Eight evidence-based approaches to beat burnout Two years into coping with the pandemic, evidence-based tools and techniques to beat burnout are vital for our mental health. Photo by Dids  on Pexels— Sleep is one evidence-based strategy to counter burnout The COVID-19 pandemic changed life as we know it. On January 9th 2020 the WHO announced Coronavirus-related pneumonia in Wuhan, China. Two years later, the new Omicron variant of COVID-19 continues in circulation. How ever much we want it to be so, a clean ending to the pandemic looks unlikely. By this point, fatigue has set in. Burnout combines exhaustion with cynicism and a reduced sense of competence. It can result in serious physical and mental health consequences, including substance addiction, Type 2 diabetes, and insomnia (difficulty falling asleep or staying asleep). Unfortunately, as well as the health consequences, professionals experiencing burnout may be unable to return to work, depleting the workforce further, and in turn, the economy. This is a double blow, given that some of the workforce is already absent due to contracting or exposure to the virus. Recently, Charlie Massey, Chief Executive of the General Medical Council stated: “The danger is that, unless action is taken, workloads and wellbeing will continue to suffer, and future burnout rates could get even worse. As we move on from the pandemic, it is vital that doctors’ training and wellbeing needs are central to service recovery plans.” Burnout in healthcare workers is a global phenomenon . Stressors include a high workload, insufficient Personal Protective Equipment (PPE), lack of knowledge, long working hours, and direct exposure with patients. A study among 3,100 nurses and 992 physicians working in Asian intensive care units in 16 countries in Asia found that nurses and physicians had high levels of burnout, 52 and 50.3%, respectively . Whilst healthcare workers are particularly affected, the pandemic affects us all and workers in other types of industries are also at risk of burnout. Because burnout was already a major issue in healthcare jobs before the pandemic, a lot of the evidence of what works draws on studies with health care providers. In general, for all professionals, if you have a heavy workload and work long hours, have difficulties maintaining work life balance, you work in a helping profession and you have limited control over your work, you are at increased risk of burnout. This blog is the final piece in a 3-part series on the topic of burnout for digital magazine, Inspire the Mind . As a recap, part one offered up an introduction to the science of burnout. Part 2 looked at the effects of Zoom in relation to burnout . In this final blog, I’ll share 8 evidence-based ways to prevent or recover from burnout. As a researcher at the Evidence Based Practice Unit , I’m passionate about projects that are based on evidence of what actually works. I think that it’s important we refer to the evidence base before testing out programmes that sound great but might not actually work. Most of us wouldn’t take a drug if it had not been scientifically tested, so perhaps it’s important to exercise a degree of caution with our mental health. First, a quick recap on how psychologists define burnout. Researchers, Maslach, Schaufel & Leiter, describe the concept of burnout as having 3 parts, that include: Emotional exhaustion , this means feelings of being emotionally overextended and depleted of emotional resources Depersonalization, refers to workers’ negative, callous, or excessively detached feelings towards their clients/customers Reduced personal accomplishment and equates to feelings of incompetence and lack of achievement at work (Maslach, Schaufeli, & Leiter, 2001). As established by the World Health Organisation burnout is a workplace phenomenon. Why is it important to draw on evidence-based interventions to tackle burnout? It takes a lot of resources and time to deliver a programme across a whole organisation, or even within one department. Before embarking on solutions, checking existing research for evidence of if a program works in other settings increases the chances that it will “work” for employees in the organisation. Evidence that a programme is really effective is most reliable when a trial has been conducted with a control group (a more or less identical group of people that have not received the programme to compare with the group that had the programme), and there are a number of different peer reviewed studies (subject to critical examination by specialists in the field). Evidence based programmes to burn out have ideally been tested on a large group of people, multiple times. Other factors that inform evidence-based interventions (and if a program might work) include a clinicians perspective and an individual’s values. Disclaimer: this blog is only a rapid overview and a full systematic review is needed on this topic. 8 EVIDENCE BASED STRATEGIES ONE. Cognitive Behavioural Therapy (CBT) to Reduce Stress The good news is that t here is lots of evidence that CBT can reduce stress, burnout and promote wellbeing . CBT is one of the most widely used approaches to treat depression, anxiety and stress, here in the UK it’s available from the NHS for a range of mental health difficulties . CBT involves a technique that can be quickly applied to change thinking patterns that in turn have an effect on behaviour. CBT may be learned via a pre-recorded video or taught by a facilitator or therapist. CBT programmes often include: Recognising unhelpful automatic thoughts and unhelpful beliefs. Automatic thoughts are those that just pop into our heads unfiltered that may not be based on facts. For example, “I’m terrible at choosing gifts”. Recognising them is like conducting “quality control” where we check that our thoughts are warranted. Unhelpful beliefs are things that we tell ourselves all the time but may not be true. Setting goals — setting goals can help us to achieve what we want from life and work and from the therapy itself and provide greater meaning and a sense of achievement. Understanding your attributional style — how we understand the meaning of events and what causes them. Identifying thinking patterns such as — catastrophising, the tendency assume that the worst outcome might follow from a small event. The challenge is that, whilst effects are seen after the intervention, these changes are not always maintained months after the intervention. TWO. Coping interventions Coping is key to managing stress. Programs that teach coping strategies have found to be effective , for example, coping and support groups for nurses to increase coping with difficult situations and encourage positive coping strategies. Lee’s review of a range of studies found that coping interventions for 6 month to a year led to a reduction in emotional exhaustion, depression, and ultimately burnout among nurses . Coping can involve confronting a problem head on, while avoidance is an aspect of burnout. A range of coping strategies may be used in a given situation that include confrontation, distancing, self-control, seeking social support from others, accepting responsibility, putting our head in the sand, avoidance, problem solving, and positive reappraisal (viewing the problem in different terms). Coping interventions often enable people to consider some of the disadvantages of their current range of coping strategies (e.g., watching Netflix) and provide them with new ones, (such as seeking support, exercise and meditation). THREE. Novel approaches There’s some evidence for novel approaches that are less widely researched. A study of Qi jong for physiotherapists found that emotional exhaustion decreased amongst participants that engaged in “White ball exercises”. Massage and touch therapy has had mixed results with some studies finding it effective and others not . Workplace appreciation events were found to have a significant effect in increasing performance and reducing depression and burnout among nurses and physicians. Photo by Herbert Santos - Some research finds that martial arts can help beat burnout. FOUR. Learning and skills training and professional identity development Learning and training can reduce burnout in mental health care workers . Interestingly, these types of interventions also increase employee performance. The pandemic has been a huge learning curve and those organisations that have learned and adapted have succeeded. Professional identity development programs have also been found to reduce burnout of the nurses. FIVE. Taking a holiday Photo by Stefan Stevancik on Pexels Taking a holiday may not change the organisation, but there is some evidence from an Israeli study led by Etzion and colleagues that it can reduce burnout in the short term, but it’s not maintained upon return to work . With lockdowns and shortages of staff, there may have been much less opportunities for staff to take holidays and to take holidays that fit with our ideas of holidays (covid testing pre, during and post trips can change our notion of what a short get away looks and feels like). SIX. Practice Psychological Flexibility Researchers have found that people that are psychologically flexible, are better able to cope with setbacks in a work environment and studies show effectiveness at reducing burnout. Psychological flexibility refers to being aware of the situation you are in and taking action based on your own values. SEVEN. Learn mindfulness Mindfulness involves observing one’s thoughts and feelings from a noncontrolling, nonelaborative, and non-judgmental perspective: A way of thinking commonly described as mindful . Mindfulness is a skill that can be learned as outlined in this blog . Researchers Luken and Sammons (2016) ran a systematic review of mindfulness practices for reducing job burnout in health care professionals and teachers. They found evidence that mindfulness practices effectively reduced job burnout. Other reviews find evidence of mindfulness reducing related conditions of anxiety and depression. Inspire the Mind has previously published blogs on what mindfulness is and on its scientific basis . EIGHT. Sleep Photo by Ketut Subiyanto on Pexels We are asleep for up to a third of our entire lives. The links between poor sleep and burnout have been well researched particularly for healthcare workers and nightshifts workers. Guidance for improved sleep includes: aim to get 7–9 hours per night, avoid drinking before bed, only use beds for sleep or sex, keep the bedroom quiet and relaxing, limit bright light exposure in the evenings, be careful of naps disrupting sleep patterns. Light from both lamps and screens can potentially disrupt circadian rhythms. The links between Sleep loss, burnout and health conditions by Stewart and Aurora, 2019 Takeaway In summary, 8 evidence based strategies have been briefly proposed: 1) Cognitive behavioural therapy 2) Coping interventions 3) Learning and skills training 4) Novel interventions 5) Taking a holiday 6) Psychological flexibility 7) Mindfulness 8) Sleep These approaches can be pursued through self-help books, online videos, apps, joining a mindfulness course online or in person, or seeking support from a licensed therapist or coach. Hopefully, employers will also be seeking to assess risk of burn out in their organisations and put strategies in place to maintain the wellbeing of their employees. Finally, there are other strategies, from talking to your employer about your mental health, to employers practicing better communication with staff to forming a support group for working parents. It is not that these other strategies do not work, they are just less studied in the literature. Many thanks, valued readers, for reading.

