How to treat depression in suicidal patients is a difficult question. Contemporary nursing models of mental health care emphasize the importance of personhood in mental health disorders, including depression. The movie The Hours presents a unique example of how depressed, suicidal women should not be treated. The Tidal Model exemplifies a new philosophy of mental health nursing, which embraces the concepts of caring, nurse’s curiosity, and patient’s personhood.
The Tidal Model of care holds a promise to improve mental health and emotional outcomes in depressed individuals and reduce the scope of their suicidal attempts. The purpose of this paper is to review and reconsider a Major Depression case through the lens of the Tidal Model of nursing. The movie The Hours and the character of Virginia Woolf will serve the basic units of analysis.
Depression: Signs, Symptoms, and The Hours
The complexity of signs and symptoms makes depression diagnosis extremely problematic. According to the World Health Organization (2010), depression is “a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration”. Depression affects at least 19 million of Americans and their families and is rightly considered as one of the major causes of disability (Nosek, 2008). According to the DSM-IV manual, the main signs and symptoms of depression include
- depressed mood every day and most of the day;
- diminished interest in all or almost all activities and significant changes in weight and appetite;
- sleep problems, psychomotor retardation or agitation every or almost every day;
- the feeling of self-worthlessness, fatigue, impaired ability to concentrate and take decisions, on a daily basis; and
- suicidal ideation and recurrent thoughts, obsessions, about death (American Psychiatric Association, 2000).
In the movie The Hours, Nicole Kidman’s character Virginia Woolf displays all symptoms of a Major Depressive episode.
Virginia Woolf constantly finds herself in a depressed mood. She feels hopeless and is disinterested in most things and activities. She is sad and lost. The sense of pleasure is unknown to her; she suffers from insomnia and does not seem to care of what is happening in her life. Mrs. Woolf’s maids complain that she never knows what she wants; she cannot take decisions or changes them every minute (Daldry, 2002). The signs of psychomotor retardation, especially slowed movements and reduced speech are too obvious to ignore. Woolf is in a constant search for something she cannot define. As a result, she hardly has a chance to achieve her purpose.
The feelings of satisfaction and joy are unfamiliar to her. She lacks energy, and her sense of guilt is enormous. In the final letter to her husband, Virginia Woolf writes: “I know that I am spoiling your life, that without me you could work. […] I can’t go on spoiling your life any longer” (Daldry, 2002). Woolf had two suicidal attempts. She constantly thinks about death. Her symptoms have lasted for more than two consecutive weeks. Mrs. Woolf feels tired, disinterested in her life, worthless and guilty, and, as a result, exemplifies a serious case of the Major Depression episode (Bernstein, 2006).
Key Dimensions of the Tidal Model
The Tidal Model of mental health nursing signifies a new stage in the evolution of nursing philosophy. The three critical dimensions of the Tidal Model include world, self, and others (Pandey, 2007). World is the domain where people develop and communicate their stories (Pandey, 2007). Depressed individuals want their personal experiences explored and validated by people, and nurses must be able to re-evaluate the person’s story in context and reveal its hidden meanings (Pandey, 2007). In case of Virginia Woolf, doctors are indifferent toward her personality and ideas about life. They cannot define the meaningful events that could have affected her mental health disorder.
Self is the second dimension of the Tidal Model – the domain where people want to feel secure (Pandey, 2007). It should be noted that patients’ ideas of security may (or most frequently) differ from those of other people, including their family members.
The issue of personal security becomes particularly sensitive, whenever the risks of suicide are involved. Virginia misses and wants to come back to London, but her husband insists that she stays in Richmond, to protect herself from the major troubles of life. His state is understandable: his sense of responsibility for a suicidal spouse and his helplessness in the face of Victoria’s illness are necessarily the results of living with a depressed, suicidal family member (Nosek, 2008). He is blinded by this responsibility and loses the touch with the emotional needs of his wife.
Eventually, it is through others that depressed suicidal patients can obtain quality care and support. Others is essentially about the complexity of the relationships with nursing practitioners, family members, friends, and significant others (Pandey, 2007). Virginia Woolf is fated to spend her life in isolation and cannot meet her social needs. She wants but cannot be regarded as a part of her family (Ahlstrom, Skarsater & Danielson, 2009).
