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How friendship shapes love and community; through the lens of a South Asian woman As someone who grew up in a South Asian household, my life has been substantially influenced by Bollywood. One of the first films I ever saw taught me that “love is friendship” and in some way I've internalised it and still believe it to this day. For me, friendship is love. It's what's needed to cope with the realities of life. It's what makes our lives sweeter, more meaningful, and so full of laughter. Rooted in the values of collectivism, kinship, and loyalty, friendships in South Asia are often seen as extended familial bonds, imbued with cultural and emotional nuances. Friendship is so highly regarded that the people we grow up with become the aunts and uncles of our children, they become family. These friendships carry a profound emotional weight that reflects the collectivist nature of the region's societies. They are the anchor that keeps us rooted, our biggest supporters in life, our means of escape. I’m Ayeshah, a 22-year-old psychology student from Pakistan, who finds herself relying on friendship exceedingly while navigating and making sense of a world full of possibilities and atrocities. In this article, I share how friendship, for many South Asians, holds such value that it transcends the boundaries of friendship by becoming family. A cultural cornerstone The word for friend in Urdu is " dost " from Old Persian, meaning ‘lover’ or ‘friend’. It is derived from linguistic expressions that mean, " to nurture or take care of" . The importance we have placed on friendship is reflected through the media around us, - the literature, the movies, and the songs - all of which use the central theme of friendship and love, which for many of us are two words for the same thing. Growing up, I saw friendship as a lifelong commitment. I saw my father’s face light up when he met his school friends: the air around us would change, you would hear stories reminiscing the best of times and lots of laughter. I saw how he would make an effort with his friends and treat them like brothers. They were and remain our uncles; not by blood but by the love they hold for our father. Transcending generations Lifelong friendships are very common in our culture. The camaraderie shared by individuals is so meaningful that it is second nature for us to give family labels to our friends. We have uncles, aunts, grandparents, and cousins other than those related to us by blood. My grandfather’s best friend lives on the other side of the world. They became friends in grade 6. Both are now over 85 years old and have a solid friendship of almost 75 years. Despite the geographical distance, they find ways to stay connected. My grandfather learned how to video call his friend and update him weekly about daily occurrences, politics and cricket. When they spend time with each other, they're no longer senior adults, they become the same 11-year-old boys who went to school together, laughing at the same stories they've been narrating for the past 70 years. Through thick and thin Since our ties find their way into our circle of family and close relatives, it is only natural to have them be a part of the happiest and worst times in our lives. For me, it’s difficult to describe in words the joy I felt being part of my friend’s wedding. From the moment she got engaged, to planning the wedding and then the big day, she made sure we were integral to it all. Later I felt a similar feeling of overwhelming joy when I found out my friend was going to have a baby and again when we were eagerly waiting on a video call to know the gender. I was present through it all and it’s strange and beautiful that the girls whom I once shared my lunch with now so graciously share their lives with me. These friends have bought front-row tickets to cheer me on for every milestone in my life; my first paycheck, my first job, my admission into university. They have been there through it all the same way they were there- front row- when I would stand on stage in school. When my Dadi (paternal grandmother) passed away, I felt like my whole world came crashing down. My friends left everything and came. They held my hand, wiped my tears, made sure I was eating and constantly checked up on me after that, on birthdays and Eid (islamic celebration) because they knew I would be missing her. That’s how we do friendship. A sanctuary for the mind Friends have such a profound impact on us that we even match their brain chemistry. Research illustrates that closer friends have more similar brain activity. After a tough week of studying, assignments, work and deadlines nothing recharges me like a few hours with my friends. We laugh, vent, eat, and leave feeling lighter than we arrived. They act as a restart switch, energising me again for the week ahead. Love and (or) friendship Human relationships are complex and multifaceted. True friendship is more than just mere companionship, it is built on a foundation of mutual respect, trust, loyalty and understanding. These qualities are not just the bedrock of a meaningful friendship but also the essential components of a lasting, loving relationship. We’ve all heard that the secret to a happy marriage is to marry your best friend and I believe this to be true. Ultimately, friendship and love are not separate entities but interconnected forces that strengthen and enrich each other. A healthy relationship thrives on the blend of both, where friendship fuels the bond with love and love reinforces the commitment of friendship. Friendships are at the core of our existence. While romantic relationships often take center stage, it's our friendships that often endure the test of time and offer the deepest forms of understanding and connection. Valuing our friends and being there for them too is essential for their happiness and ours. So while life goes on, let’s celebrate the people who’ve stuck with us through it all.

Bringing together the voices of an Israeli and a pro-Palestinian student at King’s College London. As we pass the one-year marking of the October 7th attacks, I have talked to two King’s College London (KCL) students, one Israeli and one Pro-Palestinian, trying to understand their emotional journey over the last year.   Testimonies on life at KCL for  Israeli and Jewish students  and for Arab and Muslim students  have been published before but in separate accounts; in this piece, however, I wanted to tell the two parallel stories in a single account, trying to emphasise the suffering that unites these stories and not the political views that divide them.   Both students have read and approved this piece, and I am grateful for their courage in sharing their stories.   KCL has also seen this piece, and has provided a response that is published at the end of the piece. As a KCL academic, I recognise the struggle of my and other universities as they  “face pressure from all sides”, as a recent piece in The Guardian  has written regarding US universities.   I talked to Aurele, who was a 2nd year history student and had just been elected President of the King's College London Students' Union (KCLSU) Israel Society when the 7th of October attacks against Israel took place. The first videos he saw of the attacks were from Ashkelon, where his family lives.    In the first few days after the attacks, Aurele thought it was imperative that KCL condemned Hamas, especially since the group has been a proscribed terrorist organisation in the UK since November 2021. Yet, he was disappointed that it took 11 days for KCL to publish a statement .   While there was solidarity expressed by a minority of students from the Muslim community in the immediate aftermath of the attacks on Israel, he was shocked by the hostility and lack of empathy, even before Israel’s invasion of Gaza started, and including from students he believed to be friends of his.   The situation only got worse over the subsequent months. He recalls going to the university campus and hearing chants declaring Israel a terrorist state, or reading statements from KCL academics that could be interpreted as antisemitic. Like him, many Jewish students felt threatened while on campus.   It was upsetting and isolating.   I talked to X (not the real initial), a member of the KCLSU Students for Justice for Palestine (SJP), who prefers to remain anonymous.   X was not involved in the immediate response by SJP to the attacks. Indeed, X was in conversation with many KCL students who also did not participate in the first pro-Palestinian rallies organised immediately after October 7th, as they felt that it could have been perceived as supporting Hamas. However, things changed quickly when Israel’s attacks on Gaza started.   X recalls that pro-Palestinian students organised community actions, including posters on the history of Palestine, but these were vandalised overnight, covered by David stars. Also, X tells me that KCL immediately started to investigate some of the pro-Palestinian students, and that it is still very distressing that pro-Palestinian students were burdened by both the suffering of what was happening in Gaza and the personal anguish of being investigated or suspended by KCL   On the 13th of May 2024, the pro-Palestinian encampment was established, and X joined soon after. X felt that, by that point, a lot of frustration had accumulated, both with the escalating humanitarian situation in Gaza, and with KCL failing to act against the harassment of pro-Palestinian students on campus.   Aurele remembers when the encampment started very well.   The Jewish students felt regularly harassed when on campus, and easily recognised even if they were hiding their religious symbols, for example by other students that used to study with them before October 7th. He certainly had days when he felt very low, when he could not leave his bed because of the despair.   By that point, he had already been involved in meetings with KCL leadership asking them to do more to clamp down on antisemitism on campus, as Jewish students felt unsafe. He’d received threats against his safety on social media, and felt that the security staff could do more than just monitor the situation but not intervene.   Also, he could not understand some of the requests of the protesting students, especially the request that KCL should stop all academic collaborations with Israel , something that would make it impossible for all KCL students to travel to Israel to study and for research.   Despite everything, he recognises that among the protesting students there were some well-intentioned people with genuine grievances, and he can recall attempts from individual students from the Muslim community to talk to Jewish students, to see them as human beings, to entertain complex views on the relevant political issues. X recalls that the encampment lasted over 60 days and nights.     