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I am Dr Daniel Martins, a clinician-scientist at the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London (Department of Neuroimaging), working at the intersection of psychiatry, neuroscience, and technology. In this piece, I reflect on the evolving relationship between artificial intelligence and mental health, exploring both its promise and its perils in today’s rapidly changing landscape. Illustration generated using OpenAI’s DALL·E based on prompts and direction provided by the author Late one night, overwhelmed by racing thoughts, I found myself sitting awake in bed. Instead of scrolling endlessly through social media or waiting weeks for my next therapy session, I turned to ChatGPT to express what I was feeling. The response was immediate, warm, and practical - offering validation and guidance through calming breathing exercises. To my surprise, the tension began to ease. Artificial intelligence (AI) is rapidly becoming a surprising and increasingly trusted ally in mental health care. But alongside these promising moments come unsettling reflections: the endless doomscrolling at 2AM, the creeping loneliness fueled by algorithmic bubbles, and the nagging sense that our most private thoughts might not be so private after all. "Is AI here to help us heal, or might it be silently reshaping our emotional lives in ways we barely understand?" From AI-driven therapy tools and mindfulness apps to the hidden risks of digital addiction and biased algorithms, this is a moment to pause and ask: how do we ensure AI supports - not supplants - our mental health? AI as a New Ally Just a few years ago, the idea of discussing depression with a machine felt absurd. Today, it’s quietly becoming routine. With mental health needs far exceeding available support, AI is stepping in - offering a voice at 2AM when no one else is awake. These tools don’t replace therapists, but they remove common barriers: shame, cost, waiting rooms, and geography. For many, tapping an app becomes the first step toward healing - a chance to speak what has long been kept inside. AI also offers new ways of personalized support that traditional therapy often cannot. Studies suggest AI chatbots can reduce symptoms of anxiety and depression, with users reporting a sense of being heard and helped. Some tools even analyze speech, text, and wearable data to automatically detect stress and suggest small interventions – a gentle prompt to breathe or go for a walk. These nudges, while simple, create a sense of companionship. The idea isn’t to automate care but to extend it. Let AI handle the check-ins so that humans can focus on connection. For many, these interactions feel surprisingly human. People describe late-night chats with bots as moments of clarity, relief, even joy. That sense of emotional safety comes from design: tools built by those who understand distress firsthand. The goal isn’t to mechanize emotion, but to widen access. Sometimes, just knowing there’s a place to speak – even digitally – can be transformative. Yet, it is fair to say that the evidence base remains in its infancy . Most studies to date are small-scale, short-term, and focused on specific populations, limiting their generalizability. We do not yet fully understand the long-term effects of AI-based mental health tools, nor how well they perform across diverse cultural and clinical contexts. The promise is real, but the science must catch up. In mental health, quick fixes are always tempting. Yet all interventions must be grounded in rigorous, ethical, and inclusive scientific evidence. It is our responsibility as the scientific community to scrutinize both the bright promises and the black-box risks of these technologies - with curiosity, but also with caution. Illustration generated using OpenAI’s DALL·E based on prompts and direction provided by the author The Hidden Costs With every promise comes a shadow. AI also powers the social media algorithms that erode our peace - endlessly feeding us content we didn’t ask for and can’t stop consuming. These systems aren’t built for mental well-being. They’re built for engagement, and what captures us most is often what leaves us unsettled. There’s also the risk of emotional over-reliance. Some users begin treating bots as confidants, turning to them for comfort at the expense of real human connection. The appeal is obvious: a tool that always listens, never interrupts, and offers polished empathy. However, AI doesn’t really understand us. It simulates care without sharing it. Over time, this can dull our capacity for real intimacy - making us less patient with the imperfections of human relationships, or less willing to engage in difficult conversations. We may start judging others by a standard of interaction that was never real. Another concern is misinformation. AI outputs are probabilistic, not wise. In moments of vulnerability, that distinction matters. A user might receive advice that sounds plausible but is misguided - or even harmful. Without the discernment of a trained human, AI may validate distorted thoughts or overlook signs of crisis. Algorithmic bias compounds these risks. If training data reflects social inequalities, then AI tools can replicate or amplify those disparities. Users from marginalized communities may receive less relevant or culturally insensitive responses, further alienating them from care. And then there’s identity. As we outsource emotional reflection to algorithms, our sense of narrative agency may blur. If an AI companion becomes our most attentive listener, best editor, or constant motivator, where do we end and it begin? For some, this fragmentation can lead to confusion, derealization, or a subtle erosion of self. Lastly, privacy looms large. We pour our thoughts into these platforms, often unaware of where that data goes or how it’s used. Are our disclosures truly confidential, or feeding corporate algorithms? Even when responses feel caring, the infrastructure behind them may be far less benign. Illustration generated using OpenAI’s DALL·E based on prompts and direction provided by the author Building a Future in Partnership So, where do we go from here? The goal isn’t to reject AI, nor to embrace it blindly, but to shape it wisely. That means ethical standards that extend beyond technical fixes, design rooted in empathy, and accountability for emotional impact. We need collaboration across psychiatry, psychology, neuroscience, philosophy, and - vitally - lived experience. We need policies that must protect not just data, but mental well-being. Above all, we must educate ourselves on what AI can and cannot be. No app, no matter how advanced, can replace the experience of being seen and held by another human being. And yet, there’s beauty in what’s emerging. That someone sitting alone in the dark might find comfort through a digital exchange - that matters. It reflects a collective effort to meet suffering with creativity, not indifference. Let us proceed with curiosity, compassion, and caution. Let us build technologies that serve our humanity - not substitute for it. And let’s keep the conversation going. Because the future of mental health will - and must - be deeply, irreducibly human. Image credits: All illustrations were generated using OpenAI’s DALL·E based on prompts and direction provided by the author.

Being a woman in 2025 feels frightening. During a time when society should be moving forward towards greater equality and empowerment for women, we seem to be heading in the opposite direction. With each passing day, it feels as though history is repeating itself, and we women are once again fighting battles we thought were long behind us.   I recently read Margaret Atwood’s popular dystopian novel, ‘The Handmaid’s Tale’, and it has never felt more relevant to society. As a psychology graduate and a research assistant in perinatal psychiatry, I found myself drawing similarities between the novel and real world, with a focus on the impact of being treated as reproductive bodies on the mental health of women . Set in Gilead, a totalitarian version of New England in the United States, the novel envisions a patriarchal society where women are stripped of autonomy and reduced to their reproductive functions. Inspired by real historical events , such as the communist reign in Romania, and battles over female rights in America in the 1980s, Atwood’s fictional world was once a terrifying ‘what if’. As Atwood once said, "Nothing in the book hasn’t already happened at some point in history". Disturbingly, today it reads like a warning that is slowly coming true. In Gilead, women are silenced both literally and figuratively. They are not allowed to read, speak freely, or make decisions about their own lives. Their roles are rigidly assigned: if they can bear children, they become handmaids to those high up in society, if not, they are relegated to cooking and cleaning. Their bodies belong to the state, and personal identity is erased: make-up, self-expression, and showing skin are forbidden. Women are blamed for being infertile, and those who cannot reproduce are sent to ‘colonies’ as punishment, a radioactive wasteland where physical work is carried out and survival is unlikely.   This may sound like fiction, but real-world events are beginning to echo these themes far too closely. Cover Art of The Handmaid’s Tale Since regaining control of Afghanistan in 2021, the Taliban have systematically dismantled the rights of women and girls , creating a society where female autonomy is virtually non-existent. One of the first political acts of the Taliban was to ban secondary and higher education for women, leaving them at higher risk of exploitation and maltreatment. Women have also been barred from most forms of employment, and freedom of speech has been stifled. Women are under constant threat of punishment for disobedience, with those who protest facing consequences such as enforced disappearance and torture. Confined to their homes and stripped of their voices, dreams, and identities, Afghan women are being erased from public life, harrowing a real-world parallel to The Handmaid’s Tale. In both the novel and in current Afghanistan, the tools of oppression are eerily similar, with women being treated as vessels for childbearing or for upholding the ‘morality’ of a male-dominated regime.   What’s more chilling is how easily this level of control can be implemented when fear and religion are weaponised. In Gilead, the state justifies its cruelty through Christian extremism, with religious texts and ideology being used to oppress and control women. Similarly, the Taliban enforce their rules under extreme interpretation of Islamic law. Photo by Ivan Aleksic on Unsplash This isn’t just happening in Afghanistan either. Women’s rights are being violated across the world. In the United States, the 2022 overturning of Roe v Wade has left many questioning how far governments are willing to go in policing women’s bodies. Why is it that society feels they are able to violate women’s reproductive rights, controlling what they can and can’t do with their bodies? For centuries, women have been seen as objects that bear children, and it seems that in 2025, this is no different. Nineteen U.S states have banned abortions, leaving millions of women without access to safe, legal abortions, with some states having no exceptions to this ban. The idea that women are solely responsible for bringing life into the world, but that they have no say in the matter, and their bodies are controlled by the government, has many consequences for physical and mental health.   One particularly disturbing case in Georgia highlights the extent of this control. A brain-dead woman is currently being kept on life-support in order to sustain a foetus, despite her legal status as deceased and without consent from her family. Her body is being used as an incubator, raising huge ethical and moral concerns. The implications of the abortion policy suggest that a foetus is afforded more legal protection and priority than the woman carrying it. The state intervened to preserve potential life, yet offered no support for the immense financial and emotional burden on the family. Furthermore, the chance of the foetus surviving beyond birth remains slim, and if it does survive, it may face lifelong health complications. Despite being informed of these complications, the policy and decision to forcefully keep the woman on life support stand.   Such extreme interpretations of abortion bans risk creating a society that echoes dystopian fiction, where women are reduced to their reproductive function and denied agency over their own bodies. Even in death, women’s bodies are controlled by the government. But for what reason? Perhaps there is an underlying discomfort with the power women hold, and an unease about how different society might look with more women in positions of leadership. This may help explain why some governments and institutions continue to exert control over women’s choices, shaping what we can say, how our bodies are treated, and the rights we are allowed to claim. Photo by Giulia Squillace on Unsplash Both in Gilead and in real life, governments use fear and ideology to justify the erosion of women’s rights.   The parallels between Atwood’s fictional novel and the real world are no longer relevant to history, instead, they directly relate to modern day. Governments may believe they are enforcing rules to make the world a better place, but instead women’s rights are being chipped away piece by piece. It feels as if we are slowly stepping into our own version of Gilead, with women becoming characters in a real-life dystopian reality.   The Handmaid’s Tale was never just a work of fiction for many women around the world. For some, its dystopian reality is lived. Rather than viewing it as a chilling story drawing from historical time points, we should treat it as a warning that society cannot afford to ignore.

