The art and science of mental health nursing

principles and practice Third Edition Norman pdf

download

https://ebookname.com/product/the-art-and-science-of-mental-
health-nursing-principles-and-practice-third-edition-norman/

Get the full ebook with Bonus Features for a Better Reading Experience on ebookname.com
Instant digital products (PDF, ePub, MOBI) available
Download now and explore formats that suit you...

The Art and Science of Mental Health Nursing 2nd

Edition Ian Norman

https://ebookname.com/product/the-art-and-science-of-mental-
health-nursing-2nd-edition-ian-norman/

Primary Care Art and Science of Advanced Practice

Nursing 3rd Edition Lynn M. Dunphy

https://ebookname.com/product/primary-care-art-and-science-of-
advanced-practice-nursing-3rd-edition-lynn-m-dunphy/

Principles and Practice of Pharmacology for

Anaesthetists 5th edition Norman Calvey

https://ebookname.com/product/principles-and-practice-of-
pharmacology-for-anaesthetists-5th-edition-norman-calvey/

The Clockwork Universe Isaac Newton the Royal Society

and the Birth of the Modern World 1St Edition Edition
Edward Dolnick

https://ebookname.com/product/the-clockwork-universe-isaac-
newton-the-royal-society-and-the-birth-of-the-modern-world-1st-
edition-edition-edward-dolnick/
Imperial Alchemy Nationalism and Political Identity in
Southeast Asia 1st Edition Anthony Reid

https://ebookname.com/product/imperial-alchemy-nationalism-and-
political-identity-in-southeast-asia-1st-edition-anthony-reid/

The Monotheists Jews Christians and Muslims in Conflict

and Competition Volume II The Words and Will of God
Francis Edward Peters

https://ebookname.com/product/the-monotheists-jews-christians-
and-muslims-in-conflict-and-competition-volume-ii-the-words-and-
will-of-god-francis-edward-peters/

Contemporary Music Education 4th Edition Mark

https://ebookname.com/product/contemporary-music-education-4th-
edition-mark/

Heidegger Hölderlin and the Subject of Poetic Language

Toward a New Poetics of Dasein 1st ed Edition Jennifer
Anna Gosetti-Ferencei

https://ebookname.com/product/heidegger-holderlin-and-the-
subject-of-poetic-language-toward-a-new-poetics-of-dasein-1st-ed-
edition-jennifer-anna-gosetti-ferencei/

The Politics of Orientation 1st Edition Hannah Richter

https://ebookname.com/product/the-politics-of-orientation-1st-
edition-hannah-richter/
Top 10 Miami the Keys Eyewitness Top 10 Travel Guides
1st Edition Jeffrey Kennedy

https://ebookname.com/product/top-10-miami-the-keys-eyewitness-
top-10-travel-guides-1st-edition-jeffrey-kennedy/
Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
ediTed by ian norMan and iain ryrie
PrinciPles and Practice
Mental HealtH nursing
The ArT And Science of
third edition
Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
The Art and Science of Mental
Health Nursing
 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
The Art and Science of Mental
Health Nursing
Principles and Practice

Third Edition

Edited by Ian Norman and Iain Ryrie

London Boston Burr Ridge, IL Dubuque, IA Madison, WI New York San Francisco St. Louis
Bangkok Bogotá Caracas Kuala Lumpur Lisbon Madrid Mexico City
Milan Montreal New Delhi Santiago Seoul Singapore Sydney Taipei Toronto
 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Open University Press
McGraw-Hill Education
McGraw-Hill House
Shoppenhangers Road
Maidenhead
Berkshire
England
SL6 2QL

email: [email protected]
world wide web: www.openup.co.uk

and Two Penn Plaza, New York, NY 10121–2289, USA

First published 2013

Copyright © Ian J. Norman & Iain Ryrie, 2013

All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this
publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher or a
licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction)
may be obtained from the Copyright Licensing Agency Ltd of Saffron House, 6–10 Kirby Street, London EC1N 8TS.

A catalogue record of this book is available from the British Library

ISBN-13: 978–0–33–524561–1 (pb)

ISBN-10: 0–33–524561–7 (pb)
eISBN: 978–0–33–524562–8

Library of Congress Cataloging-in-Publication Data

CIP data applied for

Typesetting and e-book compilations by

SR Nova Pvt Ltd., Bangalore, India

Printed by CPI Printers

Fictitious names of companies, products, people, characters and/or data that may be used herein (in case studies
or in examples) are not intended to represent any real individual, company, product or event.
 Praise for This Book

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
“I am delighted to offer an enthusiastic endorsement for the 3rd edition of this important book. First pro-
duced in 2004, significant changes in the delivery of mental health services, our understanding of productive
ways of working with a population in need and the importance of the services user perspective have all been
readdressed in this most recent revised edition. The previous editions were very well received and this most
recent version offers important revisions and added value to what was already a well founded and essential
textbook for both students and qualified practitioners.
The book is cleverly structured, easily read and presented with clarity by the impressive range of contrib-
uting authors. The Editors and Authors are to be congratulated for this important updated edition.
I have little doubt that this 3rd edition will be as successful as the first and second. I see it as essential read-
ing for students undertaking nursing undergraduate programs and it has value both for mental health and
general nurse undergraduate programs. It also provides an important ‘refresher’ for those undertaking pro-
fessional development and update courses. I feel able to recommend it with confidence to this broad
audience.”
Emeritus Professor Tony Butterworth CBE.
FMedSci, FRCN, FQNI, FRCPsych FRSA.
Interim Chair, NHS Institute for Innovation and Improvement Chair, Foundation of Nursing Studies.

“The 3rd Edition must succeed the 2nd as a core text for mental health nurse students and experienced nurses
alike. This considerable feat is achieved, in no small part, by virtue that the Editors have a clear picture of
what constitutes mental health nursing and have an insightful way of organizing this wonderful world of
mental health nursing. The expertise of the contributors, and the guidance and advice offered in their con-
tributions, ensures this text provides all qualified mental health nurses with an invaluable practical resource
to be consulted on an on-going basis. This is a text which needs to be available in copious numbers in any
library supporting a pre-registration nursing training, but also deserves a place in any productive clinical
team delivering mental health nursing.”
Simon McArdle, University of Greenwich, UK

“This book is certainly one of the key textbooks I would recommend to all mental health nursing students
and practitioners in the UK. It captures both the ‘art’ and ‘science’ of our profession and this current edition
articulates extremely well the service user perspective and changing policy context in which mental health
nurses practice. The scope of the book is admirable and from a pedagogical perspective many of the chap-
ters include ‘applied case studies’ or ‘reflective thinking spaces’ which illuminate and make real the often
complex nature of mental health nursing.”
Dr Andrew Clifton, Huddersfield University, UK

“An incredibly useful and insightful book for those working within the field of mental health, this 3rd edition
deconstructs and discusses a variety of topical principles, practices and perspectives that underpin mental
vi Praise for This Book

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
illness and mental health nursing. The structure and presentation of the subject matter allow the book to
meet both current curriculum and workforce development needs for students and qualified staff. The further
development and discussion around the areas of Service Development, Older Person, Therapeutic
Relationship, Continuing Professional Development, Talking Therapies and Alternative Therapies were par-
ticularly useful and impressive.”
Brian Bell, University of Wolverhampton, UK

“This is a contemporary text drawing on the practical aspects of what it is to be a Mental Health Nurse under-
pinned by the available evidence base. This 3rd edition builds upon earlier versions and situates the person
as the focus. It reflects the contemporary context of Mental Health Nursing practice, which requires techni-
cal skills whilst engendering the message that the society we care for require compassionate nurses. I believe
this balance is achieved through consideration of the art and science of Mental Health Nursing, and is pack-
aged in a user friendly text which will be a reliable point of reference.”
Dr Shelly Allen, University of Salford, UK

“Can one book draw together the collective knowledge of a profession that has evolved over the last cen-
tury? The answer is “no”, but Norman and Ryrie’s The Art and Science of Mental Health Nursing ­probably gets
as close to this as possible. This comprehensive third edition has more chapters, which are more succinct
than the previous edition, with a detailed contents page that makes it easier to use as a reference book.
Drawing on a wide variety of authors, the book is coherent and well-edited and underpinned by an optimis-
tic, recovery-focused approach to mental health nursing.
The different parts to the book represent a range of conceptual approaches to understanding mental
health nursing, which covers the material in an interesting and informative way. The frequent use of sce-
narios and “thinking spaces” encourages application of theory to practice and I will be recommending this as
a core text within the mental health specific modules.”

John Westhead, Staffordshire University, UK

“This book is a must have for anyone that studies within the mental health care setting. It highlights simple
ideas while also giving a realistic and more complex notion of what mental health is. It brings to the forefront
some issues that aren’t normally discussed openly within society.”
Nathan Hicks, Mental Health Nursing Student, Anglia Ruskin University
“As a newly qualified mental health practitioner, this book has influenced my approach to clinical practice
with a determination to integrate theory and practice. Although, this has proven to be an impossible chal-
lenge at some times, adopting this book in the clinical environment will help me demonstrate a good under-
standing of the principles mental health nursing.”
Jean-Louis Ayivor, Newly qualified Mental Heath Practitioner

“The 2nd edition of this book has been essential throughout all modules of my course and was a useful guide
to dip into when my knowledge base was challenged in placement areas. This 3rd edition brings additional
and up-to-date information which will see me through to the end of my training and beyond into practice
as a qualified nurse.”
Julie Sheen, Mental Health Nursing Student, University of Essex
Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
For Kay and Doris, from your boys
Dedication
 Brief Table of Contents

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Contributors xvi
Preface xviii Part 3 Core Procedures 169
12 The Therapeutic Relationship:
Part 1 Foundations 1 Engaging Clients in their Care
and Treatment 171
1 Mental Health 3
Megan Ellis and Crispin Day
Iain Ryrie and Ian Norman
13 Creating a Therapeutic Environment
2 Mental Disorder 17
in Inpatient Care and Beyond 184
Iain Ryrie and Ian Norman
Anne Aiyegbusi and Kingsley Norton
3 Mental Health Nursing: an Art and
14 Assessment 205
a Science 33
Iain Ryrie and Ian Norman
Ian Norman and Iain Ryrie
15 Care Planning 220
4 Health Promotion in Mental
Health Nursing 48 Jane Padmore and Charlotte Roberts

Alison I. Machin and Sandra Moran 16 Admission and Discharge Planning 233
5 Recovery and Social Inclusion 60 Charlotte Roberts and Jane Padmore

Rachel Perkins and Julie Repper 17 Assessing and Managing the Risk of
Self-harm and Suicide 252
6 Improving Mental Health Services 78
Ian P.S. Noonan
Iain Ryrie and Jean Penny
18 Identifying and Managing Risk of
7 Continuing Professional Development
Aggression and Violence 274
and Advanced Practice 92
Susan Sookoo
Sue Gurney

Part 4 Interventions 289

Part 2 Contexts 107
19 Self-management 291
8 The Social Policy Context of Mental
Mary O’Toole
Health Care 109
Paul Calaminus 20 Counselling Approaches 306
Tony Machin and Simon Westrip
9 The Service Context and Organization
of Mental Health Care 123 21 Cognitive Behavioural Techniques for
Paul Calaminus Mental Health Nursing Practice 317
Lina Gega and Ian Norman
10 Mental Health and the Law 137
Toby Williamson and Simon 22 Solution-Focused Approaches 347
Lawton-Smith Iain Ryrie

11 The Ethics of Mental Health Nursing 155 23 Motivational Interviewing 356

Ann Gallagher Iain Ryrie
 Brief Table of Contents ix

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
24 Working with Groups 367 35 The Person Who Experiences
Julie Dilallo and Jane Padmore Depression 541
Sue Gurney
25 Working with Families and Carers 383
Helen Wilde 36 The Person with a Bipolar
Affective Disorder 555
26 Psychopharmacology 393
Sue Gurney
Caroline Parker
37 The Person with an Anxiety Disorder 569
27 Mental Health Medication in Practice 417
Sally Askey-Jones and Ryan Askey-Jones
Caroline Parker
38 The Person with an Eating Disorder 587
28 Concordance, Adherence and
David Morning and Anthony Ross
Compliance in Medicine-taking 432
Sue Gurney 39 The Person with Co-existing Mental
Illness and Substance Use Problems
29 Complementary and Alternative (‘Dual Diagnosis’) 601
Therapies 442
Cheryl Kipping
Hagen Rampes and Karen Pilkington
40 The Person with a Personality Disorder 621
30 Promoting Physical Health 456
Ian P.S. Noonan
Debbie Robson
41 Forensic Mental Health Care 640
Graham Durcan
Part 5 Client Groups 469
31 Children and Adolescents 471 Part 6 Future Directions 657
Jane Padmore
42 Older People are the Future:
32 Older People with Functional Towards an Understanding of the
Mental Health Problems 489 Quality of Mental Health Nursing
Niall McCrae Care for Older People 659

33 Older People with Dementia 502 Ian Norman, Iain Ryrie and
Samantha Coster
Niall McCrae

34 The Person with a Diagnosis of Index 669

Psychosis or Schizophrenia 521
Jacqueline Sin
 Detailed Table of Contents

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Contributors xvi Strategies and policies 49
Preface xviii Models and theories 50
Health promotion in practice 54
Conclusion 57
Annotated bibliography 58
Part 1 Foundations 1 References 58

