Borris House in Carlow, scene of last weekend's Festival of Writing and Ideas
I missed the start of the conversation between Michael Harding and AC Grayling that was one of the highlights of the Sunday of the Borris Festival of Writing and Ideas. (Will write more on the festival later). I was there for the end though, when Grayling recited a poem in Chinese. This is the translation I wrote down quickly:
"We awake expecting to see the blossoms of Spring
Only to find the rains of autumn are already falling"
I like this, and thought perhaps that Leonard Cohen was right when that "a single line of Chinese poetry could change forever how blossoms fell". I went looking for the poem on Google, but couldn't find it. I found this though, which may be the same poem, translated differently.
"I slumbered this spring morning, and missed the dawn,
From everywhere I heard the cry of birds.
That night the sound of wind and rain had come,
Who knows how many petals then had fallen?"
And it is my life, right there. Everything. It's not that there any flowers left. I'm not infirm, yet. Many would call me a young woman, but only if I did something like die. Forty is young to die. It's old to do most of the things I want to do.
Now is the afternoon, when others' thoughts are turning to rest and the evening. They have done the work, some rising even before dawn. Their garners are full for the winter ahead, their young around them.
This is envy, a self-destructive emotion. I have thing that others envy and there is no balance-sheet in the sky. There's no metric for a good life, for happiness. I've been trying to follow Paul Dolan's advice in his excellent book "Happiness by Design" and focus less on the evaluating self which tots up the points on the life-satisfaction inventory and look instead at what I'm doing every day, at the experiencing self. I'm trying as well, relatedly, to consider how it feels more than how it looks when it comes to making decisions.
And I feel always that it's too late. And I feel always that I can't give up. And I know the most dangerous way of all to think of your life is that it's like a story. Especially a story from a film. The movies have spoiled us all into imagining narrative arcs where there is only rational chaos. I think, is this the critical moment, the turn of the screw, the second challenge our heroine must face and if she succeeds we will have resolution and the falling action of contented old age. This all depends on the screenplay and all too often I sit back and wait to see what will happen. All around me I see confirmation that for most people, like in most movies, there's a reasonable chance for a good outcome. These observations aren't a reliable guide. I could, for example, be the only one of my peers whose film is playing at the art-house cinema instead of at the Omniplex.
I got lost on my way to Borris. I got lost on the way home. I sought the meaning of trying to work out a shortcut instead of going the suggested route. On the way home I had decided, decided I tell you, to take the Waterford route only to get to the first T-junction and take the other road. I expend myself in such useless challenges, like trying to break the six-stone barrier (My goal when I was twenty). These roads were built that way for a reason and you have to accept risks if you turn off them.
What's my useless challenge now? I spent a long time navigating the Carlow/ Kilkenny countryside, driving in circles through the narrow streets of the confusing towns, thinking I was on the right road, thinking wrongly that I was on the wrong road, doubling-back and sucking it up, and eventually I re-joined the main road and then I knew where I was and could breathe.
I'll never known what might have happened if I'd stayed on the road I'd decided on. I'll never see the petals that bloomed while I slept, though I torture myself with imagining. What would really be unreasonable would be to go back to bed in a huff, or to forget that soon enough the rain and the wind will truly and earnestly blow all signs of life away.
"Probably nothing is more universal than the experience of stress. Nobody gets through life without experiencing physical pain, illness, disappointment, or loss. The specifics may vary, but the underlying experience is a human as it gets."
This is the week the State exams begin, and every article you read about them contains some version of the advice "chill out", or worse "it's not the end of the world". The ESRI even brought out a report this week on the harm that stress is doing our students, especially the girls. Great timing.
Stress is toxic. It damages girls' performance in exams, and when they get a bit older, damages the performance of their ovaries. Every article you ever read (if you read them) about fertility will include the importance of avoiding stress. Advice about skin conditions tends to say the same thing. Not to mention mental health, where a whole industry has been built around the notion that stress is bad for you.
So how happy was I when I clicked on the Twitter link to this 2013 TED talk by Kelly McGonigal? I was soon a fan, looking at other talks and interviews she's given and ordering her book "Maximum Willpower" (for some reason not published in Europe under its original title: "The Willpower Instinct"). "Maximum Willpower" is now one of my favourite self-help books, and I've been awaiting the publication of McGonigal's follow-up "The Upside of Stress" with anticipation.
This is a much quicker read than "Maximum Willpower", a book whose density of research findings belies its bargain-book title. "The Upside of Stress" has also got a touch of the Louis Theroux about it, as there are several vignettes of McGonigal in this lab, or meeting that researcher, or going for a run with a group of teens and adults. It's what you'd expect from Michael Mosley or Alice Roberts; you know, here I am in an MRI machine/ here I am on a zip-wire so my saliva can be tested afterwards. There's lots of that here and it kind of reminds me of a tv tie-in book.
The overall premise of the book is revolutionary, yet entirely common sense. In fact, it proves the saying that common sense isn't that common at all and that things we think are common sense are closer to nonsense. We all know that stress is harmful, we just know it at this stage. We know we should avoid stress, yet we fail. For anyone who's ever had a brush with mental illness, the spectre of stress is especially frightening, as we are told that part of minding ourselves means minimising stress in our lives.
What if all these things were wrong? Much of what McGonigal writes is convincing. The best example is also the simplest. You know the stress response you get before standing up to speak in public, or before sitting an important exam? The butterflies and the shakes and the racing heart? This is your body helping you rise to the challenge. It is to be welcomed and harnessed, not suppressed. I have tried to do this when faced with insta-stress such as last Thursday when making a speech in front of the entire staff. It is hard to do, really hard to think "this is my heart giving me courage" rather than "must.calm.down.or.else" and I can't say it worked 100% but I think it helped.
Although novel, this is unlikely to cause controversy. Most of us can see that kind of stress response as not that harmful to health. We're more likely to label chronic stress as harmful, or else traumatic stress from a major event. What about the stress of "suffering"? Here McGonigal's claims seem a little wilder. Even the most stressful of life events have an upside. There is a danger here of Nietzsche-inspired complacency towards the suffering of others and one of the papers she cites is actually called "Whatever Does Not Kill Us". There is a caveat that this research showed a U curve where experiencing extreme adversity harms much more than it benefits. It may be more accurate to say "what challenges us beyond what we thought we could do makes us stronger" but that's not quite pithy enough. Rather than The Upside of Trauma, the section on serious suffering is better looked on as suggestions on how to deal with the aftermath of decidedly undesirable events. For example providing opportunities for volunteering can lessen the impact of PTSD. She does admit that "in some cases, stress is harmful" and writes that childhood abuse, for example, can impair the "tend-and-befriend" instinct. You have to look hard for these admissions in the book, but they're there. The breezy tone can sometime be at odds with the subject matter; a section dealing with child survivors of the Rwandan genocide is an example. This cheeriness can be a double-edged sword. On the one hand, she's probably been advised to lighten it up and increase the anecdote-to-science ratio to ensure the book's commercial success. On the other, it risks making the book's thesis easier to dismiss by those who make decisions in healthcare and other areas.
And it is an important argument. I have written earlier about the prevailing dread of stress that exists in the Irish education system, but McGonigal writes of the importance of "stress inoculation". Young people, and even children, need to experience some stress in order to activate their own resilience and, I would add, to learn from adult models how to deal with stress. Therefore we shouldn't be too worried about the fact that children experience stress. The notion that children should not be under any stress at all leads to policy being dictated by inane studies that ask children what the greatest source of stress is in their lives. Predictably they mention exams (the Junior Cert is a negative form of assessment, which causes stress), making friends and the transition to secondary school. This last is now perceived as a huge problem mostly on the basis that fifth and sixth class pupils report it as their main cause of stress. Seeing stress as less of a problem and more of a learning opportunity in itself would not only ease the transition but would help reverse the trend to making secondary school more like primary.
