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Authors Note: If you are interested in taking part in the CODA study, please visit our CODA study page  or email coda@kcl.ac.uk . For millions of people worldwide, obesity  and depression are a one-two punch, with each exacerbating the severity of the other in a vicious feedback loop. In England alone, recent reports  suggest that around two-thirds of adults are living with overweight or obesity , meanwhile, one in five adults report experiencing depressive symptoms . With how widespread and interlinked the two disorders are, the need for better, more holistic treatments has never been more urgent. The classic “one-size-fits-all” treatment approach is far from helpful for many conditions; research over the years has continually emphasised the importance of tailoring treatment to each individual . This push towards personalised medicine has inspired exploration into how we look at disorders – not as discrete events but rather as overlapping and interlinked with other disorders. A Promising Alternative The frustrating but expected reality is that developing new drugs from scratch is an extremely lengthy and expensive process. In 2023 alone, global pharmaceutical research and development spending surpassed $300 billion , an almost 17% increase from the previous year’s total. The trade association PhRMA  estimates that it can take up to 15 years for a novel drug to ultimately receive approval  for medical use. So, what’s the alternative? One promising option: repurposing existing  medications . Utilising medications that we know are safe for use in humans saves years of time, millions in research funding, and countless failures. In turn, this can grant an expedited approval process, ultimately allowing patients to access necessary treatments more quickly. This can be a particularly attractive route for scientists researching treatments for rare and under-funded conditions. Furthermore, using an already vetted medication means that we already have information regarding how it works, safe dosing, and potential side effects. This provides researchers, participants, and clinicians greater insight into how the drug will be administered and reduces the risk of unexpected adverse effects. Of course, just because a drug works in one condition doesn’t guarantee it will in another, so vigorous testing must still be conducted. The Story So Far In comorbid obesity and depression, one often-suggested link between the two disorders is a dysregulated immune response. The immune system is our body’s built-in first response against infection and other threats in the body. When we are sick, the immune system is activated as a protective response. Though this is a normal and necessary reaction in the short term, when the immune system continually perceives harmful stimuli in the body despite no infection, it can lead to chronically elevated levels of inflammation . This is something that researchers have been noticing in people with obesity and depression and why our lab, The PIXIE Lab , decided to investigate further. The BARIDEP study (BARiatric surgery and DEPression)  was an observational study following patients undergoing weight loss surgery before, 6 months, and 3 years after the procedure. We looked at inflammation in the blood and depressive symptoms over time. In short, we found that those living with both depression and obesity had more chronically elevated CRP levels (C-Reactive Protein: a biological marker of inflammation) than their obesity-only peers. Running in parallel was the MINDEP study (MINocycline and DEPression) : a clinical trial investigating the effects of minocycline in people with depression. Over the years, minocycline has garnered great interest in the field of psychiatry for a myriad of reasons. First and foremost, though the drug is well-known as an antibiotic, its benefits go far beyond fighting infections and, in the context of treatment-resistant depression, its anti-inflammatory properties are particularly noteworthy. Studies have shown promise for minocycline as an add-on treatment for depression, especially in individuals with elevated C-reactive protein (CRP) levels – a biological marker of inflammation in the blood. If you’re a long-time Inspire the Mind reader, you may remember an article from a few years ago by Dr Etta Nettis about the MINDEP study . Our findings were compelling: while four weeks of minocycline treatment alleviated depressive symptoms compared to a placebo (a sugar pill with no active drug), these effects were only seen in individuals with CRP levels above 3mg/L. Minocycline’s anti-inflammatory impact isn’t limited to the blood and body though. In fact, thanks to its ability to cross the blood-brain barrier, the drug is able to act directly on the brain's immune cells, called microglia. In individuals with depression, these cells often become overactive, disrupting mood regulation and cognitive functions. Research suggests that minocycline may help “calm” this overactivity, potentially alleviating depressive symptoms. So, what’s next in the obesity meets depression meets inflammation story?   Introducing: The CODA Study Taking what we learned from BARIDEP and MINDEP, we designed the CODA study  (Comorbid Obesity & Depression with Adjunctive treatment): a feasibility study testing whether individuals with both obesity and treatment-resistant depression can complete an 8-week course of daily minocycline alongside their regular antidepressant treatment, as well as a series of biological sample collections, questionnaires, and brain scans. The study will also aim to provide insight into how minocycline functions in this population, and how helpful using biomarkers of inflammation, like elevated CRP, are to identify patients most likely to benefit from anti-inflammatory treatments. And after many many  months of admin, planning, writing, and rewriting, we finally received our ethics approval and official go-ahead to begin recruitment. Taking what we learned from MINDEP, we’re only recruiting people with depression, a body mass index (BMI) above 30kg/m2, and a CRP above 3mg/L, since research suggests they are most likely to see improvement with minocycline treatment. What could this all mean for the future? As a feasibility study, CODA will help pave the way for a future randomised clinical trial where we can explore the efficacy of this medication in a much larger sample. Likewise, our findings could highlight new targeted approaches to ameliorating depression in people with obesity. Instead of a “one-size-fits-all” approach, we could use criteria like BMI and CRP levels to identify who with TRD is most likely to benefit from anti-inflammatory treatments like minocycline. Depression and obesity are complex conditions, and finding effective treatments isn’t easy. However, by looking beyond traditional approaches and exploring the role of inflammation, we hope to provide new options for those who need them most. Research like this is a collaboration between scientists and participants, so now that the study is ready to go, we need your help! You can read more about what participation entails on our website . If all this has you interested, and you think you might be eligible to take part, please don’t hesitate to reach out to us at coda@kcl.ac.uk for more information.

In 2024, the answer to the question “what is a man” is expanding. Society is slowly (but surely) embracing manhood in all forms. Manhood in relation to race, sexuality, and gender are continuously being dissected. But, there is another sphere of men that are being left out, one I am personally connected to: autistic men (and disabled men at large). I was diagnosed when I was three years old. I presented it as a standard, DSM-following case (meaning I met the criteria for “high-functioning autism” in the Diagnostic and Statistical Manual of Mental Disorders), which led me to ABA (Applied Behavioral Analysis)  therapy , which many consider a highly controversial practice. I don’t remember specific details of my time in it, but it certainly did its job in conditioning to suppress my autism. What my ABA therapist didn’t realise was that not only did I suppress my autism; I suppressed my whole manhood. Manhood Villainized Autism I remember always questioning my every move as a kid. Most kids grow up not wanting to do or say something embarrassing since they’ll more than likely be made fun of for it. In my own brain, I came to the conclusion that childhood is an extended period of “trial-and-error.” Some kids are lucky enough to get a cheat sheet. Others - like autistic children - are never given one and get left behind. For example, one of my favorite TV shows of all-time is The Twilight Zone with Rod Serling. There was a day in middle school where I brought my copy of the second season to share with the class. Needless to say, my old interest didn’t resonate with a 2012 audience. It was that day where I consciously learned to suppress my autism for the first time. Growing up, I was certainly picked on for my “weird” habits. I remember vividly a boy in my class made fun of me for stimming (self-stimulating behaviour)   in the car on my way to school once. It struck a chord with me given it was something I did to put myself at ease. I would rock back and forth listening to music to soothe myself. It felt embarrassing to be called out like that and, since then, I haven’t stimmed that way. Moments like that would make me feel isolated. I let those moments define me as a man, telling myself I was inferior to everyone else because I have a disability. So, to combat these feelings, I searched for inspiration. Manhood Required Me to Mask My Autism Masking, in my opinion, is the most misunderstood concept regarding autism. Masking is something I learned in ABA therapy, and it’s taken me years to realise how much I let it shape my opinion on my autism. Given my manhood, the mask I was forced to wear made me see autistic people who can’t mask as inferior. “If I can mask, why can’t you?” I would ask myself. I believed that the world is a place we can all thrive in as long as we leave ourselves at the door (an oxymoron I now realise). I never saw my mask as a bad thing. I went and put all of my energy into theater, another special interest of mine (ridiculed by the men around me). It was a perfect form of escapism that only fueled my desire to “not let my autism define me.” But, it eventually caught up to me. In 2021, I experienced strong   autistic burnout for the first time. It felt like my mind was paralysed, unable to pursue any of my career endeavors. I came to the crossroads of choosing whether to “be a man” or “be autistic.” My black-and-white thinking made me believe I had to choose which identity to lean into. Because society puts us in boxes, I struggled to make up my mind. One of the most common beliefs held by men is that we can’t show our emotions. It’s a heteronormative idea, explained away through arguments such as “women think it’s unmanly” and “men are supposed to be providers.” With that, I was raised to think I had to follow the traditional path of manhood: get married to a woman, have a family, be successful in the workforce. I followed none of those rules. Instead, I came to the conclusion that “manhood” wasn’t for me and that being a man goes beyond these old school ideas. You can go on social media and see that. Autistic Men Can Rewrite Manhood In the age of social media, autistic men are able to create platforms to shine light on their experiences. Fritz Johnson is one of them, who speaks candidly of how difficult living with autism is (his Instagram bio  even reads “Autism sucks. I’m going to win anyway). He posts reels sharing his opinions on various things, such as how “masking” (hiding your autistic traits) is a good thing. In the video, he explains how masking is a sort of necessary evil in order to survive in a world not made for us. To be fair, he’s got a point. Many of the late-diagnosed/self-diagnosed crowd would say autistic people should be able to live without a mask and stim freely. Trevor Carroll   is another autistic influencer. He was diagnosed as an adult after waiting a year to receive a diagnosis. Now, he uses his social media to talk about how he lives with it today, including how fitness has become a special interest of his. Social media has many pros and cons (and the autistic influencers I mentioned here certainly don’t represent all autistic men). For me, all of my experiences have made me realise that being a man is subjective. The social constructs we’ve created based on sex are man-made, which makes them innately objective. So yes, I will indulge in The Twilight Zone . I will indulge in theater. I will indulge in my queerness. I will indulge in whatever I please because that is what being a man is. Being autistic has given me the tools to deconstruct manhood, and that is something I, as a man, would encourage other autistics to do.