1) If you put your mind to it, you can do anything you want   Author's own image When telling people that I was training for the London Marathon, most people would reply by telling me that they "could never do it". Even established runners, even people who had run half-marathons, would tell me that they could not do it, ever. And that, of course, is not true.     I had always thought of the idea of running a marathon as a challenge , but never as an impossibility . I knew it was difficult; however, I also knew that people train for it and then run it: not breaking world records, but finishing it.     For me, the challenge had always been the commitment to the regular, long and intense training that takes over your life for at least six months. And I could never motivate myself to face this challenge, until the opportunity of running the London Marathon came – the most coveted sports event in the world – for the charity that I chair and love, the Psychiatry Research Trust , which supports research and education in mental health. How could I say no?      I immediately knew I could  do it: I just had to make the necessary life changes to incorporate the training. As I described in my previous piece  in Inspire the Mind, this training ended up helping my mental health.    I have always had this semi-grandiose, over-optimistic view of life, where everything is possible if you put your mind to it. I am not talking about the long-term, lifetime commitment required to pursue a career–yes, I can do this too–but rather the grit to overcome a new challenge in weeks or months.     So here is one other example: on one distant day in Spring 2010, I was walking along the Thames near Southbank with my nephews, then aged 11 and 9. I saw a man of approximately my (then) age with two children,  all three with a skateboard in their hands. So, I thought – how difficult can this be? Very -  I later discovered with a cracked rib. But I managed, with my two nephews (and the help of a professional skateboarding instructor), to soon learn to do drop-ins and kick-turns.     Please let me clarify: I am fully aware that luck plays a big role here. If I could not buy running gear, have a workplace that allows me the flexibility to train, or simply the health required for enduring such an effort, I would not have been able to run a marathon. So, while I advocate the power of commitment and focus to achieve what we want, this goes hand-in-hand with gratefulness and compassion.     2) If you want to achieve something difficult, you better study    I have always been passionate about the technical details of my hobbies, studying them as if they were my job. I did this with photography (self-teaching books), cinematography (a Raindance Moviemaker diploma), the aforementioned lessons in skateboarding, and of course, training for a marathon.  My psychotherapist said that I prepared for the Marathon as I prepare for life: by studying as much as I can.  Author's own image I have already talked about my training . However, as the marathon day approached, I became more and more studious of the key factors determining the success of the actual race day. I read Instagram accounts, websites, and written notes provided by fellow marathon runners. I prepared for the famous “tapering” – a drop in running volume in the last three weeks before the race, which routinely brings up anxiety and withdrawal symptoms. I tested the best combination of bananas, carbohydrate gels, water and sports drinks. I planned the speed I should keep for each block of 5 km, aiming for “negative splits”, that is, faster at the end than at the beginning (which I failed spectacularly to achieve). I rehearsed where to put (and how much) vaseline to prevent chaffing. I chose the best underwear, socks, and t-shirt. I decided what food to bring with me to eat before the run and to leave in my bag at the arrival.     You hear stories of people who never trained for a marathon, showed up on the day to do something cool with friends, and ended up finishing within an incredible time and feeling as fresh as a rose. Except, I don’t believe it. Most, if not all, people who just show up to such a challenge unprepared finish with an injury or suffer severe exhaustion, or both. Like in life.    One aspect of preparation is also to prepare for the things that can go wrong, because they will, as in life. In my (and all the other 55 thousand runners’) case, it was the temperature: one of the hottest days on record for the event. I slowed down, kept drinking, took an electrolytes powder (yes, I had trained how to empty the sachet into the bottle while running), and I drenched myself in all the available showers. However, people left and right were stopping with cramps or fainting, and I also started to get anxious that I might feel sick and that I might have to stop the race. To calm myself down, I looked at the worst-case scenarios, and I embraced all possible solutions. I kept repeating to myself: “You can finish this. If you feel more tired, you can slow down. If this is not enough, you can walk. If this is not enough, you can stop, rest, and then start again. It may take a few hours, but you can finish this”. I also used a lot one of my Kung Fu mantras: "It is only pain". I was 30 minutes slower than my target time, but I finished.    One funny surprise was that the gel provided by the organisers was not the one I had trained with and was much more liquid than I expected. So there I was, running with super-sweet goo all over my hands and trying to get wet wipes (yes, I had those too) from my back pocket.  Authors own image 3) People will carry you – the supporters, the friends, the crowd    I was overwhelmed by the generosity of the people who donated to my fundraising page for the Psychiatry Research Trust (there is still time to donate here ): 83 donors, some anonymous, helped me raise more than my target of £5,000. Their written comments supported me through the weeks of hard training and boosted my confidence in the last few days before the race. I received words of love, strength and inspiration.     I felt lucky that so many of my friends (and my wife) braved a chaotic and crowded London and the long queues on public transport to cheer me along the course or at the arrival. Every time I saw them, it was like a refreshing fountain swig in a desert of fatigue, a kick that projected me a few kilometres more. It was sheer joy sharing such an important moment with them. I could not stop hugging them even if I knew I was way too sweaty for their comfort.     And finally, the crowd. Do I need to repeat this truism that is on every newspaper article, website and social media account talking about the crowd at the London marathon? But it is true: the crowd’s energy is truly overwhelming. The noise is everywhere, ranging from really loud to cacophonic, providing an addictive energy: music, shouting, cheering, instrument playing, drums beating, dancers, singers, people drinking champagne…     Now I know why people want to run the London Marathon again and again.     And so do I.