Sometimes I write on my research. Sometimes on topics I am politically passionate about. Sometimes on things that happen to me. And sometimes a scene from a tv series affects me so much that writing about it is the only way for me to understand why. Welcome to my attempt to emotionally and cinematographically dissect the famous scene “Max’s favourite song/Running Up That Hill” in #StrangerThings4, Chapter 4. Spoiler alert: if you have not seen this chapter, or indeed the series, come back here after you have done so. Max in Chapter 1 of #StrangerThings4, while listening to Kate Bush’s Running Up That Hill. Image source: Netflix. Let me do the “professor thing” first. I don’t want to claim that #StrangerThings4’s writers are particularly knowledgeable in mental health topics. The depiction of the asylum (also in Chapter 4) is a mix-and-match of the worst movie tropes depicting psychiatry and psychiatrists, from One Flew Over the Cuckoo’s Nest to The Silence of the Lambs . And the whole narrative of the final #StrangerThings4 chapters is based on the discredited theory of repressed memories  — let alone the unbelievable premise that you can re-live part of your life by simply floating in a dark bathtub with your eyes closed while videos of your childhood play on the ceiling. There is no attempt to be scientifically accurate here. But. Someone among the writers who delivered the “Max’s favourite song/Running Up That Hill” scene must have had profound personal knowledge of what mental pain truly is. And how the monsters of the mind feed on shame and guilt. This scene has excited viewers , has been discussed in the news , and has projected the song at its centre, Kate Bush’s 1985 song Running Up That Hill , at the top of the charts again. For those who don’t know the main story underpinning the tv series Stranger Things , Max is part of a group of friends that fight against dark supernatural forces killing people in the fictional town of Hawkins, Indiana, in the early-to-mid 1980s. Within the horror/sci-fi/teen drama genres, the series explores themes such as the transition from childhood to adulthood and the true horror of “not fitting in” in high school. But the main theme of Season 4 is mental pain. The new monster, Vecna , kills adolescents that suffer from mental pain. Image source: Netflix Chrissy, who is killed in Chapter 1, has an abusive mother. Fred, who is killed in Chapter 2, has caused a girl’s death in a car crash. Patrick, killed in Chapter 5, has a violent father. Nancy, whom we leave at the end of Chapter 7 possessed by Vecna, is haunted by the death of her friend Barb at the hands of the Demogorgon, another monster, in Season 1. And Max suffers from unbearable guilt for her brother’s death. We know from Season 3 that Max’s brother, Billy, is killed while fighting the dark forces, and in doing so he saves Max and her friends. Max herself talks about her guilt in the lead up to the scene, reading a letter to Billy sitting by his gravestone. Image source: Netflix Max: “I play that moment back in my head all the time… I imagine myself running to you, pulling you away… but that’s not what happened… I stood there, and I watched… for a while I tried to be happy, normal, but I think that maybe a part of me died that day too… and I haven’t told anyone this, I just can’t…”. And this is when Vecna arrives. Because Max’s inability to connect to her friends is what truly feeds the monsters of her mind — the monsters that Vecna symbolises. Max has shut everybody out. She has broken up with her boyfriend, Lucas, and has pushed her friends away. Lucas tells her this in the lead-up to the scene. Lucas: “Just talk to me, to your friends, we are right here, I am right here… I am here”. But Max does not connect . She is not here . This is the central and painful symptom of mental anguish. This feeling of shame. The inability to share the pain we feel with the people who are closer to us. Instead, the monsters. Call these monsters depression, workaholism, or just fear. The monsters feed on loneliness and shame. This is when Vecna arrives, and the scene starts. You can watch it all here and then look at the stills below. The scene starts when Vecna kidnaps Max from the real world, traps her in a different dimension (the “Upside Down”), and ties her up with his tentacles on a sacrificial pole. Max’s emotional detachment now becomes a physical one. Now she really is not here anymore. People who are in mental pain describe this as a feeling of numbness, or as being behind a glass wall. The scriptwriters put a real inter-dimensional wall between Max and the people she loves, and who love her. In the real world, Max is in a state of trance. Max’s friends’ only hope to reconnect with her across the two dimensions is by using music. They decide to use Max’s favourite song — Kate Bush’s Running Up That Hill. They start the music, and Max and Vecna can hear it. The music opens a passage, through which they can both see her friends on the other side calling her. The cinematographic dance between their dialogue, the song’s lyrics, and what Max sees in her mind, is just astonishingly beautiful and powerful. Friends: “Max, wake up. We are right here.” Image source: Netflix Lyrics: You don’t want to hurt me, But see how deep the bullet lies. Unaware I’m tearing you asunder. Ooh, there is thunder in our hearts . Vecna: “They can’t help you Max. There is a reason you hide from them. You belong here with me.” Image source: Netflix Lyrics: It doesn’t hurt me. Do you want to feel how it feels? In the real world, Max starts to levitate. We know — and her friends know — it means she is going to die imminently. Image source: Netflix Lyrics: If I only could, I’d make a deal with God, And I’d get him to swap our places. The scene continues to cut between a montage of Max’s memories, her fight with Vecna in the Upside Down, and her trance state in the real world. Because this is what mental pain feels like. You are both with your monsters and with your friends. In your nightmares and in the real world. All the time. In Max’s mind: multiple memories of her and her friends. Lucas telling her again “I am here”. And scenes from her past. Laughing with Eleven. Dressed up as Ghostbusters with Dustin and Lucas. Skating with Mike. Shopping. At the cinema. Hugging. Kissing. High-fiving. Image source: Netflix Lyrics: C’mon, baby, c’mon darling, Let me steal this moment from you now. C’mon, angel, c’mon, c’mon, darling, Let’s exchange the experience, oh Through the energy that she gathers by acknowledging that her friends love her, Max manages to rip off the tentacles and she runs toward the opening. Image source: Netflix But it is not finished. Recovery is not so easy . The monsters will throw everything they can at you. They don’t want to let you go. And so Vecna starts shelling Max with big rocks that fall from the red skies. She is running and running. She falls, she gets up, she runs again. Image source: Netflix Lyrics: And if I only could, I’d make a deal with God, And I’d get him to swap our places, Be running up that road, Be running up that hill, With no problems. Now I become tearful. She is not going to make it , I say desperately to my wife, who is also tearful by then (I talk in Italian, actually: Non ce la fa, non ce la fa!) Max is running and running, toward her friends. Cut to black and to silence. I really thought she would die. That the monsters would have taken her back. But she makes it. She reaches the opening. She returns to real life, back with her friends. Lucas: “I thought we lost you.” Max: “I am still here.” Image source: Netflix I know from my clinical experience as a psychiatrist, and from my personal psychotherapy, that recovery from a mental health problem is strengthened by sharing our pain with others. Of course, it’s not enough to run to your friends just once. And each step that Max takes toward the people she loves — in the mud, under a shower of boulders — is weeks and months of recovery in real life. But the scene works because it touches our hearts. The right message. The right symbols. The right conclusion. We can escape our monsters, but only by sharing our pain with others.

