Shira Birnbaum

Biography

Early in 2017, I had a roundtable with some students who asked questions about the book. Here is an excerpt from the transcript:

What prompted you to write this book?

This book was “cooking” for a long time. Everybody knows about the compassion, the diligence, the good will, and so on, that nurses often bring to our work. But I had a sense, over many years, that some of the creative aspects of nursing, the artistry in it, had gone under-acknowledged and under-reported. All around me, I could see creative work being done. I wanted to cast light on that.

Why do you think creativity has been under-acknowledged as a part of nursing?

I think that is happening across many therapeutic and health disciplines, not just nursing. In part, it’s a reflection of the overall societal turn toward clinical interventions that are low-cost, brief, and easy to deploy. That’s a fine turn, of course, and worth applauding in many respects, but it’s also limiting. It restricts our sense of the possible. It makes us forget that we have deeper wells of capacity to do more – and that patients sometimes really need more.

This book is very short. Why didn’t you just make it a journal article?

I was aiming for an audience of working professionals – people who don’t necessarily have access to journals and extensive library collections. And I wanted to write something they’d actually read all the way through. I tried to avoid jargon as much as I could, and I didn’t go into theoretical debates within the discipline. This isn’t a “theory” book. There’s no “lit review.” I intended for it to be more of a quick, inspirational read -- something that might spark other nurses to reflect on their own experiences and insights. Also, the book is not just for nurses. Art therapists, social workers, psychologists, and so on -- anybody who does clinical work might be able to connect to something here.

Mental health work isn't always the creative, aesthetic experience you talk about in the book. Right?

Right. In fact, there's a danger in making reference to “aesthetic experience” when you’re discussing situations that are painful, that involve someone’s suffering, or that involve really hard work. You run the risk of erasing the seriousness of the situation. The point of the book is that the clinical encounter is an encounter between whole people, complicated and nuanced people, both on the patient side and on the nursing side. And people, being people, bring to the table more than symptoms and professional credentials or techniques. The encounter between people isn’t always creative, but we do bring to it certain human abilities to communicate creatively, and those sometimes prove to be helpful for patients. I was careful, I think, not to romanticize any situation, but rather to show ways in which creative thinking is potentially available in it.

Are there policy implications in this book? If so, what are they?

Yes. Any book about mental health is going to have connections to policy – to the matrix of structures and systems that enables some outcomes and disables others. We are still struggling, nationally, with the failed legacy of deinstitutionalization: there continues to be a very grave  shortage of reliable, coordinated, appropriately resourced supports for people grappling with serious mental illness, particularly where there are other, concurrent challenges such as addiction or need for housing. The closure of the old institutions, the downsizing of institutions…this has brought varied results. It has freed many to enjoy a more dignified life, of course, but it has also shifted untenable risks and burdens not only to individuals and families, but to correctional systems, to police departments, to local service organizations, housing agencies, and so on. The result is a widespread, almost grotesque sense of “mission drift” in these sectors -- not to mention lack of coordination and, too often, some bad outcomes. Inside what’s left of the old institutions, moreover, precisely at a time of very high clinical acuity, we have fiscal constraints that bring staffing reductions and restrict treatment and programming options. The results are all around us: here in New York City, to give an example, we’re having an acute crisis of homelessness. Tens of thousands of people with serious mental illness are living in the subways, on the streets, in and out of shelters. This is connected to all the factors I just mentioned, to the pervasive shortage of affordable housing, and to various policies, many of them well-intentioned, that have not met the level of need over many years or have had unanticipated or paradoxical outcomes. Communication between nurses and patients happens inside this broader policy context -- and is framed by it. Our patients need us to grasp these connections and to get involved, at a deeper level, in policy work; they need us to be more politically savvy.

Given the complex policy context, will readers think the book is full of ideas that can’t be actually put into practice?

I hope readers see the book, first and foremost, as a statement about possibilities – about our capacity to champion what makes sense for those patients who need more than the conventionally available approaches to care and support. Who need a little more time, maybe, and a little more energy and investment. I also think there are lessons in it about working in interdisciplinary teams, where each person can make a unique but valuable contribution to a larger process. We tend to be under-trained in that area. I think the book points to areas of commonality among the clinical disciplines – areas where an integrated approach, a coordinated approach, can make a difference in outcomes. Those aspects of the book are quite practical.

Areas of Research / Professional Expertise

My work combines nursing and the social sciences and humanities. I have also published in the areas of pedagogy and child and adolescent development. Drawing from conceptual traditions in philosophy, cognitive linguistics, psychoanalysis, and the arts, Therapeutic Communication in Mental Health Nursing is about metaphor in meaning-making and the deployment of body-based gesture as a communication tool in clinical situations where conventional language is unavailable.

Personal Interests

critical social and sociological theory, inpatient mental health, pedagogy

Books