Photo by Gabby K from Pexels Throughout the ups and downs of my life, there has been one constant: music. It’s something that I’ve been doing ever since I was little. I started learning guitar aged six, had my first singing lesson, joined my first musical theatre stage school when I was 10, and started my classical singing training when I was 12. I’d always loved to sing. I remember my dad calling up the stairs to tell me to be quiet, because it was 10pm and I was in my bed, staring at the ceiling pretending I was bellowing into a crowd of people. Throughout my teens and early adulthood, music became more than just a hobby or something I enjoyed doing. It became an escape. For me, it was my happy place. I would spend hours creating playlists on Spotify ready to travel to Brighton from my home in West Sussex, where I studied Music Performance. I would spend my evening playing my guitars and writing songs to the melodies I had created. I envisioned a career in music. Unfortunately, that hasn’t happened — but that hasn’t stopped music taking up a huge place in my life. Photo by Gabby K from Pexels I’m always fascinated when people tell me they don’t really ‘like’ music. That they don’t really listen to it. Because I cannot imagine a day going by where I haven’t repeatedly gone through my favourite Spotify playlist, or sang along to a guilty pleasure in the shower. I have a deep-rooting love for music; there is something for everyone, in whatever mood, and I think that makes it incredibly special. It’s the first thing I turn to when I am happy, sad or bored. When I am walking somewhere, trying to entertain my son or driving in the car. I have songs that cheer me up. Songs that make me cry. Songs that help me to heal. That’s what I think music is: Healing. There is something about putting words down onto a page and watching them flow perfectly to a melody I have practised over and over that is so satisfying. Singing along to the notes on the page takes me out of the room and into my own world. A world I have created. I find it fascinating that music can connect so many of us together, through those first scribbled words on a page. How you can get to know a musician through their words without ever meeting them. I think there’s something special in music that joins you together without really even knowing a person. I know that’s how it felt at college, in my classes, at the school. You just seemed to ‘get each other’ more than anyone else. I think music helped me ‘get me’, myself. Music — both other people’s and my own — has helped my mental health massively over the years. It’s more than something to bob your head along to, but the opportunity to unleash your emotions in a private setting, your rules over whether they remain in that private setting or whether you perform and open up to the world. It has helped me to go deep into my creative side and to see what I am capable of. And that’s the thing with music; you never really know exactly what you are capable of. You could write something new every day, and think it is the ‘best’ piece of music you’ve ever written each time. That’s the thing with music: it’s limitless. There’s also something about an acoustic guitar or piano accompaniment that helps soothe me when I am feeling sad. A deep, soulful voice or a soft raspy one. The amazing thing about music is that there are multiple artists out there to tell your story to you, in words you didn’t know how. I’ve forgotten just how many times I’ve listened to Johnny Cash’s ‘Hurt’ or ‘Courage’ by SuperChick when I’ve been feeling sad. Photo by Burst on Pexels Escapism is a difficult thing to explain, but that’s what it is: As cliche as it sounds, when I pick up my guitar and place it down to my notebook, ready to write a song, it is only me that instrument in the room. It helps me to forget everything that is going on around me — even if it might be the influence for what I am going to write. There are lots of people who step back from music because they don’t think they’re ‘good enough’, or because they don’t feel they’re ‘creative enough’, or simply because it just seems a little overwhelming. But it doesn’t have to be. Writing music can be the perfect way to express and explore your true feelings. Ones you didn’t even know you had yourself. I’m not going to say it’s going to heal you from all of the bad things in your life — but what it can be, is a comfort. One that you have total control over. And there’s something special about that.

As I approach the end of my master’s degree and find myself once again confronted by the question of what comes next, I am reminded of Sylvia Plath’s 1963 semi-autobiographical novel The Bell Jar. In this book, Plath beautifully illustrates indecision and future possibilities through her fig tree analogy. The protagonist Esther Greenwood imagines herself sitting before a fig tree, with each fig representing her future; one fig symbolises her career, another family, and another travel. Paralysed by indecision and fear of regretting her choice, Esther watches as time passes and her choices reduce, the figs rot. “I saw my life branching out before me like the green fig tree in the story. From the tip of every branch, like a fat purple fig, a wonderful future beckoned and winked. One fig was a husband and a happy home and children, and another fig was a famous poet and another fig was a brilliant professor, and another fig was Ee Gee, the amazing editor, and another fig was Europe and Africa and South America, and another fig was Constantin and Socrates and Attila and a pack of other lovers with queer names and offbeat professions, and another fig was an Olympic lady crew champion, and beyond and above these figs were many more figs I couldn’t quite make out. I saw myself sitting in the crotch of this fig tree, starving to death, just because I couldn’t make up my mind which of the figs I would choose. I wanted each and every one of them, but choosing one meant losing all the rest, and, as I sat there, unable to decide, the figs began to wrinkle and go black, and, one by one, they plopped to the ground at my feet.” Despite being written over 60 years ago, this metaphor remains relevant today. Nearly everyone can relate to the feeling of indecision, the sense that every choice you make for the future means forgoing ten others. Worrying about making the wrong decision might mean that the right decision passes you by as you sit and struggle to make any decision at all. Image Source: Irina Alekseevskaya on Pexels Paradox of Choice This metaphor poignantly captures the psychological phenomenon of the paradox of choice, a concept by Barry Schwartz, which suggests that the more options we have, the less satisfied we feel with our decisions. This happens because an abundance of choice requires greater cognitive effort, which can lead to decision fatigue and a stronger sense of regret about the choices we make. When you were younger, and a teacher asked what you wanted to be when you grew up, you might’ve said a doctor, an astronaut, or a footballer. Then maybe as you got older, you realised you could also be a lawyer or a writer. And you could travel the world, visit Asia or South America. You could also start a family, live in a different country, or dedicate yourself to studying. According to the paradox of choice, no matter what you choose, you may feel unsatisfied and as though there were other, better alternatives you could have picked. Moreover, Schwartz argues that the paradox of choice has the greatest consequences for "maximisers", people who strive for the ‘optimal’ outcome. Unlike "satisficers", who are content with a "good enough" option, maximisers aim for the absolute best choice. When faced with many alternatives, this can make it more difficult to identify the best choice, often leading to increased regret after the decision is made. Schwartz’s concept came from a seminal paper by Sheena Iyengar and Mark Lepper, who wanted to see how the volume of choice might impact consumer behaviour. They set up tasting booths in a supermarket that displayed either a limited (six) or extensive (twenty-four) selection of different flavours of jam, and measured customers’ interest in the booths and what they bought. The researchers found that although customers were initially more attracted to visit the extensive choice booth, those who visited the limited choice booth were more likely to purchase the jams. They concluded that an abundance of choices might lead someone to not make any decision at all. Decision Paralysis and Perfectionism Decision paralysis is a state in which we, overwhelmed by potential choices, are unable to act. Confronted with too many options, we freeze and feel confused about what the ‘right’ choice might be. Shadowed by ‘should of’ and ‘could of’, we just can’t make up our mind about what we want. Image Source: Leeloo the First on Pexels Decision paralysis is closely tied to perfectionism: the desire for the best outcome, to make the ‘perfect’ choice, whilst also having the fear of getting it wrong. As explored in this ITM article by Courtney Worrell, perfectionism can turn into a hypercritical relationship with yourself, leading to anxiety and a constant fear of failure as you second-guess yourself and your choices. As expected, this mindset can make decisions feel overwhelming. When you’re aiming for the ‘perfect’ outcome, every option carries huge pressure, and instead of choosing what feels right, you end up comparing every detail, fixating on what is missing. What if I finish my master’s and pursue a PhD? In a few years, will I wish that I had spent more time travelling? What if I instead dedicate years to travelling, would I then wish I had a stable career when I got back? What if I prioritise starting a family when I am young? Would I then wish I had spent more time alone? What if I focus on my career, but then wish I had kids earlier? Of course, the assumption that having fewer options may lead to less anxiety may not always be true. In reality, people are complicated, and sometimes having one option can feel just as frustrating. For example, getting just one job offer from the hundreds of applications you sent might make you feel like you’re stuck and don’t have a choice, whereas having two or three responses offers more control over your future. Schwartz acknowledges this and suggests that it’s about finding the right balance between too many and not enough options; receiving one job offer might be just as anxiety-inducing as receiving one hundred, and a tree with one fig might leave you as stuck as a tree with twenty. Choosing the Fig Anyway However, what if there was no "best fig"? Perhaps the tragedy Esther imagines is not that she chooses incorrectly, but that she believes choosing one life means the permanent death of all the others. In reality, lives are so rarely fixed; careers change, people reinvent themselves. New branches grow. Mourning the unchosen paths is a universal part of life. There will always be alternative versions of ourselves -the poet, the parent, the professor, the traveller- who may only live in our imagination. But the real danger isn’t choosing the wrong version, it’s not choosing one at all. It’s sitting in the tree for so long, paralysed by perfectionism and fear, that the sweetness of choice itself disappears. Revel in the privilege to decide your future. Acknowledge that there is no right choice, that you can pick and choose from as many alternatives as you want. Even Esther, who once starved beneath the fig tree, imagined the possibility of a fresh start. "My stocking seams were straight, my black shoes cracked, but polished, and my red wool suit flamboyant as my plans. Something old, something new... But I wasn't getting married. There ought, I thought, to be a ritual for being born twice—patched, retreaded and approved for the road..." And so, as I finish my degree and think about my future, I will remind myself that there is no best path. Every decision I make will contain both fulfllment and struggle, and none will leave me completely, wholly satisfied. I will shift from black and white thinking of “what is the absolute best choice” to “what is the right choice for me right now” and acknowledge that my priorities will change as I grow as a person. I will remember that it's better to taste one ripe fig than to eat no figs at all.