On a Sunday evening in August this year, I was on my first on-call shift as a trainee psychiatrist in a leafy psychiatric hospital. After a day of walking between old buildings which had been converted into wards, tending to patients’ mental and physical health needs, I decided to have dinner on the grounds. Image Source: Will Paterson on Unsplash As I sat on a bench with my microwave meal, I noticed a man coming towards me over the hill. The setting sun obscured his face, but I could see he was dressed in casual clothes, stooped over and heading in my direction. He was probably a patient on one of the wards I had worked on that day. I thought about how we allow some patients on unescorted leave to roam the grounds, even when they have been sectioned. Apart from him and me, the place was entirely deserted. Stories came into my head of psychiatrists facing harassment and violence on hospital grounds. I thought about getting up, but how would it look if I, a doctor, tried to avoid one of my patients? So, I stayed put, but I could feel my heart begin to race. When he reached me, his face became clear. Judging by his salt-and-pepper beard, he was in his sixties. He stopped, smiled, and said, “Lovely evening, isn’t it? Nice to see you.” Then he continued onwards. As he walked away, I was filled with a sense of relief. After the relief came the shame. In that moment, I had made a snap judgment: I saw a psychiatric patient and instinctively feared for my safety. That moment was the painful wakeup call that l, a woman who has been studying and working in the medical field for almost a decade, still held a deep-rooted bias against my patients. Image Source: Dawit on Unsplash I see echoes of that moment in my experience with other colleagues in the hospital every day. In A&E and on acute medical wards that serve the sickest patients, people who are suffering with acute mental health problems are often seen as inconvenient, difficult and dangerous. A person who is having an episode of psychosis may misinterpret a friendly face as a sinister one, then react with outbursts of verbal and physical aggression in an attempt at self-protection. Another patient may be confused and in need of the attention of several healthcare staff, who then have to neglect their other patients to give this one time. Many medical colleagues cannot wait to hand patients like these over to the psychiatrists, with the hope that they will get whisked away to an entirely separate hospital, like the one where I work. It is important to emphasise that people living with serious mental illnesses, such as schizophrenia, are not a danger to others. In fact, people living with mental illness are far more likely to be the victims of crime than perpetrators . Yet, the stigma against mental health exists in the public space, and it is in fact getting worse . This also trickles into the medical community too. From as early as medical school, people find it challenging to deal with mental health patients, and try to avoid doing so as much as possible. Mental health is one of the biggest causes of disability worldwide , however in relation to physical health conditions, such as diabetes and heart disease, it is relatively less understood, researched, and funded. Doctors carry this stigma not only towards their patients, but also towards themselves. Levels of anxiety, depression, and burnout are at an all time high among clinicians, yet many are reluctant to seek treatment. Many doctors believe that if they disclose their own mental health struggles or ask for help, then they may be inviting potential repercussions for their career. If those of us inside the system cannot acknowledge our own struggles without shame, how can we be expected to treat patients without judgement? The attitudes of healthcare professionals toward psychiatric patients may also be shaped by racial bias . In the UK, black people are nearly four times more likely to be detained under the Mental Health Act (‘sectioned’) than white people. Under the Act, people with mental health problems can be held in hospital for assessment and treatment, against their will. Detaining someone under the Act is restrictive and often considered to be a last resort: to be used when efforts to help someone in the community have failed. Once discharged from hospital, people who are given a Community Treatment Order (CTO) can be made to return if they do not comply with certain rules. Black people are eight times more likely to face excessive restrictions through CTOs.  The reasons for this disparity are multifaceted. People from minoritised ethnic groups are less able to access mental health support when they need it. As well as racism, other contributing factors may include socioeconomic inequalities and mistrust of services due to historical barriers, which can lead to people presenting later and only once already in mental health crises. Image Source: Ümit Bulut on Unsplash That evening on the bench taught me a difficult truth, which is that doctors are not exempt from the very prejudices we criticise in the system. Mental health stigma, especially based on race, is harmful for everyone involved. One of the first steps is to acknowledge that the problem exists, and accept our role in its perpetration. Dealing with this issue will require an honest and collective effort between communities, mental health professionals, and policy makers. In a time of rising racial tensions in the UK, let us not shy away from difficult conversations about our view of mental health, and the biases that colour it.

Do you ever think about why you were born where you were born? I was born in France because a border opened. When France granted Tunisia independence in March of 1956, my father crossed the Mediterranean sea along with thousands of others, carrying with him a language, a faith, a culture, and a hope that the new world would be gentler. That decision between a man seeking opportunity and a nation opening its borders shaped my existence before I ever took my first breath. It decided who I would be, the languages I would speak, and where I would call home. Image Source: Instagram @henryzw As a student in neuroscience and psychology at King’s College London, I have always been interested in empathy, resilience, and the mind-body connection, and how these take shape in people’s lives. This piece comes from trying to understand how identity is shaped not only by personal experience, but by the borders around us.   Growing up, my sense of self was split between my parents’ nostalgia for the places they’d left behind and my own need to belong where I was. Soon, a feeling of unbelonging set in. In France, I was the Arab girl. In Tunisia, I was the French girl. Only on those summer crossings across the Mediterranean Sea from Marseille to Tunis did I ever truly feel at home, surrounded by others who, like me, also lived in-between, carrying languages, memories, and cultures from both lands. The boat was our shared borderland, proof that identity could be plural, even if the world refused to see it that way. I learned early that politics doesn’t just live in parliaments and history books. It moves through families, seeps into childhoods, and reshapes how we see ourselves.   Image Source: History in HD on Unsplash The first time I realised how fragile belonging could be was on September 11 th 2001. The shift in atmosphere was immediate. During la “récré” at school, when all children meet, conversations changed. Friends I had previously felt at ease with now spoke as if there was a line drawn between us. It seemed as though the world was asking me to choose a side, yet it had already been chosen for me. I wasn’t just Halima anymore, I was the Muslim. A word that once meant family, tradition, and faith now carried with it accusations. Overnight, it turned into a label others used to measure how threatening I might be. So, I started editing myself, lowering my voice, erasing parts of who I was. I remember hesitating over the “Muslim” box on job applications, wondering if “honesty” was a risk I could afford. Years later, I moved to the UK. During Brexit, that same unease would return. The quiet fear that belonging could once again be redefined without my consent. As a French citizen, remember the anxiety that came with uncertainty, checking the news every day, wondering if a vote or a policy might decide whether I could stay. Eventually, I was granted indefinite leave to remain, but the uncertainty clarified something. Citizenship, I learned, is not just a passport; it is a fragile permission to feel at home. Even now, that sense of instability lingers. Borders keep shifting, sometimes on maps, sometimes in laws, and sometimes in people’s minds. As I watch what is happening in Palestine, I am reminded that these lines are never just political; they are deeply human. They decide who gets to live in safety, who is seen as deserving of empathy, and who becomes invisible.   Image Source: Christian Lue on Unsplash My life has been shaped by borders inherited, imagined, and imposed. But what is happening in Palestine, and in so many places like it, reminds us that these borders shape our collective humanity too. They determine how far empathy can travel, and how easily the world forgets that every line drawn on a map cuts through someone’s life. And, as we scroll our social media, the unbearable grief streams past: Gaza, Sudan, lives unraveling. Wedged between a recipe, an influencer’s makeup ad, and someone dancing. I often wonder what this constant collision between tragedy and triviality is doing to us, collectively, as we witness threat after threat with almost no meaningful action available. We refresh. We repost. We send money. We argue. And then the algorithm lifts us onto something lighter: someone’s lunch, a dog video, a joke. How it this reshaping the way we feel, empathise, and cope. What does it mean for our minds to witness so much, and to be able to do so little?   This oscillation can look like numbness from the outside. But often it is the nervous system doing what it must to keep us going: dipping in and out of tolerable windows of feeling. It isn’t apathy; it’s survival. Still, survival has side effects. Prolonged exposure to the world’s pain can blur compassion into exhaustion, and exhaustion can harden into detachment. The danger isn’t just that we stop caring; it’s that we stop believing our care matters.   When I think back to my father stepping onto that ferry in the late 1950s, I picture a border opening both on paper and in the mind. A possibility. A permission. He didn’t know he was boarding a ship that would deliver me a different language, a different school, a different harbour to grow up in. He just knew that he was moving towards a life that might be kinder.   Image Source: Max Böhme on Unsplash I don’t have easy answers. I only have a life that has been narrated by openings and closures, by papers stamped and faces scanned, by the relief of being waved through, and the shame of being questioned. I have the memory of a boat where I felt both French and Tunisian and fully myself, and the knowledge that many people never get to feel that way anywhere.   Borders will continue to shift. The question is not whether lines exist but what kind of people we become in relation to them. Do we narrow our circle of concern until only the familiar fits inside, or do we widen it, even when widening hurts?   Perhaps the smallest, most radical act is to refuse to let our compassion be automated by an algorithm. To choose, deliberately, to look and keep looking. To tell the longer story. To notice the person who is asked, again and again, “Where are you really from?” and to understand the weariness behind their smile. To remember that for every policy there is a family; for every statistic a child; for every map a pair of hands that must carry something precious across a line. I was born because a border opened. Many are living and dying because borders close. Between those two facts is our responsibility: to keep enlarging the space in which more people can belong, and to keep insisting that belonging is not a zero-sum game.   Image Source: Max Böhme on Unsplash