Several representatives from the encampment were engaged in negotiations with KCL during the protest, emphasising that the university should disinvest from companies that supplied weapons to Israel .   However, throughout this time X felt hostility from KCL University toward the students in the encampment: greater restrictions were placed on the encampment, including a ban on inviting speakers and guests, and, on one occasion, KCL security brought police with dogs into the encampment.     X also tells me that there were warning emails by KCL threatening investigations and suspensions, that two students were excluded from campus during the protest and, as of today, only one exclusion has been lifted.   X now sees that the eviction on the 16th of July was inevitable, and that they did not achieve all that they wanted to achieve. But, in the encampment, X witnessed many examples of solidarity. Students, including some Jewish students, staff members, academics, and members of security, came to the camp to express their support.   X recognises that Jewish students felt unsafe, and understands that they were targeted in threatening emails and social media posts. But X is also keen to emphasize that pro-Palestinian students also were unsafe, considering the impact of warnings, investigations and suspension.      I asked both Aurele and X what they thought was the way forward to promote reciprocal understanding and dialogue.   Aurele is worried that, in terms of dialogue between the communities, there has been no opportunity to discuss, and no benefit of the doubt given to those on the opposite side. He believes that proximity and exposure will be the best ways to promote dialogue and bring an end to abusive behaviours. He hopes that protesters will understand that their actions and chants are likely to make Jewish students feel unsafe.   X also believes that students should all act with care and compassion towards one another, even if the past year has been characterized by hostility. However, X recognises that the focus, as a student activist, is on doing what is needed for the people of Gaza, and that the situation is past the point of trying to change each other’s minds.   Both tell me that KCL could and should do more to ensure that students can engage in safe dialogue   Aurele stresses that behavioural codes should be circulated to all students, to improve the language that we all use, and suggests that the university could organise a panel discussion with Jewish and Arab academics on peacebuilding in the Middle East at the university, as a starting point.    X is worried that new regulations brought by KCL and other universities for events bringing speakers on Israel and Palestine are actually fostering discontent on campus, rather than facilitating the dialogue, as it is the perception by student protestors that they have been largely ignored.   As I write this piece, I realise that this has been an important and difficult task, both for myself and for the wider Inspire the Mind team.   We have been struggling with multiple concerns: that it was never the right time, that we could make things worse, that we could not find students willing to talk to us. Yet, we believe that these stories should be shared, and that there is a way of writing a balanced piece on such a complex topic. In the end, with much negotiation and tenacity, we have managed.   It’s clear that universities in the UK and abroad are struggling to foster an open dialogue. In describing Aurele’s and X’s proposed ways forward to promote reciprocal understanding, I feel that this piece is a small part of a much larger effort being driven by students everywhere .   A King’s College London spokesperson said:   "On supporting students:    The safety and wellbeing of our community is our absolute priority, and that focus has been at the centre of every action and decision taken by our University, following October 7. We communicated directly with students and staff on 9 October 2023 to offer support, and The Dean and the Head of Security also swiftly met, and continue to do so, with student societies, including the Israeli, Jewish, Islamic, Palestinian and wider student societies, to listen to any concerns, provide extensive pastoral support and reassure them about safety measures on campus.    On the encampment:    When the encampment was formed, we engaged with members of the encampment to conduct regular wellbeing checks and progress dialogue. We also circulated guidance to protestors to remind everyone of our expectations regarding conduct and behaviour, as well as existing policies on external speakers invited to campus – which stipulates a requirement of at least 15 days notice - to ensure that an inclusive and safe environment is maintained. This policy is well publicised, and the notice period requirement is known among all student societies. It was not a greater restriction applied to the encampment.    It is inaccurate to suggest these communications contained threatening warnings or included any suggestion that students were going to be investigated or suspended without proper cause or process.  Protest, along with other forms of free expression, is supported, but within boundaries to ensure that an inclusive and safe environment is maintained, and opinion and differences can be aired with civility. Where there was evidence to suggest the boundaries of permissible protest had been breached, we investigated, in line with our usual processes. Two students were temporarily excluded from campus (but not from continuing to study) and have now returned to campus with restrictions. In July protestors were asked to leave the encampment – they were not evicted. King’s security did not bring police with dogs to the encampment. Police visited Guy’s campus at King’s request when individuals not affiliated with the university disrupted an open day. Any other instances of police on campus have not been at the University’s request and indeed police have been politely asked to leave by security.    On reports of bullying and harassment:    To suggest that reports of harassment or antisemitism on campus wouldn’t be acted upon, is false. Any form of racism, antisemitism, Islamophobia, abuse, violence or harassment is unacceptable and has no place at King's. We take reports of any such behaviour very seriously, investigating in line with our robust processes and should any allegation be upheld, action is taken. On creating a safe space for dialogue:     We know strength of feelings, views and opinions run very deeply across our community, and it is part of the role of a university to be a place where divergent opinions can be expressed and discussed with civility, and in line with our commitment to freedom of speech within the law. Reflecting this, we have held several academic events and discussions on this topic over the past year, to which societies have been invited to attend.  This includes a panel discussion between students on the President's Global Leadership Awards (PGLA), several King's academics, and King's Vice-Chancellor, Professor Shitij Kapur on: "Israel-Gaza Conflict: what is the place and role of a University?", with another event planned for November. Further, the Dean hosted a vigil for peace on the one-year anniversary of October 7, to provide a space to remember those who have died in Israel and Gaza and in all places of warfare, and to ask for peace. King’s has also supported KCLSU societies to host events of their own. On King’s investment policy:    King’s maintains an ethical investment policy, and specifically invests in funds that proactively screen to avoid controversial and unethical sectors and industries – like tobacco, controversial weapons and fossil fuels as well as investing in funds that actively target positive social and green investments. We are recommending to our governance committees that we formalise our existing informal policy of screening out investment funds which invest in companies involved in controversial weapons.”

It's always a great tragedy whenever a lively, creative, and genuinely talented individual loses their potential to an addiction. Here's one you've probably never heard of. Did you know that Oscar Wilde had a niece who looked just like him? I didn’t. Not until I read Paris Was a Woman by Andrea Weiss and saw a photo that I thought for certain was the Irish rockstar writer in a wig. I had to peer at the photo closely and question my own confused and distrustful eyes, but this photograph wasn’t him. This was, one hundred percent certain, his niece, Dorothy "Dolly" Wilde (1895-1941) and she was destined to become yet another one of my many hyper-fixations. Mainly because, like my other article topics of choice, she was a shining star rapidly burnt out by untreated mental illness, substance addiction, trauma in early adulthood, sexual excess, and perhaps a family curse. Dorothy “Dolly Wilde” came into the world on July 11, 1895. Her parents were Oscar Wilde’s older brother, William Charles Kingsbury Wilde and his wife, Sophie Lily Lees. Oscar Wilde was arrested three months earlier for sodomy ('illegal homosexual acts') and she missed the chance to meet him. But she was haunted by him, and something of his very troubled spirit seemed to possess her as she grew up into an eccentric woman with an array of mental health and behavioural issues. From a young age, she seemed drawn to harmful substances paired with strange habits. Her favourite childhood treat? Sugar cubes soaked in her mother’s perfume. No authority figure in her life seemed inclined to stop her from doing this, so this undoubtedly set the stage for what would be a lifetime of ingesting what she shouldn't and dangerous, unrestricted self-indulgence. Next up, as an adult, would be promiscuity. Of course, there is no shame in a woman being sexually liberated. Wilde was a lesbian and, according to all her biographers, enjoyed a rollercoaster sex life. She had an affair with Marion Barbara "Joe" Carstairs, a fellow ambulance driver during World War I who went on to become a speedboat racer. That was Wilde's taste in women: fellow daredevils who didn't present the prospect of settling down into a quiet domestic life. Reading about her, what I observe (and this is just speculation) is that Dolly Wilde deliberately evaded anything that resembled stillness and complacency; she never had a relationship in which she was someone's primary partner or the one with whom they worked to build a stable future. During the 1920s after the war, the only place, really, for a woman like Dolly Wilde was Paris, and so off to Paris she went, where she met the famous and fabulously wealthy salon hostess and centre of the Parisian lesbian community, Natalie Barney. She was, reportedly, a riot at parties. Everyone wanted to meet her and get to know her. A seasoned socialite, she knew how to stand out in a room and get people howling. She was a comedian. But