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I've been curious all my life—from collecting samples for my microscope as a kid, to investigating psychiatric biomarkers as a PhD student now—but for me, this curiosity didn't belong in the same box as dresses and pink. I was never girly . I put up a fight against my mother whenever she tried to put me in dresses when I was a toddler. Throughout my childhood, my wardrobe mostly consisted of my brother’s hand-me-downs, and even now in my late twenties, it’s a sea of black, blues, and greens with the occasional piece in white or cream. Throughout my teens, pink felt frivolous, girly , and childish—something I would roll my eyes at. The first time I bought a dress was in my early twenties, and I barely ever wore it, because, again, it felt too girly . But what does that even mean? And why did I reject it for so long? Image Source: Becca Tapert on Unsplash The Great Pink Rejection I’m not alone in rejecting pink and all things girly . For most of modern history, anything coded as “feminine”—softness, playfulness, pastels, flowery or pink aesthetics—was systematically devalued as frivolous and weak. Women dressed as men to be taken seriously and to have better opportunities and pay. Even today, many girls learn that sparkly things and bright colours are unprofessional, something to “grow out of” for career success. As young women, we discover that success in a male-dominated world requires rejecting stereotypical markers of femininity and girlhood and embracing more neutral or masculine-coded traits. Want to be seen as intelligent? Skip the pink. Want a career advancement? Ditch the glitter. We are told that femininity is an obstacle rather than something to celebrate. And of course, this affects boys too: Any “feminine” traits are frequently snuffed out and replaced with masculinity. But this is a whole other issue worth its own discussion. Yet, femininity is still expected of us in every other aspect of life. This creates the unachievable expectation women are held to, and many women hold themselves to: Be girly and feminine, but only when it suits society, and never too much or too little. As described in a previous ITM article , America Ferrera as Gloria captured this perfectly in her famous monologue in the Barbie movie, describing the impossible contradictions women face daily:  “ It is literally impossible to be a woman. […] It’s too hard! It’s too contradictory and nobody gives you a medal or says thank you! […] I’m just so tired of watching myself and every single other woman tie herself into knots so that people will like us. ” The Power of Claiming it Back In recent years, something has changed. By embracing pink and girly things, women challenge the idea that femininity means less power, less seriousness, or less maturity. There is nothing less about us. This follows a broader feminist tradition of reclamation; activists have similarly reclaimed words like “slut” and “queer”, turning insults into sources of power and identity. When I see a businesswoman presenting herself with a feminine aesthetic, I see someone refusing to play by patriarchal rules, someone rising above masculine standards with strength and attitude. We can be soft and strong, pink yet powerful, girly yet serious. Before Greta Gerwig’s Barbie, Elle Woods in Legally Blonde delivered this same message. Outside of fiction, we have Taylor Swift, who is making music history again and again while presenting herself in soft and pastel or colourful, sparkly looks. These cultural representations make pink both commercially visible and politically resonant. Image Source: Joel Frank on Unsplash Girlhood as Healing For many women, reclaiming girlhood connects to what we call “inner child work” in psychology – healing parts of ourselves hurt or suppressed in childhood. Many of us experienced being forced to grow up too quickly, told our interests were "silly", or being pressured to act maturely, prematurely. At the same time, boys’ behaviour around us was often excused with “boys will be boys”. Reclaiming pink, flowers, sparkles, and playfulness becomes self-soothing and healing. For me, this didn’t mean pink lipstick or glittery sequins. Instead, I started buying more dresses, floral blouses, and a cute blush. It might not be the epitome of girly , but 14-year-old me wouldn’t have been caught dead in them. It feels like giving my younger self permission to enjoy something I had learned to reject—things reserved for girly girls. And research shows an actual psychological benefit to this: engaging with creativity and playfulness significantly buffers stress, anxiety, and depression . This movement also counteracts internalised misogyny. Messages about femininity being weak often become internalised shame. Towards oneself and others. I never minded being a girl, I simply didn’t want to appear weak and immature. By actively embracing what we once rejected, we are rewriting those shame responses and practising self-acceptance that improves self-esteem, body image, and relationships. I don’t need a pink blazer, but I can appreciate a colleague who is rocking hers at a conference. Encouraging girlhood in others creates communities—online and offline—where women affirm each other’s experiences and validate what once was (and sadly still is) stigmatised. There’s something deeply healing about finding people who celebrate parts of yourself that society taught you to hide. Image Source: ksama on Unsplash It’s Not all Sunshine and Rainbows However, this movement still faces problems. First comes commercialisation. Brands jumped on trends like Barbiecore, turning feminist resistance and mental health into a quirky marketing opportunity. When “empowerment” becomes merely a slogan on pink products, the movement risks returning to what it opposes: playfulness and femininity dismissed as unserious. Marketing also creates exclusivity. Dominant imagery of girlhood often features white, thin, middle-class aesthetics of a narrow beauty standard and financial resources. Women of colour, trans women, plus-sized women, and working-class women get pushed aside, again, by companies and peers alike. Then there’s romanticisation. For many, especially marginalised women, girlhood wasn’t soft or playful. It meant trauma, early sexualisation, and exclusion. A nostalgic emphasis can gloss over these harsher realities, promoting a girlhood that never existed universally. Last comes concerns about depoliticisation. Focusing on pink aesthetics reduces feminism to 'vibes' rather than addressing systemic issues like wage gaps and reproductive rights. There’s also worry about reinforcing gender binaries—setting “pink” equal to “girlhood” sometimes strengthens the categories it aims to challenge. Image Source: Celina Yoo on Unsplash Making Your Own Way down the Pink Brick Road I don’t think we need to choose between feminine aesthetics and political awareness, or between healing our inner child and acknowledging that pink lip gloss is not on everyone’s path of recovery. We can enjoy pink and girly moments while fighting for systemic change. We can celebrate personal healing while recognising that empowerment looks different for everyone. Awareness of the movement’s limitations may be the key to its success. After all, the most radical aspect about reclaiming girlhood isn’t the pink and the glitter, it’s permission for women to be complex beings and revoking fake binaries of strength and softness, seriousness and play, political awareness and personal healing. Mental health doesn’t depend on embracing or rejecting pink. What matters is genuine, authentic choice, rooted in self-knowledge and acceptance and not dictated by shame or trends. Create your own path, and if healing comes through pink lip gloss? Perfect. Consider this your permission to be whoever you are—pink, political, or somewhere beautifully in between. Image Source: Hoite Prins on Unsplash

Photo by Erin Doherty on Mamamia Heartbreak is a common experience, often understood as a time of emotional crisis which can be resolved with feeling-based healing. Some typical advice you may have heard (or given) is: “the feeling will pass, you’ll get over it”, or “sit with your emotions”. But this advice feeds into the stigma that heartbreak is solely an emotional experience and pays no mind to all the physiological impacts.   I am a student on the MSc Psychology and Neuroscience of Mind-Body Interface . In this article, I will explain how the body is impacted during experiences of heartbreak, specifically regarding neurotransmitters (the chemical messengers in your brain). This may help explain some of your post-breakup behaviours and remind you that healing from heartbreak is more complex than just your emotions. Seeking support, whether that be formal, informal or clinical, is okay. But Heartbreak is an Emotional Crisis? If we reflect on the stereotypical heartbreak scene, we see the heartbroken individual in bed with tissues, crying into ice cream whilst watching the Notebook. But in the real world, not all people deal with heartbreak this way. Some people have no tears or outward sense of sadness. No one should feel abnormal or guilty for not following the “heartbreak script”. Your emotions may not align with the movies, but just know your physiology is ‘heartbroken’.   Heartbreak symptoms occur along a spectrum; it is an individualistic experience comprised of both emotional and physiological components. In extreme cases, heartbreak can even cause physical conditions such as stress-induced cardiomyopathy, also known as broken heart syndrome . This is a condition where the heart muscle becomes weakened and can be fatal. However, broken heart syndrome seems to be the only well-known physical association with heartbreak. To cope with and heal from heartbreak, it is important to understand how the body reacts physiologically.   But before we continue, let’s emphasise that heartbreak isn’t just romantic. Romance isn’t the pinnacle of everyone’s life; heartbreak can also result from grief, family issues, or strained friendships.     The dopamine binding trap in heartbreak The neurotransmitter system, which involves the happy feel-good hormone (dopamine), is (understandably) disrupted during heartbreak. Disruption in dopamine levels can impact mood and cause a reduction in motivation, sometimes triggering depression.   So, what is actually happening during heartbreak ?   When we are in love, our brain associates the other person with feelings of comfort and reward, which triggers the release of dopamine. When relationships end, and the feeling of being heartbroken creeps in, the sudden loss of reward causes dopamine levels to be unstable.   In the immediate stages of heartbreak, the instability of dopamine causes its levels to dramatically increase and decrease. Interestingly, this change in your dopamine system may help explain why you feel the urge to text your ex or check their social media after a break-up.  When memories of the person trigger dopamine release, your brain starts linking that dopamine ‘hit’ with them. Over time, this can create a pattern of reinforcement which maintains your sense of attachment to them. The dopamine release keeps you feeling attached to the person and that motivates the desire to check in on them or gain access to them.   So, to heal from heartbreak, it could be useful to remove anything that might trigger memories of the other person, to avoid this dopamine release cycle. This could be getting rid of (or even hiding) anything that triggers memories: text chains, photos, jewellery, clothes, anything! Maybe going into no contact might be the best thing for your physiology and emotional well-being.   Regulation of the dopamine system is crucial for healing; if you feel ready to move on and form new romantic attachments, regulation of dopamine function is a necessity. Cortisol’s helpful (and unhelpful) contributions during heartbreak The hypothalamic-pituitary-adrenal (HPA)  axis is a system which releases cortisol. Cortisol is known as the ‘stress hormone’, so we can think of the HPA axis as a stress alarm, and when heartbreak hits, the alarm sounds and cortisol flows!   When heartbreak, or any psychological stressor, activates this axis, the first part to respond is the hypothalamus. The hypothalamus is a region in the brain which is responsible for hormonal control. It releases Corticotropin Releasing Hormone (CRH), the first stress signal, which then triggers the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH is the second stress signal, which travels through the bloodstream to tell the adrenal cortex to cope with heartbreak. Photo by Daniel Leal, Internal Medicine Functional Medicine The release of cortisol allows the body to mobilise energy to respond to stress. This increase in cortisol is essential  and works to provide us with resources to cope with heartbreak. Despite the HPA axis working to support us in the initial phases of heartbreak, it is well known that heartbreak does not typically resolve itself overnight. The HPA axis tends to be chronically active for a prolonged period, which can cause mental and physical health complications to occur, such as appetite changes, cognitive difficulties, sleep disturbances and even reduce the immune system’s ability to fight off infections and diseases . Overall, prolonged production of cortisol “holds us” in the depths of heartbreak, contributing to many symptoms which affect daily functioning. Why is mood regulation so much harder during heartbreak Another key system affected by heartbreak is the serotonin system, which plays a key role in mood regulation and contributes to emotional wellbeing. During heartbreak, dramatic adjustments to the serotonin system  make feeling calm, balanced and in control much harder.   