And there we have it. As of October 2025, boyfriends have become embarrassing... well, according to Vogue .   An article published in Vogue on 25 th October talks about boyfriends being embarrassing, and how women are uncool or losers because they have romantic partners. This controversial piece has been discussed all over social media and on popular news outlets , with Instagram celebrities sharing their opinions, either agreeing or disagreeing with the piece.     I came across the piece when a content creator I follow on TikTok, who is recently single, was talking about how glad she is to be single, because of the Vogue article. Of course, I had to go and look at the article for myself, as someone in a long-term relationship.   Photo by Laura Chouette on Unsplash What did I like about the article? I’m all about women supporting women, so I will first start off with what I liked in this article. I like that the overall message is all about women claiming their independence, and that “ being partnered doesn’t affirm your womanhood anymore”. I like how they say that being partnered isn’t considered an achievement. So many more things make women successful: degrees, jobs, confidence, creativity and knowledge, to name a few.   And I do apologise for saying this, but this is the extent to which I agree with this piece.   So, why am I critiquing this?   Spoiler alert, I’m one of the few who totally disagreed with the piece.   The first thing that annoyed me was that the article quoted someone who said that women who have partners are “normies”, a slang term for someone ordinary or conventional, someone who doesn’t have any unique thoughts or opinions. They say it makes women lose their “aura”.   Frankly, it does bother me to be called a normie just because of my relationship. I’m sorry, but I’m a confident and independent woman who has plenty of aura (if I can say so myself), and my partner loves me for that, above all for how I stand up for my own rights and do exactly as I please. And my friends who are in relationships have plenty of aura. I don’t think being in relationships has made them boring or unlikable. We have just as much fun when we have girls' days, and don’t feel the need to talk solely about our partners because of the 1000s of other exciting things happening in our lives. So, I really feel that you can claim and affirm your womanhood while simultaneously being in a relationship. I feel that healthy relationships are a two-way street, providing support in times of difficulty, allowing one another to be vulnerable, and above all, growing together and achieving life’s big milestones as a unit.   Photo by Philip Oroni on Unsplash+ The article also states that women don’t post their boyfriends online because they’re afraid of losing Instagram followers. This really made me laugh. Come on, it’s 2025. Unless you're an influencer, who really cares about how many followers you have on social media? I can’t remember the last time I looked at how many followers either I or someone has. Isn’t that so 2014? At this point, I should say, in our world today influencing is a real, lucrative career. In that context, where posting online is your job, I understand if you don't post your partner online, since this isn't a private social media feed. It's totally justified, considering your posts are in line with brand deals, and endorsement, and you might not want to put your relationship on this page, since it's private and personal.   She also quotes a content creator who said that being single gives women the ultimate freedom to say and do what they want. I don’t agree that a relationship means you can’t have freedom. It is possible that you don’t have freedom if you are in an unhealthy relationship, but a true, healthy and positive relationship should mean that you have the freedom to do what you want, wear what you want, and above all else, have your own opinions. I have never been told by my partner what to wear. Ever . I have never felt that my freedom has been curtailed in any manner.   In the conclusive paragraph, the author says, “ Obviously, there’s no shame in falling in love. But there’s also no shame in trying and  failing  to find it – or not trying at all.”   So then, why are you shaming women for being in relationships? Why are you calling them condescending words, like losers and normies? I’d never ever think (or even consider) my single friends as losers, so why are partnered women not being held to the same standard?   I totally understand that my opinion is just one among a sea of thoughts. So, as a researcher, I felt it was appropriate to see what others thought of this. What did others think of this?   One of my friends, a female in the 25-30 age group (who disagreed with the piece) said, “I think it’s an interesting article, but I just don’t really get the general discourse around it. If you want to have a boyfriend, great. If you don’t, great. The same goes for posting. Why does who women are and how we look at them need to be about men? What happened to supporting one another as women?”   In contrast, of my coworkers in the same age range (who agreed with the piece) said, “The crux of it is that women no longer have to, by necessity, have a boyfriend to ensure our futures. So, if we choose to remain with a boyfriend who detracts from our quality of life, that is embarrassing.”   Another friend, in the same age range agreed with the part where the writer talks about how bad the dating pool is. She also stated that perhaps women don’t want to flaunt their relationship to their single friends, as they don’t want to be perceived as being boyfriend-obsessed. Photo by Brooke Cagle on Unsplash I do wish the article were more about the fact that women are claiming independence, and success doesn’t mean being partnered any more. I wish it weren’t an attack on women who are in relationships. If the article is all about empowering women, why do you simultaneously put them down?   The bigger picture is that women today are strong and independent, with skills and characteristics to look up to. As a South Asian female scientist, when I look at role models, I don’t judge them for being in relationships. That doesn’t even cross my mind. I look up to those who are able to reach incredible heights, to become professors, while also having successful relationships.   I don’t think there’s anything wrong with wanting to have an incredible career while also focusing on family life. Alongside building a successful career in academia, I also want to be a great daughter, partner, and eventually a mother. Wanting these things doesn’t make me a loser—it makes me human.

A few months ago, I found myself in a situation where I couldn’t say a single word in my mother tongue. Image Source: Sunguk Kim on Unsplash I’m a Paris-based Russian reporter, and for more than three years I have been covering anti-war resistance in my country. At this point, I should be used to the war in Ukraine.   But when I recently met a Ukrainian artist at a party, something strange happened.   I introduced myself to him in English . But since many people from post-Soviet countries in the room were speaking Russian (which is our common language), he asked : “Do you speak Russian?”.   “Yes,” I responded . “But I’m ashamed to speak it with you .”   That was the first time I had spoken with a Ukrainian since the war began. At that moment, I realised, with tears in my eyes, that I've never been able to overcome the feelings of guilt and distress that the war in Ukraine caused me. And so, I knew I had to write this piece.   The shock   What was I doing when my country invaded Ukraine? How did I get through the first weeks? Through the first year?   My memories are hazy, but I remember sharply specific scenes, sounds, and words.   Vladimir Putin announced what he called “a special military operation” on 24 February 2022 at 4.30 AM, Paris time. I didn’t sleep that night in France, and neither did my loved ones in Russia. We were all waiting for something to happen…   I remember listening to the last Russian opposition radio station, Echo of Moscow. The presenter said, in a trembling voice: “Our future and our children’s future has just been taken away from us.”   A week later, the radio station went off air, banned by the Kremlin. One of the shows was suddenly interrupted by a beep-beep-beep sound. And then there was silence. That was the sound of my country becoming a totalitarian state.   I remember the almost immediate cessation of flights between Russia and the West, including direct flights from Paris to Moscow, which I had taken all the time. It felt like the connection with my loved ones back home had been physically broken…   The guilt   I remember the words of one of my family members, addressing my younger relatives who were still in the country: “Leave, flee – you have your whole lives ahead of you. As for us, we’ve lived long enough; we will stay on this submarine until the end.”   And so, they left. Today, for our safety and for reasons I can’t detail here, none of us can travel back to Russia.   I still feel the guilt for having abandoned my elders.   But what was most difficult was this unbearable feeling, which is hard to name (guilt? shame? or a combination of both?), for what my country has done.   In the weeks following the invasion, every morning I struggled to get out of the shower. I remember the sound of the water running, and thinking, “I want to stay here forever, and never go outside again – and look anyone in the eye.”   And then one day, I had what I only later understood to be a panic attack . It happened on a rainy day in March. I was sitting on a park bench, with no one around who could help me. What’s more, I felt that no one could possibly understand why I was feeling that way…   It was all building up: the guilt, the anxiety, the worry for my loved ones. I knew I wasn’t alone in feeling that way – I discussed this, but only briefly, with other Russians I know. Briefly, because we knew that the suffering of Ukrainians was much bigger and more important, and so we felt ashamed to talk about ours.   And when the data on the toll of this war on the mental health of Russians came out, I wasn’t at all surprised by the numbers. I will never forget one statistic: in the months following the invasion, Russians spent 70 percent more on antidepressants than during the same period the previous year.   Image Soyrce: Hannah Xu on Unsplash   Work, work, work   I felt that the only solution was to work hard. Work to keep myself busy; to tell as many stories of anti-war dissidents in Russia as I could, so that those people could have a voice.   But many of these stories only worsened my mental health. After I interviewed the girlfriend of poet Artyom Kamardin, who was tortured and imprisoned by the security forces for an anti-war poem, I had nightmares for at least a week.   What gives me nightmares, too, is the burden of responsibility: I must somehow make sure that my work doesn’t cause any harm to the people I interview inside Russia. What terrifies me is the intentionally vague legislation, passed by the Kremlin in the aftermath of the invasion, which allows the authorities to punish anyone they want, for any reason.   