(This is an AI-assisted note to self that was written between seeing a few different clients while on duty. Reflecting in and on practice, I find myself split by my educational and clinical training, between two opposing cultural traditions and practices. At the heart of this are two different "sciences". I take an anthroplogical approach to understanding them, and how the 'split' they are causing me, inevitably impacts on my/our capability for work. I apologise for the inconvenience of posting it here, for the sake of future reference.)
The Split
At the heart of the relationship between psychology and mental health nursing in the UK lies a dialectical process of recovery, enacted through the therapeutic relationship between nurse and patient. Recovery is not simply the alleviation of symptoms, but a dialogical, ongoing negotiation of meaning — a co-construction of self and world. Mental health nursing, as practiced in the UK, positions this relational process at its centre, viewing care as a mutual act of transformation rather than a unidirectional application of treatment.
This stands in contrast to dominant American psychological traditions, which often situate pathology within the individual, relying on diagnostic categories that abstract the person from their social, cultural, and relational context. In this model, the patient becomes the site of illness, and therapeutic success is measured through psychometric validation and statistical generalisation. Yet such approaches risk overlooking the lived complexity and cultural situatedness of mental distress.
The science of mental health nursing, by contrast, is performative and relational — concerned with how meaning emerges between nurse and patient. The therapeutic relationship functions as a space for the co-construction of a conceptual structure, within which both participants negotiate and make sense of experience. From this perspective, the imposition of predefined medical taxonomies appears limited, even counterproductive. While such systems may originate from qualitative clinical insights, they are validated through quantitative psychometrics that often lack cultural sensitivity and contextual nuance.
A way forward, therefore, lies in developing a dialectical model of psychological understanding that honours relationality, culture, and lived experience. Theory can be grounded in a statistical landscape of productivity and deprivation, but it must remain alive and responsive to the mutual processes of recognition, reflection, and recovery that define nursing practice. Only when UK universities recognise this fact, will mental health nursing be able to offer a more inclusive, responsive, and human science of the mind than is currently available through the neo-liberal structures of the American psychological industry.
The Double Hermeneutic
The split may be resolved through Anthony Giddens’ concept of the double hermeneutic. His concept captures a key tension within the human sciences: the idea that social and psychological knowledge operates on two interpretive levels. First, scientists and practitioners generate abstract conceptual frameworks to interpret human behaviour. Second, these abstracted concepts re-enter the social world, where individuals adopt, reinterpret, and perform them within their own lived contexts. In psychology, this reflexive loop means that theories do not merely describe human experience — they constitute it, influencing how people understand themselves and others.
Within psychometric psychology, this double hermeneutic often functions in a top-down manner. Diagnostic categories and measurement tools, while presented as neutral instruments, shape public and professional understandings of mental health, producing what Ian Hacking calls “looping effects” — where classifications alter the behaviours they classify. The result is a self-reinforcing system of abstraction: concepts tested statistically across populations become reified as universal truths, even though they emerge from specific cultural, linguistic, and institutional contexts.
By contrast, within the therapeutic relationship that defines UK mental health nursing, the double hermeneutic operates dialectically and locally. Here, concepts of distress, recovery, and identity are co-constructed between nurse and patient, emerging through dialogue, empathy, and mutual reflection. The process is interpretive rather than classificatory, privileging lived meaning over standardised measurement. The universal abstractions of psychology meet the grounded, situated knowledge of relational practice, generating a productive tension between theory and experience.
Recognising this double hermeneutic dynamic invites a reorientation of psychological science: rather than imposing taxonomies from above, theory must remain open to revision through practice — allowing the conceptual frameworks of mental health to evolve through the interpretive encounters that constitute care itself.
The Big Five Personality Dimensions
One good example of the double hermeneutic in operation is The Big Five Personality Dimensions — openness, conscientiousness, extraversion, agreeableness, and neuroticism. These dimensions were developed from self-report questionnaires asking people how much they agree with a certain statement about their thoughts, emotions and behaviours. These were reduced by statistical analysis into a descriptive taxonomy of personality variation that were validated across populations and cultures.