An estimated 13% of new mothers suffer from postnatal depression , with symptoms including fatigue, sadness, low mood and insomnia. Despite positive results with medication and talking therapies , these are not beneficial for all mothers, or barriers to treatment (long waiting lists, fears around medication while breastfeeding) mean that other solutions are needed. To understand whether community group singing reduces symptoms of postnatal depression in new mothers in South London, the team of researchers from the SHAPER programme (lead by Prof Carmine Pariante, editor of InSPIre the Mind and Dr Daisy Fancourt) set up a randomised clinical trial, SHAPER-PND, to recruit 400 women with symptoms of postnatal depression and their babies. You can read the published protocol paper here . We were also interested in understanding the biological background of postnatal depression and how singing might influence it, so we are collecting saliva and hair samples to look at cytokines, cortisol and oxytocin. A Melodies for Mums session. Photo credit: Breathe Arts Health Research I am a project manager and postdoctoral researcher at the SPI Lab — by day a researcher on SHAPER and by night a writer, assistant editor and podcaster for InSPIre the Mind 😉 You can read my blogs on arts and health , yoga and inflammation and yoga and mental health  — and stay tuned for our podcast too! Postnatal depression It has been found that PND has implications not only for maternal health and wellbeing but also for the relationship between mother and child . A depressed mother is also more likely to report lower feelings of attachment to their baby , and challenges with attachment have long been linked to optimal child development, including mental health problems in the future . Consequently, early intervention is necessary to improve mother-infant interaction to protect future offspring development. However, many mothers participate in community group activities, such as mother-infant playgroups that are frequently music-based, as they have been shown to provide a sense of personal fulfilment, relaxation and social interaction . There is growing evidence that community group singing is beneficial to mental health . Inflammation, the stress hormone and the bonding hormone: the biological background in postnatal depression The most well-studied biological explanation for the benefits of music engagement on mood is the hypothalamic-pituitary-adrenal (HPA) axis, whose main product is cortisol , the stress hormone. According to various studies, singing reduces cortisol levels and increases cytokine levels, showing an impact of singing on inflammation. It has also been shown that singing increases oxytocin levels , the bonding hormone. Only one study has investigated the biological effects of maternal singing groups, which found a decrease in cortisol and an increase in oxytocin . A Melodies for Mums session. Photo credit: Breathe Arts Health Research The SHAPER-PND trial SHAPER-PND has a unique Hybrid Type II Effectiveness-Implementation design, which means that instead of just the effectiveness for postnatal depression, we are also looking at how the singing intervention can be scaled-up, as in, done across the country and in the future, embedded into the NHS. This trial is currently recruiting new mothers with symptoms of postnatal depression (according to the Edinburgh Postnatal Depression Scale) and their babies up to the age of nine months across London (primarily in the South London boroughs of Lewisham, Lambeth and Southwark). Mothers will be randomly allocated to either singing sessions or a control group. The singing sessions, aptly named " Melodies for Mums ", run in children's or community venues across ten weeks, delivered by Breathe Arts Health Research . The programme is delivered to groups of 8–12 mothers in weekly sessions that last for one hour. Mothers attend with their babies and are invited to sit in a circle on the floor, surrounded by soft play cushions and mats. Classes start with welcome songs, introducing the babies and mothers to one another, and then involve a range of singing and music activities. Some songs are accompanied by maracas, drums, hand chimes and other instruments that the mothers and babies can play. Classes are led by professional workshop leaders trained by Breathe, with the support of assistants. A Melodies for Mums session. Photo credit: Breathe Arts Health Research The control group receive details of other non-music classes available to them in the community, such as messy play, baby swimming or baby massage, where participants will join other mothers and their babies. For the control participants, after the first ten weeks, they are offered a place in the singing programme, but these data will not be part of the study. The data collection from participants will be done at baseline, before the start of the trial and at weeks 1, 3, 6, 10, 20 and 36 post enrolment in the study. A package of measurements will be collected from participants during Zoom calls or on an online database for clinical, mechanistic and implementation outcomes at different stages of the trial. Clinical assessments will include questionnaires and interviews for demographics, mental health, and social measures, together with biological samples: saliva (diurnal cortisol & session cortisol, oxytocin and cytokines) and hair (3-month output of cortisol). We hope this study will bring evidence to the field of social prescribing and arts in health — and offer an art's-based activity that many mothers can participate in with their babies to improve their mental health. Share with your network! The next 10-week programme is starting on: Tuesday 4th October 2022 10.30–11.30 at Sunnyhill Children's Centre 13.30–14.30 at Stockwell Children's Centre Thursday 6th October 2022 13.30–14.30 at Pilgrim's Way Children's Centre Register your interest here: https://breatheahr.org/forms/breathe-melodies-for-mums-shaper-registration-form/ The findings of this study will be published in peer-review journals. Participants will receive a newsletter with a summary of the study's results. For more details on the protocol, you can read the protocol paper and consult the trial registration . This trial (NCT04834622) is part of the SHAPER programme, a Scaling-up Health-Arts Programme to scale up arts interventions.