And although (God knows) I do my best to protect the people who speak to me from inside Russia, I can’t help but have thoughts such as: “What if they forget to delete our chat history and it is seen by the authorities? What if the article itself causes them problems?”   When someone speaks out under their own name, I can only pray that there are no consequences for them.   And even though I’m not in Russia, I soak up the climate of terror and paranoia in which these people and my loved ones live. Since the beginning of the invasion, we have begun to use indirect language when discussing the numerous topics banned by the Kremlin (including the war itself).   And I realise that even when I’m at home here in Paris, I use figurative terms and lower my voice when raising sensitive subjects. This is how deeply the fear generated by the Russian authorities is embedded in my psyche.   Image Source: Christin Hume on Unsplash The things which soothe me   At times, I wonder how much longer I can continue telling stories of Russian dissidents.   And then comes an interview, at the end of which the person thanks me for listening to them. And says that even if the article is never published, they already feel like they have a voice again.   Or, one day, I receive a letter from prison, where the person, jailed for speaking out against the war, subtly makes fun of the ridiculous actions of the Russian authorities, their absurd accusations in court, and their lack of pure logic. And I can’t help but laugh. And that gives me the strength to carry on.   I also began to work on my feelings of guilt for this war with my therapist. She told me once: “You do realise that many people, like yourself, have absolutely nothing to do with this war?” It sounded trite to me at first, but it really sank in over time.   And so, when I met the Ukrainian artist at a Valentine’s Day party this year, although I couldn’t bring myself to speak Russian to him, I did give him a flower.   He accepted it with a smile – and that was more than enough for me. This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Why Functioning Labels Are Harmful The discourse around autism tends to be typified by extremes. On one end is a child with severe social difficulties, sensory processing issues, and intellectual disability. On the other end of the spectrum is the popular conception of the eccentric savant. The person who —while odd, off-putting, and often seen as less than worthy— makes up for these perceived negative traits by being so good at one particular thing that their genius is seen by everyone around them. In between these two extremes is everyone else.    Autism is a neurodevelopmental condition characterised by social difficulties and sensory processing issues, as well as focused interests and a deep-seated need for predictability and routine. This condition is diagnosed at three distinct levels. Level one, what many people would label as “high functioning”, refers to people who are generally able to mask their symptoms, which may preclude them from accessing support. Level 2 autism refers to individuals who have more limited social abilities, and as such require “substantial support”. Level three, often referred to as “low functioning” or “profound”, on the other hand, refers to people with severe difficulties, requiring extensive support. However, these colloquial labels do little to elucidate how that person's autism affects them day to day; they tend to emphasise others’ perceptions rather than the individual’s experience. Image by Polina Kovaleva  on Pexels I, like 80% of autistic women , was not identified in my childhood. Of course, retrospectively, all the signs were there, even in my elementary school report cards: the inability to properly form appropriate social connections, the sensory difficulties, stimming, and more.   When I told others about my diagnosis, I generally received one of two reactions: “I know” or “well, at least you’re high functioning”.   When you go your whole life without being identified, you don’t become autistic on the day you're diagnosed, and certainly I didn’t either. The signs had always been there, but without the diagnosis, everyone assumes that you're “normal”, so your autistic traits are often misinterpreted or entirely dismissed. The label of “high functioning” can further reinforce the idea that autistic behaviours are moral failings at best, or acts of maliciousness at worst. Many times throughout my life, I’ve heard people angrily telling me, “You know what you did!”.   But I never did. Over many years, it’s led me to have a deep-seated fear of people. Most people, to me, are unpredictable. I can never quite predict which of my words or actions, that seem perfectly innocuous to me, will trigger a negative response.  I’m not the only autistic person who feels this way, and science backs it up. Studies have shown  that neurotypical individuals make negative judgments of autistic individuals that are not ameliorated by further interactions. Indeed, in one study ,  neurotypical participants who were presented with short video clips of autistic and non-autistic individuals were more like to say they disliked the former because they appeared awkward and lacked empathy. Importantly, these negative judgments have little to nothing to do with what the autistic people included in the study actually said. Rather, they come about as a result of body language and delivery. To neurotypical people, these non-verbal means of communication come effortlessly, but this isn't so for autistic people. Even when you're aware that you're autistic, you have to put a considerable amount of effort into learning these unwritten rules. Even more effort goes into putting them into practice.   I was never good at this. My family moved around semi-frequently, and no matter where we went, the story was the same. Once the novelty of being the “new kid” wore off, others would inevitably see how “weird” I really was. And then the bullying would begin and escalate in intensity until we moved again. My teachers and parents would blame me for this: “If you would just act normally, they wouldn’t pick on you!”  Essentially, I had to learn how to act like someone else. The efforts we put into mimicking our neurotypical peers are commonly referred to as “masking” within the autistic community. It's a survival strategy. We can be perceived so negatively by neurotypical people that anything we can do to seem “less autistic” can be the difference between making it in life, or facing significant challenges. Image by Ibolya Toldi  on Pexels Unfortunately, this is a double-edged sword. Masking may allow an autistic person to maintain a veneer of neurotypical-ness, but it's generally not enough to maintain more than surface-level social connections, or leave enough energy behind to participate fully in other activities of daily living.  What people don't see when they label someone “high functioning” is just how much mental energy goes into behaving just neurotypically enough to be accepted by others. None of this can be an automated process. Everything you say must be filtered, in real time, through what you have learned through trial and error about neurotypical social interactions. This, I think, is what makes the label “high functioning” so insidious. It can dismiss the struggles that an autistic person may be facing and the extreme efforts that I, and many others, have to make to present that facade of functionality, often to the point of neglecting other aspects of our lives. There is no reward for doing this - those I mask for don’t always like me better for the effort. I often feel like someone who has to put on a show but doesn’t receive genuine care from those around me in return.    Additionally, I find this process so exhausting that if I have to keep it up, I’m often unable to do anything else once I finally get to stop. This includes activities of daily living, like finding the energy to clean, cook myself a healthy meal or connect with the few friends I have. I’m fortunate in that I freelance and can adjust my schedules to accommodate for the time I need to rest and recover from even surface-level social interactions. But when I worked regular jobs, this wasn’t the case. Image  by Cottonbro  on Pexels The constant pressure and inability to partake in appropriate self-care can lead to a phenomenon called “autistic burnout” , where an autistic person — even one who is supposedly “high functioning”— will regress and even lose the skills that they have. Having experienced autistic burnout, it can take years at times to truly recover, and some skills may not return at all.    To the outside world, I may come across as “high functioning”. But to that I ask, high functioning to whom, and for whose benefit? Certainly not mine. This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Content warning: This article contains discussions of compulsive skin picking and body dysmorphia. Image source: Juan Miranda Ferris on Unsplash I am 17. My alarm goes off at 5:30 a.m., and I dread the next hour of my life. While most of my classmates are still asleep, I sit cross-legged in front of my full-length bedroom mirror and begin the painstaking process of covering the skin I had picked, squeezed, and cut into with cheap drugstore makeup. It’s a tedious process — camouflaging my skin so that I can hide in the hallways of my high school. I want to be invisible.   I knew virtually everyone popped their pimples only to have an angry red patch of skin to remind them of their overwhelming urge to exorcise the pus just beneath the surface. I also knew that what I was doing was different. I picked because I hated my face, and I hated my face because I couldn’t stop picking.   I had no sense of time during my nightly extraction episodes. It was nothing for me to spend an hour or more in front of my bathroom mirror, scratching at every blemish, bump, or perceived imperfection.  I used my nails, needles, pins — anything to aid in excavating my skin. I was a mad archeologist disfiguring my face to uncover a pain I knew no other way to express.   When I was “done,” I’d step back from my mirror in disbelief at the bleeding and red-marked face, looking back at me — like an alcoholic slowly emptying a bottle one shot at a time, wondering who drank all their whisky. I was always horrified and confused by my reflection. Did I do this to myself, I’d think, and if so, how could I? I couldn’t make sense of my auto-sadistic behaviour.   Next, I’d wash my face with Clearasil, Oxyclean, Noxema, or any burn-inducing cleansers used by 16-year-olds in the late ’90s. The harsh chemicals would sting my face as they penetrated my open and oozing skin. I’d slather on a thick layer of Vaseline and bury my face in the tie-dyed pillow on my bed until the burning subsided. It was a bizarre bedtime ritual I felt compelled to perform. Some people drink tea. I cut into my face.   Those were miserable, self-loathing years spent mostly in my bedroom furiously scribbling in my diary or in front of the TV, wishing I was Joey Potter on Dawson’s Creek with her perfect porcelain skin. I didn't go out, I didn't go on dates, I didn’t go to prom, and I didn’t even go to my graduation party. I was a prisoner to my pain, my reflection — the beast who knew no one could love someone so hideous.   Like any teenager with an affliction, I just knew I was the only person in the world doing what I was doing. If nothing else, I could feel unique in my misery and distinguish myself from every other unhappy high schooler with my particular brand of pain. I took a few stabs at anorexia, but I could only ever manage a few weeks in the size 25 Calvin Klien jeans I purchased for such occasions. But this, the mutilation of my face, I could commit to.   