Intensive care psychiatric nursing – psychoanalytic perspectives ¹

Based on unobtrusive observations, a parallel is drawn between general and psychiatric intensive care nursing. The correlation between bedside skills and the incidence of physical contact between nurse and patient in each setting is considered. The phenomenon of physical attacks by patients on carers and the process of restraint in the psychiatric intensive care unit (ICU) is then examined. It is suggested that attack by and subsequent restraint of a disturbed patient may be considered in terms of an unconscious re-enactment of an early skin-on-skin object relation. It is argued that the physical holding of a psychotic patient is functional in re-establishing their bodily ego. Some thoughts are offered on how the intensive care of psychotic patients might be carried forward in the future.