A personal perspective on neurodivergence How would you react if I said you’re neurodiverse? Collectively, you as readers are! As a population with different brains and immune systems, there is inherent diversity, much like biodiversity in an ecosystem. But what about neurodivergence specifically? As a young, white, professional female in higher education, do I need to write a blog about neurodiversity and neurodivergence? For the first two decades of my life, I wasn’t aware that I could be considered neurodivergent. Instead, I was chronically burning out, likely in part because of masking my undetected dyslexia. My misconceptions about dyslexia meant I hadn’t recognised the characteristics I had always displayed, but instead I validated my misunderstanding with the fact that I could read and write well enough. Plus, dyslexia hadn’t been suggested to me at school, where my compensatory efforts and perfectionist tendencies fooled both me and my teachers, and my slow writing was overlooked because of my academic performance at the time. I interpreted the difficulties that I faced then as my inherent stupidity, a persistent lack of effort and generally, yet more evidence of being a failure. Since receiving my diagnosis, my mental health challenges haven’t disappeared, but I can understand some of my anxiety and obsessive traits that I experience, and start to remove the self-blame I attributed to my undetected dyslexic challenges. Of course, the story is more complex than that, but you can read a little of my experience with my mental health so far in my first blog ‘ Recognising good mental health .’ My story of being neurodivergent is one of many thousands of others. I do have to acknowledge the privilege of being in the position to have my dyslexia spotted in my final undergraduate year, the resources to have a diagnostic assessment, and the encouragement of friends and family to help me respond to indirect discrimination I experience today. To help us understand the various stories, social media posts, news articles and research you may come across, I’ve attempted to differentiate between the terms we see surrounding neurodivergence — neurodiversity, neurodivergent and neurodivergence. Neurodiversity was first defined by Judy Singer in her sociology thesis in 1998 to describe the presence of neurological differences that exist in a population . This is much like the term biodiversity, in fact could even be considered a subset of biodiversity, which describing the biological variance that naturally exists in an environment. Originally, neurodiversity was created as a political and socially empowering term, rather than a purely scientific one, to inclusively group and give voice to neurological minorities. Therefore, neurodiversity is true of any given population or group of individuals, since we are not exact clones of one another. As Singer explains “every human has a unique nervous system with a unique combination of abilities and needs.” Being dyslexic, I don’t always find words easy. One way I use to remember the difference between neurodiversity and neurodivergent is by linking it back to Singer’s thought process. By remembering that neurodiversity is neurological diversity, a subset of biodiversity, I can then associate it with a whole population. The term neurodivergent (ND) was defined by Kassiane Asasumasu to refer to someone who is neurologically divergent (moved away) from typical neurological (neurotypical NT) functioning . This encompasses people who are autistic, dyslexic, or have ADHD, learning disabilities, mental health conditions and more. Neurodivergent is an inclusive umbrella term to capture all those who, in basic words, think, process or relate differently to the NT norm. Neurodivergence describes the various types of these ‘atypical’ neurological functioning and processing , so describes autism, ADHD, dyslexia etc. Note: Often, the terms neurodiversity and neurodivergence are used interchangeably in research, clinical settings and in the media. The sociological drift of using both these words to describe ND people may not be reversible, despite the loss of original intent and distinct original definitions. Both ND and NT individuals may use the term neurodiversity when describing mostly neurodivergence and ND individuals. Below is a great illustration by Sonny, autistic trainer, consultant, and therapist, showing the difference and use of these terms. So why celebrate and advocate for neurodiversity? For too long, the question in research has been “What is wrong with this individual or group in relation to those who are normal?” [and it is being replaced by] “How can we understand the strengths, limitations, struggles, or potential of this group or individual in the wider social context?” . Whilst empathetically acknowledging that neurodivergence can be disabling, we can learn to recognise the individual and societal advantages of neurodivergence, that exist alongside the hardships. This acknowledgement is the opposite of ‘toxic positivity’, where for example, with ADHD, hyperfocus may be misunderstood as a malleable tool for universal productivity when desired. If the environment we are in favours neurotypical attributes, at the expense of, or by not also favouring, neurodivergent attributes, then neurodivergence will confer a disadvantage, due to the environmental context. However, both acknowledging neurodivergent advantageous traits and providing support to level the playing field (eg. assistive technology, a communication plan, even simple non-specific modifications like sending emails in an easier-to-read font type) can start to create more equal opportunities for neurodivergent individuals. For example, elsewhere on the blog site, you can read Tse-Yi Li’s piece about creating a dance class, specifically accessible for neurodivergent people, which resulted in the classes having a positive impact on the attendees’ wellbeing. Research has shown that dyslexia can lead to greater creativity and enhanced pattern recognition compared to neurotypicals. Broadly, neurodivergent individuals can find ways to help adapt to the neurotypical environments, as well as uniquely displaying high levels of creativity, innovation and problem solving. Traditionally, society, especially the corporate world, has indirectly asked individuals to fit into a uniform model, thus suppressing or excluding the benefit the increased neurodiversity brings. Anna Wittenberg , an economist and former Chief Diversity and Inclusion Lead (SAP), notes that “Innovation is most likely to come from parts of us that we don’t all share.” There are many important conversations and topics that follow on from this blog, such as the perceived connotations of not being neurotypical, the mental health impacts of neurodivergence from pre- to post-diagnosis in our societal context, the mismatch between legal equality rights, actual provision and failings leading to indirect discrimination. I wish I’d learnt more about the misconceptions and facts of neurodivergence in societal functioning before my diagnosis — not so much for me, but so I could have better understood and related to the 15% of our population who think and process in a more unique way.