Professor Sir David Goldberg (1934 – 2024) Tomorrow, 4th of June, the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, together with the  Psychiatry Research Trust , are hosting a commemorative event to celebrate the life and work of Professor Sir David Goldberg. When I started training in psychiatry in 1981, apart from the six months in academic psychiatry, all my training was in asylums in Leicestershire. Working in clinical settings and reviewing research, I came across the General Health Questionnaire (GHQ) and the name David Goldberg as its creator. Along with all trainees and colleagues, I was aware of his name, reputation, and status. We would discuss his papers in the journal club and were in awe of him and his contribution to psychiatric research. After finishing my basic training, I joined the Maudsley (as there was no SLaM at that time) rotational higher training scheme. My first-year posting was at Hellingly Hospital, Hailsham, near Eastbourne. The following year, I was posted to the Bethlem Royal Hospital , working with four consultants. Now, as a retired Professor of Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London (IoPPN), where David eventually came to work until his retirement in 2000, and in preparation for an event that will commemorate David’s legacy next week organised by IoPPN and the Psychiatry Research Trust, I find myself reflecting on those early years and the impact that David has had on me, both personally and professionally.    My first face-to-face contact with David was in that position. As Chair of the Joint Committee for Higher Training (JCHPT) of the Royal College of Psychiatrists , he led the college inspection of higher training at Bethlem-Maudsley, including various outposts. Those were the days when the College conducted site visits to ensure standards of training, supervision, and academic learning. David was very matter-of-fact and said that there was no way I should be working with four consultants. A couple of years later, out of the blue, I got a phone call from him offering me a job in Manchester, which I very politely declined. On the phone call, it was, again, a very matter-of-fact and focused conversation. Another couple of years later, he arrived at the Institute of Psychiatry (IOP as it was called at the time) as Head of the Department, replacing Professor Gerald Russell , who had retired, and I had the pleasure and honour of working for him as Senior Lecturer.   David Paul Brandes Goldberg was born in January 1934 in London. He was just 5 years old when the Second World War broke out, and for a period, his family moved to Oxfordshire near Banbury. As a newbie, local children ganged up on David, and he mentions in his privately published memoirs that he started "making exploding jam jars with calcium carbide and a little water to keep our enemies in order and maybe treat us with greater respect!" It is not clear in this feeling whether these enemies were bullies at school or the Germans. David's father was a civil servant and was sent to the USA in order to negotiate a contract between the two governments. He told the family that were Nazis to invade Britain, he would kill them. David mentioned that he kept the bottle of barbitone (a powerful sedative) in his desk to remind him of those peculiar days. When I had the privilege of interviewing him for my book, Psychiatrists on Psychiatry , he talked about not being able to understand why people he had never met were determined to kill him. He was getting ready to leave for the USA, and the ship that left before his was supposed to was torpedoed, killing all the children on board, and as a result, his parents changed their minds and David stayed on in the UK.    In 1952, he went to Oxford to study medicine. He was interested in doing psychology, but had to be re-examined in Latin. His father had run rehabilitation units for returning soldiers, which really interested David. He studied medicine and then moved to St Thomas’ Hospital in London, where he came across a paper, Between doubts and certainty in psychiatry, by Sir Aubrey Lewis , who was based at the Institute of Psychiatry and the Maudsley Hospital. David noted in his life story that Sir Aubrey Lewis (Head at the Institute of Psychiatry) had a different perspective on psychiatric disorders, unlike William Sargent (based at St Thomas’ Hospital), who saw mental illnesses as just like physical illnesses. David took his MRCP examination multiple times and kept failing. Perhaps that is why he took on a rebellious position against the establishment of the Royal College of Psychiatrists when it was being set up in 1971. He felt that the new College would do exactly what the old colleges were doing — examinations would become expensive, and the College would use this as a money-making activity. Consequently, the College decided never to make any profits from exams and invest the profits in the examinations themselves.   He arrived in the Maudsley for training in psychiatry, and six out of ten of his cohort went on to become professors. While training at the Maudsley, David got interested in the General Practice Research Unit run by Professor Michael Shephard, and he developed the General Health Questionnaire and Clinical Interview Schedule. He then went to Philadelphia to obtain what he called a BTA (Been to America) degree. He worked in the Community Mental Health Centre initially and then at the University of Pennsylvania. He returned to Manchester, where he continued to work in primary care psychiatry. He changed the training model using videos to train junior doctors. When he set up a Master's course for International Medical Graduates. He worked with his NHS colleagues and banks to help new arrivals settle down. His research remained focused on general practice, and subsequently, he spent a sabbatical year in South Carolina, where he said that he learnt to use recordings to help improve general practitioners' skills in mental health care. In Manchester with Peter Huxley, he developed the pyramid model of mental healthcare and led research in pathways to care. Upon his return, he continued to improve teaching and training. He continued to innovate research as well as clinical practice. Sir David received a knighthood in 1997 for his contributions to medicine David returned to the Institute of Psychiatry in 1993 for seven years before retirement. He established interdisciplinary research groups, set up Maudsley debates and discussion papers, and revived Maudsley monographs, amongst other innovations. Bethlem celebrated its 750th anniversary during his time, and he worked with the King’s Fund to celebrate it and commissioned Professor Roy Porter to write a book on the history of Bethlem. His style was facilitatory. When I joined him and his department in 1994, I recall him popping into my office before a meeting where he was chairing, and I was attending. He asked me about participants, their strengths and likely challenges, and what the outcomes we wanted were.   When I requested him to look at my PhD thesis, not only did he agree very promptly, but within 48 hours, he had commented on it in detail with some irate comments. Ilfra, his wife, rang me to ask me not to mind as he was in bed and had a horrible cold and was being grumpy. He met Ilfra while they both were at St Thomas Hospital and got married in 1966 and had four children, Paul, Charlotte, Kate and Emma, with grandchildren. David was a handyman as well and did electrical wiring himself in various houses they lived in. David with his wife, Ilfra He met Anne during his Oxford days, and their relationship at that time lasted two years. Subsequently, she moved to New York and in his later years returned to London to be with him for 3-4 years as Ilfra had predeceased David. After retirement, David took on the role of Chair of Psychiatry Research Trust — a mental health charity that is now a partner of ITM in supporting writers with lived experience. He continued with lectures and worked with the World Health Organization (WHO) on various surveys in primary care and helping develop diagnostic classification of psychiatric disorders in primary care. David on his 90th birthday, with Dinesh and with Gabby Ivbijaro, a GP whom David supervised for his PhD After he developed dementia, my partner and I would go to his place almost every week and spend an hour or so with a bottle of bubbly. He remained interested, enjoying our visits and talks, and we would share jokes and old stories. His sense of humour would emerge from time to time, reminding us of his vivacity and energy. He described himself as an average academic and was really proud of his family.   Please join us at the IoPPN on the 4th of June to celebrate David!

Henry's dad used to love football. That's how it always used to be. Growing up, Henry spent more time in stadiums, breathing the cool air around him as he watched with anticipation the ball fly around the pitch, his dad's rough hand in his, than he did in his own room. In his own house. Or, that's how it felt, anyway. And he never once complained—why would he? He learned to love the game almost as much as his dad did, and while he would never tell him, he enjoyed having an excuse to spend time with his dad. Photo by NoName_13 on Pixels His mum used to say that Henry worshipped his dad; he was sure she was joking every time she said it, as her eyes sparkled and she always had the same slight smile on her face, but Henry never once corrected her. He was sure his dad was in on the joke, too—he always laughed, deep and hearty, and Henry always felt as if he was right back at a football match, listening to that same laugh after a goal, as his dad hugged him tight. So, he supposed, after the joke had run for a while, that maybe he did. But then, after a while, Henry's dad stopped taking Henry with him to games. And then his dad stopped going to watch football at all. It didn't bother him much at first; he just assumed that his dad had a cold or stomach ache or something, and that maybe he needed a break. But after a few months had come and gone, Henry started to miss going to watch football—the buzzing of the crowd, the singing, the fresh air, the happiness of winning, and how happy his dad would get when their team scored… He didn't even watch the games on TV anymore or even check the scores. Henry missed it so much that he felt empty. The memories of past games kept appearing like flashbacks in a film, like when their team scored once, right in the last minute, to win the game, and afterwards, his dad just couldn't stop grinning. Even long after the game finished, he just couldn't seem to stop smiling and whistling one of the songs from the game. It occurred to Henry then that he had never seen his dad smile, laugh, or even whistle like he was then. Once his dad stopped going to the games with him, or even talking about football, Henry soon realised that he was right. His dad was never really happy anymore. Henry wasn't quite sure what to do about this. In his mind, the only thing that made his dad happy was football, so he had another thought and decided one day to mention football, in the hopes of seeing his dad smile again. "Dad?" "Yeah, bud?" his dad said quietly, from where he sat on the sofa, as he did most days now. "Are we playing today?" "Who?" his dad asked, seemingly confused. "The team. Football?" Henry replied, equally confused. Henry then watched as his dad's eyes darkened, and a strange mixture of emotions flickered across his face. Then, his dad sighed so heavily that he seemingly sank deeper into the sofa. "Not today, mate," his dad said, his voice so low that Henry struggled to even hear him. Henry nodded, assuming that meant that they weren't playing at all, but his dad then asked him to go and play somewhere else because he was being too loud, even though he was just reading a book. Henry just nodded, thinking that he must have hurt his dad's feelings somehow, because his dad barely even looked at him after that. Henry gripped the steering wheel tightly so the memory would fade. He wasn't quite sure why it still hurt him, even now, when it had been just over 30 years. Going to watch football used to be something that just the two of them would do, and it made him feel so happy, so grown-up… and he assumed it made his dad feel happy too. But he must've been wrong. Maybe his dad just took him to games because he felt like he was supposed to as a dad, and then got bored with them. Or maybe it was something Henry had done… He couldn't think of anything specific that would've made his dad hate football, but why else would he suddenly act like it didn't exist? Maybe it wasn't the game that his dad got tired of, but him. As that thought cemented itself into his brain, Henry had to remind himself to keep his eyes on the road. This afternoon was going to be hard enough as it was—he didn't need that thought tripping him up while he was dealing with... everything. Since his dad went into the care home, Henry had only heard how things were going through the occasional check-up phone calls from the carers. They were kind enough, saying that he was just getting used to things, but Henry knew well enough that his dad could have rung him if he wanted to. Not that Henry called the care home himself during those weeks when his dad was settling in, either. It's not that he was waiting for the nurses to call, really. He was just… busy. Henry hated that he sounded like his dad; he didn't mean it in that way… he just… had a lot going on. And Henry would have listed all of these responsibilities if he hadn't just driven into the car park of his dad's care home. Henry suddenly felt his palms go cold, and his mouth was scratchy and dry as he tried to swallow. The nerves always hit him quickly, like a shot of whiskey burning his throat—he didn't drink much, just as he didn't really speak to his dad much, not since he was a kid, which made doing both of those things quite daunting events. More so, the 'attempting to speak to dad', but still. Henry wanted to try and be a good son, despite everything. Admittedly, it wasn't as if he was busy anyway; all he did was get through the workday, sleep, and repeat… but it was never easy with his dad. It was the same now, as he quietly signed in with a friendly receptionist. He tried his best to be polite before he ambled his way through the care home corridors, desperately searching for his dad's room: 407. It was typical, his dad had to have one of the highest room numbers, which meant it was as far away from the entrance, and Henry, as possible. It was as if the universe liked to emphasise that what he felt was true, his dad got tired of him. Henry felt the muscles in his legs strain from the stretch of being sat driving his car, and sighed. He used to love running and wouldn't think twice about having to do any kind of walking. He used to take a strange kind of joy out of it, his muscles waking up like this. Lately, though, he found that he didn't get much joy out of anything. Even as he walked into his dad's room and noticed a football game flickering on the TV, there was no pang of joy in Henry—because his dad was turned away from the screen, his face drawn, and sad. "Alright, Dad?" Henry asked. "Hello, son," his dad answered, his voice quiet. Henry sat down gently in a chair, facing the silent football game on the TV screen, and his dad opposite him. The next few moments of silence dragged on, and Henry felt like he’d been sitting there for an hour before his dad’s chair finally creaked as he twisted to face the TV.  