Australian and New Zealand Journal of Mental Health Nursing (2000) 9, 29–41

INTRODUCTION

Crowe’s (1998) recent contribution to definingthe role of mental health nursing is important formore than the reasons she outlines. Crowe saidthat role definition helps to validate nursing’sposition in relation to other roles and promotesprofessional accountability. I would argue furtherand suggest that shared understanding performsan important cultural function: it develops aculture’s language, and each member’s ability tospeak it. People who are fluent in their culture’slanguage often enjoy a healthy sense of belong-ing, they know their heritage and are proud of it,and they also tend to be committed to theirculture’s survival. Thus, they nurture and protecttheir young, defend the culture against attack,and seek ways to make their culture flourish.

In this paper, I want to contribute to thelanguage that we use to speak about our shared

culture by examining the craft of teaching mentalhealth nursing. By communicating sharedteaching practices, the quality of educationoffered to mental health nurses improves, andour profession grows. In the sections to follow, I will present a narrative of a mental healthteacher’s practice, entitled ‘Lisa’s Story’. The aimof the story is to reclaim teaching as a craft bybringing into focus particular aspects of the rolethe teacher played within the classroom topromote learning. The narrative is one of threeproduced in a larger study about teaching andassessment (McAllister, 1997). In order to contextualize the narrative, I will provide areview of the literature on mental health cur-ricula and craft knowledge of education as wellas an explanation of the methodology used toconstruct the narrative.

LITERATURE REVIEW

Course content

Part of the challenge of teaching is to strike abalance between curriculum content, learningprocesses, teacher responsibilities and student

FEATURE ARTICLE

Lisa’s lessons: A case study of mentalhealth teaching and learning

Correspondence: Dr Margaret McAllister, School ofNursing, Faculty of Nursing and Health, Griffith University,Nathan 4111, Queensland, Australia.

Margaret McAllister RN, RPN, BA, M Ed, Ed D.Accepted May 1999.

Margaret McAllisterSchool of Nursing, Faculty of Nursing and Health, Griffith University, Brisbane, Queensland,Australia

ABSTRACT: Practical approaches to the educational preparation of mental healthnurses need to be shared in order to contribute to discipline development. This paperpresents the results of an ethnographic study using case study and educational criticism to explore mental health classrooms and share practical approaches toteaching.

KEY WORDS: case study, craft knowledge, educational criticism, mental healthnursing education, narrative.

involvement (Balla & Boyle, 1994). At the sametime, one needs to enact sound and fair princi-ples in order to guide and judge student progressand promote quality teacher performance(Rowntree, 1987). A curriculum that is content-loaded may produce different outcomes fromthose that focus on developing meta-learningskills. Similarly, a curriculum that is predeter-mined and non-negotiable may affect studentlearning in different ways from one that is responsive to students’ needs.

Psychiatric/mental health curricula, like otherkinds of school learning, contain some contentwhich is non-negotiable, required learning(Biggs, 1991; O’Brien, 1993). While there is nouniversally agreed content for psychiatric/mentalhealth curricula, decisions about what to includein courses are influenced by the particular dis-cipline’s epistemology. For example, a wellnessapproach may be a nursing ideal, but if the institution or teacher values a medical modelthen the course will reflect that influence.Furthermore, teachers’ expressed beliefs mayhave little relevance to their actual practice(Briscoe, 1991). Given that the medical modelcontinues to enjoy hegemonic social influence,despite teachers’ protestations, many continue topractise an illness educational model eventhough they believe in something else. Teachersdo this because they can speak no other educa-tional language. Consciousness-raising andcritical reflection on teaching practice can helpto improve teaching literacy.

Baum et al. (1993), on behalf of the AmericanPsychological Association, have described anumber of principles for achieving quality under-graduate psychology programs that are readilyapplicable to a psychiatric/mental health context.They argue that the curriculum should enablestudents to first accumulate a body of knowledgeabout mental health and illness. Second, studentsshould master intellectual skills such as criticalthinking, written and spoken expression skills,ethical judgment and sensitivity to people andcultures. Third, students should strengthenpersonal characteristics such as maturity, rigour,tolerance, flexibility and a positive attitude tolifelong learning. Finally, the course should

contain multiple opportunities for students to beactive and collaborative learners and to under-take field work to apply knowledge.