She cannot go to London, nor can she interact with other people beyond her husband, maids, and sister. Once, Virginia Woolf exclaims that even psychiatric patients have the right to express and have their wants satisfied (Daldry, 2002). The absence of a comprehensive treatment strategy, the lack of family support, and failure to accept the voice and language of the patient lead to the tragic consequences. Virginia Woolf drowns herself, and her suicide marks the ultimate failure of the therapy that had to improve her health.
Three Commitments of the Tidal Model
The first three commitments of the Tidal Model include
- “value the voice”,
- “respect the language”, and
- “develop genuine curiosity” (Buchanan-Barker & Barker, 2008, p.95).
These three commitments could have helped all characters of The Hours to cure their emotional ills. The first commitment is about listening to the patient’s story and accepting its language (Buchanan-Barker & Barker, 2006). A practitioner must demonstrate an ability to listen carefully to the patient and record the patient’s history in his (her) own words (Buchanan-Barker & Barker, 2008). Virginia Woolf has a unique writing talent, and can easily find words and expressions describing her emotional state and its possible causes. She is able to provide an insight into the mystery of her illness, and the main task of the nurse would be to record her story the way she presents it, to ensure that her voice and uniqueness are retained.
Respect to language as the second commitment of the Tidal Model logically follows from the first one: nurses must value patients’ natural language (Buchanan-Barker & Barker, 2006). The story of the patient’s life, written and transcribed in his (her) terms and expressions, is the best measure of respect and attention on the side of the nurse. Medical professionals must avoid using excessive medical terminology but, instead should convey simple thoughts and meanings (Buchanan-Barker & Barker, 2006). The picture of Woolf’s diagnosis is increasingly complicated, and this is one of the key mistakes. The lack of genuine curiosity does not let the doctors and family members improve Virginia’s emotional state.
Genuine curiosity, the third dimension of the Tidal Model, produces significant effects on how patients tell the story of their lives (Buchanan-Barker & Barker, 2006). In case of Virginia Woolf, doctors fail to identify and discuss the meaningful events affecting her state. She is treated as a usual object of medical investigation. Medical professionals believe that depression is similar to other physiological disorders, which require nothing but medication and isolation from the tensions of life. As a result, her family develops coercive strategies of coping with the illness, but these strategies do not benefit Virginia Woolf’s health outcomes (Ahlstrom, Skarsater & Danielson, 2009).
It is due to unresponsiveness from her family and doctors that Virginia Woolf fails to relieve the burden of her emotional problems. The story of Virginia Woolf’s illness teaches a good lesson to nursing professionals in mental health facilities. The story of Virginia Woolf’s illness suggests that the Tidal Model of care could have helped the famous writer to meet her social and emotional needs.
Conclusion
The Tidal Model of nursing marks a new stage in the evolution of nursing philosophies and embraces the concepts of care, curiosity, and patient’s personhood. Virginia Woolf displays all signs and symptoms of the Major Depression episode: she is disinterested in her life, experiences guilt and the sense of self-worthlessness, and constantly thinks about death. The story of her illness presents a unique example of how depressed, suicidal women should not be treated.
Medical professionals have no curiosity about her life and experiences that could have affected her state. Virginia Woolf’s suicide is a rebellion against her emotional confinement and failure to cure her mental health ills. The Tidal Model of care holds a promise to improve emotional outcomes in depressed individuals and reduce the scope of their suicidal attempts.
References
Ahlstrom, B.H., Skarsater, I. & Danielson, E. (2009). Living with major depression: Experiences from families’ perspectives. Scandinavian Journal of Caring Sciences, 23, 309-316.
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Buchanan-Barker, P. & Barker, P. (2006). Ten commitments: A value base for mental health recovery. Journal of Psychosocial Nursing, 44(9), 29-33.
Buchanan-Barker, P. & Barker, P.J. (2008). The tidal commitments: Extending the value base of mental health recovery. Journal of Psychiatric and Mental Health Nursing, 15, 93-100.
Daldry, S. (2002). The Hours. United States: Paramount.
Nosek, C.L. (2008). Managing a depressed and suicidal loved one at home: Impact on the family. Journal of Psychosocial Nursing & Mental Health Services, 46(5), 36-44.
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