Eileen Skellern - A brief biography
(acknowledgement: David Russell and Brian Woollatt who offered recollections of Eileen Skellern).
See here: Winship, G; Repper, J; Bray, J & Hinshelwood, R D(2009) Collective biography and the legacy of Hildegard Peplau, Annie Altschul & Eileen Skellern; the origins of mental health nursing and its relevance to the current crisis in psychiatry. Journal of Research in Nursing, 14, 6: 505-517.
After Eileen Skellern completed her state registered nurse training (SRN) she joined the Cassel Hospital in Richmond in 1950. The Cassel was a renowned Therapeutic Community and the foremost psychoanalytic hospital in the UK. Tom Main, the psychiatrist-medical director during Skellern's time at Cassel, had been involved in the war-time group experiments at Northfield Hospital in Birmingham treating shell shocked soldiers using methods of group and milieu based approaches to therapy. The Northfield experiments coincided with the group experiments at Mill Hill and Peplau's milieu work at the 312th at Staffordshire. Concurrently then, a model of treatment based on social and group methods, emerged from these separate sources and Tom Main went on to hone these therapeutic community ideas at the Cassel Hospital maintaining close connections with the Institute of Psychoanalysis (cf; Pines, 1996). The Cassel version of therapeutic communities differed to the way that Maxwell Jones had advanced the idea; whereas the Henderson was committed to the idea of democracy (as Altschul noted), the Cassel was more inclined to explore the vertical dynamics of hierarchy. It was in the ferment of these community based innovations that Skellern entered nursing.
At the Cassel, Skellern became close friends and roomed with Isabel Menzies Lyth who later carried out important studies of nursing systems (Russell, 1997). During this time Skellern herself underwent psychoanalysis and it appears that subsequently Skellern was more inclined to working with medical staff who were psychoanalytically orientated (Russell, 1997). With non-psychoanalytic psychiatrists she was less able to forge easy alliances (Russell, 1998). During Skellern's time at the Cassel ideas of note emerged, in particular a model of practice that was called 'psychosocial nursing' (Barnes, 1968; Barnes et al, 1998) which defined the idea of the nurse 'working-alongside' the patient by engaging in day to day activities and 'problem-solving'. The key to this approach was the concept of the therapeutic 'use of self' and the matron Doreen Wadell was an important theoretician who unfolded the idea. Wadell collaborated with the medical director Tom Main running clinical supervision groups that were described in Main's memorable paper 'The Ailment' (1957) which highlighted how counter-transferential self-consciousness on the part of the nurse was a valuable adjunct in understanding the patient.
Skellern left the Cassel in 1952 to go to the Belmont Hospital (the forerunner to the Henderson Hospital) where she worked as Sister-in Charge of the Social Rehabilitation Unit of 100 beds. Skellern and Maxwell Jones published a clutch of papers in the Lancet and the Nursing Times (Skellern, 1955; Jones & Skellern, 1957; Jones, Pomryn & Skellern, 1956). Skellern's leadership was noted in particular by the Rapoport in his major sociological research study of the Henderson, Community as Doctor (Rapoport, 1960), a book which set the timbre for the first era of social psychiatry. Skellern's leadership was again noted in Jones's (1968) later book Social Psychiatry which was: "dedicated to the work of Eileen Skellern and the other nurses at the Henderson". Skellern developed a reputation as an inspiring teacher and leader, and this was apparent in Briggs (2002) account of his first visit to see the Henderson at work in 1956. Briggs, who became Maxwell Jones' friend, collaborator and biographer, made a particular note of his attendance at one of Skellern's seminars:
"I was especially interested in the training of the social therapists whose energy, like that of the patients, seemed to be boundless. Their daily 'tutorial' with the senior staff was a cauldron of ideas. I was especially impressed by the sessions that Eileen Skellern conducted. In one, the matter of emotional attachment to a patient and his subsequent 'sexual blackmail' was the initial focus. By the end of the tutorial Eileen was reviewing David Henderson's types of psychopaths and strategies for dealing with each.' (ibid: p21).
