| |
|
Key Philosophical
and Theoretical Influences
An Acknowledgement
Our development of the
Tidal Model has been influenced by many people
we have met and worked with down the past 40 years
in the mental health field. Some were colleagues and
mentors; others were the people who were,
temporarily, in our care. They are too numerous to
mention, but we acknowledge here our gratitude for
their support and inspiration.
Key Influences
We have chosen here seven key
influences on our development of the Tidal Model.
 |
The
Japanese psychiatrist Shoma Morita
referred to
his ‘patients’ as students, believing
that his role was not to fix or change them,
but to help them learn something directly
from life. Morita’s most famous maxim - ‘do
what needs to be done’ –occupies an
important place in the Tidal
philosophy. Over 80 years ago, Morita
reminded us that, although change is rarely
easy, if we are to live more effective and
meaningful lives, we must act, not
just sit around talking about what we
think or how we feel about life
|
|
 |
Morita's philosophy is perfectly suited to
today's uncertain world: accept your
feelings - whether 'good' or 'bad', they
are no more than passing signs that you are
alive; know your purpose - rather
than being driven by our 'moods' or 'whims',
we need to accept that our feelings and
thoughts are like the weather, they come and
go. Finally, we need to stick to our
purpose, and 'do what needs to be done'
- our behaviour is all we have dominion
over. 'Action' is a sacred responsibility.
We need to act carefully and wisely..
|
|
Harry Stack Sullivan
1892-1949
 |
|
|
The American
psychiatrist and psychoanalyst Harry
Stack Sullivan first developed his
interpersonal relations theory in the 1920s.
Sullivan was the first analyst to pull his
chair up alongside the 'patient' and begin a
conversation. He was also the first
psychiatrist to use specially-trained
'attendants' to provide peer relationships,
which Sullivan believed were fundamental to
their growth and development.
Sullivan's interest in
relationships probably stemmed from his
Catholic upbringing in a non-Catholic area
where he experienced isolation and
rejection. Later he was also isolated by his
psychiatric colleagues when he was rumoured
to have had a 'breakdown' and was thought to
be homosexual. In this sense Sullivan
pre-dated the contemporary notions of the
'wounded healer' by more than a half
century. |
|
Sullivan coined the expression 'problems in
living' as an alternative to talking,
specifically, about psychosis. He believed
that people (called 'mentally ill')
experienced problems in living with
themselves, and in living with other
people. As a result, other people
experienced problems in living with them.
This focus on 'living' and its 'problems' is
a far more realistic outlook than talking in
the abstract metaphors of 'mental illness'. |
|
Hildegard E
Peplau
1909-1999 |
 |
Our friend and
mentor Hilda Peplau was known as the
'mother of psychiatric nursing' in the US.
Following her experience of working with
Sullivan at Chestnut Lodge, she
developed her own interpretation of his
Interpersonal Relations theory, and applied
it to nursing. She also pioneered, and
named, many of the nursing practices
now taken for granted, - the 'nurse-patient
relationship', the 'one-to-one
session', the 'milieu' and 'groupwork',
among many others.
Hilda offered us
wise counsel over the last 15 years of her
life and we believe that we have extended
some of her ideas about 'relating' in a
direction of which she would have approved.
Like all our other
influences here Hilda was more interested in
'persons' and their 'problems' than
'patients' with 'illnesses', and was
interested in how nursing might help such
'persons' grow and develop. In that
sense, she anticipated the contemporary
interest in 'recovery' by many years. |
|
Our
friend and mentor Thomas Szasz is,
without doubt, the greatest philosopher of
psychiatry of the modern age. His exposure
of the metaphorical nature of 'mental
illness', and his emphasis on 'problems in
living', is now widely accepted, as all
kinds of professional abandon 'mental
illness' in favour of talk about 'mental
health problems'. He was also the
first psychiatrist to publicly challenge (in
the 1950s) the idea that homosexuality was a
form of 'mental illness'. This challenge led
to the its eventual removal from the DSM 15
years later. His writing on the 'psychiatric
will', from 30 years ago, led to the
development of the 'advanced directives',
increasingly popular today . Contemporary
mental health work stands in the towering
shadow of the work of Thomas S Szasz. Should
any form of 'mental illness' ultimately be
shown to be biological in origin then, as
Szasz noted fifty years ago, it will become
a 'physical illness'. As he has noted, we do
not coerce people with 'physical' ailments
into receiving 'treatment'.