I am a Black Mother! Words that for many years came with an element of discomfort. Words that for most of my adult life filled me with imposter syndrome and sounded like they were someone else’s familiar truth. The Motherhood group are facilitating another year of Black Maternal Mental Health Week (BMMHW) from the 26th of September to the 2nd of October, and I cannot begin to express the importance of this week for Black mothers. As a Black mother, and Project Manager at The Motherhood Group, this is an opportunity to be seen and heard in ways we should be, but unfortunately rarely are. We are highlighting the inequities and sharing knowledge and fact-based information to really make a change without negating individual experiences. This blog is a personal account of my experience to highlight the importance of BMMHW and why organisations, public health and care services and private corporations need to get involved, reflect and listen to Black mothers as we share and validate our experiences. This year The Motherhood Group is focusing on equity in black maternal mental health. Black mothers are often overlooked, misrepresented, and misunderstood. We will be highlighting various areas including: The inequalities black mothers face during the perinatal period and the negative implications associated. We will be exploring stigma and how culture and generational practices impact us internally and externally. Over recent years many organisations have been working tirelessly to address the trauma and loss black mothers suffer disproportionately due to such terrible morbidity and mortality rates in mothers and infants, both first-hand and through the experiences of our sisters and peers. We will be exploring how this affects Black Maternal Mental Health, as well as overcoming barriers Black mothers face when it comes to making healthy choices for their own and their child’s wellbeing: due to lack of knowledge, support, available representative resources — and how racism plays such a large role in affecting all these areas. Photo of Chaneen Saliee By Chantelle Edwards As a Black mother, successful businesswoman, loving wife, confident speaker and educator, I had an image of myself as the oh-so-familiar “Strong Black Women”. Show no weakness, hold your head up, nurture all and step with confidence. My trauma-riddled inner child had long been abused and neglected in a way you would never dream of treating your own child. Yet somehow, on the rare occasion I returned to her, it was a familiar interaction, and the treatment was somewhat… normal. My mother was stern and my only example. The hand that abused was my sole reference in parenting yet somehow my main reason for change. My aunties were “Strong Black Women”, and they carried their strength in their tongues and wooden spoons as their weapons of choice. As a little girl I used to live in my imagination as the mother I dreamed I’d be, returning home to tend to my dollies who had been at Teddy day-care whilst I was at school (Work). My only aspiration was to fulfil that fantasy that I had romanticised in my mind. At 17 I was told I would never have children. Polycystic Ovary Syndrome (PCOS), Endometriosis and my first miscarriage only filled me with shame and misery — something I tucked in a corner when I stepped out as the “Strong Black Woman” day in and day out. I hid it well. Kept that child and the trauma nicely tucked away: Misinformation, 4 more miscarriages, 4 surgeries, 3 children, 16 prescription drugs a day and then a final word from my consultant, “…we’ve scheduled your hysterectomy, Leah you understand this means you won’t be having any more children?!” I twisted and turned those words every which way in my mind for two months, to help wrap my mind around them. I had carried two babies and had one born of another’s womb (my husband’s first son). I was lucky! I should be grateful! Don’t be greedy! At least you can have children! These ohh-so-familiar words tore through me until they exposed that poor neglected little girl. I began vomiting uncontrollably. Just as I thought I had got my head around the words that my consultant burnt into my brain…. I’m pregnant. I couldn’t get my mind to undo all the work it had done, my inner child couldn’t take anymore and as she took centre stage, I fell into a severe antenatal depression which encompassed every ounce of my being. It was raw, it was gruesome, painful, burdensome, dark, lonely, and overdue! It came with an overwhelming force that took hold of everything and everyone around me as it consumed us deeply for 6 months relentlessly until my husband was able to reach his hand out of the tornado that had drawn us all in. The doctors prescribed the usual, barely blinking. Not one said, “are you ok?” I was referred to IAPT, to a psychotherapist and an independent counsellor. No one looked like me. No one understood that having fertility treatment made me feel like I failed to conceive repeatedly, that my miscarriages were “unviable pregnancies”, (the same triggering terminology used when I went into early labour with my now 7-year-old son) and I failed to carry my babies, that my failure to progress meant I had an emergency c section and that when I expressed milk on day nine with my firstborn, I failed to nourish my baby naturally. Something that inner child was all too familiar with. Failure. The language used around me in my care was constantly triggering. My mother was 1 of 11, my dad and my husband are both 1 of 7, yet I failed at every step and needed assistance. My mind spiralled as they told me how different it was for my parents and not to compare, but they didn’t understand. My grandmother, aunties, mother-in-law, and mother all did this! In the yard! Took care of all the babies, kept house whilst breastfeeding, carried all these babies and even had time to practice self-care whilst yoni steaming before supporting the community as a Strong Black Woman. “They didn’t really do that did they?” My therapist asked in disbelief, a simple statement that made me pivot during the depths of my antenatal depression. Could they really do it all? Was I just a Weak Black Woman? Was I just making it up? I realised that, as a White woman, she had no idea about what it was like, what I was going through. How can she help me? Why did they not know? There are whole stereotypes about it; I’ve literally been trying to live up to them. She continued to inform me that yoni steaming is not a safe practice. I focused on this longer than necessary frustrated that an ancient practice that had been passed down through generations was disregarded without thought. She referred to Gwyneth Paltrow being sued, and I wanted to scream. Why was she talking about a White woman’s perfumed pseudo products when I was talking about an ancient, herbal practice, we used natural herbs grown on our land steeped in water to extract the healing properties of the plants, ancient medicine that paved the way long before pharmaceutical science…… I was so tired. This is not to say that this is best practice for everyone, more research is required to determine safe and consistent commercial practice. But I just agreed and faced my own guilt for not speaking up later. I never returned. I didn’t feel seen, and these comments were thought-provoking in a detrimental way. I struggled with paranoia and felt I was judged and misunderstood so I began educating myself and this became my therapy. The more I studied and researched maternal mental health, generational trauma, trauma-informed care and conscious and unconscious bias, I identified more and more flaws in the care I had briefly received. From the frequent microaggressions to the inherent ignorance for my culture. Leah Lewin and her family by Pictoria I started to implement boundaries to protect my peace, I leaned into my spirituality and finally spoke out about my experience. Not all of my family “believe” in depression. I gave myself permission to experience and understand what was happening regardless of judgement and I no longer had to wear the “Strong Black Women” façade. Instead, I experienced vulnerability and softness. I spoke to other women of all races and was intensely drawn to the black women’s story as they recounted their trauma almost as if it was mine. We heard each other and understood the unique challenges we were facing. We bonded through the unburdening of a collective experience and the knowledge that what we experienced with our care providers was not all in our heads but the subtle mocking of culture, misunderstanding of our stories, and the lack of compassion for our generational trauma were real. My antenatal depression changed my life, dramatic as that may seem, I now only do the work I am led to do. Not a day goes by when I don’t feel, see, reference or reflect on my experience, as it shaped not only my business but also my parenting style and how I allow myself grace and time to rest and heal without guilt. Why I will always strive to support Black Maternal Mental Health and speak on the importance of trauma-informed, unbiased, representational and equitable support that Black mothers require. Why we must be seen, heard and understood and why Black Maternal Mental Health Week is so important to me and so many other Black Mothers. This is my personal account, but also a collective experience. It’s time for us to relinquish the burden of the Strong Black Woman! For more information and to get involved, follow @themotherhoodgroup and subscribe to our newsletter as we share further details of the focus points for each day. Header image: Photo of Leah Lewin – The Perinatal Specialist by Simon Langham