With a click, he then turned it off with the remote. Henry tried not to read into the meaning of that action, instead looking over at his dad's face, lined with age and years of frowning. He was frowning again now, and his eyes were watery as he looked steadily into Henry's. "I need to talk to you," his dad said. "What's wrong?" Henry asked, his heart suddenly beating fast; his dad sounded serious, and he hadn't spoken to him so directly in what seemed like forever. Whatever this was, it couldn't be good.  "Since I've been here… they got me speaking to a doctor about my falls an’ that, and they gave me something to help with my back pain, and the doc… they also said there was something else wrong with me." Henry's heart shot into his throat so quickly that he almost choked on it as he said. "What is it, Dad?" His dad sighed and cleared his throat. "He told me I have depression." Henry coughed as his heart slid back down in his chest. "I know - I was shocked, too. Didn't believe him at first, but then he said… well, he asked me about my mood and things. And…" Henry's dad looked away for a moment, his eyes misty. "It kind of made sense. I'm not sure you remember, but we used to go and watch the footie a lot, you and me." "No," Henry said quickly, "I remember." "Well," his dad continued. "One day, the day before a match… it was like a switch flicked in my brain. The games I used to love, and the time with you I used to treasure… it was like all the colour had gone out of it. I thought I'd just gone off the football, but talking to the doctor, he said it sounded like it was depression, and I just used not liking football anymore as an excuse to pretend everything was fine when it wasn't. I wasn't fine because there was no happiness in my life anymore. Not for football, which I loved… Not for anything." Henry felt tears well up in his eyes as his dad's words landed heavy on his chest, as hard as punches. What he said—about him not enjoying things he loved, about there being no happiness in his life—sounded just like he was feeling, now. "Dad…" "No, let me... let me just… I just wanted to say, I'm sorry, son. I'm sorry that I was so miserable for most of your life." "Dad? What?! No!" Henry said, his words coming out louder than he intended. "Well… the doctor said depression can run in families, sometimes. Which explains my mum, but since then I just keep thinking… how much I failed you," his dad said, twisting his aged hands over and over on his lap. "When you were a kid. But even now… I've noticed how low you seemed when I spoke to you the last few months, and just waved it away, but… I'd hate to think I did this to you." "You didn't," said Henry. "It's not your fault. It's no one's fault. It's just chemicals, that's all." He didn't bother to pretend he was fine—what was the point, really? And anyway, he hadn't talked to his dad so openly in years, he wouldn't dare waste this moment by spouting lies. Henry's dad coughed and rubbed at his eyes. "You're right; the doctor said the same. Even so, I'm sorry, lad. All the games we missed when you were a kid…" "Dad, please, you don't need to apologise," Henry said, before reaching over to hold one of his dad's aged hands in his. "It's alright, you weren't well. Listen to your doctor." His dad nodded, "You're a smart boy. You know, he's told me I should start going on some tablets for it. Can you believe-" "Dad," Henry had to stop himself from sighing. "You know there's nothing wrong with medication. Trust the professional and at least try them out -" His dad smiled, making Henry pause. "I'm not that decrepit, you know," Henry's dad said. "I was just going to say that I can't take tablets for the life of me. I must have them split in half by the nurses, or I almost choke on them." Henry remembered his dad trying to take an ibuprofen years ago and having a coughing fit. "So… Have you started taking them, then?" His dad nodded. "A few days ago." "Wow, Dad — that's amazing. I'm proud of you." Henry's dad smiled. "Thanks, son. So, do you think you can take your own advice and go and talk, and then listen, to a professional yourself?" Henry thought for a moment. "Maybe." "Well, how about this: if you do, I'll take you to a match, just like old times." Henry grinned. "Alright," he said, shaking his dad's hand, "it's a deal." In what felt like a distant memory set in the present, Henry and his dad spent the rest of the visiting hours talking and reminiscing and making each other laugh, just like old times. Then, after a heartfelt goodbye and a hug, as Henry walked out of the care home, he could've sworn that he felt… lighter. Not quite joy, but he felt that if he were in a similar hole to his dad, he could see the way out. That he knew he could climb out, if he tried. And Henry wanted to, he thought, as he fished out his phone from his pocket to remind him to book an appointment with his GP. He even decided to go for a gentle jog when he got home—no time like the present, really—not since he was going to go to a football game again with his dad in a few months. Henry felt his younger self, somewhere, jumping with joy at that news, and promised he would get better by then, for his dad. After all, if his dad could, then so could he. Especially if it meant they could go and watch a football match together again. Just like old times, only better.

In January 2024, we held the first dissemination event for the CELEBRATE Project, a UKRI-funded research programme dedicated to improving how researchers study the biology and mental health of young people through co-development with young people . Fast forward to May 2025, we have just hosted the final dissemination event, From Mission to Framework , where we shared key findings, celebrated milestones, and marked the successful conclusion of this two-year project.  Understanding the CELEBRATE Project:   Adolescence is a crucial period that shapes long-term outcomes, with mental health challenges during this time often having lasting effects. To better understand adolescent mental health, we must examine how environment and background influence and interact with biology during this key developmental phase. While numerous studies have examined social and environmental influences, biological research focused on adolescent mental health remains limited, particularly regarding the inclusion of diverse and representative cohorts. Addressing this gap requires a comprehensive framework to guide large-scale biological research that authentically reflects the diversity of adolescent populations.  This is exactly where the CELEBRATE project comes in. CELEBRATE stands for C o-producing a framework of guiding principles for E ngaging representative and diverse cohorts of young peop LE  in B iological R esearch in men T al h E alth . The project is a collaborative effort involving researchers, young people, parents, and teachers across Birmingham, Bradford, and London. At its core, CELEBRATE seeks to answer the question: What principles do young people and key stakeholders believe should guide researchers conducting biological research on youth mental health? Beyond this, CELEBRATE   explores the perspectives of young people, parents/guardians, and schoolteachers, on how best to involve, engage, and retain young participants in biological research, recognising that many evidence gaps in biological research stem exactly from challenges in these very areas. To achieve its aims, the CELEBRATE Project is structured into five work packages. At the final event, members from each of the work package teams presented key findings and reflections, bringing together representatives from all three study sites. I had the privilege of co-presenting work package 1, which focused on conducting a thorough review of scientific evidence to investigate the needs, barriers, and facilitators of conducting biological mental health research with young people. The event was a great opportunity to see how our findings fit into the wider project, a nice way to wrap up everyone’s hard work.  The CELEBRATE Project Work Packages Co-production with Young People   At the heart of each work package and the overall project is the Young Experts Working Group (YEWG), composed of ten young people aged 11–16 with a strong interest in mental health research. The YEWG played a central role in co-leading and co-delivering the project, demonstrating a new research approach that prioritises and amplifies youth voices. Their involvement ensured the project remained relevant and reflective of the real needs and experiences of young people, aiming to overcome barriers to their participation in biological mental health research. The YEWG were also actively involved in co-delivering the event alongside members of the team from all study sites. The event opened with remarks from our Principal Investigator, Professor Paola Dazzan, who set the stage by reflecting on the journey and highlighting the power of co-development. Soon after ,  we were joined by members of the  YEWG, Noa, Daniel and Tash, who walked the audience through reasons for behind their involvement and the structure of their involvement. This included bi-monthly meetings where they discussed project updates, plans for future involvement and completed group activities that allowed them to actively engage with the research process, as well as email updates containing both written and video content prepared by Niyah Campbell, our youth involvement co-lead, presenting an innovative way to communicate with young people in research! Towards the end of the event ,  the YEWG reflected on their experience, emphasising the value and opportunities CELEBRATE had offered them.   Last year, during Children’s Mental Health Week, we asked members of the YEWG to share their thoughts on the importance of including young people’s voices in mental health research. Abel said, “We aren’t as experienced as adults, but we still know what we’ve experienced,” highlighting the value of lived experience regardless of age. Daniel noted, “Our voice matters because we are the ones being affected,” underscoring that young people are at the centre of these issues. Fawad added, “Adults may not have the same diverse and impacting opinions that children have… if you ask them about their youth, it might have looked different.” Together, these insights make a powerful case for why youth perspectives are vital to shaping meaningful research, illustrating exactly why CELEBRATE was co-developed with young people themselves.  As a research assistant, I had the opportunity to attend several of the YEWG meetings, getting the opportunity to witness firsthand the insight, enthusiasm, and thoughtful contributions these young people brought to the project. Seeing them take such an active role in the final dissemination event was a fitting and meaningful way to bring the journey full circle ,  highlighting the value of their involvement throughout.  Principle Investigator Professor Paola Dazzan Conclusion and Next Steps The project concluded with our Principal Investigator presenting a draft framework that synthesises insights from each work package. This framework stands as a primary outcome of the project, offering guiding principles to help researchers conduct more relevant, valid, and representative biological research on young people’s mental health. Moving forward, these findings will be shared widely through research papers, conference presentations, and engaging content on social media. The review as part of work package 1 will also be published soon! By doing so, we aim to ensure that the knowledge gained contributes to shaping future research practices and ultimately improves mental health outcomes for young people. Stay tuned for updates as we continue to share our journey and findings with the wider scientific and research community.

