There was no question that Jonathan Block was healthy. He exercised regularly. He ran marathons. He was relatively young and undoubtedly fit.
And yet he could not stop going to the toilet. Every 20 minutes, he was conscious of an overwhelming urge to pee.
His doctor sent him to see a specialist consultant, who ran a barrage of tests. None of them identified any irregularities. And so the consultant asked whether, possibly, he might be under a little bit of stress.
Jonathan Block was the headteacher of a struggling secondary school in the English Home Counties. He was sleeping poorly: he would wake up early and arrive in school before 7am. And despite a happy marriage and good friends, he was feeling strikingly lonely and isolated.
"As headteacher, you know things going on in a school that no one else knows," he says. "Someone comes and confides in you about their divorce, their cancer, that sort of thing. You keep it to yourself. It's not fair not to. And that's lonely."
Leading any organisation can be tough. There is something isolating about being the here at which the buck stops. But for school leaders, this loneliness can be particularly pronounced.
Judy Beard had only just been appointed principal of a school in a conservative community in rural South Carolina, US, when she and her husband went out grocery shopping. Her husband was stocking up on beer, and he hefted a six-pack on to the counter just as three of her students and their parents walked down the checkout aisle.
Immediately, Beard was conscious of how this would appear. "I was so embarrassed," she says. "Like they thought I was going to go home and drink all this beer.
"The public expects so much from us, morally, that you just have to be cautious. I know there are certain people who, if they saw me at a bar, would be calling up my supervisor and saying 'this person should not be a school principal'. You're always subject to scrutiny. You're always subject to judgement. That can be very lonely."
This is something that Jenny Blount hears regularly. She is the founder of Headspace, which runs support groups for almost 400 school leaders across Britain. "One of the things that headteachers often talk about is the loneliness of the job," Blount says. "If you're the senior leader in an organisation, you set the emotional temperature of that organisation. Staff watch headteachers very closely. What's their mood like? Are they OK with everything? Headteachers are very aware that they can't be seen to wobble."
"We had a 10-year-old student killed in a car accident," says Judy Beard. "You want to show your human side, but you have to be something else because that's what's expected of you. It's been one of the hardest things ever for me to stand and make remarks at the eulogy when actually you just want to grieve. But you have a role to play. You have to demonstrate leadership."
Playing the part
There are school leaders who take this role-playing to its natural extreme. These are the leaders who have an on-the-job manner, an on-the-job wardrobe and an on-the-job insistence that they will never smile before Christmas, never show weakness and never admit to failure.
Block had always tried not to split Mr Block the headteacher from Jonathan Block the man. But when he took over a struggling school, he realised that it might be impossible to avoid a Jekyll-and-Hyde career entirely.
"Headteachers sometimes play a role and I think it can be a challenge to keep that role-playing going," he says. "I normally work with staff and want them to improve. But I realised that sometimes you have to say 'thank you very much and goodbye' to staff. That was me playing a role. I found it very stressful."
The need for role-playing is something that Beard, living in a world where ordering a bottle of wine with a meal is the equivalent of playing Russian roulette with her career, is particularly aware of. "We have staff functions," the principal of Whittemore Park Middle School says. "Staff members might have a holiday dinner, or may want to go out after hours and get together.
"If the principal is there, it puts a different tone on conversations that happen. I'm their supervisor and evaluator. I don't want to know a lot about their personal lives outside school. It's very awkward for me if I go out and one of my staff members drinks too much beer and maybe gets inebriated.
"So even though there are some people I'd like to know better, I don't go. I can't socialise with them. There might be people you like but you can't be friends with them. That's where the loneliness comes in."
'People confide in you'
Anne Byrne is headteacher of Hampton Vale Primary School in Peterborough, England, where extracurricular drinking is not a sacking offence. But she says there is nonetheless an assumption, in school and beyond, that the leader is somehow set apart. She regularly encounters people who believe that she was handed infinite powers along with the keys to the staffroom and the right to the best parking space.
"Sometimes you have absolute accountability, according to some of the parents, for whether it rains on sports day," she says. "Sometimes you get phoned up because somebody's badly parked in the area. Not near the school. But they might be a parent at the school. While I understand and I want to help, and I recognise my part in the community, I don't have any jurisdiction over where people park."
On that particular occasion, she tracked down the parent involved and attempted to make peace. And when a traffic accident occurred opposite the school - this time involving neither parents nor staff - she also ended up taking charge of events. "People turn to you," she says. "You often find yourself in situations where you're mediating between adults, because people look to you as a source of authority."
In the past, people have come to Byrne when they were evicted or - possibly because she had by then acquired a reputation as a road-traffic expert - banned from driving. Not all of them had children at the school.
"I consider myself a resourceful person and I'm generally good at resolving situations," she says. "You do find yourself wading in there because you're the one people turn to.
"A school is seen as a source of authority and sometimes a source of comfort. It's very flattering, but it does put pressure on you. It's another situation where you're expected to know what to do and how to manage it."
Such problems are not always external intrusions into school life. Sometimes they are an inherent part of it. "When you have 100 staff members, you have adult issues to deal with," Beard says. "People come and confide in you."
Beard has recently had to offer support to an employee who returned to school after a period of hospitalisation. And to another member of staff who was going through a divorce. And to a teacher whose brother was terminally ill with cancer. In addition, four of her teachers are expecting babies in the spring. She expressed pleasure at their good news, while at the same time hunting down supply teachers and worrying about keeping the school's test scores level.
"That's life, and things happen in life," she says. "You have to learn not to take things personally and not to be angry about it. It's quite similar to those people who used to spin plates. You have to keep all those plates spinning without letting people know that you're worried that it might not all work perfectly."