This is the first blog of our Maternal Mental Health series. For the next six weeks, dear reader, you will read about the often misrepresented, largely misunderstood world of maternal mental illness. We will publish stories from lived experience perspectives and give you the researcher or clinician's perspective on the topics of perinatal OCD, postpartum psychosis, clinical and community mental health support, and childbirth-related post-traumatic stress disorder, and we will close with a final interview led by Dr Jodi Pawluski . We hope that this series brings you a greater insight into maternal mental illness and demystifies its prevalence, symptoms, experiences and outcomes for mothers and their families. There are many misconceptions about pregnancy and motherhood. Perhaps the biggest one is the idea that becoming a mother is an inherently happy time for a woman. It isn’t. I’m a neuroscientist, therapist and author who focuses on understanding how the brain changes with the transition to motherhood and perinatal mental illness. I also like to talk about all things Mommy Brain . I recently sat down with Prof Carmine Pariante , Editor in Chief of InSPIre the Mind, Professor and perinatal psychiatrist, to talk about mental illness during the perinatal period — beyond postnatal depression — to bring our awareness to the range of illnesses that a mother (and father ) can be faced with. (You can find a recording of our conversation on my podcast Mommy Brain Revisited episode #33.) Photo by Jenna Christina on Unsplash Perinatal Mental Illnesses We talk about postnatal depression quite a bit these days, which is a significant improvement compared to even 5 years ago, but what about other significant mental illnesses that mothers struggle with? As it turns out, there are a number of mental illnesses that occur during the transition to motherhood — either during pregnancy or the postnatal period —  that often occur together and may have started prior to pregnancy. These illnesses include “depression, anxiety, eating disorders, substance abuse, bipolar disorder, and OCD ,” says Pariante. There are also two less common mental illnesses that occur only during the postpartum period —  Postpartum Psychosis and Childbirth-related PTSD. Over the course of this Perinatal Mental Health series, we will focus on anxiety and OCD, Postpartum Psychosis and Childbirth-related PTSD. Many Moms Have Scary Thoughts Recent research states that clinical levels of anxiety exist in 13–21% of pregnant women and 11–17% of postpartum women in the western world. That’s nearly 1 in every 5 moms, and we believe these numbers are underreported, with the actual figure being considerably higher. This perinatal anxiety can take the form of constant worry about the well-being of the baby or doubting one’s ability to be a mother. It can be coupled with physical symptoms such as heart palpitations, sweaty palms, or feelings of panic. Other moms will struggle with obsessions which take “the form of unpleasant distressful images” says Prof Pariante, and are part of what we call OCD (and can occur without any compulsions). Obsessions in mothers are often thoughts of harming the baby — which are incredibly distressing and can result in a mother not wanting to be near her baby. It’s important to know that obsessive thoughts are not related to actions. The thoughts are about things that could happen, but never will. Unfortunately, mothers struggling with obsessive thoughts are unlikely to share how they are feeling with those around them or a health care provider, for fear of the reaction of others. Dr Pariante urges moms to talk about these thoughts with health care specialists in perinatal mental health, to learn how to manage them. Photo by Claudia Wolff on Unsplash Beyond Scary Thoughts The most severe mental illness occurring with motherhood is Postpartum Psychosis . It occurs in 1–2 of every 1000 women, “usually occurring quite predictably within about 2 weeks postpartum, and most often in women with a history of bipolar disorder,” says Prof Pariante. Often not feeling the need to sleep is an early sign that something could be wrong. This coupled with other symptoms such as racing thoughts, paranoid feelings, feeling very energetic, and believing in ‘signs’ from the world around you, are indications that it is time to talk to a health care professional. This illness requires immediate medical and psychiatric intervention, and is treatable. The Impact of Birth The experience of birth itself can contribute to perinatal mental illness and in certain cases results in childbirth-related PTSD — affecting 1–2 of every 100 women. We know that many women do not have the birth experience they thought they would — perhaps due to unrealistic expectations, lack of education about the process, or being the victims of medical procedures or neglect. When I spoke with Prof Pariante about the impact of the birth experience on perinatal mental illness, he talked about how important it is to acknowledge that trauma at birth can contribute to mental health outcomes, but there are often additional contributing factors involved in a diagnosis of perinatal mental illness. Photo by Amit Gaur on Unsplash The Perfect Storm What are the causes of perinatal mental illness? “Every woman has a slightly different story,” says Prof Pariante, but there are common threads in these stories that can provide us with answers. First of all, there is no denying that maternal mental illness is “largely driven by psychosocial circumstances,” Pariante states, “Women in the perinatal period are the most vulnerable members of our society.” I couldn’t agree more, yet what are we doing about it? Second, there is always a biological component, and if you know me, I’m always looking for a neurobiological component. Pregnancy and the postpartum period involve a number of changes throughout our body and brain , over the backdrop of genetics. These changes, coupled with life experiences, can contribute to perinatal mental illness — we just have yet to understand these biological factors completely . Third, we have moved away from extensive family and community support for moms. “It’s only been the last 50 years or so where western culture has focused on individualization — doing it alone. This is not how mothering should be,” says Pariante. I know I’ve probably said this too many times, but it does take a village to raise a child. It must. It’s Not a Mother’s Fault Often our narrative around perinatal mental illness isn’t about how it impacts the mother but how it impacts that developing child. But we need to remember that the majority of children born from mothers with a perinatal mental illness are perfectly fine. There is a strong element of resilience in children — even in severe cases [of perinatal mental illness],” says Prof Pariante. The impact of the mother’s health on the child is important, of course, but mothers deserve support too. “It’s not a mother’s fault she is struggling,” says Pariante. It is our society’s inability to value motherhood and maternal health — the people that give birth to the next generation. To learn more about maternal mental illness check out the Maternal Mental Illness Series at InSPIre the Mind every Wednesday and Thursday until the 9th of November.

This is the second week of our Maternal Mental Health series, which is dedicated to perinatal Obsessive-compulsive disorder (OCD). In honour of OCD awareness week, we are publishing two blogs, one from Maria Bavetta, co-founder of the charity Maternal OCD , about her personal experience of dealing with and overcoming perinatal OCD, and another by King’s College London researcher Dr Fiona Challacombe that focuses on what we know about this condition and the challenges that need to be addressed in research in order to help treat these individuals. My name is Maria, one of the co-founders of the charity Maternal OCD along with Diana Wilson. I also work as part of the Maternal Mental Health Alliance team, campaigning to ensure all women and families affected by perinatal mental health problems have access to high-quality, comprehensive perinatal mental health care. I am writing this after our eldest flew the nest and has embarked on her next adventure, so what better time to reflect on the last 18 years and to consider what my next adventure could also be? As I start my new chapter and think about my daughter’s new world, I am reminded of all the ways I had to stand tall and trust I had it in me to succeed — even in the most challenging times during recovery. Perinatal OCD — how it impacted my family and me Perinatal obsessive-compulsive disorder (OCD) is basically OCD during pregnancy or after birth — known as the perinatal period. Pregnancy or birth can sometimes trigger the disorder and/or a woman may have had OCD in the past. For more detailed descriptions of the main symptoms and the disorder as a whole, I would like to direct you to co-produced material with The Royal College of Psychiatrists focusing on what perinatal OCD is and information for carers . I experienced perinatal OCD three months after my daughter was born, as the bottle washing started. My husband and I genuinely thought I was just being a little ‘too careful’ and tired from a new baby, so he washed the bottles, and we carried on. Fast forward a few months, and I doubled our water bill with excessive washing and was very unwell. In my mind, everywhere was a risk of harm and therefore needed daily meticulous planning to ensure complete safety. This was an unattainable goal which led me to listen to my intrusive thoughts and inadvertently maintain the illness. Photo by Tembinkosi Sikupela on Unsplash I often wonder how (or even if?) my OCD impacted my children, I’m not sure I will ever know. What I do know is for a while I was unable to be the mum, wife, daughter, sister or friend I wanted to be. I was unable to be truly present and had to ‘fake it’ which was exhausting especially when running on empty because of OCD. It was also a time when OCD was not really spoken about; I am now becoming more confident in the national understanding albeit we have some way to go yet. I do sometimes get sad for the times OCD stole from me. But I am now able to manage my emotional bank account in a way that wasn’t necessary years ago and maintaining a healthy mind is part of our planning and decision-making as a family. My recovery journey: has there been a difference? I am very fortunate to have been eligible for a research trial which gave me my wings. After a vast amount of homework, working with a skilled therapist trained in a type of talking therapy called cognitive behavioural therapy (CBT) (who understood the perinatal stage and applied techniques to the perinatal period and beyond), having supportive family and friends by my side and a dogged determination and energy that I’m not sure I could muster again, I got better. I became a typical mum who was tired because it was a long day not because OCD was demanding and stealing time from me. Photo by Shannon Pitter on Unsplash As a mum, I have experienced services commissioned for people in the general adult population and services specifically for the perinatal period — it’s the latter that brought me home, the latter which helped me. This is not a finger-pointing exercise to health care providers (HCPs) providing services for the general adult population, this is written unreservedly because for mums to recover from a perinatal mental health problem, they need and should have access to HCPs with a perinatal specialism. Maternal OCD: who we are and what we do Diana and I started Maternal OCD because there was nothing ‘out there’ for us during recovery and we felt alone. We found each other and realised the strength behind hearing other people’s stories and the need for raising awareness across various communities including healthcare professionals, commissioners, national decision-makers, academics and the local community. We work with organisations who care passionately about improving services for women and families and have seen a cultural shift in awareness. This includes making perinatal OCD central to training for perinatal mental health teams, delivering commissioned training on perinatal OCD, co-producing leaflets with the Royal College of Psychiatrists, training student midwives and health visitors and psychologists, and meeting the general thirst for knowledge to support women and families impacted by perinatal OCD. Supported by Maternal OCD patron Dr Fiona Challacombe, who also has a blog piece being published tomorrow for Inspire the Mind, we co-produce outputs including the creation of an animation, plans into computerised or online CBT, and most recently an infographic with the Perinatal Anxiety Research Lab. Resources For more information, you can watch me talk more about my experiences of suffering and recovering from perinatal OCD , as well as a workshop lead by Diana, Dr Fiona Challacombe and myself about ‘Dispelling the Myths of Perinatal OCD’ as part of OCD Action and The BDD Foundation’s Joint Virtual Conference 2021. Maternal OCD will now be focusing on training and education, as a result peer support for women and families impacted by perinatal OCD will be provided by OCD Action. Find the support options below: • Perinatal OCD support groups via Skype/Phone — twice monthly on the second and fourth Tuesday of the month, 7pm. • OCD Action Helpline: 0300 636 5478 • OCD Action email address: support@ocdaction.org.uk Maternal OCD contact details: www.maternalocd.org info@maternalocd.org @maternalocd on Twitter