Like Morita, Tom
Szasz is an existential behaviourist -
believing that we create the meaning of our
lives by the actions we take. His learning
and vision is matched only by his humanity
and gentility. In human relations we can
only 'care with' our fellow women and
men. To do otherwise risks coercion and
containment. |
 |
Dr
Loren Mosher established Soteria House in the
early 1970s (Soteria from the Greek for
'deliverance'). He believed that the violent
and controlling atmosphere of psychiatric
hospitals and the over-use of drugs hindered
recovery. The Soteria Project closed in 1983
when funding from the National Instiute for
Mental health was withdrawn. An illustration
of psychiatric politics.
Loren Mosher insisted
that people could recover from so-called
severe psychotic states without drugs, and
pioneered the kind of work that is now
called 'early intervention'. In the mid
1980s he established another crisis house,
McAuliffe House, based on Soteria
principles. |
|
Loren Mosher
1933-2004
 |
|
Loren
Mosher worked closely for years with many
advocacy groups, including the psychiatric
survivor group
MindFreedom International.
In 1999, he famously resigned from the
American Psychiatric Association in disgust
at its 'unholy alliance' with drug
companies. When we first met him in the mid
90s we were struck by his gift for
story-telling and obvious interest in
people. Without a sense of 'story' how could
we discover an interest in people? |
 |
The psychiatrist and psychoanalyst
Edward Podvoll began his
career as a
staff psychiatrist at
Chestnut Lodge
Hospital and went on to become the Director
of the graduate program in Contemplative
Psychotherapy at The Naropa University
from 1978 to 1990. He was the founding
Medical Director of Maitri Psychological
Services, the first
Windhorse centre. Ed Podvoll
described the Windhorse Project in his
groundbreaking book,
Recovering Sanity
Shambhala
Publications, 2003; (first published as
The Seduction of Madness by
HarperCollins, 1990). In 1990, Ed Podvoll entered a long-term meditation
retreat in a Buddhist monastery in France,
returning to Boulder to resume his teaching,
writing, and consulting activities.
|
|
 |
Ed Podvoll showed
how we might 'make sense' of even the most
extreme human states, illustrating vividly
the importance of 'being with' people. More
importantly, with his Windhorse colleagues
he showed how people could recover in
ordinary home settings. We are fortunate to
have visited the Windhorse project in
Northampton Massachussets, and witnessed the
reality of Windhorse recovery at first hand.
As he wisely said: "The bottom line is:
what would you want if you, or your child,
were crazy? Would you want any other kind of
treatment?"
We would plump for
care and compassion. What else is there? |
|
Steve de
Shazer
1940-2005 |
 |
The American social worker, jazz musician
and psychotherapist Steve de Shazer
was one of the key contributors to what has
become known as 'solution-focused therapy'.
We first met Steve in Glasgow, and were
attracted by his cautious approach -
especially when it came to pretending to
'know' what people's problems were. We do
not believe there can ever be 'solutions' to
the problems that life throws in our path
(we can only learn better how to live with
them). However, we value Steve's
contribution towards recognising that people
have their own 'resources', which they can
bring to the possible 'solution' of their
problems in living. |
| Solution-focused
thinking is more talked about now, if not
actually accepted, than it was when we first
met Steve twenty years ago. The idea that we
might need ONLY to help people help
themselves, is a belief held dear by all the
'influences' listed here. It points towards
a 'democratic psychiatry' that has long been
hinted at, but still remains overshadowed by
the false god of 'biopsychiatry' and foolish
notions like 'psychoeducation'.
People are their
own 'experts' - pure and simple. We may not
approve of the lives they lead, and the
decisions they make, but these are their
lives and their decisions after all.
|
|
|
|
