Backlash against mindfulness

Mindfulness has been written about loads in the last few years. From some of the articles you’d think it was a magical cure all, and perhaps inevitably, it seems to me that recently the worm has turned, and people have got bored, or irritated, with mindfulness.

Only a few weeks ago I was interviewed by a CQC inspector who rolled his eyes when I said that I ran a mindfulness group on the ward where I work. He was fed up of hearing about mindfulness, which reminded my of this piece a few weeks back by Eva Wiseman, on how she’s had enough of mindfulness colouring books being sent to her. To me, the backlash is interesting for a few reasons:

buddha

  1. Reasons behind the backlash. The pattern here feels familiar to me – setting something up to be brilliant then rubbishing it, when the reality is somewhere in the middle (as the evidence base suggests).
  2. The experience. The boredom and irritability that people describe feeling about mindfulness actually reminds me a bit of what it’s like to sit and practice mindfulness sometimes. It isn’t about having a blank mind, it’s about having your mind as usual, watching your mind do its thing, which often is boring, or annoying, and not always calm and peaceful.
  3. The idea of mindfulness having grand claims. Mindfulness itself has never claimed anything – it just is. It isn’t mindfulness practice that has big promises, marketing strategies and glossy packaging. That’s what we, as people, do with it. Mindfulness is just being in the here and now, instead of getting caught up in the past or the future.
  4. Mindfulness aids. You can use a colouring book to do it but you don’t have to. There are a growing number of mindfulness resources, like these books, available, and they are not for everyone, but I don’t think there’s anything wrong with trying to use new ways to help people meditate.

One group who are brilliant at explaining mindfulness to children using clever resources (and no colouring books) are the mindfulness in schools project. They use this clip from kung fu panda to explain what mindfulness is. Check it out if you want to see what Ugway is talking about.

If you aren’t bored or irritated by the idea and you want to give it a go then you could try the ubiquitous Headspace app or Mark Williams‘ down to earth introductory book: Finding Peace in a Frantic World.

Mindfulness might not be a panacea, and it might be boring sometimes, but I’d still really recommend it.

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Is living in the city bad for our state of mind?

app picture mechelliMental health problems are more common amongst city dwellers – but why? Is it the stress? The noise? The lack of green spaces? A study involving scientists from King’s College London, architects from J & L Gibbons, artists from Nomad Projects and design experts from the Van Alen Institute, is trying to find out how the urban landscape affects how we feel.

To take part, download their free app, called Urban Mind, which will prompt you at random, seven times a day for seven days, to answer questions about how you feel and where you are. The app gathers geotagging data, and if you choose to you can also upload images and sound files, to give a full sensory picture of your location.

The geotagging – which says where you are – can then be used to compare with existing mapping data to see whether you are in a deprived or affluent area, whether there are many trees or rivers nearby, and even what levels of pollution there are.

Dr Andrea Mechelli, Reader in Early Intervention at the Institute of Psychiatry, Psychology & Neuroscience and lead investigator on the project, hopes the app will enable a rich dataset to be collected.

“This has been developed to look at how the built urban evironment affects our mental wellbeing, Dr Mechelli said. “It’s important because within the area of urban planning and design a lot of decisions are made without much scientific evidence. The longterm aim of the study is to design some policy guidelines in this area.”

Dr Mechelli’s usual area of research is psychosis, and he sees the Urban Mind project as highly relevant to mental illness as well as mental wellbeing. Whilst some people may be genetically more vulnerable to developing certain mental illnesses, environmental stress can be a major trigger to make this more likely.

“Although we’re not looking at mental illness directly we’re looking at something that’s related,” said Dr Mechelli. “We’re all on a continuum, some of us tend to be more anxious, some less so… some may have slight psychotic symptoms that are much more common than we tend to think…. By understanding how the general population responds to the environment we’ll also understand how the environment becomes a risk factor. Longer term the study might reveal how the environment may contribute to the development of mental illness.”