Fear of stress also permeates advice given around mental health. "Recognising and managing stress early will help prevent it leading to more serious problems such as anxiety, depression or high blood pressure" says the HSE's own mental health website. The notion that stress can be "managed" is slipped in there very innocuously but is perhaps the most dangerous stress belief of all. It's what keeps thousands of people chasing their own mental-health tail, caught in a never-ending personal campaign to protect their fragile mental health (yes, the HSE actually sponsors ads that tells people their mental health is "fragile), curtail the amount of stress they're under and dampen down their stress response through endless relaxation exercises.
A typical memory I have of my time in mental-illness care is being told to be "a human being, not just a human doing". I was exhorted to spend time "just being", even though I was unemployed at the time and really, really needed to spend more time "doing". If I started a job or a course, at the first hint of trouble I'd be encouraged to quit or drop out on the basis that "nothing is more important than your health".
This is where a book like "The Upside of Stress" would have come in handy. The difficulties I was experiencing could have been reframed as training in resilience. I have also come to realise that "put your health first" is often a euphemism for "put the organisation first". Quitting is promoted as an act of self-care, when perseverance might be the more selfish, yet wiser move.
While I think the book has much to offer the individual, I shudder at the ends to which this research might be put. McGonigal writes early in the book about a "mindset intervention" as a company was about to make 3,000 employees redundant. Such interventions are fine if conducted by a disinterested, outside party such as a group of researchers. They're less cosy and more creepy when sponsored by the companies themselves or used as subtle advertising by mental-health groups. No company or institution should think that it's okay to rack up the stress on employees, or others, or that a "stress mindset intervention" cancels out inhumane or unfair practices.
What I like most about "The Upside of Stress" was its link between stress and meaning. Meaning, or purpose, is the true upside of stress. And meaning can come from choice; either a project of our own choosing that we know will incur an inevitable amount of stress, or the choice to respond to stress in a the best way you can.Quitting your job or dropping out of a course or giving up on a goal for the sake of your health can make that health seem fairly meaningless. McGonigal writes "Rather than being a sign that something is wrong with your life, feeling stressed can be a barometer for how engaged you are in activities and relationships that are personally meaningful". When you have no meaning, then even small amounts of stress seem unbearable and learning is hard.
So the title of the notes books "Less Stress, More Success" is totally misleading, not just when it comes to exams but in life in general. That's not to say that "More Stress, More Success" is necessarily the case either, or that stress is all good. "Seeing the upside of stress isn't about deciding whether stress is all good or all bad. It's about choosing to see the good in stress can help you meet the challenges in your life."
My resolution for June is to embrace stress and see stressful events (past and present) as learning opportunities. Funnily, this last resolution (learning from stress) is one that has driven me absolutely mad when others have suggested it to me. It can be very, very insensitive and ill-timed, so I'm going to recommend you actually read this book for yourself and maybe give it to other people when they're not actually in full-stress mode.
We'll see how well the stress-embrace is going in two weeks time when I'll be waist-deep in Leaving Cert exam scripts.
It was my best friend's fortieth birthday. My own is fast approaching. We were walking through our local department store, looking at the fancy face creams. I am a product junkie and spend far too much money on jars of gunk that never live up to the promises on the lovely, embossed cardboard boxes.
My friend is a pharmacist and in a successful effort to avoid temptation I asked her "Is it true that if any of these worked they'd be on prescription?".
"Absolutely" was the reply. "If they did what the claim to do [reverse skin damage, slow cell degeneration] that'd be a medical effect and there are no effects without side effects."
When we think about psychotherapeutic interventions in education, we shouldn't seek reassurance in studies showing that this therapy or that therapy is effective in a clinical setting. Rather any such effectiveness should be taken as a warning that such an intervention is probably unsuitable in schools. School is not, and never will be, a clinical setting. If something is potent enough to have a measurable and predictable effect, then its effects on the general population (who are fine) may be, on balance, negative. Its effects on the vulnerable, when administered outside a clinical setting by people whose training is in an entirely different discipline, may be catastrophic.
Nick Rose (@turnfordblog) has written recently on proposals to utilise Mindfulness Based Cognitive Therapy on a widescale basis in UK schools. Rose writes on his http://evidenceintopractice.wordpress.com blog that:
" My concern is that CBT and mindfulness are forms of psychotherapy which are being gently scaled into schools in the name of developing ‘resilience’ or ‘well-being’....Part of the push towards psychological interventions in schools (I’d include ‘Growth Mindset interventions in this list) is to develop children’s self-regulation strategies and improve attainment. If the suggestion was to offer low doses of a therapeutic drug to help children in school, teachers would be up in arms – yet, we appear remarkably blasé when low doses of ‘talking therapy’ are being offered. If the aim is to improve well-being, then there are still important questions to answer. Do all children need psychotherapy to maintain their well-being within school? How do we screen for the children who would benefit from a psychological intervention and which children would not – and most importantly, children for whom it might have a negative effect?"
I don't have experience of MBCT but to me it seems entirely sensible. I have never found the traditional CBT description of thoughts as "negative" convincing. I have met people in hospital and elsewhere plagued with the conviction that if only they could control and eliminate these negative thoughts then they would be restored to health. Except such control and elimination are impossible.
My own experience is with Dialectical Behaviour Therapy, a forerunner of MBCT. It is currently being rolled out around Ireland within a mental health care setting, a move which I wholeheartedly welcome. I was dismayed, however, to hear Marsha Linehan, speaking at UCC last year, refer blithely to plans to extend DBT "into the schools".
Those who work in mental health promotion, like those who work for campaigns for sexual health, road safety and drug-abstinence often see schools as a golden opportunity. All those malleable young minds with nothing else to be doing all day besides absorbing healthy messages like "just say no to drugs/ binge-drinking/ unsafe sex/burning fossil fuels". Nothing new here.
The move to embed mindfulness in the curriculum is a new departure, one that sees the lines between education and mental health-care provision blur to obscurity. This is not psychotherapy in schools for well-being, this is psychotherapy in school for learning. Learning and well-being are increasingly seen as one and the same thing. The highlight of this year's Feilte Irish Festival of Education is touted as a panel discussion of Well-being featuring educationalists and teachers such as Bressie and Eoghan McDermott. It's the Mind, Body, Spirit Festival brought to you by the Voice of Ireland and sponsored by the Teaching Council.
Interventions like mindfulness are seen as entirely benign, to be rolled out in school by teachers with little or no training or else by outside facilitators. A private enterprise, Bright Sparks Coaching, is offering a two-hour course that will allow teachers to "understand [mindfulness'] application in the classroom". The work of this company is supported by education centres and they have conducted "mindfulness training" in schools. Their website states
"The ability of children to be able to self regulate has a profound impact on their ability to learn. It has been proven that negative & destructive emotions inhibit our ability to learn and hold information. It is therefore an invaluable asset to teach our children the ability to recognise and manage their emotional lives. Furthermore it is now understood that our brains are elastic and continues to grow, develop and shape itself throughout our childhood and adolescents. During the process of growth, our brain has the capacity to be shaped and wired in a way that supports the development and activation of Pre Frontal Cortex, which is responsible for the integration of all areas of the brain that create optimal health."
Brain words and neuroscience aside, the idea that this intervention can sort out children's pesky emotional complexity and "negative emotions" so they can learn better and faster is naïve in the extreme. The reference to "negative and destructive emotions" is also a red flag to anyone even slightly acquainted with mindfulness, as one of the primary aims of the practice is to not judge emotional states or classify them as harmful. The first item on a list of the benefits of mindfulness training in schools is that it "saves time". Yes, it's annoying how much time and patience goes into teaching and learning. How convenient it would be to have a class of thirty little Zen masters with rapid-growth mindsets and bullet-proof resilience.
For most students the worst outcome of mindfulness training in school-time is the opportunity cost of educational time. Some may even derive modest benefits, but those benefits have to be weighed against the potential harms. What about students who could benefit the most from mindfulness training? Shouldn't they get the training in school, where their lack of mindfulness is having an undeniable impact on their education? Not if you consider the reasons that children come to school with a mindfulness deficit serious enough to be interfering with their learning.