she was also an addict, and that is what would ultimately rear up and triumph as her main identity in the second half of her life. She would transition from being Oscar Wilde's fascinating niece to yet another unfortunate casualty of the Roaring Twenties. Her poisons? Alcohol and heroin. All readily available in Europe at the time — prohibition was only a thing in America — and serving as dangerous substitutes for emotional and mental support. It’s been theorised that what she saw during her participation in the war escalated what was already an addictive personality (this is what happened to Ernest Hemingway, also a Paris expatriate in the 1920s). It also may have been hereditary, as her father, Willie Wilde, was an alcoholic, having turned to drink to cope with his failed career ambitions and marital problems. To me, one of the greatest tragedies that make up Dolly Wilde’s story is the wasted potential. She had a spark of brilliance, but no fuel in her lighter. She had a touch of genius but no discipline to direct it. She had every advantage and circumstance to become a classic writer in her own right, but this never manifested into anything. It was all in place for her: the scandalous family background, the wartime experiences, the torrid romances, the wild Parisian nightlife, the rich lover/patron to fund her, and of course the inherited wit. Dolly Wilde’s dependence on drugs ultimately claimed her and ended her lifelong party in 1941, when she was only forty-five years old. Her cause of death was documented as "causes unascertainable", with the two main candidates being either breast cancer or a drug overdose. Having refused a mastectomy after being diagnosed in 1939, Wilde turned to copious painkilling substances to combat the agony instead, and it was likely one bout of self-medication too many that ultimately brought about her untimely death. Wilde’s biographer Joan Schenker theorises that Wilde’s murderer was paraldehyde — a drug used traditionally as a sleeping sedative and as a hypnotic — and points out an account made by a Dr. Simpson, who attests that he smelt the drug on Wilde while examining her corpse, found in a rented room at Twenty Chesham Place (a guest house for low-income tenants) in London. As she left no note behind, the possibility that it might have been a suicide will remain just that. A possibility. There’s a particularly beautifully worded passage from Schenker’s Truly Wilde: The Unsettling Story of Dolly Wilde, Oscar's Unusual Niece that I want to share, which so strikingly paints the morbid setting of Wilde’s final resting place and really captures the ambiguity of the situation: “The day of her interment was the day after the worst air-raid London had yet experienced, and so Dolly was put to rest in her final bed against the backdrop of a brilliantly stained and smoky sky. The clouds had all been coloured by the fire started by German bombs falling on London, and the effect must have been rather like the violence and beauty of Delacroix’s ‘Death of Sardanapalus,’ the painting that had given Dolly such a lovely idea for her own death in a bed.” Dolly Wilde should be remembered as a woman who lived life by her own terms until the very end. Her judgement could be considered poor, and she may have had her struggles, but her streak of independence was indomitable and admirable. She was, just like her uncle, a true nonconformist. For more information about Dolly Wilde and her turbulent life, here are the sources I consulted: Rodriguez, Suzanne (2002). Wild Heart: A Life: Natalie Clifford Barney and the Decadence of Literary Paris . New York: HarperCollins. Schenkar, Joan (2000). Truly Wilde: The Unsettling Story of Dolly Wilde, Oscar's Unusual Niece . New York: Basic Books. Weiss, Andrea (1995). Paris was a Woman: Portraits from the Left Bank. Counterpoint Press.

Not too long ago, I wrote articles about Apple’s Commitment to Mental Health and about how Neuralink was approved for Human Brain-Implant Trial Recruitment . I wrote these because of my fascination for the tech world and because, as a member of Gen Z, I am among the generation that grew up with technology. I quite literally grew in parallel to electronics, including all their updates, legal battles, and scientific advancements. I was born in the year 2000, so whilst I missed the launch of Google by a mere two years, I saw the evolution of mobile phones from hand-bricks to smart devices, I was one of the first guinea pigs to take their exams on laptops instead of paper and pen, and am now increasingly surrounded by the use of AI in my every-day life. If you thought Siri and Alexa were advanced, wait till you hear this... Put simply, technology is advancing at a faster rate than anyone expected, driven by rapid progress in artificial intelligence, machine learning, and other cutting-edge domains. For example, generative AI ( like Google's Gemini models ) has seen a surge in development and investment, with applications that now outperform human experts in certain benchmarks and dramatically improve capabilities like programming and scientific research, within ethical reason. The pace of these advancements is reshaping industries, with AI being integrated into everything from healthcare to agriculture and route optimisation on a global scale . And it's not even creating new content yet, it's just mimicking and echoing the large sea of data that's already out there! But AI isn't the only field seeing this explosive growth. Other areas like quantum computing, renewable energy technologies, and bioengineering are pushing boundaries, transforming sectors like energy and medicine faster than anticipated . And not to mention its radical impact on research. AI and machine learning can be tools which allow researchers to analyse vast datasets that would have been impossible to process even a decade ago.   For me, it's wild to think about how fast technology is advancing these days. If you take a step back and look at the bigger picture, human progress used to take so much longer. It took us thousands of years to go from simple tools to things like farming and writing. But in the last century alone, we’ve gone from figuring out flight to landing on the moon, and from inventing smartphones to the rapid and widespread integration of AI that can almost "think" for itself. Safe to say that technologically speaking, we’re living in a time of exponential growth. And we're only just starting to understand how AI could reshape the world as we know it. So, you might be asking yourself, what comes next? Well, we’re already seeing brain implants being tested ( yes, you guessed it : Neuralink ), Apple just announced that their AirPods Pro will contribute to hearing health by doubling as a hearing aid, and AI diagnosing diseases has started to become more accurate and efficient than human doctors in some extreme cases. It feels like the lines of what's possible are starting to blur.   As technology keeps evolving, we’ve got to ask ourselves: where does this all lead? Does it ever slow down, or are we just scratching the surface of what’s possible? Sources like the  World Economic Forum ,  Google DeepMind , and  McKinsey & Company   all point to the same conclusion: the pace of innovation is rapidly increasing. We're in a race with our own technological creations, and it's both exciting and a little overwhelming to think about where we’re headed. When I was a kid, I often thought about future technology and what it would look like. A tool that could help you tidy your room? A computer that would do your homework for you? A flying car? Maybe even time-travel… and it turns out, those are far from out-of-reach. What once seemed like wild imagination is edging closer to reality. From a community perspective , tech has transformed how we connect and engage with each other. Social media, instant messaging, and video calls have reshaped relationships, enabling real-time conversations with people across the world. As I mentioned in my article depicting The Life of a Third Culture Kid , creations like FaceTime have allowed me to stay connected with my loved ones across the globe, bridging gaps of time and distance, and making it feel like I’m just next door. From a mental health and wellbeing perspective technology has had a profound impact, both positive and negative. On the one hand, apps and platforms for meditation, mindfulness, and therapy have become more accessible than ever, giving people tools to manage stress and anxiety. Virtual therapy sessions, mental health forums, and digital communities have made professional support available for those who might not have had it otherwise. It’s incredible how far we’ve come in using tech to enhance mental wellbeing. But, like with all things, there’s a flip side. The same technology that connects us can also isolate us. Social media, for instance, often amplifies feelings of inadequacy, comparison, and loneliness . The constant bombardment of information and stimulation from our devices can also lead to digital burnout. So, as we move forward, it’s clear that we will need to be even more conscious of how we engage with technology, balancing its benefits with its drawbacks. I think it will be the key to ensuring it enhances our well-being rather than diminishes it. We don’t want to be living a lonely life amongst robots now, do we?   In conclusion, it’s pretty clear that technology is advancing faster than we ever imagined. It’s not just changing how we communicate or how we engage with our communities; it’s transforming everything — from how we understand ourselves to how we go about our daily lives. AI, machine learning, brain implants — things we used to think were just sci-fi dreams are suddenly becoming a not-so-distant reality.   But as cool as all this tech is, it comes with a lot of questions. How do we make sure that while tech is helping us, it’s not overwhelming us? And in the case of AI, how do we ensure that it won't take over as the main form of connection? Social media bonds us, sure, but it also brings feelings of isolation and burnout. We’ve got apps that help manage anxiety, but at the same time, our devices can be a source of constant stress. The balance between these benefits and drawbacks is something we need to figure out as we move forward. Not to mention all the legal and ethical elements that come with these conversations ( note to reader: we would be here all day if I went into that) .   So where do we go from here? Honestly, it feels like we’re just scratching the surface of what’s possible. The challenge is making sure that, in all this excitement, we use technology in ways that make life better — not just more convenient, but healthier and more connected. The future is full of potential, but it's up to us to ensure that all these advancements really serve to improve our lives and well-being.   So, dear reader , what do you think — are we ready for what comes next?

