The inhabitants, about 50,000, include, besides the native tribes,

Sierra Leonis, Fanti, Krumen and the descendants of some 6000
Brazilian emancipados who were settled here in the early days of
British rule. The Europeans number about 400. Rather more than
half the populace are Moslems.

LAGOS, a seaport of southern Portugal, in the district of Faro

(formerly the province of Algarve); on the Atlantic Ocean, and on the
estuary of the small river Lagos, here spanned by a fine stone
bridge. Pop. (1900) 8291. The city is defended by fortifications
erected in the 17th century. It is supplied with water by an aqueduct
800 yds. long. The harbour is deep, capacious, and completely
sheltered on the north and west; it is frequently visited by the British
Channel fleet. Vines and figs are extensively cultivated in the
neighbourhood, and Lagos is the centre of important sardine and
tunny fisheries. Its trade is chiefly carried on by small coasting
vessels, as there is no railway. Lagos is on or near the site of the
Roman Lacobriga. Since the 15th century it has held the formal rank
and title of city. Cape St Vincent, the ancient Promontorium Sacrum,
and the south-western extremity of the kingdom, is 22 m. W. It is
famous for its connexion with Prince Henry (q.v.), the Navigator, who
here founded the town of Sagres in 1421; and for several British
naval victories, the most celebrated of which was won in 1797 by
Admiral Jervis (afterwards Earl St Vincent) over a larger Spanish
squadron. In 1759 Admiral Boscawen defeated a French fleet off
Lagos. The great earthquake of 1755 destroyed a large part of the
city.

LA GRÂCE, or Les Grâces, a game invented in France during

the first quarter of the 19th century and called there le jeu des
Grâces. It is played with two light sticks about 16 in. long and a
wicker ring, which is projected into the air by placing it over the
sticks crossed and then separating them rapidly. The ring is caught
upon the stick of another player and thrown back, the object being
to prevent it from falling to the ground.
 LA GRAND’ COMBE, a town of southern France, in the
department of Gard on the Gardon, 39 m. N.N.W. of Nîmes by rail.
Pop. (1906) town, 6406; commune, 11,292. There are extensive coal
mines in the vicinity.

LAGRANGE, JOSEPH LOUIS (1736-1813), French

mathematician, was born at Turin, on the 25th of January 1736. He
was of French extraction, his great grandfather, a cavalry captain,
having passed from the service of France to that of Sardinia, and
settled in Turin under Emmanuel II. His father, Joseph Louis
Lagrange, married Maria Theresa Gros, only daughter of a rich
physician at Cambiano, and had by her eleven children, of whom
only the eldest (the subject of this notice) and the youngest survived
infancy. His emoluments as treasurer at war, together with his wife’s
fortune, provided him with ample means, which he lost by rash
speculations, a circumstance regarded by his son as the prelude to
his own good fortune; for had he been rich, he used to say, he might
never have known mathematics.