Serotonin levels drop during heartbreak, causing mood swings and a lack of impulse control. Dysfunction in the production of serotonin is associated with a variety of mental and physical symptoms including sleep disturbances, cognitive difficulties, depression and anxiety . This can make the process deeply confusing; though heartbreak is the time you wish to regulate and understand your mood, it’s also the time where your own neurobiology is working against you!   Good news is, this disruption is not permanent. When your serotonin levels return to normal, mood regulation becomes easier, and many people notice improvements: mornings where you feel like yourself again, can think more clearly, and experience moments of peace within your emotions.   Final reminder to all The reason I wrote this article is to bring attention to the physiological impacts of heartbreak, but also to remind you all that getting help is okay. Please reach out to friends, family members, loved ones, and if necessary, your GP. The neurotransmitter systems discussed in this article provide some insight into the physiological impacts of heartbreak. If you have had appetite changes, sleep disturbances, anxiety, cognitive difficulties, sickness or feelings of depression, it may be due to contributions of the body in reaction to this emotional shift. The biggest take-home message of this article is do not underestimate how your body reacts to what your mind is having to process and to reach out for help if you need it. The mind and body are connected in many ways and heartbreak is not exempt from this. Photo from Marah Bashir on Unsplash

A biological overview of the seasonal changes across mood disorders “The changes of the seasons are especially liable to beget diseases” — Hippocrates (5th century BC). Here we are, April has come and is already about to end. We are now in the middle of the spring and approaching summertime, to the delight of many. However, even if most of us are happy for the arrival of spring, this may be a very trying time for both our body and mind. Spring is a period of great changes, not only in the landscape surrounding us. The progressive and massive environmental development of the contemporary world have certainly detached us from changes in the natural world. We do not live in the wild, and we can vastly adjust the environment to our wishes. Still, we are significantly affected by seasonal changes . We just need to look outside. The days are getting warmer and the sun is staying out longer, increasing the daylight time. This has been further amplified early this month by the “summer time”, that forced us to reset our clocks to one hour ahead. All these modifications could seem trivial, but they affect our wellbeing. Of course, under physiological conditions, our body is able to face them and react in a positive way. However, people suffering from mental illnesses may be hyper-sensitive to these changes. These changes could actually be a trigger for the development or exacerbation of the disease. The way our body reacts to this combination of external stimuli is multifaceted, and involves several biological factors in an intricate interaction orchestrated by our brain. The light-dark cycle has a deep impact on the biology of the brain . In particular, there is a specific cerebral area, located in the very middle of the brain, which has been proved to be crucial in mediating these changes: the hypothalamus . It is strictly connected to the other brain areas and regulates several essential biological functions, for example hormone secretion and response to stress . Image from topsimages.com The hypothalamus contains a specific group of cells that regulate the so-called circadian rhythm , from the Latin circa : approximately, and diem : day. We can think of it as an internal clock regulating a wide variety of biological functions within a 24-hour time frame. And health problems can be linked to a disruption of this rhythm. Many of us have experienced the well-known “jet-lag”, often related to long-distance trans-meridian (east–west or west–east) travels, and mostly characterized by sleep disturbances and fatigue. However, this 24-hour daily rhythm is also strictly related to a longer rhythm which covers the four seasons all over the year, known as circannual rhythm . So, during seasonal changes our body must face a plethora of signals. This can destabilise our homeostasis, that is, our steady internal functioning, affecting also our mood. Someone could feel happier and more energic, while others tired, fatigued, and listless. Well, this may not be just the weather. Indeed, specific psychiatric disturbances, such as mood disorders (depression, bipolar), are frequently sensitive to seasonal changes. The arrival of spring, as well as autumn, could be associated with a failure in the biological adaptation of the body to the seasonal changes , leading to disrupted communication between the circadian (day) and circannual (seasonal) rhythms, and resulting in the onset of an episode of a mood disorder . Seasonality and mood disorders Mood disorders are disturbances of the basic individual’s affective status. These may occur as a lower —  depression  — or an elevated —  mania  — mood compared to the subject’s normality. Both these conditions are pathological and related to severe and life-threatening consequences. Depressive disorders are characterized by the presence of depressive episodes only, while bipolar disorders by the presence of manic (or hypomanic, when less severe) episodes, besides depressive ones. Seasonality is important in both depressive and bipolar disorders. A cyclical course, with recurrent episodes, is typical of mood disorders. Exacerbations and remissions may repeatedly occur at specific times of the year. According to the diagnostic criteria of the last version of the most commonly used classification of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the presence of a “ seasonal pattern ” can be applied to both. This means that patients with mood disorders could experience relapses and remissions of their illnesses recurrently at specific times of the year , usually in association with specific seasons. Photo by Omar Lopez