1 Mental Health 3 5 Recovery and Social Inclusion 60

Introduction 3 Introduction 60
A framework for mental health 4 The meaning of recovery for people
The nature of mental health 5 with mental health problems 61
Integral mental health 9 Principles of recovery and inclusion 63
Implications for nursing 10 Promoting recovery, facilitating
Conclusion 13 inclusion 67
Annotated bibliography 15 Conclusion 75
References 15 Annotated bibliography 76
References 77
2 Mental Disorder 17
Introduction 17 6 Improving Mental Health Services 78
Models of mental disorder 18 Introduction 78
The classification of mental disorder 23 Drivers for change 79
Key symptoms of mental disorder 26 Origins of service improvement 80
Prevalence and incidence of The discipline of improvement 80
mental disorders 27 Service improvement tools and
Conclusion 30 techniques 84
Annotated bibliography 31 Applications in practice 86
References 31 Conclusion 89
Annotated bibliography 90
3 Mental Health Nursing: an Art References 90
and a Science 33
Introduction 33 7 Continuing Professional
Origins 34 Development and Advanced Practice 92
Psychiatric hospitals in decline 36 Introduction 92
UK government reviews of mental What is CPD? 92
health nursing 39 Professional registration
Traditions 40 requirements and standards 93
Capabilities for contemporary practice 44 Barriers and pathways to CPD 94
Conclusion 44 Advanced practice 96
Annotated bibliography 46 CPD and clinical supervision 97
References 46 Work-related stress in nursing 100
Implications for mental health
4 Health Promotion in Mental nursing practice 102
Health Nursing 48 Conclusion 104
Introduction 48 Annotated bibliography 104
Definitions of health promotion 48 References 105
 Detailed Table of Contents xi

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Conclusion 165
Part 2 Contexts 107
Annotated bibliography 166
References 167
8 The Social Policy Context of
Mental Health Care 109
Part 3 Core Procedures 169
Introduction 109
The relationship between statutory
providers and the public 109 12 The Therapeutic Relationship:
Stigma 111 Engaging Clients in their Care
Confidence in health services 112 and Treatment 171
Population change 113 Introduction 171
Public safety 117 What is a therapeutic relationship? 171
Information 117 What is engagement and why is it
Democratic legitimacy 118 important? 173
Methods of implementation 119 The type of therapeutic relationship 173
Conclusion 121 Personal qualities and interpersonal
Annotated bibliography 122 communi­cation skills 177
References 122 Tasks of care and treatment 178
Conclusion 182
9 The Service Context and Annotated bibliography 182
Organization of Mental Health Care 123 References 183
Introduction 123
Aims of mental health services 123 13 Creating a Therapeutic Environment
The context for service delivery 128 in Inpatient Care and Beyond 184
The organization of care 133 Introduction 184
Conclusion 136 Therapeutic milieus 185
Annotated bibliography 136 Why inpatient settings are not simply
References 136 therapeutic 185
Controlling maladaptive behaviour
10 Mental Health and the Law 137 and promoting psychosocial skills 187
Introduction 137 Practical application of Gunderson’s
The Mental Health Act 1983 (MHA 1983) 138 five principles: tips for ward managers 189
The Mental Capacity Act 2005 Unconscious impediments to effective
(MCA 2005) 144 health care delivery 191
The Human Rights Act 1998 (HRA 1998) 150 Establishing and maintaining therapeutic
The Equality Act 2010 151 alliances in the ward setting 192
Children and young people under Recognizing and dealing with
the MHA 1983 and MCA 2005 151 destructive processes 193
The nurse’s duty of care and the Unconscious roots of untherapeutic
common law of negligence 152 practice 195
Conclusion 153 Application of therapeutic milieu
Annotated bibliography 153 priniciples to outpatient/community
Statutes 154 settings 197
References 154 Conclusion 201
Acknowledgements 154 Annotated bibliography 202
References 203
11 The Ethics of Mental Health Nursing 155 Acknowledgements 204
Introduction 155
Ethics: normative and empirical 155 14 Assessment 205
Mental health nursing: ethical Introduction 205
principles and virtues for practice 156 Defining assessment 205
Dignity in care 160 The purpose of assessment 206
A framework for ethical deliberation 162 The scope of assessment 207
xii Detailed Table of Contents

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Methods of assessment 210
Part 4 Interventions 289
Assessing the whole person 212
Conclusion 217
Annotated bibliography 218 19 Self-management 291
References 219 Introduction 291
Origins and terminology 293
15 Care Planning 220 Policy 294
Introduction 220 Behaviours that support
Care plans 220 self-management 295
Engagement and assessment 221 Self-management programmes 300
Developing a care plan 225 The evidence base for self-
Implementation 230 management programmes 303
Review 230 Role of the nurse/mental health
Discharge 231 care professional 303
Conclusion 231 Conclusion 303
Annotated bibliography 232 Annotated bibliography 304
References 232 References 304
Websites 305
16 Admission and Discharge
Planning 233 20 Counselling Approaches 306
Introduction 233 Introduction 306
Pre-admission 235 Core values and principles of
Admission 237 counselling approaches 306
Discharge planning 243 Attributes of therapeutic
Conclusion 249 communicators 309
Annotated bibliography 250 Counselling 310
References 250 Specific skills 312
Clients with cognitive impairment 314
17 Assessing and Managing the Risk Ending therapeutic relationships 315
of Self-harm and Suicide 252 Conclusion 315
Introduction 252 Annotated bibliography 316
What is self-harm? 252 References 316
Why do people self-harm? 253
Assessing self-harm 257 21 Cognitive Behavioural Techniques
Treatment for self-harm 263 for Mental Health Nursing
Nursing someone who is suicidal 266 Practice 317
Conclusion 272 Introduction 317
Annotated bibliography 272 What is CBT? 318
References 273 The CBT model 318
CBT assessment 321
18 Identifying and Managing Risk of CBT formulation 326
Aggression and Violence 274 Key CBT interventions 329
Introduction 274 Conclusion 345
Background 275 Annotated bibliography 346
The evidence base for managing References 346
violence and aggression 275
Factors influencing violence and 22 Solution-Focused Approaches 347
aggression 276 Introduction 347
Practice model 279 Foundations 348
Conclusion 286 Practice skills 351
Annotated bibliography 287 Conclusion 354
Note 287 Annotated bibliography 355
References 287 References 355
 Detailed Table of Contents xiii

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
23 Motivational Interviewing 356 27 Mental Health Medication in
Introduction 356 Practice 417
The cycle of change 357 Introduction 417
The foundations of MI 359 The ‘five rights’ of medicine
The practice of MI 361 administration 417
Conclusion 365 The NMC standards for medicines
Annotated bibliography 365 administration 419
References 366 Involving patients in medicine
administration 419
24 Working with Groups 367 Assessing the benefits and adverse
Introduction 367 effects of medicines 422
A historical introduction to group Psychotropics and physical health 423
therapy 367 Medicine interactions 426
Defining a group 368 Smoking and psychotropics 426
Rationale for group work 369 Psychotropics during pregnancy and
Types of group 370 breastfeeding 427
Research and evidence base Principles of using psychotropics in
for practice 371 children 427
Setting up and facilitating a group 373 Psychotropics in older adults 428
Stages of group development and Conclusion 428
leadership 377 Annotated bibliography 430
Conclusion 380 References 430
Annotated bibliography 381
References 381 28 Concordance, Adherence and
Compliance in Medicine-taking 432
25 Working with Families and Carers 383 Introduction 432
Introduction 383 Concordance, adherence and
The case for working with families compliance 433
and carers 383 What is adherence? 433
Contexts and levels of intervention 386 Factors that influence adherence
Principles of practice 387 with medication 435
Conclusion 390 Implications for nursing practice 437
Annotated bibliography 391 Conclusion 440
Useful resources 391 Annotated bibliography 440
References 391 References 441

26 Psychopharmacology 393 29 Complementary and Alternative

Introduction 393 Therapies 442
Antipsychotics 393 Introduction 442
Antidepressants 398 An introduction to complementary
Mood stabilizers 401 and alternative therapies 442
Anxiolytics and hypnotics 404 Specific complementary and
Medicines for dementia 406 alternative therapies 445
Medicines for attention deficit Conclusion 451
hyperactivity disorder (ADHD) 407 Annotated bibliography 453
Medicines in rapid tranquillization 407 Useful websites 453
Medicines for alcohol and opioid References 453
withdrawal and abstinence 409
Adverse effects and monitoring 30 Promoting Physical Health 456
requirements 410 Introduction 456
Conclusion 415 Policy guidance 456
Annotated bibliography 415 What physical health conditions do
References 415 people with SMI experience? 457
xiv Detailed Table of Contents

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Reasons for poor physical health in Psychosis and schizophrenia within
people with SMI 458 a broad spectrum of psychological
What can nurses do to improve experiences 522
the physical health of people with SMI? 461 Classification and diagnostic criteria 522
Conclusion 464 Prevalence and incidence 524
Annotated bibliography 466 Symptoms and presentations 526
References 466 Prognosis, course and recovery 528
Aetiology of schizophrenia: theories
of causation 529
Part 5 Client Groups 469 Assessment 531
Treatments to promote recovery 533
31 Children and Adolescents 471 Nursing care 537
Introduction 471 Conclusion 538
Assessment and classification 472 Annotated bibliography 538
Mental health problems in young References 539
people 472
Disorders 476 35 The Person Who Experiences
Principles of child and adolescent Depression 541
mental health treatment and care 484 Introduction 541
The role of nurses in child and What is depression? 541
adolescent services 486 Screening, assessment and diagnosis 544
Conclusion 486 Approaches to care and treatment 546
Annotated bibliography 487 Mental health nursing: caring for
References 487 people with mood disorders 550
Conclusion 552
32 Older People with Functional Annotated bibliography 553
Mental Health Problems 489 References 553
Introduction 489
The psychosocial challenges of ageing 490 36 The Person with a Bipolar
Mental health services for older people 492 Affective Disorder 555
Functional mental health problems Introduction 555
in old age 494 Differential diagnosis 558
Conclusion 499 Assessment 559
Annotated bibliography 500 Care planning 560
References 500 Approaches to care and treatment 560
Implications for mental health
33 Older People with Dementia 502 nursing practice 563
Introduction 502 Conclusion 566
Epidemiology, course and symptoms 503 Annotated bibliography 567
Assessment and diagnosis 506 References 567
Experience of dementia 508
Person-centred care: from rhetoric 37 The Person with an Anxiety Disorder 569
to reality 510 Introduction 569
Therapeutic interventions 513 What is anxiety? 569
Ethical considerations 515 Aetiology 571
Conclusion 517 Screening 576
Annotated bibliography 518 Assessment 577
References 518 Psychological treatments 579
Pharmacological treatments 581
34 The Person with a Diagnosis The role of the nurse 582
of Psychosis or Schizophrenia 521 Conclusion 583
Introduction 521 Annotated bibliography 584
 Detailed Table of Contents xv

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Self-help resources 584 Annotated bibliography 638
References 585 References 639

38 The Person with an Eating Disorder 587 41 Forensic Mental Health Care 640
Introduction 587 Introduction 640
Diagnosis of eating disorders 588 Settings 641
Prevalence and incidence 589 Personality disorder 648
What causes eating disorders? 589 Key practice issues 649
Screening and assessment 591 Conclusion 654
Contemporary treatments 593 Annotated bibliography 654
Recovery 595 References 655
Conclusion 596 Acknowledgement 656
Annotated bibliography 599
References 599
Part 6 Future Directions 657
39 The Person with Co-existing
Mental Illness and Substance
Use Problems (‘Dual Diagnosis’) 601 42 Older People are the Future:
Introduction 601 Towards an Understanding
Concepts and terminology 602 of the Quality of Mental Health
Overview of dual diagnosis 602 Nursing Care for Older People 659
Foundations for working with people Introduction 659
with a dual diagnosis 604 The ideal of person- and relationship-
Assessment, treatment and nursing care 608 centred care 661
Conclusion 616 What’s gone wrong with nursing? 661
Annotated bibliography 618 A workforce under strain 662
Useful websites 619 The nature of nursing work in older
References 619 adult mental health services 663
Organizational support 664
40 The Person with a Personality A conceptual model of the quality of
Disorder 621 nursing care 664
Introduction 621 A research and improvement agenda
What is a personality disorder? 622 for enhancing the quality of mental
Diagnosis and clustering of personality health nursing care 666
disorders 623 Conclusion 667
Aetiology of personality disorders 628 References 667
Treatment and nursing care 629
Conclusion 638 Index 669
 Contributors

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Anne Aiyegbusi, Deputy Director of Nursing, Ann Gallagher, Reader in Nursing Ethics, Editor
Specialist and Forensic Services, West London of Nursing Ethics, International Centre of Nursing
Mental Health NHS Trust and Visiting Fellow, Ethics, University of Surrey, Guildford, UK.
Buckinghamshire New University, UK.
Lina Gega, Lecturer in Mental Health, Norwich
Ryan Askey-Jones, BABCP-accredited Cognitive Medical School, University of East Anglia, UK.
Behavioural Therapist and Mental Health Nurse,
Teacher of Mindfulness, UK. Sue Gurney, Mental Health Pathways Project
Co-ordinator, Croydon Borough Team, NHS South
Sally Askey-Jones, Tutor, Mental Health Depart- West London, UK.
ment, Florence Nightingale School of Nursing &
Cheryl Kipping, Consultant Nurse Dual Diagno-
­Midwifery, King’s College London, UK.
sis, South London and Maudsley NHS Foundation
Paul Calaminus, CAMHS Service Director, South Trust, London, UK.
London and Maudsley NHS Foundation Trust, UK.
Simon Lawton-Smith, Head of Policy, Mental
Health Foundation, London, UK.
Samantha Coster, Research Fellow, Florence
Nightingale School of Nursing and Midwifery,
Alison I. Machin, Principal Lecturer, Pre-regis-
King’s College London, UK.
tration Nursing (Adult), Faculty of Health and Life
Sciences, Northumbria University, Newcastle upon
Crispin Day, Head, Centre for Parent and Child
Tyne, UK.
Support, South London and Maudsley NHS Foun-
dation Trust and Head, CAMHS Health Services Tony Machin, Programme Manager, Post Qualify-
Research Unit, Department of Psychology, King’s ing and Postgraduate Studies (Mental Health),
College London, UK. Faculty of Health & Life Sciences, Northumbria
University, Newcastle upon Tyne, UK.
Julie Dilallo, Consultant Nurse CAMHS, Oxleas
NHS Foundation Trust, UK. Niall McCrae, Lecturer, Mental Health Depart-
ment, Florence Nightingale School of Nursing and
Graham Durcan, Associate Director, Criminal Midwifery, King’s College London, UK.
Justice Programme, Centre for Mental Health,
and Senior Fellow, Institute of Mental Health, Sandra Moran, Senior Lecturer, Pre-registration
­Nottingham, UK. Nursing (Mental Health), Faculty of Health and
Life Sciences, Northumbria University, Newcastle
Megan Ellis, Programme Leader (The Helping upon Tyne, UK.
Families Programme) and Deputy Head, Centre for
Parent and Child Support, CAMHS National and David Morning, Senior Lecturer Mental Health,
Specialist Service, South London and Maudsley Faculty of Health and Life Science, Northumbria
NHS Foundation Trust, UK. University, UK.
 Contributors xvii

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Ian P.S. Noonan, Lecturer, Mental Health Depart- Julie Repper, Recovery Lead, Nottingham Health-
ment, Florence Nightingale School of Nursing and care Trust and Associate Professor, University of
Midwifery, King’s College London, UK. Nottingham, UK.

lan Norman, Professor, Florence Nightingale Charlotte Roberts, Ward Manager, Kent and
School of Nursing and Midwifery, King’s College Medway Adolescent Unit, South London and
London, UK. Maudsley NHS Foundation Trust, UK.