If we look at where mindfulness interventions have been successful clinically, we can see that a mindfulness deficit is associated with trauma, depression, eating disorders and other serious issues. Linehan's "Skills Training Manual for Borderline Personality Disorder" reports that approximately 75% of the patients who met the criteria for the original intervention had been sexually abused. Emma Seppala at Stanford University recently reported meditation as a successful intervention for combat trauma. This is potent, serious stuff and we should, as Rose, suggests, no more think of applying it in schools than we would hand out psychoactive drugs in the canteen.
Linehan writes "Mindfulness to current emotions means experiencing emotions without judging them or trying to inhibit them, block them, or distract from them. The basic idea here is that exposure to painful or distressing emotions, without association to negative consequences, will extinguish their ability to stimulate secondary negative emotions". Eliciting painful emotions while protecting vulnerable people from their negative consequences is a hard task for a trained psychotherapist. Eliciting painful emotions in an SPHE discussion, or encouraging them to surface in an RE guided meditation, and sending a child off to Maths when the bell rings borders on cruelty. Allowing mindfulness trainers (no matter how vetted and qualified) into schools to offer psychotherapy in a whole-class setting is irresponsible. We must remember, always, that the students we know are at risk are not the only students who are at risk.
As my friend pointed out, if things work they need to used judiciously and their supply controlled. I believe that mindfulness based interventions can offer much to young people who need them, and that an important benefit is that it can enable them to be present (physically and psychologically) enough in school to gain an education that will give them the same life chances as their peers. But teachers are not the people to do this, and school probably isn't the place to do it in. Mindfulness for teachers themselves is probably a good thing and I don't doubt that a mindful approach to teaching can be as useful as a mindful approach to any job. But implicitly fostering mindfulness in the classroom is quite different from didactically teaching its precepts as scientific fact, or attempting lift-all-boats interventions that are ultimately amateur, unstandardized and potentially harmful.
Postscript: I wrote the above post before Feilte 2014 which featured Ann-Marie Ireland from www.chilloutireland.ie. ChillOutIreland appears to be a similar business to Bright Sparks Coaching, but has achieved much greater influence and acceptance within Irish education.
I've been looking at www.juniorcycle.ie instead of getting a life and enjoying the holidays. I mean, I am enjoying the holidays but feel compelled to season this enjoyment with the piquant sting of looking at where Irish education is headed. I blame the Twitter. We really should have a gentleman's agreement to suspend school-related content, at least for August.
One thing - among many - that strikes me about juniorcycle.ie is the recurring reference to students as "learners". For example:
-"learners' overall well-being must be supported alongside their intellectual development."
-"This skill [working with others] helps learners develop good relationships and to appreciate the value of cooperating"
-"The learner's junior cycle programme builds on their learning to date and actively supports their progress in learning"
I've been asking myself where I stand on this. On the one hand, I'm all for it. It's not ungrammatical and it reinforces the idea that that's what school is for: learning stuff. Learning is also something students do for themselves, so the emphasis on learning and learners should, in principle, recognise the responsibility of students for their own effort.
So far, so positive. A little doubt niggles away at me that the intended benefits of renaming students as "learners" may soon be lost. I'd say it'll be lost the day they start referring to themselves as "learners". For example we might soon hear "We, the learners, demand that our individuality be recognised and catered for through personalised learning" or more likely "We, the learners, object to the removal of Lucozade from the vending machines". When we make "learner" a synonym for "student" the word no longer implies that the learner is doing any learning. Soon all you will have to do to be a learner is enrol in, and perhaps attend, a secondary school. I can think of a few pupils I've had, particularly early in my career, whose school life was unfortunately not characterised by learning but by other activities.
You might say the same about "student", which implies that the person does some studying. Again, this term is presumptive but nowhere nearly as much as "learner". You can study without learning anything, if you study badly. For example you could read a chapter of "Discover History" ten times the night before a test. You'd have studied but it's unlikely you'd have committed anything to your long-term memory. I would say, in fairness, that all those in secondary school do some study, at some point. If you're studying you know you're studying but if you're learning you don't necessarily know you're learning. I don't mean this in an "I'm having so much fun in this engaging, group activity that I didn't notice the stealth fact-attack". I mean learning happens at a subsensory level and we only really know we learned something when we try to remember and succeed. "Trying to remember" itself could be a sign of partial, or imminent, forgetting.
Learning is hard. It takes a lot more than just showing up for school (though that's a start that far too many are failing to make).
When I was in school "students" attended third level. We were "pupils" as we were still in prison at school. As far as I know that's how children in primary school are still referred to. I can see why we've moved on from there as the term, at least to my mind, does not recognise the input a person should, by the time they're a teenager, be able to put into their own education. I'm sure there was an analogy in "First Aid in English" that said "Teacher is to pupil as shepherd is to sheep", or "Pupil is to teacher what shrub is to gardener". So I'm fine with "student" as long as it means secondary student and not "young adult who's entitled to wander in with a take-away coffee and take an
à la carte approach to the timetable".
I've noticed that I've begun to use "learning" quite a bit, especially in language classes where methods of acquiring and practicing new vocabulary are taught as a matter of course. I talk about becoming an "effective language learner", as acquiring another language requires effort and technique. But the key word here is "becoming". MFL is one of the few areas that the phrase "learning to learn" has meaning. The skills of language-learning are almost infinitely transferable, a reason why there's absolutely no need to worry if a student chooses a language other than their parents' preferred option.
Really though, "learning to learn" is a misused aphorism that confuses "learning to drive" and "learning to swim" with what students do in school. Students in school learn (hopefully) and the more you know, the easier it is to learn new things. "When it comes to knowledge, those who have more gain more" Daniel Willingham writes in "Why Don't Students Like School" There are more and less effective ways of studying but learning itself, thankfully, is an innate ability of the human brain. You don't need to learn to learn, any more than you need to learn to think
"Learning to learn", if interpreted as it is here by former Minister Ruairi Quinn at 2 minutes in, has the potential to seriously damage education. The phrase can be used to suggest that it doesn't matter what students learn in school as long as they're learning the skills of learning. Quinn for example states that "learning to learn" has taken over from "learning to remember". This new definition of learning does not seem to involve memory, which is extraordinary. Students can leave school with no knowledge as long as they have acquired the skills of learning. Of course, as teachers, we know this is nonsense as you can't acquire the skills of learning by any other method than practice and if you've learned something you remember it. Nevertheless the concept of learning without remembering persists. Take today's call from the ESRI, for " a greater use of project and team work to equip young people with the type of skills they need for lifelong learning and the labour market". Whether it's Chinese or Klingon, programming or origami, European geography or the Enneagram- so what? School is really only an apprenticeship for the adventure that is life-long learning. As such it doesn't really matter what learners do or if they do it badly. We'll allow for false starts and abortive attempts. If a child does a project on earthquakes and still can't tell the Richter scale from the Beaufort, does it really matter once he or she has selected an area of interest, done some collaborative research and produced a nice multi-media presentation? After all, we don't have teenagers in charge of monitoring these things.
Does this change in language matter? I'm not sure. I know that teaching in a single-sex school obviates the need for a term for our charges as we universally refer to them as "the girls", and our counterparts in the other-gender school across the road refer to "the boys" or"the lads". Colleagues at mixed schools do tend to use "students" more often. Very few use "pupils". Will "the learners" catch on, outside of official literature? I think it could be case of the Department attempting to make something so, by saying it is so. If we phrase things so it sounds like children are taking responsibility for their own education, they'll step up to the plate. And if we call all the young people enrolled in our schools "learners", well they must be learning something.