Dickstein (1994) provided very specific sug-gestions for content of mental health withinmedical degrees, suggesting that an introductorypsychiatric/mental health curriculum shouldprovide the ‘expected topics’ of anxiety disorders,psychotic disorders, dementias, psychosexualdisorders, personality disorders, reactions ofpatients to severe illness and other losses, and, ifthere is time, forensic psychiatry, and issuesunique to each stage of the life cycle as well astherapies.

Other recommendations for curriculuminclusions, based on research from varioushealth-care disciplines, include care of the chronically and seriously mentally ill, women, theaged and AIDS issues (Cavallaro, 1991; Coursey,1994; Firn, 1993; Henderson, 1990; O’Brien,1993; White, 1986).

Barker (1989) stated that mental healthnursing curricula should teach symptoms of dis-orders, care of people suffering from disorders,the role of health care workers, and therapeuticattitudes and tasks. According to Barker, curric-ula should be aimed at helping clients in hospitaland the community; they should be holistic,taking a bio-psycho-socio-spiritual approach andinclude health-assessment skills that value theclient’s view of self and his/her needs.

Moller, Peirce, Roach, Shannahan, and Loch(1991), in reference to nursing degree courses,did not agree that psychiatric disorders ought to be covered in a mental health course within an undergraduate degree. Moller et al. believedthat it is more important to teach the psycho-social practical approach to caring for people.These authors argued that concepts such asempathy, communication, behavioural observa-tion, crisis intervention, self-awareness andgroup process ought to take priority.

However, a study by Garrard, Hausman, Mans-field, and Compton (1988), comparing educa-tional priorities of mental health professionals withmental health consumers, found that consumersrated knowledge of disorders a priority, followedby knowledge of interventions, and then practical

30 M. McALLISTER

skills and the ability to teach. Professionals fromvarious disciplines saw things differently. Theyrated knowledge of psychosocial concepts first,interventions second, and disorders eleventh.

Long and Chambers (1993) have criticizedmental health curricula for overemphasizingfactual knowledge. Long and Chambers (1993)argued that, in order to promote mental healthin clients, practitioners need to develop contex-tual knowledge and skills in analysis, criticism and problem-solving. From this view, then,psychiatric/mental health curricula and assess-ment strategies should focus on what Bevis(1988) described as syntactical, contextual andinquiry learning. These latter types of learninghave more to do with critical thinking and meta-learning than simple content knowledge. Longand Chambers (1993) have stated that mentalhealth requires the generation of self-knowledgeand occurs as a result of reflecting on and learningfrom life’s experiences. Deeper knowledge aboutself is also a kind of qualitative learning. Whenself-knowledge has been developed, the studenthas learned effectively. Their attitude about selfand others may be altered so that their capacityto support, empathize and understand a clientwith mental health problems is strengthened.

Curriculum coherenceApart from what to include in a curriculum formental health, it is also important to develop acoherent curriculum model that explores episte-mology, which is helpful for nursing. Hopton(1997) argues that the goal for the disciplineshould direct curriculum. For Hopton, theprimary goal for mental health nursing is anti-oppressive practice and therefore curriculashould focus on the impact of social, political andcultural forces on mental health/disorder, and thenursing role of helping clients identify oppres-sive aspects in the environment and feel more incontrol of their lives.

Crowe (1998) details a similar curriculumframework currently in use at GriffithUniversity. The course places primacy on themental health nurse’s role in empowering aclient, which forms the thread to meaningfullylink each subject of inquiry. Divided into three

phases, the student is assisted to understand theneed for, and then to enact change by, (i) decon-structing mental health nursing practice; (ii) crit-ically reflecting on mental health nursingpractice; and (iii) reconstructing mental healthnursing practice.

This curriculum model does not ignore theillness model, so students do learn about factualand theoretical knowledge of mental disordersand their treatments. However, students learn itfrom a position of critical observer. Thus,students are constantly assisted to imagine otherpossibilities for thinking and acting which may bebeyond the medical/psychiatric model. On issuesfor which medicine provides less than satisfac-tory solutions, this approach to reasoning can beenlightening. For example, non-compliance, selfharm and manipulation are all social acts whichrequire social responses and are not well solvedusing an illness approach. Thus, students areassisted to step outside ritualized, entrenchedways of thinking and behaving.