The genius of Lagrange did not at once take its true bent. His
earliest tastes were literary rather than scientific, and he learned the
rudiments of geometry during his first year at the college of Turin,
without difficulty, but without distinction. The perusal of a tract by
Halley (Phil. Trans. xviii. 960) roused his enthusiasm for the
analytical method, of which he was destined to develop the utmost
capabilities. He now entered, unaided save by his own unerring tact
and vivid apprehension, upon a course of study which, in two years,
placed him on a level with the greatest of his contemporaries. At the
age of nineteen he communicated to Leonhard Euler his idea of a
general method of dealing with “isoperimetrical” problems, known
later as the Calculus of Variations. It was eagerly welcomed by the
Berlin mathematician, who had the generosity to withhold from
publication his own further researches on the subject, until his
youthful correspondent should have had time to complete and
opportunity to claim the invention. This prosperous opening gave the
key-note to Lagrange’s career. Appointed, in 1754, professor of
geometry in the royal school of artillery, he formed with some of his
pupils—for the most part his seniors—friendships based on
community of scientific ardour. With the aid of the marquis de
Saluces and the anatomist G. F. Cigna, he founded in 1758 a society
which became the Turin Academy of Sciences. The first volume of its
memoirs, published in the following year, contained a paper by
Lagrange entitled Recherches sur la nature et la propagation du son,
in which the power of his analysis and his address in its application
were equally conspicuous. He made his first appearance in public as
the critic of Newton, and the arbiter between d’Alembert and Euler.
By considering only the particles of air found in a right line, he
reduced the problem of the propagation of sound to the solution of
the same partial differential equations that include the motions of
vibrating strings, and demonstrated the insufficiency of the methods
employed by both his great contemporaries in dealing with the latter
subject. He further treated in a masterly manner of echoes and the
mixture of sounds, and explained the phenomenon of grave
harmonics as due to the occurrence of beats so rapid as to generate
a musical note. This was followed, in the second volume of the
Miscellanea Taurinensia (1762) by his “Essai d’une nouvelle méthode
pour déterminer les maxima et les minima des formules intégrales
indéfinies,” together with the application of this important
development of analysis to the solution of several dynamical
problems, as well as to the demonstration of the mechanical
principle of “least action.” The essential point in his advance on
Euler’s mode of investigating curves of maximum or minimum
consisted in his purely analytical conception of the subject. He not
only freed it from all trammels of geometrical construction, but by
the introduction of the symbol δ gave it the efficacy of a new
calculus. He is thus justly regarded as the inventor of the “method of
variations”—a name supplied by Euler in 1766.

By these performances Lagrange found himself, at the age of

twenty-six, on the summit of European fame. Such a height had not
been reached without cost. Intense application during early youth
had weakened a constitution never robust, and led to accesses of
feverish exaltation culminating, in the spring of 1761, in an attack of
bilious hypochondria, which permanently lowered the tone of his
nervous system. Rest and exercise, however, temporarily restored
his health, and he gave proof of the undiminished vigour of his
powers by carrying off, in 1764, the prize offered by the Paris
Academy of Sciences for the best essay on the libration of the moon.
His treatise was remarkable, not only as offering a satisfactory
explanation of the coincidence between the lunar periods of rotation
and revolution, but as containing the first employment of his radical
formula of mechanics, obtained by combining with the principle of
d’Alembert that of virtual velocities. His success encouraged the
Academy to propose, in 1766, as a theme for competition, the
hitherto unattempted theory of the Jovian system. The prize was
again awarded to Lagrange; and he earned the same distinction with
essays on the problem of three bodies in 1772, on the secular
equation of the moon in 1774, and in 1778 on the theory of
cometary perturbations.

He had in the meantime gratified a long felt desire by a visit to

Paris, where he enjoyed the stimulating delight of conversing with
such mathematicians as A. C. Clairault, d’Alembert, Condorcet and
the Abbé Marie. Illness prevented him from visiting London. The
post of director of the mathematical department of the Berlin
Academy (of which he had been a member since 1759) becoming
vacant by the removal of Euler to St Petersburg, the latter and
d’Alembert united to recommend Lagrange as his successor. Euler’s
eulogium was enhanced by his desire to quit Berlin, d’Alembert’s by
his dread of a royal command to repair thither; and the result was
that an invitation, conveying the wish of the “greatest king in
Europe” to have the “greatest mathematician” at his court, was sent
to Turin. On the 6th of November 1766, Lagrange was installed in his
new position, with a salary of 6000 francs, ample leisure for scientific
research, and royal favour sufficient to secure him respect without
exciting envy. The national jealousy of foreigners, was at first a
source of annoyance to him; but such prejudices were gradually
disarmed by the inoffensiveness of his demeanour. We are told that
the universal example of his colleagues, rather than any desire for
female society, impelled him to matrimony; his choice being a lady of
the Conti family, who, by his request, joined him at Berlin. Soon after
marriage his wife was attacked by a lingering illness, to which she
succumbed, Lagrange devoting all his time, and a considerable store
of medical knowledge, to her care.
 The long series of memoirs—some of them complete treatises of
great moment in the history of science—communicated by Lagrange
to the Berlin Academy between the years 1767 and 1787 were not
the only fruits of his exile. His Mécanique analytique, in which his
genius most fully displayed itself, was produced during the same
period. This great work was the perfect realization of a design
conceived by the author almost in boyhood, and clearly sketched in
his first published essay.1 Its scope may be briefly described as the
reduction of the theory of mechanics to certain general formulae,
from the simple development of which should be derived the
equations necessary for the solution of each separate problem.2
From the fundamental principle of virtual velocities, which thus
acquired a new significance, Lagrange deduced, with the aid of the
calculus of variations, the whole system of mechanical truths, by
processes so elegant, lucid and harmonious as to constitute, in Sir
William Hamilton’s words, “a kind of scientific poem.” This unification
of method was one of matter also. By his mode of regarding a liquid
as a material system characterized by the unshackled mobility of its
minutest parts, the separation between the mechanics of matter in
different forms of aggregation finally disappeared, and the
fundamental equation of forces was for the first time extended to
hydrostatics and hydrodynamics.3 Thus a universal science of matter
and motion was derived, by an unbroken sequence of deduction,
from one radical principle; and analytical mechanics assumed the
clear and complete form of logical perfection which it now wears.