As a young Nigerian, I have always wanted to understand human behavioural patterns and societal trends. This curiosity for human relationships and culture led me to study sociology at the undergraduate level. As a sociologist, I was trained to determine and treat mental health with an understanding that social variables in our environment influence health and illness.    Over time, the important role of the social environment and its effects on mental health and illness gained more traction in the fields of aetiology and therapy. Some indicators of good mental health include self-efficacy, autonomy, generational reliance, the realisation of the capacity to reach one’s intellectual and emotional potential, competency, and subjective well-being.     Understanding the relationship between mental illness and social issues cannot be traced back to one single source of origin. Emile Durkheim, a sociologist, contributed to findings in this field as results from his empirical investigation revealed  a significant association between deplorable social conditions and mental health. Unlike other early ideas, he asserts that mental illnesses are social illnesses.  Unemployment and Mental Health: Anything for the boys?     ‘Chairman, anything for the boys?’ I asked a long-time friend and mentor after meeting him at the bus stop. I told him about my job search after graduating from university, and he advised me to keep searching and updating my skills.    I had just graduated from the university that year after studying Sociology and Anthropology and was preparing for my National Youth Service, a compulsory one-year public service for graduates in Nigeria. Like every graduate after university, I was uncertain about what to do and how to face the outside world.     While waiting for my call-up letter, I joined an iron processing company as a casual worker and remained optimistic for better days. Later that year, I enlisted for the compulsory public service year and picked up a teaching job. While working on the job, I had this ongoing thought of ‘what next?’. I have heard many tales of unemployment among young Nigerian graduates and wondered what my fate would be after my compulsory service year.  Youth Unemployment in Nigeria   Most unemployed youths in Nigeria within the age bracket of 18 and 35 years are faced with the precarious challenges of life that further plunge them into the vicious cycle of poverty eroding their confidence and mental health.    Chronic youth unemployment remains evident in Nigeria, as data  shows that the unemployment rate stood at 5.3% as of the first quarter of 2024, indicating a third consecutive increase since the second quarter of 2023. The misery index— the sum of inflation and unemployment rates - rose to 36.9 % from 30.5% in the first quarter of 2024. With one of the world's highest misery indexes, many Nigerians are experiencing weak purchasing power and a cost-of-living crisis due to rising inflation and youth unemployment.    When discussing mental health, it is important to note that it is more than just the absence of mental illnesses. The World Health Organisation  (WHO) defines  it as a complete mental, bodily, and social well-being, not just the absence of infirmity or disease.    Mental health and illness can be viewed from either an interactionist viewpoint or from a structuralist standpoint. The interactionist viewpoint focuses on understanding how people behave in face-to-face interactions and how circumstances and people are categorised in specific ways. This viewpoint believes that there are several drawbacks for a person once they have been classified as mentally ill, as it is believed that every action they take, is proof of their mental health. On the other hand, the structuralist standpoint believes that a range of material and cultural factors that structure society contribute to poor mental health and that there is a social pattern to mental health as mental illness cannot stem purely from individual or biological factors.  Any way you choose to look at it, the sociology of mental health is primarily concerned with the social construction of mental health and the distribution of mental illness by social groupings such as gender, class, and ethnicity.  Although during my service year anxiety would always creep in after I finished classes, I looked forward to life after service. I was always on my phone applying for any job opportunity that came my way as the fear of leaving service and going back home unemployed kept me awake at night.  I also made it a point of duty to reach out to former colleagues, classmates and relatives, as I tried to keep them aware of my status post-service.    With the magnitude of poverty and hunger in the land, the issue of unemployment remains one of the biggest challenges facing the country today. Despite major reforms  that have been undertaken to restore economic stability in Nigeria, the unemployment rate has not experienced many improvements. The desperation and frustration that come with unemployment create a fertile ground for restiveness, internet fraud, political instability, kidnapping, and other forms of social problems.    Factors Responsible for Youth Unemployment in Nigeria   Although a myriad of variables are responsible for youth unemployment in Nigeria, evidence shows  that factors like high population growth, lack of quality education, corruption and red tapism, high cost-of-living, and insecurity, are predominant factors to blame amongst other variables.  Due to corruption in the public service, there is always a refusal to retire from active service and often, new job openings are not publicly advertised for all to apply. With rising inflation figures, unemployed youths in the country are unable to attend to their immediate needs such as rent payments, food, groceries and phone bills —leaving them in a frustrated or depressed state.  I was lucky to secure a job with a media outfit after the end of my service year and my journey into the labor market began in earnest. While on the job, my earnings were not enough to take care of my immediate expenses. Therefore, I decided to take up a freelance role with other firms. As an in-house correspondent, I was using my time on the job to fight feelings of depression, inadequacy, and lack.     The job exposed me to learning new things and I discovered that the more I learnt, the more earning potential I gained. This encouraged me to continuously acquire new knowledge and information. Working would always reduce feelings of depression and anxiety for me, as I narrowed my focus towards delivering on the job.     While the abundance of new knowledge and experiences kept me going, the supportive tutelage of my supervisors and editors also contributed to helping me scale through daily. All these contributed to improving my mental health post-graduation as I figured out how to overcome depression and anxiety through continuous learning and development.    Since a high unemployment rate increases violent behaviour, suicidal thoughts, physiological disorders, and stress, intervention programs that address the psychological and economic deprivation associated with unemployment must be put in place.     Welfare packages should be rolled out to unemployed youths in Nigeria to help cushion the lack of funds. By providing adequate welfare benefits for the unemployed youths in the country, the impact of mental health issues associated with unemployment would be put to rest. Membership in social  organisations such as sports groups, trade unions, professional bodies, churches, or political organisations should also be encouraged, as this would serve as a strong support system for unemployed youths.

Are you an unpaid carer or do you know someone who is? It is more than likely that you fall into either one of those categories, as at least 5.7 million people in the UK are considered to be unpaid carers (according to the 2021 census; C arers UK reckons the actual figure is closer to 10 million ). Now, here’s the startling thing – if we as a nation had to pay for the care that unpaid carers provide, it would cost £162 billion per annum – (yes, billion; 2021 figure). That is equivalent to paying for a second NHS (the NHS 2021 budget was £164 billion). It is a staggering amount – admit it, you didn’t know that, did you? That’s because unpaid carers are rarely spoken about. We know they are there, but unless we have firsthand, day-to-day knowledge of their contribution, as a nation, we aren’t really interested. 47 % of that 5.7 million carers provide more than 20 hrs a week of care – for no reward and often at great sacrifice and cost to their own pocket (many leave jobs to provide round-the-clock care) and cost to their mental and physical health.   Away from my day job (that includes being an editor for Inspire the Mind ), I am honoured to be Chair of the Board of Trustees for Kingston Carers’ Network (KCN) – a support organisation for carers from the age of 5 years upwards. The organisation is run by an incredibly dedicated and compassionate staff team (led by Rachael Stokes, our CEO), who put the welfare of others before themselves. The team provides advice, advocacy and support to people who care for someone living in the Royal Borough of Kingston upon Thames (over 4000 adult carers and around 800 young carers). Essentially, KCN exists to help carers live their best lives and remove some of the stress of navigating the benefits system and challenging DWP (Department for Work and Pensions) rules. We also provide respite activities and operate a dedicated young carers programme. It is estimated there are around 1 million young carers (5-18yrs) in the UK, some of whom need to spend 50 hrs a week or more looking after family members with illness, disability or addiction. In addition, this leads to an impact on their schooling.   Last weekend, we held a Young Carers Conference at Chessington World of Adventures on the theme of “Dream big”. It was an amazing event –  young carers had the opportunity to showcase their talents, including singing, dancing, poetry and creative arts. They shared their dreams for the future with the Rt. Hon. Sir Ed Davey (Leader of the Liberal Democrats), which included becoming a fashion designer, web content creator, baker, teacher, footballer for England, and singer. Ed also met Ana Gra ça (opposite) , who has written 2 books about young carers. Below are the lyrics from wannabe singer Lena, whose song was played at the conference and received a tremendous reception..   VERSE 1 I had a hope, an ambition to achieve Where I was bigger, better, with something to believe I’ll never stop, I’ll stand up tall And I rise each time I fall.   PRE-CHORUS Singing is my passion It’s all I want to do, It’ll always be in fashion So, I sing this song to you   CHORUS My dream is a joy to bring For my dream I’d do anything, I want to be on stage to dance and sing!   VERSE 2 It’s like it’s got a life of its own, When I sing, I’m never alone, Every day, I work so hard, This is just the beginning – just the start!   PRE-CHORUS Oh, my heart needs it, Nothing is more true, Life would be weird without it, So, I sing this song to you   CHORUS My dream is a joy to bring For my dream I’d do anything, I want to be on stage to dance and sing!     KCN’s Young Carers Project (YCP) is designed to support our young carers and help create the conditions that will allow them to achieve their goals through our mentoring and activities programme. Sadly, young carers are disadvantaged when it comes to education – on average, they miss 23 school days per year and are substantially (38%) less likely to achieve a university degree than their peers. These disadvantages worsened during the pandemic. When schools finally did re-open, many young carers couldn’t return to school for fear of bringing COVID-19 home to their vulnerable mums, dads, siblings, and grandparents. You can find out more about the lives of young carers through this BBC news piece from last year featuring Narges , one of our young carers.   