There is no doubt that the practice of medicine has always been an extremely stressful profession, but of late, with the introduction of more complex investigations and interventions, it has become even more stressful. Furthermore, with changes in public expectations, health is now seen as a commodity and thus, additional pressures are placed on health practitioners. In addition, training and education in medicine also create a degree of pressure. Over the past 50 years, although increasing attention has been paid to the mental health and well-being of doctors, it is only recently that the focus has shifted to the mental health and well-being of medical students. A series of studies have shown that the rates of mental ill-health among doctors and medical students are exceptionally high and are getting worse. In studies across 12 countries with over 3600 responses, it was reported that rates of burnout among medical students vary between 65% and 95% across countries. Medical students are the future workforce and are the key to patient care and the well-being of society in decades to come. It is well recognised that the majority of mental illnesses in adulthood start below the age of 24, which corresponds with the age of students in medical schools. Additionally, factors such as loneliness, isolation, the stress of medical education, financial pressures, and rapidly changing advances in medicine, are also likely to contribute to burnout and poor mental functioning. Although there have been challenges to the use of the term burnout, it is defined as a pervasive and debilitating state due to a period of overwhelming stress. It has been classically defined as an experience of physical, emotional, and mental exhaustion. In addition to exhaustion (that is, the feeling of being emotionally overextended by one's work and its effect on functioning), burnout also has other components, which include depersonalisation (the feeling of being outside yourself and observing your actions, feelings, or thoughts as if from a distance), and feeling an absent sense of personal accomplishment. Although burnout itself may show symptoms of anxiety, individuals experiencing burnout are likely to be in despair and depression. It has been noted that medicine has always been a stressful job related to making life-and-death decisions, 24 hours a day, with pressures to not being able to form personal relationships with the team, or the patients and their carers. Additionally, increased bureaucracy and managerialism in the NHS, as well as other healthcare systems, further contribute to a sense of powerlessness. These factors are only further complicated by two factors: the changing face of medicine and the role of doctors, but also changing patient expectations which contribute to blame culture. Burnout creates not only a detached attitude towards others but also a sense of disengagement. Thus, if individuals already feel they are not part of a team, such further isolation and alienation can be truly damaging. Of the three stages of burnout, the first one is to do with stress arousal, poor concentration, memory lapses, irritability, and anxiety. The second stage focuses on energy conservation and maladaptive strategies, such as avoidance, lateness, and social withdrawal when students do not attend their classes or wards. The third stage is exhaustion, which is associated with anxiety, depression, apathy, and suicidal ideation. This can result in non-presence, low work rate, rage, and difficulties with examinations. Individuals may disappear, not respond to calls, or be on frequent sick leave. They may be physically present but mentally absent. Not surprisingly, future doctors may face problems related to career choice and promotion, as well as disillusionment with medicine. Most doctors tend to work long hours and worry constantly about the welfare of their patients. Furthermore, a fear of things going wrong puts them under additional pressure. Medical students may observe this and further feel worried about potential pressures as blame culture, on the one hand, and obsessional personality characteristics on the other, contribute to stress. Studies have shown variation in rates across countries as well as varying pressures which contribute to burnout. These factors are related to academic pressures, relationship difficulties, financial pressures, and housing problems. Worryingly, across countries, students show increased usage of alcohol or cannabis to cope with burnout. The BMA survey mentioned earlier, showed that one-third of consultants were using alcohol and /or self-medication to cope. What should be done? There are things that need to be done at national policy level, at institutional (University or Hospital) level, and at individual level. For example, at policy level resources must be allocated to provide confidential services to medical students. Institutions have a duty to provide services which are easily accessible, confidential and ensure privacy. Bullying and harassment can contribute to stress and burnout, so these must be eliminated with prompt action. At an individual level, other strategies can be used. These include developing the ability to adapt to and manage stress by facing fear through coaching and mentoring. Additionally, developing cognitive and emotional flexibility and realistic optimism, learning how to get work-life balance, whilst asking for appropriate support and advice as needed. Attaining and maintaining good mental health is critical to one’s functioning. This can be achieved through a number of actions, including exercise and other physical activity, yoga, meditation, mindfulness, amongst many more. These can help an individual to relax, and time must be made available to allow this to happen. Receiving support from peers can be incredibly helpful as it is less stigmatising and more 'acceptable'. Safe spaces must be made available to take this forward. Systems should be in place to ensure that immediate access to support is available and that students are aware of this. For example, Balint groups can provide support in the context of clinical pressures. Balint groups are small group sessions involving case presentation and discussion, centred on the emotional component rather than the clinical content .  As a final reccomendation, individuals, when on call or in hospital or university settings, must have access to places where they can rest and good quality healthy food.   To find out more, you can purchase the book below with a 30% discount using the QR code below!

Our new MSc in Psychology and Neuroscience of Mind-Body Interface offered by the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London aims to offer knowledge on the interaction between mind and body in psychiatric and physical conditions. This article has been written by Dr Giulia Lombardo and Professor Valeria Mondelli, co-leads of the Psychology module. For a long time, people have been anchored to the mind-body dualism, a concept partly introduced in the 17th century by the philosopher Rene Descartes viewing the mind and the body as separate entities. This has unfortunately partly contributed to an “unbalanced” clinical approach, trying to resolve either physical or mental health issues without recognising the influence they have on each other. We are now entering a new era, where we are becoming increasingly aware that there is no real separation between the mind and the body, and that mental and physical health conditions are often interconnected. This blog is part of a series of ITM pieces  on our MSc in Psychology and Neuroscience of Mind-Body Interface at King's College London   starting in October 2024. We already have three pieces: two by the MSc lead, Dr Alessandra Borsini , on how this knowledge can project the clinical and academic career of students , and on the many mechanisms connecting the brain, the mind, and the body , and a third one by the co-lead of the Neuroscience Module, Professor Carmine Pariante  on the role of blood in the mind and body interface . Here, we want to take a step back and give an overview of the importance of studying the co-occurrence of psychiatric and somatic symptoms (that is bodily symptoms) in physical health and psychiatric conditions respectively.  This interdisciplinary and integrated approach views the individual as a whole, considering both mental and physical health. Such an approach is of primary importance, whether you study to become a researcher or a clinician . As part of the Psychology Module, we will also discuss some examples of how understanding the interaction between mind and body can aid in advancing clinical care and research framework, bringing insights into the development of new therapeutic approaches. Understanding the shared biological mechanisms To understand the relationship between mental and physical health, we need to understand the shared biological mechanisms, that is the changes in the body and the brain that are common   between two or more conditions . This is one of the best approaches we can use to ultimately find new ways to improve patients’ well-being. One clear example is obesity , a condition characterised by metabolic dysfunctions (such as type 2 diabetes ) and is highly associated with depression . The co-occurrence of these two disorders is a major public health issue but the biology behind this comorbidity (that is, having two or more health-related disorders at the same time) is still unclear. Therefore, it’s important to investigate the link between metabolic dysregulation and depressive symptoms. A shared biological mechanism between obesity and depression is the dysregulation of the immune system . The immune system is the system that fights infections and other threats in our body, and of course, it is helpful and protects us in the short term. However, when its activation becomes chronic, the body is affected by this maladjustment. Interestingly, both obesity and depression can be associated with increased body inflammation, indicating an over-activation of this biological mechanism. The immune system is quite complex and there is no straightforward answer as to where exactly the dysfunction comes from and how we could act to improve clinical symptoms. However, the study of immunometabolic abnormalities   (problems in how the immune system and metabolism work together) will help in informing targeted treatments (which are treatments targeting specific mechanisms in the body) for individuals   with obesity and depression.   A united front in investigating the interaction between the two aspects in individuals with obesity and depression will help in ultimately managing the care of these patients and improving the overall quality of life.   Taking care of both physical and mental health Generally, it is important to consider psychological wellbeing in individuals with medical conditions when providing traditional health care. A striking example of this integration can be seen in the case of cardiovascular diseases (CVDs).  T he interface between mind and body is extremely relevant to this diagnosis, as mental health can increase the risk of developing CVDs .   Stress, anxiety, and depression can greatly impact the cardiovascular system (that is the heart and blood vessels), by triggering body responses such as increased heart rate and blood pressure, and the presence of inflammation.  In turn, this can contribute to the development and aggravation of heart conditions, highlighting the intricate connection between psychological factors and cardiovascular health. On the other hand, the chronicity of CVDs can induce mental health problems, creating a scenario that can make difficult both treatment and recovery.   A practical delivery of this clinical approach in the healthcare system is through a discipline called “ liaison psychiatry ”. T his is an essential branch of psychiatry that fills the gap between physical and mental health. The multidisciplinary team is usually made up of various professional figures such as psychologists, psychiatric nurses, social workers, and of course, the lead liaison psychiatrist. This approach offers an opportunity for joint physical and psychiatric care to patients with physical conditions.   This is important as improving mental wellbeing can also have some positive effects on the prognosis of patients with physical comorbidity. Indeed, the co-occurring of both psychiatric and physical symptoms could hide the primary medical or psychiatric problem of an individual, and thus the need for a holistic approach.   In conclusion, this approach recognises the intricate interplay between mental and physical health, which is crucial for advancing both clinical care and research. The interdisciplinary approach of the MSc in Psychology and Neuroscience of Mind-Body Interface aims to offer the knowledge to fill the gap between mind and body, emphasising the necessity of viewing individuals in a more integrated way rather than an assembly of separate fragments.