A publisher having with some difficulty been found, the book

appeared at Paris in 1788 under the supervision of A. M. Legendre.
But before that time Lagrange himself was on the spot. After the
death of Frederick the Great, his presence was competed for by the
courts of France, Spain and Naples, and a residence in Berlin having
ceased to possess any attraction for him, he removed to Paris in
1787. Marie Antoinette warmly patronized him. He was lodged in the
Louvre, received the grant of an income equal to that he had
hitherto enjoyed, and, with the title of “veteran pensioner” in lieu of
that of “foreign associate” (conferred in 1772), the right of voting at
the deliberations of the Academy. In the midst of these distinctions,
a profound melancholy seized upon him. His mathematical
enthusiasm was for the time completely quenched, and during two
years the printed volume of his Mécanique, which he had seen only
in manuscript, lay unopened beside him. He relieved his dejection
with miscellaneous studies, especially with that of chemistry, which,
in the new form given to it by Lavoisier, he found “aisée comme
l’algèbre.” The Revolution roused him once more to activity and
cheerfulness. Curiosity impelled him to remain and watch the
progress of such a novel phenomenon; but curiosity was changed
into dismay as the terrific character of the phenomenon unfolded
itself. He now bitterly regretted his temerity in braving the danger.
“Tu l’as voulu” he would repeat self-reproachfully. Even from
revolutionary tribunals, however, the name of Lagrange uniformly
commanded respect. His pension was continued by the National
Assembly, and he was partially indemnified for the depreciation of
the currency by remunerative appointments. Nominated president of
the Academical commission for the reform of weights and measures,
his services were retained when its “purification” by the Jacobins
removed his most distinguished colleagues. He again sat on the
commission of 1799 for the construction of the metric system, and
by his zealous advocacy of the decimal principle largely contributed
to its adoption.

Meanwhile, on the 31st of May 1792 he married Mademoiselle

Lemonnier, daughter of the astronomer of that name, a young and
beautiful girl, whose devotion ignored disparity of years, and formed
the one tie with life which Lagrange found it hard to break. He had
no children by either marriage. Although specially exempted from
the operation of the decree of October 1793, imposing banishment
on foreign residents, he took alarm at the fate of J. S. Bailly and A.
L. Lavoisier, and prepared to resume his former situation in Berlin.
His design was frustrated by the establishment of and his official
connexion with the École Normale, and the École Polytechnique. The
former institution had an ephemeral existence; but amongst the
benefits derived from the foundation of the École Polytechnique one
of the greatest, it has been observed,4 was the restoration of
Lagrange to mathematics. The remembrance of his teachings was
long treasured by such of his auditors—amongst whom were J. B. J.
Delambre and S. F. Lacroix—as were capable of appreciating them.
In expounding the principles of the differential calculus, he started,
as it were, from the level of his pupils, and ascended with them by
almost insensible gradations from elementary to abstruse
conceptions. He seemed, not a professor amongst students, but a
learner amongst learners; pauses for thought alternated with
luminous exposition; invention accompanied demonstration; and
thus originated his Théorie des fonctions analytiques (Paris, 1797).
The leading idea of this work was contained in a paper published in
the Berlin Memoirs for 1772.5 Its object was the elimination of the,
to some minds, unsatisfactory conception of the infinite from the
metaphysics of the higher mathematics, and the substitution for the
differential and integral calculus of an analogous method depending
wholly on the serial development of algebraical functions. By means
of this “calculus of derived functions” Lagrange hoped to give to the
solution of all analytical problems the utmost “rigour of the
demonstrations of the ancients”;6 but it cannot be said that the
attempt was successful. The validity of his fundamental position was
impaired by the absence of a well-constituted theory of series; the
notation employed was inconvenient, and was abandoned by its
inventor in the second edition of his Mécanique; while his scruples as
to the admission into analytical investigations of the idea of limits or
vanishing ratios have long since been laid aside as idle. Nowhere,
however, were the keenness and clearness of his intellect more
conspicuous than in this brilliant effort, which, if it failed in its
immediate object, was highly effective in secondary results. His
purely abstract mode of regarding functions, apart from any
mechanical or geometrical considerations, led the way to a new and
sharply characterized development of the higher analysis in the
hands of A. Cauchy, C. G. Jacobi, and others.7 The Théorie des
fonctions is divided into three parts, of which the first explains the
general doctrine of functions, the second deals with its application to
geometry, and the third with its bearings on mechanics.