Skellern was not disinclined to training social therapists (who would be something of the equivalent of graduate mental health workers today). Maxwell Jones had, from the 1950s onwards, been keen to employ 'social therapists' at the Henderson. His aim was to 'de-professionalise' the hospital in order to foster an atmosphere where the patients could be treated more like persons and less like medical cases. Likewise, Joshua Bierer employed Occupational Therapists at the Marlborough Day Hospital in London in order that the therapeutic relationship would be a practically based and social, less wedded to a medical model approach. And at Kingsley Hall, London, RD Laing was starting to employ colleague sufferers as caregivers, and later at the Arbours Crisis Centre in North London, established by Laing's colleague Joseph Berke, the community was staffed intentionally by psychotherapists or trainees and not nurses. So the idea that non mental health nurses might take on the challenge of everyday running of a psychiatric unit was not an anathema to Skellern. Indeed, as Woollatt (2005) has pointed out Skellern was not actually qualified as a mental health nurse herself and it was only after she left the Henderson that she completed a mental health nurse training;
"A point worth making is that the staff at the Cassel were not trained mental nurses, but SRN's. Skellern did a short post-graduate course at the Creighton Royal Hospital before starting at the Bethlem and Maudsley. She left the Henderson in 1962 and after her RMN training and a period of study leave during in which she visited psychiatric hospitals in the United States, she started at the Bethlem & Maudsley in 1963. The Superintendent of Nursing at the Bethlem had been in post from the inception of the NHS in 1948 until the early 60's. Eileen Skellern was possibly head-hunted for the post. During the 60's with a group of like minded Senior Nurses from in and around London she started an ongoing group with an analytical psychotherapist. Its aim was to explore group dynamics and was reviewed in a paper she wrote for the Nursing Times (or Mirror as it was then). She had to give it up when her National Working Party task with Richard Crossman became too demanding". (Woollatt, 2005)
Her senior position and growing reputation provided her with new scope to exert influence not only at the Bethlem & Maudsley but also nationally. Russell (1998) recorded:
"From 1969 to 1974 she gave large numbers of talks and lectures on nursing, the introduction of change and on stress. Committee work inside and outside the hospital (for example, at the King's Fund) became an important part of her life. She was the first ever nurse to become an Associate of what is now the Royal College of Psychiatrists. One project of particular note was her participation in the 1969 national working party, chaired by Richard Crossman, the then Secretary of State, to review policy on mental subnormality following revelations of malpractice and the enquiry at Ely Hospital, Cardiff. The work involved her with persons such as Professor Brian Able Smith, Baroness Serota and other major figures. Eileen took this work very seriously, and devoted much time to it. Unfortunately, before it could be completed, the Government fell and brought the work to a premature end. However, some results were eventually recognised and included in the White Paper of 1972, Better Services for the Mentally Handicapped". In 1972 she was awarded the OBE". (Russell, 1998).
At the Bethlem & Maudsley Hospitals she was instrumental in establishing the Charles Hood therapeutic community unit, the first dedicated TC at the Maudsley offering a day programme of dynamic psychotherapy where the nursing staff carried individual case loads. This was an innovation which influenced the development of other nurses who were keen to develop dynamic psychotherapy skills (cf; Strang, 1981). Bob Hobson, the leader of the Charles Hood TC at the Bethlem acknowledged Skellern's "sage-like" influence on the project (Hobson, 1979) and Dietrich's (1976) seminal paper about nursing in the therapeutic community captured the atmosphere of progressive thinking that emerged under Skellern's stewardship. Likewise, under Skellern's wing Beatrice Stevens (1995) and Harry Wright (1996) described the atmosphere of the Maudsley during the seventies as conducive to the development and embedding of psychoanalytic ideas in the practice of nurses throughout the joint hospitals that remained pertinent for generations that followed.
One of Skellern's last contributions was the planning of the First International Psychiatric Nursing Congress in 1980. This took place in London, two months after her death though she had prepared an address of welcome which was given to the delegates. The inaugural Eileen Skellern Memorial Lecture was established two years later to remember her career and influence.
IIn 2014 we saw the passing of two people who have been closely connected to the Skellern Lecture and the JPMHN Lifetime Award. Firstly Julia Brooking, who succeeded Eileen Skellern at Maudsley as Chief Nurse. Julia played an important role in establishing the Skellern Lecture in the 1980s and she supported the revitalisation of the event in 2006. Helen Bamber also passed away. Helen was awarded the JPMHN Lifetime Achievement in 2009 and her address, for those who were there, was indeed a privilege to witness. Helen was a giant who shaped the way which we have come to appreciate the necessity of human rights as a core value, whose influence has penetrated deeply into many fields including Mental Health practice.
See Julia Brooking’s Obituary in the Guardian here