Clearly, there are differences in values aboutthe explicit curriculum structure. Anotherimportant consideration is how that curriculumought to be conveyed by teachers. The mentalhealth nursing literature sheds very little insighton the practical role of teaching even though educators have produced convincing evidencethat the teacher’s role is crucial in assistingstudents to reach turning points in their study(Zeichner, Tabachnick & Densmore, 1987;Johnston, 1994; Marland, 1992; Schön, 1983).Without that teacher’s presence, and ability toassist students to swiftly negotiate diversebodies of knowledge and reconstruct new pos-sibilities, the student is at risk of being over-whelmed by complexity, or reduced to thinkingat a level that is whimsical and shallow. Howteachers facilitate this rite of passage for mentalhealth nurses needs critical reflection andpublic comment.

The craft of teachingTeacher practice is discussed in a body of edu-cational literature termed ‘craft knowledge’.Craft knowledge embraces thinking that is intuitive, judgments that lack a rationale and

MENTAL HEALTH TEACHING AND LEARNING 31

reasoning without consciousness or calculation(Tanner, 1993). Moreover, craft knowledge ofteaching is complex, context specific, personal,and still only partially understood, and thereforeinvites further exploration (Carter, 1990;Dershimer, 1991; Marland, 1992; Russell,Munby, Spafford & Johnston, 1988). Few casesof teaching and assessment taking place are available in the literature (Hyman, 1994). As aconsequence, educational discourse persistswith a technical rational view of assessment, andfails to appreciate how teacher stories aboutassessment can advance the craft of education.According to Hyman (1994: 21), this gap in theresearch has ‘left unanswered many practicalquestions concerning assessment goals,methods, and applications for specific campussettings’.

METHODOLOGY

The research I conducted into teachers’ valuesand the way teachers implement assessment intheir craft represented an alternative to an areathat has in the past been the realm of empiricaland quantitative research. Evaluation of educa-tion has traditionally been conducted using quantitative methods such as surveys and quasi-experiments, and underpinned by values such asrandomization, control, objectivity and general-izability. In these inquiries, attempts are oftenmade to separate out parts of the learning envi-ronment so that they may be studied in theirminutiae, purely. Such approaches to educationrepresent a view of knowledge that is logico-positivist, or technical-rational. But a technical-rational epistemology assumes that parts can beunderstood outside of the whole in which theyare embedded and consequently the way educa-tional environments are understood, evaluatedand appraised tends to privilege one part of thelearning environment, and ignore others.

Educational environments, like the socialworld, are not pure cultures but messy, complex,interwoven worlds requiring an appreciation forthe networks between parts. Thus, qualitativeeducational researchers argue that empiricaldesigns such as experiments are inadequate for

evaluating the complexity of curricula programs(Simons, 1996; Eisner & Peshkin, 1990).

Technical-rational research also tends by itsnature to be less able than interpretiveapproaches to explore subjective experiencessuch as teachers’ values (Connole, 1990). Thus,extended classroom observation, as opposed tosurvey methods that may indicate beliefs anddesires but not practice, is a useful research toolin helping to uncover tacit beliefs lived out inpractice, and leads to understanding of how particular teachers view teaching and learning in psychiatric/mental health.

EpistemologyThis research was grounded in the interpretiveparadigm and aimed to explore the phenomenonof the practical knowledge of psychiatric/mentalhealth teaching. Specifically, the study wasethnographic, describing three Case Studies ofmental health classrooms using the EducationalCriticism method. The epistemologies under-pinning case study and educational criticism willnow be summarized.

Case studyCase study expands inquiry by illuminatingaspects of a phenomenon not before appreciated,or reconstructing ways of understanding theexperience (Donmoyer, 1990). Simons (1996: 20)sees these qualities of case study method as par-ticularly significant in educational research, andstated that ‘Case study can challenge orthodoxthinking, get beneath the surface ... to reveal indepth understanding ... and take a quantum leapin how we come to understand complex educa-tional situations’. Case study also gives morespace to participants’ perceptions and judg-ments, and case study reports engage readerswith the veracity of the experience under analysis(Simons, 1996).

I hold the view that detailed observation ofparticular mental health classes was importantbecause it might offer fresh insights into how well mental health content is learned, as well aswhat other knowledge, learned within theimplicit and null curriculum, is acquired bystudents (Eisner, 1994).

32 M. McALLISTER

Educational criticism

Because I was also interested in the creativeapproaches teachers take within psychiatric/mental health, the experiences within the class-room and a research method that used accessi-ble language, educational criticism was selected.