On the establishment of the Institute, Lagrange was placed at the

head of the section of geometry; he was one of the first members of
the Bureau des Longitudes; and his name appeared in 1791 on the
list of foreign members of the Royal Society. On the annexation of
Piedmont to France in 1796, a touching compliment was paid to him
in the person of his aged father. By direction of Talleyrand, then
minister for foreign affairs, the French commissary repaired in state
to the old man’s residence in Turin, to congratulate him on the
merits of his son, whom they declared “to have done honour to
mankind by his genius, and whom Piedmont was proud to have
produced, and France to possess.” Bonaparte, who styled him “la
haute pyramide des sciences mathématiques,” loaded him with
personal favours and official distinctions. He became a senator, a
count of the empire, a grand officer of the legion of honour, and just
before his death received the grand cross of the order of réunion.

The preparation of a new edition of his Mécanique exhausted his

already falling powers. Frequent fainting fits gave presage of a
speedy end, and on the 8th of April 1813 he had a final interview
with his friends B. Lacépède, G. Monge and J. A. Chaptal. He spoke
with the utmost calm of his approaching death; “c’est une dernière
fonction,” he said, “qui n’est ni pénible ni désagréable.” He
nevertheless looked forward to a future meeting, when he promised
to complete the autobiographical details which weakness obliged
him to interrupt. They remained untold, for he died two days later
on the 10th of April, and was buried in the Pantheon, the funeral
oration being pronounced by Laplace and Lacépède.

