An Interview with Phil Barker

Phil Barker talks to Chris Hart

(recorded in 2002)

Phil Barker’s nursing career stretches back over thirty years. Starting out as a nursing assistant ‘to pay off his debts,’ he became one of the country’s first nurse psychotherapists, one of the first nurse clinicians to gain a PhD and our first professor of psychiatric nursing practice, at Newcastle University. Given an honorary doctorate at the Oxford Brookes University in 2001, he has long been both a distinctive and controversial figure in nursing. The author of 14 books - often in collaboration with others - he developed the Tidal Model, which has been adopted by mental health nurses in numerous countries. Earlier this year, he decided to give up his post at Newcastle to concentrate on writing, lecturing, and not to mention, returning to his first love, painting.

You have left your post at Newcastle University. Can you describe what you have been doing over the last few years and what aspects of your work are you giving up?
For the past decade I have been trying to find out, 'what are psychiatric nurses needed for?' With some great colleagues at Newcastle I got some answers, which prompted the need for more exploring. This led to the development of the Tidal Model, which offers a philosophical template for developing the kind of care people need, now. I am focusing more on developing recovery dialogues, leaving behind all those over-professionalised stories about psychiatry, mental illness and the whole control agenda that made me uncomfortable. I chose to go now because the time just seemed right. There was nothing rational or planned about it.

I am still involved with users and carers, developing and delivery different forms of help - that I would rather not call psychotherapy, but some might - and writing, speaking, doing research and worskshops. And I have made the time to paint - which I didn't do for a long time, I think because I thought it was taking me away from my 'work'. I will maintain academic links with universities, doing supervision and the occasional lecture, mainly to give something back to the system that gave me so much.

Was it an 'easy' decision to make and, why now?
In professional terms I have been very successful. In a very real sense
there was nothing left to do as far as my ‘career’ went. However, in the mental health field there is so much to do. I'm probably more active now, but in different ways. I never wanted to be a 'nursing leader'. I wanted to be an activist. It is time that the younger generations generate some new leaders, maybe even some new activists.

What will you miss most from your work?
Hard to say. Apart from going to the office, I am doing pretty much
everything I ever was, sometimes in bigger measures. I am still involved
with users and carers, developing and delivery different forms of help -
that I would rather not call psychotherapy, but some might - and writing,
speaking, doing research and practice-focused worskshops. And I have made the time to paint - which I didn't do for a long time, I think because I thought it was taking me away from my 'work'. Now my life is my work.

What do you think were your biggest achievements?
Staying clinically connected over more than 30 years. It was difficult
doing that as a Professor - some staff were suspicious of my motives, it
seemed so odd to them. But I never had any problem hanging out with the
clientele. They didn't care who I was anyway, which was great. The rest of
the stuff - doctorate, research ratings, Fellowships etc, - yes great at the
time but only symbols. The real stuff is about people - being with people,
learning from people, discovering more of your own humanity. Can't put a
value on that. Priceless.

When you look back, do you have any particular disappointments or
aspects of your work that you wish had developed differently?
None. Absolutely. I have always believed that I was leading the perfect
life, even when I or someone else thought it was off course. I think that is
true for everyone, but some people want to control their life, influence it.
Life is the great Teacher. We should pay more attention to what She is
saying. Why is this happening to me now? What's going on here? I guess,
those were the kind of questions I used most in my psychotherapy practice.
What else is there to ask?

Are there any objectives that you had hoped to achieve but didn't? If
so, what were the factors that prevented you from doing so?
None. I was ridiculously successful. OK, it is a cliche, but life is a
journey: So much to see, so much to remember. I never missed anything: too
busy trying to take it all in.

You have had a long career in mental health nursing - thus far. Did
you have any notion of how you were developing your own career or was much of it accidental?
The whole thing was a total accident. I took a job one day, as a nursing
assistant at the end of the 60s, planning to leave when my debts were paid
off. I woke up the next day as a Professor. OK, I had a fantastic helter
skelter ride in between, but none of it was planned, in the conventional sense.

For those unfamiliar with the Tidal Model, could you summarise it?
Change is the only constant. The Tidal Model emphasises ways that we might help people become more aware of the changes going on within them, and how they might influence those changes, to effect positive changes for them. The medium for all of this is the person's stories - those they tell themselves and other people. It seems simple but can be hugely complex in practice.