We have been told for a few years now that "teaching" is a bit of an old-fashioned idea. It was a kind of custom prevalent in less civilised times, but will soon be relegated to its rightful place. It won't be eradicated but will exist beside the much more important "learning". Like many teachers, I've had the pleasure of a Whole-School Inspection. Ours, which took place last year, was of the MLL variety. That is it looked at the quality of management and teaching in the school, and also at the quality of "learning" that was going on. I have sat at a conference where a school principal asked everyone in the room to consider, then pair n' share, what we felt good learning looked like. I've attended a Learning Schools Project event where the chairman of The Teaching Council admitted that he doesn't like talking about "teachers" and how in the future, we will distance ourselves even further from this arcane idea. "Teaching" to "teaching and learning" was only the first step and in future we will refer to "learning and teaching". I think there will be a fourth step and can guess what it is.
Talking about learning is important, and the more we know about the subjective experience of learners, the more it appears we are mistaken in our belief that they hear what we think we're saying. Recategorising pupils and students as "learners" is welcome if it in recognition that their own efforts are as crucial to their achievement as the is the quality of teaching they receive. But sometimes I feel this focus on "learning" is less about student behaviour and more about a profession that is gradually assimilating public opinion that sees teachers as irrelevant and possibily obsolete.
I bring this up because I've been reminded lately of a thought I had following an inschool talk ( you know the ones) that informed us that we needed to stop thinking we knew more than the learners did, and that we had to move towards being "guides on the side", that everything now was on google anyway and that we would need to be developing twenty-first century skills. Imagine if a UFO landed outside a bingo hall and that was the aliens' first experience of human society. Well this was our first experience of EduSpeak Bingo and we didn't even recognise it, let alone have our cards and markers ready.
"Wow" I said after the speaker had departed, "Now I know where I'm going wrong with my Ordinary Level fifth years." I didn't really think I was going wrong at all. My OL fifth years were a lovely group of co-operative individuals whom I taught in the library for want of a free classroom. While good-natured and diligent, self-starters they weren't and motivating and inspiring them could be a challenge. "Wow," I went on " I know now that I should just stay in the staff room. In no time at all they'd be tearing the books off the library shelves, eager to teach themselves all about poetry, and then they'd be so excited they'd start writing essays comparing the books they'd read".
Now we did use the library, and I'm a huge believer in school libraries. They are a fantastic resource and should be funded, supported and used. Every few weeks the students would take out books. We used to spend time in class reading silently, me along with them and I'd try to get a discussion going about which books they liked and which they'd recommend to the others. It was a struggle but a worthwhile struggle and I wasn't overly bothered that the first chapters of all the books were much more dog-eared than the final chapters. The library was for pleasure, and I wasn't going to dilute that pleasure with admonitions about finishing what you'd started or seeing things through to the end.
Now I learn that my school is to introduce "library classes" across the school from next September (as we teachers are fond of calling the third week of August). We are not alone in this: I know of at least two other schools in the area that are introducing, or have introduced, such classes. Students will be obliged to keep a log of their reading and it is yet to be decided if further proof of finishing the books will be required. The students will be supervised during this time in the library by a teacher. The rationalisation is that by being invited to read for pleasure during the school-day, students will become hooked on reading and will read for pleasure at home as well. The motivation for the initiative is to promote reading, to raise standards of literacy and by doing so raise academic standards because we all know the French got it right when they said "Un enfant qui lit, est un enfant qui réussit" (a child who reads is a child who succeeds).
I'm delighted with this, as it means I will no longer have to give up precious English class time down in the library. But I wonder if we might have a bigger impact on the literacy of our students by adding not a library class to the timetable slot - that has become available due to the withdrawal of a one-class-a-week subject from the curriculum - but a regular class. A class where they would learn about a subject, under the expert guidance of a specialist teacher in that subject. It could have meant an extra Maths class, or an extra Modern Foreign Languages class or a History or Geography class. I would love an extra English class of course, but the school is thankfully already generous in our allocation. There was a time when schools could include study classes on the timetable; a time for students to get ahead on their homework and benefit from an extra forty minutes of evening freedom in which to watch television, walk the dog, chat to their siblings or even read.
Study classes are now verboten, as all students must be gainfully engaged in active learning for the entire school day. So why is it okay for students to go the library and read books? It is because of the belief that reading books is an important factor in academic achievement.
Last year a colleague and I attended the first round of in-service training linked to Junior Cycle English. The facilitator was adamant that silent reading, and the promotion of "reading for pleasure", was worthwhile and should be a priority for schools. Her rationale was that studies had shown that children who read a lot of books for pleasure are likely to achieve more academically than children who don't do much reading. She didn't have any of these studies to hand. (I have noticed that, as humanities graduates, English teachers are expected to believe anything if it's prefaced by an authoritative "research shows....".) A few present tried to argue that there all sorts of reasons that reading and academic achievement go hand-in-hand. Their reasoning was that correlation is not causation and having lots of books at home, fewer televisions and more interested parents was likely to lead to both more reading and more learning. They got nowhere as promotion of reading as a strategy to raise literacy and facilitate achievement is now Policy. The Specification for Junior Cycle English has a specific Learning Outcome that students will "engage in sustained private reading as a pleasurable and purposeful activity".
I remained silent because I couldn't formulate my own objection. On the one hand, I believe part of the appeal of reading promotion stems from the covert realisation that the Specification for Junior Cycle English does not cater for the able student. I don't mean students on the G&T spectrum, I mean any student of even slightly above-average ability. An emphasis on private reading allows these students to make progress at their own rate as they can read books more suited to their reading age and interests in addition to the material covered in class. They can read whole books rather than excerpts, and can read long novels. (I'm not suggesting that long novels are better or harder than short ones, just that texts read in class will now be short novels only as the stipulation is to read so many). By making the teacher responsible for the private reading for pleasure that students do at home, it appears that these students are being challenged and developed.
However, my greater objection is that my friends may have been mistaken in their insistence that "correlation is not causation". What if there actually was a causative link between reading and academic achievement? But what if that link were in the opposite direction than that supposed by the SLSS and the NCCA? What if those children were good readers because they had learnt lots of stuff, including the meaning of lots of words and how words work? How then does private reading for pleasure foster academic achievement? Might it be the other way around? As I listened to the facilitator enthuse how private reading would expand the horizons and aspirations of unmotivated students and how reading would lift children who had more electronic devices than books in their bedrooms into the realms of the "word-rich", I got a funny feeling in my stomach. Somewhere, something was missing. I had been an avid reader as a child. and as a young adult and I was able to read hard books because I knew enough words and I'd learnt enough about history and other subjects to make sense of what I was reading.
I knew from reading Doug Lemov's "Teach Like a Champion" that enthusiasm for reading as a panacea for low achievement was not universal. It was this blog-post by David Didau however, that articulated and shed light on my misgivings.
On the blog, and again in his practical book, "The Secret of Literacy", Didau writes the following about silent reading as a school practice:
...Pupils who are good readers experience more success, which makes them want to read more. As they read more, they become even more successful at reading. their vocabulary and comprehensions grows. Hey presto! a virtuous circle. Readers who struggle with decoding or who have poor vocabularies are unlikely to want to expose these weaknesses by picking up a book. they get much less practice and the gap opens and widens. Silent reading is a lovely experience for the word-rich...For the word-poor it becomes an exercise in trying to disguise the fact that they're holding the book upside down....Silent reading looks like a good idea because it gives pupils the space and time needed to read. What it doesn't do is help poor readers become more fluent, and is therefore doomed to failure."
"Doomed
to failure" seems a bit strong but is justified if the promotion of
private reading is considered a device to lift literacy across the board. I
have heard reading classes credited with increasing vocabulary but
Didau claims elsewhere that a reader must understand at least 95% of the
surrounding content to be able to infer the meaning of an unfamiliar word. Thus
reading becomes a vehicle for the
Matthew effect, whereby the rich become richer and the poor become poorer.
So how far do the library classes, wherein students choose their own books and read them under the supervision of a teacher who may or not be a teacher of English enforce the Matthew effect? Let me say first of all that the wealth and poverty alluded to in the Matthew effect are not quite analogous to economic wealth and poverty. Vocabulary is not a commodity. If a class encounter a new word and only three students learn its meaning, their learning is not tenfold what it would be were the whole class of thirty to learn it.