One afternoon, I was channel surfing as we elder millennials often did during the years before Netflix became ubiquitous, and I came across an episode of the Dr. Phil show. I hesitated before changing the channel in hopes that he would be tearing into some spoiled 16-year-old headed to one of those troubled teen camps in rural Montana. Or a clueless married couple who couldn’t understand why their open marriage was causing issues in their relationship. Alas, it was two sisters discussing their incessant skin picking, or “dermatillomania”.   I was dumbfounded. What I was dealing with was a real thing, and I wasn't alone. I felt satisfied in the way that it feels good to find out when other people dislike someone you also dislike and strangely vindicated by the knowledge that I had a real  problem. Dr Phil said so.   The Mayo Clinic categorises dermatillomania or excoriation disease as the most common body-focused repetitive behaviour, along with nail-biting and hair-pulling. According to Psychology Today, skin picking is classified as a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders (DSM) organised under obsessive-compulsive and related disorders.   Unlike occasional skin picking, which nearly everyone engages in throughout their lives, dermatillomania is characterised by regular skin picking leading to skin lesions, efforts to curb or stop picking, distress over one’s lack of self-control, and even shame. Check, check, check, check. I had it all.   Putting a name to what I was dealing with gave me some relief, but unlike Dr. Phil’s guests, I wouldn't be gifted the therapy and dermatology visits I likely needed to stop picking and heal my skin. I did, however, convince my mom to throw down the $29.99 for a month's supply of Proactive—the millennial's answer to acne endorsed by everyone from Jessica Simpson to P. Diddy. The proactive did little to change my skin or curb my incessant picking. I gave up when I didn’t see immediate results.   At 39, I have more control over my compulsion. I still find myself obsessing over my skin – staring at it with a small, magnified hand mirror, searching for even the slightest blemish – but I draw a strange comfort from mapping my imperfections. I know their exact locations on my face and the distance between each of them. I still have to keep track of them, as if knowing precisely where will keep them from surprising me.   Ultimately, unbelievably, I grew so sick and tired of my self-destructive behaviour that I began to fight my urges with real fortitude. At the time, my skin was young and resilient, but I knew if I continued to indulge my compulsions, it would lead to scarring and infections. I had caved to my immediate need for relief for so long that it was nearly impossible for me to even look at my reflection without immediately attacking my face.   Breaking my habit was a slow, arduous process. I’d be “good” for a week, then something would set me off, and I’d take it out on my face. It took years for me to develop the discipline to combat the impulse to pick along with a low dose of antidepressants, but above all, I had to learn to like myself enough to care how I would feel after picking my skin. I guess I finally did. This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Writer’s note: This article has been co-written by Aeron Kim and Asilay Seker   In mental health services, clinicians write thousands of notes every day. These records capture the details of people’s lives: how they feel, what they struggle with and how they respond to treatment. Hidden within these words is an enormous amount of knowledge about mental health but most of it has never been analysed in a systematic way. The reason is simple. Clinical notes are written in natural language, using words rather than numbers. They are full of nuance and context which makes them invaluable for clinicians but difficult for researchers to analyse on a large scale. Over the past decade,  Natural Language Processing (NLP) , a branch of machine learning and artificial intelligence, has begun to change this. NLP enables computers to process and interpret human language, making it possible to study large collections of text and extract meaningful information from them. In mental health science, this means we can now learn from the real-world experiences recorded in electronic health records (EHRs). Image Source: Unsplash+   What NLP Brings to Mental Health Science Most people have encountered NLP in everyday life through predictive text, translation tools or voice assistants. In mental health science, its power lies in its ability to interpret clinical language. Clinicians often use different words to describe similar concepts. For example, “mood swings,” “labile affect,” and “difficulties managing emotions” might all refer to the same experience. NLP algorithms can identify these variations, group them together and transform them into structured data that researchers can work with. This allows patterns to be detected across thousands of patients, helping answer questions that were previously impossible to study using traditional methods. Rather than replacing clinical expertise, NLP supports clinicians and researchers in making sense of what is already recorded in clinical notes, revealing large-scale trends and relationships that would otherwise remain hidden. The Clinical Record Interactive Search (CRIS) Platform King’s College London and the South London and Maudsley NHS Foundation Trust (SLaM), has set up a unique infrastructure to process free-text clinical record for research and quality improvement purposes, which is called the Clinical Record Interactive Search (CRIS) platform . CRIS provides researchers with secure, anonymised access to millions of mental health records from SLaM services across South London, compatible with numerous NLP algorithms to structure clinical notes into analysable data. Using CRIS, researchers can study real-world clinical data without identifying individuals. Within this system, a growing library of NLP applications has been developed to extract information from text, capturing everything from clinical symptoms and medications to complex emotional phenomena such as mood instability, suicidal thoughts or self-harm behaviours. Image Source: Unsplash+ Exploring Mood Instability in Neurodevelopmental Disorders Mood instability, which refers to rapid and/or frequent changes in mood, is common in psychiatric conditions but often lacks standardised screening. Much like the related construct of emotion dysregulation, it is likely to predict adverse outcomes in clinical paediatric populations. However, research investigating this issue is scarce, possibly due to data collection challenges. Traditional studies often rely on small samples or self-reported data, which can miss important patterns in how emotional instability presents in clinical practice. While most NLP algorithms are traditionally used in adult mental health data, recent research has shown their applicability in child and adolescent mental health. A recent body of research led by the CAMHS Digital Lab  at King’s College London explored mood instability in children and adolescents utilising Child and Adolescent Mental Health Services (CAMHS). By applying NLP to large-scale clinical data, the study examined the presence of mood instability in mental health records and how it relates to clinical outcomes such as cannabis use. How the Study Was Conducted The study analysed anonymised electronic health records (EHRs) from children and young people aged 11 to 18 who received care through SLaM’s CAMHS between 2008 and 2022. Using a previously validated NLP algorithm, the team searched clinical notes for language related to mood changes, including terms such as “mood swings,” “unstable mood,” and “rapid cycling mood.” These mentions were identified within three months of a depression or ADHD diagnosis. This approach allowed the researchers to estimate how common mood instability is across diagnostic groups and to explore its associations with cannabis use. Key Findings NLP-identified mood instability is associated with increased odds of cannabis use in both depression and ADHD groups. There was 25% higher likelihood of cannabis use due to mood instability in adolescents with ADHD, compared to those with depression. The prevalence of NLP-identified mood instability aligns with existing literature and estimates of emotion dysregulation in the ADHD population, supporting the utility of this method for CAMHS patients. (Seker et al., 2025) Why These Findings Matter Together, these findings highlight mood instability as a clinically significant but potentially under-recognised feature in young people utilising CAMHS. They also demonstrate the potential of NLP analysis as a scalable identification method, enhanced by tailored algorithms to capture the wider spectrum of emotion dysregulation within clinical records. Mood instability can have a major impact on young people’s lives affecting relationships, school engagement, and overall wellbeing, and is often associated with increased use of services and medication. The results from this study suggest that clinicians should consider mood instability, or the broader spectrum of emotion dysregulation, as an important aspect of assessment and treatment planning for children and young people with commonly diagnosed conditions such as depression and ADHD. Early recognition could help improve outcomes and reduce distress for young people and their families. This work further demonstrates the value of NLP in unlocking insights from complex clinical data. Analysing the records of more than thirteen thousand young people manually would have been unfeasible, yet NLP made it possible to carry out this analysis efficiently and objectively while maintaining the strict data governance and anonymity standards of the CRIS platform.   Beyond This Study: NLP in Medical Science NLP is being increasingly used across medical science to turn text into data that can drive discovery and improve care. In physical health research, it can identify early signs of difficulties in clinical notes or radiology reports. In mental health research, it can detect constructs as complex as mood instability or self-harm, and track emotional changes over time, or monitor how people respond to treatment. These approaches share a common purpose: to learn from existing data in ways that respect privacy and ethics while deepening our understanding of people’s experiences and care. As NLP models continue to advance, they are beginning to better distinguish contextual factors such as temporality and experiencer, offering a richer picture of mental and physical wellbeing than structured data alone can provide. Image Source: Unsplash+   Looking Ahead The CAMHS Digital Lab  continues to build on this work by developing new NLP tools to study emotional dysregulation, self-harm and crisis risk in young people. One of these projects, supported by the Psychiatry Research Trust , focuses on improving the early identification of emotion dysregulation in CAMHS by leveraging the NLP methods and the online routine outcome measurement platform, myHealthE . These are innovative steps forward to personalise the CAMHS experience for young people and families. Language is central to mental health. It is how clinicians describe symptoms and how young people express their experiences. We now have the tools that can analyse these words at scale without losing their meaning. By combining clinical expertise with advances in NLP, we can uncover patterns that were previously invisible and use them to guide earlier, more responsive and more compassionate care. This work is part of a growing effort to ensure that the stories recorded in clinical notes do not remain silent but instead help shape a future where every young person can be understood and supported at the right time.