You have long asked the question, 'What are psychiatric nurses needed for?' What answer have you arrived at?
Nursing originally meant 'nurture' and people in human crisis appear to need someone to 'be' there for them, offering unconditional support, providing a human medium within which they can grow through, and maybe out of, their distress. If professional nurses can't or won't provide this, other people will. Nursing as a social construct has always existed and always will. Professional nursing will not last if it doesn't deliver.

What do you think, for the most part, they are actually doing?
Regrettably, because nursing is so influenced by the military model too many nurses blindly follow orders. Currently, they think they are being told to contain, manage and control people's expression of distress - which disturbs society, or families or even the person themselves. So, many nurses opt for this in the name of 'care'.

Is it possible, within the current policy and political climate, to bring them closer to your model and how can that be achieved?
The evidence of my huge e-mailbox is that nurses, young and old, say the kind of care I talk about is what attracted them to nursing in the first place. The evidence of our research at Newcastle is that many nurses radically altered their practice, and their clientele greatly appreciated the result. I think I helped a lot of nurses know what they were trying to do was right. Caring is simple. Trying to do it in a careless culture is extremely difficult.

What were the most significant events in MH nursing over the last decade?
The flourishing of the user/survivor movement that had sprung up first in the 70's. I am fortunate to have worked with a lot of the key players, at home and abroad. That movement helped nursing remember why it was needed in the first place.

Speaking socially, was there ever a 'golden age'?
My wife and I grew up in small town 50s Scotland, with hard working,
morally conscientious parents, who had nothing in material terms, but who
thought that love and work were important, and laughter wasn't bad either.
In one sense it must have been a 'golden age' because it provided the basis
for our abundant mentality. But I would hope that every age might be a 'golden age' for its young. We have the gifts of our 'golden era' inside us. I hope that the cycle is repeated through every generation, but these do seem
like hard-bitten times, despite our affluence.

What do you think of recent trends in mental health nursing?
I think there is splintering and splitting (psychodynamically speaking). In one sense this is good, as it is a recipe for debate which might lead to discourse. But nurses are always looking for leadership and I don't think it is there. We should have had a College of MH Nursing, like our Australian and New Zealand colleagues, or similar to the psychiatrists or BASW. We made a stab at it in the 70s and 80s with the Psychiatric Nurses Association, but it died a decade ago. Now we look to 'nurse advisors' from the Department of Health for direction. Not a good sign as they are following political orders, whatever they say, and the politicians are often fickle, as history attests so well.

What do you think of the current politics and philosophy of mental health nursing?
I think that there is a huge 'silent minority', that wants to develop genuine, empowering, collaborative 'care', but which is overwhelmed by one bureaucracy after another. When I have asked users who made a difference in their lives, they never say 'my psychotherapist' or 'my psychiatrist' or even 'my keyworker'. they name a person, often of little status, who did something significant.

You have aligned yourself increasingly with the user movement - which has been very critical of services in the UK - and also ant-psychiatry figures such as Tom Szasz. It could be construed that you have given up on mental health nursing as it is practiced in the NHS. Would that be right?
I began developing alternative collaborative projects as far back as 1986, when I established a community mutual support group for women with manic depression. They accepted me, for who I was and what I was. My professional life changed radically from then onwards. I have tried to stay loyal to nursing, but many nurses have re-fashioned themselves, as control and management agents, playing down (or isolating) care. I share Tom Szasz's view that the concept of mental 'illness' is an unhelpful metaphor. However, like him, I recognise that a special kind of human distress exists and that people should be offered help with that, but I don't believe in forcing it on them. That only adds to the mythology of madness and dangerousness. The dangerous people in any society are not the 'mentally ill'.

Some of your critics suggest that your model and theories have led to nurses becoming confused about how to react to patients who are either psychotic, very distressed and/or disturbed and that their nursing care is compromised in terms of safe practice. What is your response to that?
Nonsense. This is probably that old chestnut about 'observation' versus my description of 'engagement'. The distress that threatens people's physical safety stems from emotional insecurities. That much is clear. Watching them, locking doors or hiding anything sharp, will not protect them indefinitely. We need to work out how to enter the world of their emotional insecurity, and begin to understand it. If we can foster greater emotional security the care will be 'safe' and so will the person.