However, as Giddens’ double hermeneutic suggests, such models do not simply represent personality; they also reshape how individuals and institutions understand, value, and regulate it. Once abstracted into measurable traits, the Big Five re-enter social discourse, informing educational, occupational, and clinical judgments about what constitutes a “healthy” or “disordered” personality.
This process becomes particularly pronounced in the construction of personality disorders. The same traits that the Big Five describe as normal variation are often pathologised when expressed beyond socially tolerated thresholds. For example, high conscientiousness may be celebrated as diligence, yet when excessive it becomes “obsessive–compulsive.” Similarly, low agreeableness may be reinterpreted as antisocial or narcissistic; but it becomes "revolutionary" when expressed by the political opponents of a totalitarian regime. The classificatory schema thus performs a moral as well as a scientific function — it legitimises particular ways of being as normative while marginalising others as pathological.
From a developmental perspective, all personality traits emerge through processes of neural selection and pruning during puberty, reflecting each individual child's adaptive response to their unique set of environmental and social demands. Evolutionarily, each trait serves a function: even “maladaptive” traits confer survival advantages in a certain context. Yet, within modern societies, only certain constellations of traits — typically those that support emotional regulation, empathy, and stable adult attachment — are normalised as healthy. The Big Five, when used diagnostically, implicitly encode this social bias, presenting contingent cultural ideals as universal psychological truths.
The result is a powerful double hermeneutic: psychological theory both interprets and prescribes personhood. As individuals internalise these frameworks, they shape their self-understanding and behaviour accordingly, reinforcing the very norms that the taxonomy was meant to describe in a scientifically neutral and objective way.
Splitting and Catastrophising
The cognitive–emotional patterns often associated with personality disorders — such as splitting (the oscillation between idealisation and devaluation of self and/or other) and catastrophising (the tendency to interpret events and relationships in extremes) — can be interpreted through the lens of the Big Five Personality Dimensions, though this translation reveals the limitations of the psychometric method.
In theory, the Big Five involve constellations of loosely connected words that humans use to describe each other. These words can change in their relationships to each other over time, but the same broad psycho-linguistic dimensions seem to appear over and over again, wherever and whenever they have been studied. This means that it is only within the cultural context of the author that it becomes legitimate to speak about the cognitive tendencies of splitting and catastrophising, being best referenced by the personality dimensions of neuroticism, agreeableness, and openness to experience.
With that qualification in mind, it can be predicted that high neuroticism will capture most of the emotional volatility and sensitivity to threat associated with the cognitive distortions of splitting and catastrophising. Neuroticism is fertile ground for catastrophising when cognitive regulation is weak or stress is high. Splitting, meanwhile, can emerge from the interaction between high neuroticism and low agreeableness, reflecting difficulties in integrating ambivalence within relationships and maintaining stable representations of self and other. Elevated openness may amplify both processes by heightening emotional imagination and perceptual complexity, leading to vivid, rapidly shifting interpretations of events and a dissociation from the social reality observed by others.
However, it may also prove impossible to reduce mental states to personality traits in this way - a theoretical distinction has to be maintained between their respective fluid and static natures. From a dialectical perspective, splitting and catastrophising are not fixed pathologies but dynamic strategies for preserving the coherence of an individual identity in the face of contradictory internal or interpersonal experiences. They are attempts to stabilise and control the meaning of insecure attachments within a triggering (or re-traumatising) context. The Big Five, by abstracting these processes into individual traits, obscures the relational field in which they arise.
Thus, while the Big Five can statistically map the impact of emotional instability, it cannot capture the dialogical logic of recovery that mental health nursing foregrounds — where emotional extremes are understood, contained, and integrated through relationship. Within that therapeutic dialectic, the polarity of splitting itself becomes a site of co-constructed understanding rather than a symptom to be measured. Unfortunately, the therapeutic relationship also becomes the site of contamination, where the 'othering' of split-off fragments of a narcissistic self can be normalised by a staff team. Thus, through poor mental hygiene, blurred boundaries, and the contagion of toxic emotions, mental health nurses may end up splitting the most vulnerable members of the communities that they are supposed to serve.
