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Kenichi Ohmae |
Rowing doesn't help
if the boat is
headed in the wrong
direction
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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.
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Key Assumptions of the Tidal Model
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The Tidal
Model begins from four simple,
yet important starting points: |
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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.
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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.
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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.
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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.
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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). |
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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." |
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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: |
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"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.
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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. |
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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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