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Kenichi Ohmae

Rowing doesn't help if the boat is headed in the wrong direction

Thomas Szasz

How can you know more about a person after seeing him for a few hours a few days, or even a few months, than he knows about himself? ...You are making suggestions and exploring alternatives - helping the person change himself. The idea that the person remains entirely in charge of himself is a fundamental premise.


Key Assumptions of the Tidal Model

The Tidal Model begins from four simple, yet important starting points:
  1. The primary therapeutic focus in mental health care lies in the community - the world of ordinary life. People live on an 'ocean of experience', which is their natural lives. A psychiatric crisis is only one thing, among many, that might threaten to 'drown' them. Ultimately, if there is any single 'aim' for mental health care it must be to return people to their 'ocean of experience', so that they might continue with their 'life voyage' of their lives.
  2. Change is a constant, ongoing, process. Although people are constantly changing, this may lie beyond their awareness. A main aim of the Tidal Model, is to help people develop their awareness of the small changes that, ultimately, will have a big effect on their lives.
  3. Empowerment lies at the heart of the caring process. Nurses, and others, help people to identify how they might take greater charge of their lives, and all its related experience. Of necessity. this requires the helper to give up the power relationship that characterises normal professional-client relations.
  4. The nurse and the person are united, albeit temporarily, like dancers in a dance. When effective nursing happens, as WB Yeats might have remarked, "how do we tell the dancer from the dance?" Nursing is something, which involves caring with people, rather than caring for them or even just caring about them. This has implications not only for what goes on within the relationship, but also for the kind of support nurses might need from others, to maintain the integrity of the caring process.


In referring to the 'ocean of experience' we acknowledge the spiritual journey that underpins life, and which is writ large in the experience of mental illness or madness, as people like Sally Clay would describe it. Of course not all people describe their distress in spiritual terms. However, we have yet to meet someone who was mentally distressed and who was not seeking meaning - trying to find, as Hilda Peplau said," the truth about themselves and their lives". The developmental journey made by people as they move through various stages in their lives, is a journey of exploration and discovery. It yields not only the opportunity to discover new lands, but also carries many risks: metaphorical storms, as well as the risk of running aground, or of the ship sinking. The seaworthiness of the ship may be an apposite metaphor for the person's health status or constitution. Clearly, the extent to which we are able to journey across our ocean of experience is dependent on the physical body on which we roll out the narrative of our human lives.

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However, when people experience a disruption of their sea-journey, they may - like Coleridge's Ancient Mariner, become becalmed at sea.

Day after day, day after day,
We stuck, nor breath nor motion;
As idle as a painted ship
Upon a painted ocean

Depression often has just such a becalming effect. Or, people may be thrown violently on to the rocks. Psychosis often resembles the experience of the shipwreck.

Either way, a signal emerges that something special needs to be done - crisis care - and, if this is to be ultimately successful, it needs to be followed up with a range of different forms of support- from simply keeping the person afloat (community support) to deep sea-diving (exploring the submerged causes of the crisis).
This is a different perspective on some age-old understandings. However, our discoveries of how people function, psychologically and socially, has tended to get in the way of our appreciation of what it might, ultimately, all mean in human terms. Dickens acknowledged the tidal nature of life and death, through his character - Mr Peggotty, who said:

"People can't die along the coast, except when the tide's pretty nigh out. They can't be born, unless its pretty nigh in.- not properly born, till flood. He's a going out with the tide."

A similar understanding is found in much eastern thought, where the breath the life force or prana heralds life with each inhalation, and death with each exhalation. People, are therefore, poised, constantly on the tidal cusps of life and death.
Most famously, at least within the Western canon, Shakespeare summed up the fundamental assumptions of the Tidal Model in Julius Caesar:

 "There is a tide in the affairs of men,

    Which, taken at the flood, leads on to fortune;

    Omitted, all the voyage of their life

    Is bound in shallows and miseries.

    On such a full sea are we now afloat,

    And we must take the current when it serves

    Or lose our ventures."


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The Tidal Model aims to provide person (or family) centred care. This should recognise the person's fundamental need for security - both existential and physical; acknowledging the person's capacity for adaptation to changing life circumstances; emphasising the person's existing resources, both personal and interpersonal. We seek to do as little as we need to do to help support the person. Intervention should be our watchword, not interference.
Many nurses are encouraged to believe that they need to develop 'new' skills or learn 'new' therapeutic models, in order to become effective in mental health care. The Tidal Model challenges such assumptions. Nursing is effective when the person begins to experience growth and development. 

Nursing originally meant to offer nourishment. Nothing has changed across the centuries. Today, people in mental distress need the nourishment that nursing can offer. They need the human support that will help them to deal more effectively with the tidal forces that have rocked their lives. They need help to gain the confidence to get back in their boat and push off, from the shore, to begin again the journey on their ocean of experience.

We live in a world of rapid change. Nurses need the security of a model of practice that provides some boundaries for their practice, and some suggestions as to how they might develop the nursing interventions that will become the focus for their practice. The Tidal Model offers some suggestions and examples of possible interventions. We hope that these will be accepted as suggestions for further research and development. Like the metaphor of water itself, the Tidal Model will be subject to change. All is flow. Nothing lasts. We hope that you will feel free to make your own contribution to the further development of the model, out of your own experience of caring.




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