Taking control while letting go This is day 14 of my working from home because of the COVID-19 crisis. I have had to start early my social distancing habits, according to Public Health England guidance , as I am living with two vulnerable people. Everything I do that increases my chances of getting the virus, might pass it on to them, and for them, the risk of a deadly outcome is much much higher than it is for me. They are my family, my most loved ones. I cannot bear the thought of losing them. And the thought that this may happen because I was not careful enough, or because I exposed them unnecessarily to the virus is excruciating. However, I am aware that this way of thinking is dangerous because what we are fighting, we can’t completely control. And we are used to control in many aspects of our lives — certainly I am. We decide what book we read, which movie we see, which friends we go out with, which job we prefer and even which city we would like to live in. Suddenly, we find ourselves stuck in a situation over which we have little control left. And our brains are not wired to tolerate uncertainty, but rather to evaluate the threat and decide what actions to take. The COVID-19 crisis has forced us at home because of social distancing (avoiding unnecessary contact with other people) in the best case scenario, or because of self-isolation (not leaving home, other than for exercise), or worse, because of quarantine (staying separate from society until it is certain we don’t have the virus). Whatever the reason, we need to make sure we protect our mental health, as well as physical health, during this threat. As a psychiatrist, I think about protecting mental health all the time, for my patients, for my team members, my friends, and of course for myself. But COVID-19 is different: is about managing the anxiety of a major, invisible threat in a situation where we cannot put in motion our tried-and-tested stress coping skills. And suddenly we may feel deprived, locked in, ineffective, powerless, hopeless, with no control over our present, and end up with more anxiety , more low mood, more obsessive and compulsive symptoms. So what shall we do? Well, I do not have that silver bullet, but if you keep reading, you will perhaps find some understanding of how you can make it work for you. We need social interactions to maintain good mental health, as Aristotle said, “man is by nature a social animal”. But now we are separated from our friends, family members and work colleagues. Luckily, modern times have brought us new ways to interconnect. Over 3 billion of us are using social media , and digital tools, such as video calls and instant messaging, to stay in touch. While we have heard many times that these means, especially when used excessively , may lower our mood, damage positive interpersonal relationships, or disrupt our sleep, they may turn out to be helpful in feeding the needs of our social nature while home-bound. And yet, many in our societies will not have access to these means. My 80-year old mother barely knows how to use her mobile to call her relatives and friends, let alone to share photos or videos with them. So let’s not forget about those digitally-shy people who may still rely on a landline call for contact, and make an effort to make that call, or to drop a card on their doorstep. While it is under our control how we use social media and digital means to keep in touch, it’s also easy to lose control over them, and let them dominate our day. At this time of crisis, we may end up searching the press compulsively, for news on that vaccine or treatment, and instead find the same upsetting headings repeated over many sites, with a less than reassuring result. Again, anything to reduce the uncertainty we can’t tolerate. The WHO recommends that we limit the times we check the news, be rigorous, and refuse to be constantly distracted by media. As Rosie Weatherley, spokesperson for the mental health charity Mind said recently: “A lot of anxiety is rooted in worrying about the unknown and waiting for something to happen — coronavirus is that on a macro scale”. And Daniel Freeman, a professor of clinical psychology at the University of Oxford, recently suggested in The Guardian : “We have to come to terms with such uncertainty… it is best to concentrate on what is meaningful in our lives”. So, time to let go, accept we have little control over this new situation, and instead control and select what we look at and when. And shall we let go of the nice structure we had for our days? Well, maybe let go of how we used to do it, and find a new way. Now, this is something we can control! Yes, we cannot go to the gym or our pilates classes, and our friends in some countries cannot even go out for a run, but there are many other things we can do to exercise . Many exercise apps have made some of their usually paid-for-services available for free, with a great choice of workouts, yoga, and anything that can give us both mental and physical benefit. Because at the end of the day, this is about controlling how we spend our time, we decide when to do it and with which teacher! Let’s not let our working day slip into our evenings, protect the time we previously had blocked for yoga or theatre, and replace it with something equally pleasurable, or start that online course we never had time to do. In fact, we have control over this, just need to let go of our old habits. And if we are staying home for a while, we better stay connected with ourselves, in many practical but highly symbolic ways, looking after our self-care, getting dressed and not just staying in our PJs all day. While I am writing this, I am finding it as difficult, as I am sure you all are, to think about how and whether this really represents control, or just letting go of it. Can I keep this going for weeks on end, and how different is this from my normal life? Let’s keep reminding ourselves that, if we just manage to have some control over how we fit this new, unfamiliar crisis into our lives, while protecting our mental health, we will all find each other again on the other side of this. And we will be stronger, and even more able to savour the normality of our everyday life. During these months, my friends in Italy have sent me many videos about responsible behaviour and staying positive and well during this crisis. One that has made me shed tears ended by saying: “One day we will say, do you remember those months during the coronavirus crisis? Let’s get to that day as soon as possible” And stay healthy in the meantime. Header image source: Adli Wahid on Unsplash

A Journey from Ancient Infections to Modern Mental Health The notion that 8% of our genome is derived from ancient viruses sounds like a plot twist from a science fiction movie, but it is true. Hidden within our DNA are sequences that originated hundreds of thousands, or even millions, of years ago from infections with retroviruses — viruses that can invade our cells and insert their genetic material into our DNA to replicate. I am a Senior Lecturer in Translational Genetics & Neuroscience at King’s College London. My research group  uses a combination of large genetic datasets and wet lab experiments to explore the biological mechanisms underlying psychiatric disorders. Recently, my lab became fascinated by the notion that ancient viral sequences in the human genome might play a role in the brain and affect susceptibility to mental health conditions, like schizophrenia and major depression. Integration into Our Genome During our evolutionary past, retroviruses inserted their genetic material within the DNA of our sex cells (the cells which go on to produce our children). Through a ‘copy and paste’ mechanism, genetic material was copied from retroviruses and pasted multiple times into our sex cells, generating offspring that then contained these DNA sequences within all their cells. Over many generations, these viral DNA sequences became fixed features in the human genome. We refer to these ancient viral sequences as human endogenous retroviruses , or HERVs . The Enigmatic Role of HERVs We know very little about what HERVs do. They were initially dismissed as inert "junk DNA", with limited biological importance, particularly as existing HERVs are no longer capable of adding more of their DNA into the genome. Despite this, as research advanced, we realised there were special cases in which HERVs had been co-opted for specialised biological functions. For instance, syncytin 1 and 2 are genes which are derived from HER Vs and are essential for the development of the human placenta. More recently, a myriad of HERV-derived sequences within the human genome have been recognised as having the potential to produce viral-like proteins and regulate cellular processes. Furthermore, there is evidence that some of these HERVs could be implicated in disease states. Exploring HERVs and Psychiatric Disorders During discussions with Prof. Douglas Nixon, a HERV specialist and immunologist at Northwell Health in New York, I became fascinated by the potential role HERVs could play in the brain. In collaboration with Dr. Rodrigo Duarte at King’s College London, we sought to determine whether HERVs are expressed at the RNA level in the brain — RNA being a molecule that carries instructions from DNA to make proteins — and if their expression is associated with a higher susceptibility to psychiatric disorders. Using advanced analytical tools and data from nearly 800 autopsy brain samples, we explored the role HERVs might play in psychiatric disorders  with greater precision than ever before. To our surprise, we discovered that over 4,500 HERVs are expressed at the RNA level in the human brain, supporting growing evidence that HERVs have more biological significance than previously expected. To understand the role genetics might play in regulating the expression of HERVs, we considered the effects of common genetic variation. Within the population, individuals contain differences in their DNA sequences known as genetic variants . While most of these variants are harmless and contribute to diversity among humans, some can influence an individual’s risk of developing certain health conditions or disorders. In our study, we found that some common genetic variants associated with susceptibility to psychiatric disorders were also associated with specific profiles of HERV expression in the brain. Specifically, the genetic variants regulating the expression of four HERVs, were also associated with genetic susceptibility to major psychiatric disorders. Two HERVs were associated with schizophrenia, one HERV with both schizophrenia and bipolar disorder, and one with major depression. What Do Our Findings Mean? Our findings suggest that HERVs are regularly expressed in the adult brain and that their expression is influenced by genetic variants. In some instances, these genetic variants also correspond to risk factors for psychiatric disorders. This suggests that genetic susceptibility to psychiatric disorders might impart some of its effects through modulating the expression of particular HERVs in the brain. It also suggests that ancient viral DNA in the human genome is connected to brain function and psychiatric disorder susceptibility. Do Ancient Viruses Cause Psychiatric Disorders? Ancient viruses do not directly cause psychiatric disorders. The causes of these disorders are multifaceted, involving complex interactions between genetic and environmental factors. In addition to genetic risk factors affecting hundreds of known protein-coding genes, our findings suggest some HERVs are also affected. The results shed light on new mechanisms that might increase susceptibility to psychiatric disorders. It adds to a growing body of knowledge about the risk factors for psychiatric disorders and their origins, which we hope one day will reveal better interventions and treatments. For instance, it might be that a subset of patients could benefit from treatment that targets HERVs in the brain, but we won’t know this until we test it. What’s Next? We have recently been awarded a Psychiatry Research Trust grant, enabling us to expand our approach and investigate the potential importance of HERVs in neurodegenerative conditions as well. Our findings so far demonstrate that HERVs are also linked to the causes of multiple sclerosis and amyotrophic lateral sclerosis , suggesting an even broader role for HERVs in the brain. Ultimately, we hope this line of research will provide new insights into the role of HERVs in the brain and their importance for mental health and neurodegenerative conditions.