I was watching Barbie in my room when I heard soft thuds. I waited, and after I heard it again, I rushed out to the parlour, my heart thumping, my mind already painting an ugly picture of what was probably going on.  Photo by Cottonbro Studios on Pexels My parents' attention was firmly fixed on the TV show, which had bad sound quality. In my mom's hand was a stick of sugarcane, which she took a bite from before passing it over to my dad. Neither of them noticed me. I walked back to my room, relieved but still breathing fast, like I had just run a marathon. I couldn't concentrate on the show anymore as, subconsciously, I was listening for a change that indicated conflict.  That's how alert my senses had become after I stood between my parents many nights before, crying at the top of my lungs. My mom was screaming insults while a metal jug swung from my dad's hand, looking for an opening to hurl it at her.  If not for my sister, who held him back, puny me wouldn’t have stopped him from getting to her. It was the most violent altercation they'd had, and ever since, whenever I'm at home, my mind is always attuned to sounds or signs that indicate a physical fight is happening or is going to happen. Living like this is like waiting for a bomb to go off.  He did throw that jug at my mom, or more accurately, at me. It bounced off my head, leaving a small but bloody cut. I still have the scar.  Where I come from, marital discord is not unheard of. I'd watch foreign films and TV shows and marvel at the characters playing husband and wife, how they never raised their voices at each other or fought. I know it's just Hollywood, but I figured it's a reenactment of how most Western families lived.  The opposite is quite common in my culture. When I was about 7, my class teacher asked us to stand up and say how many times our parents had fought. I wish I could remember what led to such an inappropriate and unprofessional thing, but we all stood up, airing our families' dirty laundry. "2 times," "once," "five times." I said, "3 times," happy I wasn't the only one who didn't have a normal family. "Never," some chorused.  How lucky you all are. I come from an immensely toxic household. My parents fight nearly every day, verbally and physically, and living in such an emotionally distressing environment takes a great mental toll. Once, after a heated argument, I unintentionally left the gas cooker on after I finished cooking. Hours later, my dad, a light sleeper, woke up and raced to the kitchen.  What followed was a barrage of reprimands from them both, outside in the compound, for our safety. Throughout it all, I wanted to scream at them that they had caused it. Of course, they knew. But would they ever try to change? Photo Monstera Production by on Pexels My parents have always had an imbalanced dynamic due to their differing personalities, upbringing and values. These differences have always been evident in their interactions and have persisted throughout their marriage. While my dad is laid back, peaceful, and boisterous, my mom is agile, feisty, and cautious.  They fight over everything, from how to peel an orange to money. It doesn't help that my mom is the breadwinner, which makes my dad feel emasculated. I've noticed that their verbal exchanges are never about what happened in that moment but about hurts that have been lingering for years.  Their voices would echo past the walls and filter out to the street, right into the ears of our neighbours, and I'd be filled with shame to leave the house. Occasionally, they would even do it outside, on the veranda, and passersby would gape unashamedly at them. Not even my friends' visits belied their arguments. They'd try to maintain an impassive expression, but the discomfort on their faces was always painfully apparent to me.  Recently, it's gotten so much worse. Before, all they did was exchange bitter words, and I'd remain in my room unbothered because I knew that would be all it was. But now, I'm afraid of leaving them alone. I don't know what's changed between them, but each time I detect any change in their conversation, I hang around. I wish I could say that my presence makes them put their knives away, but it doesn't. I stay around to stand between them.  I don't like coming back home, and when I can't avoid it, my mind is never at peace. It's the same when I'm not around, as I worry about what they both could be up to. My mom is really sassy but can't defend herself. What if she sustains a serious injury or dies at his hands? Photo by Mikhail Nilov on Pexels It's a living hell. I've always wished they would get divorced or separated, but my culture is, again, very different from the ones I watch on the screens. Recent data shows that Nigeria's divorce rate is only 2 per 1000 people.  It appears like an actionable statistic, but I do not know any couple that split up in court, just people who no longer consider their marriages as valid.  Hitting sounds and loud voices increase my heart rate and breathing. I avoid confrontations with people. One thing that puzzles me is why it's causing me tremendous distress now that I'm a full adult. I'm 25 years old. I wasn't bothered this way when I was 15. Why do I feel directly affected now? Am I an adult who's never really grown up? I wonder if the disharmony stunted my mental development.  I've never tried talking to them about it because I feel so ashamed on their behalf. Our neighbours, a young couple, fight, and my parents play marriage counsellors, which fills me with great disgust. I wish they would take their own advice. I know marriages are never easy, but I'll never expose my children to such chaos. That's if I'll ever get married. I've turned down several proposals for varying reasons. I'm beginning to think that it's the trauma and fear of a quarrelsome household that makes me averse to the institution.  However, one thing I admire about them is that they've never spoken against each other to my siblings and me or forced us to take sides. It's also spilled over into my interpersonal relationships; my friends don't discuss people when I'm in their company. I get teased for being "boring", but I know I'm positively regarded for that. Despite all that happens, I love them so much. They may not be a role model couple, but they are certainly good people. I may have cold feet about getting married, but not about love, and I'm trusting it to lead my soul to peace and serenity, one day at a time. I have my own life to live and enjoy, and it shouldn't be diminished or stunted by trauma. Or daggers. This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Author's own image “Trauma” is a word we hear all the time now — in podcasts, therapy TikTok, or casual conversations. People say things like “We’ve all got trauma” and nod, almost accepting it as part of who they are. And while that’s a step forward, I think we stop short. Because naming your trauma is not the same as understanding it.   But what exactly is trauma?    Trauma is any experience that overwhelms our ability to cope. It leaves an imprint — not just emotionally, but physically and neurologically. For some, the nervous system gradually returns to a state of balance. For others, the impact lingers, reshaping how we think, feel, and respond to the world.   Sometimes, this disruption develops into Post-Traumatic Stress Disorder ( PTSD ) , a clinical condition that can include symptoms like flashbacks, avoidance, hypervigilance, and shifts in mood or thinking. PTSD and trauma are deeply connected, but not the same. However, both matter and deserve to be met with curiosity and care.   This is something I’ve come to realise through experience and study. When I experienced trauma, I felt stuck — the kind of stuck that stretches time and makes everything feel heavy. But instead of pushing that feeling down, I got curious. I started searching for answers. And it just so happened that I’d begun my Master’s in Neuroscience at the same time. I knew the science wouldn’t heal me, but instead might help me understand what was happening in my mind.   And with understanding came something unexpected: empathy . Not just for others, but for myself;  for my brain.  And that changed everything.  The brain isn't broken; it is adapting   In complexity science, the brain isn’t viewed as a machine with separate parts, but as a self-organising system, constantly adapting to our internal and external worlds. This also means it can adapt, rewire, and regulate itself without a single control centre .   Even under extreme stress, the brain doesn’t shut down; it reconfigures and reroutes. After trauma, this adaptability becomes especially clear, though not always in ways that feel helpful. Like a city after an earthquake, the brain reshapes itself in response to new conditions. Sometimes that means forming patterns of fear or hyperarousal — not because we’re broken, but because the brain is trying to protect us from future harm.   That reframed how I looked at trauma. It’s not about weakness. It’s about adaptation.     The brains storyteller   A part of the brain that stood out to me is the posterior cingulate cortex (PCC). It acts like an internal narrator, helping to weave external experiences into a sense of self. It’s also part of a larger brain network that activates when we daydream, reflect, or remember the past.   A recent study  found that the PCC processes traumatic memories differently from ordinary sad ones. In people with more severe PTSD symptoms, the PCC was more active when they reflected on traumatic events, especially when those memories felt deeply connected to their identity. This was a powerful insight.   In PTSD, the brain's ability to self-organise is disrupted by an anxiety-inducing event. In particular, the region of the brain responsible for encoding memories is unable to do so effectively. Instead of the traumatic experience being organised into a structured narrative, it is stored in fragmented forms, raw emotions, sensory details, and disjointed images without a clear timestamp.   