on Unsplash Seasons and mental health have mostly been studied in relationship with the old concept of “ seasonal affective disorder ”. This is a peculiar subtype of depressive disorder, with recurrent depressive episodes in autumn-winter and remissions in spring-summer. It is still the most common type of depression with seasonal features, also called “ winter-depression ”, and it is observed particularly in higher-latitude countries (for example, Scandinavia or Alaska) where variations in daylight across seasons are most marked. It is also clear that mood alterations could involve not only depressive episodes, but importantly also manic (and hypomanic) ones . Moreover, episodes of a mood disorder could be worsened not only in autumn-winter, but also during the spring-summer shift . Mood disorders with seasonal features are quite common. Around 10% of depressed patients have a seasonal course. Even higher rates have been reported for bipolar disorders. Seasonal depression is more frequent in younger persons and is often associated with a specific symptomatologic pattern, characteristic of the “atypical” subtype of depression , which includes increased appetite and need for sleep, and loss of energy. These symptoms are also frequent in the bipolar form of depression (or bipolar depression), that is, depressive episodes occurring in people suffering from bipolar disorders. Of note, patients with manic episodes have higher rates of admission into hospitals during spring and summer, when sunlight exposure is longer. A seasonality effect is also present for the most tragic consequence of mood disorders, suicide, with rates that also increasein spring or early summer. Clinical implications From a psychiatric point of view, these observations are particularly important. It is important that a correct diagnosis considers the life-time history of the patient , and specifically investigates seasonal patterns of relapse. It is important also for patients and their relatives not to underestimate fluctuations in mood related to seasonal changes, promptly asking for help if needed. Seasonality can also offer an opportunity to prevent (or at least be prepared for) an episode of a mood disorder. Of note, a treatment specifically acting on circadian rhythms and counteracting the effects of light variations exists: light-therapy . This treatment is effective in addition to antidepressant drugs for depressive episodes, mostly for those with a seasonal pattern. “ April showers bring May flowers ” Spring is certainly a particularly delicate time of the year for people with mental health problems, and changes in mood, appetite, energy or sleep during this period should be considered a wake-up call for clinicians and patients. But it is not all just bad. The knowledge of the potential effects of seasonal changes in some people with mental disorders can allow us toprevent or better treat recurrences, thus limiting their impact . “Is my mental health problem seasonal?” This is a question that all people suffering from a mood disorder should consider, and should try to answer together with their clinicians, in order to improve their mental health. Photo by Jeremy Bishop on Unsplash

As time progresses since the pandemic struck, we have found ourselves plunged into a new world that has forced us to change how we live, work and look after ourselves. Having an avid interest in the arts, I’m always in vigorous pursuit to get my diary booked with music, poetry, arts exhibitions, and events on offer. No longer able to absorb the creative and cultural tapestry which brought pleasure, autonomy and fulfilment, due to COVID-19 government regulations , my quest for meaningful activities was thrown into disarray. I am currently in my final few months of qualifying as an Occupational Therapist at St George’s University of London. I recently completed a research placement with the incredible King’s College London research team and was thrilled to be offered the opportunity to share my reflection of using photography to enhance health and well-being. ‘Timeless Love’ - Author’s own work Using photography to stay engaged with the world and to help combat this solitude, brought salubrious benefits beyond expectations and felt like having the power of a therapeutic tool in the palm of my hands. Balancing my final year of occupational therapy practice placements, academic commitments as well as a health condition which required trips to hospital for treatment and surgeries without the support of close friends and family, due to government regulations , proved challenging. ‘Tranquillity’ - Author’s own work On my hospital trips, or blithely wandering to get a daily dose of fresh air and exercise when the need to decompress bellowed, I found myself taking photographs. Despite having convinced myself of being scarce on the creative front, I was captivated by filtering nature’s beauty and the turmoil around me. Author’s own work One paramount tip I have learnt from a dear friend, who is a talented portrait artist, is to pay attention to what I feel, see, hear and think, before taking a shot. Ruminating in my own thoughts, aspirations and desires, my photographs subconsciously capture the essence of my surroundings. Almost like a heightened state of inner self, there is a psychological link in my creativity, emotions, identity and communication, which is captured in my photographs. This coupling of photography and psychology is not new, as described in another Inspire the Mind blog . Taking photographs has been shown to promote mindfulness, whilst stimulating making meaning of what is around us. It gives a sense of purpose, and for some, creates a community. We share experiences and achievements which have been shown to tackle loneliness, stress, anxiety and grief during times of adversity, evidenced in this research by Lancaster University . From my standpoint, this has illuminated the therapeutic power of photography and the camera as a creative instrument, described by Dr Bursztajn . Portrait Painter Clae Eastgate in her studio, Shopshire Hills, UK - Author’s own work A few photography tutorials and YouTube videos later, recognising the need for allocating time to self-care, I began exploring what being a shutterbug (a photography enthusiast), had to offer. There is no master plan for what I photograph. Anything that evokes an emotive, energised, creative feeling which allows me to decelerate and breathe, is captured in my photographs. ‘Reverie’ - Author’s own work Admittedly, it feels as though I am in a state of ‘flow’. Are you familiar with this term? It is a psychological concept named in 1975 by Hungarian-American psychologist Mihaly