Of course, all this support costs money, and KCN is no different from many massively underfunded charities that are struggling to keep going. The funding for our YCP has recently taken a hit. Our ‘go to’ funders now think that although young carers are a worthy cause, we are located in a ‘wealthy area’, so we no longer deserve support. It seems the young carers of Kingston are also disadvantaged by geography.   Next week we have Carers Rights Day 2024   (21 Nov).   This year’s theme of ‘Recognising your Rights’  encourages empowerment. Surely all carers, young and old, deserve better? Don’t they have a right to have the same opportunities in life and the same chance of succeeding? Unpaid carers are a group we neglect at our peril. We need to ensure they are both mentally and physically fit; otherwise, society will have to pay for the care, and we know how expensive that is. We need some long-term thinking here, including investing in unpaid carers and supporting them better to do their caring.   I have one suggestion – invest in creative health programmes for carers. Creative health, or arts in health, uses creative activities (such as music, visual arts, dance and storytelling) to improve health outcomes. Studies demonstrate its effectiveness for people with anxiety, depression, and social isolation – a particular problem among those with long-term caregiving responsibilities. For more information about creative health, the All-Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW) reported in 2017  that arts interventions could reduce demand on health services and improve population health cost-effectively.   At KCN, we have seen firsthand the positive impact of creative arts on our adult carers, including when we took part in the HeArt of Care  project. HeArt of Care  is an international alliance of organisations that are working together to raise awareness of the role of carers in our societies. We joined forces with an arts organisations, Rosetta Life, Helix Arts, Tyneside, and Bristol Black Carers. The project involved the choreography of care, alongside poetry and journaling, and aimed to widen the understanding of caregiving. The project culminated in a series of public projections in 2024. The first was in Kingston Market Square, Jan 19th, 2024 .   Despite the funding shortfall, we will somehow continue supporting unpaid carers. It is too important a cause to abandon, and our compassionate staff and 90+ volunteers would carry on regardless. Yes, carers deserve our thanks and admiration, but they also deserve help from society and our politicians. Remember, any one of us could need their  help at any time, or you  could become a carer at any time. After all, 12,000 people become unpaid carers for a partner, family member or friend every day. It could be you.   Dr. Tony Woods Chair, Kingston Carers Network

As a third-year psychology student, I’ve felt the stress of juggling assignments and staying focused in classes, especially during exam weeks. These common challenges of university life make balancing academics and socialising tough. Deciding between the two can feel overwhelming and often affects our mood. According to the World Health Organisation (WHO) , depression, anxiety and behavioural disorders are among the leading causes of illness and disability among adolescents and young people. People like me often experience anxiety symptoms before exams, such as stomach pain and constipation , which can worsen with ongoing anxiety. This affects emotional and academic well-being, sometimes leading to emergency room visits due to bowel problems and vitamin deficiencies. Since the beginning of my studies, I’ve been fascinated by neuroscience, inspired by my lecturers Mr. Kahraman Kıral and Mr. Çağrı Utkan. Experiencing symptoms sparked my interest and made me explore how diet and the gut-brain axis influence mental health, deepening my curiosity in the field. Nutritional Influences On Mental Health and Cognitive Function Have you ever woken up feeling completely drained, as if the night has taken all your energy? Perhaps this might be associated with your diet. This was my experience before I changed my eating habits. I often skipped meals and consumed junk food. Turkish people have a saying “Hungry bear doesn’t play.” which rings true for me as I realised my diet was impacting my emotions, stress, memory, and overall well-being. This prompted me to change my eating habits. We are aware that Omega 3, which is frequently included in fish oils, along with polyphenols may have potential benefits when managing depression , as discussed in other ITM articles . That’s why I take great care to consume fish for at least one meal almost every week (even though my mom hates the smell of it). In this article I will be talking about how lower levels of vitamin B12, creatine, Omega-3 fatty acids, iron and zinc are related to neuropsychiatric disorders including depression and anxiety. On the other hand, if we don’t get enough of the above mentioned essential substances, then it might cause brain fatigue and problems in concentration, and loss of mental clarity. Most of the essential fats such as Omega-3 fatty acids are important to help maintain top-notch mental functions and general wellbeing of the brain . The Relationship Between Meals and Emotional Wellbeing Our daily eating habits not only affect our physical health but also our mental wellbeing deeply. There is evidence that the timing of meals can have an impact on how a person feels and can also have a significant impact on supporting mental health. A healthy diet helps the brain chemicals to be balanced, improve cognitive function , and maintain the overall mood. On the other hand, a diet low with nutrients might increase the risk of depression and anxiety . One effect of foods on our mental health is through the gut-brain axis. This connection is linked to various issues , including obesity and mood disorders. Improving gut health may manage mood disorders. Research shows that a potential probiotic named Lactibacillus farciminis can prevent harmful bacteria and microbes from entering the intestines by preventing the permeability of the protective layer of the intestines. The hypothalamus-pituitary-adrenal (HPA) axis includes the hypothalamus, pituitary gland, and adrenal glands, which becomes active in any stressful situation and releases cortisol, (known as the stress hormone), in the body. Lactibacillus farciminis can reduce cortisol levels, showing the gut brain axis's role in managing stress. To understand the relationship between diet and mental health, we can observe university students' eating habits. Many of us rarely have breakfast or eat fruit. Among my friends, we celebrate eating breakfast together. I am not a breakfast person, so I’ve never received a “congratulations.” but I'm trying to fill this gap by adding tasty fruits to my diet instead of processed sweets. In an another research study done among university students, the researchers examined eating breakfast, vegetable intake and their relations with happiness in college students . The findings of this research showed us that students who ate breakfast every day more than 8 servings of fruit and vegetables daily, and had 3 meals in addition to 1-2 snacks per day had the highest levels of happiness. From what we can interpret here, having breakfast could boost cognitive function and overall mental health among university students. Effect of Vitamins and Dietary Choices on the Brain and the Gut Axis Vitamins from diet and supplements have strong relationship with the brain and depression. For example, Folate and Vitamin B12 contribute to the formation of the myelin sheath that protects nerves and neurons in our brain. In addition, Folate plays an important role in the production of brain chemicals such as Serotonin (5-HT) , commonly known as the "happiness hormone". From what I learned from my classes, producing enough Serotonin in the brain regulates mood, thoughts, sleep, and appetite, crucial for overall brain function and happiness. Iron is important for neural function., the function of nerve cells, the formation of the myelin sheath, and the production of chemical messengers known as neurotransmitters . This role of iron is also supported by the Mediterranean diet, which consists of iron-rich foods like vegetables, olive oil, fruits, legumes, grains, and fish. In contrast, the 'Western' diet is known for processed ready meals and sugary packaged foods. In this study , it showed us that people who experienced distress consumed processed foods more. Research shows that a ‘healthy’, balanced diet can significantly improve symptoms of depression. In addition, micronutrients, known as vitamins and minerals that our body needs to function properly, also play a big role here. B vitamins (B6, B12) , Folic acid, and Vitamin D are examples of these micronutrients. Accordingly, higher diet quality is associated with reduced risk of behavioural health disorders . What Can We Do More As Students? To conclude, struggling with vitamin deficiencies made it tough for me to eat due to anxiety. By changing my diet, timing and number of meals, I got rid of my vitamin deficiencies and, as studies show us, I observed a positive improvement in my own mental health during this process. We all can be a little bit more cautious for what our body is trying to tell us and listen to it when it comes dietary patterns and mental health.

On a busy road, when the traffic rushes like water breaking through a dam and the lights refuse to turn red, the decision you may make to run across when there is a small break between cars, is a conscious one.   Our ability to make informed decisions is what allows us to take responsibility for our actions. Every choice we make, every action we take is a result of neuronal pathways firing in a particular sequence in various areas of the brain. An area called the pre-frontal cortex is particularly associated with decision-making and planning. But what if the very organ that makes those choices, our brain, becomes damaged? How ethical is it to expect compensation or retribution for actions taken following damage to this decision-making organ?   During my year as a PsychStar - a scheme run by the Royal College of Psychiatrists, awarded to medical students who have shown a commitment and interest in psychiatry - I was fortunate enough to attend the annual NeuroPsychiatry conference held by the Royal College of Psychiatrists. While attending, one particular lecture stood out to me in which the speaker discussed the impact of brain injuries on behaviour, and the association between acquired brain injuries and crime.   An acquired brain injury  (ABI) refers to any damage to the brain post-birth. This can include traumatic or medical causes, such as strokes and seizures, in the absence of congenital (present from birth) or genetic disease to the brain. In 2018, approximately 1.3 million  individuals in the UK were living with an ABI. Importantly, the damage caused by an ABI can lead to dysfunction in various physical and mental processes including memory and personality . Additionally, research has shown there is an association between ABI and crime. Approximately 24.7%  of individuals in prison have been hospitalised for an ABI, which is significantly more prevalent than in the general population, where 18.2% of people have been hospitalised for ABI's. Additionally, those with ABI's are 2.5 times more  likely to be incarcerated than those without. What could account for these statistics? ABI’s are associated with a number of factors which may increase the likelihood of criminal behaviour. For example, individuals with ABIs are at greater risk of  substance misuse, and antisocial behaviours ( behaviours and actions that cause   distress, alarm, or harassment to others ) . Importantly, both substance misuse and antisocial behaviours are also associated with higher levels of criminal behaviour s .   