This is the second week of our Maternal Mental Health series, which is dedicated to perinatal Obsessive-compulsive disorder (OCD). In honour of OCD Awareness Week, we are publishing two blogs, one from Maria Bavetta, co-founder of the charity Maternal OCD , about her personal experience of dealing with and overcoming perinatal OCD, and another by King’s College London researcher Dr Fiona Challacombe that focuses on what we know about this condition and the challenges that need to be addressed in research in order to help treat these individuals. My name is Fiona Challacombe, I’m a clinical psychologist and researcher in the field of perinatal mental health. For many years I have been researching and working with perinatal OCD, which occurs at the time of pregnancy or after having a baby. This was an almost unknown issue when I began work in this area about 15 years ago when almost everything was considered to be postnatal depression (depression occurring after childbirth). We have come a long way since then, but perinatal OCD can sometimes still be met with misunderstanding, which can get in the way of treatment. Photo by Pixabay on Pexels OCD is a condition whereby unwanted thoughts (also known as obsessions), which might be verbal, images or urges, occur in a person’s mind that makes them worried about a potential danger. Importantly, this is a danger that they could either cause or prevent, which leads to particular actions (compulsions) to prevent this danger, or at least, try and do as much as they possibly can to prevent it. The danger may be external, for example, some form of contamination that could cause illness, or it can be internal, such as a thought that you could harm someone close to you. We know that these types of thoughts are very common and most people experience them, but research has shown that parents of young babies are very likely to experience these thoughts frequently, especially in the early months. This makes sense, as it is a time when many parents are preoccupied with their baby’s safety and getting things right as they learn on the job, often feeling very uncertain and sleep-deprived. We know that parental thoughts of accidentally causing harm to the baby (“Is the bath water too hot?” “What if I drop her?”) affect nearly all parents. We also know that about half of new parents will also say that they experience unpleasant intrusive thoughts of doing deliberate harm (“What if I abuse my baby?” “What if I put them in the microwave?”). Photo by Francesco Ungaro on Pexels The theory behind this is that there is some kind of evolutionary protection mechanism that throws up all sorts of ideas of possible threats that keep parents safety-focused at a time when their babies are most vulnerable in the early months. But we all experience such thoughts from time to time. While most parents find the thoughts mildly unpleasant, and some may even engage in avoidance or other responses, these won’t become excessive, and the thoughts become less frequent. However, for others, the thoughts become very difficult to dismiss, and they begin to try too hard to respond to them. This is due to interpretations about what the thoughts mean, for example, that each one is a signal that cannot be ignored or they would be irresponsible, or that having the thought itself may mean that they are a bad person. It is this level of meaning that distinguishes someone who has OCD and is spending time and effort trying to prevent harm, from those who respond differently. This idea is very important for clinicians to be able to make a correct diagnosis and distinguish OCD from other problems that may also involve intrusive thoughts of harming the baby and can be associated with increased risk, such as psychotic depression or postpartum psychosis. This is not the case for people with OCD. Getting this wrong can be very detrimental as it prolongs the problem and causes considerable distress for parents. People with perinatal OCD have often had OCD before, or perhaps some symptoms of OCD that don’t meet the full threshold for a disorder in the past, but the perinatal period provides a new context that ups the ante in terms of both responsibility and stress. For those who have experienced OCD in the past, it is not uncommon for it to morph, to now revolve around the baby and caregiving. Usually, this is the focus for those with a new incident disorder at this time. OCD affects about 1–2% of people at any one time, and our research shows that it is much more common in pregnancy and increases postnatally, possibly affecting up to 7% of women. It’s clear that some non-birthing partners also experience perinatal OCD but we do not have good prevalence figures yet. However, this demonstrates how important the perinatal context is. We do know that only a relatively small percentage of people with perinatal OCD seek treatment — this may be due to fears of being misunderstood, or a lack of accessible treatments. Healthcare professionals need to ask the right questions to establish whether the problem is OCD in order to offer the right treatment , or get advice from OCD experts if they are not sure. A type of talking therapy called cognitive-behaviour therapy (CBT) is a very well-evidenced treatment for OCD, and it is acceptable to women, who generally prefer psychological therapies in the perinatal period. Photo by SHVETS production on Pexels We have tested out time-intensive versions in our clinic, where we deliver the whole course of treatment in twelve hours over two weeks followed by more spaced-out follow-ups. In our treatment trial, this format worked well for women with postnatal OCD, with many commenting that it allowed them to focus on therapy and put it into practice. Organising childcare around four afternoons rather than twelve weeks was much easier! We need more research on the best way to deliver therapy for perinatal OCD, and how best to treat those women for whom the OCD is more longstanding, perhaps starting before they have a baby, in order to put them in the best position for parenting. Our research trial also showed that OCD did not affect mother-infant attachment, but it certainly impacted the woman’s daily life and enjoyment of parenting, leaving many with feelings of guilt that they had even been unwell at this time. These feelings persisted even when the OCD symptoms improved, so more support for women around parenting in addition to the treatment of their difficulties could make for the ideal treatment package. We have come a long way in raising awareness, but these difficulties remain. The increasing knowledge of perinatal OCD and unwanted intrusive thoughts amongst parents and healthcare professionals should help to prevent difficulties for some women and get those who need it into treatment more quickly. Photo by William Fortunato on Pexels

This is the third week of our Maternal Mental Health series, which is dedicated to Postpartum Psychosis —a rare but extremely severe postnatal mental illness, which must be treated as a medical emergency to protect the safety of the mother and baby. This week we are publishing two blogs: one by Eve Canavan on her personal experience, and another by researchers Alessandra Biaggi and Katie Hazelgrove from King’s College London, focusing on what we know about the illness and what further research is needed to help the people affected and their children. 12 years ago, I fell pregnant with my son Joe. He was much longed for as I had experienced miscarriages previously due to a uterine condition, and as we reached each milestone of my pregnancy with a scan, showing our baby growing, our hopes grew. Being a mother was my dream and one I had started to think would not come true, but in January 2010, Joe was born, changing my life forever. However, becoming a mother didn’t follow the path I had assumed and had been told it would. I had bought everything the baby would need, read every book and attended antenatal classes, noting down what I thought was all the information I needed to help me through those first few weeks and months of being a parent. But, just hours after I had given birth, I realised something was happening to me that I had not been warned about. While I had pages of notes on how to change nappies, I realised I knew nothing about what could happen to me after giving birth. I had assumed I would be enjoying the much-fabled tea and toast in the recovery ward, staring in wonder at my baby. But this didn’t happen. Instead, I found myself staring at the old Victorian hospital windows, which had bars on them, wondering if it would be possible to climb out of them. Because I felt trapped. My mum came into the ward, arms wide yelling, where is he, searching for her grandson but as she pulled the curtain back, she stopped, lowered her arms and said “Evelyn, what’s wrong with your face?”