Csikszentmihalyi and is especially well recognised in occupational therapy practice . The state of flow is a subjective experience; precisely how I feel when taking photographs. I am immersed in an activity which is enjoyable and nothing else seems to matter. Experiencing a shift of consciousness from one’s worries, a forfeit of self-consciousness almost, and a distortion of time in pursuit of pleasure, which this study describes. I capture the feeling, or moment in my photographs and what that evokes, rather than what I see. ‘Solitude of the sea’ - Author’s own work So, why has photography been so paramount in enhancing my health and well-being, as I try to adapt to a second year of life with Coronavirus? For some of you reading this, you may think this trivial and unimportant. However, research from the National Institute of Clinical Excellence (NICE) shows, when we need a break from work or other responsibilities, partaking in meaningful and enjoyable activities, be it photography, sports, arts or time in nature, manifests a feeling of calm, vitality and restoration, whilst improving our self-care. ‘Joie de Vivre’ (Joy of Living) - Author’s own work Globally, the pandemic is having a detrimental effect on the mental health of people whilst placing increasing demand on services. There is no silver bullet, or panacea , for how we adapt to a different way of living since the emergence of Covid-19. Nonetheless, by using an approach where we prioritise, look after and take time out for ourselves, be it photography, arts, sports or whatever else colours your world, undoubtedly, you’ll begin to recognise how vastly this can enhance your emotional, physical and mental health and well-being, as I have discovered with photography. ‘London Sunrise’ - Author’s own work I’ll leave you with one of my favourite quotes by photographer, Henri Cartier-Bresson, which I think applies to any activity we partake in to promote well-being: “It is an illusion that photos are made with the camera… they are made with the eye, heart and head.”

I never had to think when I switched between speaking Tamil and English, it was second nature to me. I spoke Tamil at home and English at school, sometimes mixing the two without realising it. I had never given much thought to the role of an interpreter. I had always translated for my parents during appointments and considered it normal. It wasn’t until I began observing GP appointments as a student that I realised how many details were overlooked. There is one appointment I remember clearly. A woman in her thirties walked in with her son, who volunteered to translate for her as the scheduled interpreter was not available. They both spoke Tamil, and without meaning to, I understood every word they said. At first, everything seemed to go well; the GP asked general details about the abdominal pain the woman was experiencing, and her son translated clearly everything she said. The GP continued, asking more personal questions about her menstrual cycle; I could sense a shift in both the mother and son. The mother took her time before speaking, giving very short and rushed answers. The son started to hesitate before translating, missing out details and mumbling his words. It felt very uneasy seeing the awkwardness and discomfort between the two. Image by National Cancer Institute on Unsplash I quietly caught the GP’s attention and told him I was fluent in Tamil. With the consent of the patient, her son waited outside while we finished the appointment. I spoke very gently in Tamil, trying to make her feel at ease. Her answers started to be longer, more specific, and the relief was evident on her face. The GP continued to ask direct questions, which helped him gain a clearer picture of what was going on. At the end of the appointment, the woman and her son thanked me. In that moment, I realised how differently the appointment could have ended and the value of a professional interpreter. I am writing this piece as a current medical student, whose understanding of language barriers has been shaped by both my personal and professional experiences. From translating for my parents as a child to observing GP consultations as a student, I have seen firsthand how communication gaps can affect patient care. This has motivated me to reflect on the impact of language barriers and the urgent need to address them. Language Barriers in UK Primary Care The UK is very linguistically diverse, with more than three-hundred different languages spoken. In fact , over 20% of primary school children speak English as an additional language . Nonetheless, patients with limited proficiency in English face significant language barriers in healthcare , resulting in a higher risk of adverse events, misdiagnosis and unplanned readmissions.   The UK’s Equality Act 2010 places a legal duty on the National Health Service (NHS) to reduce inequalities between patients with respect to their ability to access health services. The guidance for primary care states that ‘patients should be able to access primary care services in a way that ensures their language and communication requirements do not prevent them receiving the same quality of healthcare as others.’  However, there has been little progress in implementing this guideline, with large gaps between the policy and the reality that many patients experience.   Non-English-speaking patients face multiple barriers when accessing healthcare, including struggling to communicate their symptoms clearly, understanding medical information, booking an appointment, and even requesting the needed language support. For example, a pilot study exploring the experience in South Asian communities with limited English proficiency reported that lack of confidence in the system, difficulty in requesting language support, and fear of being a burden impacted the experience of care in this population.  Image by Hrant Khachatryan on Unsplash+ Communication barriers are also experienced by healthcare professionals. A nationwide study of 599 primary care physicians in Switzerland found that 90% experienced language barriers at least once a year, with 30% encountering them weekly. While no large-scale nationwide survey exists in the UK, qualitative research and numerous reports consistently highlight clinicians’ concerns regarding language barriers. Lack of Adequate Support for HealthCare Professionals What is even more striking is that healthcare professionals do not have access to adequate tools to overcome these barriers. Although professional interpreter services are considered the gold standard for addressing language barriers in primary care, they are often unavailable and, as such, replaced by ad hoc translation by patients’ family members or friends. In fact, the study cited above reported that while 88% of clinicians expressed a desire to access professional interpreting services, over 60% had never done so. This led over 60% of clinicians to rely on patients’ relatives and friends, including 23% who depended on minors. While translation by relatives and friends is often the most practical solution, it is not the most optimal. As illustrated by the earlier example of the woman presenting with abdominal pain, relying on her son to translate created discomfort and reduced the amount of information shared, which in turn limited the clinician’s understanding of her medical needs.  