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12. Mindfulness and silence

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Introduction

We think we might have just introduced the world’s first mindful and interactive sub-heading. There’s the main heading (Mindfulness and silence) and then the sub-heading, which we’ll frame this time:

Did you see what we did there? In case it’s not quite as nifty as we like to think, what we were attempting was to illustrate the loveliness of considered emptiness. Restful, simple, clean, clear, full of possibilities. Devoid of anything nasty or painful because it’s pure space.

Pure space, mindfulness, silence, meditation, yoga have become very trendy. And being an  inpatient is a great opportunity to learn and practice these extraordinarily effective ways of not just quieting the mind at that moment, but infusing even very traumatised lives with considerable serenity.

Silence is relatively straightforward, although we hope you discover in the pieces below some fresh perspectives on this invisible treat. The term ‘mindfulness’ is confusing. For us at Star Wards, a simple way of considering mindfulness, especially for ‘beginners’ and people in the grip of acute mental illness, is mind-emptyness. Stopping the continuous, usually negative and often terrifying stuff going round and round our heads. Quietening our minds. Anything from sitting on top of an Indian mountain and chanting through to a quiet afternoon angling on a Scottish loch. Knitting, gardening, looking at fish in an aquarium….. just as there’s complete diversity in what people find gets their mind whirring, so quietening one’s mind is also highly individual.

 

Ward examples

  • A service user is running weekly meditation sessions.
  • The chaplain runs weekly meditation sessions.
  • Night staff have a half hour relaxation group at 9PM.
  • OTs run stress management groups.
  • The ward has a ‘Retreat room’.
  • Some patients have access to a yoga mat in their rooms.

Patient Examples

  • Sometimes when I wanted space but didn’t want to be isolated I would just ask a member of staff to come and sit in silence with me. It was hugely powerful and refreshing.
  • I like it sit and watch my thoughts float past like clouds without feeling the need to act on them.
  • The more I practice my coping mechanisms the less I think of them being ‘mechanisms’ and more just a part of my everyday life.
  • I can’t always understand why I feel the way I do so I try to practice acceptance and patience with myself.
  • The more time you can enjoy your own company the more you learn to value yourself.
  • I choose to make the most of my stay in hospital by getting lots of rest, putting problems aside until I could deal with them.
  • If it was meant to be I could do something about it later.
  • I decided not to wear a watch and found time did not go as slowly.
  • Meditation is one of the best things I learnt during my stay. I found it very soothing and my mind would be clear by the end of the session.
  • Ward life can be overwhelming so I found it vital to have space and time just to myself at least once a day but it’s also important to connect with others aswell.
  • There is something extremely grounding and peaceful about just sitting outside and watching the clouds. It was my five minute coping strategy.
  • I found the best way to understand myself was to listen to the very quiet inner voice. Having times of silence enabled me to do this. Now the inner voice has no qualms in speaking up
  • Silence can be a barrier and it can also be a bridge. Sometimes it is essential.
  • Silence often speaks volumes.

A little note from Marion

As with all skills, there’s a vast range with mindfulness. Training would be wasted, for example, on Buddy, who (like most dogs and few humans) is deeply content in the moment. She’s simply not fretting about whether she peed in the highest status spot in the park nor angsting about whether she’s having a bad fur day. She’s lucky. It is very likely that some of your ward staff will already be skilled in mindfulness, whether self-taught or as a result of training courses. The people who are best placed to help with mindfulness skills are your psychology colleagues, and if they are unable to provide training (eg because of time constraints!!), they should be able to recommend books, DVDs and courses.

Silence

If mindfulness is about silencing the internal, then silence is about – er, well it’s still about absence of noise externally. Still, quiet, peaceful. Pico Iyer eloquently described silence as:

not an absence but a presence; not emptiness but repletion. Silence is something more than just a pause; it is that enchanted place where space is cleared and time is stayed and the horizon itself expands.

Perhaps it’s a cultural thing, but we seem to have an allergic reaction to silence – especially during interaction. It can seem like a kind of lack or emptiness rather than an enriching activity. We have a tendency to fill in every snippet of silence with something – anything will do! – to avoid the feeling of awkwardness or unease. Just sitting together with a patient, with little words can be a therapeutic and containing experience.

Wards can often be chaotic and noisy atmospheres and it can be difficult to geographically and practically find a space for silence. Simply making a room available for this purpose can be a great start, especially if it’s away from the blaring TV or CD player.

Sometimes silence can expose us to a lot of mental noise, scary thoughts and horror. So the balance of sound and silence is important. Embracing / basking in silence is a skill. But allowing silence when with a patient shows that it’s okay, it gives the message that your there should anything happen – i.e difficult thoughts and feelings.

As with most things in life, context is all. Silence can be healing or hellish, peaceful or punishing. It all depends on expectations, relationships (including the power dynamic within these), cognitive ability, location etc etc. Silent meditation and contemplation are recognised and facilitated as central not only to most faiths and Quaker spiritual gatherings (Meetings) are characterised by silence. Iyer puts it like this: It is no coincidence that places of worship are places of silence: if idleness is the devil’s playground, silence may be the angels’.

Look how nice this is:

Perfect if you’re wanting a quick breather, a bit of space and absence of clutter, a (tiny) blank canvas onto which you can arrange your thoughts – or just let your mind go equally clear. As Iyer puts it: in silence we can hear ourselves not think, and so sink below ourselves into a place far deeper than mere thought allows. In silence… we can hear someone else think.