Educational criticism is a type of qualitativemethod that focuses on creating detailed, vividdescriptions and interpretations of particularencounters in schools and classrooms. It is anartistically grounded approach that was origi-nated by Eisner who is both an artist and aneducator (see Barone, 1989; Flinders, 1989;Matthews, 1994; Powell, 1994; Singer, 1990;Uhrmacher, 1991). A major strength of educa-tional criticism is its emphasis on art and imagi-nation, which are facets of the teaching craft thatare relatively unexplored in educational research.

An artistic method may be a rather shocking,certainly unusual, methodological approach to areader who perhaps is much more familiar withmethods that attempt to seek legitimacy byespousing scientific values. But, as Eisner (1995)has said, ‘Artistic inquiry is not just a matter ofseeing things differently, but of seeing differentthings’ and art, no matter how mundane thesubject matter, has the capacity to evoke,surprise, enrich, disturb and awaken us. Artmakes us feel alive. Thus, an artistic epistemol-ogy has the potential to open up inquiry into whatis known about mental health education.Educational criticism not only focuses on the artof teaching, but also uses artistic methods togather data and communicate findings.

Educational criticism requires the researcherto be a connoisseur of education. Educationalconnoisseurs are individuals able to perceive the important, complex and often subtle quali-ties of educational experience (Eisner, 1985;Uhrmacher, 1991).

Unlike other qualitative approaches, which tryto bracket personal knowledge and set it asidefrom the research process, this method reclaimspersonal knowing by relying on it as part of theresearch act. In this sense personal knowing is thepredominant epistemology underpinning thisresearch. It involves valuing one’s imagination,

aesthetic judgment, feel for the rightness of fit,and ability to create structure out of ill-structuredsituations and processes (Eisner, 1995). In orderto do this credibly, one’s own beliefs and valuesneed to be explicit.

Educational criticism involves four inter-woven stages in order to construct a story. Thecritic first aims to produce a description of the phenomenon, then an interpretation of the significance of events within that phenomenon,followed by an evaluation of the value of thoseevents to the quality of teaching and learning, andfinally a comment on thematics, or the majorthemes drawn from the story which may promoteunderstanding for other educational events.

Narrative

The outcome of the method is a narrative accountof the case study. Increasingly, disciplines such ashistory, anthropology, nursing, education, eveneconomics are looking to the storytelling methodto share understandings and research findings(Jalongo, Isenberg & Gerbracht 1995; McMillen,1996; Sandelowski, 1994; Wenckus, 1994). Inareas such as teaching and mental health, whichconcern interactions with human beings, story-telling is particularly relevant. Storytelling as aresearch method offers richness to understand-ing for a variety of reasons.

Wenckus (1994: 30) has observed that story-telling can ‘relate cultural history, teach ethicsand morals, relax, entertain, and stimulate imag-ination and creativity’. Stories are powerfulbecause they can transmit feelings, therebyallowing other people to relate to them.Therefore, the listener or reader is not detachedbut involved, and the understanding gained ispersonal rather than theoretical. Stories alsopromote learning because whole images, inclu-ding thoughts and feelings, literal and expressiveconcepts, may be more easily remembered thandisembodied concepts. Stories are also able toconvey a contextual understanding. Stories setthe scene and organize information to fit into aparticular environment and some subjects, suchas the lived curriculum, cannot be understoodout of context. Stories are also valuable because

MENTAL HEALTH TEACHING AND LEARNING 33

when they are shared they can strengthen a bondbetween the teller and listener. In areas liketeaching and mental health, this characteristic isparticularly useful because sharing stories iden-tifies and preserves the whole knowledge andpractice of the profession (Geanellos, 1996;Jalongo, Isenberg, & Gerbracht, 1995).

The paper will now move on to a story thatcontains powerful lessons for teaching. The storyis an unapologetic rendering of the truth, as artattempts to be. While some may see this as amethodological limitation because findings arenot scientifically generalizable, the study’s valuelies in its generative nature. Readers may findaspects in this story that resonate meaning forthem; perhaps about other teachers they haveknown or about complex and persistent educa-tional problems which have not been successfullysolved using traditional epistemologies. A goodcase study offers fresh insights for the way situa-tions are understood and problems are solved.

LISA’S STORY

The scene is set at one of the most prestigiousuniversities in the USA. Sandstone buildings,hallowed halls, world leaders in many disciplines,especially psychology, the area in which this storyunfolds.

