What we learned when we met Malala Yousafzai

While travelling through the Swat Valley in 2010, we interviewed the young school girl standing up to the Taliban.

We don't expect to switch on the news and see that someone we know has been shot, though this was our experience when we saw the face of young Malala Yousafzai on the television. During 2010, we had been to Pakistan to create a book that uncovered the difficulties of being a woman in Pakistan. We met and interviewed over 150 women and were fortunate that one was a fiery young girl named Malala.

While staying in Peshawar we heard about a school girl from the Swat Valley who was standing up to the Taliban and promoting education for women. This is an area of the world where women rarely walk the streets, definitely not alone and never uncovered. And as Malala's example shows, there is a genuine threat to your life if you dare to step outside the strict social fabric.

We left for Swat with some trepidation and against the advice of our local friends. Although the Taliban were officially ousted by the government, it was still an area known for extremist views and occasional lawless violence. It was supposedly safe but still foreigners were not allowed in. We took our chances; “let’s go and see for ourselves” was our policy. We went through the checkpoints without any fuss, almost too easily. We were left questioning how effective the military crackdown actually was.

As the mountain roads turned from tarmac to dust we passed by Buddhist relics, a reminder of Swat’s more enlightened times. Tragically many of the Stupas had been vandalised or destroyed by those determined to erase any non-Muslim aspect of Pakistan’s history. As we crossed the final mountain we were afforded a spectacular view of the valley, justifying its reputation for being a popular holiday destination. Only now it had the air of a dilapidated English seaside town; lots of hotels but no tourists.

We arrived in Mingora and were met by Malala's father Ziauddin Yousafzai, who unlike many Pakistani men, wasn’t in a hurry to talk about himself but preferred to give the centre stage to his daughter. On first appearances an ordinary twelve-year-old girl but when she spoke there was an aura of confidence that only comes from speaking the truth.

We asked Malala about life under Taliban rule and she replied that it was like being in the Stone Age, "everyone was afraid of the Taliban, a child or a young man, because they were so cruel, they just cut peoples’ throats or left them hanging in the square." The Taliban used the radio to spread their ideas, to appeal for money and canvas for new members. They took over the airwaves, imposed Sharia law onto the area and banned girls from attending school. They said any girl caught going to school would be kidnapped and married off to one of their young talibs.

Malala and her class had been the centre of resistance to the Taliban. This group of young girls lead by Malala were horrified at the idea of giving up their education at such a young age. While others were so traumatised by the violence they had witnessed that they stopped attending, Malala’s group continued schooling in secret. They were so afraid of being stopped and questioned by the Taliban, that they had to make their way to school wearing plain clothes and hiding their books.

We were taken to the school where the students gave a stiff formal greeting before giving way to fits of shy giggles. There we talked to the girls about their experiences under Taliban rule and Malala gave an impassioned speech about the importance of education for women.

Painted on her wrist was a small Pakistani flag and it became clear to us that this girl was speaking from a place filled with nothing but love for her country. She says that before the Taliban she wanted to be a doctor, but after witnessing the ineffectual nature of her country’s politicians, she now wants to become a spokeswoman for her nation.

As a child, she would have been excused for giving up on such a dream once the imminent danger had passed. Despite the disappearance of media interest in the Swat Valley, Malala has continued to promote freedom as proven by her National Peace Award.

Malala’s father is her inspiration. Throughout Taliban rule he also worked tirelessly, a lone voice promoting equality and education for women. He is an example of conviction and bravery, qualities that have been adopted by his daughter. She would make most fathers proud but these aren’t ordinary circumstances.  It is worth questioning the wisdom behind encouraging Malala to speak openly against the Taliban. Though it is disheartening to think that the only way to have avoided this devastating act, would have been to silence a young girl brave enough to carry the hopes of every woman in her country.

When Malala Yousafai spoke "there was an aura of confidence that only comes from speaking the truth." Photograph: Geoff Brokate and Kaye Martindale.
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Relax – there’s new evidence that mindfulness actually works

The relaxation therapy could prevent relapses in sufferers of depression, according to a new study.

If there’s one thing that can be said of buzzwords, it’s that they almost always fall by the wayside in the end. Yet in the field of mental health, one buzzword has survived the best efforts of critics and naysayers – “mindfulness”.

First coined by Dr Jon Kabat-Zinn from the University of Massachusetts Medical School, the term mindfulness was initially characterised as a state of mind that would enable someone to pay “attention on purpose” to the present moment. Modern secular society seems to have embraced it as a form of meditation. Everything from exercise to breathing now has an associated mindfulness manual attached.

However, not everyone is convinced. For example, the recent phenomenon of adult colouring books – devised to promote mindfulness and serve as a form of therapeutic escapism – has been criticised by therapists as over-hyped and not necessarily helpful.

Meanwhile, sceptics have pointed out an alleged bias in the publishing of positive findings from trials using mindfulness as a form of mental health therapy. Researchers at McGill University in Canada “found that scientists reported positive findings 60 per cent more often than is statistically likely” after analysing 124 different published trials involving mindfulness as a form of mental health therapy. In some cases, the practice has even had a reverse effect, inducing anxiety, pain or panic.

However, a new study published in the journal JAMA Psychiatry seems to demonstrate that mindfulness-based cognitive therapy (MBCT) can be a potent treatment in preventing and managing relapse into major depression. Led by the University of Oxford, the study’s researchers conducted the largest meta-analysis (an analysis of various different studies) to date on the therapy’s impact on recurrent depression.

The particular form of mindfulness-based cognitive therapy that was used aimed to equip patients with the skills required to successfully recognise and repel the thoughts and feelings they most commonly associated with the state of depression, in order to prevent any future relapse.

According to the study, “the MBCT course consists of guided mindfulness practices, group discussion and other cognitive behavioural exercises. Participants receiving MBCT typically attended eight 2-2.5 hour group sessions alongside daily home practice.”

Using anonymous patient data from nine randomised trials involving 1,258 participants, researchers found that 38 per cent of those who received mindfulness-based therapy experienced a depressive relapse, in comparison to 49 per cent of patients who didn’t receive treatment. The patient data covered age, sex and level of education – key inclusions, as the meta-analysis was able to show no significant influence by these factors on the therapy’s performance.

The most prominent form of remedy currently available for mental health patients is anti-depressant medication. Four of the nine randomised trials comparatively assessed the impact of therapy alongside medication, to deduce if a combination of therapy with varying doses of medication was more beneficial than medication alone. The patients from the study who received mindfulness therapy along with continued, reduced or discontinued medication were less likely to fall back into depression than patients on maintenance anti-depressants alone. This helps legitimise mindfulness as an option in combating depression’s debilitating effects and reinforces its efficacy, whether it is taken up with or without anti-depressants.

Willem Kuyken, Professor of Clinical Psychology at the Oxford Mindfulness Centre and lead author of the study, called the results “very heartening”. “While MBCT is not a panacea, it does clearly offer those with a substantial history of depression a new approach to learning skills to stay well in the long-term.

“It offers people a safe and empowering treatment choice alongside other mainstay approaches such as cognitive-behavioural therapy and maintenance antidepressants. We need to do more research, however, to get recovery rates closer to 100 per cent and to help prevent the first onset of depression, earlier in life. These are programmes of work we are pursuing at the University of Oxford and with our collaborators around the world."

Though the findings will certainly reinvigorate confidence in mindfulness, Richard Byng from the University of Plymouth and one of the co-authors said, “clinicians need to be cautiously optimistic when tapering off antidepressant medication, and treat each patient as an individual who may or may not benefit from both MBCT and other effective treatments."