Firstly, introduction to Nidotherapy
Peter Tyrer, with the help of many people who have aided in the developing nidotherapy, has written a short book about its essentials. The book can be purchased via the Royal College of Psychiatrists website or Amazon. Here are some extracts from the book to give you a bit of its flavour. First, how did it all begin?
‘although Darwin was enticed by the psychologist Herbert Spencer into adopting the phrase ‘survival of the fittest’ to summarise the main principle of evolution, he began by using the ‘survival of the adapted’, thereby stressing the important fit between organism and environment. This is the key to nidotherapy – it not only recognises that paying attention to the environment in mental health is valuable but goes further by arguing that the systematic planning and management of the environment is the best way to create mental harmony as a long term goal’.
Secondly, where does the ‘therapy’ come in?
‘Nidotherapy is not just a form of environmental manipulation or social engineering, a social model of psychiatry that regards most interventions in mental illness as examples of ‘medicalising’. Such a model does indeed focus on the social environment but generally makes no attempt to change it specifically as a form of management. Nidotherapy is also none of the following: a re-badged housing advice service or accommodation bureau; a career development service that finds out your abilities and picks the right role; a lifestyle advisory service or an internet dating service that provides the perfect place to meet the person of your dreams (or though it is prepared to use any of these agencies once a way forward has been developed). Instead, it is essentially a complicated matching process whereby people’s deep desires, vague wishes, fundamental opinions and lifestyle are understood sufficiently to ensure that environmental factors in all their forms are adjusted sensibly and specifically to make the best fit for the patient’.
Thirdly, what experience have we of nidotherapy to date? Who has been treated, and why, and who might be affected?
This book might be better entitled ‘An Introduction to Nidotherapy’, as my experience to date is only addressed to a very small part of the population who may benefit from this approach. My clinical experience is reasonably broad but, as explained at the beginning of this book, nidotherapy developed out of despair at trying to provide something more positive to a population with not only sever mental illness but also ‘triple diagnosis’ (a combination of a psychosis, substance misuse and personality disorder). This represents only one part of the extreme end of the mental illness spectrum and it would be wrong to assume that nidotherapy has no place elsewhere. ‘Ill-matching environments need not always be poverty stricken. David Owen (2008) has coined the term ‘Hubris Syndrome’ described the problem as being in an environment in which almost every aspect of your physical, social and personal life is not only under your own control but can be manipulated almost any way you please. The outcome is that you become cocooned in a universally positive reinforcing environment of your own making and then lose your critical faculties, hence the hubris epithet. This adverse effect of too much nidotherapy can be true of despots and dictators but also of democratic leaders, and Owen suggests that both George W. Bush and Tony Blair are world leaders who have manifested this condition’.
Fourthly, am I suggesting that nidotherapy can change your life fundamentally ?
‘Unrealistic aims are frequent at the beginning of nidotherapy. At first many are awash in amazement amidst the luxury of being actually asked unconditionally what changes they want in their environment. This is such a difference to the standard barked order to do something you know not what or why, and so it is not surprising that the invitation for the patient to make their own suggestions goes a little to the head and odd ideas are born. These need to be explored gently but not dismissed out of hand, and by the time the discussion is finished the person will have been convinced that there are more practical alternatives that should be explored first.”