I recognized Lisa as soon as I walked in. Shewas seated by the projector at one end of an over-sized table. Surrounding seats were graduallyfilling with students who were silently copyingdown the first transparency. Lisa looked a good10 years older than the students, which broughther to her early thirties. The students wore jeansor shorts, their hair messy from a long day. Incontrast, Lisa was neatly groomed, seemingly atone with the students: seated at the same level,comfortably waiting for others to arrive, col-league-like, and at the same time different. Herage and smart, unpretentious dress marked herprofessional status. I learned that she is a research psychologist and part-time teacher.

I introduced myself, shook her hand andwaited for small talk, conversation that wouldbond us as colleagues. ‘Welcome’, she respondedquickly but not unkindly, without even a cursory

comment about the weather. I asked lamely,‘where would you like me to sit?’.

‘You can sit anywhere you like.’ Lisa was happyto have me observe her classes and was carefulto caution me to maintain confidentiality. I seatedmyself and read through the semester assessmentactivities.

The projector’s light marked the start of thelesson. The topics of the class are shown inAppendix 1.

This was a 2-hour class! I got the feeling thatthis teacher had a strict schedule and a clear idea for the direction the class would take. As a teacher myself, I knew the pressure of a cur-riculum stacked with content, the complexity ofpsychiatric/mental health issues and the need tokeep firm direction so that important conceptscould be understood. What to include and omitcan be confounding for teachers no matter whatthe discipline.

Throughout the evening, Lisa relentlessly andefficiently ploughed through the content, single-handedly conquering the axes of DSM-IV, sexismin psychiatry, cultural influences on symptomsand diagnosis, assumptions about biology, psy-chology, sociology and disorder, and fundamen-tals of Freud (1938) that reflected depth ofinsight and experience. Lisa believed that tomake a good psychologist, one had to master alot of subject matter.

For students, class participation was easy. Lisadid all the talking and students just needed to sitback and soak up the content; but were theyengaged?

A spectator sport?I admired Lisa’s mastery of the subject ofabnormal psychology, amazed that she could talkso much about wide-ranging issues. OnPsychiatry and the State, Lisa said:

This is a fascinating story of Harvey Weinstein,a psychiatrist who learns that his father had beenthe unwitting participant in a series of CIAexperiments in the 60s in Canada. They wereinvestigating mind control issues, and theKorean War, and the CIA pumped a whole lotof money into trying to figure out how thoseKoreans brainwashed our soldiers.

34 M. McALLISTER

I was hooked. I wanted to read that book.Most of the students who paused from theirnote-taking to listen to her story gave me thesense that they were hooked too, but I felt uneasyabout our curiosity. Did we genuinely feelempathy or compassion? Or was it the news-worthiness of such a story that caught ourinterest? After chastising myself for being toopicky I tuned in again to hear:

... for years people have tried to find pathogno-monic symptoms because some [symptoms ofmental illness] can be so wild, that you wouldthink that they couldn’t possibly exist in otherconditions or in normals but they do. Virtuallyevery symptom is found in organic conditions,in mania, sometimes you can find them innormals once in a while. So there is no tip off towhat the disorder is. Also, manics can look thesame as schizophrenics ...

Normals? Manics? Schizophrenics? Were anyof these people too? This was objectifying talk,the language of a scientist, distanced and dispas-sionate. In one way this language served apurpose. Treating clients as cases and using tech-nical terms to describe human experiences canteach skills in pattern recognition and classifyingdisorders. But Lisa wasn’t boring or lacking incompassion. Examples from her life and researchwere enthralling. We heard tales that rangedfrom her success in shaping the behaviour of hercat to the way the famous behaviourist, Skinner,raised his child. She spoke of the first time shemet with a client who had paranoid schizophreniaand was not afraid to convey her clumsiness, fearand uncertainty in relating to him.

Lisa made frequent and careful video selec-tions using brief vignettes that encapsulated asymptom or issue. For example, on Axis II dis-orders she said:

personality disorders are like traits with avengeance, they’re very inflexible characteris-tics that impede the individual’s capacity towork, or to interact with other people, or to havesatisfactory romantic relationships.

She followed this with a 5 minute videotapedinterview with a prisoner in jail for the murder ofa married couple. Despite being the perpetrator,

he spoke matter-of-factly about the rage he felttowards the husband who was hitting out in self-defence. He said, ‘I don’t think I feel thesame way as other people’. It was a great examplefor students to see the under-developed, ego-centric thinking that characterizes personalitydisorder of this type.