Additionally, ABIs can lead to  emotional dysregulation , which can impact one’s ability to control impulses and override strong urges or temptations. Difficulty in regulating impulsivity and control has been associated with  higher rates of violence, resulting in increases in offensive behaviour .   Whilst we can see an association between the characteristics of patients post-ABI and criminal behaviour, it is important to consider other contributing factors to criminal behaviour which may influence this association.   The personality traits of someone before an ABI, their  socioeconomic status  and  familial relationships,  have all been shown to impact rates of criminal behaviour. Additionally, if we look at socioeconomic status, there is a complex bi-directional relationship between head injury and socioeconomic status. Individuals with lower socioeconomic status are more likely to experience a head injury , and individuals with head injuries are more likely to have a lower socioeconomic status  following their injury. Such complicated associations between these factors therefore make it difficult to conclude the exact extent ABIs, as an independent factor, have on an individual’s likelihood to offend. Nevertheless, given that individuals with traumatic head injuries are 2.5 times   more likely to be incarcerated compared to those without, the link between ABIs and crime cannot be ignored.   So where do we go from here? Just as with any medical condition that has a significant impact on a patient's life, it is important for healthcare professionals to consider a preventative approach in the management of offensive behaviour in relation to ABIs. This starts with recognising the impact of brain injuries on patients. Once a patient has experienced a brain injury, it is important for them to have a formal assessment of not just the physical, but also the mental impact of their injury. Additionally, educating patients regarding possible long-term effects of their condition, and provision of a point of contact to aid in recovery, is also important in providing appropriate patient care. If such approaches are adopted at a wider level and earlier on during the diagnostic process, patients will feel better supported. This support may have a knock-on effect, and potentially reduce first-offence and consequent criminal behaviours .   Mindsource , a charity in Colorado, USA, works with individuals in the criminal justice system who have had ABIs using neuropsychological screening to establish personalised tools to help reduce reincarceration rates. For example, they advocate for the use of written notes during court hearings. This allows individuals to focus on the information being delivered at the time, and have material to take away to review and plan, such as dates of next court hearings and rules of bail. In England, there is no current national protocol which dictates the follow-up of patients suffering from ABIs. However, there is a sub-speciality of healthcare workers, forensic psychiatrists, who see patients suffering from brain injuries within the prison population. Forensic psychiatrists work closely with individuals in the justice system to aid their recovery and transition. Medical questionnaire’s for measuring the impact of an ABI  on physical and emotional disability are now being used by forensic psychiatrists and neuro-psychiatrists for distinct patient groups, such as prisoners with ABIs. However, with approximately  333 consultant forensic psychiatrists in England  and  87,900 individuals in prison , it is clear that the doctor-to-client ratio is unbalanced.   Training staff within the healthcare and judicial systems on the management of individuals with ABIs, and developing national guidelines on how to manage patients with ABIs would aid in the delivery of equitable treatment and follow-up for those affected.   Albeit, due to current staffing and financial restraints on the NHS and the global healthcare system in general, this type of intensive care and follow-up is not always feasible. However, further research and education into the association between ABIs and crime is imperative to further our understanding, and develop a better criminal justice system that works to support rehabilitation from the ground-up.   How far Can we go? How far Should we go? As research moves forward, it is our duty as clinicians to understand the consequences of pathology on the lives of patients and their environment. Part of this includes further research into the consequences of brain damage on behaviour and personality, acknowledging the impact brain damage can have. Thereby, facilitating improved personalised support and care.   Furthermore, it is not only enough to consider the psychological and biological impact of ABIs. The ethics of potential change in treatment and legislation must also be considered. How do we accurately measure the extent of changes in personality and behaviour following an ABI? And how fair on the victims is it to attribute crime to a brain pathology? Hopefully, with future research, the development of systems better supporting those living with ABIs (in and outside the criminal justice system) and those impacted by them, will emerge.

The lecture theatre is abuzz with voices. I see a group of girls hunched over a laptop, laughing. The professor is standing by the podium, talking in low voices with students. I get pushed aside repeatedly as more people fill in. One, two, three, no matter how many times I scan the crowd, I don't see a familiar face. My face feels warm, shame creeping onto me. I retreat. This day blurs into countless others I have spent trying to not feel lonely and alone. Is all this effort futile? 1 in 4 students  report feeling lonely "all" or "most" of the time at university. In fact, loneliness has been identified as a main cause  of mental illness in students. It affects belonging, psychological well-being, academic performance, and even one's social identity . Those experiencing loneliness are more likely to also have feelings of hopelessness , depression and anxiety , suicidal behaviour , poor sleep quality , lower levels of resilience, and engage in harmful health behaviours such as smoking . It is therefore a major concern for universities trying to improve the overall mental health of their students. I am Hina, a recent university graduate and a Research Assistant on a project that has been put in motion in response to these rising levels of loneliness in university students. The U-Belong Project, a three-year Medical Research Council (MRC) funded project based at King's College London, aims to understand experiences and predictors of loneliness and belonging, the evolution of social relationships in the transition to university, and the impact of social expectations on loneliness. The project's focus on belonging, in addition to loneliness, recognises that the two phenomena work in tandem with each other and need to be targeted together for sustainable change. In the two years of U-Belong's research, the team has found that nearly 1 in 3 students feel like they do not belong at university, echoing the prevalence rates of loneliness. In an effort to reduce loneliness and build belonging across UK universities, U-Belong launched a student co-created toolkit in September 2024. The toolkit consists of 16 guidance pages that detail a range of problems that students might be dealing with, such as having social anxiety and low mood, being an international student, having experience living in the care system, and how these situations make belonging an even greater challenge at university. When I felt distressed at university, I would try and look for support online. However, search engine results always overwhelmed me. There were far too many links to click through and in my already exhausted state, I would just shut the laptop and walk away. This issue came up during U-Belong’s discussions with its student advisory and research groups, which inspired the ‘one-stop’ design of the toolkit. Resources from across the internet have been listed in the guidance pages so students do not need to do a deep dive to find something beneficial. Such student involvement has been key in creating the toolkit. Over 40 student research assistants worked with the U-Belong team over the summer to choose 16 topics for the toolkit and draft the guidance pages in small groups. Students were given the freedom to use relevant research and personal experiences to write up the guidance pages. In addition to incorporating student voice in its creation, the toolkit also calls on existing videos and blogs that students across the world have uploaded to share their university experiences. Their lived experience perspectives are reflected in the action plan and advice present within the toolkit. The toolkit, now freely available on the U-Belong website , has been vetted by researchers and professionals, adding different perspectives to the advice being given to students. To complement the more self-help nature of the toolkit, the U-Belong team also organised webinars across September and October where they hosted senior researchers and student experts by experience to talk more about different toolkit topics. Insights from these webinars can be accessed via U-Belong’s YouTube  and Instagram  pages. When using the toolkit, it is best to start with a specific page that seems most relevant to the student to make it less overwhelming. These pages should be used in addition to university-specific support already available. Academics and personal tutors can also use the toolkit as a resource they refer their students to, if they are approached for help. Similarly, university professional services can link the toolkit on university webpages for well-being, using it alongside an existing resource. In addition to being a self-help resource, the toolkit gives students the space to build their psychological literacy and show them that they are not alone in facing the challenge of loneliness at university. With accessible descriptions of problems and resources to tackle them, it is hoped that students will gain an understanding of their experiences and use that to help themselves and others around them. It also hands the autonomy over university life back to the students, where students are not stuck feeling isolated and can take steps to craft a more fulfilling and enjoyable university experience. The toolkit has received positive feedback since its launch, with one student saying: "I wish I had this toolkit when I first started university. It is a great way to familiarise yourself with university life and expectations" With continuous updates and improvements, the toolkit is aimed to be an evergreen resource students can turn to help with their feelings of loneliness. While there is a need for more systemic changes in the way institutions function to tackle the problem of loneliness more permanently, a resource like this serves the purpose of helping students feel supported in the meantime. My hand hesitates at the door. Should I bother going inside today? Nothing ever seems to change. But what if it did today? I take a deep breath in and walk into the lecture theatre. It is abuzz with voices. I walk down the stairs and sit next to a girl I have not spoken to before. Turning to her, I say hello and introduce myself. She smiles at me. Maybe this will be the start of something new.