Amongst the brilliant group of mathematicians whose

magnanimous rivalry contributed to accomplish the task of
generalization and deduction reserved for the 18th century,
Lagrange occupies an eminent place. It is indeed by no means
easy to distinguish and apportion the respective merits of the
competitors. This is especially the case between Lagrange and
Euler on the one side, and between Lagrange and Laplace on
the other. The calculus of variations lay undeveloped in Euler’s
mode of treating isoperimetrical problems. The fruitful method,
again, of the variation of elements was introduced by Euler, but
adopted and perfected by Lagrange, who first recognized its
supreme importance to the analytical investigation of the
planetary movements. Finally, of the grand series of researches
by which the stability of the solar system was ascertained, the
glory must be almost equally divided between Lagrange and
Laplace. In analytical invention, and mastery over the calculus,
the Turin mathematician was admittedly unrivalled. Laplace
owned that he had despaired of effecting the integration of the
differential equations relative to secular inequalities until
Lagrange showed him the way. But Laplace unquestionably
surpassed his rival in practical sagacity and the intuition of
physical truth. Lagrange saw in the problems of nature so many
occasions for analytical triumphs; Laplace regarded analytical
triumphs as the means of solving the problems of nature. One
mind seemed the complement of the other; and both, united in
honourable rivalry, formed an instrument of unexampled
perfection for the investigation of the celestial machinery. What
may be called Lagrange’s first period of research into planetary
perturbations extended from 1774 to 1784 (see Astronomy:
History). The notable group of treatises communicated, 1781-
1784, to the Berlin Academy was designed, but did not prove to
be his final contribution to the theory of the planets. After an
interval of twenty-four years the subject, re-opened by S. D.
Poisson in a paper read on the 20th of June 1808, was once
more attacked by Lagrange with all his pristine vigour and
fertility of invention. Resuming the inquiry into the invariability of
mean motions, Poisson carried the approximation, with
Lagrange’s formulae, as far as the squares of the disturbing
forces, hitherto neglected, with the same result as to the
stability of the system. He had not attempted to include in his
calculations the orbital variations of the disturbing bodies; but
Lagrange, by the happy artifice of transferring the origin of
coordinates from the centre of the sun to the centre of gravity of
the sun and planets, obtained a simplification of the formulae,
by which the same analysis was rendered equally applicable to
each of the planets severally. It deserves to be recorded as one
of the numerous coincidences of discovery that Laplace, on
being made acquainted by Lagrange with his new method,
produced analogous expressions, to which his independent
researches had led him. The final achievement of Lagrange in
this direction was the extension of the method of the variation of
arbitrary constants, successfully used by him in the investigation
of periodical as well as of secular inequalities, to any system
whatever of mutually interacting bodies.8 “Not without
astonishment,” even to himself, regard being had to the great
generality of the differential equations, he reached a result so
wide as to include, as a particular case, the solution of the
planetary problem recently obtained by him. He proposed to
apply the same principles to the calculation of the disturbances
produced in the rotation of the planets by external action on
their equatorial protuberances, but was anticipated by Poisson,
who gave formulae for the variation of the elements of rotation
strictly corresponding with those found by Lagrange for the
variation of the elements of revolution. The revision of the
Mécanique analytique was undertaken mainly for the purpose of
embodying in it these new methods and final results, but was
interrupted, when two-thirds completed, by the death of its
author.

In the advancement of almost every branch of pure

mathematics Lagrange took a conspicuous part. The calculus of
variations is indissolubly associated with his name. In the theory
of numbers he furnished solutions of many of P. Fermat’s
theorems, and added some of his own. In algebra he discovered
the method of approximating to the real roots of an equation by
means of continued fractions, and imagined a general process of
solving algebraical equations of every degree. The method
indeed fails for equations of an order above the fourth, because
it then involves the solution of an equation of higher dimensions
than they proposed. Yet it possesses the great and characteristic
merit of generalizing the solutions of his predecessors, exhibiting
them all as modifications of one principle. To Lagrange, perhaps
more than to any other, the theory of differential equations is
indebted for its position as a science, rather than a collection of
ingenious artifices for the solution of particular problems. To the
calculus of finite differences he contributed the beautiful formula
of interpolation which bears his name; although substantially the
same result seems to have been previously obtained by Euler.
But it was in the application to mechanical questions of the
instrument which he thus helped to form that his singular merit
lay. It was his just boast to have transformed mechanics
(defined by him as a “geometry of four dimensions”) into a
branch of analysis, and to have exhibited the so-called
mechanical “principles” as simple results of the calculus. The
method of “generalized coordinates,” as it is now called, by
which he attained this result, is the most brilliant achievement of
the analytical method. Instead of following the motion of each
individual part of a material system, he showed that, if we
determine its configuration by a sufficient number of variables,
whose number is that of the degrees of freedom to move (there
being as many equations as the system has degrees of
freedom), the kinetic and potential energies of the system can
be expressed in terms of these, and the differential equations of
motion thence deduced by simple differentiation. Besides this
most important contribution to the general fabric of dynamical
science, we owe to Lagrange several minor theorems of great
elegance,—among which may be mentioned his theorem that
the kinetic energy imparted by given impulses to a material
system under given constraints is a maximum. To this entire
branch of knowledge, in short, he successfully imparted that
character of generality and completeness towards which his
labours invariably tended.