Kingsley Norton, Consultant Psychiatrist in Psy- Debbie Robson, Programme Leader and Re-
chotherapy, Head of Psychotherapy, John Conolly search Nurse in Medication Management, Section
Wing, St Bernard’s Hospital, Middlesex, UK. of Mental Health Nursing, Health Services and
Population Research, Institute of Psychiatry, King’s
Mary O’Toole, Lecturer in Mental Health N ­ ursing, College London, UK.
Faculty of Health, Education and Society, ­Plymouth
University, UK. Anthony Ross, Senior Lecturer Mental Health,
Faculty of Health and Life Science, Northumbria
Jane Padmore, Consultant Nurse, CAMHS, South University, UK.
London and Maudsley NHS Foundation Trust, UK.
lain Ryrie, Statt Nurse, Elite Care Services, South-
Caroline Parker, Consultant Pharmacist, Central sea, Hampshire.
& North West London NHS Foundation Trust, UK.
Jacqueline Sin, NIHR Research Fellow, Florence
Jean Penny, Visiting Professor of Healthcare Im- Nightingale School of Nursing and Midwifery
provement, University of Derby and Faculty Mem- King’s College London, UK.
ber for Patient Safety and Quality Improvement,
NHS Institute for Innovation and Improvement, UK. Susan Sookoo, Lecturer, Mental Health Depart-
ment, Florence Nightingale School of Nursing and
Rachel Perkins, Consultant with the Implement- Midwifery King’s College London, UK.
ing Recovery through Organizational Change,
(ImROC) programme and Chair of Equality 2025 Simon Westrip, Senior Lecturer, Mental Health,
cross-government strategic advisory group on Faculty of Health and Life Sciences, University of
­disability issues, London, UK. Northumbria, UK.

Karen Pilkington, Senior Research Fellow, Helen Wilde, Lead Systemic Psychotherapist, Kent
School of Life Sciences, University of Westminster, and Medway Adolescent Unit, South London and
­London, UK. Maudsley Hospitals, UK.

Hagen Rampes, Assistant Professor, Faculty of Toby Williamson, Head of Development & Later
Medicine, Department of Psychiatry, University Life, Mental Health Foundation, London, UK.
of Toronto and Staff Psychiatrist, Mood and
­Anxiety Disorders Program, Centre for Addiction
and Mental Health, Toronto, Canada.
 Preface

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
The first edition of this book, published in 2004, impact of services upon his or her life journey, rather
quickly became a best-seller and it is now an estab- than the place of the ‘patient’ within mental health
lished core text for mental health nurse education services. In reality, practising nurses must be artists
programmes in the UK and beyond. This third edi- and scientists simultaneously and they need to find
tion has been revised substantially to incorporate ways of integrating these elements while meeting
changes to the policy context of mental health policy directives and service users’ demands. This
nursing, the legal framework of mental health care book seeks to be a resource to practising nurses to
within the UK, advances in treatment, changes in help them meet this remit.
the philosophy and principles of mental health and It seems to us that any contemporary account
also in response to the many comments we have of mental health nursing as a practice discipline
received from readers of the first two editions, who needs to establish its case within three broad
have pointed to aspects of mental health nursing parameters:
which merit more attention.
■■ professional diversity;
Our aim, as in previous editions, has been to pro-
duce a comprehensive textbook that takes account ■■ national policy; and
of the diversity of mental health nursing as a practice ■■ service user perspectives.
discipline and the contemporary context in which
nursing is practised. In so doing we have sought to Professional diversity
avoid the tendency within academic nursing, and We avoid aligning the discipline of mental health
some other textbooks, to present a restrictive con- nursing to any one theoretical perspective but,
cept of mental health nursing as a uni-dimensional rather, acknowledge the breadth and complexity
activity – typically as an ‘art’ concerned with nurses’ of the perspectives upon which mental health
therapeutic relationships with ‘people’ in distress, or nurses draw in their work. The title of this book
as a ‘science’, concerned with evidence-based inter- reflects our aim, therefore, which is to provide an
ventions that can be applied to good effect by integrative account of the discipline that accom-
nurses, often working in what might be seen as modates its many origins, influences and prac-
extended roles, to ‘patients’ with defined mental ill- tices. To assist this process we introduce a schema
ness. The polarized views expressed by both artists in Chapters 1 and 2 which integrates explanatory
and scientists within mental health nursing are models of mental health and illness, and which
becoming less relevant today than previously as the demonstrates each one’s crucial, though partial,
focus of mental health care changes towards an contribution to our understanding of the human
emphasis on promoting social inclusion and recov- condition. We contend that all mental health
ery, reducing social stigma and supporting principles nursing, whatever its origin or theoretical basis,
such as choice. Thus, evidence-based practice and can be mapped onto this schema. Further, no one
interventions are now framed within a recovery- part of the schema is, itself, adequate to deal with
oriented approach that emphasizes the central place people’s changing needs in relation to mental
of the person with mental health problems and the health and mental illness.
 Preface xix

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
National policy There have been many such reports into cases
of poor nursing, dating back to the enquiries into
The UK National Health Service (NHS) and social
abuses at Ely and Normansfield Hospitals in the
care provision have long been subject to govern-
1960s and 70s and beyond (Walshe and Higgins
ment policy. As a consequence professionals who
2002) and so it is far from certain that nursing care
work in these organizations must be expected to
standards are in decline, in spite of what media
adjust their practice to meet contemporary demands.
reports would have us believe. What is striking
Today mental health nurses have increasing levels of
though is the public attention that these recent
professional responsibility and autonomy, and in
inquiries have received and our impression is that
many settings lead the delivery of care.
public confidence in nursing is at a low point.
The first edition of this book pre-empted the
Typically, inquiries that expose poor nursing are
findings of the Chief Nursing Officer for England’s
followed by a response from the UK government
(2006) review of mental health nursing in its call for
designed to promote care standards. Recent initia-
mental health nurses to incorporate the principles
tives have been the Prime Minister’s Commission
of recovery into their work with service users and
(2010) (established by the outgoing Labour prime
focus on improving their health outcomes.
minister, Gordon Brown), the Nursing & Care
The second edition, published in 2009, reflected
Quality Forum (2012) and most recently a consul-
moves internationally to widen the focus of mental
tation document issued by the Chief Nurse for
health services from a concern with individuals suf-
England and the Director of Nursing at the UK
fering from mental disorder and their families, to
Department of Health (Cummings and Bennett
improve the mental health of communities and
2012). This document acknowledges reports of
populations as a whole. Looking to the future we
unacceptable nursing care and identifies six values
anticipate that the demands of health promotion,
and behaviours (the so-called ‘6 Cs’) which it says
for promoting healthy living and for reducing health
nurses exhibit when they are performing at their
inequalities, which many of us come across in our
best: care, compassion, competence, communica-
daily clinical work, will become more pressing. Our
tion, courage and commitment.
impression is that most mental health nurses have
In the final chapter of this edition we make our
yet to find ways of incorporating this within their
own contribution to the quality of nursing debate
work and that the focus of nursing care remains
by proposing a multi-factorial nursing care quality
treatment and care rather than primary or second-
framework grounded in the literature and our clini-
ary prevention.
cal experience, which applies particularly to older
The third edition is published at a time when
people with mental health difficulties, but may
questions are being raised in the British media
have a wider application beyond this client group.
about the motivation and education of nurses (see
If our framework of nursing care quality is consist-
e.g. Marrin 2009; Odone 2011; Phillips 2011) and
ent with the experience of readers we hope it will
enquiries and reports cite unacceptably low stand-
help to provide a platform for interventions and
ards of nursing, particularly for older people with
initiatives to improve the quality of nursing care.
mental and physical health difficulties and other
vulnerable patient groups – for example the Health
Service Ombudsman’s report (Abraham 2011); the Service user perspectives
Care Quality Commission (CQC) report (2011) and An important tenet that underpins this textbook is
the forthcoming report of Robert Francis, QC, fol- our belief that mental health nursing is concerned
lowing the full public inquiry into the role of the primarily with helping people find meaning and
commissioning, supervisory and regulatory bodies purpose in their lives, and assisting them in the
in the monitoring of Mid-Staffordshire Foundation process of recovery. Nurses cannot do this
NHS Trust. ­adequately unless they (we) are prepared to hear
xx Preface

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
service users’ accounts of their difficulties and social policy issues facing mental health nurses in
appreciate their own preferences for a meaningful their work and show how these are reflected in the
life. This fact is so central to understanding how organization of mental health services. Thus we
mental health nurses can help that we have sought have tried to produce a text that is not too paro-
to make it explicit throughout the book, rather chial and which can cross geographical boundaries.
than confine it to a single chapter. Thus, each con- Other chapters in this section cover the legal
tributor incorporates user perspectives into their (Chapter 10) and ethical (Chapter 11) frameworks
chapter. The terminology used to describe recipi- within which mental health nurses practice.
ents of mental health services does however vary Part 3, ‘Core procedures’, covers the fundamen-
between contributors. There are chapters that use tal processes of mental health nursing care. The
the term ‘patient’ and others that refer to ‘service chapters here have a very practical orientation.
user’ or to ‘client’; these terms tell us something They are concerned with the ‘know-how’ of mental
about the perspective that the contributor brings health nursing, with the skills needed by nurses
to bear on their work. working in partnership with clients in any care set-
Following the introduction of the schema in ting. Chapter 12 deals with the engagement of cli-
Chapters 1 and 2, which is used to integrate explan- ents in treatment and how best to work with them
atory models of mental health and illness, it follows to identify and solve their problems. Chapter 13
that all perspectives are valid, though each is partial. considers the creation of the therapeutic environ-
We have, therefore, chosen not to standardize these ment within mental health nursing settings, and
terms (into service user, for example), but have subsequent chapters consider assessment (Chapter
allowed contributors to speak for themselves. 14), care planning (Chapter 15), admission and dis-
charge (Chapter 16), assessment and management
Content and organization of risk of suicide and self-harm (Chapter 17) and of
The book is divided into six parts. Part 1, aggression and violence (Chapter 18).
‘Foundations’, deals with the historical origins and Part 4 incorporates 12 chapters which cover
contemporary basis of mental health nursing. the interventions which mental health nurses can
Chapter 1 introduces a schema that provides an draw upon in the course of their work. It includes
integrative account of the many and varied factors chapters on self-management (Chapter 19), psy-
that influence our sense of mental health and well- chological interventions (Chapters 20, 21, 22 and
being. In Chapter 2 the schema is used to explore a 23), working with groups (Chapter 24) and families
range of aetiological theories for understanding and carers (Chapter 25), pharmacological interven-
mental illness. Chapter 3 examines the origins and tions and medication management (Chapters 26,
traditions of mental health nursing, Chapter 4 con- 27 and 28) , complementary and alternative thera-
siders health promotion and Chapter 5 deals with pies (Chapter 29) and promoting physical health
recovery and social inclusion as a fundamental ori- (Chapter 30).
entation for contemporary mental health care. In Part 5, ‘Client groups’, examines the major chal-
this part we include a chapter on improving mental lenges confronting those who use mental health
health services (Chapter 6) and a new chapter services and outlines evidence-based interventions
which deals with nurses’ continuing professional available to the mental health nurse. Each of the 11
development (Chapter 7). chapters in this section is oriented to a particular
Part 2, ‘Contexts’, considers the policy context type or group of disorders that a person can experi-
(Chapter 8) and the service context and organiza- ence (Chapters 31–41).
tion of mental health services (Chapter 9). While As discussed previously in Part 6 of this book
most examples are drawn from the UK context, we, together with our colleague Sam Coster, draw
these chapters take a thematic approach to the key upon the research literature and our current clini-
 Preface xxi