The Semantic Differential
While the Big Five Personality Dimensions aim to describe stable, universal structures of personality, they are poorly equipped to account for the polarising affective shifts that characterise splitting and catastrophising. In contrast, Charles Osgood’s Semantic Differential model offers a more dynamic and relational framework. These scales originally introduced to commodify public (voting/purchasing) intentions for the 1950s US advertising industry. They are therefore at the heart of the industrialisation of psychological processes, which has been a feature of global capitalism in the post-War era.
Rather than reducing personality to latent trait factors, the semantic differential maps the connotative meaning people ascribe to objects in their physical and social environments — typically (but not reliably) along evaluative dimensions such as good–bad, strong–weak, and active–passive, but the actual form and number of dimensions depends on the host culture. These bipolar adjective pairs reveal not only how individuals perceive others, but how affective valuations fluctuate within social and emotional contexts.
In cases of splitting or catastrophising, it is precisely the sudden reversal of evaluative polarity — from idealisation to devaluation, from safety to danger, or from victim to abuser — that defines the psychological process. Within Osgood’s framework, such reversals represent abrupt shifts in the semantic field: the same object or person moves from one pole of meaning to its opposite, reflecting an instability in the integration of affect and cognition. This instability is not a fixed personality trait but a relationally mediated oscillation in the meaning system through which self and other are interpreted.
From this perspective, what psychometric models frame as “emotional dysregulation” can instead be understood as fluctuations in affective valuation within a shared symbolic field. The nurse–patient relationship thus becomes a medium for stabilising these semantic reversals through empathy, dialogue, and attunement. Rather than classifying the patient’s responses as pathological extremes, the therapeutic task involves co-creating a more continuous semantic space — one in which conflicting meanings can coexist without collapse into binary opposites.
In this sense, Osgood’s model resonates more deeply with the dialectical, interpretive ethos of mental health nursing, where recovery is achieved through the gradual re-integration of polarised meanings within the relational encounter itself. Where it struggles is in finding the mediating values between the two extremes, which is where the one-to-one cognitive-behavioural therapies (IAPT), and the Big Five model, do the majority of their narrative restorying work.
Summary and Conclusion
The relationship between psychology and mental health nursing in the UK is ultimately a dialogue between individual experience and collective context — between the intrapsychic and the social. While US psychology provides models for understanding personality traits, such as neuroticism, mental health nursing situates the mental states they give rise to within the lived realities of relationships, communities, and institutions. From a public health perspective, neuroticism, for example, is not distributed equally across society: exposure to chronic stress, precarity, discrimination, crime, and organisational dysfunction amplifies anxiety, vigilance, and emotional reactivity. In this sense, neuroticism becomes both a psychological disposition and a socially produced vulnerability, a double hermeneutic in every sense of the term.
Elevated neuroticism increases susceptibility to expressing cognitive–emotional dysregulation and behavioural impulsivity when triggered by the relevant stressors and perceptual cues. The polarities of splitting and catastrophising are central to the lived experience of neighbourhoods where personality disorders thrive. When experienced collectively — within families, workplaces, or marginalised communities — they risk a pattern of externalising and internalising co-dependencies that will reproduce cycles of fear, mistrust, and toxic emotional contagion across generational divides. At a population level, such dynamics will probably contribute to the social patterning of mental distress, including domestic violence, substance misuse, deliberate self-harm, and inevitably, intentional and unintentional suicide. Thus, neuroticism operates as a social determinant of splitting and catastrophising, whose prevalence and expression are shaped by the structure of relationships through which people live, relate, and work.
For mental health nursing, this realisation can reframe psychological care as both relational and structural, a process and an outcome of toxic interpersonal relationships. Recovery involves not only the therapeutic containment of emotional instability by mental health nurses but also recognition of the societal forces that cultivate it. The NHS primary care system is on the threshold of achieving this insight and being able to respond to it in a meaningful way. Psychometric models such as the Big Five can help map risk, but they must be integrated into a broader, dialectical framework that understands the expression of personality as the interface between individual neurobiology and collective meaning systems. A truly holistic nursing science must therefore unite psychological insight with social awareness — recognising that to heal minds, we must also address the environments that continually shape, stress, and divide us into us and them.