His share in the gigantic task of verifying the Newtonian

theory would alone suffice to immortalize his name. His co-
operation was indeed more indispensable than at first sight
appears. Much as was done by him, what was done through him
was still more important. Some of his brilliant rival’s most
conspicuous discoveries were implicitly contained in his writings,
and wanted but one step for completion. But that one step, from
the abstract to the concrete, was precisely that which the
character of Lagrange’s mind indisposed him to make. As
notable instances may be mentioned Laplace’s discoveries
relating to the velocity of sound and the secular acceleration of
the moon, both of which were led close up to by Lagrange’s
analytical demonstrations. In the Berlin Memoirs for 1778 and
1783 Lagrange gave the first direct and theoretically perfect
method of determining cometary orbits. It has not indeed
proved practically available; but his system of calculating
cometary perturbations by means of “mechanical quadratures”
has formed the starting-point of all subsequent researches on
the subject. His determination9 of maximum and minimum
values for the slowly varying planetary eccentricities was the
earliest attempt to deal with the problem. Without a more
accurate knowledge of the masses of the planets than was then
possessed a satisfactory solution was impossible; but the upper
limits assigned by him agreed closely with those obtained later
by U. J. J. Leverrier.10 As a mathematical writer Lagrange has
perhaps never been surpassed. His treatises are not only
storehouses of ingenious methods, but models of symmetrical
form. The clearness, elegance and originality of his mode of
presentation give lucidity to what is obscure, novelty to what is
familiar, and simplicity to what is abstruse. His genius was one of
generalization and abstraction; and the aspirations of the time
towards unity and perfection received, by his serene labours, an
embodiment denied to them in the troubled world of politics.

Bibliography.—Lagrange’s numerous scattered memoirs have

been collected and published in seven 4to volumes, under the
title Œuvres de Lagrange, publiées sous les soins de M. J. A.
Serret (Paris, 1867-1877). The first, second and third sections of
this publication comprise respectively the papers communicated
by him to the Academies of Sciences of Turin, Berlin and Paris;
the fourth includes his miscellaneous contributions to other
scientific collections, together with his additions to Euler’s
Algebra, and his Leçons élémentaires at the École Normale in
1795. Delambre’s notice of his life, extracted from the Mém. de
l’Institut, 1812, is prefixed to the first volume. Besides the
separate works already named are Résolution des équations
numériques (1798, 2nd ed., 1808, 3rd ed., 1826), and Leçons
sur le calcul des fonctions (1805, 2nd ed., 1806), designed as a
commentary and supplement to the first part of the Théorie des
fonctions. The first volume of the enlarged edition of the
Mécanique appeared in 1811, the second, of which the revision
was completed by MM Prony and Binet, in 1815. A third edition,
in 2 vols., 4to, was issued in 1853-1855, and a second of the
Théorie des fonctions in 1813.
 See also J. J. Virey and Potel, Précis historique (1813); Th.
Thomson’s Annals of Philosophy (1813-1820), vols. ii. and iv.; H.
Suter, Geschichte der math. Wiss. (1873); E. Dühring, Kritische
Gesch. der allgemeinen Principien der Mechanik (1877, 2nd ed.);
A. Gautier, Essai historique sur le problème des trois corps
(1817); R. Grant, History of Physical Astronomy, &c.; Pietro
Cossali, Éloge (Padua, 1813); L. Martini, Cenni biográfici (1840);
Moniteur du 26 Février (1814); W. Whewell, Hist. of the
Inductive Sciences, ii. passim; J. Clerk Maxwell, Electricity and
Magnetism, ii. 184; A. Berry, Short Hist. of Astr., p. 313; J. S.
Bailly, Hist. de l’astr. moderne, iii. 156, 185, 232; J. C.
Poggendorff, Biog. Lit. Handwörterbuch. (A. M. C.)

1 Œuvres, i. 15.

2 Méc. An., Advertisement to 1st ed.

3 E. Dühring, Kritische Gesch. der Mechanik, 220, 367; Lagrange,

Méc. An. i. 166-172, 3rd ed.

4 Notice by J. Delambre, Œuvres de Lagrange, i. p. xlii.

5 Œuvres, iii. 441.

6 Théorie des fonctions, p. 6.

7 H. Suter, Geschichte der math. Wiss. ii. 222-223.

8 Œuvres, vi. 771.

9 Œuvres, v. 211 seq.