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
cal experience to propose that the causes of poor References
nursing, particularly for older people, are multi-
Abraham, A. (2011) Care and Compassion.
factorial, arising from the stressful demands of nurs-
London: Parliamentary and Health Service
ing older people who may be agitated, withdrawn
Ombudsman.
or disorientated and have complex physical needs,
CNOE (Chief Nursing Officer England) (2006)
in the context of perceived poor job control, low
Review of Mental Health Nursing: from values to
status care work and poor professional support.
action. London: DH.
Each chapter begins with an overview that out-
CQC (Care Quality Commission) (2011) Dignity
lines its scope and content and concludes with a set
and Nutrition Inspection Programme: National
of bullet points to summarize the main points. An
Overview. London: CQC.
annotated bibliography at the end of each chapter
Cummings, J. and Bennett, V. (2012) Developing
points the reader towards more detailed reading.
the Culture of Compassionate Care: Creating a new
The chapters also include ‘thinking spaces’ which
vision for nurses, midwives and care-givers. London:
provide the reader with an opportunity for reflection
DH.
and to consolidate what they have learned. Case
Marrin, M. (2009) Fallen Angels: The nightmare
studies are used within some chapters to illustrate
nurses protected by silence, available at: www.the-
the practical application of the material. Though
times.co.uk/tto/public/sitesearch.do?querystring=
written primarily for mental health nurses and nurs-
marrin&p=tto&pf=all&bl=on#http://www.thetimes.
ing students the book aims also to provide a useful
co.uk/tto/public/sitesearch.do?querystring=marrin&
reference for other health care professionals, lay car-
navigators=&from=20090101&to=20100101&p=
ers and for people with mental health difficulties.
tto&pf=all&bl=on&service=searchframe, accessed
We owe the success of his book to the authors
26 September 2012.
of the individual chapters who have been chosen
Nursing & Care Quality Forum (2012) www.
to reflect the many diverse professional perspec-
dh.gov.uk/health/2012/05/nursing-forum.
tives within mental health care. All are experts in
Odone, C. (2011) Sulky, lazy and patronising:
their field and in writing their chapter each was
finally, we admit the existence of the bad nurse, the
asked to draw upon their specialist knowledge and
NHS’s dirty little secret, Telegraph Online, available
practice rather than try to relate their subject to a
at http://blogs.telegraph.co.uk/news/cristinaodone/
narrow definition of mental health nursing.
100083415/sulky-lazy-and-patronisingfinally-we-
Without the commitment and patience of each
admit-the-existence-of-the-bad-nurse-the-nhss-
author, this book would not have been written. We
dirty-little-secret, accessed 26 September 2012.
are grateful to each of them for taking time out of
Phillips, M. (2011) The moral crisis in nursing:
their busy lives to produce their chapters. This
voices from the wards, Daily Mail, 21 October, avail-
book will have been successful if it goes some small
able at: http://melaniephillips.com/the-moral-crisis-­
way to helping mental health nurses become skil-
in-nursing-voices-from-the-wards, accessed 26
ful, well-informed and sensitive practitioners who
September 2012.
work confidently in the context of mental health
Prime Minister’s Commission on the Future of
services to promote mental health and in partner-
Nursing & Midwifery in England (2010) Front Line
ship with service users to help them regain control
Care, available at: http://webarchive.national-
over their lives.
archives.gov.uk/20100331110400/http:/cnm.inde-
pendent.gov.uk, acessed 26 September 2012.
Ian Norman and Iain Ryrie Walshe, K. and Higgins, J. (2002) The use and
London, UK impact of inquiries in the NHS, British Medical
September 2012 Journal, 325(7369): 895–900.
 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
part
1
Foundations
1 Mental Health 3
Iain Ryrie and Ian Norman
2 Mental Disorder 17
Iain Ryrie and Ian Norman
3 Mental Health Nursing: an Art and a Science 33
Ian Norman and Iain Ryrie
4 Health Promotion in Mental Health Nursing 48
Alison I. Machin and Sandra Moran
5 Recovery and Social Inclusion 60
Rachel Perkins and Julie Repper
6 Improving Mental Health Services 78
Iain Ryrie and Jean Penny
7 Continuing Professional Development and Advanced Practice 92
Sue Gurney
 Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Chapter Foundations

1 Mental Health
Iain Ryrie and Ian Norman

No health without mental health (HM Government 2011)

1.1 Introduction form, mental health is the culmination of everything

that contributes to the experience of being human.
Whether you begin this book as a student nurse or a In this opening chapter we introduce a simple
registered practitioner, the UK government’s assertion framework to map human experience and use it as a
sets a significant challenge for mental health nursing. starting point for understanding mental health. We
It implies that physical health counts for little if people demonstrate how mental health arises from the inte-
do not also enjoy mental health. Cardiovascular fit- gration of all that we experience and fluctuates as all
ness or an immune system that provides protection things relative to it change. The emergence of mental
from the common cold may be of little value to a per- health as a complex, integral phenomenon is clari-
son who is in the depths of depression or experienc- fied and its implications for the work of mental health
ing an acute episode of schizophrenia. nurses are explored. In summary this chapter covers:
‘No health without mental health’ has a deeper
■■ a framework for mental health;
meaning. Whatever we experience is both depend-
■■ the nature of mental health;
ent on our mental faculties and contributes to our
sense of mental health, since all of life is realized ■■ integral mental health;
through mental processes. In its most rudimentary ■■ implications for nursing.

Thinking Space 1.1

Mental health can be conceptualized as a state of well-being in which the individual realizes his or
her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and
is able to make a contribution to his or her community. In this positive sense, mental health is the
foundation for well-being and effective functioning for an individual and for a community.

(WHO 2007)

(Continued)
4 PART 1 Foundations

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Read through the above definition of mental health a few times to familiarize yourself with its content
and meaning. You will notice that the first sentence describes a number of different factors that contrib-
ute to mental health (e.g. coping abilities, meaningful employment). The second sentence suggests that
the term ‘mental health’ can be applied to communities as well as to individuals.
1. Using the WHO definition as a starting point make a list of everything you can think of that contributes
to mental health. Try to be as specific as possible for example, a healthy diet, exercise and friendship
are examples of what helps people cope with the normal stresses of life. Social networking and
volunteering are specific examples of community contributions. Spend at least five minutes on this
task, jotting down whatever examples come into your head.
2. Once you have completed your list, take a closer look at it. Can its content be organized into groups
that represent different types of contributing factor (e.g. individual and community factors)?
As you progress through this chapter you can review and develop your ideas as a framework for mental
health is described and elaborated.

crossed with the first dimension from ‘self ’ to ‘com-

1.2 A framework for mental munity’ forms a quadrant schema or framework
health (see Figure 1.1).
Figure 1.1 describes the physical and psychoso-
Following Wilber (2001), one approach to mapping cial elements that arise within each quadrant. Thus,
everything that lies within human experience from the subjective-self quadrant a person f­ ormulates
involves just two key dimensions. The first of these their personal intentions while the objective-self
concerns me and you, I and we, mine and theirs. exhibits behaviours that can be observed and meas-
This dimension differentiates between what is you ured. The subjective-community quadrant is respon-
and what is everything else, what is ‘self ’ and what is
‘other’. In this chapter, ‘community’ is substituted
Figure 1.1 Framework of human experience I (after
for ‘other’ so that the first dimension runs from ‘self ’ Wilber 2001)
to ‘community’. For the second dimension human
Subjective Objective
beings have an interior, subjective sense of them-
selves but also an exterior objective-self. The for- Interior Exterior
mer includes thoughts and feelings and the latter individual individual
the physical body. The subjective-self can be
Self

Intentional Behavioural
described, even written down, but remains wholly
within a person’s own experience and is not directly (upper-left) (upper-right)
accessible to others. The objective-self can be
quantified and measured, and in this sense is acces- Interior Exterior
collective collective
Community

sible to the direct experience of others who may be

doing the measuring. It is true also that communi- Cultural Social
ties have interior (subjective) and exterior (objec- (lower-left) (lower-right)
tive) characteristics. The second dimension there-
fore runs from ‘subjective’ to ‘objective’ and when
 CHAPTER 1 Mental Health 5

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
sible for our sense of culture and in the objective- or flight impulses. It is focused in a rather limited
community quadrant reside social systems and struc- way on self, on the preservation of ‘me’.
tures. Everything that is within human experience The mammalian brain or limbic system evolved
can be mapped onto this framework, which provides millions of years after the reptilian brain and pro-
an important starting point for understanding the vides more sophisticated functions including the
nature of mental health. generation of feelings, desires, emotions, sexual
impulses and interpersonal needs. Common to all
mammals is their tendency to protect and nurture
1.3 The nature of mental their young, and to a lesser extent, to experience
health and communicate empathy. This aspect of the brain
introduced a collective sense of ‘us’ rather than just
Objective-self the limited ‘me’ of the reptilian brain.
In the upper right or objective-self quadrant reside The cerebrum is the rational, analytical brain
the physical attributes of an individual. This includes that evolved only 200,000 years ago. It governs
a person’s anatomical form and biochemical func- visual processing, sound, speech, calculation and
tioning as well as their physical behaviours. It also pattern matching. It integrates several functions
includes a person’s genes. such as thinking, analysing, conceptualizing and
planning. It has allowed humans to develop the
Genes written language and to generate ideas and con-
Genetic determinism is a highly contested area cepts (Plant and Stephenson 2008). It is now recog-
though it is now broadly accepted that genes alone nized that different aspects of a person’s brain are
are not responsible for most complex traits. associated with different experiences of mental
Interactions between DNA and signals from other health (or illness). In particular, the older reptilian
genes as well as from the environment influence and mammalian brains generate feelings and emo-
the development of a trait. Within such a context it tions, the cerebrum registers those feelings and
is hard to follow a deterministic line. Genes are not enables people to express them and to a certain
simply the determinants of behaviour but are also extent control them.
the servants of the environment (Dobbs 2007). In The mammalian brain is also responsible for the
essence this means that much can be done by peo- physiological functioning of the body’s organs. The
ple to promote and maintain good mental health autonomic nervous system begins in the mamma-
regardless of any genetic risk factors they may have lian brain and spreads throughout the body via two
inherited. distinct branches: the sympathetic and the para-
sympathetic nervous systems. The former releases
Anatomical form the hormones adrenaline and noradrenaline, which
Anatomical form, and in particular the different focus a person’s attention on threats, increases their
regions and aspects of the brain, are key factors that heart rate and determines a fight or flight response.
influence a person’s sense of mental health. Of par- The latter releases acetylcholine, which induces
ticular importance are the reptilian brain stem, the relaxation, slows the heart rate and generates calm.
limbic system or mammalian brain and the cere- This is why humans literally feel their emotions. The
brum, each of which represents a seismic evolu- sympathetic nervous system creates some of the
tionary leap. The reptilian brain stem drives many of most unpleasant physical symptoms associated
our basic instincts such as the need for food and with anxiety and depression including rapid or
water. It also stimulates sensorimotor actions essen- irregular heartbeats, dry mouth and cold sweats
tial for self-preservation including reflexes and fight (Plant and Stephenson 2008).
6 PART 1 Foundations

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Table 1.1 ​Neurotransmitters and their general effects (adapted from Plant and Stephenson 2008)

Neurotransmitter Type of effect

Glutamate Excitory, agitating
Gamma-aminobutyric acid (GABA) Inhibitory, calming
Dopamine Physical arousal
Noradrenaline Attention
Adrenaline Fight or flight
Serotonin Optimism
Endorphins Pleasure
Acetylcholine Relaxation

Biochemical functioning Subjective-self

An important biochemical function that mental In the upper left or subjective-self quadrant reside
health nurses should be aware of is the role of neu- immediate thoughts, feelings, emotions and
rotransmitters, which control the electrical circuits of ­sensations all described in first-person terms. This
the brain and nervous system by allowing messages represents a person’s interior, subjective world made
to transfer between the nerve cells or neurons. If lev- up of emotions and cognitive processes. There
els of key neurotransmitters become depleted or remain difficulties in agreeing a common language
unbalanced then the electrical circuits will not func- and shared definition for this subjective sense of our
tion properly and mental health is threatened. own mental health. For example, mental health,
Table 1.1 presents an overview of what are con- mental well-being, emotional well-being and quality
sidered to be some of the most important neuro- of life tend to be used more or less interchangeably.
transmitters for mental health. Behind these collective terms lie many more
concepts used to describe subjective well-being,
Behaviour
which reflect two key dimensions: hedonic (positive
A number of behaviours can support mental health
feelings, effect, mood) and eudaimonic (positive
through their direct effect on different parts of the
functioning such as meaningful engagement, fulfil-
brain and on its chemical messengers. It is possible
ment and social well-being). Keyes (2002) describes
for example to staunch the flow of anxiety and agi-
the combination of positive feeling and positive
tation from the emotional brain by gentle but con-
functioning as ‘flourishing’ and proposes six feelings
sistent exercise through which natural endorphins
that foster psychological well-being:
are released (MHF 2005a). It is also possible to help
calm the mind by eating a diet rich in the precursors ■■ self-acceptance;
of specific neurotransmitters (McCulloch and Ryrie ■■ positive relations with others;
2006). There is also evidence for the benefits of ■■ autonomy (or ability to think for yourself);
behaviours that induce relaxation such as mindful-
■■ environmental mastery (the sense that you can
ness exercises, meditation and yoga (NICE 2009;
change your circumstances for the better);
MHF 2010). These promote balance and coherence
between the sympathetic and parasympathetic ■■ life purpose (having goals and feeling helpful);
nervous systems, regulating heartbeat and calming ■■ personal growth (being able to learn from the
the emotional brain. stresses and challenges in life).
 CHAPTER 1 Mental Health 7