Dr Mechelli, who grew up in a small village but now lives in London, thinks living in the city has many effects, socially, physically and culturally. “There are certainly aspects of urban living that are not very healthy but there are also aspects that can be very positive,” he said. “For example social networks, less risk of social isolation.”

Previous studies have shown downsides to urban life, Mechelli explained: “some aspects of city living are not good for us, for example increased sensitivity to stress and increased vulnerability to many mental disorders.”

Whether we find the city exciting or stressful might depend a lot on our individual characteristics, so Urban Mind asks some initial questions about what we are like and where we grew up to try to understand how this interacts with environmental factors.

Mechelli is excited about the project which he described as a “true cross-sector collaboration” between science, architecture and art. Anyone can download Urban Mind and participate, and Mechelli thinks using the app might make us appreciate the effects of our environment more.

To download the app check out the Urban Mind website. Images from the pilot data are available from the project-related Instagram and will be on exhibition at This Public Life – Festival of Landscape Architecture to be held in Melbourne, Australia, 15-18 October 2015.

For more on how where we are affects how we feel try these pieces on whether green spaces make us more creativehow natural light can make us feel more awake and how hospital architecture can make us feel better or worse.

This piece is cross-posted on Huffington Post UK

King’s Fund summary calls for focus on better value, not cost reduction

Productivity in the NHSA clear summary from the King’s Fund published this month outlines the findings from their “Better value in the NHS” full report. Responding to the recent call for £22 billion efficiency savings, it highlights the key point that: “focusing on the monetary value of the challenge risks missing the real essence of the task… which is about getting better value from the NHS budget.”

Thinking about how to provide best possible care in the most efficient way is less of a turn-off than the usual narrative of NHS budget constraints. Most healthcare professionals are sick as a parrot of news about cuts and deficits, but The King’s Fund describe three areas where the NHS has already been successful in promoting efficiency: generic prescribing, length of hospital stay and day-case surgery.

The King’s Fund have rightly noticed that framing the challenge in terms of improving value rather than reducing costs is much more likely to engage clinicians in thinking about how to do this, which ultimately is probably the only way that meaningful and beneficial change will happen.

New special report on mental illness from The Economist

The Economist’s special report this month is on mental illness. It’s well worth a read. As you’d expect it has some interesting stats, some lovely infographics, and is written engagingly by John Prideaux.

The report divides mental illnesses into those associated commonly associated with different life stages: it talks about Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disoder (ASD) in childhood, depression and psychosis in adulthood, and dementia in old age.

I was struck by how diagnosis-driven the report was, and it made me think a lot about the teaching sessions I’m involved in as part of my lecturing role, which are also often led by a diagnostic framework. It’s much easier to think about mental distress in terms of categories: it helps us think about the evidence base for treatment, it helps us have a shorthand for the types of experiences we are talking about, it helps us interpret statistics, but it leaves out a lot too. It couches everything in terms of the abnormal, the psychopathological, even if we caveat it with the usual consolations that these illnesses are on a spectrum.

The final paragraph of the report clocked the difficulties of this approach to some extent, although the medical framing remained:

“Many syndromes are now understood as points on a spectrum. Most people will have a touch of something at some point, and a large minority will get a longer-lasting illness. Over the course of their lives, nearly 30% of Americans are likely to suffer from clinical anxiety and 20% from a mood disorder such as depression.”

For me these last couple of lines struck the most helpful note though, particularly in the wake of debates this week on whether people with a diagnosis of mental illness should reveal it to their employer or not:

“Mental illness is less extraordinary and exotic than it is currently considered. Better treatment starts with acknowledging that.”

I agree. Better treatment of people in all sorts of ways could result from thinking about mental illness in “less extraordinary” terms. Not only psychiatric treatment, but our everyday treatment of each other, can only be improved by considering each and every one of us as holding the potential for profound sadness, overwhelming emotions of all other kinds, and bizarre internal worlds.

How do we look when we are sad? Time to Change’s campaign against head-clutching.