10 Grant, History of Physical Astronomy, p. 117.

 LAGRANGE-CHANCEL [Chancel], FRANÇOIS
JOSEPH (1677-1758), French dramatist and satirist, was born at
Périgueux on the 1st of January 1677. He was an extremely
precocious boy, and at Bordeaux, where he was educated, he
produced a play when he was nine years old. Five years later his
mother took him to Paris, where he found a patron in the princesse
de Conti, to whom he dedicated his tragedy of Jugurtha or, as it was
called later, Adherbal (1694). Racine had given him advice and was
present at the first performance, although he had long lived in
complete retirement. Other plays followed: Oreste et Pylade (1697),
Méléagre (1699), Amasis (1701), and Ino et Mélicerte (1715).
Lagrange hardly realized the high hopes raised by his precocity,
although his only serious rival on the tragic stage was Campistron,
but he obtained high favour at court, becoming maître d’hôtel to the
duchess of Orleans. This prosperity ended with the publication in
1720 of his Philippiques, odes accusing the regent, Philip, duke of
Orleans, of the most odious crimes. He might have escaped the
consequences of this libel but for the bitter enmity of a former
patron, the duc de La Force. Lagrange found sanctuary at Avignon,
but was enticed beyond the boundary of the papal jurisdiction, when
he was arrested and sent as a prisoner to the isles of Sainte
Marguerite. He contrived, however, to escape to Sardinia and thence
to Spain and Holland, where he produced his fourth and fifth
Philippiques. On the death of the Regent he was able to return to
France. He was part author of a Histoire de Périgord left unfinished,
and made a further contribution to history, or perhaps, more exactly,
to romance, in a letter to Élie Fréron on the identity of the Man with
the Iron Mask. Lagrange’s family life was embittered by a long
lawsuit against his son. He died at Périgueux at the end of
December 1758.

He had collected his own works (5 vols., 1758) some months

before his death. His most famous work, the Philippiques, was
edited by M. de Lescure in 1858, and a sixth philippic by M.
Diancourt in 1886.

LA GRANJA, or San Ildefonso, a summer palace of the kings of

Spain; on the south-eastern border of the province of Segovia, and
on the western slopes of the Sierra de Guadarrama, 7 m. by road
S.E. of the city of Segovia. The royal estate is 3905 ft. above sea-
level. The scenery of this region, especially in the gorge of the river
Lozoya, with its granite rocks, its dense forest of pines, firs and
birches, and its red-tiled farms, more nearly resembles the highlands
of northern Europe than any other part of Spain. La Granja has an
almost alpine climate, with a clear, cool atmosphere and abundant
sunshine. Above the palace rise the wooded summits of the
Guadarrama, culminating in the peak of Peñalara (7891 ft.); in front
of it the wide plains of Segovia extend northwards. The village of
San Ildefonso, the oldest part of the estate, was founded in 1450 by
Henry IV., who built a hunting lodge and chapel here. In 1477 the
chapel was presented by Ferdinand and Isabella to the monks of the
Parral, a neighbouring Hieronymite monastery. The original granja
(i.e. grange or farm), established by the monks, was purchased in
1719 by Philip V., after the destruction of his summer palace at
Valsain, the ancient Vallis Sapinorum, 2 m. S. Philip determined to
convert the estate into a second Versailles. The palace was built
between 1721 and 1723. Its façade is fronted by a colonnade in
which the pillars reach to the roof. The state apartments contain
some valuable 18th-century furniture, but the famous collection of
sculptures was removed to Madrid in 1836, and is preserved there in
the Museo del Prado. At La Granja it is represented by facsimiles in
plaster. The collegiate church adjoining the palace dates from 1724,
and contains the tombs of Philip V. and his consort Isabella Farnese.
An artificial lake called El Mar, 4095 ft. above sea-level, irrigates the
gardens, which are imitated from those of Versailles, and supplies
water for the fountains. These, despite the antiquated and
sometimes tasteless style of their ornamentation, are probably the
finest in the world; it is noteworthy that, owing to the high level of
the lake, no pumps or other mechanism are needed to supply
pressure. There are twenty-six fountains besides lakes and
waterfalls. Among the most remarkable are the group of “Perseus,
Andromeda and the Sea-Monster,” which sends up a jet of water 110
ft. high, the “Fame,” which reaches 125 ft., and the very elaborate
“Baths of Diana.” It is of the last that Philip V. is said to have
remarked, “It has cost me three millions and amused me three
minutes.” Most of the fountains were made by order of Queen
Isabella in 1727, during the king’s absence. The glass factory of San
Ildefonso was founded by Charles III.