When these fragmented memories are triggered, the brain reactivates the same intense emotional response as during the original event. Because the memory hasn’t been fully processed, it remains stuck — not just in time, but in us.    But here’s what I found profound: this study didn’t just show heightened brain activity — it revealed intent. The PCC may be trying to integrate that trauma into the broader narrative of who we are.    And that brings me back to something I’ve been sitting with: Saying you have trauma isn’t the same as understanding it.    There’s a difference between having gone through trauma and truly understanding how it’s living in you now. And that understanding, even just knowing what your brain might be trying to do, can create space. Enough space to observe rather than identify.    The brain is trying to help, trying to narrate, but without the tools of understanding, it loops. It embeds the memory into identity, not because it belongs there, but because it hasn’t been given anywhere else to go.      Author's own image Curiosity over judgement: a shift in perspective   When we understand the brain as a self-organising, adaptive system, it becomes easier to respond with curiosity instead of judgment. Instead of asking, What’s wrong with me?  We can ask, What is my brain trying to do right now? What is it protecting me from?    That shift from judgment to observation is part of something called   metacognition : the ability to reflect on your thoughts. It’s a powerful tool in healing because it creates space between your experience and your identity.     And in that space, healing begins.      A different kind of gratitude    I turned to practices like yoga and meditation — not just for peace of mind, but because I’d learned how they can support the brain’s ability to rewire itself. They’ve been shown to increase levels of BDNF (a molecule that promotes brain plasticity, which is the brain’s ability to make adaptive changes) and calm the nervous system .   Over time, I noticed subtle shifts — not only in how I felt, but in how I related to myself. I began to move through the world not just with understanding, but with something deeper:     Gratitude — for my brain, for my body, for continuing to show up.   Love — not for who I thought I had to be, but for who I was becoming.       You are not your trauma   Most of us will experience trauma in some form. It’s a part of life. But when we understand that the brain isn’t betraying us, it’s trying to protect us, we can begin to meet ourselves with compassion instead of criticism.   Your trauma may shape your path.     But it doesn’t define who you ar e.     And your brain, even in the hardest moments, is on your side.  Author's own image

Image by Gabriel on Unsplash Infertility can affect each and all of us. A very healthy stranger jogging in the park, your young nephew who recently graduated, or your neighbour hosting yet another baby shower for a friend, may all be infertile. If you’re one of them, you know only too well what infertility means. The term "infertility" applies to a situation when an individual or a couple is attempting to conceive but cannot establish a pregnancy after 12 months of regular, unprotected intercourse. In this article, I’d like to share some insights and personal reflections I’ve gained during my PhD , working as a psychological researcher with individuals facing infertility treatments at the Institute for Maternal and Child Health “IRCCS Burlo Garofolo” in Italy. The focus of this article is to examine the emotional, relational and existential implications of infertility. I also previously wrote an article in ITM about medically assisted reproduction, intended for anyone seeking to have a baby through medical assistance, Aspiring Parents: Insights for Those Seeking Medical Assistance . It's a read for anyone—whether facing infertility or not—considering or currently undergoing medical procedures. An Intimate – But So Public – Issue Image by Aleksandra Sapozhnikova on Unsplash Constantly facing the question, “Are you having Kids?” is exhausting. And maybe, instead of answering honestly, you find yourself offering a variety of excuses, each time tailored to the different people who ask: family members at Christmas gatherings, colleagues during coffee breaks, friends at children’s birthday parties, and so on. This defensive reaction is understandable. Discussing such a personal issue in a five-minute coffee break with an annoying colleague, or around a table of ten relatives with children screaming in the background, is not very comfortable. Infertility is often a deeply isolating and silent condition . Individuals facing this problem typically keep this private, choosing not to share it even with close family or friends. This is because the emotional impact of infertility is overwhelming and not easily discussed. Indeed, infertility brings significant psychological stress and emotional vulnerabilities . People can experience common emotions like shock, sadness, anger, grief, and frustration, or more clinical issues such as anxiety and depression . Moreover, feelings of shame can also lead to hiding this condition, as those facing infertility may perceive themselves as being seen by others as somehow unattractive, defective, different, or unlovable. Reminders of the inability to have children seem to be everywhere—even something as simple as watching a family movie or meeting up with friends who have children can be painful. People may even seek relief from stress by actively avoiding situations and prompts of infertility , such as distancing themselves from friends with children, or excusing themselves when conversations turn to pregnancies and parenting. Furthermore, it is important to consider that the social context in which we live shapes the experience of infertility.The sociocultural contexts matter as, in certain societies, childlessness —particularly in women —may face blame and stigma. This stigma surrounding infertility profoundly affects the well-being of those experiencing it, often leading to poor mental health and a reduced quality of life . Therefore, socioeconomic disparities have a considerable impact on the mental health of women with infertility , and in some cases, infertility may even increase the risk of domestic violence against women. A crack in the identity mirror Image by jurien huggins on Unsplash Infertility can lead to a negative sense of self, driven by a range of factors . One significant impact is a perceived loss of personal control over one’s life. In fact, people may have invested considerable time and energy into planning for a family, and an unexpected diagnosis of infertility can be profoundly destabilising. Feelings of inferiority and inadequacy may emerge, as comparisons with others who have had no trouble starting a family can be difficult to avoid, leading to thoughts of failure from both social and biological perspectives. Additionally, body image can suffer, as infertility is a condition that affects the body’s natural functioning, potentially leading one to feel as though their body is "not working as it should”. Being in a couple’s relationship is not always easy. It’s a balance between personal freedom and shared spaces, individual and mutual goals, similarities and dissimilarities. In this space, personal vulnerabilities may emerge and seek their place on a common ground that may sometimes feel supportive and, at other times, challenging. Infertility can disrupt the delicate balance within a relationship, as the shared aspiration of having a child is altered. Indeed, couples who share the same desire often experience greater satisfaction in their relationship compared to those without a common goal. Moreover, sexual problems and fear of losing a partner’s love can emerge, particularly when one partner feels responsible for infertility. Infertility can even trigger an existential crisis . When something unexpected like an infertility diagnosis occurs it can force people to re-evaluate personal beliefs. Even religious or spiritual beliefs can be shaken, leading to profound psychological effects, especially when reconciling these beliefs with infertility feels impossible. Such beliefs are closely tied to one’s identity, and many may struggle to find meaning in their reality. Infertility: only a loss or a possible resource? Photo by Jonathan Pendleton on Unsplash So, is that it? It seems that there is little good news for those facing infertility. However, research offers hope by highlighting the positive aspects of embracing unconventional paths, such as non-traditional parenthood or a child-free lifestyle. For example, families formed through medical procedures are usually a group of resilient people who tend to develop stronger family relations . An essential factor in this process is the quality of a couple’s relationship, which shapes the experience of infertility. Mutual support and effective communication are indeed fundamental to successfully undergoing infertility treatments. In fact, perceiving a partner as supportive enhances communication within the couple, making it easier for couples to face critical decisions and overcome challenging moments together. While parenthood is often considered a life model of fulfillment, research suggests that individuals without children may experience even greater life satisfaction , particularly women, singles, those from lower socioeconomic backgrounds , and people in societies less supportive of childbearing. Moreover, after an infertility diagnosis, reconsidering life plans and exploring alternative paths is often associated with a more positive outlook than feeling trapped in an unchanging plan. Therefore, actively embracing a life without children can provide a sense of empowerment and control over one’s circumstances. Experiencing a health issue such as infertility is a profound event that could lead people to reconsider previous values, ideas, and projects.  Such moments may inspire a re-evaluation of what truly brings fulfillment, whether that means accepting the possibility of undergoing Medically Assisted Reproduction, discovering new purposes in life, or even pursuing a different career path.