In South Korea, especially among Gen Z, the MBTI personality test isn’t just a tool for self-discovery—it’s a full-blown social phenomenon. From casual conversations to dating preferences, these four-letter codes are everywhere, and if you’re not familiar with the latest craze, you might feel a bit left out. My name is Aeron. Originally from South Korea, I am a researcher at the Stress, Psychiatry, and Immunology (SPI) Lab at King’s College London. Having lived between the UK and South Korea, I’m intrigued by how personality tests like MBTI offer insights into the Korean psyche and social dynamics, and how it can spark engaging conversations with people from different cultural backgrounds, like in the UK, where MBTI may not be all the rage. So, what exactly is MBTI, and why are Koreans so obsessed with it? The Myers-Briggs Type Indicator (MBTI) categorises people into 16 personality types based on simple self-report surveys , each represented by a four-letter code. It offers a general framework for exploring personality preferences, and many find it relatable—and easy to share! Image Source: MBTI Online Website The 8 core personality traits you can see below are paired in binary opposites, combining in different ways to form a 4-letter code, resulting in 16 distinct profiles. For example, one is either Extroverted (E) or Introverted (I), and Sensing (S) or Intuitive (N), and so on. Image Source: The Myers Brigs Website Origins of the MBTI test The MBTI was devised in 1943 by the American mother and daughter duo – Katharine Cook Briggs and Isabel Briggs-Myers, drawing inspiration from Carl Jung’s analytic psychology. While their initial goal was to simplify the complexities of the human psyche, the binary nature of the test has faced criticism for its questionable scientific basis . Despite these flaws, it proved useful during World War II for matching people to jobs and gained widespread acceptance in the early 2000s, becoming a popular tool for career counselling in schools and workplaces. Since then, it has drifted in and out of fashion in other countries, primarily due to ongoing debates over its scientific credibility. In Korea, however, it has taken off and become a unique socio-cultural phenomenon over the past decade. Prevalence in Korean culture MBTI has integrated into everyday life in Korea. People frequently ask for your MBTI type in casual conversations, celebrities discuss it on TV, and politicians use it to shape their public image (e.g., ENFJ - Compassionate Facilitator). From commercial ads on the bustling streets of the capital, Seoul, to MBTI-themed products like letter-shaped bread, the trend is everywhere. A bakery in Seoul is selling MBTI letter-shaped bread with a DIY box for customers to create their own MBTI bread set. Source: Blog.Naver.com A recent controversy revealed that some companies post job descriptions specifically seeking applicants with certain MBTI types, characterised as being outgoing, socially active, and open-minded. In the world of dating, Korean dating apps and match making services offer MBTI-based compatibility matching, and some might even reconsider a date if your MBTI falls outside their compatible zone. This trend also extends to the K-Pop scene, where a popular K-Pop boy group that made it to the Billboard charts released a new single , filled with love songs for star-crossed lovers whose MBTI types did not match. So, why do so many Koreans embrace this pseudo-scientific personality test when most people outside Korea either haven’t heard of it or have already debunked it? There are several plausible reasons when viewed through the lens of Korean culture and history.   Korea’s collectivist social structure: ‘We’ over ‘I’ In the Korean language, the term ‘ we ’ carries a different weight compared to many other languages. For instance, while English speakers might refer to their familial or social relationships using terms like ‘ my mom,’ ‘ my school,’ or ‘ my company’, Koreans often use phrases such as ‘ our mom,’ ‘ our school,’ and ‘ our company.’ The cultural significance of the term ‘ danil-minjok ,’ which translates to ‘ single ethnic group ,’ reflects a deeply rooted emphasis on collective identity within Korean society.   This collectivist mindset has persisted through socioeconomic, historical, and political upheavals, shaping modern Korean society. The need for unity during times of hardship has been crucial for survival but has also reinforced cultural norms that emphasise social conformity and, at times, exclude those perceived as different. In Korea's relationship-oriented and collectivist culture, which has been described as a society that can reach harmony when "all members fulfill certain obligations", categorising individuals by social groups such as age or background is a common and socially accepted practice. In this cultural light, MBTI perhaps serves as an effective tool for simplifying the categorisation of individuals into distinct personality groups, helping define individuals' roles and create a sense of predictability or harmony within the social structure.   Lonely youth: desire for connection in the age of social media The growing trend of sharing MBTI types among young Koreans reflects a deep-seated desire for connection and self-discovery. As the pandemic isolated many, this need only intensified , leading young people to seek quick, identifiable ways to define themselves. Social media has further fuelled this trend, catalysing widespread discussions and making identity-sharing more accessible than ever. Sharing a four-letter code often feels far simpler than grappling with the complex and fluid nature of one's personality, offering predefined traits that seem more stable and easily understood. Through this exchange, young Koreans create connections, a sense of belonging, and engage in self-discovery. However, the focus often stays on positive traits, glossing over more complex or less flattering aspects of human nature. This selective emphasis also makes MBTI feel more accessible and openly shareable, allowing people to reveal aspects of their identity without fear of judgment or exposing their "bad sides” to the wider public. The Good, the Bad and the Ugly Side of MBTI In a fast-paced, competitive society like Korea’s, MBTI offers a convenient way to explore identity and build connections. However, the efficiency that makes MBTI attractive can also result in shallow evaluations, reducing complex individuals to simple labels. Beyond its potential for superficial assessments, MBTI can also create divisions—not just across the 16 personality types, but between those who embrace it and those who do not, promoting an ‘ us versus them ’ mentality.   While MBTI offers a sense of structure in a complex world, relying too heavily on this rigid and binary framework can stifle genuine self-exploration, as an individual’s character cannot be neatly defined and fully captured by a four-letter code. Building relationships or making decisions based on personality types can constrain personal development, encouraging predefined judgments over open-minded growth. Its misuse—such as in hiring practices or dating preferences—can also contribute to social discrimination and exclusion. The trend has also sparked a wave of commercialisation, with businesses capitalising on MBTI’s popularity through themed products, advertisements and events. This blend of collectivist culture, the desire for connection, social media influence, and commercial interests, has turned MBTI into an obsession for many young Koreans, for better or worse. That said, I believe that most Koreans, including myself, view MBTI as a fun, light-hearted, and game-like way of discovering ourselves and others in an era full of uncertainty. So why not approach it with a healthy dose of scepticism? By the way, in case you’re wondering, I am an INFP - Thoughtful Idealist.

