Eileen Skellern - A Brief Biography
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.
Skellern (in the blue dress) pictured here at the Cassel, with Isobel Menzies, Doreen Wedelll, Tom Main and others
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. [Brief Bio compiled by Gary Winship].
Read here a collective biography:The legacy of Hildegard Peplau, Annie Altschul & Eileen Skellern; the origins of mental health nursing
Eileen Skellern - A Biographical essay by David Russell (retired Director of Nursing - Bethlem & Maudsley Hospitals).
Eileen Skellern was one of the great innovators in mental health nursing and made an outstanding contribution to the advancement of this field. She played a leading role in developing the knowledge, skills and professional contribution of nurses. Flora Eileen Skellern was born on 14th June 1923, the eldest of three sisters. At the age of eighteen she went to Leeds to undertake general nurse training at the General Infirmary. On qualifying, she worked briefly as a Staff Nurse in the operating theatres. Later she obtained the post of Sister on a medical ward in the same hospital, where she worked for two years. Interestingly, in addition to the medical beds her ward also had beds for psychiatric patients. Perhaps it was this that stimulated her to move to the Cassel Hospital at Richmond, Surrey where she studied for the Certificate for Nervous Disorders. Once completed, in 1950, she gained a sisters post at that hospital. The Cassel, under the direction of Dr Tom Maine, pioneered psychotherapeutic and psycho social treatment of patients with neurotic illnesses. In 1952 Eileen gained an award which was to produce perhaps the most significant work of her career in nursing. A scholarship from Boots, the manufacturing chemists, was awarded to undertake research into ward administration and instruction. This work she carried out on behalf of the Ward Sister's section of the Royal Collage of Nursing. The following year she pursued her research, visiting twenty-three hospitals and five factories throughout the country.
By this time, Eileen had left the Cassel Hospital and moved to the Belmont Hospital at Surrey. There she worked as Sister-in Charge of the Social Rehabilitation Unit of 100 beds. At the same time she collaborated with a team of anthropologists and social scientists studying the Unit. This was a particularly active period when she worked with Dr Maxwell Jones and others in pioneering models of social rehabilitation by group methods. This work later became well-known as the model for therapeutic communities at the Henderson Hospital. She also published papers in The Lancet, the Nursing Times and the Nursing Mirror. In 1957 when she was 34, she embarked on a tutor's course at the Royal College of Nursing. After two years she pined the Sister Tutor's Diploma, and took a post as Sister Tutor at St Bartholomew's Hospital. She also lectured on psychological topics to nurses at St Thomas's Hospital. This move away from mental health was short lived. In 1961 she achieved an appointment to the Bethlem Royal Hospital and the Maudsley Hospital which was to occupy the rest of her working life and to be the crown of her career. The post was that of Superintendent of Nursing, Eileen was allowed to spend two years at the Cheadle Royal Hospital, a private psychiatric hospital in Cheshire, undertaking further studies. She qualified as a Registered Mental Nurse and returned to preside over the development of nursing services and nursing education at the Bethlem & Maudsley.
She continued to write and began undertaking more lectures and teaching. 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. Unfortunately Eileen did not remain in good health. As early as the statics she had problems with her back necessitating weeks away from work. In spite of this she continued to work phenomenally hard when well, waking early and working at home in her hospital house in Monks Orchard Road, Beckenham then coming to work at about 7.30 am, usually staying for eleven to twelve hours. There was not much time left for socialising, although she always enjoyed meeting people and was vivacious and amusing. Constantly alert to new developments in treatment Eileen Skellern encouraged nurses to acquire specialist skills. She pioneered the role of nurses in behaviour psychotherapy and in 1973 with Professor Isaac Marks established the first course for nurses in adult behaviour psychotherapy.
The 1970s saw a long decline in Eileen's health when she developed cancer which spread throughout her body. There were intermissions during which she struggled to continue to develop the work of the Bethlem & Maudsley although her outside work declined. She was frequently in Hospital at King's College, London, undergoing surgery and radiotherapy and then in St Christopher's Hospice, Sydenham. During these times she counselled other sufferers with cancer and showed great fortitude. Her last public appearance was at the hospital Founder's Day Service in the autumn of 1979. At the beginning of l980, taking advantage of a re-mission she went to stay with her parents and sister in Winchester. It was there she received the news she had been made a Fellow of the Royal College of Nursing. On the 29th July she died. Following her funeral at Winchester Cathedral, she was buried in a Winchester cemetery.
Her very last piece of work had been planning the First International Psychiatric Nursing Congress to be held in 1980. This took place in London, two months after her death. The address of welcome she had prepared was given to the delegates. A plaque in the chapel at Bethlem Royal Hospital and a portrait in the board room at Maudsley serve to remember her career within the hospital. The Eileen Skellern Memorial Lecture on psychiatric nursing serves to remember her wider career.