You have been a great advocate of nurses such as Hildegard Peplau while others see her as the source of much that is wrong in nursing. What would you say to critics of Peplau?
Most of Peplau's critics have simply not read her work. I was fortunate to have spent a lot of time with her, but she was fairly explicit in her writing. Through careful study of nursing practice, Hilda unpacked the ever-changing roles of the practitioner who engages with the person in distress. She avoided giving easy answers, in the form of templates for practice - boxes to tick and all that stuff. She saw nursing as a careful, collaborative, almost creative practice. However, it is demanding. I think that is what puts off a lot of people.

Does evidence based practice, quantitative research and the notion of an increasingly scientific approach to nursing help nursing progress in finding its role and in developing a more collaborative relationship with people using services?
No, its just another illustration of the neurotic times we live in. Even physicists know that observation is always a dynamic process - even molecules don't sit still under observation. The pseudo-science of psychiatry has no place in the human practice of helping people in distress. As soon as one person meets another a powerful dynamic is established. Nursing has bought the 'scientific' myth that it can control and change from outside. All human change emerges from within, but is obviously a product of social and interpersonal factors. My question is, how can I help you to move in the direction that seems 'good' for you right now? Simple, yet amazingly complex.

What do you think of training initiatives such as the Thorn Programme ?
My colleagues and I developed a very similar programme at Newcastle (The Phil Hearne Course) named after a fine nursing colleague who committed suicide. I think lots of nurses are scared of such associations. Thorn is OK as far as it goes but many people use it to reify the notion of mental illness, which is unnecessary. Also, it is the decendant of the nurse therapist thing at the Maudsley in the 70s that the psychiatrist Marks started. He famously claimed that he could take people off the street and turn them into 'nurse therapists'. The Thorn programme now has noting distinctively 'nursing' about it. Of course, some people would like nursing to be come a similar kind of 'irrelevance'.

What do you think of the pre-reg education for psychiatric nurses?
Over the last 20 years educationalists have been overwhelmed by 'information anxiety' and have tried to stuff as much info into their curricula as they could, hoping that students could find a way to use this. Nurses ended up knowing a lot 'about' people, but little (directly) 'of' them. Educationalists appear to realise this folly and are turning again to the practice focus.

Can you see any evidence of your theories and philosophy having been accepted into the mainstream of mental health policy as it is being determined at the moment?
I spent the best part of a decade in England and was never once asked to be part of any policy making group. I don't know what that says but it sure is interesting. The DoH nodded in the direction of the Tidal Model in their recent report on acute care, but couldn't bring themselves to actually cite any of my research. I have no interest in policy and policy makers. Change happens in the world. Policy makers are running to catch up, pretending that they have actually made a difference in the world.

Would you say institutions like NIMHE and the work that is coming out of the Department of Health is taking psychiatric nursing forward?
I don't think either has any interest in nursing per se. A few prominent nurses have sold their birthright to gain temporary acceptance under their patronage. Research tells us that people find genuine nursing makes a huge impact on their recovery, but that rocks the boat for outfits like NIMHE, which are essentially polishing the rough edges of psychiatric medicine. For them 'treatment' is still the key factor.

You have made your opposition to the draft Mental Health Bill plain. What do you think of this government's overall approach to mental health?
In short, woeful. The Scots have a saying that some people are "really clever but not very bright". That applies to a lot of the ministers and advisors who shaped this nonsense. Western society is a crazy (and dangerous) place. However, we find it difficult to admit to this real madness and maintain the idea of a mad (dangerous) minority, so that we can dump all our genuine madness there, and feel that we are dealing with the issue.

What have you most enjoyed in your career?
Learning from people called patients. It sounds corny but people are such a fabulous mystery - to themselves as well as others. Dirk Bogarde once said
that some people just want a clock to tell them the time; others want to
take the back off, and see what makes it tick. I am definitely the latter.
Being paid to do that is, of course, a huge bonus.

What are your plans for the future?
I spend just about every hour of the day with my wife, Poppy, as we live and work together. After almost 40 years together we still find the need to talk, talk, talk. I would like to die in her arms. But not just yet.