However, if we say that the most capable students learn the most in library class, is this at the expense of their classmates? It is at the expense of some, who would be better served having a normal class. And the learning in library class is at the expense of students who are find reading exceedingly difficult. Being given free rein in the library is an experience of confirmation that reading's too hard and not for them. It comes down to proportions and how confident we can be that a significant number of students has reached a reading level where they can benefit.
I am not against library classes, along as certain caveats be observed. One is that the teacher in charge of the class is there not just in a supervisory capacity but encourages the readers and when necessary, nudges students towards books that are hard enough to challenge or easy enough not intimidate. The other is that these classes be targeted as opportunities for Resource or Learning Support provision where appropriate. And lastly, library classes should not be a given on the timetable but should be reviewed annually and revert to normal classes if appropriate.
School management everywhere are under pressure to max out teachers' timetables before another teacher can receive as much as a minute's employment. Cuts to the pupil-teacher ratio and the abolition of allocations for most special programmes mean that principals and deputies have less and less wriggle-room. Library classes, or any class where a teacher can be deployed regardless of subject speciality, can make things slightly easier.
Do we view reading as a factor of achievement, rather an achievement in itself? A factor that has been weighed and valued, along with background and motivation, and now it seems to be ranked above teacher instruction. I prefer to think of reading as a product. I don't mean "product" in its industrial sense, but in the sense of the eventual outcome of our endeavours. I want my students to achieve academically, I'm in favour of the retention of an exam system and I want my students to do well in their exams. I do not, however, see encouraging reading as a factor in their success. I see what they've learned in the process of studying for exams as a factor in their reading development, a development that can continue long after they have left school.
So when students go the library, as they will be doing for forty minutes every week, I don't want them to see what they're doing as an academic supplement. I'd rather they see it as a taster for the freedom they will have, after school, from the constraints of lists of prescribed texts and enslavement to the teacher's preferences. And I wish we'd stop telling children, and their parents, how important reading is. "Important" is taken to mean "important to learning" when really it is learning that is important to reading.
Reading, at least to my biased English teacher's mind, is important to life. And life is much, much more important than exams.
Next month is May, mental health awareness month. Already green ribbons are appearing in my Twitter feed and my blood pressure is starting to rise. I originally called this post "why I won't be wearing the green ribbon" but then I looked at the website www.greenribbon.ie and thought, if all you're looking for is people to talk about mental health, then I'm up for the challenge. I think we do need to think about mental health, but we need to think critically about what we're told, and we need to be scrutinise how the mental health agenda is promoted in schools and to young people generally.
At least they remembered the apostrophe
I can't understand how so many people, including people whose views I normally admire, are so gung-ho on the notion of mental health and the need for mental health awareness campaigns. How can I be so wrong and so out-of-step? Don't I care about how many people are dying by suicide? Don't I care about the numbers of children in adult psychiatric care? What about stigma: don't I want to reduce the stigma around mental illness? Aren't these all important issues? I do care, what I don't do is share the conviction that mental health awareness campaigns are the answer to any of these issues.
Suicide, adult units and stigma
Reducing the number of people who die by suicide is a hugely complex area, as the reasons people take their own lives are myriad and all these reasons are have to be dealt with separately. I am not an expert in this area so will confine my comments to suicide among psychiatric patients and recent psychiatric patients as this was the category I fell into at the time of my own suicide attempts. Better services are key, and by better I don't mean "more". In fact less is often more; in particular the practice of prescribing anti-depressants to those aged under twenty-five must be curtailed as much as possible. By better services I meant services whose goal is to minimise the long-term contact the patient has with mental health services over his or her lifetime. A real recovery where patients leave the system altogether, rather than a recovery approach that orients them to a lifetime of patienthood. It is good to see DBT being rolled-out nationally and this, I believe, is a step in the right direction. I take issue of course with the Irish Times' inaccurate description of DBT as a "new treatment". It has existed, in more or less its current form, for the past twenty years. Imagine if the HSE suddenly made a life-saving drug available to Irish patients after it has been on the market and proved to be safe and efficacious in other countries for twenty years. Would we call that drug a "new drug"?
While the admission of children to adult psychiatric units is certainly a problem, we have to avoid the simplistic conclusion that the country needs a raft of dedicated child-and-adolescent inpatient psychiatric facilities. Hospitalisation should be a last resort and if it is decided there is need for such a facility I would favour a national centre of excellence rather than have children treated in small, paediatric units in adult facilities.
What about the stigma surrounding "mental health"? I don't like the word "stigma" in this context as it suggests something attached to the sufferer. "Prejudice" might be a better word, as in the public are prejudiced against people with mental health problems. I certainly experienced prejudice, most notably from the college radio station who told me I couldn't volunteer there any more because I was "a psycho". I would call them from the locked psychiatric ward several times a day, begging them to take me back. I can see that my enthusiasm seemed bizarre under the circumstances and also that the fact I was heavily medicated and locked up was all the proof they needed to confirm their fears. In my own experience the more educated people believe themselves to be in relation to mental health, the more prejudiced they were towards me, and the most prejudiced of all were the health-care professionals tasked with looking after me. To me, improving services is the most vital step in combating stigma. There is no point in Kathleen Lynch giving out about how we should be nice to the mentally ill when her own department denies "voluntary" patients the right to sign out AMA, and insists on the right to administer ECT to patients "able but unwilling" to give consent.
What about educating the public? Mental health campaigners put great store on this. We are all familiar with "facts" about mental health such as that one in four of us has a mental health problem, that everyone is vulnerable to mental health problems, that mental illnesses are all real illnesses the same as cancer and heart disease, that your GP is your first port of call if you suspect you have a mental health problem and that there is an epidemic of mental illness among young people. You may also know that there are safe and effective treatments for most mental illnesses, that will not cure you, but will make life more manageable and that help is always available. But are these facts beyond dispute or do they just reflect current, dominant thinking among journalists and health professionals? To me, the science of mental health is not yet advanced or conclusive enough to warrant the attention and column inches it receives. Take for example, the role of self-esteem in mental health. Raising self-esteem continues to be a key objective of mental health promotion and the phrase features heavily in last year's Well-Being in Post-Primary Schools Guidelines. But there are some psychologists- such as Kristen Neff in the video below - who argue that our obsession with raising self-esteem is partly to blame for the continued prevalence of bullying in our schools.
Promoting Positive Mental Health
My past life, as a psychiatric patient, and my current existence as a teacher converge on the issue of mental health education in schools. To many people this is a no-brainer. Surely if we can get in there, into schools where young people are, after all, a captive audience and educate the hell out of them around mental health, all will be resolved. I mean, on the one hand they can learn the scientific facts around mental illness and decrease their prejudice. We can expose them to real life stories or even class visits by sufferers of mental illness, thereby increasing their empathy and reducing stigma. We can educate them about the importance of doing things to protect their mental health, like eating well, exercising and reducing stress and also instil the importance of help-seeking behaviours. If we could only improve their emotional literacy, teach them how to look out for each other and how there's no need to fear mental illness, or the mentally ill.
I've always felt queasy about this sort of thing. Firstly I agree with Daisy Christodoulou that before we commit content to the curriculum we need to be careful that there is consensus among experts that the information is correct. To me, almost all of the discourse around mental health is not there yet. That's not to say that this theory or that theory is right or wrong, just that I would far rather students spent more time studying biology and chemistry, and that they would develop empathy through the time-honoured practice of reading fiction. Also, we have to ask questions about who is delivering this content. Recently there has been much justified scrutiny of what kind of groups are delivering sex education to Irish teens. I think similar scrutiny must also be applied to the many groups, voluntary and otherwise, who are giving mental health presentations in Irish schools every week. For example, World Mental Health Day is celebrated every year in Cork by a conference where in recent years students have received lectures such as one on nutrition by Patrick Holford.