Including cogent, riveting and eloquent guestspeakers reflected Lisa’s desire to help studentssee the person behind the disorder. No one couldhave been left unmoved by the personalaccounts. Raoul, a successful entrepreneur andrecent university graduate, traced for us his 10month spiral into a depression that was to leavehim abandoned by friends, officially cautioned bythe university, jostled and pressured by healthcarers and forever scarred with the memory of adeep, insistent, inescapable pain. As a storyteller,he allowed us to not only glimpse his despair, butalso to appreciate his strength, his wisdom andhis wit. The students got to know that disordersaren’t just ‘out there’, they can affect anyone,even the smart and the strong.

Lisa also used cartoons and photographs ontransparency that were pithy, insightful andhumorous. While Lisa used humour and readilyjoined in the occasional class laughter, she alsogently chided, by ignoring and failing to respondto the jokes made out of naivety and carelessness.‘Not a person I’d ever go out with!’ whispered ayoung, pretty student as the class watched a videoof an odd looking man bizarrely explaining thereason he persists in wearing broken glasses. Lisadidn’t smile. Students got the message, I think,and without loss of face.

Now I want to turn to formal thought disorderand before I show you this video example I wantyou to read these definitions and identify it inlanguage.

Students read a transparency which definedterms like clang associations, neologisms, tan-gential thinking, cognitive slippage and incoher-ence. Lisa clarified any uncertainties regardingthese definitions. Students then viewed threepersonal letters on transparency. The letterclearly showed a disorder of content (seeAppendix 2).

MENTAL HEALTH TEACHING AND LEARNING 35

Students read and clarified meaning with Lisa.Students then viewed a 5 minute video showinga girl who displayed marked incongruent affectand facial grimacing, inappropriate behavioursuch as silly questions, yelling at her mother, dis-regard for social etiquette, rambling and inco-herent formal thought disorder, tangentialthoughts and delusional content. Lisa asked them‘So what did you see in that?’. Discussion ofinterpretations took place.

Any questions?A while later discussion moved to the next assign-ment that was due.

So the paper deadline is now Friday 21 and ifyou don’t come to class Monday or Wednesdayjust put it in my box which is just outside thisdoor. Any questions about the paper? Dideveryone have a chance to look at the syllabus?It should be pretty straightforward. I certainlydo not want book reports. That’s not what thisis about. Ok? I’ve read it. I know what it says. Idon’t need just a rendering of facts.

Lisa certainly could talk and it was difficult toget a word in edge-wise. While she asked threequestions, they went by so quickly that studentswere not given the chance to respond. Yet it seemedto me that this was the very time to slow down andlisten to uncertainties. Assignment topics can bestressful. Requirements that seem ambiguous tostudents need to be carefully discussed.

Some of the questions I would have askedwent unexpressed. What’s the difference betweena book review and a critique? How can I possiblyhave anything of consequence to say aboutmental health? Where should I go to read moreon the subject? What if I can’t decide whichargument I support?

When the class was over, students quickly leftthe darkened building. But, as usual, a few con-scientious or anxious students stayed to press Lisaone last time. For some, it was their first chanceto get a word in.

DISCUSSION OF THEMES

A boardroom meeting

Having sat absorbing the goings-on in this

extremely busy classroom, I began to understandwhy this space just didn’t look like a classroom tome. My initial discomfort with the oversized tableand the crowded room began to take morerational form when I took the metaphor of aboard-meeting and applied it to what I was experiencing. Some of the similarities, the tableand the crowded room, were vestiges of univer-sity bureaucracy, the luck of the draw in roomallocation. Other features were of deeper con-cern. An agenda that was way too long meant thatat times Lisa could only skate across the surfaceof topics. Conscious of time constraints, shewould slip quickly out of discussion and retreatto lecture: a format she could control and use tocover more ground. Even the most expertteacher would have shared her stress in attempt-ing to facilitate equal and open discussion in aclass of 25. I am not sure, though, that anotherteacher would have set so many lesson objectives.

Participation was not easy for students in theback row who were unable to see Lisa as shespoke, let alone achieve and maintain eye contactwith other students. A comfortable boardmeeting has enough seats, no clutter, and all whoparticipate have full visibility of each other. Inthis space, however, some students had a moreprivileged and comfortable position. For some itwas easy to dip in and out of the lesson, to day-dream, doodle, or work on a budding romance.Others sitting close to Lisa were more able to taketurns speaking and asking questions. As a resultthere were a favoured few who were selected tospeak and more timid and less visible participantswent unacknowledged.