As a woman and a mental health researcher, I’ve had my fair share of frustrating doctor visits. Nothing tops the time when my skin suddenly began to itch and erupt in bumps. I feared I was experiencing an allergic reaction. After calling 111 for medical advice, they sent paramedics to my home and, unsure yet concerned about my condition, they insisted on taking me to A&E.   After the never-ending hours in the waiting room, the doctor dismissed me. “Are you sure it’s not just hormonal acne? I can see you have acne scars, so surely it’s just that? Are you on your period?” he questioned. I assured him I would not have waited all those hours if it were just hormonal acne. After three days of agony, I sought further medical advice from my GP, only to discover that I had adult chickenpox.  Although the condition itself was not life-threatening, I was left invalidated and embarrassed. We women know this feeling too well, having our pain questioned, our bodies scrutinised, and our concerns reduced to something ‘hormonal’ or imagined.  Throughout history, the term ‘ hysteria ’ was used to pathologise a woman’s emotional experiences. Symptoms included emotional outbursts, hallucinations, attention-seeking behaviours, increased suggestibility and loss of sensation. Rooted in misconceptions about its origin, hysteria reflected societal beliefs towards femininity, religion, sexuality, medicine and mental health.   From its original conception and Freud's use in the last century, the perceptions of hysteria have drastically shifted. Despite no longer holding relevance in medical diagnosis, the historical context demonstrates the ongoing understanding of mental health and medical conditions affecting women.  Origins of the Wandering Womb In Ancient Greece, it was believed that a woman’s uterus could wander  through her body, evoking a series of emotional and physical symptoms. This concept, called   The Wandering Womb Theory , led to the term hystera, the Greek word for uterus, which later became the root word of hysteria. This umbrella term classifies all kinds of conditions in women, from irregular menstruation to anxiety. Hippocrates documented these ideas in his medical texts . By attributing psychiatric symptoms to the reproductive biology of women, he helped solidify the link between femininity and fragility in medical thought.  Photo by Dante Mu ñoz on Pexels Plato reinstated the beliefs of his time, famously stating that a uterus becomes ‘sad’ or ‘restless’  when deprived of male companionship. His proposed cure? Marriage, sex and childbirth, all solutions which entrap women into their expected societal roles. Ancient beliefs trickled down for centuries, contributing to the misunderstanding of women’s health.  From Spiritual Origins to Medicalisation  With the rise of Christianity in the Western World during the Middle Ages, hysteria was interpreted as spiritual failure. Women experiencing psychotic symptoms, abnormal behaviours, symptoms of erotic fantasies, or epileptic seizures  were believed to be witches or under demonic possession.  The  cures  were brutal and extreme, going as far as exorcisms, witch trials, and institutionalisation. By the 18th to 19th century, spiritual reasoning for hysteria began to lose traction and was replaced by a medicalised view. Despite this, sexist ideologies persisted.  In the Victorian Era, physicians conjured up invasive and problematic treatments to cure hysteria. With the belief that hysteria originated from sexual dissatisfaction, doctors would induce a ‘ hysterical paroxysm ’ via genital stimulation in their hysterical patients. Around the same time, neurologist Jean-Martin Charcot was working to redefine hysteria as a neurological disorder. Interested in the aetiology of hysteria, Charcot believed that the condition was of hereditary or psychological origin and challenged long-standing gender assumptions by attributing its symptoms to both men and women .  Photo by Maycon Marmo on Pexels Although Charcot broke away from the outdated idea that hysteria was linked to the uterus, his approach came with its own set of issues. He became known for his dramatic public hypnosis demonstrations, where he attempted to unveil his patients’ traumas, emotions and subconscious thoughts. These shows often featured the same patients, most notably Marie ‘Blanche’ Wittman,  who earned the nickname ‘Queen of Hysterics.’ As hypnosis had limited scientific backing at the time, the line between medicine and theatrical spectacle became quickly blurred.   It’s important to emphasise that this piece is not challenging the fact that people can express psychological suffering through physical symptoms, especially in cultural and historical contexts when medical explanations are more acceptable than psychological ones. What we are challenging, however, is the notion that such a concept has been used in the past predominantly for women and beyond the cases that would now fulfil the criteria of "somatoform disorder”. Beyond the 20th century, knowledge and understanding of psychiatric conditions were propelled. Diagnoses of hysteria declined, coinciding with anxiety and depression becoming well-recognised disorders, and by 1980, hysteria was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) .  Modern Perception and Medical Biases    Today, female hysteria is widely discredited and recognised as a product of control in patriarchal systems. Nevertheless, its legacy is a reminder of how medical and cultural narratives throughout history are used to silence and marginalise women. Despite the term ‘hysteria’ itself no longer in use in modern medicine, its history seeps into the persistent medical bias women face today. Conditions of the reproductive system, autoimmune disorders, and chronic pain take years to be properly diagnosed , and when finally addressed, they are often under-diagnosed or misdiagnosed. Research shows that the perception of a woman’s symptoms by healthcare professionals (HCPs) is influenced by gender stereotypes . The underestimation of a woman’s pain originates from the belief that women are oversensitive to pain and exaggerate their pain to others. This research coincides with the Nurofen Gender Pain Gap Index Report 2024 , wherein 81% of women aged 18-24 in the UK believed that their pain had been neglected by HCPs, with an additional 25% of women feeling unable to access pain treatment due to their gender. Through systemic minimisation of medical issues attributed to women, the pain experienced is ascribed to emotional distress or anxiety. Such systems may amount to medical negligence, by which biases from HCPs result in delayed diagnoses, inadequate treatment, or outright neglect.     Photo by RDNE Stock Project on Pexels As awareness surrounding medical biases in women’s health grows, it is imperative to recognise and critique the legacy of hysteria. Once used as a catch-all diagnosis to disproportionately silence women, hysteria pathologised emotional expression and reinforced patriarchal norms under the guise of medicine.     In today’s technologically advancing world, gender biases in research and medicine persist. Artificial Intelligence (AI) is being developed for healthcare tools, many of which are programs used to diagnose and predict a patient’s disease risk.  AI-powered risk prediction models are operated by identifying patterns from past patient data; therefore, it is imperative to steer away from creating male-centric models. Since cardiovascular disease is often mistakenly viewed as a ‘man’s disease,’ it is frequently under-diagnosed in women. Researchers from Imperial College London identified this gender gap in diagnosis, treatment and clinical research, and have developed an AI model to read electrocardiograms (ECGs) to identify women at risk of cardiovascular disease.   By eradicating biases from seeping into healthcare AI, we can help break the cycle of perpetuating medical inequalities and move toward equitable care for all. This is especially important when we consider how historical biases have shaped women’s health.  The history of hysteria reminds us that discussions around mental health and women’s health are shaped by cultural expectations, institutional power, and long-standing inequalities that continue to influence the decision on whose pain is considered and whose is dismissed.

