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Jane Austen in the Nursing Classroom: A Tool to Expand Psychiatric Assessment Skills

It is a truth universally acknowledged that a nursing instructor in possession of a large cohort must be in want of a new way to teach personality disorders.  It is a nursing instructor’s privilege to introduce fifty new students each semester to the world of psychiatric nursing, including to one of the most commonly misunderstood clusters of diagnoses: personality disorders.  A useful way to allow students to observe a disorder safely is to watch a movie or read a book detailing the diagnosis.  Unfortunately, movies or books often focus on dramatic and sometimes exaggerated symptoms, only superficially illustrating personality disorders or realistic relationship dynamics. 

As a self-professed Janeite, psychiatric nurse practitioner, and nursing educator, I appreciate Austen’s astute descriptions of character as she reveals an individual over the course of a novel, one layer after another.  As a mental health clinician, I enjoy seeing how specifically Austen describes an individual’s motives and thinking.  She does not hide character flaws, nor does she over-sell a likable character.  Austen also accurately describes how each individual would realistically interact with other personalities.  A character with antisocial personality or antisocial personality traits does not miraculously become reasonable merely to make the plot work, and Austen does not burden the reader with the premise that a good woman can change a bad man.  Her characters remain true to themselves throughout, even when confronted with difficult situations or difficult people.  Austen’s minor characters appear to exhibit a disproportionate amount of dramatic or histrionic personalities with impulsive behavior.  Although the plots revolve around questions of commitment or around issues related to social position, the characters conduct themselves in patterns consistent with their pathology.  I find it impossible as a psychiatric nurse practitioner not to take note of Austen’s ability to document the character traits and coping mechanisms of characters that populate her works. 

Because Austen focuses on relatable topics with characters that feel familiar, it is easy to incorporate her work into the interests of psychiatric nursing.  Fellow nurse practitioner Christine Shih, drawing on her clinical knowledge and the experience of having borderline parents, identifies borderline personality within Austen’s works and cites Lady Susan as the quintessential depiction of this diagnosis (Hill).  Phyllis Ferguson Bottomer applies her experience as a speech pathologist, her work with patients on the autistic spectrum, and her expertise with speech patterns to her discussion of possible autism spectrum disorder among many of Austen’s characters.  When looking at Austen’s characters through a psychiatric lens, however, it is essential to allow for a variety of diagnostic possibilities.  Austen presents readers with living characters, distinct from each other.  The complexity of these characters draws the reader in and provides rich material for analysis. 

Using lecture as a primary teaching method is ineffective, with poor outcomes for students.  A successful student is an engaged student, and one of the tools I use in class is an unfolding case study that helps students tie their reading to realistic scenarios.  It occurred to me that utilizing the works of Austen as a form of case study would be the perfect way to allow students to observe several personality disorders.  I began reading or watching adaptations of Austen’s works together with the Diagnostic Statistical Manual, which categorizes and provides diagnostic criteria for psychiatric disorders, and found that her depictions of character often matched the diagnostic criteria perfectly.  This realization led to the development of an assignment for the psychiatric mental health nursing course.  Giving students a list of characters with corresponding diagnoses positioned students to use either the novel or the film adaptation as a comprehensive assessment tool. 

The psychiatric mental health nursing course is part of a pre-licensure baccalaureate degree for students studying to become registered nurses.  An integral part of the nursing process—in all areas—is the assessment.  The North Carolina Board of Nursing describes the nursing assessment process as involving the collection of data, the comparison of data to normal values, and the distinguishing between relevant and irrelevant information.  Registered nurses do not, however, diagnose illness, a subtle but essential distinction that was important to keep in mind while developing the assignment.  The goal was to help the students summarize their new knowledge of the criteria or symptoms attributed to various personality disorders while allowing them to practice assessment skills and to work together.  Students choose a character with a provided diagnosis.  They must then familiarize themselves with the symptoms corresponding with the diagnosis given to their character.  They compare the list of symptoms of the diagnosis to their observation and then write a paper describing their findings.  The final step in the assignment is disseminating their knowledge of the diagnosis by working in character-based groups:  they create a poster and present their findings to the class.  Ultimately, the goals are for students to understand personality disorders more deeply by practicing their assessment skills and to work collaboratively in groups to educate each other. 

In the case of Pride and Prejudice, readers observe the traits of various characters through the eyes of Elizabeth.  Her rational thought patterns, unflinching self-knowledge, and clear insight into not only her own flaws but the motives of others reveal the emotional underpinnings of the diagnoses. 