Much mental health promotion is indistinguishable from health promotion generally. Activities like sleeping, exercising and eating healthily might be promoted as part of looking after your mental health. But why would we believe the students will do these things to protect their mental health but not be motivated to do them to protect their physical health? If we really believed menssana in copore sano why bother with mental health promotion at all? I would argue that we don't need the mental health tagline and it is enough to educate students about how their bodies work, including the need for sleep and the benefits of exercise.
The Fear
Mental health promotion goes beyond this and promotes what I can only call fear. The fear is the idea that your own mind is probably faulty and not at all to be trusted. Your emotions are not a guide to your situation but instead are alien things that must be managed and suppressed in the case of anger or vented in the case of sadness. Students are still being taught about "negative" and "positive" thoughts, even though one of the first interventions of mindfulness and DBT programmes is to encourage patients to stop labelling thoughts and feelings as negative or positive. Mental health promotion often calls itself "positive" as in positive mental health. But this adjective is misplaced. Their view of the human subject is anything but positive. In fact they believe in what Ecclestone and Hayes call "the diminished human subject."
Young people are actively encouraged to see aspects of their own personality as maladaptive and possible pathological. Take this campaign for SpunOut.ie , entitled "Ditch the Monkey". The monkey in this case is the young person's own negativity. Negativity which is wrong. We must all be happy! We're sure that all teenagers invite all their friends to parties, just like in junior infants. No teenager ever has to sit at home on a Saturday night because being a teenager is all about having fun, fun and more fun.
They also learn that a healthy teen is a confident teen. Better iron out those insecurities and develop a healthy body-image and high self-esteem. This is despite research, as referenced here by Kelly McGonigal that "stress, anxiety and self-doubt are not necessarily a barrier to your ability to succeed." In fact, they're not even a problem. What about exam stress? Again according to McGonigal, not a problem. "You don't need to get rid of it and it's not a sign that something's going wrong". In fact academic pressure is only a problem when it is fear-driven and the biggest fear driving students is fear of letting down their parents. The problem stressing out students is not lack of mental health awareness. The problem is unrealistic and/or unhelpful parental expectations. Another fear students have is not getting into a particular course. I think all teachers are familiar with students who become fixated on courses for which the points are beyond what the student will realistically achieve. This is a harsh lesson for a young person to learn, particularly a young person raised on positive, cheerleading messages like "if you believe it, you can achieve it", "you can if you think you can" and "no negative thoughts allowed".
There are attempts by mental health promoters (or "ambassadors") to square this circle with slogans like "it's okay not to be okay". The idea seems to be to worry young people about their mental health but not to really scare them. Along with the checklist comes the assurance that if they don't make the mental health grade, help is available if they just "reach out". No-one seems to have any qualms about the effects on young people of entering into the mental health system. Even while those who work in the system complain that it is stretched to capacity, it still advertises for clients. Any reluctance among young people to engage with services is attributed to "myths and stigma" rather than mistrust of the service or concerns about its quality or relevance.
I speak from my own experience of how easy it is to be side-tracked into a futile, expensive and traumatising quest for better mental health. I was a sucker for the kind of things now being taught in classrooms all over Ireland. Time and again when a crisis would hit my life I would turn to psychiatry, my GP, my counsellor-du-jour and every time the approach was the same; I needed to fix myself. I needed to improve my mental well-being, normally either by taking medication o alter my neurotransmitters or by talking endlessly about my early life experiences, and then life would improve. I know I was not alone in this experience. Others have told me they had similar experiences of seeking help and finding themselves mired in the quicksand of the mental health system. The only thing that actually worked for me was radical acceptance and mindfulness of what actually was and is. The less time I spent worrying about, and working on, my mental health the more I was able to achieve and do in my life. And the more I did, the better I felt.
But what about people who really are ill? I'm not denying that these people exist. The brain is an organ like any other in the body and must be susceptible to malfunction and disease. I can also appreciate that many people benefit from psychotherapy, particularly those who have suffered trauma and abuse. But the mental health agenda in schools does not deal with illnesses that will surface no matter how much we mind ourselves. Students, and the public, love inspirational happy endings and remain ignorant of lifelong struggles with psychiatric illness. Neither does mental health awareness tend to deal with the trauma and abuse that so many children suffer. From talking to the many people it has been my privilege to encounter in inpatient and outpatient units throughout the years, I can definitively say that mental health problems do indeed discriminate, despite what we're told, and are much more likely to affect individuals who were abused as children, neglected as children, were exposed to violence in the home and/or who grew up surrounded by addiction. No amount of mental health awareness can counter insufficiencies in our child protection system.
The Worried Well
So while mental health awareness does nothing for children who need help, it risks creating a cohort of the worried well. These are anxious students, or students going through a rough patch, who are encouraged to pathologise their experience and "seek help." For some students, being asked to think about their mental health leads them down a path of anxiety, where they miss out on the real education that would allow them to achieve academically and live independent, fulfilled lives. Mental health issues can seem like a get-out-of-jail free card to stressed teenagers but focusing on their mental health might be doing more help than good. Repeated attempts to "ditch the monkey" will fail if the monkey is an integral part of their personality. Here is another quote from McGonigal
If we put our attention on inner experiences..and we try to control these inner experiences it almost always backfires. It tends to strengthen those experiences and we feel even more self-doubt and more stressed and more anxious...energy gets pulled away from the energy we need to simply take action in the direction of our goals.
I have written about people who take the message of mental health awareness to heart and start to doubt their own mental health status. There are also students whose faith in their own mental health is bolstered by what they learn and whose already robust self-esteem is further enhanced. They also are susceptible to the idea inherent in Staying Well that mental health can be conserved if we only mind ourselves. I fear that this idea must inevitably lead to a lack of empathy with those who didn't follow the programme and didn't stay well. I teach Senior Cycle English and one thing I have noticed in the last few years is pupils frequent lack of sympathy for the poet, Sylvia Plath, who took her own life. Why did she not just ask for help? they wonder. Why did she give in to her negative thoughts?
I would hope that the emotional development and well-being of students is important in all schools and to all teachers. I would also hope that where students develop mental illnesses they are treated with kindness and understanding by staff. I would hope that staff members are approachable and that listening support is available in schools. We can do all these things without putting mental health on the curriculum.
Kelly McGonigal addresses education-related stress at around seventeen minutes in.
Last Friday I attended Marsha Linehan's lecture at University College, Cork. Dr. Linehan is Professor of Psychology at the University of Washington, Seattle and is best known as the originator of Dialectical Behaviour Therapy. She has recently opened up about her own struggles and how they led her to develop the therapy, which is largely based on mindfulness, acceptance and the facilitation of change.
Professor Marsha Linehan
DBT and me
It's more than ten years ago that I came across the work of Dr Linehan. I had been hospitalised in St. Patrick's in Dublin and had been held for five days in the euphemistically titled "Special Care Unit". I took the opportunity that the nurses' station was unmanned to have a peek at my file, that was lying on the counter. I got the shock of my life when I saw that the box marked "diagnosis" was marked "borderline personality disorder". At this stage I had been a mental health patient for eleven years and a psychiatric patient for six years. This was the first I'd heard tell of borderline personality disorder. I was vaguely aware that such a diagnosis existed but knew little else.
I came down to Cork that weekend and took myself to Q+2 and the medical section of the UCC's Boole library. I took a couple of books on borderline personality disorder and started to read up but it wasn;t until a second visit a couple of weeks later that I took out Linehan's book "Skills Training Manual for Borderline Personality Disorder".
This slim, A4 book, comprised mostly of photocopiable worksheet changed my life, as it has changed the life of thousands of others. The change was twofold. On the one hand, for the first time ever, I felt some-one got me. Up until that time my diagnoses had been schizophrenia, anorexia or depression (although my last consultant in St. Patrick's did concede that he could find no evidence I suffered from any of these conditions). I had read books on all these conditions and while some of it fit, most of it didn't. Linehan's descriptions of the borderline patient struck a resounding chord. So did her discussion of the invalidating family. Looking back, I don't think I fit the prototype nearly as neatly as I thought I did, and of the three family types Linehan describes, I'd say mine fell mostly within the "Normal" parameters.