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Experiencing these positive feelings may be rele- nation is a key factor that influences mental health,
vant markers for mental health service users on and belonging is also mediated by ­ emotional
their own recovery journeys. ­intelligence, which applies to our relationships with
A form of intelligence that people use to under- others as well as with ourselves. Thus, emotional
stand and regulate their feelings is known as emo- intelligence is also characterized by a person’s abil-
tional intelligence (Mayer et al. 2000). In objective- ity to accurately identify, grasp, reason and regulate
self terms it reflects biochemical cooperation the emotions of others. This capacity for relating to
between the emotional and cognitive brains. Its others makes a significant contribution to mental
subjective-self qualities are characterized by a per- health and in children is predictive of success in
son’s ability to: adulthood (Servan-Schreiber 2011).
When people do not belong they feel excluded.
■■ accurately identify their emotional state;
The marginalization and exclusion in society of peo-
■■ grasp the natural course of their emotions, ple with mental health problems is a form of social
what generates them and how they ebb and deprivation. ‘Stigma’ is a related term that refers to
flow; the way a society views particular groups of individ-
■■ reason about their emotions, being aware of uals and represents a negative feeling or world view
the consequences of different courses of about the group in question. It is pernicious and
action they could take; damaging, not least because of the internalization of
■■ regulate their emotions, taking charge appro- those collective messages by the individuals to
priately (Mayer et al. 2000). whom they are aimed. This leads to lower self-
esteem and a seemingly self-imposed reluctance to
We can misinterpret our emotions particularly engage in mainstream life and to do the things that
when faced with constant demands on our time a person might really want to do. Furthermore, it
and resources. A frequent misinterpretation is stops people seeking help for treatment or sharing
between stress or fatigue and hunger. In a society their difficulties with others. Stigma is not a tangible
where food is abundantly available and stress very commodity therefore, but a subjective quality that
common, overeating has become quite ordinary. resides in the lower left quadrant of the framework.
Poor mastery of emotions, fuelled by crude market- An antidote to stigma and social deprivation is
ing, is one reason for the growing incidence of obe- ‘social capital’, which describes the invisible ‘glue’
sity in society (Servan-Schreiber 2011). that binds communities together, giving them a
shared sense of identity and enabling them to work
Subjective-community together for mutual benefit (Kawachi et al. 1997).
The community quadrants contain environmental Research into social capital suggests that commu-
mediators or markers for mental health. The social nity cohesion and efficacy, levels of trust, tolerance,
and physical characteristics of communities and the reciprocity and participation are important media-
degree to which they enable and promote healthy tors of mental health (Friedli 2000).
behaviours all make a contribution to social ine-
qualities, and mental health is very closely related Objective-community
to many forms of inequality (Marmot 2010). The In the lower right or objective-community quad-
experience of oppression can gradually dampen the rant are the physical attributes of a community such
spirit and jeopardize people’s mental health. as its legislature, policy and environment.
In the lower left or subjective-community quad-
rant reside collective thoughts, feelings and world Legislation
views often referred to as ‘culture’. A person’s sense Legislation has a key role to play, particularly that
of belonging to a friendship, family, community or which promotes tolerance and inclusion. Listed
8 PART 1 Foundations

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
below are two key UK government Acts that sup- develop and strengthen mental health resilience
port the mental health of the public: factors at an individual, family and community
level.
■■ The Equality Act 2010 aims to protect disa-
bled people and prevent disability discrimina-
Environment
tion. In the Act, a person has a disability if they
Poverty, low wages, unemployment, poor housing,
have a physical or mental impairment and the
environmental pollution, poor education, limited
impairment has a substantial and long-term
access to transport and shops, and a lack of recrea-
adverse effect on their ability to perform nor-
tional facilities all impact on people’s mental
mal day-to-day activities. It provides legal
health. These reflect objective community attrib-
rights for disabled people in the areas of:
utes from the lower-right quadrant of Figure 1.1.
●● employment; They can be referred to collectively as ‘material
●● education; deprivation’, which is a corollary to the social dep-
●● access to goods, services and facilities rivation discussed under the subjective-commu-
including larger private clubs and land- nity quadrant.
based transport services; It is now recognized that the built and natural
●● buying and renting land or property; environments in which we live have marked effects
upon our mental health. In a systematic review con-
●● functions of public bodies, for example the
ducted in the UK, Clark et al. (2006) identified rela-
issuing of licences.
tionships between neighbourhood disorder and
■■ The Civil Partnership Act 2004 came into poor mental health, and between neighbourhood
operation on 5 December 2005 and enables a regeneration and improved mental health. It is
same-sex couple to registry as civil partners known also that the availability and regular use of
of each other. Register offices or other green space can result in:
approved premises in England and Wales can
be used for this purpose, providing a venue ■■ improved self-awareness, self-esteem and
and formal procedure for same-sex couples mood;
to make a public declaration of their commit- ■■ reductions in negative feelings such as anger,
ment and for families and loved ones to sup- anxiety and fear;
port them in that.
■■ improved psychological health, especially
It is worth considering the experiences that some emotional and cognitive function;
members of society would have if these Acts had ■■ restored capacity for attention and concentra-
not come into force and how this might impact on tion (Maller et al. 2002).
their mental health.
The Association of Public Health Observatories
Policy (www.apho.org.uk) has developed a range of indi-
Key policy for the mental health field is presented in cators for public mental health. These echo many
Chapter 8 of this textbook. However, we draw par- of the points raised in discussions of the four quad-
ticular attention to Healthy Lives, Healthy People, rants including employment, alcohol and drug use,
the UK government’s public health White Paper physical activity, healthy eating, social capital,
(DH 2010). This seeks to radically shift power to social networks, neighbourliness, violence and
local communities, enabling them to focus on the safety. Mental health nurses can use this type of
needs of the local population, improve health information to better understand the contributions
across people’s lives and reduce inequalities. It rec- they can make to community and public mental
ognizes the importance of targeted interventions to health.
 CHAPTER 1 Mental Health 9

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Figure 1.2 Framework of human experience II (after
Thinking Space 1.2 Wilber 2001)

Having reviewed the four quadrants in Figure

Subjective Objective
1.1 and examined those elements in each
that contribute to our sense of mental health,
consider the following challenge.

Self
I IT
■■ You have been asked to prepare a sim-
ple health education campaign to pro-
mote and protect people’s mental
health. The campaign must be brief and

Community
take the form of ‘top tips’ to promote
WE ITS
and protect mental health. What would
be your 10 top tips?

1.4 Integral mental health integral approach suggests there are other dimen-
sions to the physical phenomena of excited limbic
Integral mental health has four dimensions (the and sympathetic nervous systems, one of which is
quadrants), each of which provides a vital though expressed through a person’s thoughts and feelings
partial explanation of human experience. This implies (upper left quadrant). It should therefore be possible
that every moment of awareness contains elements to calm these physiological functions by non-physio-
from all four quadrants. This is illustrated by Figure logical approaches as the integral framework sug-
1.2 which shows the framework introduced previ- gests. Research into the mechanisms by which talk-
ously but now containing the pronouns that major ing therapies, including cognitive behavioural ther-
languages use to describe different aspects of human apy (CBT), have a therapeutic effect confirm this.
experience. Thus, a person can witness an event from Brain scans of individuals who receive CBT for
the point of view of ‘I’ in terms of what I see and feel depressive symptoms indicate that the therapy may
about the event; or from the point of view of ‘we’ in help the prefrontal cortex (cognitive brain) take better
terms of how others or ‘we’ collectively feel about control of the emotional brain (Plant and Stephenson
the event; and then again it can be viewed as an ‘it’ or 2008). Thus, there is an integrated system through
‘its’ in terms of the objective facts of the event (Wilber which brain chemistry alters our emotions and,
2007). All events or phenomena in the manifest equally, our emotions alter brain chemistry. This
world can be interpreted from each of these four highlights the importance of identifying the wider
­
dimensions (I, it, we and its), each of which are vital issues that impact on brain function, in this instance
though partial accounts. Integral mental health the subjective, integral correlates of an over-stimu-
therefore implies that different treatment approaches, lated limbic and sympathetic nervous systems. Integral
reflecting different quadrants, should have beneficial mental health also implies that a deficit or damage
effects for the same condition. For example, an experienced in one quadrant is likely to have impli-
orthodox or conventional medical practitioner cations for the other quadrants. In human beings
(upper right quadrant) might prescribe anxiolytic and other mammals, physiological balance (upper
medication to calm the limbic and sympathetic nerv- right quadrant) is dependent on the love we receive
ous systems, both of which are involved in the devel- from others (lower left quadrant). This was strikingly
opment of anxiety and depression. However, the demonstrated in a study conducted in the 1960s
10 PART 1 Foundations

Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
and published in the British Medical Journal (Parkes number of psychological symptoms in the popula-
et al. 1969). The team of researchers studied two tion, many more individuals would cross the thresh-
groups of elderly men of the same age. One group old for flourishing. Similarly, a small shift in the
had been widowed while the wives of the other mean number of symptoms or risk factors would
group were still alive. The average survival time of result in a decrease in the number of people in both
the widowers was significantly less than the married the languishing and mental disorder tail of the dis-
group. Servan-Schreiber (2011) has used this study tribution. This is an important insight for nurses
and others, which demonstrate clear links between who have been trained in the care of individuals
emotionally supportive relationships, social net- and who may find it difficult to change focus to
works and health to argue that the physiology of communities and populations.
social mammals is not separate from the rest of their
being, particularly their mental health. Humans are
integral beings and optimum mental and physical 1.5 Implications for nursing
functioning depends on relationships with others,
especially those that offer close emotional ties. It is Figure 1.4 presents mental health as a complex phe-
of little surprise therefore that when mental health nomenon that arises from the integration of everything
service users are asked about the strategies they find that is within human experience and fluctuates as all
‘most helpful’, relationships with others is top of their things relative to that experience change. The figure
list (Faulkner and Layzell 2000). Psychiatrists at the also represents the art and science of mental health
University of San Francisco refer to this phenome- nursing. It contains its subjective and objective orienta-
non as ‘limbic regulation’ and argue that a relation- tions, and its interpersonal and evidence-based tradi-
ship is a physiological process as much as it is a social tions. Those traditions, which developed principally
process, as real and as potent as any pill or surgical around the care of people with mental illness, can now
procedure (Lewis et al. 2000). People can die from be understood in relation to mental health. In this
broken hearts and Servan-Schreiber (2011) argues respect there are two overarching themes that have
that love is quite literally a biological need. implications for the practice of mental health nursing.
A further implication of integral mental health is The first concerns the delivery of care to promote the
that interventions aimed at the group (community) mental health of people who experience mental disor-
should also have benefits for the individual (self). In ders. This is additional to the profession’s established
this respect Huppert (2005) has developed an argu- tradition of delivering interventions designed to man-
ment for shifting the health of the whole population age the mental disorder itself. The second concerns
in a positive direction rather than focusing on indi- extension of the profession’s role to support the mental
viduals per se (see Figure 1.3). By reducing the mean health and well-being of communities and the public.

Figure 1.3 The effect of shifting the mean of the mental health spectrum in a positive direction (from Huppert 2005)