A campaign launched by Time to Change in Spring of this year aims to get rid of “headclutcher” pictures in articles about mental health. The campaign was started as a response to the wealth of images accompanying articles about mental illness which have someone sat with their head in their hands, as highlighted by twitter users with the #headclutcher hashtag.

It’s a challenge to represent emotions that are often private in a way that can be understood quickly, but the photos of people with their head in their hands tend to be stereotypical and fairly hopeless. They also make it seem like it’s easy to spot someone who is really distressed, when actually we know that isn’t the case. If it were then it would be much easier to offer help to people who need it, but who aren’t necessarily showing this in any obvious way.

I asked comedian Jo Brand, who used to be a psychiatric nurse, what she thought about the headclutcher campaign. She said: ‘I have always thought that portrayals of individuals with mental health issues in the popular press are really inappropriate. Either you get the terrifying, out of control, wild eyed maniac or someone that looks like a pauper out of a Dickens novel who has their head in their hands in a darkened room with the curtains drawn.”

Brand agreed with the importance of showing mental health in a more ‘normal’ way: “I think it is absolutely essential that mental health issues are portrayed by people who look completely ordinary, because it is something that happens to ordinary people. It has to be said that many library photos used in newspapers of ‘families’, ‘schoolchildren’, or ‘workers’ are somewhat ridiculous, but portrayals of those suffering from poor mental health are always at the more bizarre end of the spectrum. In this day and age, one might have hoped we’d have moved on a bit.”

What should we be using instead? The campaign has come up with a whole stockpile of photos that journalists can download for free. But the campaign made me think of an image by Quentin Blake, from a brilliant book I’ve used a lot with children and young people in my clinical psychology job.

Image reproduced with kind permission from AP Watt at United Agents on behalf of Quentin Blake

Michael Rosen’s Sad Book describes feelings of deep sadness with beautiful simplicity. One image which often resonates with young people I have worked with illustrates the contrast between how we might look on the outside and how we feel inside. The picture is accompanied by the text “This is me being sad. Maybe you think I’m being happy in this picture. Really I’m being sad but pretending I’m being happy.”

How often have any of us said “I’m fine” and put a brave face on things when we’re not really? Feeling sad often makes us withdraw or lash out at others just when we need them most. I hope the headclutcher campaign makes us think about how we represent mental health in the media, but I also hope it helps us think about how we show other people what we are feeling, and how much we presume that what other people are showing us is the full story.

Pints full of science and how do you spot a psychopath when you’re dating?

Dr Gemma Modinos, Neuroscientist, speaking at Pint of Science

Dr Gemma Modinos, Neuroscientist, speaking at Pint of Science

I went to some great Pint of Science nights recently, the annual festival where scientists give talks in pubs. I saw Professor Jon Cooper speak about his research into Batten’s Disease, Dr Claire Troake describe the Brain Bank where people can donate their brain tissue after death, Dr Gemma Modinos describe her research into social and emotional aspects of psychosis and Dr Nigel Blackwood talk about psychopathic traits.

Psychopathic traits are measured by a questionnaire called the psychopathy checklist-revised (PCL-R). They include callousness, a lack of empathy, a tendency towards relating to others in a grandiose way, or trying to manipulate others. Psychopathic behaviours also include persistent aggressive acts, both as a reaction and as a way of trying to get something. Studies also show people with psychopathy have difficulty being able to recognise fear and sadness in other people’s facial expressions.

Psychopathic traits can be thought of on a spectrum, like most human characteristics. The presence of a high level of these traits is really dangerous, as high levels usually go along with committing severe violent crimes. It is possible to have lower levels of these traits as well, perhaps not reaching a clinical cut off but still suggesting some problems in the same areas.

I asked Nigel Blackwood, clinical academic in forensic psychiatry, if it’s possible to spot someone with high levels of psychopathic traits when you’re dating. He acknowledged it could be difficult at first, that often they are very charming, although they might not be that interested in you. His top tips were “take your time, and seek collateral information.” Good advice for us all.