This, adds Jenny Blount of Headspace, is the part of the job that few training courses mention. "However well-trained you've been as a headteacher, nothing can prepare you for the emotional aspects of the job," she says. "Having to work in a world of people making demands on you, expecting you to know things, can be quite exhausting."
Finding a balance
The loneliness of responsibility is exacerbated by the lack of anyone to share it with. Depute headteachers can discuss problems with assistant headteachers or key stage leaders, all of whom are roughly their peers. But the headteacher has no peer in school.
"Even the best deputies don't know how, once you accept that post, the mantle of responsibility settles on your shoulders," Byrne says. "When you accept the post, you accept the mantle of responsibility. So you do choose that. But there's still that isolation. There are times when you can't talk to anybody. We as a profession need to be much better at finding support systems."
Of course, theoretically the school leader is supported by a board of governors. But theory and practice often diverge here. After all, just as leaders may prefer their staff not to have first-hand knowledge of their ability to down two bottles of wine and still discuss their personal lives in gloriously explicit detail, so they may also prefer that their school governors keep them on a professional pedestal.
"Will I say to my chair of governors that I'm not sleeping at night? That I can't cope with my level of work?" Block says. "Of course not."
This is echoed by Byrne. "If you're wrestling with an issue and you're not sure of the way to go, actually at that point you don't want to talk to your governors," she says. "You want your governors to have confidence in you. And it's not very confidence-inspiring to say, 'Actually, I don't know what to do.'"
Traditionally, Blount says, school leaders might have worked with others in their local authority or school district. But such networks are breaking down. With the numbers of autonomous, state-funded academies and charter schools increasing in the UK and the US, leaders are left uncertain where to go for support.
The obvious solution, Block says, would be for local leaders to club together, creating their own unofficial network. But there are problems here, too. "We had a very good consortium, a few headteachers who could share one or two things," he says. "But not too much, because you're in competition with those schools.
"We used to say that we all stab each other in the front, which is much nicer than stabbing in the back. So we were open with each other in most things - there were lots of collaborative things going on. But I don't care what people say: you are in competition."
And leadership can be a vicious circle of loneliness, stripping away alternative outlets. Long working hours mean little time for socialising. This, in turn, feeds the sense of isolation.
"This week, there's something on every night after school," Byrne says. "I won't see anybody this week at all. Often, I'll be coming home from work at 10, half 10 at night. At that point your brain is turned to mush and you can't have a conversation about anything that isn't to do with work. All you want to do is go to bed.
"I find it very, very difficult to remember friends' birthdays, to get a card in the post - just the little things that friends do. It's very easy not to realise that weeks and weeks have gone past and you've not called your friend to ask how things have gone in their driving test. Your mind has been elsewhere and you've just not realised time has passed."
Blount recognises the toll leadership can take on headteachers' personal lives. "This is a group of people who have very strong perfectionist tendencies," she says. "They have a very strong sense of moral purpose. They want everything to be right. They want to be present for the children; they want to be seen by the parents.
"We encourage them to put some boundaries around their work. But I would say that a lot of headteachers struggle to find the correct balance between their work life and their home life."
A sympathetic ear
Of course, going home does not necessarily mean switching off. Many school leaders offload troubles by discussing them in detail with their partners at the end of the day. But this can be perversely counterproductive. There is a limit to how much non-teachers can empathise with leaders' worries: they will not, for example, understand the politics of school inspections.
"People will say, 'It's an inspection. What's the worst that can happen?' " Byrne says. "I don't think they understand the stress that comes from an unfavourable result."
And even the most sympathetic partner will have a much lower tolerance threshold for school chat than someone whose professional life is inextricably entwined with the school's success. "You're thinking about it 24 hours a day," Beard says. "You go to bed thinking about it. You wake up thinking about it. You dream about it."
Besides, not all school leaders have spouses in whom they can confide. Dr Karen Edge, from the University of London's Institute of Education, conducted interviews with leaders in their thirties and forties in London, New York and Toronto. She found that many of the female leaders she met had felt forced into making unpalatable decisions.
"This generation is supposed to be more committed to creating and finding work-life balance than previous generations," Edge says. "But there are women who've said, 'If I continue on this career path, I'll be single for the rest of my life, because I don't have time to find someone who I want to spend my time with.'
"I wouldn't say that it's the headship or the husband. It's not any different for same-sex couples. But it's a living, breathing issue and that's really sad. It will be to the detriment of our schools and our teachers."
"If I didn't have a spouse, I'd have a dog," Judy Beard says. "Dogs are always glad to see you, no matter what. When I had a dog, he just seemed to take the stress right out of my body."
But she has also found solutions not based on her willingness to go for walks and wield a tin opener. "I confide in another principal," she says. "He's in an elementary school and I'm in a middle school. The ages are different, but the problems are the same. We've become very close friends, dealing with the same sorts of issues."
This is something that Byrne, too, insists every school leader should have. "Sometimes it's nice to have somebody picking up the phone to say, 'How are you? How's your work? How's school?'" she says. "You can say, 'I'm fine', or you can say, 'Can we go for a cup of coffee to talk?' You need reflection time and we don't get reflection time. The ante's always being upped."
This is actually the principle on which Headspace operates. It matches school leaders with others nearby, and arranges regular discussion sessions. "They feel they can have open and honest conversations, where it's not going to come back and bite them," Blount says. "Headteachers are very good at putting on a mask. They don't necessarily talk about things.
"But I think there's something incredibly valuable about talking to other people who do the same job as you. They're the only ones who are going to be able to understand."