Flourishing Moderate mental Languishing Mental disorder

health
Exploring the Variety of Random
Documents with Different Content
 26 THE PARSHALL FAMILY received in return for his
services the two Maeris and Raumsdal. He married Ragnhildr,
daughter of Hrolfr Nefja, by w^hom he had three sons, viz., Ivar,
who fell in the Hebrides, whilst on an expedition with King Harald ;
Hrolfr, or RoUo as he was afterwards called by the French ; and
Thorir the Silent, who married King Harald's daughter Arbot, by
whom he had a daughter, Bergljot, mother of Hakon Jarl the Great,
the hero of the battle of Gomsviking. Rollo, the second son, was
expelled from Norway in the latter half of the ninth century for
making a raid on the coast between Norway and Gothland, contrary
to the King's commands. On being outlawed, he first retired with his
ships among the islands of the Hebrides, whither the flower of the
Norwegian nobility had fled on the conquest of the Kingdom by
Harald. Those warriors readily accepted Rollo as their leader, and
soon began reasserting their old habits of raid and plunder. Towards
the end of the ninth century, Rollo and his followers made several
attacks on French coastal towns, culminating in the siege of Paris of
886 when the City was successfully defended by Count Odo. In 911,
however, Charles the Simple, then King of France, saved the country
from further attacks by the Northmen by the Treaty of Clair-sur-Epte.
By that Treaty, the district of the Lower Seine, now called Normandy,
was given to Rollo and his followers, who rapidly adopted the French
language, manners, and religion, and came to be known as the
Normans. Duke Rollo appears to have been baptized into the
Christian faith in the year 912, and in 919, he was married to his old
love Popei, daughter of Beringer, Earl of Bessin and Bayeux, whom
he had taken captive at the fall of Bayeux in 890. He was already
married to her ' more Danico^ but this Christian marriage rendered
legitimate, in the eyes of his Christian subjects, the two children he
had
 THE EARLS OF CORBEIL 27 THE EARLS OF CORBEIL TO
ROBERT DE CORBEIL OR DE PESHALE, FIRST LORD OF PESHALE.
RoLLO THE Viking, First Duke of Normandy Osmon the Dane,
Foulges, Count Tutor of Rich I. 956 of Anjou I I Count Haymon, =
Elizabeth = Bouchard, I St Earl of I 2nd Earl of Corbeil, b. 920,
Corbeil, d. 967 d. 1006 William, Duice of Normandy Richard, =
Gunnor Duke of I Normandy Germaine = M auger, 3rd Earl of
Corbeil, 1029 Richard, Duke of Normandy I I I Haymon Dentatus,
Guilleaume (Werling), 2nd son. Lord 4th Earl of Corbeil, of Thorigny
and d. 1060 Granville, killed I 1047 Herlwin = Arietta = Robert, Duke
of sr I Normandy Herleva Robert Fitz Hamon (Robert the Great)
(1040-1 106) I Bouchard, 6th Earl of Corbeil, killed, 1090 Eudes, 7th
and last Earl of Corbeil Rainaud, 5th Earl of Corbeil (1020-1079) I I
III i Richard d' = Emma Odo Robt. Willi; the Conqueror Gilbert de
Corbei b. about 1050 ■■ Isabelle Loup Hugh Lupus Robert de Corbkil
OR DE Peshale, First Lord of Peshale i Sn Chap. 11.
 28 THE PARSHALL FAMILY had by her, namely, William and
Gerloc or Gerletta, who received the name of Adela at her baptism,
and afterwards became the wife of William, Duke of Acquitaine and
Poictiers. In 926, Rollo, owing to his extreme age, handed over the
cares of government to his son William, and on his death some five
years afterwards, was buried at Rouen. A tomb with inscription
erected to his memory, several hundreds of years afterwards, is to
be seen there still. Dean Spence in his Homes of the Norman Dukes,
writes of Rollo as follows : ' The thirty wild years as a rover by land
and sea, thirty years of rapine and of cruel deeds done to well-nigh
defenceless cities, villages, and monasteries, would seem a strange
preparation for one who was to organize an important nation, who
was to weld together men of various races, who was to lay the
strong ground stories of a mighty realm, destined in a few short
years powerfully to influence the history of the world. Yet this is
what Rollo the Viking, the wild Northman freebooter, did in Rouen
and Bayeux, between a.d. 911 and a.d. 927. The first of the seven
mighty Dukes of Normandy must have been more than sixty years
old when he began his curious, but enduring work. For enduring it
indeed was. What he began his six successors went on with and
developed — the strong and firm government, the respect for the
Christian faith, law and order, the gradual restoration of the old
ruined religious houses and their great educational and other works,
the curious welding together of Dane and Frenchman which
produced the Norman, — all these changes were the care of the old
freebooter Rollo the Viking, his children and children's children for
six generations, so that in less than a century and a half after the
grim old Dane was laid in his tomb in the Rouen Minster that he had
restored, his Norman land was famous for its new school of
architecture, for its lovely minsters, its vast monasteries, its
flourishing
 THE EARLS OF CORBEIL 29 cities ; was (still more
remarkable) famous for its matchless schools, and even for the
wealth and beauty of its " Romance " or French literature. For three
generations, that is during the reigns of the first three Dukes, a
period of some ninety eventful years, the old Norsk religion — in
which Thor and Odin were worshipped, and the wild banqueting hall
of Valhalla looked to as the glorious goal of the unconquered fighting
hero — struggled with Christianity in the hearts of the great Norman
Dukes and their faithful companions in arms. Rollo and his two
successors were more than nominal Christians, as we shall see ; nay,
at times his son and grandson were even fervent devotees to the
Christian faith ; yet ever and anon the spirit of the old loved
Paganism of their fathers influenced them and their followers. This
was especially noticeable in their marriages. The aversion of these
brilliant and successful men to the Christian marriage tie is
remarkable, and the first three Dukes made no concealment of their
dislike to the princesses to whom, mainly for political reasons, they
were united by Christian rites. Their love and affection all belonged
to the partners whom they had chosen for themselves, and to whom
some Pagan rite loosely bound them, and not to those highborn
women, whom, without pretending to love, they had rnarried with all
the ceremony of the Christian Church.' RoUo's son William,
surnamed Longsword, is said to have been a man of culture and
refinement, as well as a warrior unrivalled in horsemanship and the
use of arms. He was a strong Churchman, and during his reign
rebuilt the Abbey of Jumieges. With all his zeal for the new faith,
however, he did not appreciate the Church's teaching of the sanctity
of marriage, and, like his father, contracted a ' Danish ' marriage
with one Espriota ^ (daughter of Herbert, Earl of Senlis, and sister
of Bernard the Dane), by whom he had a son Richard his successor.
Soon after the birth of Richard, William was persuaded by one of his
Counsellors to enter 1 St. Alleis, Guillaume de Jumieges.
 30 THE PARSHALL FAMILY into a Christian marriage with
one Luitgard, daughter of Herbert Count of Vermandois, but there
was no issue of this marriage. In 936, Duke Wilham, accompanied
by Hugh the Great, Herbert Count of Vermandois, and others,
received at Boulogne, on his landing from England, Louis
d'Outremer, the new King of France, son of Charles the Simple, who
acquired his nickname by having been educated at the English
Court. William conducted him to Laon and assisted at his coronation.
Three years afterwards, however, he quarrelled with him and
entered into a formal league against him with Hugh the Great and
Herbert of Vermandois. The remainder of his life was occupied in
invasions and political disturbances, and he was assassinated in the
year 942,' after a reign of less than twenty years. Upon William's
assassination, Bernard the Dane, the brother of Espriota, fetched
from Bayeux William's only child Richard, then barely ten years old,
in order that he might be solemnly invested with the ducal sword
and mantle and to receive the homage of the Normans. Dean
Spence describes the scene as follows : ' The Norman chieftains
gathered round William Longsword's coffin. They included old grey-
headed companions of RoUo, with their sons and grandsons, men
who were the ancestors of the future conquerors of Italy and Sicily ;
men, whose children's children fought and won on the stricken field
of Hastings ; men, whose descendants became the foremost
Crusaders, the fathers of the proudest Houses of the mighty Anglo-
Norman kingdom, and in their midst, standing by his murdered
father's coffin, the little fair-haired boy with ruddy cheeks, whom
they had fetched from Danish Bayeux. One grey-headed chieftain
held the ducal coronet on the boy's head, one kissed the little hand,
and the others swore eternal allegiance and fidelity to their child
Duke Richard, who in sorrow and perplexity stood gazing on his 1
Anseline and Guillaume de Jumieges.
 THE EARLS OF CORBEIL 31 father's coffin. It was the last
great service RoUo's son could do his people and the land, this
welding together by his coffin the varied interests of his mighty
chieftains. In this solemn moment the Norman Dane and the
Norman Frenchmen forgot their jealousies, their antipathies, the
conflicting interests of the old religion and the new, in their stern
resolve to avenge their master's death by raising the throne of their
master's son higher than the thrones of any of the Princes of
France.' Acknowleged by the Norman chiefs, Richard next received a
formal investiture from the French King. Louis, however, under the
pretence of educating the young Duke at his own court, persuaded
the Normans to allow Richard to accompany him back to France.
Soon after, Richard was imprisoned at Montleon, and Louis sought to
recover Normandy for himself. A Norman esquire, Osmund or Osmon
the Dane, had been allowed to accompany Richard to Montleon as
his tutor however, and with his help he escaped and joined his Uncle
Bernard. Thereupon Louis, with the aid of Hugh the Great, in the
year 945, made war upon the Normans. Bernard called to his
assistance the King of Denmark, and Louis was defeated. Peace was
concluded, and Richard received a further grant of territory. Osmon
then skilfully arranged a marriage between the young Duke and
Esme, daughter of Hugh the Great, then Count of Paris and the most
powerful man in France. With the celebration of this marriage
commences the history of the Earldom of Corbeil. The occasion is
described by Le Paire, in his book on the History of the Town of
Corbeil^ published in Paris in 1901. Referring to the marriage of
Richard and Esme, this author states that the betrothal ceremonies
were carried out at Paris in 956. All the nobility of Normandy were
present at this festivity, amongst them being Haymon, son of
Osmon, a young man of much promise, ' beloved and made much of
by the ladies.' In the French Court was a lady equally prominent by
name, Elizabeth, a
 32 THE PARSHALL FAMILY near relative of Avoye, wife of
Hugh the Great and sister of the Emperor Othon. These young
people fell in love with each other, and the match being approved by
the statesmen on both sides, Elizabeth was married to Haymon in
the following year, viz. 957. As a wedding gift, Hugh the Great gave
Haymon the Earldom of Corbeil and the Manor of Gournay on the
Marne. At this time Hugh the Great was at enmity with the Emperor
Othon, and hoped by these intermarriages to keep the support of
Normandy, This marriage of the young Duke with a daughter of
Hugh the Great was not pleasing to Louis, and shortly afterwards he
allied himself to Othon of Germany, and attacked Normandy. Othon
and Louis penetrated as far as Rouen, where Hugh the Great had
withdrawn with Richard, Duke of Normandy, now his son-in-law.
Here they were repulsed in battle by the two princes and compelled
to retreat. Haymon, the first Earl of Corbeil, was naturally a strong
supporter of Richard, and it is recorded that he and his followers
greatly distinguished themselves at this battle. After depositing his
booty in his castle at Corbeil, Haymon set out to avenge himself on
certain nobles who, under cover of the foreign invasion, had
offended him. Amongst these was the Count of Pallnau, — Pallnau
being a small castle situated at the junction of the rivers Etamples
and Essonne, above the bridge of Gomiers. In this castle were
preserved the relics of two patron saints, St. Exupere or St. Spire
and St. Leu, both Bishops of Bayeux. Haymon took the castle by
storm and slaughtered the defenders. The relics he retained as his
own portion of the booty, and resolved to build a church at Corbeil in
which to place them. The booty taken during the war and the
ransom of his prisoners provided funds for the building of the
church, and these were supplemented by property left him by his
father, Osmon. The church was built and the relics installed
 THE EARLS OF CORBEIL 33 therein, and provision was also
made for the upkeep of four priests to celebrate Holy Mass daily in
the church. According to the Abbe Leboeuf, the building was
completed in the year 963. About the same time the relics of St,
Guenault, Abbe of Landevenne, were brought from Courcouronne to
the Castle of Corbeil, and placed in the care of Count Haymon. It is
recorded that the Count received them with great ceremony, and
later placed thern in a chapel situated in St. Jacques, just outside
the town. This chapel, with its grounds, he gave to the monks, and
we find that the Priory of St. Guenault was enjoying this heritage as
late as the year 1630. According to Dom Guillaume Morin, the old
bridge of Corbeil was also built by Count Haymon. This bridge
spanned the Seine, thus connecting Old Corbeil on the right bank
with New Corbeil on the left bank, which included Count Haymon's
castle and the church. Louis d'Outremer died in 956, and Hugh the
Great shortly afterwards. Their sons and heirs, Lothaire and Hugh
Capet respectively, were on friendly terms, and Count Haymon took
advantage of the peace to go on a pilgrimage to Rome. He died,
however, on the road, not far from Corbeil, on the way home from
Italy. The Countess Elizabeth had the body brought to Corbeil, where
it was buried in the Church of St. Spire. There is no contemporary
inscription giving the date of the death of Count Haymon, but La
Barre estimates that he died in 967, ten years after his marriage. For
some time afterwards, the anniversary of his death was solemnly
observed on the 28th of May in the Church of St. Spire, but the
exact date of his death is uncertain. A tomb, raised to his memory,
still exists in the church, and is of great interest on account of its
antiquity. A good description of the church and of Count Haymon's
tomb is given by M. Pinard, member of the Societe
 34 THE PARSHALL FAMILY Fran^aise (for the preservation
of historical monuments), in his Monograph on the Church of St.
Spire, Corbeil. St. Spire, or St. Exupere as he should be called, was,
says M. Pinard, a missionary sent from Rome to preach the faith to
the Gauls. Nothing is known of his life, except that he was the first
bishop of Bayeux, and that he died towards the end of the fourth
century. He was buried, it is said, in the Church of St. Jean at
Bayeux, and it is not known how his remains came to be transferred
to Pallnau. The second patron saint of Corbeil, St. Leu, commonly
called St. Louis, is said to have been the third bishop of Bayeux. He
died at the end of the fifth century. As related above, the relics of