The essential was that here was some-one saying that the way I was acting was understandable and explicable, instead of merely deviant, mischievous or psychotic. And she offered hope that I could change. Change had never been a possibility within my treatment within the psychiatric system or from any counsellors I had attended, There was a polarity in their attitude towards me. On the one hand I was nuts, seriously ill and in need of constant medication and frequent hospitalisation. On the other, I was totally in control of myself and should just do what I was told and stop being such a nuisance. There was no future. There was no reality. The problem, as far as they were concerned, was my reluctance to obey, to concede and to comply.
DBT Venn diagram
Here, in DBT I found tools that I could use to make things better. The whole thing was structured around four key skills : mindfulness, interpersonal effectiveness, emotional regulation and distress tolerance. I followed them as closely as I could. I made homework cards for myself and completed them, even though no-one ever corrected them. I photocopied all the worksheets and filled them out religiously. I copied sheets like "Cheerleading statements for Interpersonal Effectiveness" and pasted them on the inside of my bedroom door. I made myself do something daily from the Adult Pleasant Events Schedule. I tried to practice willingness instead of wilfulness.
It's debatable how well I succeeded in all of this, given that I had no-one to guide me. It was hard but this was another benefit of the book; the book acknowledged that this was hard. Up until that time things I had been expected to do, or wanted to do, fell into two categories A) Easy, I should be able to do them, and B) Impossible, I should just give up. Living at home, staying away from certain people, giving up things I enjoyed, staying in hospital, being grateful: these were easy things. Going back to college, living independently, being medication-free, going back to the radio station where I had been a volunteer: these were impossible things that I should give up on.
DBT gave me a handle, a manual to do things that were hard but worth doing. The immediate impact on my quality of life was dramatic, although it would be some years before I actually moved out of home. Most of all was the inward comfort and confidence I gained from the knowledge that some-one, somewhere, even though it was half-way around the planet, understood my situation. Some-one knew that things other people found easy, I found hard, and that it was this difficulty and not some faulty wiring that made my life the mess it was.
I ordered Linehan's other book, "Cognitive-Behavioral Therapy of Borderline Personality" on-line and found even more comfort there. Take for example Linehan's debunking of the assumption that borderline behaviour is "manipulative."
"my own experience in working with suicidal borderline patients has been that the frequent interpretation of their suicidal behaviour as "manipulative" is a major source of invalidation and of being misunderstood. From their own point of view, suicidal behaviour is a reflection of serious and at times frantic suicide ideation and ambivalence over whether to continue life or not. Although the patients' communication of extreme ideas or enactment of extreme behaviours may be accompanied by the desire to be helped or rescued by the person s they are communicating with, this does not necessarily mean that they are acting in this manner in order to get help."
Somewhere else in the book (I can't find it but am sure it's there) is the line that has influenced me most of all. I'm paraphrasing because I can't find it but I'm fairly sure it goes something like. "All attempts by the patient to use "mental illness" to explain or justify her behaviour should be rejected".
UCC Lecture
So imagine my excitement when eleven years later I hear that Dr. Linehan's coming to UCC. I had to attend the morning session for "service users" rather than the afternoon session for mental health professionals. (I wonder if my consultant attended the afternoon session. He was the head consultant in the Cork hospital that I attended and at our last meeting in out-patients I told him I had found a new approach that was working. I said I was reading the work of Marsha Linehan. "Who's she?" he asked. "An American psychologist". "Hmmph".)
The title of Dr Linehan's lecture was "Real Change is Possible". Here is something that works. That takes people out of the psychiatric system. That builds lives worth saving. That if the HSE implemented properly would save hundreds of thousands of euro and potentially millions. In fact I will say millions as the saving involved in giving people effective treatment - as opposed to prescriptions, out-patient appointments and infantilising OT - is threefold. Less is spent on inpatient stays, less of visits to A&E and less on medication.
DBT costs more in the outset. Patients receive psychotherapy from a trained professional and also attend meetings where they are coached in the key skills. Having both individual and group sessions facilitates one of the dialectics of the therapy's title; the dialectic between being flexible and responding to what's going on at the moment and being consistent and following protocol. DBT also has a specific and prescriptive response to suicidal behaviour protocol, which rarely involves locking the patient in the nearest secure psychiatric ward.
The difference between Linehan's approach and the Irish model is striking. She said at one point "I wouldn't let fear rule my treatment" when I remember fear being a major driver in policy. Fear of us killing ourselves, fear of their being sued if we killed ourselves, fear of our committing criminal or quasi-criminal acts, fear of us, fear that we'd escape, fear that we'd stop taking our medication or object to taking our medication.
"I Have the Right to be on Earth"
Linehan defines this concept of having a right to be on Earth as "essential validity" and said that affirming it is of major importance. Again, when I think back, even though my psychiatric team were very strong on the idea that killing myself was a bold, inconsiderate thing to think of doing, their behaviour towards me did nothing to instil the feeling that I had a right to be on Earth. They didn't recognise my right to be free, my right to wear clothes, my right to autonomy over my body, my right to fresh air and the feel of sun on my skin.
In the original "Skills Training Manual" Linehan writes that DBT is not a suicide prevention programme but a life-enhancement programme. This distinction is crucial and linked, I feel, to the concept of essential validity. Suicide prevention sounds vaguely coercive. It's about stopping some-one doing something, forcing them back into a life that may not be worth living. A life where you don't feel you have the right to be on Earth is no life.
A part of the lecture I found particularly interesting was when she discussed suicidal thoughts. Thinking about suicide is extremely common, far more common than parasuicide or completed suicide. "Thinking about suicide" is a behaviour in and of itself. It's a behaviour that is practiced because it is soothing. It is soothing because it presents an alternative reality and also because while you're thinking about suicide, you're not thinking about your problems. Linehan compares the practice of thinking about suicide to a drug. I can relate to this; when things get bad I find myself thinking about suicide. Not that I'd do it, just that thinking about it brings relief.
I didn't ask a question at the lecture but if I had, it would have been this, and I'd appreciate your views on this in the comments. Can we apply the idea of thinking about suicide being a displacement activity to society as a whole? Take the recent RTE coverage of suicide, something I've referred to in a previous post. This coverage was embarrassingly simplistic and made several unwarranted assumptions: that all suicides are calculated choices, that undiagnosed mental illness is a major factor, that there is plentiful "help" available were people not too feckless to bother asking for it. Take also the plethora of voluntary organisations with suicide in the title. The awful radio ads urging us to choose life, not suicide as though one were Tesco and the other Lidl. We have anti-suicide cycles and anti-suicide bumper stickers and are told frequently that we need to "break the silence" and have lots of chats about suicide.
But I wonder; when we talk about suicide are we putting off talking about our problems? When we shake our heads and mutter about how awful it is that so many young people don't just ask for help, or think of their families, are we avoiding asking the hard questions. When we put the entire responsibility for reducing suicide onto the shoulders of GPs and the psychiatric system, are we abdicating our own responsibility? I lost count of the number of tweets I received over Christmas telling me to call the Samaritans. That could be because of the type of tweeter I tend to follow, but still.
Hard questions might include what is wrong with our psychiatric system when involvement with it is a factor in so many suicides? Other questions might be how we look after children in their infancy. Are we too quick to refer troubled teens to the GP? Might it be a good idea to reverse the cuts to school guidance counsellors? Is anyone ever going to come out and categorically say that children should not have televisions or internet access in their bedrooms? Why are we still so slow to acknowledge the scale of child sexual abuse? Why does our economic system leave so many able-bodied, capable young people surplus to requirements?
Success
The fundamental goal of DBT is not to prevent suicide but to build a life worth living. When you consider how much is involved in this, how long it takes, the costs involved you see that by side-stepping "suicide prevention" DBT faces up to some of the problems and indirectly, saves lives. It isn't a panacea of course and has had very limited success with, for example, Post Traumatic Stress Disorder. There may also be patients for whom it will never replace medication, but can still help them lead a life worth living. Its major successes, apart from the original borderline personality application have been in Substance Abuse (87% success rate), major depression (68%) and eating disorders (64%). Interestingly, Linehan sees depression mostly as a behavioural issue, like taking drugs or being anorexic, rather than a mysterious fog that descends for no apparent reason.