A Personal Account of Navigating Womanhood, Pre and Post ADHD Diagnosis. In the May of 2019, approximately 12 hours before my first A-Level exam, I opened my untouched copy of Shakespeare’s ‘Othello’. Armed with red bulls and seventeen open tabs of various ‘SparkNotes’ pages, I worked into the wee hours immersing myself in the unchartered territory that was my entire two-year A-Level English literature syllabus. This was a studying method I had discovered in my early secondary school years that I continued to employ, increasingly unsuccessfully, right up to my final term of university. I had more or less sailed through school without ever submitting homework, yet always finishing with disproportionately high grades in end of year exams (much to the annoyance of my teachers). My school reports had consistently followed the line that I was exceptionally bright - when I put my mind to it and wasn’t distracting others or staring out the window. This behaviour pattern follows the common experience for young women with undiagnosed ADHD (Attention Deficit Hyperactivity Disorder) . Photo by Bulat Khamitov on Pexels In secondary school I attended a high achieving girls Grammar school. That environment was entirely un-conducive to supporting students who may need extra help - the primary focus of the school was maintaining high grades and therefore a combination of low funding and a disbelief in the existence of female ADHD meant that, as long as grades were flourishing, the rest would go unnoticed. My personal difficulties with ADHD went far beyond those that affected my education. Not unlike many others, I was an incredibly difficult teenager, but concern arose when many issues spanned into adulthood. I had atrocious money management problems - I was always running out of money and regularly built-up parking tickets to the point of debt collection. I couldn’t deal with the stability of relationships and was constantly picking fights. Any room I entered was somehow immediately (and often quite dramatically) untidy. My impulsivity was affecting every corner of my life - fidgeting in lessons was only a fraction of it. Photo by Liudmila Chernetska  on Pexels I had previously been attending therapy sessions for an anxiety disorder and low mood, and presented the idea to my therapist that I might have ADHD. She gave me two forms - one for my parents, and one for my teachers. She suggested I give it to the teacher who knows me the best - a difficult task, as I had spent my time at school flying under the radar academically, and increasingly skipping lessons, so my relationships with my teachers were certainly far from friendly. The one teacher I did choose scored me incredibly low on many of the indicators, not least because it was a poorly designed form designed around the stereotypical ADHD characteristics of a loud and disruptive young boy. These traits are often not recognised in young women, as female gender norms do not connote the more outlandish symptoms of ADHD which leads girls to ‘mask’ their behaviours so as to fit in. Indeed, she even suggested that I avoid ‘putting a label on one’s individuality’. Therefore, I returned to my regular, disorganised, chaos-filled life with even less understanding about why I work so differently to my peers. Not to mention, with my upcoming a A-Levels, I now buried my head in the sand and tried to copy the study methods of my friends - all to no avail.   My personal experience perfectly epitomises the prevalence of the myth of female ADHD. Understanding the differences between the ‘typical’ perspective of ADHD characteristics and those presented in women was critical to my ability to garner sufficient belief from people that I did actually operate differently to them. Albeit, to those who know me best, there was little persuasion needed…   When I was finally re-diagnosed in my third year of University, I began taking stimulant medications and was beyond excited as I thought they offered some magical cure. They certainly helped me focus, although often on entirely the wrong tasks. Just recently, my housemate reminded me of the two-month period when she would return home from a long library day only to find me maniacally trying to deep clean my rug. I had been ecstatic to be diagnosed as I hoped that medication would offer a holistic solution to my problems, although quickly understood it would not be my preferred route. I was disheartened that I felt like I was back at square one, feeling isolated because my peers all seemed to live such well-adjusted lives and now, I didn’t even know where to begin trying. I felt as though we were living in opposition: I've since come to realise that ADHD is not such a binary issue. I could not approach ‘fixing’ my ADHD as one entity, rather that each challenge that ADHD presents must be tackled individually.   Helping the disorganisation side took nothing more than sheer perseverance: I have no concept of time and can’t differentiate how long ten minutes is versus an hour, which affected how long I would dedicate to tasks and caused chronic lateness. Although I still struggle with time blindness, I have to ensure I set disproportionate timings for myself (e.g., leaving an hour to travel a 30-minute journey). I also previously struggled with dysregulated moods, a common factor in ADHD, especially in women. I would often aggravate this by engaging in self-destructive habits - no exercise, unhealthy eating and sitting on my phone all day, to name a few. These habits are like crack to people with ADHD as we’re constantly in search of dopamine-raising stimulation. To counteract this, I had to ensure I focused my time doing things that did not excite me. However, I was very frustrated to find that exercising, eating a balanced diet and deleting apps like TikTok were hugely instrumental in fixing a load of issues in my life (shock). My moods were now more stable, which in turn helped me find joy in simpler tasks. Executive dysfunction is not about a lack of willingness to perform. People with ADHD are fundamentally limited in their ability to balance things like timing, organisation, or impulse control. By nourishing my brain, I am now able to put myself in a better starting position to even begin to consider maintaining some essence of an organised life.   Now that I understand how to mitigate the disruptive facets of this disorder. I wholeheartedly believe that neurodiversity is a strength: I rarely feel stress, often being able to perform tasks even better   under pressure. And, as with most ADHD people, I am highly extroverted and socially confident. The benefits of having ADHD do not come without the necessity of micromanaging every element of my life. Realising that speaking over somebody does not translate as excitement as much as it does rudeness was instrumental in limiting some of its effects on my personal relationships. I often have ‘To Do Lists’ saved as the lock-screen on my phone, and the alarm app punctuates my day in 15-minute intervals, keeping me timely and ensuring I don’t leave my laundry in the machine for three days straight. I have always had a terrible fear of beginning a corporate job as I could only ever envision myself going stir crazy sat at a quiet desk job. However, I recently started a career in recruitment, an industry not unfamiliar to people with ADHD - the fast paced and people-facing nature of it aligns brilliantly with the kind of structure we need. It has been unbelievably reassuring to realise that there really is a stable for every donkey!