this saint were brought to Corbeil by Count Haymon, together with
those of St. Spire. M. Pinard is of the opinion that Count Haymon
died before the completion of the church, and that it was Count
Bouchard, his successor, who actually performed the pious duties of
depositing the precious relics in the church. The church constructed
by Haymon, however, did not exist long, for it was burned about the
year 1019, and was afterwards rebuilt on the same site. This new
building was also burned down between the years 1137 and 1144.
The Cartulary of the Church of Notre Dame in the same town
preserves contemporary evidence of this disaster. Some parts of the
present edifice were certainly constructed at this time, but
considerable additions have been made since then. The
reconstruction must have been slow, since the consecration did not
take place until October loth, 1437. The powder factories established
at Essonnes in 1688 caused much damage to the churches in
Corbeil, more particularly to St. Spire, which was the nearest to
them. The violent shocks produced by the frequent explosions had
most serious effects, and the iron bands, which it was found
necessary to place round the pillars, still exist in the present edifice.
A Charter of 1029 refers to the ' Castellum Sancti
 THE EARLS OF CORBEIL 35 Exuperii,' ' and one hundred
and fifty years later we find it designated ' Sanctus Exuperius de sub
castro forti,' ^ but in recent times the name has come to be
abbreviated to St. Spire. In describing the monuments, M. Pinard
points out that whereas Count Haymon's tomb is now in a side
chapel, it was originally in the cenotaph. This monument is believed
to have been erected to his memory at the commencement of the
fourteenth century, that is, nearly 350 years after his death. The
statue is in the form of an armed man lying prostrate ; it is of stone
of a very fine grain, while the head, neck and hands are of white
marble. The veins and muscles are reproduced in a remarkably fine
manner. The body is clothed in a coat of mail, over which there is a
cloak edged with fur. The baldrick is large and of an unusual form,
and on it is represented, alternately, the head of an angel or child,
and a griffin with two heads. Although coats of arms were not much
worn before the Crusades, yet his shield has on it a coat of arms
consisting of a lion salient on a red background The costume,
likewise, is somewhat of an anachronism. ' Gules, a lion salient,'
were the arms of the later Earls of Corbeil, and it is probable that
these were chosen for that reason. At the foot of the statue is a
dragon with two heads, which, tradition says, represents a monster
much feared in the country, and from which Haymon delivered it. In
a street of Corbeil, namely, the TrouPatrix, there is an old covered
drain entering into the river Essonne, and, according to tradition, this
place was the den of the dragon. The legend doubtless indicates
that Count Haymon did much to better the health of the town and to
rid it of disease. In the base of the monument was at one time a
black marble panel with the following inscription beautifully inlaid in
white marble mosaic : ' Cy gist le cors de hault et noble homme, le
comte Hemon, jadis comte de 1 ' Church of St. Exuperius.' 2 ' St.
Exuperius near to the castle.'
 36 THE PARSHALL FAMILY Corbeuil, qui fonda cette eglise
et plusieurs autres. Dieu ait rame de luy. Amen.'^ Returning to Le
Paire's History of Count Haymon, the writer states that Thibauld, at
first Abbe of Cormery in Touraine, and later Abbe of St. Maur, is
generally considered to have been a son of Count Haymon, but it is
difficult to believe that, if Haymon had an heir, he should have
persuaded him to enter in his youth the monastery of Cluny, as did
Thibauld. However this may be, Haymon's actual successor was
Bouchard,^ son of Foulques the Good, Count of Anjou. Bouchard
received the Earldom on his marriage with Elizabeth, Haymon's
widow, who was still comparatively young, and is said to have been
very beautiful at this time. From his youth, Bouchard had been
brought up in the royal house, together with Hugh Capet, son of
Hugh the Great. He naturally became his friend and confidant, and
was later invested by him with many titles and honours. At the news
of the death of Count Haymon, Hugh immediately thought of
marrying his widow to his favourite Bouchard, and, succeeding in his
designs, he invested Bouchard with the Castellanies of Corbeil and
Gournay-surMarne. The Count later received also the Earldom of
Paris, but by right of office only, as it was by this title and position
that the Capets had succeeded to absolute royalty. In 982, Bouchard
went to Arras to demand in the name of the King, from Count
Arnould, the relics of the saints which he had taken from the monks.
He succeeded in his mission, and acquired great popularity in
Flanders, and renown for holiness. The Abbe Lebceuf writes : ' A
Charter of this Count, given in favour of the Abbey des ' Here lies
the body of the high and noble man, tlie Count Hemon, formerly
Count of Corbeil, who built this church and many others. May God
receive his soul. Amen. -See Life of Bouchard^ Count of Melun and
Corbeil, by Eudes, a monk of the Abbey of St. Maur des Fosses.
 THE EARLS OF CORBEIL 37 Fosses, finishes thus : Actum
pubhci in Curia Nostra Corboli anno Incarnationes Dominicae mvi ( 1
006) — which shows that the Counts of Corbeil had a palace there
from this time.' Another exploit of Count Bouchard was in connection
with the mon^tery of St. Maur. Scandalized at the worldly conduct of
Magenart, then Abbe of St. Maur, he succeeded, with the aid of
Hugh Capet, in reforming the monastery, and later gave to it, with
the consent of his wife Elizabeth, the Lordship of Neuilly-sur-Marne,
and the Lordships of Lisse, near Corbeil, of Siaux-en-Gatinais and of
Couresaux en Melunais. Hugh Capet's successor, Robert, who came
to the throne in the year 996, granted the same friendship and
confidence to Count Bouchard as had his father, and both were
equally zealous in religious matters. During the difficult period of the
separation of the King and his wife Berthe, and of the marriage of
the King with Constance, Bouchard was a faithful supporter of
Robert. Amongst the Nobles who had taken up the cause of Berthe,
was Eudes, son of Eudes, Count of Chartres and of Blois, and of
Berthe herself, who had married Robert after the death of Eudes.
Under the influence of Eudes the son of the abandoned Queen, one
Gaultier, guardian of the castle of Melun, took possession of the
town and delivered it up to Eudes. Thereupon, Bouchard, with the
support of the King and Richard, second Duke of Normandy,
besieged the town with such success that the defenders were
obliged to surrender. Bouchard's last exploit was the quashing of the
rebellion of Reinart, Count of Sens. Reinart wished his son Brunon to
be elected Archbishop, and on Geotheric being chosen, Reinart took
up arms against him and forced him to take refuge with Regnaud,
Bishop of Paris, said by some to be a son of Bouchard. Instructed by
the King to restore order and punish the rebels, Bouchard set out
against Reinart. who narrowly missed being captured.
 38 THE PARSHALL FAMILY After this expedition, Bouchard
became ill and retired to the Abbey of St. Maur, where he undertook
all the duties of a novice, even to carrying the candlesticks in
church. Thibaud, then Abbe of Saunt Maur, is said to have protested
against Bouchard performing this humble office, and Bouchard is
stated to have replied in the following words : ' Si lors que j'etais
Capitaine suivi de gens d'armes et de noblesse, j'ay fait gloire de
porter la chandelle devant un roy terrien, a plus forte raison je me
dois humilier devant la Majeste de Dieu, et porter les chandeliers en
sa maison, et, selon mon pourvoir, aider a celebrer le Service divin.'
^ Bouchard did not long endure these hardships, however, for,
according to the Chronicle of St. Denis, he died on March ist, 1007.
The obsequies were magnificently carried out in the presence of all
his family, and he was buried in one of the chapels of the Abbey. On
his tomb, the following epitaph was engraved : ' Hie vir magus
quondam, dom Corpore vivit, Nomine Bucardus, per mundi climata
notus, Celsus erat meritis distisfactisque modestus. Pauperibus
largus viduis per cuneta benignus, Ipsius en corpus tumulo requescit
in illo, Martuis ostendit obiisse Kalendus.' According to Gaignieres,
the tomb represented the statue of a knight lying prone on a
pedestal which was let into the wall. Elizabeth, the widow of Count
Bouchard, and formerly wife of Count Haymon, died, according to
the Chronicle of St. Denis, on January i8th, 1008, and was buried in
the * ' If, while I was a Captain followed by the common soldier and
by the noble, I took glory in carrying the torch before an earthly
King, how much the more then ought I to humble myself before the
majesty of God, and carry the candlesticks in His House, and
according to my power, help to celebrate Divine Service.' 2 ' Here, in
this tomb, lies the body of a man great during his life, named
Bouchard, renowned throughout the whole world, of a high merit,
kindly in his speech and in his actions, generous towards the poor,
liberal in his charities. He died on the first of March.'
 THE EARLS OF CORBEIL 39 same chapel, her tomb,
according to Gaignieres, was that of a lady lying likewise on a
pedestal. The epitaph inscribed on the tomb was as follows : ' Hoc
placuit Domino conjungere vivos, Et poliendras simul jungere sic
voluit, Hoc qui cunque legis persolve carmina Psalmi, Spiritus ut
valeant sexudere regna poli.'^ Both these epitaphs were transcribed
by the Monk Oddes in 1508, and at the time of writing he said that
the epitaphs were already half destroyed. Before he died, Count
Bouchard confirmed in writing all the pious gifts of his predecessor
Count Haymon, and it is stated by the old historians, that he also
completed the Church of St. Pierre at Melun. According to La Barre,
Bouchard had by his wife Elizabeth an only daughter, Germaine, who
was married to Maugis or Mauger, a Norman Prince, son of Richard
first Duke of Normandy, who received thereby the Earldom of Corbeil
in the right of his wife, and so became the third Earl of Corbeil.
Richard, first Duke of Normandy, surnamed ' The Fearless,' reigned
from 945 to 996, during which time the province of Normandy
increased steadily in strength and prosperity. As already stated, in
956 Richard, at the age of fourteen, had married Esme, daughter of
Hugh the Great. There was no issue of this marriage, and on Esme's
death, Richard married his mistress, Gunnora, or the ' Lady Gunnor,'
who is described as sister to Herfaste, a Dane of noble birth. Dudo
calls her ' une tres belle femme, tres adroite et de grand esprit, et
une femme, accomplie, et d'une famille de Dannemark de haute
noblesse.''^ By this ^ 'Just as it pleased God to unite them during
their life ; so in the same way it has pleased Him to reunite them in
death. Whoever ye be that read this, remember the verse of the
Psalmist, "Souls such as these transcend the Kingdoms of the
Earth."' ^'A very beautiful woman, very skilful and of great intellect,
an accomplished woman, of a noble Danish family.'
 40 THE PARSHALL FAMILY marriage, Richard's several
children by Gunnor were made legitimate. According to Guillaume de
Jumieges, Duke Richard had three sons, namely, Richard the Good,
his successor as Richard, second Duke of Normandy ; Robert, who
became Archbishop of Rouen ; and Mauger or Maugis,* who married
in 1012, Germaine, the daughter and heiress of Count Bouchard,
thereby coming into the Earldom of Corbeil. This Mauger is not to be
confused with Mauger, son of Richard the Good, Archbishop of
Rouen in the time of William the Conqueror. Richard's daughter
Emma, the ' Flower of Normandy,' was twice crowned Queen of
England, having married, first in 1002, King Ethelred, and second in
10 17, King Canute. By her first husband she became the mother of
Edward the Confessor, and by her second of King Hardicanute.
According to various authorities, Richard had, besides the above,
two or three illegitimate children. Richard the Good, fourth Duke of
Normandy, was not the equal of his forefathers, but during his reign
the province enjoyed continued prosperity. He married first, Judith,
daughter of Geoffrey, Earl of Brittany, by whom he had three sons ;
Richard, who succeeded as the fifth Duke ; Robert ' le Diable,' the
sixth Duke, who, by Arietta or Herleva, had William, the seventh
Duke and the Conqueror of England. The third son was William, said
to have become a monk at Fecamp. By his second marriage with
Estrite, Princess of Denmark, Richard the Good had no issue, but by
his third wife Papia, he had a son, Mauger, who, as mentioned
above, was Archbishop of Rouen, 1037 to 1056. Richard the Good
died in 1026. With Mauger, third Earl of Corbeil, the family of Corbeil
begins, and it was his descendant, Robert de Corbeil, who settled in
England and took the name of Robert de iDudo, p. 137. Guillaume
Gemmet, Hist. Angl. Serif ta, in British Museum, 2070, d. p. 458.
Speed, p. 413.
 THE EARLS OF CORBEIL 41 Peshale. Mauger's wife,
Germaine, was celebrated for her beauty and grace, and the
marriage is said to have been strongly advised by Bishop Regnaud,
Chancellor of France, who wished to maintain the alliance between
the Dukes of Normandy and the Counts of Corbeil. Mauger rendered
great services to King Henry of France in the struggle for the crown
against the King's mother, Constance, and became one of his
greatest friends. As a reward for his services he received the county
of Mortmaigne. He died about 1030, leaving by Germaine two sons.
The elder, named Guillaume, succeeded him as Earl of Corbeil and
Mortmaigne, while the second son, Hamon, nicknamed Dentatus 1
(from having been born, it is said, with teeth), received the
seigneuries of Thorigny and Granville. Little is known of Hamon
Dentatus, but according to Robert Wace's Roman de Rou he took
part in the rebellion of the principal Norman barons against Duke
William, and was slain in the celebrated battle of Val-es-Dunes. He is
recorded to have struck down King Henry, who was assisting the
young Duke against the rebels, and this story is confirmed by
William of Malmesbury in his narrative of the battle.^ Freeman,
describing the fight, writes : ' The King presently encountered one of
the three great chiefs of the rebellion ; another thrust, dealt by the
lance of Hamon, again laid Henry on the ground ; but a well-timed
stroke from a French Knight more than avenged this second
overthrow ; the Lord of Thorigny was carried off dead on his shield
like an old Spartan. The King honoured his valiant adversary, and, by
his express order, Hamon was buried with all fitting splendour before
the Church of our Lady at Esquai on the Orne.' ^ 1 William of
Malmesbury (ii. 230) introduces him as ' Haimo Dentatus, avus
Roberti quo nostro tempore in Anglia multarum possessionum
incubator exstitit.' [Hamon Dentatus, father of Robert, by whom in
our own time Anglia was deprived of many possessions.] 2 William
of Malmesbury (iii. 120). ^History of the "Norman Conquest, vol. ii.
p. 257.
 42 THE PARSHALL FAMILY Haymon Dentatus left two sons.
The first, Robert FitzHamon, joined Duke William on his expedition
to England, and later fought against the Welsh on behalf of King
William Rufus. He was afterwards styled Prince of Glamorgan. He
had no son, but one daughter, Mabel, who married Robert, Duke of
Gloucester, natural son of King Henry I. According to William of
Malmesbury (v. 398) Robert FitzHamon died of a wound received at
