First, do no harm

primum non nocere: first, do no harm.

A central tenet of the Hippocratic oath

As Tom Bennet OBE wrote on the platform formerly known as Twitter this week, “Even qualified practitioners are bound to ‘do no harm’. But the desire to support children leads many schools to well-meant but potentially damaging mental health ‘interventions’.”

This week I have listened to a quite horrifying piece of investigative journalism by the Financial Times into Goenka mindfulness retreats, at which attendees are encouraged to practise an extreme kind of meditation known as Vipassana. People on the retreat are not allowed to speak and strongly discouraged from leaving for 10 days. They are awakened at 4.00am, deprived of food and taught to medidate for multiple hours per day. Anyone who struggles with the process or becomes confused or distressed is encouraged to keep meditating. For those of you with even the most basic grasp of mental health and wellbeing, it will not come as a massive shock to discover that some people are affected very negatively by this process. I recommend you listen to the podcast but please be aware that it does not shy away from some very difficult material: there are people who have lost their loved ones to this process.

Human beings are social animals. We have evolved to live in groups and we know that extreme social isolation and withdrawal has a very negative effect on mental health and wellbeing in an extremely short time. The dangerous impact of solitary confinement is well-documented and has caused neuroscientists to campaign against its prolonged use in the penal system. Even good old-fashioned and ever-familiar loneliness has been proved to have a significant impact on a person’s health and longevity, never mind their psychological well-being. It should not surprise us in the least to discover that a process which demands people shut themselves off from each other and concentrate entirely and exclusively on the what’s inside their own head carries the risk of a psychotic break.

As part of my studies during my degree in Classics I did a course on the rise of Christianity in the Roman world. I recall reading an account of the life of St Antony by the Bishop Athanasius and being particularly struck by a passage that reports upon his demeanour when leaving a fortress in which he had shut himself for 20 years in order to commune with God and battle his demons. It reads as follows:

“Antony, as from a shrine, came forth initiated in the mysteries and filled with the spirit of God. Then for the first time he was seen outside the fort by those who came to see him. And they, when they saw him, wondered at the sight, for he had the same habit of body as before … but his soul was free from blemish, for it was neither contracted as if by grief, nor relaxed by pleasure, nor possessed by laughter or dejection. For he was not troubled when he beheld the crowd, nor overjoyed at being saluted by so many.”

While I do not wish to mock or offend anyone’s deeply-held beliefs, it seems pretty clear to me that this is a description of someone who has completely detached from other human beings and is suffering from the psychological effects of that process. While the religiously-minded among you may see this as an account of someone in touch with the holy spirit, I see it as an account of someone who is suffering from a psychotic break. Antony is described as being unmoved by and disconnected from the people around him, in possession of a strange kind of detachment. Given that he had spent 20 years in isolation while – in his mind – battling between good and evil, this is not greatly surprising.

During my final few years in mainstream education there was a big push on “mindfulness” for all students. This was what Tom Bennet was referring to in the Tweet I quoted at the start pf this blog and I share his concerns about this growing trend. The mental health of young people is a painful and emotive issue and has been brought into sharp relief once again with calls from a grieving mother asking for mindfulness to be rolled out across all state schools (although it is already being promoted and practised in many). As Daniel Bundred wrote on the same platform as Tom a few months ago, “Schools probably shouldn’t do mindfulness, because most teachers are fundamentally unqualified to lead mindfulness, and entirely unequipped to deal with the potential outcomes of it.” As he puts it, “Mindfulness strikes me as being very similar to guided meditation in approach and potentially outcome; how many teachers could handle a student experiencing ego-death in their classroom? Ego-death is a potential outcome of successful meditation, it’s not desirable in tutor time.” Daniel here is referencing exactly the kind of experiences that the young people who underwent a psychotic break at the Goenka retreats have experienced. This is of course the worst-case scenario and while not widespread it is crucially important consider if we are to stick to the concept of “do no harm”; the advocates of the Goenka retreat point to the many people who say that meditation has helped them, as if the handful of attributable deaths are therefore irrelevant. It is essential to remember that teachers (like the volunteers at the Goenka retreats) are not mental health experts; fiddling about with something as potentially profound and intimate as mindfulness or meditation is profundly dangerous and goes way beyond the remit of educators.

Beyond the enormous risk of potential harm to a student who may have experienced past trauma or may simply not be an appropriate candidate for mindfulness for a variety of reasons, there is an increasing amount of evidence indicating that mindfulness in schools does no good for anybody. A recent study revealed no tangible positive outcomes, which places the profund risk of harm to some in an even more alarming context. Why are we doing something with risks attached to it when there are no estimable benefits anyway? Beyond this, why are we demanding that teachers expend their time and energy on something unnproven and valueless?

Tom Bennet is right. As he puts it: “The best way to support children’s mental health in a school environment? Provide a culture that is safe, calm and dignified. With purposeful activities.” In our desperation to support the most vulnerable of children, we must never forget the simple power of providing routine, stability and boundaries for those whose personal and emotional lives may well (for all we know) be dominated by chaos, trauma and distress. The more we acknowledge that some children face the most horrifying of circumstances, the more essential the security of our education system becomes. School and the reassurance that its stability provides is a lifeline for many of our children. This is what we should be providing for them.

Photo by Colton Sturgeon on Unsplash

Self-talk

The importance of what we say to ourselves in our own heads has been highlighted to me in the last fortnight. A couple of weeks ago, I wrote about my reticence when it comes to travel, and found that – by the time I had finished my blog post – I had brought myself round to the idea of getting onto the plane. The very process of voicing my fears and then talking myself through the reasons that I was choosing to go abroad helped to turn things around for me, to reframe my perspective. This reminded me how powerful our own minds can be, what a difference we can make to ourselves when we take charge of our own self-talk.