. She said I looked glazed over and like a zombie, and was worried something was wrong with me. The nurse said, “a c-section is a major operation and I imagine you are tired aren’t you, Eve?” I nodded yes, that’s it, I feel tired, all while staring at the windows. But as everyone was cooing over the baby, my hearing in my right ear became muffled, my vision blurred, and I felt as though was on a train standing still while everything was whizzing past me. Later that night, after my husband, John, had been made to leave the hospital just 3 hours after I had given birth, I sat in my bed, sweating, eyes darting around the room. I had a sense of intense panic that something awful was about to happen. I started writing long lists of things I needed for the baby and at one point found myself crawling around the floor of my bed. It was as if I had temporarily found myself in another dimension and as my brain switched back to reality, I had no idea why I was on the floor on my hands and knees, in the dark. When we left hospital 3 days later, as soon as I felt the outside air hit me, I burst into tears. I got into the car and declined when asked if I wanted to sit next to the baby. I said someone else can, trying to sound as though I wanted to share the love I had for him but, I didn’t want to be near him. I felt my head going into the other dimension again, as my vision blurred and all I could see was a tunnel. Voices became muffled and when I looked out of the window, the car was surrounded by hundreds of people, shaking it, making me rock back and forth. I started crying asking what was happening, who were all these people. Those people were not there. No one was shaking the car. My Husband, Joe and I At home, John was becoming really worried about me as I started to refuse to be near Joe. He took me to our GP, the start of many, many medical appointments where he begged for help, but he struggled to get it. I was hallucinating, thinking the duvet was dancing and that I was floating in the corner of my room. At my worst, I thought I was in a coffin, buried alive, unable to get out. I found myself on the bed on all fours, screaming so much, the side of my mouth bled while John was on the phone all morning trying to get a psychiatrist to come and assess me. In his frantic endless search for help, he had discovered online that there were specialised psychiatric mother and baby units for women experiencing mental illness while pregnant or after the birth of a baby. A few hours later, I saw a psychiatrist and I was admitted to a mother and baby unit after it was confirmed I was experiencing symptoms of psychosis. As I walked down the hallway, with no shoes on, convinced I could smell burning, and I saw the signs saying psychiatric wards, I was crying. The nurses were amazing. As soon as I walked into the unit, they gave me a hug and promised me things would get better. One of them gave me a folder to read which contained letters from women who had been in the unit and recovered. The stories gave me hope. A week later, after lots of support and new medication, I closed the door, and was on my own with Joe, and the nurses gave me a cuddle. It was a massive step for me to take and the most ground-breaking turning point in my illness. Joe and I My recovery took time. I started with spending a few minutes on my own with Joe each day and had to build up to walking to the local shop, spending the afternoon on my own with him in the house — ‘exposure therapy’- and eventually, spending all my time with Joe to accept that he was here. We spent 3 months away from home altogether, with John having to take compassionate leave from work, to get me to a point where I could come back to London. Without knowing it, I developed a natural love for Joe. My path to parenthood was one that went down a road no one had warned me about. I so wish someone had told me that it can affect 1 in every thousand women and that the healthcare professionals I saw knew about it and the treatment options available. I am so grateful for organisations such as Action on Postpartum Psychosis , who provide information, advice and training to ensure families and health care professionals are knowledgeable about the illness but most importantly, the fact that recovery is possible with the correct help. If you would like to learn more about Postpartum Psychosis, don’t forget to check out the next blog in the series by Alessandra Biaggi & Katie Hazelgrove on the science behind it — out 20th October 2022.

Pregnancy is a remarkable time of profound transformation for both the mother and the fetus. During these nine months, the pregnant person undergoes significant physical changes, including complex shifts in hormones and metabolism, which are essential to support the developing fetus. Alongside these physical demands, emotional challenges can increase levels of perceived stress and, in some cases, lead to mental health issues.   Meanwhile, the fetus is developing rapidly in the mother’s womb - protected and nourished by her body - yet vulnerable to adverse changes of its intrauterine surrounding. In fact, the physiological and psychological changes occurring in the mother can affect the development of the fetus via the intrauterine environment. Specifically, current research indicates that elevated maternal stress can alter this environment, creating conditions that may affect the child’s health long after they are born. Image Source: Aditya Romansa on Unsplash My name is Paula Pfeiffer, and I’m an MD/PhD candidate at Charité Universitätsmedizin Berlin, Germany.  In my research, I study how maternal conditions during pregnancy - especially stress - shape offspring health trajectories into childhood and even through to adulthood . Together with my mentor, Sonja Entringer, Professor of Medical Psychology at Charité Universitätsmedizin Berlin, we investigate the biological pathways that translate maternal psychological stress into a physiological response in the mother, and subsequently encode vulnerability in the fetus’ biology, ultimately shaping its lifelong risk of disease.   The Fetal Programming Hypothesis Our research builds on the  fetal programming hypothesis . This concept suggests that the early developmental period - particularly the time spent in the uterus - shapes how the body and the brain function in later life. Over 30 years ago, researcher David Barker observed that individuals with low birth weight were more likely to develop cardiovascular disease as adults. Importantly, he argued that low birth weight was not necessarily the direct cause of later health problems; instead, he suggested it was a sign that the baby experienced less-than-optimal conditions in the womb, which may have influenced how certain physiological systems developed.   Since Barker’s initial discovery, researchers have become increasingly interested in factors involved in shaping the intrauterine environment. Among the many factors identified, an increasing amount of studies suggest that the mother’s emotional well-being plays an important role in this context. Experiencing stress and associated mental health issues, such as depression or anxiety, can affect the conditions in which the baby develops. In some instances, they may be linked to a higher likelihood of health challenges later in life , such as obesity, cardiovascular diseases, and psychiatric conditions. This growing body of evidence highlights how closely maternal well-being and long-term child health are connected from the very beginning. Image Source: Anna Hecker on Unsplash What Is ‘Stress’ Actually? Before we dive deeper, we must clarify how stress is defined in the context of our research. Stress is way more than just a feeling ; it is a complex interaction between a psychological state and the body’s physical response to it. When we encounter a stressor, our body activates a sophisticated internal alarm . Among others, this triggers the  hypothalamus-pituitary-adrenal (HPA) axis , a hormonal system which leads to the release of cortisol - often referred to as the primary stress hormone in humans.   While this response is essential for handling acute challenges, chronic stress can cause the HPA axis to fall out of balance. This results in persistently elevated cortisol levels, which can in turn lead to adverse health consequences in the long term, such as weakened immune system, cardiovascular conditions and metabolic dysfunctions.   The Placenta – An Underrated Organ How exactly does this maternal stress signal reach the developing fetus? This remains one of the most intriguing questions in our field. Since there are no direct neuronal or vascular connections between the mother and her unborn child, all communication must pass through the placenta – the interface that connects the mother and the fetus.   The placenta is a fascinating organ. Formed primarily from fetal tissue, it does more than simply pass along oxygen and nutrients; it acts as a dynamic communication hub between the mother and the fetus. It produces hormones and interacts with the maternal immune and endocrine systems. Image Source: João Paulo de Souza Oliveira on Unsplash One of the placenta’s especially important roles is helping to regulate the fetus’ exposure to the stress hormone cortisol - it acts like a protective shield that limits how much of the mother’s stress hormones can reach the baby. This stress‑hormone barrier is created by proteins in the placenta, which work together to convert active cortisol into an inactive form and control how strongly cortisol can act in placental and fetal tissues.  This placental function is particularly important given that exposure to excessive cortisol levels in the womb has been found to be associated with adverse long-term health outcomes.   Emerging evidence has begun to explore the role of maternal stress on the placental cortisol barrier, among other factors, including nutrition, inflammation, and maternal mood symptoms. Animal and human studies suggest that, in healthy pregnancies, this system can temporarily ramp up to deal with changes in maternal stress; however, when stress is very strong or long‑lasting, the barrier may become less effective at up‑regulating its protective activity and allow more cortisol signals to reach the fetus.   Understanding how this placental cortisol barrier operates is key to explaining how early experiences before birth can shape long-term health. Insights into these mechanisms can help us offer better support to pregnant people who experience high stress, so both they and their babies can thrive. While these findings are promising, it is important to note that more research is still needed before clear clinical recommendations can be made.   Why Does This Matter? The intention of our article is not to cause worry or guilt about how people feel during pregnancy. Feeling stressed at times is part of human nature. It is also important to remember that many factors, such as social support, self‑compassion, and effective coping strategies, can act as a protective buffer against the effects of stress.   Importantly, stress is not just a personal issue. When looking into who is most exposed to stress, it is not surprising that social and economic circumstances play a major role. Our research highlights a critical point: health inequalities start even before birth. Individuals born into lower socioeconomic backgrounds have a higher probability of being exposed to prenatal stress, potentially setting them on a different health trajectory from day one.   Importantly, this evidence suggests that many of these risks are not fixed, but may be modifiable. This highlights pregnancy as a crucial window of opportunity to provide tailored support, reduce inequalities, and promote better long-term health outcomes for both mothers and their babies. Image Source: Getty Images on Unsplash   A Call For Public Health Action This evidence underscores the need for research and infrastructure in maternal and child health, which remain significantly underfunded. We need to shift the focus from individual responsibility to systemic support. It is vital to identify and support those at high-risk of stress during pregnancy, to promote both their own well-being and the long-term health of their offspring. By providing better mental health resources and social security, we are not just supporting individuals, but investing in the lifelong health of the next generation.   If we are to treat health as a fundamental human right , our prevention strategies must begin where life starts: in the womb. Ensuring the mental well-being of pregnant people is a cornerstone for building a healthier and more equitable society.