A pilot project is currently running in Cork and there is hope that DBT will be rolled out across the country. I would hope that it is not customised too much to fit in with current (mostly dreadful) practice. I hope it will not be adopted in a lacklustre fashion on the grounds that "nothing works with these people". The fact that so many clinical trials have been conducted will hopefully bring the medical people on board. This could be a huge shift in psychiatric policy. Let's hope so.
According to Chambers we need to have a "positive conversation" about mental health. As opposed to one that says that health is bad, and a thing to be avoided. We need to be positive about our mental health, but also worry about it and be constantly "minding ourselves". Positive is tacked on here as a buzz-word, something being used to sell us a product; the concept of mental health.
Chambers writes that "Too often, mental health equates to mental illness in the public consciousness." He's right there. Headlines often proclaim that Celebrity X "struggles with mental health". The reason for the this confusion is due to semantic squeamishness on the part of editors. No one wants to write the words "mental illness". So now we have "mental health problems" or "mental health issues" or even "mental health", as in "she suffers with her mental health". We all know what that means.
Attempts to bisect the coin that has health on one side and illness on the other are well-meant but illogical. "Positive mental health" does not mean the blessed state of being free of psychiatric illness. Rather, it is a large sub-section of the wellness and well-being industry, a concept brought to us by self-help books, motivational speakers and life coaches.
"The trick, when it comes to changing attitudes, is to convince as many of the population as possible that mental health is personal to them." The trick, indeed. Read that sentence again, and ask yourself if you're starting to feel tricked, misled or misinformed.
"Through the internet, we have the potential to market mental health as a fundamental part of being human." Chambers is right here; mental health is a product and we are being persuaded to but into the concept, to invest our time, effort and often money, into gauging, maintaining and repairing this new product. A product that, like the internet about which Chambers enthuses, is now so part of our daily lives that we take its existence for granted. It's hard to remember a time before "mental health" was not a given term in our lexicon.
The article ends on a positive note, telling us all to use an Australian-developed app to send each other "cyber-cuddles". World Mental Health Day is "about all of us". Or is it? For all its positivity and celebration of the fun of mental health, the article is followed by an "If You've Been Affected List."
The list includes the Samaritans, Pieta House, Console and Aware. Now if positive mental health is the harbinger of a new happier way of life, then why are these help-lines for those affected by distress, suicide and mental illness?
Because the idea that mental health is a product, available to all who invest the right resources, and simultaneously as a vulnerable state that is as prone to decay as depleted uranium, has contributed to an increase in distress in the population. In particular it has convinced thousands of young people that they have a health problem, and need "help". It has convinced their parents of the same.
A report from the Royal College of Surgeons in Ireland...indicates that one in three young people in Ireland is likely to have experienced some form of mental disorder by the age of 13.
This rate increased to more than one in two young people who had experienced some form of mental disorder by the time they reached the age of 24.
Based on international evidence, this means up to one third of Irish adolescents and over one half of young Irish adults are at increased risk of mental ill-health into their adult years
As commenters on thejournal.ie are so fond of saying, correlation is no proof of causation. But I wonder if there is any link between the numbers of young people who feel they are mentally different from others and how mental health is promoted. The report lists risk factors for mental health disorders but have these risk factors increased? Or has our detection rate increased, in which case this should be a good news story instead of an opportunity for the wringing of hands.
In cases of genuine mental distress, I think we are better at picking things up than before, but that progress has been slow or non-existent in the area of child protection. By the time a teenager presents with a mental health disorder, most of the damage of abuse or neglect has been done. These young people will not be saved by "cybercuddles" but a properly resourced and efficient social work system would be a help.
And while family problems have historically been under-reported in Ireland, do we really believe that half of all Irish young people are from dysfunctional homes? One in two, that's half. A pandemic. Are all these young people really mentally ill, or have they just failed to meet the standards demanded by "positive mental health"? A standard that I've described as approaching perfection.
Helen Coughlan, clinical research fellow at the RCSI, is quoted in the Irish Times as calling for services to support young people in need before they reach a crisis. So far, so sensible but she goes on to assert that "Mental health literacy should also be highlighted more within the education system".
Why? The majority of children are not at risk. Those that are, are at risk because of circumstances they cannot control, circumstances that it is our responsibility, as the adult members of society, to rectify as much as possible.
I'm going to leave you with an extended quote from Kathryn Ecclestone and Dennis Hayes' book "The Dangerous Rise of Therapeutic Education".
"Far from creating a more balanced and rounded personality, therapeutic education promotes the emotionally diminished human subject and promote a life focused on the self and self-fulfilment rather than with understanding and changing the world. The paradox of therapeutic education...is that an obsession with the self means that you will not change the world, and nor will you change yourself: it is active engagement with the world that leads to confidence, self-esteem, fulfilment, or to used the latest piece of therapy-speak "happiness and well-being" The wish and will to change the world characterises humanity; to turn humanity inwards is to diminish all our selves."
Finally, on the sixth day of the month I get around to writing about this month's theme: time. This tardiness is not a result of poor time management; rather the opposite as, in fairness, writing the blog comes way down the list of things to do. And I've been sick. Too sick to type.
Andrew Marvell. I'd be coy too.
Three weeks ago this Monday my watch stopped at seventeen minutes past three. And it was Friday (the day before yesterday) before I replaced the battery. Yes, that was as poor as time management gets. Of course the delay in getting to the jeweller's was exacerbated by my lack of a working watch. I was late leaving the house every morning. Even though all our classrooms are equipped with functioning clocks, I found it hard to get into the habit of consulting them instead of my wrist, and class after class has been timed awry. I know there are those who get by without a watch, who rely on clocks and mobiles, but really -how do you people manage?
Losing and regaining the gift of accurate time-keeping has made me conscious of time itself.
"Make Time for the Things that are Important"
This phrase has been running through my brain for a few weeks now. It's one of the answers to my constant question "how do avoid similar f**k-ups in the future?" And sometimes life seems like one fuck-up after another. The answer to "how did I let this happen" is "you were busy doing stuff that doesn't matter"more often than not.
To say time is our most precious resource is a clichéd understatement. Time is not a resource, but one of the most important dimensions in which our lives are lived. Even though the path I've taken so far in life has taught me lots, and shown me some good places and great people, I feel that an appreciation of time would have helped me be happier. For much of my adult life, time has been something to be endured. I suffered from chronic FOMO. Weekends were deserts to be crossed instead of two days crammed full of lovely time. I was hanging on in there, and hanging, and hanging...until letting go and falling became a fantasy.
Time is precious even when I'm alone. Time is precious even if I don't have children. Time is precious even when I'm tired. Because there is always something to be done. There are always things to do.
My first hospital admission. I remember it coming to me. Clear, clear as day. There was no need not to eat. There was no need to worry about money. Because the world was full of food, and the world was full of money (even if little of it was within my possession). But time. Time was scarce. I felt an incredible urge to live life. To do things. To make use of my time. I was twenty-one, and in hospital on my first psychiatric admission. By the time I got out again, and free again, it was many years before time stopped being painful. Empty hours were the worst and I became adept at keeping busy by doing inconsequential things really slowly.
You'd expect this theme, of making the most of time, to generate resolutions, productivity tips and trigger lists. I've tried these and concluded they're mostly other people's systems that work fantastically for them, but don't translate into my life and probably not into yours. I even borrowed a library book with the title "How to Make More Time" but realise I might as well have read "How to Turn Back Time" because none of us can add the twenty-fifth hour to the day. The one where I could've popped to the jeweller's or cleaned the car or had a nap before going out.
So this month there is no Resolutions Chart or small daily goals. There is only the mantra in the back of my head, always, to Make Time for What Really Matters. Not to fear its wing'd chariot, but to to live every minute, and appreciate every hour.