Could the activity of our genes hold the clues to the biological secrets of depression and open new doors for treatment? Image licensed under the Unsplash+ License Depression is a complex condition. We know its symptoms well, but we still do not fully understand what happens in the body when someone is depressed. Also, not all individuals with depression are the same, and this diversity may arise from differences in biology – the many bodily processes that constantly shape the way we are and behave. As both a psychiatrist and researcher, I find this question deeply fascinating. If we could decode the biological changes behind depression, it could completely transform how we understand those who live with it and, most notably, how we treat it. In two recently published studies, carried out through collaboration between UK and Italian researchers, we explored exactly these questions: What are the biological mechanisms that underlie depression, particularly those linked to the immune system? And can these biological markers help us predict who might benefit from anti-inflammatory treatment?   Depression and the immune connection Around one in three people with depression show signs of inflammation, meaning their immune system is activated, as if fighting an infection. Normally, this response protects us against harm. But if chronically sustained, the immune system can stay switched on, potentially contributing to the symptoms of depression. What’s more, people with depression and inflammation often respond less well to standard antidepressants. That’s why researchers are exploring whether anti-inflammatory medications might help this subgroup, for whom we clearly need new and alternative treatments . And this is exactly the main aim of a large study we are coordinating, called ASPIRE , together with many other research centres around the world, as we already covered in a recent blog article . Understanding how inflammation affects our bodies and minds, and why it is activated in a relevant proportion of people with depression, could help us deepen our understanding of these individuals and to find more effective and more tailored treatments . Image by Tanja Tepavac on Unsplash   The role of gene expression To study the relationship between depression and inflammation at its roots, we looked at gene expression , which is essentially how active our genes are . Think of it as seeing which “light switches” in our genetic code are turned on or off. This activity determines which biological functions are at work. In particular, using a technology called RNA sequencing , we measured the activity of thousands of genes in blood samples from people with depression . By analysing these patterns, we can begin to map which biological processes are active – and which are quiet – in different types of depression, including the one associated with inflammation. In our first study , published last year, we found that people with depression and higher inflammation showed greater activity in genes related to the immune system and metabolism , that is how our body creates and uses energy. Of note, even people with low inflammation using clinical blood tests had evidence of  immune activation, confirming that with gene expression we might observe a larger proportion of people with depression with activation of the immune system compared with standard inflammatory markers . On the other hand, high inflammation also affected genes involved in metabolism besides immune-related ones. Meanwhile, people with depression but no inflammation  showed a different biological signature : a reduced activity in genes related to cell growth and repair . This might reflect a kind of protective mechanism, shielding them from some of the damaging effects of inflammation. We also identified unique gene expression patterns in people who responded well to antidepressants , showing changes linked to both reduced immune activity and enhanced brain protection. These biological clues could help explain why some treatments work for certain people but not others. Can anti-inflammatory treatment help? In our second study , published just a month ago, we focused on a clinical trial testing minocycline , an antibiotic with anti-inflammatory properties. All participants had depression that hadn’t improved with antidepressants and showed at least some signs of inflammation. When we compared their gene activity, we found that, before  treatment began, people who later responded to minocycline had distinct immune activity . Their immune system was “on the move”, showing markers of immune cell movement and activation. Those who didn’t respond lacked these immune signatures. Interestingly, by the end of the four-week treatment, these differences had disappeared, suggesting that it is the starting biological state (the activated immune state, in this case), and not just the medication, that determines who benefits most.   This could be a vital clue for future precision psychiatry : identifying who might respond to anti-inflammatory treatments before they start these medications.   Toward a more personalised future in psychiatry Depression, like most medical conditions, is not one-size-fits-all . Understanding its biological diversity means recognising that not every patient’s depression looks – or behaves – the same. The immune system is a crucial piece of that puzzle. By uncovering how genes and immunity interact in depression, we move one step closer to precision psychiatry, where treatments are tailored to each individual’s biology. Our findings offer hope that, one day, we’ll be able to match patients with the therapies most likely to help them, transforming depression care from a process of trial and error to one of true personalisation . And perhaps, in doing so, we’ll come closer to understanding not just the science of depression, but the people who live with it every day . Image licensed under the Unsplash+ License

Not surprisingly (perhaps because we are the Stress , Psychiatry and Immunology Laboratory — the SPI Lab, and this is, by the way, the reason why InSPIre the Mind has the capital SPI) I often gets asked to discuss this topic at public festivals, dissemination events, or online interviews — being these the Wellcome Trust Hub at the Latitude Festival in 2015 , the Wellcome Collection Packed Lunch in 2016, the Also Festival in 2017, the Museum of the Mind in 2019 , or an interview with the blogger and podcaster host, Danny Whittaker. And people always have a very good level of knowledge on these topics, and are prepared to resonate emotionally with the research findings and to bring their own personal experiences into the open, through insightful questions. It is always great fun and very rewarding. We seem to forget — certainly people are usually surprised to hear — that the stress response is an automatic survival response, designed to save our lives during life-threatening situations. It’s not helpful if you are having a row in the office, you have missed a deadline, or you have a thousand unopened emails in your inbox. It is very helpful, however, if you encounter a lion. Hundreds of years of evolution have not changed our stress response much. An Indian lion in the Sasan-Gir National Park in Gujarat. I took this picture. I am myself, quite stressed during these interviews. The audience may be lying relaxed on the floor of a big tent in a green space, sitting in a theatre, or listening to my voice in a podcast through their headphones - but I am super nervous, not knowing if I am going to say something boring, or annoying, or upsetting. So, I usually start by describing my stress response. My breathing is rapid. My heart is racing. My skin is sweating. My pupils are dilated. The adrenaline and the cortisol are raised in my blood. My immune system is activated. Of course, none of these changes are helpful during my public performance: it is all about getting oxygen and sugar to my muscles, increase my vision, and protect me from infections, in case I have to fight a predator. But they would have been helpful if I had to fight for my life or run to safety — if the tent or the theatre had been full of lions. And this is what people in the audience are always surprised to hear. How it is possible that years of evolution have not really changed our stress response? As far as stress is concerned, are we all still cavemen and cavewomen? But, this time, I do not want to bore you further with reading. This time, if you are interested in stress, please listen to these podcasts on this topic : The first is my interview at the Wellcome Collection Packed Lunch in 2017. Fifty-five minutes literally packed with information on how stress makes us ill. We know that stress isn’t good for us but how and why exactly does it make us ill? Carmine Pariante is a biological psychiatrist who explores the ways that stress, whether in the womb or in adulthood, can increase our immune system activity and affect our mental and physical health. Speaker: Carmine Pariante, Professor of Biological Psychiatry and Head of section, King’s College London. This packed lunch event was recorded live on Wednesday 6 July 2016 at Wellcome Collection. I was particularly delighted when the charity, MQ , asked me to inaugurate their podcast series. Here , I talk about a specific aspect of the stress response, the activation of the immune system, and its relevance to depression and mental health. The third one is my more-than-two-hours long interview with podcaster, Danny Whittaker, with a broader remit that includes stress, mental health, social adversity, biological changes in the brain, and also my favourite books to read. (BTW, do check Danny’s website for dozens of other very interesting podcasts on mental health). In today’s episode Prof. Carmine Pariante joins us to discuss the biology of stress, everything from the anatomy of the brain, to the endocrine system, and how it’s all functions together. We explore the evolutionary advantages of the stress response, how the pressures of modern life can cause stress to become chronic, and how the physiological damage of long-term stress can lead to conditions such as anxiety and depression. For show notes and to join the conversation visit: http://myownworstenemy.org Email: danny@myownworstenemy.org Follow Danny on Twitter: http://twitter.com/dannydwhittaker Podcast Image: Amy McTigue https://flic.kr/p/5PkrCC Theme Music: Ryan Little http://youtube.com/user/TheR4C2010 Perhaps, after hearing these podcasts, you too will realise that there are no lions in the theatre. We all encounter problems: difficult, emotional, or sometime tragic problems — with bosses, colleagues, partners, friends or relatives. But there are no lions. Unless of course we are truly exposed to violence, war, or terror, to really life-threatening situations. But for most of us, luckily, there are no lions. It is time to recognise this and appraise reality. We can control our stress response. We no longer need to be cavemen. This blog contains some ideas that I first presented in another blog published in 2015 and available at https://www.huffingtonpost.co.uk/carmine-pariante/effects-of-stress-on-the-brain_b_7840032.html . Header Image on Unsplash by Gabriel Matula