Trigger warning: The following article contains discussions about suicidal ideation with explicit descriptions. Some readers may find this distressing. Photo by Louis Maniquet on Unsplash My name is Bryn, and this year I turn 36 years old. I have never told my story like this before, and never in this much detail. I’m hoping it gives others some comfort and strength to know that life can get better and is worth living. Keep in mind that despite how this all happened, I’m here to write this today. That being said…   The day I turned 18 wasn't fun or exciting. It was the day I was supposed to off myself.   During the 5-7 years before my 18th birthday, I had developed a sense of dread about life and an overwhelming, seemingly ceaseless case of depression. I was diagnosed with Bipolar II Disorder ,  depression, anxiety, and was put on antipsychotic medication that did nothing for me (years later, I discovered I was misdiagnosed and that I was actually suffering from Premenstrual Dysphoric Disorder  (PMDD), so no wonder). I felt hopeless and just wanted the misery to end, but I decided to give myself time to see if it got better. If they hadn’t by the time I turned 18, I’d take myself out. Over the years, the only thing that felt like it gave me any relief was reading books and writing. I got lost in other realms, put myself in the shoes of others, and embarked on extraordinary adventures. I wrote fan fiction in notebooks, took refuge in English class assignments, and even wrote my own book (which I never published, but I've tried to rework the cringeworthy parts recently to see if it’s still a relevant story today). Escapism was my drug, and I was a heavy user.   The characters I read and wrote about developed themselves and took up residence in my head. I've learned this can be an occurrence for writers. I wrote out scenes and conversations with them and got to know them in an intimate, personal way. The relationships I built with them were one of the few things I could take solace in. Unfortunately, anxiety and depression never went away; they were as present as my imaginary friends. Even with all of my imaginative powers, I still couldn’t dream up a future for myself, which I took as a sign that I wasn’t going to have one.   Two years before my self-imposed expiration date, I went for a hike with my dad in a new park I’d never visited. We walked up steep hills and circled around until my dad deviously stepped over the wooden fence that was meant to deter hikers. I reluctantly followed him, and what I found on the other side was a breathtaking view. Far, far, down below was the remnants of a retired quarry, which nature was reclaiming.   It was beautiful. I knew in my heart that this place was where I wanted to die. Photo by Bryn Wolanski On the afternoon of my 18th birthday, I left my house and drove to that same park. It was cold and cloudy, as is expected in March. The upper half of the park, where my dad had taken me, was blocked off for the season to prevent possible accidents. I parked at the very bottom lot, which I’d never parked at before, and started the winding uphill trek up to the quarry.   I can tell you that there was doubt in my mind as I hiked forward. At that point, though, the overwhelming sense of the unknown and the fear drove me to continue. I didn’t cry for most of the hike, not until I got to the base of the final hill that would lead to the quarry. As I wiped away the first tears and started the ascension, I heard them- the characters I had developed such strong emotional bonds to.   You can’t do this. Well, I can, and I am. You have so much to live for. I have nothing to live for. No plans, no future, nothing. You may think that, but things change. Nothing is going to change. Fine, then consider this: If you die, we die, too. To be frank, we rather like our current arrangement.   That was, to be fair, a weirdly true thought that made me feel rather uncomfortable. My goal was to take myself out of the equation and not hurt anyone else (imaginary or otherwise). I wanted to be free, but I hadn’t really assessed what the cost of that freedom might be. I had carried the notion in my mind that I wasn’t meant for this world for years, and that I would put an end to my suffering on my terms. My eyes were flowing steadily, and I straddled the fence to climb over, heading to the edge of the quarry. There was a thin tree that had grown on the very last spot of earth before the drop. I placed a hand on it and looked down with a shuddering breath.   I told myself that if I did this, it would be done. I wouldn’t hurt anymore or feel like a burden. I wouldn’t have to be afraid.   You’re doing this because you’re afraid, but there’s nothing to be afraid of. That is where you are entirely wrong. Why? Because you don’t have a plan? You’re not afraid of dying, you’re afraid of living. We know you, and we know you’re better than this. You have worth in this world. I have nothing- no plan, no future. I would rather do this now and spare myself (and everyone else) the time and energy of me killing myself after I’ve failed and disappointed everyone. Besides, I don’t know what I’m going to do if I don’t do this. If you’re afraid to live for yourself, then live for us. We have stories to tell. Promise us.     I whispered my promise to the wind as I wiped away more tears. Even if I didn’t have a plan or any idea what to do, even if the prospect of failure was terrifying… It wasn’t about me anymore. I was going to be a messenger, a storyteller, a lesson, a conduit of creation.   The effort it took for me to walk away from that ledge was astounding. I was exhausted from the hike up and from the emotional upheaval and revelation I’d experienced. My legs felt like jelly, and it was a slower return to my car that afternoon than the trip up had been. When I got to my car and unlocked the door, I took a deep breath and murmured a thank you as I got inside and headed home.   This year marks 18 years since I made that fateful decision. I’ve lived an entire lifespan of the teenage version of myself that I almost killed. I graduated from high school and went on to earn my Bachelor of Arts degree. I got my Master of Library and Information Science in graduate school and became a librarian so I can connect individuals with things that resonate with them. I got effective help for my mental health struggles, including Cognitive Behavioural Therapy (CBT) and going to several doctors before finally being diagnosed with PMDD, anxiety, and depression. This resulted in experimenting with various birth control options until I found one that was able to help, as well as finding the right other medications that could help my anxiety and depression. (Personal note: women’s health is still a very “mysterious” subject, and there is so much research that needs to be done to help those suffering from cases like mine.) I fell in love with (and married) the man of my dreams. I even developed my own business, writing and helping others with their creative processes. I have built an existence for myself that I never thought was possible. Let me tell you. You are not alone, and your life is what you make it. Even if you feel like you’re flying by the seat of your pants, it’s worth it. You are worth it. Never give up. Photo by Bryn Wolanski This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

The Stepping Stones Study Women who use drugs during pregnancy have complex health and social needs. Stigma can be a barrier to their engagement with services. The Stepping Stones study aimed to identify way to provide care for this group of women to encourage engagement and improve health outcomes. The study was funded by the National institute for Health Research  (NIHR130619) and was conducted by researchers from King’s College London and the Universities of Stirling and Huddersfield and Homerton Hospital. Researchers worked with an advisory group made of health and social care practitioners, and people with lived experience of substance use treatment.   Study design created by Louise Honeybul    Research participants were recruited from maternity services. They were invited to take part in up to five interviews to tell us about their experiences of the health care services  they were in touch with during pregnancy and after their babies were born. To help them tell their stories, women and researchers created visual timelines to describe important events in their lives.      Who took part in the study?   Thirty-six women took part in the study in four contrasting sites in England and Scotland. All the women who took part were receiving treatment for drug use, mostly for heroin or prescription opioids (e.g., codeine and tramadol). Many women had experienced abuse as children and in their relationships as adults. Many described experiencing anxiety and depression. Many had also experienced children being removed from their care. Treatment for opioid use   Opioid replacement medications are the standard treatment for opioid withdrawal symptoms and include medications such as methadone and buprenorphine. These can also be prescribed to women in pregnancy. Women are not encouraged to stop replacement treatment during pregnancy as this can present a risk of miscarriage and relapse. Babies exposed to any opioids in utero - heroin as well as prescribed opioid replacement medications - can experience withdrawal symptoms, meaning that babies are more difficult to soothe. These symptoms can take some days to appear and babies are monitored for up to five days in hospital after their birth, with some babies needing treatment. Care pathways   We identified ‘critical moments’ in the care pathway when access to particular kinds of support and resources can make a difference to  women’s experiences and outcomes. Prenatal Care Prenatally, women often had supportive relationships with specialist midwives. They were  often worried about the impact that drug use and medications may have had on their babies in utero and appreciated clear communication from midwives regarding this topic. They also valued being able to access a range of services in one place rather than having to travel to multiple appointments. Postnatal inpatient care   Women often felt vulnerable in hospital after giving birth. They told us that access to opioid replacement medications was sometimes poorly managed by staff and they sometimes felt judged. “As soon as they found out in the postnatal ward that I had the [medication], they took it off me. They said, ‘You can’t have controlled substances in here’, and I just felt immediately that they were judging me” Although breast feeding is safe for infants of women who are receiving medications for opioid use; information about breastfeeding was not always clear: “So I did breastfeed, because the midwives were telling me, ‘Yeah, you can,’ but the consultants was telling me, ‘No, you can’t ”. Women were sometimes able to stay in hospital with their babies if they needed to be treated for withdrawal symptoms, but in some hospitals women were discharged before their babies, which made it difficult for women to feed and care for them. Postnatal care Some women in the study had not engaged with substance use treatment or prenatal care until after the ten week ‘window’ in which ‘booking’ appointments should ordinarily take place. Often this was because their pregnancies had not been planned and they had not realised they were pregnant. Outcomes for these women depended on the the services and treatment options that were available to them in different sites. In one site, women who had engaged with substance use treatment or maternity care were given access to specialist mother and baby treatment services after their babies were born. In other sites, women were not offered these services, making them feel that they were not given a ‘chance’.   “I’ll move. I’ll do anything. I go into rehab. I just want a chance with my child.’ I think given half a chance, I’d be a brilliant mum. I really would.” Care for women whose babies were removed from their care   Women whose babies were removed from their care often felt that communication about the removal of their babies  had not been clear. Services for new mothers were no longer available to them, and mental health support was not always available. “I've never had any checks. Nothing at all. I had the baby… It’s like I just gave her up. It’s like I never had a baby. They wanted me to just not behave like a mum”.    This is very concerning as we know that women who lose care of their babies are particularly at risk of overdose and death. Recommendations   Our findings suggest there is a need to improve the way care is coordinated for this group of women throughout their perinatal journeys, including:   Continuity of care pre and postnatally should be guaranteed Health and social care services should be be delivered in one place so that women do not need to travel to multiple appointments Staff need to be informed about substance use treatment medications and about the complex lives women may have led, so that they can provide compassionate and evidence based care Women need access to treatment and support services postnatally wherever they live Supportive care is needed for women whose babies have been removed from their care NEXT STEPS The Stepping Stones team are working with Outside Edge theatre Company, the only UK theatre company that specialises in plays concerning addiction, to develop an interactive play based on our findings for KCL Midwifery BSc students, midwifery and social work students at Sheffield University and Sheffield Hallam University in December 2025 . Photo: Adrianne McKenzie The play will be based on the interview transcripts from our study and will give students an insight into women’s experiences of care systems that sometimes do not meet their needs.  To find out more  about the Outside Edge performances in London and Sheffield, please contact Polly Radcliffe ACKNOWLEDGEMENTS We are grateful to the women who took part in the study and the maternity care staff in the four sites who helped us to carry out the research.  The study was funded by the NIHR (NIHR130619).