Tinchebrai, 1106. He was buried in a chapel, founded by himself, in
the Abbey of Tewkesbury. On a plate erected in 1397 in the chapel is
inscribed, ' In ista Capella jacet Dominus Robertus Filius Hamonis,
hujus Loci Fundator.'^ His arms are depicted as ' Azure, a Lion
rampant, guardant, Or.' It is interesting to note that a lion salient
was depicted on the shield of Count Haymon on the tomb erected to
his memory in Corbeil in the fourteenth century, and further that the
arms of the Peshales of the thirteenth century consisted of the
Swynnerton Cross with an escutcheon bearing a lion salient. On the
death of Robert Fitz-Hamon, all his titles and property descended,
according to Norman law, to his brother Richard de Granville, the
ancestor of the present Granvilles and Grenviles. Guillaume, Earl
Mauger's eldest son, besides being Earl Corbeil was also Count of
Mortagne. He is identical with the count called de Verlange or
Werling by the Normans, and is so referred to in Freeman's Norman
Conquest. The first manuscript in which Guillaume is mentioned is a
deed dated 1040, in which he confirms the gift by Nantier, his
viscount, made to the monastery of St. Pierre des Fosses, of the
Church of St. Jean, newly built, 'juxta murum Corbeili,' which proves
that Corbeil was already a fortified town. In 1048, at Sens, in the
palace of the King, he took part in a meeting composed of seven
bishops ; of Robert, Duke of Burgundy ; of Rainard, second Count of
Sens ; and of ' In this chapel lies Duke Robert, son of Hamon ; he
was the founder of this place.
 THE EARLS OF CORBEIL 43 Raoul, third Count of Valois. At
this meeting King Henry granted a Charter authorizing the
estabhshment of the priory of St. Ayoul. In a Charter of 1050 he is
mentioned as ' Guillelmus Miles nostri Castri CorbeiH/ Shortly after
this, however, Duke William, natural son of Robert of Normandy, who
was at this time strengthening his position by despoiling all his foes
of their possessions, and bestowing them on his own kinsmen, took
advantage of a treasonable remark of Count Guillaume to deprive
him of his title and property as Count of Mortagne. Count Guillaume
was obliged to leave the country temporarily, and went to the wars
in Apulia in Italy, attended by a single esquire, but he soon returned
and took up his residence at Corbeil. The county of Mortagne was
bestowed by Duke William upon his half-brother, Robert, the son of
Herlwin and Herleva, whose connection with the Duke is referred to
later. It is recorded of Count Guillaume that he had had a stormy
youth, that he loved fighting, that he had a violent temper, and was
always ready to do ill rather than endure anything. In spite of all
this, however, he was by disposition inclined to piety and devotion.
Doublet remarks that Guillaume assisted at the opening of the Hunt
of St. Denis in 1050, and was one of the noblemen who affixed their
seal to the record of this ceremony. Tired by his labours in the war,
and his dissolute youth, Guillaume, already old, decided to give his
county of Corbeil to his son Rainaud, and to retire to the Abbey of
St. Maur les Fosses. He obtained a Charter from the King dated
1058, giving him the same rights as the Count Bouchard had in the
possession of the abbey, and devoted much time and expense to
reforming and redecorating it. La Barre, writing about the year 1430,
states that in his time there was in the Chapel of St. Babolim, at St.
Maur, under the image of the Virgin, a tablet on which was written in
French the following: 'During the time when King Philip
 44 THE PARSHALL FAMILY reigned in France, in the year
1060, there was a count at Corbeil-le-Chatteau, rich and powerful,
but neither devoted nor pious, who, being attacked by a cruel fever
and fearing to die, and thinking of his grievous sins, entered this
house, in devotion, and proposed, if it pleased God to give him his
health, that he would take the habit in this house. His petition was
favourably accepted and he was cured, in thanks for which he
distributed his goods amongst the poor and improved the Church.'
La Barre also relates the following quaint story : ' It happened one
day that, walking in the church. Count Guilleaume perceived that the
sacred images were worn and falling to pieces, and took upon
himself the expense of renewing them. To this end, he obtained the
services of a workman named Rumolde, an expert in his work, who
prepared everything necessary to make an image within the Chapel
of St. Denis. Just as he was about to commence the work, he heard
a voice calling him by name. Rumolde, thinking it was the Count, left
his work to go and see what he wanted, but he could not find the
Count, although he searched for a long time, asking the monks, in
vain, whom he met whether they had seen him. When he returned
to his work, he found the image of Our Lady quite finished by the
Grace of God, and of the glorious Virgin Mary. Rumolde related this
miracle to the Count and to many others, who thanked God for it.'
La Barre adds, ' Of that which is written above, each one may
believe as much as pleaseth him.' Guillaume died in the Monastery
of St. Maur about the year 1060. According to all accounts, writes Le
Paire, Rainaud, son of Guillaume and the fifth Count of Corbeil, was
one of the favourites of Philip I. of France. At the Court of the King,
he affixed his seal to the act of dedication of the Church of St.
Martin des Champs, made in 1067. Count Rainaud is there described
as ' Rainaldus, Comes Curbuli 
 THE EARLS OF CORBEIL 45 ensis,' and one of his kinsmen
is referred to as ' Fredericus de Curbuilo.' Little else is known of
Rainaud, except that he left several sons. Bouchard, probably the
eldest, succeeded him as the sixth Earl of Corbeil. One of the
younger sons of Count Rainaud was Gilbert de Corbeil, whose son,
Robert, was the first of the Peshales, Guilbert de Corbeil married
Isabella Loup, daughter of Richard d'Avranches, a Norman nobleman
in high favour with Duke William. Isabella Loup's brother, Hugh
Loup, became the first of the Norman Earls of Chester, and was
known as Hugh Lupus, or Hugh the Wolf He bore on his shield the
head of a wolf, which later became the crest and arms of the
Peshale family. The descent of the house of d'Avranches is traced
back through Ansfrid the Dane to Hrollager, a son of Rognvaldr the
Viking, and a brother of Rollo, first Duke of Normandy.^ Richard
d'Avranches' father, Thurstan, had rebelled against William, Duke of
Normandy, shortly before the latter's invasion of England, and had
forfeited the whole of his possessions, which were then given to the
Duke's mother. Arietta. Richard, however, proved a loyal servant to
William, and later obtained his father's pardon. He further set
matters aright by marrying Emma or Emmeline de Conteville,
Arietta's daughter by her later husband, Herlwin de Conteville, who
brought him back all the lands that his father had lost.^ Arietta, or
Herleva, the Consort of Robert, Duke of Normandy, and mother of
William the Conqueror, was a daughter of Fulbert de Crey, a tanner
of Falaise. She captured the young Duke's heart, and was received
into the Court at the Castle of Falaise.^ William, her only son by
Robert, was born in 1028. The Norman writers look upon Herleva as
Robert's only consort, lawful or unlawful, but no ' Duchess of
Cleveland's battle Abbey Roll, vol. i. p. 45 et seq. ^Ibid., and
Anderson's Royal Genealogies, p. 741, second edition. ^Freeman's
Norman Conquest, vol. i. p. 203 ; vol. ii. p. 176, and Appendix U.
 46 THE PARSHALL FAMILY writer asserts any actual
marriage except the Tows Chronicler in Bouquet X284, who marries
Herleva to Robert soon after William's birth. 1 Former Dukes of
Normandy had contracted this irregular kind of union (already
referred to as a marriage more Danico), and following the examples
of his ancestors, Robert later raised the kinsfolk of his consort to
high honours. Herleva's father, Fulbert, the tanner, was granted the
post of ducal Chamberlain. After Robert's death in 1035, Herleva
married Herlwin de Conteville, and became the mother of two sons,
Odo and Robert, and of a daughter, Emma or Emmeline, who
married Richard d'Avranches as related above. Odo and Robert
followed the Conqueror and attained to great distinction ; the former
became Bishop of Bayeux^ and the latter received the County of
Mortagne, in the Diocese of Avranches.* Robert de Corbeil, who
later was known as Robert de Peshale, is described in an old deed
(page 49) as the son of Guilbert de Corbeil and Isabella, his wife,
but it is not known whether there were any other children by this
marriage. Robert de Corbeil's marriage, and his occupation of the
Lordship of Peshale are discussed in Chapter II. Before concluding
this chapter, a few paragraphs may be added on the history of the
Earls of Corbeil, subsequent to Guilbert's father, Rainaud. Bouchard,
called the Superb, sixth Earl of Corbeil, married Elizabeth de Crecy,
daughter of Hilduin, the third Count of Montdidier, in 1030. He had
by her two children ; a son, named Eudes, who succeeded him
about 1092, and a daughter, named Alix, who married Hugues de
Puiset. Bouchard built the cloister of St. Spire at Corbeil in 1071, and
granted great privileges to the Canons of the Church ; and the
documents confirming 'Freeman's Norman Conquest, vol. i. p. 203. -
Ibid., vol. ii. p. 210 et seq. ^ This Moretolium or Moretonium must
be carefully distinguished from Mauretania, Moretonia, or Mortagne-
en-Perche, in the Diocese of Seez (Freeman's Norman Conquest, vol.
ii. p. 290).
 THE EARLS OF CORBEIL 47 these privileges, signed by King
Phillip and many prelates, still exist. At this time King Phillip was
growing in disfavour amongst the nobility, chiefly on account of his
passion for Bertrade de Montfort, which, in 1094, was the cause of
his excommunication and interdict from the kingdom. Bouchard,
discontented like the rest, did not hesitate to rebel against the King,
though this act of hostility against royalty by a Count of Corbeil is
the first to be recorded. Bouchard, moreover, haughty, proud, and
ambitious as he was, had the audacity, Le Paire tells us, to aspire to
the crown of France. He prepared an army, and set out against the
King. Suger tells the following story of the Count : ' On the morning
of the battle, Bouchard refused to take his sword from the hand of
his equerry, but demanded it from the hand of his wife, to whom he
said in a gay and gallant manner, "Noble Countess, give cheerfully
this sword to your noble baron, who will receive it from your hand
under the title of a Count, but will bring it back to you to-day as King
of France." But the fortunes of the day went otherwise than he had
expected, and the unfortunate Count was killed by a blow from the
lance of Etienne, Count of Chartres, then allied with the King.' His
death quieted the rebellion and peace was re-established. This was
in the year 1092. Bouchard's son Eudes succeeded him as seventh
Earl of Corbeil, for the King did not deprive him of his inheritance, in
spite of the rebellion of his father. His mother, Elizabeth de Crecy,
was still young, beautiful, and rich, and was sought in marriage by
various noblemen. Marriage for her was a necessity on account of
the embarrassment of her possessions, and on account of the
hostility of her neighbours who had been offended by the arrogance
of Bouchard. Very soon afterwards she was again married. Her
second husband was Guy, surnamed le Rouge, Count of Rochefort
en Yveline, a great friend of Prince Louis, son of Phillip, and later
twice Seneschal of France.
 48 THE PARSHALL FAMILY The seventh Earl, Eudes,
married Eustache de Beaudemont, who survived him, and was
married again to Gilbert de Garlande, Bouteiller de France. On the
death of Eudes, the title of Earl of Corbeil appears to have
descended to Hugues de Puiset, husband of Eude's sister Alix, and
Vicomte de Chartres. Hugues, hov^^ever, appears to have been
imprisoned by Louis the Great, and forced to surrender to him the
title and County of Corbeil. Hugues was thus the eighth and last Earl
of Corbeil.
 CHAPTER II THE EARLIER PESHALE FAMILY As stated in
Chapter I, Robert de Corbeil, son of Guilbert de Corbeil, was granted
the Lordship of Peshale by Robert de Stafford, his Overlord, shortly
after the Conquest. The following is recorded as being a transcript of
the deed granting Peshale to Robert: 'Omnib: p'sentib. & futur. Salut.
— Sciatis me Rob'tum de Stadforde dedisse & hac Carta mea p'senti
confirmasse Rob'to Filo Gilb'ti de Corbeil & Isabelle ux. me &
haeredib: suis totam istam terram meam & Maneri de Peshale, etc.
tenend. de me p. feod. I Mil. dat 6 Cal Jan. A° Incarn. 1068. Testib.
W. de Eaton. R. de Weston, etc' ^ Robert de Stafford, whose
Norman name was Robert de Teoni, was a cousin of William, and
one of his most powerful followers, and, as is shown by the
Domesday Book, held eighty or more Lordships and Manors in
Staffordshire. The name ' Pershale ' is inscribed on the Battle Abbey
Roll, which is said to be the muster roll of the Norman knights who
came over with William the Conqueror in iprom the Peshall MS.
History, which refers to Charters of the Basset family of Drayton : —
'To all present and in the future, my salutations. Know that I Robert
de Stafford have given, and confirm by this my present Charter to
Robert, son of Guilbert de Corbeil and Isabella his wife, to him and
his heirs all this my land and the Manor of Peshale, to be held from
me for the service of a Knight's fee. Dated December 28th, a.d.
1068. Witnessed by W. de Eaton, R. de Weston, etc'
 so THE PARSHALL FAMILY 1066 ; but apart from the fact
that the first Lord of Peshale was then known as Robert de Corbeil,
the name was evidently interpolated later, perhaps as late as the
fourteenth century when the name was beginning to be spelt with
an ' r,' thus — Pershall, Persall, etc. The name occurs in both the
Holinshed and Duchesne Rolls, however, which are the two generally
acknowledged copies, the former from Holinshed's Chronicle dated
1577, and the latter dated a few years after.! Robert de Corbeil, as
the son of a younger branch, dropped his original surname in
accordance with the custom of the time, and assumed the name of
his Manor, calling himself Robert de Peshale. As explained above, he
was related to William the Conqueror, and no doubt occupied a high
position in the retinue of Robert de Stafford. He married an English
wife of Royal descent, one Ormonda, daughter and heiress of Osbert
de Stafford,* second son of Liulph of Lumley Castle, Durham, a
nobleman of the time of Edward the Confessor. The mother of
Osbert de Stafford, and grandmother of Ormonda, was Aldgyth, a
daughter of Alfred, Earl of Northumberland, the son of the great
Utred. This Utred, son of Waldese, Earl of Northumberland, a
descendant of the earlier Anglo-Saxon Kings, was the Earl of
Northumberland in the time of King Ethelred, and, as a reward for
his victories over the Scotch in Northumberland and Durham,
received from King Ethelred the honour of his youngest daughter
Elfgyve or Aelfgifu in marriage. ^ Elfgyve is generally considered to
be a child of Ethelred's first marriage with Elgiva, a daughter of
Thorold, an English Earl, and not of his second marriage with Emma,
daughter of Richard, Duke of Normandy. ' Duchess of Cleveland's
Battle Jbbey Roll, vol. ii. p. 387. -See Collins' Peerage of England, 4th
ed. vol. iv. p. 116. ^Ramsay Foundations of England, vol. i. p. 376.
See also Betham's Genealogical Tables. Table 673 for descent of
Ormonda, wife of Robert de Peshale. OF 'JTAH
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebookname.com