A Veterans Art Engagement Project: 2021-2025 An article that is linked to The Mask - a veteran's story . It was 6 pm on September 7th, 2021, and the U.S. Department of State’s Office of Cultural Heritage exhibition And Yet We Rise: 20 Years of Reflection and Remembrance of September 11th was opening at the American embassy in London. As the senior curator for the office, it is in my portfolio to design exhibitions on cultural exchange framed within the realms of culture and diplomacy. This project was five years in the making and more difficult than many because of the subject matter and goals. My hope was to capture less than just that one terrible day, and more of healing, forgiveness, and the indomitable human spirit. An incredibly hard task, but one that succeeded by highlighting amazing people on a personal level. As the crowd moved in and slowly circulated, I watched their every move. As a curator, openings are not only our opportunities to embrace an accomplishment, but just as importantly they represent a time of reflection. So, I watched how the crowd moved, expecting a certain outcome, only to be surprised when I saw another.  Beforehand my guess would have been that visitors would have immediately stopped at what I considered the “big-ticket” items. That is, fire men’s jackets from the events of the day, an American flag that hung at Newark airport, or even some large and imposing works from a celebrated artist. Yet I was wrong, and in that moment found myself beginning another journey that turned out to be even more important than the exhibition.  That night, many visitors seemed to find their way to a smaller corner of the exhibition that was not center stage.  It featured masks created by American veterans of foreign wars. The more I watched the visitors interact with the masks, the clearer it became there was more to them than met the eye. The masks possessed an honesty and raw emotion that not only matched everything else in the exhibition but surpassed it in many ways. The essence of these objects was the draw, and everyone else felt it too.  As all these thoughts coalesced in my brain, I had a light bulb moment that would take me on an even greater journey of self-discovery and learning.  Not soon after the event I found myself doing a deep dive into the world of art therapy, starting the journey that would become the Behind the Mask  program. I already knew staff from SUNY Jefferson Community College of Watertown, New York where the mask came from on loan, but the actual process and role of art therapy was unfamiliar. As a lifelong student and professional working in the cultural arts the power of objects has always been my companion, yet this project with its own goals of self-expression and personal growth were new to me. From this background I began to imagine how to transform a piece of the original show into a project to benefit new audiences in similar ways the masks created in Watertown had done for their makers. Transforming a piece of the original show for a new audience that could benefit in equivalent ways the original students and artist had. By the time the program was ready to launch I had over two years of study under my belt and the world of art rehabilitation had found a new adherent in me. Our mask would be both an inner and outer expression of self.  Simply put, the outer portion, or face, of the mask was what the veterans believed they showed the world, while the interior was ultimately how they felt about themselves.  Powerful emotions distilled into a simple format. I’ll confess I was nervous before meeting The Not Forgotten veteran cohort and those involved in the program. After all, they were all part of a distinct tribe that I wasn’t a part of. My father is a veteran, and my grandfather too, but I am not. Service for me always took on a different shape.  This made me feel like an outsider of sorts and I didn’t quite know how to express my own inspirations and feelings. Or better yet, I wasn’t sure how my personal experiences would be interpreted by this group. Ultimately, I told myself to smile, be myself, and let the art do its thing. That I did understand. Art is a powerful teacher and healer in all its forms.  This is the hard part, putting into words the powerful impression the veterans, and art, left on me. Firstly, the vets accepted me immediately into their group, sharing jokes and anecdotes in a way I was humbled by.  The simple truth is I ignored my own first rule of the arts, that is, to let culture speak for itself in all its wonderful simplicity. This simplicity was expressed through shared loves, hates, sorrows and joys. These universal imperatives are present in peoples across the globe and serve as the greatest trait in cultural diplomacy which, coincidently, can be seen through art engagement and therapy. The veteran’s engagement program shared all these hallmarks, perhaps displayed in a more pronounced way because of the extreme environments that they were found in. Their bonds were forged in high stress environments, almost always starting at a young age, while not given time for reflection until the servicemen and women retire.  Throughout the week we spent together I watched the veterans create their masks, studying the cues they left behind in colours and design. I was struck by what I can only equate to a form of sympathetic magic. That is, their work on the masks was imbued with energy of the veterans themselves, infusing their art with decades of experience and emotion. Universally the art exudes raw and unadulterated emotions; they spoke of love, loss, and both physical and mental scars.  At the program’s conclusion the synergy of the beginnings and endings of the program couldn’t be more obvious to the careful observer. Our originals goals of healing and expression became projected through a window of the veterans’ internal journey using external markers left by the mask that we as a society know how to interpret better then mental health journeys themselves.  These physical legacies created in forms of colour and shape leave lasting tributes to better understand the search for a healthy state of mind, reminding us all just what the human experience can be if we free ourselves to let it. Joseph Angemi Jr. SENIOR CURATOR, OFFICE OF CULTURAL HERITAGE U.S. Department of State

We often find ourselves discussing with friends and family our earliest ever memory, reminiscing on how young we were and laughing about the silliness of some of those memories, but at times remarking on how others are amazing. My earliest memory was one that shaped the rest of my life, as it was seeing a helicopter hovering beside a cliff in Cornwall. I remember vividly watching this incredible machine drop a winchman down the cliff face whilst hovering perfectly. I then became obsessed with flight and in particular helicopters. In 1992, after 8 years service in the British Army, I began my pilot’s course and then flew helicopters right up until my medical discharge in 2016. I adored flying.   Sadly my involvement in several wars, quite suddenly and without a great deal of warning, caught up with me. It was the summer of 2014, and my work telephone rang. I lifted the receiver and burst into an uncontrollable cry. I couldn’t speak, and the person on the other end calmly told me to put the receiver down and stay where I was as he’d get help. The Padre (military chaplain) suddenly arrived and took me to his car and drove me to the Defence Centre of Mental Health. That was my last day at work. I then began therapy and rotated through various medicines, but was then sadly admitted to a Mental Health ward just two months prior to my discharge.   The Mental Health ward was awful. I struggled to make sense of my life, my nights were the worst, and I remain haunted by them though much less so all these years later. Luckily, I had an amazing Doctor (Dr Kate Goble) who also volunteered with a service charity, The Not Forgotten , whom she reached out to on my behalf. I was invited to Malta with a wonderful group of veterans from all three services and it was my first opportunity to converse with others, both men and women, who had been suffering just like me, and suddenly I wasn’t alone.   Once I was discharged, I reached out to another service charity for assistance with my mental health, but they soon discharged me as things were just too complex for them. Luckily I have always been a fighter, and I knew I had to take control of my own recovery, but at this stage I didn’t know how. Then, one morning I awoke with extremely darkened thoughts of bringing this all to an end and I decided I should go for a walk and strolled to the town park. As it was a warm summers day the park was busy and so I crawled underneath a willow tree and leant against the trunk.   Suddenly and almost magically I heard a voice in my head telling me just how similar we were, that willow tree and me. We were in synergy as we looked so sad and forlorn and yet we had firm trunks. Following on from this feeling I wrote a poem about that willow tree, my first ever use of poetry. Afterwards, whilst I didn’t feel any euphoria, I did feel that I had reconnected with the planet once more. I’ve written almost daily ever since.   The Not Forgotten  had kept in touch and invited me to other events and most importantly listened to me and showed an interest in my writing. Indeed, it was such a surprise when they reached out about a US led project utilising masks and art to portray one’s feelings. It was such a brilliantly simple idea, that we could use art and creativity to show others our inner troubles. By complete coincidence one of my earliest poems had been about my mask, and what it allowed me to hide from the world, and I thought it time to share that emotion as well as poem:   My Mask   I wear a mask that looks like me Try to look but you won’t see Behind that mask I hide my fears Inside that mask I hide my tears   A few weeks later, “we few, we happy few” gathered in a couple of beautiful cottages in Devon, hosted by both The Not Forgotten  and the US State Department’s Cultural Heritage team. We travelled for a day or two for inspiration, but I sensed we already knew how we’d paint our masks and were very eager to begin. Sadly and without warning we lost a member of our veteran team who had passed away in her sleep. That day was spent in reflection, but we all agreed she’d want us to carry on and she’d already created her wonderful mask.   Thursday came along at a fast pace, and we were then given an opportunity to not only show our masks but to explain the logic of how we had formed our design and what in our lives had influenced our artwork. Each and every mask had a difficult story behind it and emotions were high that afternoon. It was incredible to listen to the stories of life that was being told by the voice behind the mask. We all felt the unity of not only our pain but also that of human kindness, a belonging, a harmony of hope.   So, where are we now and what might be the update of all of this? Firstly we all remain super friends and often discuss how we are feeling in our little band, but more excitedly, our masks were displayed inside the US Embassy in London in October 2024. We were invited to attend the opening night (24th October) and had a grand tour of the building prior to seeing our work.   I am ever so pleased we got together again and am so honoured to have been involved in this hugely beneficial project that began in the USA. I do believe that helping others witness how service has affected us, both physically and mentally, connects us once again as human beings, much like that willow tree did for me all those years ago.