Students were given some, but not much,opportunity to practise grappling with theory andmake interpretations. Questions to test how wellconcepts were understood flew by quickly andwere given only cursory consideration. But Lisadid wait at the interval for individuals to approachher and she responded with interest, suggestionsand encouragement.

Content over process

In some ways this teacher enacted the belief thatcontent was more important than process.

36 M. McALLISTER

Teaching by one-way transmission generally tookprecedence over transaction. Students weregiven very little voice. Yet I couldn’t help butnotice that things could have gone differently.Lisa’s ‘any questions’ was a sincere invitation forstudents to speak, but her commitment tocoverage outweighed her openness to discussion.She answered questions briefly, turning directlyback to the lesson plan.

Instructor-centredNow, as far as instructors go, Lisa is a good one.She knew the subject deeply. She could respondto all of the challenges and questions students putforward about particular aspects of the subject.She could elaborate on matters, at studentrequest, that she initially intended to glide over.She revealed a mastery over details and com-plexities about many specific psychologicaltheories. She was also well versed with currentresearch and would cite individual researcher’sand author’s works to support a concept she wasexplaining. She also made the most of the con-straints of a lecture-style pedagogy by infusingher lectures with anecdotes from the text book,experience and wide-reading. She couldrephrase and restructure information whenstudents communicated their confusion. Sheused humour, eye-contact and colloquiallanguage to connect and engage with herstudents.

However, despite Lisa’s sensitivity to students,she preferred to put her own interpretations onthe subject matter as if she was not yet ready, orcould not afford the time, to be led by studentswho might wander down undiscovered paths. Inthis way she was leaning too much towardsinstructor-centredness and was a little too lighton student-centredness. Her approach was to‘give’, not ‘discuss’, the basics of every ‘important’issue relating to abnormal psychology. What wasdeemed important concerned the ‘what is’ ofpsychiatric/mental health, the disorders, thetreatments. Less important was the ‘how’ and‘when’ that may be explored through reflectionon life experiences, or discussions on issues forunderstanding rather than just surface learning.

Teaching distanceLisa’s teaching style was imbued with the valueof distance. A scholar and skilled observer, shewould articulately present the facts and thenregale us with stories that evoked curiosity. Hereyes expressed humour and enthusiasm and onlyoccasionally depicted psychic pain, confusion,bewilderment or ambivalence, which can becardinal emotional signs in mental illness. Hercompassion was certainly evident but I’m notsure that she afforded students enough opportu-nity to develop their own. Students were fre-quently asked what they ‘thought’ about a videorepresentation. They were not asked how they‘felt’, or how they ‘thought the client might feel’.There were, however, exceptions. Lisa assistedstudents to re-view a video depicting thegrandiose, bizarre beliefs and behaviour of a manwith florid paranoia to see instead his underlyingfear and self-doubt. Her frequent ‘what did yousee?’ questions, while effective in honing obser-vational and diagnostic skills, could have beenmore frequently followed by a more contempla-tive ‘how do you think that makes the person (ortheir family) feel?’.

Teaching knowledge: Cognitive andaffectiveThis was a classroom in which cognitive learningwas the focus. Lisa’s teaching goal that was closestto her heart was to teach students how to thinklike a scientist, like a psychology researcher, andthat meant students had to learn to step back fromthe subject matter. Ironically, I had recentlybrowsed through a recommended text andrecalled a powerful image in the beginningchapter. The photograph showed two seatedpeople. A young man on the left leans toward awoman who sits upright. He is in mid-speech, hisintense gaze meets with her downcast eyes, andhe holds her hands as if about to lead her in agentle dance. The caption below it reads

Being a mental health worker requires not onlyintelligence and skill, but also deep human com-mitment and an unusual capacity for empathy(White & Watt, 1981: 44).

But in this class, there was no time for learning

MENTAL HEALTH TEACHING AND LEARNING 37

how to dance. Students received modelling onhow to be a rigorous thinker, a scientist. However,they did not learn how to be a good person andtherapist. For this, students need to be mindfulof the context: that these disorders are happen-ing to real people, with families and futures. It isnot easy to suffuse lectures on complex theoret-ical concepts with compassion and empathy.However, failure to do so is a failure to teach wellthe essentials of mental health.