Several personality disorders are identifiable within Austen’s works.  Students usually express a considerable amount of curiosity surrounding the diagnosis of antisocial personality disorder, and Austen has supplied an exciting variety throughout her works.  Pride and Prejudice’s Mr. Wickham immediately comes to mind, with the added benefit for this assignment that his childhood is documented.  Many students choose this character/diagnosis either from familiarity with the novel or curiosity surrounding the diagnosis.  The student needs first to read the DSM-5 criteria for antisocial personality disorder, then to collect data from the novel or a film adaptation, and then to note in an essay the traits and behaviors that meet the criteria.  The criteria required to meet the diagnosis of antisocial personality disorder are listed here: 

A.  A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 

        1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
        2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
        3. Impulsivity or failure to plan ahead.
        4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
        5. Reckless disregard for safety of self or others.
        6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
        7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. 

B.  The individual is at least age 18 years.

C.  There is evidence of conduct disorder with onset before age 15 years.

D.  The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder. (DSM 659–63). 

Mr. Wickham makes a noticeable entry into the village of Meryton.  He is charming (PP 80) and almost immediately deceitful.  Elizabeth Bennet observes the interaction between Mr. Darcy and Mr. Wickham and wonders at the reaction of both men (81–83).  Mr. Wickham’s choice of conversation on their next meeting indicates that he was aware of being observed in the unexpected meeting with Mr. Darcy.  He takes the very first opportunity to disparage Mr. Darcy’s character and fabricates a history scattered with half-truths for the express purpose of manipulating Elizabeth.  Mr. Wickham presents himself as a faithful friend to Mr. Darcy’s father and protector of the family name, while painting Mr. Darcy as jealous of the attentions given to Mr. Wickham by his father to such an extent that he would financially ruin a helpless, fatherless young man. 

“This is quite shocking!—He deserves to be publicly disgraced.”

“Some time or other he will be—but it shall not be by me.  Till I can forget his father, I can never defy or expose him.” 

Elizabeth honoured him for such feelings, and thought him handsomer than ever as he expressed them. 

“But what,” said she, after a pause, “can have been his motive?—What can have induced him to behave so cruelly?”

“A thorough, determined dislike of me—a dislike which I cannot but attribute in some measure to jealousy.  Had the late Mr. Darcy liked me less, his son might have borne with me better; but his father’s uncommon attachment to me, irritated him I believe very early in life.  He had not a temper to bear the sort of competition in which we stood—the sort of preference which was often given me.”  (89–90) 

This false narrative is in direct conflict with the information given by Mr. Darcy in his rebuttal letter to Elizabeth’s refusal of his proposal. 

By contrast, in Mr. Darcy’s letter we see the extent of Mr. Wickham’s antisocial behavior.  These behaviors predate his eighteenth birthday and continue over his lifetime in most of his intimate and social relationships.  In his letter Mr. Darcy speaks highly of Mr. Wickham’s father and acknowledges his own father’s affection for Mr. Wickham with no hint of jealousy.  He provides a good history of Mr. Wickham’s youth. 

“As for myself, it is many, many years since I first began to think of him in a very different manner.  The vicious propensities—the want of principle which he was careful to guard from the knowledge of his best friend, could not escape the observation of a young man of nearly the same age with himself, and who had opportunities of seeing him in unguarded moments, which Mr. Darcy could not have.”  (222–23) 

Mr. Wickham expresses feigned interest in several educational and professional pursuits to manipulate financial assistance from Mr. Darcy without completing any of his proposed schemes.  When he exhausts all opportunity, he seduces the young Miss Darcy for both fortune and revenge, without concern for the damage it will cause her emotionally and socially.  He gambles and incurs great debt without any intention of repaying his debts, although such actions could lead to imprisonment.  After turning the disgrace brought to the Bennet family by his running away with Lydia into a financial boon, he returns to the family he disgraced with no remorse or humility, entering the Bennets’ home without shame (349). 

Because each of Austen’s works entertains with delightfully intricate characters and relatable and realistic interactions between the characters, each novel can be viewed through this exercise in psychiatric assessment, and new perspectives on familiar characters can be gained.  Students have enjoyed this exercise in assessment skills and feel that it has given them a depth of understanding they would not have gained by merely attending lectures and memorizing diagnostic criteria.  As a bonus, students have expressed an acquired appreciation for Austen’s works.  One student shared that since high school he had viewed Austen’s works as torturous; however, since evaluating Pride and Prejudice through the lens of assessment, he has encouraged others to explore Austen’s works for their excellent character development.  As a reader who uses perspectives gained from symposiums, summer programs, and even reenactment events when yearly rereading Austen’s works, I appreciate the importance of revisiting familiar and beloved novels through a different lens.

Works Cited
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