Authors Note: Obsessive love. It can be a barricade. A chain. It doesn't let you move forwards or backwards. It keeps you stranded in one place until that place can no longer accommodate you and your stubbornness. The protagonist of my story is obsessively in love with someone who is not available to them and it's made them a prisoner of their own emotions, unable to establish or maintain new relationships or even set up a home of their own. While reading, consider this, when does one's love for another cross into the realm of toxicity? When does the only place really become the only place, like a trap? You let your hands rest in your lap as the bus bounces along. You admire your freshly manicured nails and the softness of your translucent white hands. You haven’t been to work in four months and for once, they’re not stained with house paint, or grimy from picking through records at the vintage shop, your favourite pastime. Beside you, on an empty seat, your red plastic suitcase slides about. You’ve got a mask on. So does every other passenger. You feel like it’s Halloween. You’re ten years old again and costumed as a ninja. You’re clever and sneaky, darting behind trees to pounce on your fellow, unsuspecting trick-or-treaters. Your only worry then was how many Kit-Kat bars you would get, and whether or not your Mom would take them away from you, because when it came to sweet, forbidden things, you just couldn’t control yourself. You still can’t. On the bus, everyone is suspicious of each other. Everyone eyes one another warily. People have learned to masterfully command and wield their own space, to make themselves smaller by curling up, tucking their limbs away, becoming invisible, making themselves disappear. You are part of a generation of contortionists and magicians. Even before all this started, you already knew how to make something out of nothing. Nothing is new or challenging anymore. You know nothing will change when this is all over. You would go out without the mask if you could because you’ve lost the will to care, to pretend. Glum and bored, and unimpressed by the bland, empty farmlands and loitering, grazing cattle streaming past your window, you check your phone. There’s still no message from him.  No plea to be taken back. You never expected one, but deep down, you wanted one, just a little. Before the quarantine began there were hopeful glimmers of a future with him. You went with him to view an apartment that you might have shared with him, had the world not ground to a screeching halt and the potential landlord struck down with the much-dreaded and much-feared disease. There might have been mornings of waking up in the same bed, arms and legs entwined, breath and body odors mingling, sunlight streaming through the one window with the mauve-painted frame and the wispy lace curtains that he liked and you didn’t. You might have gone grocery shopping with him, filled the cart with bell peppers and cookies, and pretended you were two adults with a solid meal plan for the week. You might have sorted through the laundry, washed and dried dishes, bickered over money, talked about adopting children, and moving somewhere better, eventually. But now, at that moment, you only think about the prospect of seeing your best friend again. You want to be with the only person you think you truly love. You put your phone away. The bus screeches to a slow stop. A few more people come aboard this brave vessel, ploughing through a pestilence-riddled province. You don’t think of pulling your suitcase off the seat to free up room, even for the hobbling older lady with creaky knees and hunched shoulders. You take advantage of the new rules, permit yourself to be a little selfish. The older lady has to sit away from you, just as you have to sit away from her. The red suitcase is your barrier, your Great Wall. You hide behind it. The bus door swings shut. You’re moving again, closer towards your best friend’s house, your peculiar oasis. The couch you will sleep on that night and claim as your own is corduroy brown. You know it well, it was yours before your best friend bought it. It sags in the middle and squeaks slightly when you toss and turn, but you don’t mind. You always sleep well on it. It’s a second home for you. You close your eyes and think about what you told your now ex-boyfriend when you broke up with him, only a few days earlier. “The only place I want to be right now is on his couch.” You remember the look on his face when you spoke those words. A smooth succession of feelings. A dynasty of feelings. A wobbly card house of feelings. Confusion, understanding, betrayal. Then, finally, pity. Pity for you, the utter fool with the deck. He figured it out. The puzzle pieces snapped together, and he resigned herself then and there. You will never stop being in love with someone else. You have decided you will gladly forfeit having a life of your own to latch onto your best friend’s life, your best friend’s marriage, your best friend’s future family, his corduroy brown couch. Like a barnacle, you will cling to the underbelly of a cargo ship at sea, along for the adventure but never coming up to the surface to breathe the fresh, briny air. This is your fate. You picked it. It’s meant for you. He felt sorry for you, and he left you to it. He drove off in his car and you watched him go. You remember how many times in the past he sped past your house in that car, forgetting your address, and the colour of your garage, until the day your brother put up a sign in the front window in support of the striking airport workers’ union, making your house distinguishable on the street of suburban clones. Making it marked for him to find so you could climb into the car with him, and spend the whole day with him. He would always defend himself, while laughing. “I’m directionally challenged. Thank God for that sign.” He’ll never come back now. Your best friend is waiting for you at the station when at last the bus delivers you to him. He’s wearing a mask too. You force yourself not to jump into his arms, to dive headfirst into the safe refuge of him. It’s a public place. There are too many people around, and everyone’s watching. You’d be recorded in an instant, demonized on the news. Yet another mean millennial breaking the rules. No morals, no decency, no thought of the common good. Your life and his life were ruined by one carelessly human moment. He's taller than you, a full foot taller. If you could get away with it, if no one had cameras in their pockets, ready to damn you, catch you in the act, you’d bury your face in his shoulder, while standing on your tiptoes. You would cry, you would sob into him, fill up his well, flood him. You’ve missed him so much, it felt like a withdrawal. His wife is not with him. This doesn’t surprise you, even though you were a groomsman at their wedding. You knew already she wasn’t happy about you visiting him and her. That didn’t stop you. Your best friend tells you you have to carry your own suitcase, if that’s okay. You say, “Of course.” He looks tired, with his eyes, behind their rounded glasses, devoid of their usual sparkle. You’re in love with his slimness, his hair, dark like black coffee, twisted into a plump bun at the nape of his neck. You would lift that bun to tenderly kiss the spot on his neck where your ex once tried to kiss you. You refused then, feigning ticklishness, when in truth you felt nothing. Your best friend refused you when he got married to someone else. When will you learn? The drive to your best friend’s house is awkwardly silent. Or silently awkward. Does it matter which? Now   you begin to regret coming to this place. It’s a small town, where the rents are cheap, but it’s all a big, ironic joke when there’s nothing to spend all that saved money on. The movie theatre is closed, as are all the restaurants except for that sandwich shop that caters to the truck drivers, the true heroes, passing through. There’s nowhere to go dancing, nowhere to go bowling, nowhere to play games, nowhere to seek a thrill, an escape route. You thought you were doing your friend a favor, by being the break in the long, uniform days. You realize, as the car rolls into his quiet suburban neighbourhood, that you’re not so much a relief from boredom as a disturber of the peace. To ease your flared-up guilt, you start to think selfishly again. You start imagining that you live here with him and that you’re both driving home from your jobs in a world where there are still jobs to go to every day. He’ll lean over and kiss you on the lips when you pull up in the driveway. You’ll joke about the dinner you’ll have, pasta again, maybe with a cheese sauce this time, instead of tomato. You sink into this fantasy world like you’re planning to sink into his couch. Beside you, his hands grip the steering wheel, his knuckles rigid and needle-like, almost ready to stab, and you don’t know what he’s thinking. You only know that you love him to the point of desperation. At the front door of his house, his wife greets you, and takes your red suitcase from you. She smiles and welcomes you back, but there’s tension in the air already. There’s the tightening of her jaw, a certain hard coldness in her eyes. Her hostility chokes you like a sour-smelling perfume she’s wearing. And like a good guest, you can say nothing about it. She was wearing that scent when you were there helping her and your best friend, her new husband, move in a year earlier. Then, she accepted your help begrudgingly, holding out on a cousin’s plan to set you up with another guy.  She drops off your suitcase next to the couch where you will sleep that night, all the while wondering what the hell happened to that plan. You were not supposed to be there, in her house, crashing on her couch, distracting her husband, being so unbearably, disorderly  you in what was by then meant to be a solid, comfortable, well-established us.  You are supposed to have a boyfriend. You are supposed to be living with that boyfriend. It was all arranged for you, with careful, thoughtful precision. You were supposed to be on your own, at last. How could you have possibly botched it? You tell the story at dinner, over slightly burnt sausages and mashed potatoes, made by your best friend with plenty of butter and salt, just the way you like it. You didn’t want to break up with him over a video call, you tell them, so you convinced him to drive over to your house. You walked with him for an hour, in your neighbourhood park, stepping over shards of beer bottles, stopping to read the optimistic chalk messages left by children on the picket fences. He was optimistic too, chattering on about how when all this was over, you could plan a trip to Prince Edward Island or Newfoundland, and stay in this hotel, or that one, or hike through some famous trail or another, the names unmemorable like illusions. He was floating away with ideas. He was a million miles away from you, in the future already, while you were sinking further and further into the quicksand of the present, mere inches away from being swallowed entirely by despair, real despair, the kind that makes people eye the deep end of the lake, the train tracks, the bottle of vodka. You almost reconsidered dumping him, because he might have saved you. But you did dump him, at the end, when you both stood in front of your house with the sign in the front window. Without bothering to meet his eyes, you told him you stopped missing him. Neither your best friend nor his wife understands what that means. “How could you…stop missing him?” your best friend asks you. He’s the jury, you’re the defendant. His wife could easily be the judge and sentence you to exile if your defence isn’t strong enough. Nevertheless, you offer what you have, which really isn’t much, you realize then. “My brother cries about missing his girlfriend every night. I never cried over him.” “That doesn’t mean you didn’t miss him, though,” your best friend counter-argues. You shrug your shoulders, a reflex gesture like the doctor tapping your knee. “I don’t love him.” I love you! I love YOU! You would scream it if you could, throw it across the table, spill it on the floor if your best friend’s wife wasn’t there. She