Teenagers are particularly poor at self-talk, since their brains are still developing and they do not have the life-experience to have learned how to manage their feelings and their responses properly. Many young people who struggle with study can find themselves in a terrible negative loop of work-avoidance followed by beating themselves up for the work-avoidance, the result of which is such a negative experience that it only drives them to avoid the work even more. Many parents end up watching in horror from the sidelines as their child becomes more and more detached from their studies and less and less inclined towards motivation. I have written more than once on how tutoring can assist in breaking this awful cycle by demonstrating some easy wins to a child who has become convinced they can’t do something, thus sparking their motivation once they gain a small taste of success.

Yet negative self-talk is by no means confined to the young, indeed I am constantly reminded how prevalent it is in the adult population. Over the festive season I met with more than one friend who reminded me that many people say the most dreadfully negative things to themselves, and it worries me greatly. Believe me, I am not implying that we should all adopt some kind of ghastly instagram-meme-style positive self-talk: I have no truck with telling myself I am beautiful (demonstrably false) or brilliantly clever (I’m pretty average, like most of us). What I mean is that we would all benefit from checking the manner in which we speak to ourselves: the things that we say and the way in which we say them. A good general rule is this: if it’s something that you wouldn’t say out loud to a friend in distress, then why on earth are you saying it to yourself in your own head? Why should we expect ourselves to put up with insults and cruelties from our own internal voice that we would not tolerate from a friend or a partner? Would you tell an upset friend that she is being “stupid” or “pathetic” or that she needs to “get a grip”? No? Ok, then consider why you would not do such a thing. One reason, of course, is that it is not kind. But there’s more to it than that. Not only is it not kind, it is not helpful. We all realise that saying such things to a person in distress is the least likely path to resolution for them. Most people understand (either consciously or instinctively) that a person in distress needs space to talk and to express their feelings, affirmation and acknowledgement that those feelings are valid and understandable, followed then (and only then) by some support in getting those feelings into perspective. If you do this for your friends (as so many people do) but never think to apply those same principles to yourself inside your own head, then maybe it’s time for a re-think.

I have one friend who consistently calls herself “thick” when this is palpably untrue. She is a highly successful, well-qualified, interesting and capable woman. Yet whenever she can’t do something, is introduced to a new skill or finds something difficult, her default response is “it’s because I’m thick” or “I’m just thick, I don’t get it”. On one level, I don’t really think that she truly 100% believes her own words: when challenged, she will acknowledge that she is incontrovertibly capable in her chosen fields. Yet on another level, let’s just think about the fact that she calling herself “thick” out loud to me and to others and no doubt internally to herself, on a constant loop in her own mind. This simply cannot be healthy and nobody should do this to themselves. There are a million things I can’t do, have little to no natural affinity for or understanding of. I frankly never tell myself that I am “stupid” or “thick” as a result. Instead, I would say something like, “I’m not particularly good at that”. If it’s a skill I aim to acquire or at least something I wish to improve at to a basic level of competency, then I will say “I’m not particularly good at that yet – I’m working on it”. Some of this kind of talk is advocated by those who have bought into the “growth mindset” model, something which (like most things) started quite sensibly from an evidence-based model and mutated into an epidemic of box-ticking as schools across the country attempted to apply it at an institutional level. But forget growth mindset – there is much more interesting research to support the use of appropriate self-talk.

If you haven’t read Staying Sane by Raj Persuad then I highly recommend it. The book takes a radical approach to mental health by exploring the ways in which we can all guard against the tendencies towards anxiety, depression and other common mental health conditions. Persaud explores how everyone can support themselves and build their resilience for the future. He has a whole chapter on self-talk and one on being your own shrink. He scripts how you should talk to yourself when you’re experiencing feelings of distress or overwhelm and the first time I tried it I could not quite believe the difference it made. It was genuinely extraordinary. But when you think about it, why should this be so surprising? It actually makes perfect sense. Imagine again the scenario in which a distressed friend is sobbing her heart out, saying she feels lonely and anxious. Then picture yourself telling her to shape up and stop whingeing, that her tears are embarassing and pathetic. It’s genuinely unimaginable, isn’t it? Simply and utterly awful. Nobody would do this. Yet this is what so many people do actually say themselves in their own heads. In place of this kind of self-abuse (for this is what it is), Persaud advocates talking to yourself along these lines: “you’re feeling really upset, and that is perfectly understandable because X has happened and/or this situation has triggered memories of Y. Hang in there. This feeling will pass. You just need to ride out the storm.”

The first time you try it, it feels a little strange. However, I guarantee you that the impact will be so great that the strangeness will wear off immediately. Being your own friend is a far more sensible approach than giving yourself a kick up the butt every time you’re having a bad day. Since when did that particular approach work for anybody, ever? So, if you recognise yourself in any of this, maybe it’s time for a belated New Year’s resolution: stop talking unkindly to yourself. Stop insulting yourself. Stop saying things to yourself that you would not say to anybody else and start saying the things you would say to your friends when they need support. It’s the least you can do for yourself and a better path to sanity.

None of this has anything to do with smug self-satisfaction or any kind of conviction that you are anything more than an ordinary person doing your best. All Persaud advocates for is affording yourself the same kind of empathy and dignity that you would afford to others. “Do unto others as you would have others do unto you” is a mantra repeated several times in the Bible and can be found as a principle in most major world religions. It’s a great mantra. Yet quite often, especially for people who have habitually negative thought patterns, the saying really needs turning around. “Do unto yourself as you would have yourself do unto others”. Be kind to yourself. Be strong for yourself. Be understanding of yourself. Trust me, it makes life a whole lot easier.

Photo by Adi Goldstein on Unsplash