It seems that I do have a trend of finding life lessons from my hobbies and interests. Two years ago, I wrote a piece on how ballet taught me life lessons. Then, I wrote about the deep symbolism of children’s movies, and finally, Taylor Swift . These are just some of my hobbies and interests alongside my full-time job as a researcher, and part time PhD. I was inspired by Taylor Swift, who spoke about making sourdough when she was on press tours promoting her new album in October 2024. So, seeing the joy it brought her, I went on my own journey, which really kept me going through the cold, dark, and wet January days in London. Today, I will talk about some life lessons I have learnt through this process. Lesson 1 - Resilience and consistency: The sourdough process begins with the creation of a ‘starter’ (equal amounts of water and flour) and takes about a week (or so I thought) to mature, grow, and be ready to bake with. And this is a journey in itself. The recipe I was following made it very clear that I would have an active, bubbly starter by day 7, fresh and ready to bake with. So, I bought all my accessories: a baby pink Dutch oven, a scorer, and a banneton. However, 7 days, even 14 days later, though I’d been feeding it every day, making sure it was warm, my starter refused to show all the telltale signs it was ready to bake with. I woke up with excitement every morning, hoping it had doubled in size (meaning the wild yeast is active and producing enough gas to expand the mixture), or passed the ‘float test’ (If a spoonful of starter floats in water, it indicates enough trapped air from fermentation, suggesting it’s active). I was disappointed every day, but I decided to keep at it, with the hope that one day, my starter will be ready. Lo and behold, one fine Saturday morning I woke up to an active, bubbly starter, who had doubled in size, passed the float test, and it genuinely made my day. Image Source: Olimpia Davies on Unsplash This journey really showed me not to give up. Every day, I thought of quitting the process, thinking I’d done something wrong and wouldn’t actually be able to complete it. And I know, a few years from now, when I am at the stage of writing my PhD thesis, or in my career, there will be days where I feel like giving up. And it is on those days where I will remember these moments of my starter, which has inspired me in so many unexpected ways.   (P.S. In the sourdough community, it is not uncommon to name your sourdough starter, so, dear reader, I’d like to introduce you to Doughphelia!) Image Source: Riddhi Laijawala Lesson 2 - Community Something that pleasantly surprised me was the sense of oneness and community in the process. Now, my boss and I have a shared interest, and when not talking about our work, he (way more experienced in both research and sourdough skills) shares tips on how I can improve on my breadmaking skills, and also be a better researcher. I have also begun to appreciate the sourdough community on social media. When I, on what felt like day 100 of my sourdough starter, was not seeing any signs that it was ready to cook, I’d find so many similar experiences, showing me that I’m not alone. And this really goes on to show how community and social support can go such a long way. I’ve seen how home bakers swap tips and troubleshoot flat or over proofed loaves and even share starter across cities and countries.    Lesson 3 - Learn from your mistakes I had an incredible first try, and my first ever sourdough loaf was a success. So, I decided to take it a step further and make another such loaf as a present for someone. Long story short, it was an absolute failure. In an attempt to make a smaller sized loaf, I miscalculated the amount of water I had to put into the mixture, and as a result, was left with sticky dough which didn’t firm up to become a loaf. But when the dough didn’t rise the way I hoped, I chose not to see it as a failure. Instead, I reshaped it, pressed it into a pan, drizzled it with olive oil, and turned it into focaccia. What was meant to be one thing became something else, still warm, still nourishing, still good. And thus I learnt, sometimes life works the same way. The plan we carefully shape may fall flat, but that doesn’t mean the effort was wasted. Rather, it might be a great opportunity to transfer that energy and effort into another meaningful project. Image Source: Natalie Behn on Unsplash Instead of throwing it down the drain (which you must NEVER do with starters, it will clog your pipes), repurpose it, and reap the fruits of your labour. I really didn’t expect that something Taylor Swift said in passing would inspire me so much. Now, on Friday evenings, I look forward to feeding my starter, so that it is fresh and ready to start the process on Saturday, finally baking on Sunday morning. While at the surface level I now have a new skill, or passion I can enjoy in my free time, I know that these lessons are some that I will apply to my career, and my PhD. "Let time do the work. That's the secret of sourdough." —  Chad Robertson

Author's own image I am running the 2026 London Marathon in support of the Zoological Society of London (ZSL), the charity that runs the London Zoo and a range of amazing international conservation programmes. The adult in me – and hopefully those of you who want to support my 42 km of sweat and tears – is proud to support the conservation charity, but I would be lying if I did not also acknowledge the child in me who still feels so excited at visiting the Zoo and seeing its spectacular creatures. I have always loved animals. Their amazing looks, the vibrant sounds they produce, their idiosyncratic behaviours and their weird names. I was an obsessive collector of animal stickers in my colourful albums at age 6, with the pages reproducing fascinating landscapes with empty spots where the relevant animal images were missing. With plenty of knowledge on the page, this is where I learnt my platypuses and my echidnas, my pangolins and my tigers. Author's own image And as a child so enthused with animals - and admittedly, 50 years ago, when the debate on animal welfare was less sophisticated, or perhaps I was too young to understand it – I felt touched every time I had the opportunity to see animals alive in a zoo, especially the more mysterious, rare and majestic. Of course, I was, even then as a child, sad for the cages, and I understood that these were not the conditions in which such proud and independent beings should spend their lives. Yet, I found a profound love and joy in my proximity to them. As I grew up – and as an adult without kids - the occasions to visit a zoo decreased drastically, although I occasionally visited Rome Zoo and London Zoo with my nephews when they were kids, probably me more spellbound than them by the animals. I do not need to do PR for ZSL, they have much more famous advocates like Sir David Attenborough. But, as I am putting my name and my face next to their logo, and asking my friends and relatives for donations to support them, I am aware of the potentially controversial nature of such an alliance, with the intense ongoing debate on whether zoos are sources of education or outdated relics. Thus, I wanted to look personally at what ZSL is doing, beyond the Zoo. If you do not have the time to go through their extensive website, here are some interesting highlights. For a start, ZSL (as other modern and conservation-focused zoos) does not capture animals from the wild and put them in their zoos, unless it is for protection and conservation reasons. While I was visiting the zoo recently for an event organised for their running team (including me), they explained that the animals that we see are either born in captivity or have been moved from another zoo, to facilitate conservation breeding programmes, meaning the animals are part of a concerted effort with a population that could eventually be released back into the wild. Often animals are born in the zoo, like the two incredible baby gorillas that were born just two years ago and that I recently saw climbing on their mothers’ backs and playing together in the large garden and the indoor gymnasium. Author's own image Interestingly, ZSL is not only the famous London Zoo in Regent’s Park, with its beautiful 19th century architecture that, even if a listed historical site, was not certainly planned for the best experience of the animals inside. It is also tiny: 36 acres, or 25 football fields. There is another ZSL Zoo in Whipsnade, on a 600-acre site: the space for 10,000 average suburban homes. As I write, they have baby rhinos and baby giraffes. With a decrease of 70% in animal population over the last 50 years, ZSL is busy protecting close to 200 endangered species. Of course, we all cheer for cheetahs, but did you know that the Mexican pupfish now only lives in zoos and aquariums? Or that they work to support 16 species that are extinct in the wild, and 10 species that are threatened in the UK? But what really surprised me was the work that ZSL does on protecting natural habitats - forests, seabeds, rivers, wetlands – which are continuously desecrated by pollution, greed, or the need for human consumption. So, they are replanting mangrove trees, restoring Sumatran forests and rebuilding oyster beds. As an academic – and Inspire the Mind is an academic publication – I am very proud of the educational work that ZSL does, not only for school children but up to Master’s and PhD, with a program for students from less privileged backgrounds. But most importantly – and I experience this myself – zoos can offer an experience that is mentally refreshing and can improve our wellbeing. We know that more frequent contact with the green space (forest, countryside) or the blue space (rivers, lakes, sea) can improve mental health, and so it is connecting with nature in any possible way. So much so that zoos and aquariums have been proposed as places where well-being can be improved by the connection with the animal world and the active engagement with a novel environment. So, if you are interested in reading more about my running, you can read these previous pieces in Inspire the Mind, including three things I have learnt from running the London Marathon, running during COVID, five groups of people I am smiling at when I am running, and whether training is good for my mental health. And here you will have the opportunity to support my efforts for ZSL and to be updated on the progress of my campaign.

