Laurel Archer Copp titled her chapter in Critical Moments: Doctor and Nurse Narratives and Reflections "The Principle of Alternation."1 She explained that the writing of her narratives "produced some important insights, which, like cream, rose to the surface only after the fact. So, of course, it had to be done again incorporating what had been learned." We can learn much from her method and analysis. Although The Principal is usually thought of in scientific terms (such as an electromagnetic device that converts mechanical energy into electrical energy), she found a Principle of Alternation within the narratives of her nursing practice, which is psychological. Knowing the depth of her knowledge of history, philosophy, ethics, and religion, I wonder, today, as I read her words, if she was thinking of epic tragedy such as the epinician principle... whatever happiness humans can achieve is the anecdote to pessimism. If we think about the effect of the suffering of others upon ourselves and the strength of purpose that it takes to be fully present to the sufferer, we begin to realize the cost of compassionate care and the necessity of renewal. The outline of her Principle of Alternation in the psychological sense is found in the following Humanities. It is exemplified in The Psychiatric Nurse.

Humanities

What is the alternation from or to or between?

From: Stress, fear, helplessness, inability to help, fatigue of the body and spirit

To: Religion, meditation, friends and family, nature, music, exercise, peace

Between: The pull of the clinical and the growth (lifetime) of the inner self

THE PSYCHIATRIC NURSE

Point

In the days before phenothiazine, one could hear and smell the hospital prior to arrival. It was a miserable existence, for patients and their families. Patients shouted out at the voices. Some lined up for the next meal shortly after the last. Many were so catatonic they had to be fed. Because the weather was so cruel, a whole network of tunnels lay under the hospital. Some patients stood there all day-from breakfast to bedtime.

There was a program called "total push." If the patient couldn't brush his teeth, for example, one applied toothpaste to the brush. If nothing happened, one took his wrist and moved it across his teeth. Every aspect of activities of daily living was assisted.

Few patients were dressed properly. Going into "the clothing room," I was appalled. There were shelves and shelves of both lovely and serviceable clothing. These were gotten out on visiting days-before relatives arrived, to demonstrate the gifts were cared for well-better than the patients actually.

Since winter lasted 5 months-during which we were virtually snowbound, we played lot of whist, pool, and games with patients. In my case, these were initiated by the clear-minded patients, of which there were many. We spoke of many things, I think of them often 5 decades later.

Counterpoint

The saving grace was the piano. Staff and patients sang together. We were not terrific musicians, but that didn't seem to matter. We enjoyed the tired old songs and the company of one another. We put on little shows. I moved from the frozen north to the hottest weather I had ever known in the deepest south-but the biggest shock was not the weather. In this primitive psychiatric hospital, I was hired as the "evening supervisor." More drugs were now available-staff was not. Although technicians did their bit, I was the only registered nurse in a hospital of 1200 patients. I made rounds to the various buildings, problem solved, and dealt with the new admissions and emergencies. When the phone rang, it could be a scalp laceration requiring stitches, or it could be a voice saying, "Can you come to our ward; the patients want to dance and need you to play the piano?" Of course!

"What is the alternation from or to or between?" Is it not the interchange of our humanity with the humanity of those we serve? And isn't it assisted by the arts, nature, and faith?

Dr Laurel Archer Copp was and remains a mentor and teacher of enduring importance to me and to many others.

Laurel Archer Copp, PhD, RN, FAAN (1932-2010) Editor Emerita, Journal of Professional Nursing Dean and Professor Emerita, School of Nursing University of North Carolina at Chapel Hill

Dr Copp remains one of nursing's leading authorities on the concept and management of pain. Her seminal article, an AJN classic, "The Spectrum of Suffering" reveals the depth of her wisdom and understanding (AJN, August 1990). Her editorial in the Journal of Professional Nursing, "What Is Your Life's Work?" is philosophical, practical, and visionary. It is a must-read for us all-"nurses and nonnurses" [Journal of Professional Nursing, November 2010;26(6)] Dr Copp was a guest author for this column writing "Suffering and the Will to Create" [2006;20(6)].

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