It was in La Granja that Philip V. resigned the crown to his son

in January 1724, to resume it after his son’s death seven months
later; that the treaties of 1777, 1778, 1796 and 1800 were
signed (see Spain: History); that Ferdinand VII. summoned Don
Carlos to the throne in 1832, but was induced to alter the
succession in favour of his own infant daughter Isabella, thus
involving Spain in civil war; and that in 1836 a military revolt
compelled the Queen-regent Christina to restore the constitution
of 1812.

LAGRENÉE, LOUIS JEAN FRANÇOIS (1724-1805),

French painter, was a pupil of Carle Vanloo. Born at Paris on the 30th
of December 1724, in 1755 he became a member of the Royal
Academy, presenting as his diploma picture the “Rape of Deianira”
(Louvre). He visited St Petersburg at the call of the empress
Elizabeth, and on his return was named in 1781 director of the
French Academy at Rome; he there painted the “Indian Widow,” one
of his best-known works. In 1804 Napoleon conferred on him the
cross of the legion of honour, and on the 19th of June 1805 he died
in the Louvre, of which he was honorary keeper.
 LA GUAIRA, or La Guayra (sometimes Laguaira, &c.), a town
and port of Venezuela, in the Federal district, 23 m. by rail and 6½
m. in a direct line N. of Caracas. Pop. (1904, estimate) 14,000. It is
situated between a precipitous mountain side and a broad,
semicircular indentation of the coast line which forms the roadstead
of the port. The anchorage was long considered one of the most
dangerous on the Caribbean coast, and landing was attended with
much danger. The harbour has been improved by the construction of
a concrete breakwater running out from the eastern shore line 2044
ft., built up from an extreme depth of 46 ft. or from an average
depth of 29½ ft., and rising 19½ ft. above sea-level. This encloses
an area of 76½ acres, having an average depth of nearly 28 ft. The
harbour is further improved by 1870 ft. of concrete quays and 1397
ft. of retaining sea-wall, with several piers (three covered) projecting
into deep water. These works were executed by a British company,
known as the La Guaira Harbour Corporation, Ltd., and were
completed in 1891 at a cost of about one million sterling. The
concession is for 99 years and the additional charges which the
company is authorized to impose are necessarily heavy. These
improvements and the restrictions placed upon the direct trade
between West Indian ports and the Orinoco have greatly increased
the foreign trade of La Guaira, which in 1903 was 52% of that of the
four puertos habilitados of the republic. The shipping entries of that
year numbered 217, of which 203 entered with general cargo and 14
with coal exclusively. The exports included 152,625 bags coffee,
114,947 bags cacao and 152,891 hides. For 1905-1906 the imports
at La Guaira were valued officially at £767,365 and the exports at
£663,708. The city stands on sloping ground stretching along the
circular coast line with a varying width of 130 to 330 ft. and having
the appearance of an amphitheatre. The port improvements added
18 acres of reclaimed land to La Guaira’s area, and the removal of
old shore batteries likewise increased its available breadth. In this
narrow space is built the town, composed in great part of small,
roughly-made cabins, and narrow, badly-paved streets, but with
good business houses on its principal street. From the mountain
side, reddish-brown in colour and bare of vegetation, the solar heat
is reflected with tremendous force, the mean annual temperature
being 84° F. The seaside towns of Maiquetia, 2 m. W. and Macuto, 3
m. E., which have better climatic and sanitary conditions and are
connected by a narrow-gauge railway, are the residences of many of
the wealthier merchants of La Guaira.

La Guaira was founded in 1588, was sacked by filibusters under

Amias Preston in 1595, and by the French under Grammont in 1680,
was destroyed by the great earthquake of the 26th of March 1812,
and suffered severely in the war for independence. In 1903, pending
the settlement of claims of Great Britain, Germany and Italy against
Venezuela, La Guaira was blockaded by a British-German-Italian
fleet.
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