Trigger Warning: The following content contains discussions about suicide, self-harm, and mental health struggles, which readers may find distressing. Today, on World Bipolar Disorder Day, we celebrate not only awareness of the condition, but also the birthday and legacy of one of the most brilliant minds in art history: Vincent van Gogh. Public understanding of mental health has grown significantly in recent decades; however, during Van Gogh’s lifetime, emotional vulnerability was often silenced and left unsupported. Through an analysis of the correspondence between Vincent and his brother Theo, a 2020 study highlighted some of the most critical moments of his journey, revealing periods that appeared to alternate between profound depressive states and intense creative surges. According to the DSM-5 (a diagnostic manual for mental health disorders), bipolar disorder is defined by the presence of mood episodes that include both manic (or hypomanic) phases and depressive phases. Manic episodes are periods of abnormally elevated mood and energy, while depressive episodes involve prolonged sadness or hopelessness. These mood shifts can impact a person’s ability to function in daily life, and the condition requires careful diagnosis and management. It’s important to understand that bipolar disorder is a complex but manageable condition with the right support and treatment. This genius, immortalised through his vibrant colours and expressive brushstrokes, endured silent suffering without the medical knowledge or societal support available today. With advances in treatment and growing awareness, bipolar disorder is no longer a solitary fate, but a path that can be met with understanding and care. Today, we honour the artist, the person, and the possibility of a more welcoming and understanding future. Before we start to honour his legacy, I would like to introduce myself. I’m a psychologist currently doing my master’s at King’s College, and I’m also a visual artist at heart. For most of my life, I’ve woven together the worlds of art and psychology, and Van Gogh’s life has always been a source of fascination for me both as a psychologist and as an artist. And now, being here today, celebrating this occasion and sharing his story feels incredibly meaningful to me. I spent a truly special and almost magical bit of time exploring The Museum about Vincent Van Gogh in Amsterdam , where they’ve curated this beautiful collection of his life story, and I’ve put together a little summary of some of the most meaningful moments to share with you all. Vincent van Gogh, Self-Portrait, 1889. Oil on canvas, 65 x 54 cm. Musée d'Orsay, Paris.   On 30 March 1853, in the quiet Dutch village of Zundert, Vincent van Gogh was born into a world that would one day struggle to understand him. Sensitive from childhood, deeply attached to nature, and introspective beyond his years, Vincent’s inner world was already intense long before he ever held a paintbrush as an artist. His early life was marked by restlessness. He moved from school to school, from art dealer to teacher, from bookseller to lay preacher. Nothing seemed to settle him. His letters, particularly those written to his younger brother Theo, reveal a young man oscillating between spiritual fervour and profound self-doubt. He longed for purpose with almost feverish intensity yet repeatedly felt he had failed to find it. At 27, he made a decision that would redefine art history: he would become an artist. What followed was not a steady ascent, but a life lived in extremes. In the Netherlands, Vincent immersed himself obsessively in drawing and painting rural life. He worked relentlessly, often at the cost of his physical and emotional stability. Letters from this period reveal determination bordering on compulsion, sleepless dedication, rigid focus, and grand hopes that art would redeem both himself and humanity. Then came Paris. Exposure to Impressionism and Japanese prints ignited something electric within him. His palette exploded into colour. His brushstrokes grew bolder and more urgent. His correspondence suggests exhilaration, creative acceleration, and heightened ambition. The darkness of  The Potato Eaters  gave way to luminous fields, cafés, and skies. Vincent van Gogh, The Potato Eaters, 1885. Oil on canvas, 82 x 114 cm. Van Gogh Museum, Amsterdam . But light was always shadowed. By the time he moved to Arles in 1888, his creative energy surged almost uncontrollably. He painted with extraordinary speed, sometimes completing works in a single sitting. He envisioned building a community of artists, the “Studio of the South.” His letters pulse with excitement, ideas, and momentum. Yet this intensity came at a cost. Tensions with Paul Gauguin escalated. Emotional volatility deepened. In December 1888, after days of agitation, Vincent cut off part of his ear. Hospitalised in Arles, his condition frightened even those closest to him. His brother described symptoms of what doctors at the time called “madness.” Vincent van Gogh, Self-Portrait with Bandaged Ear, 1889. Oil on canvas, 60 x 49 cm. The Courtauld Gallery, London. Today, modern psychiatric scholars who analysed the correspondence between Vincent and Theo suggest that these alternating periods, profound despair followed by bursts of productivity, agitation, and expansive creative drive, are consistent with features of bipolar spectrum disorder. While retrospective diagnoses must always be approached with caution, the pattern of emotional oscillation is striking. In Saint-Rémy, voluntarily admitted to a psychiatric hospital, Vincent continued to paint, sometimes with astonishing productivity. In one year alone, he produced around 150 works. On better days, he painted orchards and skies. On darker days, confusion and despair returned. At one point, he reportedly ingested his own oil paint during a severe episode. And yet, in this very period, he created  Starry Night . Vincent van Gogh, The Starry Night, 1889. Oil on canvas, 73.7 x 92.1 cm. The Museum of Modern Art, New York. In 1890, after signs that his work was finally gaining recognition, and despite brief moments of renewed hope, financial anxiety and fear of relapse weighed heavily on him. In July of that year, overwhelmed by illness and uncertainty, Vincent shot himself in a wheatfield in Auvers-sur-Oise. He died two days later, aged 37. He left behind more than 850 paintings. He used to visit the National Gallery in London and could never have imagined that one of his most important masterpieces would one day be displayed there. Today, people from all over the world come especially to see it. He did not live to see the magnitude of his impact. Vincent van Gogh, Sunflowers, 1888. Oil on canvas, 92.1 x 73 cm. The National Gallery, London. To finish up this special journey of this great artist, I’d like to share that my love for Van Gogh’s art and legacy once took me all the way to Saint-Rémy-de-Provence, where he painted some of his greatest works during his time in the facility. So, if you ever find yourself in the south of France, especially in spring or summer, step into those landscapes that shaped his masterpieces. I promise you, you’ll see them come alive. It’s a journey you won’t forget. Vincent van Gogh’s life was not a romantic tale of the “tortured artist.” It was the story of a man living in a time when mental illness was misunderstood, untreated, and often feared. There were no mood stabilisers. No structured psychological therapies. No language to describe what he experienced. Today, bipolar disorder is recognised as a treatable condition. With appropriate care, medication, psychotherapy, and social support, individuals can lead fulfilling, creative, and meaningful lives. The very date of his birth, 30 March, now marks World Bipolar Disorder Day, not to define him by illness, but to foster awareness, reduce stigma, and remind us how far mental health care has come. Vincent’s legacy is not only in his colours, but in what his life teaches us. Brilliance and vulnerability can coexist. Creativity does not require suffering. And no one should face psychological storms alone.