How nifty that silent is an anagram of listen.

And that we’re repeating the point we made in the pioneering sub-heading.

You probably don’t want us to list all the times when silence isn’t such a great idea, like in the middle of wedding vows or if you’ve just got a Full House in a shout-out bingo hall. Iyer again: There is, of course, a place for noise, as there is for daily lives. There is a place for roaring, for the shouting exultation of a baseball game, for hymns and spoken prayers, for orchestras and cries of pleasure. Silence, like all the best things, is best appreciated in its absence: if noise is the signature tune of the world, silence is the music of the other world.

 In silence, suddenly, it seems as if all the windows of the world are thrown open and everything is as clear as on a morning after rain. Silence, ideally, hums. It charges the air.

And we should acknowledge that silence can be used in a hurtful or punishing way – to reject people, or as part of isolating people. It’s one of the aspects of seclusion rooms that Star Wards finds ghastly.

A little note from Marion

When my mother was dying of cancer, a doctor came to see her. He sat by her bed, in my parents’ bedroom, and we waited for him to pronounce. But he didn’t. He just sat very still, looking composed and focused. He sat like this for a few minutes, just looking at my mum who was ‘unconscious’. I was astonished. I’d never have thought that ‘just sitting’, in complete silence, could be such a powerful behaviour. The messages the family got from this gentle conduct were:1. the doctor wasn’t in a rush. He would take the time necessary, in this agonising situation, to find out what was needed and help mum through her remaining days
2. he could learn about her physical state by carefully observing her – presumably things like her breathing and skin colour.
3. he understood and respected the very quiet, deeply subdued mood and timeOver to Pico Iyer one more time:“Silence, then, could be said to be the ultimate province of trust: it is the place where we trust ourselves to be alone; where we trust others to understand the things we do not say; where we trust a higher harmony to assert itself”.

Night-time

Idea #76 looks at some of the issues of night-time on wards. The extent to which near silence can be achieved obviously depends on the type of ward, abilities and needs of the individual patients and whether there are admissions or other significant occurrences during this time.

Silence, while vital for most people’s ability to sleep, can be terrifying for some patients and seriously unnerving for some staff in some circumstances. Some people with dementia are very afraid of and disoriented by the relative darkness and (intermittent) silence of the night, contrasting with familiar daytime noises and activity. This, understandably, can result in their seeking security and reassurance at night to help soothe their distress.

For others, it’s the continuous fracturing of silence through the night which is deeply stressful, and it is to everyone’s benefit to minimise disruptive, intrusive noise by being vigilant about:

  • Staff talking quietly, away from sleeping patients etc.
  • Staff making sure that equipment they’re using (including phones, computers…) are as quiet and as shielded (eg by closed door) as possible.
  • Jangling keys, which are particularly unnerving for people who have been locked up in traumatic circumstances eg in prison
  • Opening and shutting doors – we can’t enthuse enough about the importance of well-adjusted automatic door closures. Doors slamming closed when all is dark, still and quiet are likely to try the patience of the sanest person.
  • Laundry trolley clanking along corridor
  • Flushing toilets (keeping the door closed til the flushing is finished can help)
  • Creaking floorboards – see if the Estates Department can do anything to help!

Conversation

Silence in conversation can feel as threatening to some as silence at night feels to others. TalkWell has a section on silence, including these areas of staff concern:

•    they could be seen as disinterested in the patient or not listening properly
•    the patient might think they’re boring
•    the patient might feel under pressure to come up with something to say
•    it could look like they’re not working

But it’s so worth it! Pauses, and silence in conversation:

  • gives time for you and the patient to reflect on what has been said and what you both feel about this
  • allows the chance for some mind-awareness – for both of you to consider what’s going on in your own and the other person’s mind, including what feelings may have been stirred up for each of you
  • is a lovely breather. Just like having a rest during a walk
  • shows you’re not in a rush as a listener, exquisitely illustrated by mum’s doctor. This really helps people feel valued and able to take their time in getting to the issues which matter to them and which might be very difficult to say at first

Therapy

In Henry Wilmer’s Quest for Silence, a psychoanalyst described how he once had an entire hour when he and his patient said nothing. Not a word. He was (understandably!) worried afterwards that he should have been pro-active in helping the patient express herself. “However: she appeared a few days later for her next session, positively beaming and happily told me how vitally important the hour of silence had been for her. She said it was the first time in her life that she felt nothing whatsoever was being demanded of her: she could just be – silent and accepted as she was. This experience marked a major turning point in her life. And it confirmed for me the healing function that silence can have.”

Therapists use silence to:

  • convey empathy, interest, safety, understanding and containment
  • facilitate reflection by client and therapist
  • take time for themselves to think of how to respond
  • allow patient to compose themselves if very distressed
  • challenge the client to take responsibility
  • observe the client
  • think about the therapy
  • think about what the client might be thinking, feeling and perhaps communicating,  and what might have led to this

Necessary conditions:

  • a sound therapeutic alliance – a safe, trusting, effective relationship

Therapists avoid:

  • using silence with clients who were psychotic, highly anxious, or angry, disturbed
  • the client potentially experiencing the therapist’s quietness as distance, disinterest, and disengagement
Categories: Mindfulness, Wardipedia
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