Author’s note: Please note, I have decided to use the word ‘women’ for simplicity within this research, whilst recognising that menopause can affect anyone assigned female at birth, regardless of how they identify. My name is Kat Frere-Smith, and I am a third-year National Institute for Health and Care Research (NIHR) Applied Research Collaboration Kent, Surrey and Sussex (ARC KSS) funded PhD student from the University of Kent. My current research investigates the barriers women face to accessing appropriate information and support around menopause. As it is Menopause Awareness Month, I am writing this article for Inspire the Mind (ITM). Menopause marks the end of the menstrual cycle, when the ovaries stop producing as many hormones, and it is actually a point in time 12 months after the last period. This can either occur naturally or because of surgery, radiation or chemotherapy.  Women can experience symptoms related to the hormonal changes ahead of menopause, whilst they are peri-menopausal, and post-menopause. I set out to hear from some of the more under-resourced and under-researched populations in the South East of England (including those living in poverty and from minority demographics), in areas where health inequalities are prevalent. Discussing the big news recently Have you noticed that there has been a shift over the last few years, with menopause becoming more commonly spoken about on social media and on the TV? Celebrities, like Davina McCall , sharing their menopause journeys has certainly contributed. In many ways this has been a good thing, breaking down the taboo around the subject. However, as the discussion has grown so has the risk of misinformation, sometimes leaving women feeling unsure of what to do if they experience symptoms. This month Dr Louise Newson, the self-branded ‘Menopause Doctor’ and founder of the Newson Clinic, published a 66-page report called 'Women's Experiences of Perimenopause and Menopause' . The report emphasises the need for women to be able to access safe, effective, evidence-based treatments. It talks about historic gender bias in medical training and clinicians misdiagnosing menopause symptoms - prescribing antidepressants, painkillers and sleeping tablets when perhaps what might be needed is a hormonal treatment. It looks at the potential impact of menopause on workforce productivity, highlighting that a fifth of all NHS employees and a quarter of GP employees are women of menopausal age. It raises lots of important points. In the same month, however, the BBC aired a Panorama documentary called ‘The Menopause Industry Uncovered’ , which focused on Dr Newson’s private menopause clinic and featured stories from several women who felt the clinic had put their health at risk by prescribing them higher than licensed levels of hormone replacement treatments (HRT). In response, many news articles were published, with some suggesting the Panorama episode was a ‘headline-grabbing shock story’ that could stop women taking HRT and that the real scandal around HRT has been overlooked. The frenzy of debate generated by the Panorama programme illustrates the challenges women frequently face when it comes to the menopause. It is too often the case that many are left confused about who to trust and what to listen to when it comes to accessing support and advice. Dr Newson’s report was based on a survey of nearly 6000 respondents, 96% of whom were white, 43% stated they had already seen a menopause specialist and 79% of them were already on HRT. Getting this number of respondents to a survey on the menopause in the UK is unprecedented, and it certainly offers further insight into women’s experiences.  However, the survey’s lack of representativeness highlights the challenges we have in trying to understand the experiences of the women in our diverse communities across the UK. A lack of diversity, inclusion and representation A noteworthy response to the Panorama documentary came from the team at @blackwomeninmenopause who wrote that they were unimpressed by its lack of diversity, inclusion and representation. They shared that 'Moving forward, we must widen the paths and provide equitable support to ensure that all - regardless of background, race, ethnicity, gender identity, disability or financial means - have the tools and guidance' to access menopause care.  In 2023, the British Menopause Society published the report 'Menopause in ethnic minority women ' , which drew attention to the limited research evidence of menopause experiences in British ethnic minority women and highlighted the need for more research to understand the impact of race and ethnic differences on women’s menopause. The 2022 Fawcett Report showed that black and other ethnic minority women were more likely to experience delays in diagnosis and treatment than their white counterparts. This year’s Health of the Nation Report in Relation to HRT told us that Black and Asian women are far less likely to be prescribed HRT than white women. Researchers at the University of Warwick and the University of Oxford are currently undertaking some valuable work around bridging the gap in menopause care for minority ethnic women.   What are the other barriers women face to accessing information and support? This lack of diversity and inclusivity in menopause research and care is mirrored in varying levels of awareness and knowledge of menopause and access to support. Financial strain has been identified as the variable most strongly and consistently related to menopausal symptoms; women facing substantial financial limitations lack access to health care and related resources. Those with a chronic disease and those who are obese / overweight also tend to suffer from more severe symptoms. Meanwhile, we see a longer duration and increased severity of symptoms in women with a lower socioeconomic status, and women with low educational levels tend to be more severely affected by menopause. We know that those who are less educated and with lower family incomes have less knowledge of the menopause and HRT, and are less likely to access any educational material on HRT. In addition to this, the evidence tells us that GP practices in the most deprived areas prescribe HRT at a rate 29% lower than those in the most affluent areas. We know that women want to be listened to and given the facts to help them feel informed about treatment options. The majority of menopause-specific research to date has focused on symptoms and there has been less focus on women’s menopause-specific knowledge (their health literacy) or their perceptions of health care, support and treatment options available to them.   And so what? What’s next? While there has been some research published into the association between menopause awareness, help seeking and demography (such as those cited above), my review of the academic literature has highlighted gaps in the evidence base, particularly when it comes to the experiences of women from low-income backgrounds. As a result, I set out to collect additional data about women’s understanding of menopause, its symptoms and treatment options, specifically from women from low-income backgrounds. So far, we have collected qualitative data (research that focuses on non-numerical information) through 5 focus groups. These were organised after extensive engagement work, through community organisations with pre-existing relationships with the participants recruited. We heard from women using a community supermarket (a bit like a food bank), women attending an English language class, women facing financial deprivation being supported by a specific charity, women from minority ethnic backgrounds and women in recovery from drug and alcohol addiction. We will shortly be publishing a survey to collect more data from a wider audience, and the questions will be based on what we heard in the focus groups. My aim is to ensure that the insights generated from the research inform future communication and education strategies directed at women in under-resourced and under-researched communities, and my hope is that the work will contribute to a better understanding of how to provide opportunities to support women from all backgrounds at this stage of their life.   Get in touch If anyone is interested in finding out more about the research, has any interesting links to share with me, or would like to get in touch for any other reason, please email me at kjf26@kent.ac.uk .

When perimenopause hit, it triggered a perfect storm , which led to me discovering I was Autistic, aged 58.    After my autism diagnosis, I was cast adrift with some leaflets and a reading list. Over the next six years, I learned how to thrive Autistically. Getting involved in research has been an important part of this journey. I am finally stepping into who I fully am (look out for our paper which will be published in the International Journal of Disability and Social Justice soon).  Bridging the Silos    For the last three years I have been a Community Research Associate on the international Bridging the Silos: Autistic Menopause Study . Involvement in research has been enlightening and cathartic. In the course of this co-produced study we have collected rich qualitative data through interviews, focus groups, creative submissions , and open questions included in a survey. We then analysed the qualitative data using reflexive thematic analysis .   Many of our participants described similar struggles, even though their menopausal journeys were highly individual in terms of when they started, how long they lasted, and what was involved. Accessing support was often challenging because services were fragmented, difficult to navigate, and unadapted for Autistic people’s needs. Individual experiences of menopause were shaped by multiple factors: co-existing health issues and disabilities, relationships, employment, caring responsibilities, trauma, socioeconomic status, and the availability of services locally. Most people felt despondent about the lack of suppo rt available to them, while a few preferred managing things independently. Caught off guard Until very recently researchers have neglected issues which predominantly affect Autistic women , leading a participant in one of the earliest studies of Autistic menopause to comment that autism research  is “all about the blokes and the kids" . Menopause has been similarly neglected , and although it is now attracting considerable media attention, much of the available information lacks a solid evidence-base, is influenced by commercial interests, and targets affluent white women. Many of the Autistic participants in our study described not knowing what to expect or being caught off guard when perimenopause affected them in unanticipated ways. A few participants said they had transitioned through menopause relatively easily while most described struggling, sometimes for years (our paper on this will be published in Neurodiversity soon).   Dismissed and disbelieved Some of our participants described being dismissed by clinicians when they tried to explain their difficulties. Not being believed after desperately seeking help was horribly invalidating. A few participants avoided contact with services altogether because they had prior negative experiences. Even if participants managed to get treatment for perimenopausal symptoms, a lack of follow up contact often left them feeling abandoned and unsupported. Sometimes things spiralled out of control. Several of the accounts were deeply disturbing, indicating that a lack of understanding and support could put people at considerable risk. Some participants described having masked or camouflaged their Autistic characteristics up until perimenopause, when maintaining a veneer of social conformity became too difficult. Pressures they were already experiencing, combined with the additional disruption of menopause, made this life stage a tipping point for autism diagnosis.   