Costs and benefits

Pedagogical preferences such as content knowl-edge over values, distance over empathy,instructor- before student-centredness can havecosts. A focus on content is likely to developsound knowledge of facts. However, because thisclass was primarily teacher-controlled, studentsonly occasionally practised interpretingbehaviour. While this skill was assessed in a paperand examination, learning this skill was basicallyunguided. Therefore, deeper levels of learning,knowing how and when, may not have been wellchallenged. Individual feedback during classtime rarely occurred. Thus, guidance, supportand the opportunity for development in individ-uals was restricted to written feedback providedin term papers. Significantly, an opportunity tomodel partnership in learning and in therapy mayhave been lost because students, on the whole,were permitted to be passive, while Lisa did allof the hard work. Furthermore, learners andbudding therapists learned that they can andshould keep a distance from educational andpsychiatric/mental health experiences withoutreally needing to be engaged.

An active classroom

If one accepts that knowledge arises within theperson, rather than from external sources, thenthe transmission model of teaching must be irrel-evant. The mind can be cultivated and stimulatedby such things as experience, learning throughinquiry, observation, listening and comparison,but knowledge and understanding does notsimply arise from storage of pieces of informa-tion coming from an outside source.

Therefore, for a student to learn effectivelythey must be able to construct their ownconcepts. Teachers can certainly assist in thisprocess but they do not ‘cause’ it to occur.Attempts to deposit information positions thestudent as passive and immobile but in reality astudent can never be this way. An alternativetransactional view sees students as active, movingtowards independence and generating new waysof thinking. This notion is more dynamic andevokes a sense of excitement in teaching. In thisimage students are encouraged to ‘catch hold ofideas and “run with them” beyond what is, as yet,known for sure’ (Hyman, 1994: 73).

A classroom that is alive with transaction hasstudents running all over the place with ideas.The skilful teacher, like a good coach, runsalongside. The coach knows the rules, is experi-enced and can help athletes avoid pitfalls,develop discipline and strategy. The coach mayguide the game but ultimately it is the athleteswho play it. Teachers need to learn how to bebetter coaches.

Beyond the spectacleTeachers of psychiatric/mental health also walk afine line: they need to engage the audience byarousing curiosity, but also to avoid the voyeurismthat has for so long positioned people with mentalillness as ‘the other’. For ‘a penny-a-look’, as theBedlam wardens used to cry, the world ofmadness can become a spectacle. While theintrigue may motivate students to overcome theirfear and avoidance, images that objectify fail to illuminate the subjective experience andstudents may not learn to empathize. Thus,engagement with the subject matter is not asingle aim for the mental health teacher, nor is itfree from ethical responsibilities. Engagement,then, means more than inspiring curiosity andkeeping the students’ attention in the short term.If teachers of mental health are to be effective inimproving the care of people with disorders,engaging students should simultaneously involvecapturing interest ‘and’ cultivating empathy,respect and compassion so that students appre-ciate the magnitude of problems and realise thattheir involvement can make a difference.

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CONCLUSION

People’s lives continue to be shattered by theeffects of mental disorder. If society is seriousabout wanting to improve mental health, then weneed to build upon what is known, and challengeand extend knowledge boundaries. Therefore,teachers have a dual responsibility: to teach thefoundations and to encourage foundations to betested. In guiding students through the knowntowards the unknown, teachers decide what it isthat students must know and then prepare themto enter new frontiers. Good teaching is a risk-taking venture that involves much more than achoice between quantity of knowledge or qualityof knowledge. It requires flexibility and fluidity,attributes not easily expressed through lecturesand other one-way models of teaching. Teacherswho are prepared to take the risk, and encouragestudents to discuss, challenge, question, andexplore issues, may find that the classroombecomes a place of excitement, a place for newideas, a meeting of minds.

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APPENDIX I. Topics for lecture

Today’s topics1. Diagnosis2. Reasons to diagnose3. How to diagnose4. DSM5. Difficulties in diagnosing6. Theoretical models of abnormality7. Psychoanalysis8. Modern psychodynamic psychotherapy9. Video

APPENDIX II. Letter

12.2.94Bethany HospitalCanada

Dear doctor Green,Kindly relocate Joseph... and Susanna... to the mountainlodge as soon as possible. You know the reason.

Sincerely,

GenevieveSecret Service

MENTAL HEALTH TEACHING AND LEARNING 41