The perspective of mystery: threading the connection between patient and nurse.

While understanding psychopharmacological principles is an integral and inescapable aspect of modern advanced practice psychiatric nursing, it also is a real, lived, personal experience for those for whom we write prescriptions. Within the science and the neurobiology and discussions of the principles of receptor affinity and bioavailability, there remains inescapable mystery--the coming together of the psychiatric nurse and the patient. It is the mystery occurring in the interaction among those who live with mental illness, those who care for them, and the praxis that threads together those lives. Psychiatric disorders are common co-occurring illnesses seen in all arenas and all levels of the healthcare system. These disorders are the widespread, frequently encountered markers of the passing of our professional lives; markers of the ebb and flow, the rhythm of our advanced practices. Increasingly, psychopharmacology is an inescapable reality of that professional life. We are expected more and more to prescribe and monitor medications, educate our patients and their families about their medications, manage adverse events, and maximize the therapeutic outcomes of drug therapy. Our role in psychopharmacology is one of the markers of advanced practice. Perhaps no other single concrete marker is more emblematic of advanced practice than the ability to attain prescriptive authority. It is an element of the inherent expansion of the APRN role, along with expectation for billing, and DSM-IV and ICD-9 labeling, the documentation of significant signs and symptoms, and the codification of reimbursement fee schedules. But pharmacology is not an impersonal science. It is not an abstraction or simply the real-world visualization of textbook facts and findings. Pharmacology is personal. It is the living and breathing embodiment of the people for whom we prescribe and the diseases from which they suffer. And there is mystery. We live and practice surrounded by mystery--the mystery of our professional lives, composed of the contexts and trappings and colors of advanced practice. The mystery of our patients, of their personal lives, lived experiences, and the subjective meanings, colorations, and emotional reactions to health. The reality is that we live and practice surrounded by mystery. And the ultimate mystery is that of praxis, of the caring actions that connect and bridge the professional and personal mysteries, connect and bridge nurse to patient. The Personal Face of Psychiatric Illness Where do we say it began? Was it something innate? A moment in the distant past of humanity transferred through time, through circumstance, through genes? Was it a nano-sized particle turned round and misplaced in location or action? Was it in the air or in the family picnics and parties and suppertime conversation? Or in childrearing and sibling interaction and school-age experience? Where did it begin? Where is the end of the thread of memory and remembrance? The end of the thread that runs through a person's life of several decades, that winds around wellness and illness, around function and happiness, and melancholy and apathy? Where do we say it began? It is perhaps far easier to say when it grew large enough to matter, when the string stretched tighter and the thread began to fray. When the eruption of the emotions spilled out with the soup and the salad at dinner time. When the dominance of grace and gentleness of spirit struggled to stay upright. It can be said to have started after the heat of life's daily action began to scorch the thread of relationships, of connection, of eager possibilities that had anchored the thread, at times so tenuously. When it began is a mystery. More conscious and clear is the moment the confluence of forces registered on the Richter scale of living enough to be noticed. Differences don't matter until they are suddenly noticed as if they just appeared. "She's behaving oddly here," they would whisper. …