During perimenopause I was arrested and spent a night in police custody after an intense meltdown. As an ex-police officer, once I got over the initial shock, I knew how to manage the situation. Incidents like this could be prevented through earlier interve ntion for menopausal emotional dysregulation, and timely recognition and diagnosis of autism rather than a long wait to be assessed .                 The ‘double empathy problem’   Those of us who are diagnosed Autistic often experience considerable stigma, prejudice, and discrimination. If we attempt to blend in, by masking, we expend a huge amount of energy maintaining the illusion that we are just like everyone else, increasing the risk of burnout . Women are generally under more social pressure to ‘mask’ Autistic traits than men which can easily damage their mental health. Individuals who belong to more than one minoritised group face multiple marginalisation which has an amplified effect. Learning more about autism after my own diagnosis enabled me to reframe the challenges I had faced. I realised that many misunderstandings had occurred because people with diverse neurotypes tend to experience things differently and misinterpret each other (the ‘double empathy problem’ ). Communication difficulties are a mutual responsibility, but Autistic people tend to be held accountable simply because we are a neurominority. Victimization of Autistic people is a significant problem in every age group and social context .    Being diagnosed or self-identifying as Autistic can help an individual to find peer support, access relevant information, and reframe negative past experiences. But it’s difficult to develop a positive sense of identity if other people view Autistic traits as deficits. Evidence-based identity-affirming treatment for neurodivergence should be standard practice in mental health services. Focusing on strengths supports the well-being of Autistic people. Resolving past trauma Like many late diagnosed Autistic people , I was burdened with trauma by the time I reached midlife. Bereavement by suicide, and separation from my children after my marriage breakdown created considerable grief and guilt. Bullying, exploitation, and abuse had also traumatised me. I avoided looking over my shoulder, sensing that the past would catch up with me one day. When I sought psychological help post autism diagnosis I discovered that complex issues could not be resolved in a few ‘IAPT’ sessions, and longer-term therapy was unavailable via the Community Mental Health Team (CMHT). All I got was misdiagnosis with Emotionally Unstable Personality Disorder (EUPD) which triggered despair because I knew how difficult it would be to shake off this label. In fact, my EUPD diagnosis turned out to be an “admin error”. This was a careless and dangerous mistake for a mental health service to make given the heightened risk of suicidality for Autistic adults .      Eventually I paid to see an experienced, qualified, Autistic therapist. In this psychologically safe relationship, I addressed past trauma and learned how to flourish by recognising legitimate Autistic needs, developing self-compassion, and setting healthy boundaries. Once again, privilege saved me. The opportunity to have evidence-based therapy post autism diagnosis should be open to everyone. Late autism diagnosis is often experienced as an existential crisis ; being given a few leaflets to read isn’t sufficient. Looking to the future The Bridging the Silos research study suggests that menopause may involve additional challenges for Autistic people, but this finding is tentative. Our study may have been affected by self-selection bias (individuals who had experienced significant difficulties may have been more likely to participate). A follow-on study comparing menopause in Autistic and neurotypical people hasn’t reported yet. Autism affirmative attitudes are gradually taking hold, and Autistic people’s priorities are beginning to influence the research agenda . A major study of Autism from Menstruation to Menopause is underway, in which participants are being contacted several times over a period of years to get a better understanding of their experiences. A multiplicity of factors which contribute to inequity during menopause are beginning to be addressed: gender, sexual orientation , age, socioeconomic status, social class, disability, race/ethnicity , religion/spirituality, geography, war/political conflict, and displacement. We are discovering much more about Autistic ageing, cognition, health and quality of life and developing a more nuanced position on menopause which is usually but not always experienced in mid to later life . Increasingly, menopause is being seen as an opportunity for self-fulfilment and freedom ; even though some people experience negative outcomes this life stage can often be something to celebrate. As diverse menopause is better understood, support is becoming more accessible and inclusive. We are breaking down barriers and bridging the silos. Equity is within reach.

Trigger warning : This article mentions pregnancy and baby loss. As a researcher working in the field of perinatal psychiatry, I am part of a team that focuses on two key periods: pregnancy and the postpartum period. But there is another key aspect of this part of life that is far less researched: pregnancy loss. October is Pregnancy and Infant Loss Awareness Month , and in today’s article, I will be talking about a devastating obstetric condition known as Recurrent Pregnancy Loss (RPL). In this article, I will reference a recently published review in the Brain Behaviour and Immunity - Health Special Issue . Recurrent pregnancy loss is an obstetric condition referring to the loss of more than one pregnancy. Losing a pregnancy at any stage is a heartbreaking experience. Last year, Sarah Jappy, an Inspire the Mind guest writer, shared her story  of losing a pregnancy, and how she created her own coping mechanisms to heal. We know that experiencing repeated losses can intensify the grief and can even lead to significant anxiety in subsequent pregnancies, due to the fear of losing yet another baby. But what causes this condition? The Causes of Recurrent Pregnancy Loss RPL can be caused by a variety of factors, including genetic causes, anatomical abnormalities, and autoimmune conditions. Still, many cases of RPL unfortunately remained unexplained. Since this is an under-researched field, I undertook t his review published in Brain, Behaviour, Immunity - Health , where I previously discussed the immune-associated causes.   We know that the immune system has numerous impacts on various domains of health, both physical and mental. Studies have found contrasting levels of immune cells in women with, and without, a history of RPL. One of these is the Th1 cell, which releases cytokines (proteins that help control inflammation) such as IFNy and IL-2 . Levels of Th1 cells are increased in women who have experienced RPL, compared to those who have not experienced a loss. Another set of cells associated with RPL are Natural Killer, or NK, cells. These are white blood cells which destroy infected cells , like cancer cells. In pregnancy, one type of these cells, called CD56+ NK cells, have been studied. Specifically, researchers have found that in women with a history of RPL, the numbers of the CD56+ NK cells are increased . In contrast, women with no history of RPL have decreased numbers of the same cells , especially in the first trimester, Certain immunological disorders are also associated with an increased risk of RPL. One such example is Antiphospholipid Antibody Syndrome (APS), a disorder of the immune system known to increase the risk of blood clots . When RPL occurs because of immunological factors, some of these, like APS, are treatable.   Experiencing a pregnancy loss is extremely distressing, and it is something that no one should have to go through. When couples experience it more than once, it is even more heartbreaking and can have further outcomes on their individual mental health and that of their partnership. What impact does RPL have on mental health? Studies have investigated how RPL also affects mental health in subsequent pregnancies. When a woman gets pregnant after experiencing losses, she can become anxious throughout the pregnancy due to the fear of losing the baby. Research has found that women who experience RPL have higher levels of stress, anxiety, and depression . However, these symptoms do vary across the trimesters of pregnancy. Researchers have also found that levels of depression and anxiety are highest in the first trimester , reducing as pregnancy progresses. This finding is understandable, given that most losses occur in the first 12 weeks . Research from UK baby loss charity Tommy's has highlighted how the risk of loss diminishes as pregnancy progresses. In their study, they found women who had a heartbeat at their 6-week pregnancy scan had a 78% chance of their pregnancy continuing - this went up to 98% at their 8-week scan. This further reiterates that when women who have previously experienced RPL get pregnant subsequently, they should have additional mental health support , especially in the first trimester, to mitigate the impact of potential anxiety on the pregnancy. Apart from mood disorders, RPL has also been associated with lower self-reported quality of life . How does RPL affect non-birthing partners, you might ask? In a qualitative study conducted amongst men whose partners have experienced RPL, the main themes that emerged related to men taking over in the supportive role for their birthing partner, and that they potentially felt overlooked and marginalised in comparison. In our Fatherhood and Mental Health column , dads have spoken about their experiences of being overlooked in the perinatal period. So, the results of this study, along with the lived experience of our ITM writers further reiterate that fathers need support too, and avenues to support their wellbeing must be integrated into perinatal services. My colleague Kristi Priestley in this ITM article writes about fathers and perinatal loss if you’d like to know more. Talking about loss and raising awareness goes a long way Last week was Baby Loss Awareness Week . In line with this, the UK Government announced that baby loss certificates would be offered to any family who lost a baby before 24 weeks , no matter when their loss happened. This is a big step in recognising families who lost their pregnancies, even if this might have been many years ago. While not everyone might want this certificate, other families see this as recognising the lost pregnancy and acknowledging the baby. As an example, Olympic swimmer Rebecca Adlington said in a recent article that this loss certificate helps keep her lost daughter a part of the family. Something that I witnessed on social media which truly touched my heart was the Wave of Light , which took place on the 15th of October. This act encourages you to light a candle at 7 pm, recognising all the babies who passed away, bringing families from all over the world together, recognising their lost pregnancies, and remembering their babies. To conclude, ultimately, my initial research into this field has shown me one thing: We sadly do not discuss pregnancy loss enough. As this is such a sensitive topic to talk about, there is often hesitation to address it adequately. There continues to remain so many avenues unexplored, which, if addressed, would benefit so many families around the world if they knew a little more about how to manage the condition. Ultimately, the goal is to give birth to a healthy infant, while also protecting the mental health of all those involved. As an emerging researcher in this field, I do hope that we get the chance to research this more to improve outcomes. Pregnancy loss matters, and it is high time that we started talking about it.