stands between you and your performance art. Where you stand, you don’t know. You only know that your knees are giving out under you and that when you fall, it will always be on their couch. You know no other way to land. Dessert is vanilla-bean ice cream. You let yours melt into a cold soup in your bowl. You’ve eaten it like that since you were a child, waiting for it to be soft enough to spoon into your mouth. You’re grateful for that ice cream. You’re grateful that your ex, a history buff, wasn’t there to tell you all about how Typhoid Mary had unknowingly passed on half her name to her unfortunate victims through her homemade ice cream. “The germs got killed while the hot food was cooking, but not with ice cream, or anything else that was cold.” He did that, a lot. Offer facts no one asked for, that no one wanted to know. You used to find it endearing. Your best friend, pushing over to you the bottle of fudge sauce, tries again to make sense out of your parting-of-ways with the promising boyfriend. “Do you think you’ll get back together with him when this is over?” You shake your head, your mouth full of sticky sweetness. You’re bored of this conversation now. You don’t want to talk about it anymore. You broke up with the boyfriend and it’s a done deal. Irreversible. You ask for a second scoop of the ice cream and your best friend gives it to you. Again, you let it melt in your bowl. You let it become warm. That’s all you have patience for now. Cordoned off in their bedroom later that night, protected by the walls that conceal the intimacies and secrets of their marriage, your best friend and his wife are free to whisper about you, their secretly unwanted and imposing guest. The displeasure has had its time to melt. She’s really not happy, and she makes that fact known. “He can’t keep coming here.” She’s chosen exile. You will leave. You will  leave. She’s decided. But your best friend, your lawyer, your willing representative, stands up for you, more out of habit than any desire to implement justice. He’s as exasperated by you as she is. You’ve shipwrecked on his shore too many times, compelling him to play rescue team. Yet he plays again. He loves you back, but as a father loves his child. It’s not a good thing for either of you. “He’s lonely.” “He has a boyfriend!” “Had a boyfriend.” “He can get him back.” In your best friend’s wife’s mind, that’s possible. She didn’t personally witness the cinematic finality of your boyfriend’s car driving away. Beside him, your best friend sighs and shakes his head tiredly as he reaches over for the lamp switch. “Can we talk about this tomorrow?” he asks her. In the darkness, he slides under their shared covers, where you and the problems you bring can’t follow. “I’m asking him to leave tomorrow,” she says. “No, you’re not.” “Yes, I am. He can’t keep sleeping on our couch. That’s our  couch.” Our includes the souls of the unborn children not yet roaming the Earth. The children they will have when it’s safe to go into a hospital again. That couch is theirs too, for the future movie nights, the spilt juice and Cheerios, the pet cat’s hair, and every stern parental talking-to yet to come. The jumping up and down. The being told not to jump up and down. The sleepovers the children will have with their friends when they make friends, whom their parents hope won’t be like you. You’re infecting it with your germs. You need to stop, to think of the common good. The couch is not   yours anymore. It will never be yours again. Shuffling about under the quilt your best friend dug out of the closet for you, you almost feel a sense of contentment. The quilt is musty but warm. You pull it up to your chin, achieving momentarily that sense of yours,  which you know will disappear in the morning with the rising of the sun and the vanquishing of the cold you’re sheltering yourself from. In their bed, your best friend’s wife rolls on top of him, and he guides her to where she needs to be. She’s his blanket and she keeps him warm. They agreed beforehand not to do this while you were here, but in defiance of you, they will click together back into us for the few volatile moments it takes. There’s a sense of victory in it. You haven’t yet managed to separate them. Your best friend stashes away his cry of pleasure into his pillow, where it will stay preserved, but not for you. On their couch, you settle into a comfortable sleeping position, and let your eyelids rest as the lumpy pillow parts its sea for you and accepts your head. For now, you’re just glad that you’ve made it here one more time. You feel better, just being near your true love again. You will not give him up until you’re ready. You are not done with being you  yet.

Dr Annabel Sowemimo is a senior clinician in sexual and reproductive health, a part-time PhD student, founder of a charity   Reproductive Justice Initiative (RJI) , and author of   Divided , a book on racism and medicine. I am a Cognitive & Clinical Neuroscience on placement at King’s College from the University of Westminster. In the course of interviewing her for   Black History Mon t h , we touched upon her creative endeavours through activism, her work in the NHS, and decolonising the healthcare system. She starts by saying, “I encourage others to explore, to read widely and have breadth, and not be scared of doing more than one thing!”  Her passion for making impactful change has inspired her to learn more about the healthcare system and its flaws.  “Activism is a term that people shy away from due to its association with strong political views”, she adds, additionally entailing that she wanted things to be different. Her going to medical school and being taught about the body as well as her academic training made her more aware of health inequalities, which deepened her motivation to start a grassroots organisation as well as form a collective of like-minded people who wanted to take action alongside her.  “Look at the specific issue you are trying to address and see what is going to activate people”, she advises. “I started talking about racism and what I saw within my own social and reproductive health specialism and that's why I wanted to decolonise contraception”. She initially started creating logos with an artist called Nicole Choe reflecting the topic of decolonising contraception. Together they created stickers and posts. She was surprised at how fast the stickers circulated when someone mentioned that they saw the stickers up in toilets in Edinburgh. “I was like oh my God! It went all the way up to Scotland”  She started getting invitations to panel discussions at SOAS (The School of Oriental and African Studies) and other events that had a big turnout.  “For me, it was mostly a creative endeavour. I liked the science and the humanities and my way of subverting the narrative was to build art into that movement; my house is covered in protest art. I absolutely love it!” In Divided, she explores the intersection of race and health and she explains the deep historical and present impacts of colonisation on healthcare. She has reported in her book that people thought she was being too overly critical of the medical profession therefore I asked her how she responded to this.  She clarifies that she does not want to diminish the struggles of becoming a clinician but she emphasises clinicians’ positionality in a society where they are holding life in their hands so they don't face as much scrutiny and critique as they should. She continues, “I think that critique needs to come from within as well as outside because medicine is one of those things where it is quite difficult to understand the system unless you are a part of it. I’ve been both a patient and a clinician. Ultimately critique is vital if we’re going to improve as a society.”  She continues, “Colonisation hasn’t ended in terms of the way that we structure our overall healthcare system: who gets medication, for example, or where our research is conducted. It's very much an ongoing process. All lives are not treated equally, which is why it's our duty to stand up for and combat. We need to question why we pull up more for some people than others, and how we allocate resources in our healthcare system. We need to keep reasserting what we think is right, to move closer to a better system.” The wave of   Black Lives Matter protests  made people more aware of the oppressive system. This prompted me to ask her whether the protests have shed light on decolonising healthcare. Indeed, she saw within her work that people were more willing to listen and engage. However, she also noticed a pushback.  “Once people are more aware of oppressive systems,  then they change and adapt so they remain oppressive.” Difficult conversations were moved to surface-level actions, to light touch topics, because it's easy to say that they’ve done something. So even though black lives matter protests did shed light, we must be mindful about how language gets co-opted.”  Following up on that question I asked her how we can have these difficult conversations especially when it comes to big institutions.  “Some organisations (for example,   the Royal Infirmary in Edinburgh ) have done a detailed analysis of what the relationship has been with slavery and its legacy today. Only recently did we realise that slave owners were still being paid by UK taxpayers until 2015 . A lot of people were not aware of that fact and it took investigative journalism and writing to bring and highlight that. Now there are still some exploitative relationships and things happening within our academic institutions, and we don’t know the full details because no one brings them up. In my book, I talk about the fact that UCL was   hosting an intelligence conference  for 4 years, about how the intellect is different along racial lines until a student paper brought that to the front. That is a present-day issue and was only revealed 6 years ago so for me it's very much about understanding also the hidden present that is happening so we can address it because the idea that it's just historic is not right. There are still things that are happening now and we need to know what they are, and we need to address them.”   COVID-19 significantly impacted health professions, especially the access to reproductive health services for marginalised communities. Annabel explained that a lot of sexual reproductive health services across the UK closed down or got temporarily suspended, limiting accessibility to contraception. This flagged issues regarding individuals struggling to handle their contraceptive needs, particularly people experiencing side effects or wanting to conceive. She raised human rights issues: “We shouldn’t be giving medical devices to people and then telling them we can't take them out when they want it removed. That’s not what they consented to. This was especially tough for people navigating that system when they have other challenges in their lives, like poor housing, difficulties making ends meet, or jobs getting more intense because of the pandemic.” COVID was certainly a devastating period, however, she also acknowledged that there was a massive shift to improve their telemedicine services allowing for easier consultation and information accessibility. She notes that it isn't a substitute for complex issues but it prevents people from being “lost at sea”. To conclude our insightful conversation, I asked Annabel what were three components of the NHS she wished to change. Firstly, she recommends a truly holistic healthcare system that incorporates social determinants of health, allowing clinicians to work with professionals in housing and education. “This is not currently how the system works, we are very much working in silence.” Second, a need for flexible funding supporting a wider range of providers, and less privatisation which is causing more fragmentation due to outsourcing within the NHS. Lastly, opting for better working conditions. It is important to look at occupational health issues of the staff, from burnout to muscular-skeletal pain, and particularly issues affecting those who migrate to the UK. Addressing these issues is crucial to determining staff well-being and the overall effectiveness of the NHS.