Indeed, research has shown that translation by relatives or friends is associated with higher rates of errors, ethical and confidentiality concerns, as well as lower satisfaction for both patients and clinicians. So, What is the Way Forward? To address this issue, alternatives to professional interpreting services have been explored. At present, the most promising solution involves using digital translation tools and remote interpreting devices. A systematic review assessi ng different research studies exploring the performance of ChatGPT-4 and Google Translate in translating text and instructions found that translation accuracy was above 90% in both tools . However, it is important to note that up to 6% of instruction sets were translated incorrectly, which was deemed clinically concerning . As such, the study concluded that currently these tools are suited for low-stakes situations, as they lack accou ntability and clinical validation. Despite these limitations, digital translation tools represent a key area for future research and hold potential to help mitigate language barriers for both patients and clinicians. Image by Andrey Matveev on Pexels Beyond professional interpreting services, education is another area for addressing language barriers in healthcare. There are many educational initiatives aimed at helping healthcare professionals develop the skills and awareness needed to recognise communication challenges and work with the services effectively. For example, the Interpret2Improve initiative was an educational programme designed for healthcare students to focus on collaborating with interpreters. Out of the 22 participants, 14 reported increased awareness in addressing language barriers after the programme. This suggests that education can improve clinicians’ confidence in interacting with interpreter services; however, it cannot alone resolve the wider systemic issue. Nonetheless, these programmes still remain valuable in teaching clinicians to advocate for their patients’ rights, particularly when access to professional interpreting services is required.   Educational programmes should also focus on improving awareness of non-verbal cues — such as tone, facial expressions, pauses, and body language — and on the ability to read between the words to recognise subtle signals from patients. This is especially important when language directly limits what can be verbally expressed. Everything discussed in this article highlights that no single solution is sufficient to address language barriers in healthcare; rather, a combination of strategies is required. The need to address these issues is undeniable, and we must continue to advocate for change. Equitable care means providing patients with a space where they feel comfortable enough to express themselves and have their voices heard. As a future doctor, this is the kind of care that I aspire to deliver.

Celine’s day was the same, come rain or shine. It helped that she never really knew what the weather was, but that was beside the point. As soon as she got her heart to stop palpitating after her alarm clock woke her up, she got up, brushed her hair, cleaned her teeth, got dressed nicely, just in case she met somebody new or got hit by a car, and then sat in her living room. She managed to ignore the postman’s knocking by keeping her curtains closed, despite the worry that bubbled up in her chest like a toxic chemical reaction - and then kept on sitting there, safe, until it got dark and it was time for bed. The strange thing was that every day, come rain or shine, despite new batteries in her alarm clock or resetting her phone… the date never changed. It just happened out of nowhere. Celine was living her life the way she always had, well, at least the way she had since the accident. She’d buried the memories deep inside, like bad seeds, and tried to carry on as though nothing had changed. But slowly, she realised she needed to make a few adjustments. Small ones, at first. Like not going outside. Or avoiding people so no one would judge her, or mock her, or so she wouldn’t humiliate herself by getting hit by a car again. And before she knew it, Celine hadn’t left the house in days. Then weeks. Then a month. And then, all of a sudden, the date stopped changing. It remained Sunday, the 20th of November. First for a few days, then a few weeks, and before long, Celine found herself reliving the same day over and over for a month straight. At first, she thought it was an anxiety-fueled dream or some kind of trauma response, but eventually she stopped being scared and unnerved by being stuck and instead settled into this new routine. After a while, it almost felt as though her life had always been like this; but of course, it hadn’t. Just as there had been a life before and after the car accident, there must be a life before and after this ‘same day loop.’ Celine just couldn’t imagine what it would look like - she was now too set in the rhythm to unsettle things by daring to do anything different. Anyway, what was the point? But it was when she was brushing her teeth, following the same routine as always, that a thought suddenly crossed her mind: should she do something to celebrate this strange 30-day anniversary?’ Not anything silly or terrifying like a party. The very idea of seeing other people made her choke on the white foam gathering in her mouth as her heart tried to jump straight out of her chest via her throat, because all she could see was that concerned crowd around her as she lay on the cold tarmac... She quickly spat the foam out and took a few deep breaths as she tried to steady her heart back into its resting place. No. Nothing like that. Photo by Iga Palacz on Unsplash But maybe… maybe she could do something different today. Nothing too grand, just something small, to mark the time she had spent in this strange, repetitive loop. Celine let the ideas flow through her head, trying her best not focus on any one of them, otherwise her anxiety might go haywire - and a panic attack certainly wouldn’t be the best way to mark this ‘anniversary.’ It just had to be something small… The idea popped into her head so suddenly it was as if Celine had been struck by lightning. She’d kept her curtains closed for 29 days straight. If she opened them even an inch, then that was progress, and letting in light after so long… that sounded like the perfect way to celebrate to her. It was certainly strange, walking into her living room and ignoring her feeling of deja vu, resisting going to sit on the sofa, and instead walking towards her thick curtains that were so still it was as if they were holding their breath. Waiting. Celine waited too. And then, when it felt like at least an hour had passed, she pulled them open. The light was so bright it felt as if she was standing in a spotlight. No, not a spotlight – headlights, just that feeling was enough to make her feel sick. She was about to pull them closed again, experiment failed - when someone walked into her view. It was the postman. A tall man, in his early fifties, maybe? Celine tried desperately to list the things she saw as anxiety hit her like the car did that day – heavy and all-consuming. Thankfully, given the glass between them, the fact that she wouldn’t need to speak to him helped ease her worries - even if it felt as if she’d swallowed a mouthful of gravel just at the idea of her having to say something to him. Celine wondered if she’d have time to duck out of view and forget all of this before he looked right at her. Time seemed to freeze. Oh God. I bet he’s thinking I’m a right weirdo. The worries rushed through her mind, like the worry on that crowd’s face… but in a moment of genius, she decided she might as well just wave at him - that would make him go away, right?  she thought. She was right, thank God . Seeing her wave at him, the postman smiled, offered a small wave of his own, and went on his way, out of her view. Just like that. As easy as that. When the anxiety subsided a few days later, Celine was hit with the realisation that her terror aside, it was much easier than she had originally thought it would. The ground didn’t swallow her up. The world didn’t end. He didn’t viciously laugh at her before starting to film her for his TikTok. So, the next day, she tried something new yet again. Even though her hands were shaking so hard she struggled to turn the handle, she opened the door slightly - just enough so the light didn’t shock her so much that she fainted. Despite every atom in her body begging her to close the door, she managed to keep it open. She had an idea, an experiment, even, and something inside her stronger than even her atoms was telling her that she had to see it through. Even if she did faint. She waited so long that she could’ve sworn her vision was starting to fade, until she saw the postman appear in her field of waning vision, snapping her back to reality. ‘Hi!’ He said, kindly. ‘Hello,’ Celine said, quietly, her voice so quiet she was sure that he could barely hear it. He must have thought, because he smiled at her, and then said, ‘Got anything nice planned?’ That almost made her laugh. ‘Oh, no,’ she replied. ‘No - not really.’ ‘Same rubbish, different day, eh?’ the postman asked kindly. ‘Something like that,’ Celine answered, careful not to talk as fast as her heart was hammering in her chest. Her nerves got the better of her, however, and she shut her front door before he could reply. The next day, Celine decided to try again. She figured that not doing anything had kept her in this loop, so maybe doing something different - even something small - might help her, somehow. Their conversation was the same, but this time she watched as the postman smiled kindly at her, nodded, and went to walk away. Unfortunately, he seemed so distracted when he walked away that he then tripped on the uneven slab that lay just beyond Celine’s window - and, almost in slow-motion, fell to the ground with an unceremonious thump. He hurried to his feet again, his face beet red both in embarrassment and from the impact. ‘What am I like?’ He asked, before laughing shakily and hurrying away - all the while not looking her in the eye. Oh, Celine thought. It was as if the world around her shifted slightly, just like that uneven slab being part of an otherwise perfectly flat pavement. In all this time, in all those repeated days… seeing something new, something bigger than just opening the curtains, and those headlights. It was strange. It made her feel like a piece of a puzzle, small and insignificant, but more than that - like she had a part in the world and belonged in the universe, all at once. Because other than the postman, she was the only person there to see him fall. And the way he reacted afterwards - he didn’t seem to care about her at all, just her reaction to him.  Is that it?  The realisation hit her like she was the one who had just fallen… people really did care more about other people’s opinions and thoughts of them than anything else. Even if they were hurt! It all seemed so silly. So obvious. All this time, she was so scared and so anxious about what other people thought of her, like that crowd, when they didn’t care about things like her greasy hair and stained top, because they were all just thinking the same about themselves! Or at the very least, worried about more important things, like someone not getting hurt or dying. Celine hurried inside and decided she had to sleep. Now. Because this had to be it, right? The reason for every day being the same… it had to be because she needed to learn that. But the next day, nothing changed. And the next was the same. Until Celine realised what she might need to do next. It was, of course, a day like any other when Celine cautiously stepped outside for the first time in what felt like years, and for a moment, the bright light that hit her made her feel dazed and unwell. It was different from looking at it through a window - harsher. Thankfully, she was able to pull herself together just as she heard the thud of her postman’s footsteps on the slabs that lined the path in front of her house. Despite going through the same day over and over so many times already, Celine found it strange, a nice kind of strange, to be experiencing something different after so long. Even if it was absolutely terrifying at the same time. ‘Hi!’ The postman said, offering her a wave. Celine noticed he had something in his teeth, but she also noticed the lines around his smile and was shocked by how little it all bothered her. Is this what it was like for everyone? Did they notice these little things about others, and just not care? She was stuck pondering that thought and having the realisation settle calmly in her mind like a wave that she almost forgot the reason she was out here in the first place. She smiled before calling out as loudly as she could, despite her scratchy, dry throat. ‘Morning! Careful there, by the way - that slab is sticking out a bit!’ The postman heard her and noticed just in time to step over the slab and avoid falling. He turned back to her, both shock and relief on his face. ‘Thanks! You saved me a split lip there!’ ‘No worries,’ Celine replied, so full of adrenaline and anxiety that it felt as if she was trying to swallow a mouthful of rocks and they were stuck in her throat. She had done it, she thought. She’d saved someone else from an embarrassing and painful fate, even if it wasn’t quite as severe as hers. That is, until she saw the postman walk into the road to start on that side of the street, and hear a squeal of wheels on tarmac as a car roared down the street. As the memories flashed through her mind, the world in front of her seemed to slow to a stop, her legs started pumping, and she was running out into the sun before her mind realised she was even running, outside, and straight towards the car that was still barreling towards a stunned postman. ‘Watch out!’ She shouted, her voice stronger than she ever thought it could be, as she reached out and pushed the postman out of the way of the car, just in time. But not in time to avoid being hit by it herself. As the pain flooded through her like a tsunami, she watched through fading vision while letters flew around above her like doves freed from a cage. And strangely, her last thought wasn’t of embarrassment, or anxiety, or regret, but of an apology – for not saving the postman from a split lip after all. Although it could’ve been worse, Celine thought, as her vision faded into an inky blackness, and she fell asleep. And then she woke up again. Like nothing at all had happened. Her muscles ached as if she’d run a marathon, but she moved each limb in turn, and nothing felt broken. Other than what felt like a vivid dream of saving her kind postman from being hit by a car and the aches and pains, everything felt exactly as it was. Although she could see from her bed that there was no sun trying to peek through. Almost as if it were cloudy… Almost as if… Celine wouldn’t dare let that thought enter her head. It had been so long that she’d been stuck like this, she wouldn’t dare jinx it. She had no idea why she didn’t grab her phone to check - it must’ve been the adrenaline. ‘Hi!’ She said, quickly, to the postman, who flashed that familiar smile at her in response. ‘Uh, what day is it today? Sunday?’ She had to resist adding ‘again.’ The postman shook his head, still smiling. ‘Nope! It’s Monday - a brand-new week!’ ‘Nope’ suddenly became Celine’s favourite word in the entire world. She felt herself just standing there, blinking, as that word, and the rest, slowly sank in. Somehow, she had made it through that haze of day after day being the same and made it through the other side. Even if it meant having been technically hit by a car twice. She’d done it. ‘Wow, I - thanks!’ She said, suddenly aware that she was grinning so wide that her cheeks started to hurt. ‘No problem,’ the postman replied, before looking at her a little closer and saying, ‘Are you alright?’ A familiar anxiety appeared in Celine’s chest, heavy, as if she’d swallowed a mouthful of rocks - again. But after all this time, she helped him and looked ridiculous, and he didn’t care… he only cared what she thought, and she was so happy that was her only thought at all. After a moment, she was able to will the anxiety away and ignore it. Finally. ‘Yeah, I’m good, thanks,’ Celine said, smiling kindly at him. ‘It’s just one of those days.’ ‘Same rubbish, different day, eh?’ The postman said, with his familiar smile. Celine nodded - he had no idea how right he was. But she couldn’t just stand there and ponder this - she had to warn him, quickly, about the uneven slab, and then the car, and watched as it barreled down the road and came to a stop, hitting no one, as the driver hurried out the car, shouting that his wife was in labour and he needed to get her ton hospital. Celine and the postman wished them both luck before she headed back inside to call the council to see if they’d be able to get that slab fixed, and to order her neighbour a new baby gift online. She had no idea they were even expecting. The days flew by after that, but Celine still had no clue why it all happened. Maybe she’d figure it out later - it didn’t matter right now. Celine was a determined woman. Every day was a new day, finally, and she didn’t have time for thinking and worrying and caring so much, or at least paying as much attention to her anxiety as she had over those past 29 days. She had, as the postman so aptly said, rubbish to do right now, before it was a new day. Because before she knew it, it would be another new day - and Celine was determined to appreciate them again.

Warning: This article contains spoilers for the Netflix series, 'Stranger Things' Mike, Lucas, Max, Will, and Dustin playing the last D&D campaign. Screenshot from Netflix, Stranger Things, Series 5, Episode 8 It’s time to accept it, Stranger Things  is finished. El is alive, trekking in a remote place with waterfalls. Mike is a successful writer. Will enjoys his life in New York. Max can walk again, and she and Lucas are still together. Dustin is an academic. I am planning my retirement. We have all become a little bit more adult since Episode 8, which aired on New Year’s Eve.   Why is it so difficult to accept that it is over?   This is not a rhetorical question. Thousands of fans online have, for weeks, argued that Episode 8 was not the end. According to the viral “Conformity Gate” theory , fans believed that there should have been a new episode coming out on January 7 th . Then on January 17 th . Netflix crashed because so many people visited the site looking for an episode that never existed. In the end, perhaps because of the strong rebuttal from Netflix, this hope has faded, too.   The Conformity Gate theory could be seen as a response to collective disappointment with the series’ ending, as many felt that the happy ending was too happy. All the protagonists return to a normal, conformity-based life, which is an impossible ending for them. Aren’t they a group of rebellious young heroes who have fought with interdimensional evil and saved our universe? How can they possibly settle into adulthood? It must be an illusion. A surprise will come. More adventure. More fights, with an even worse evil. There are so many clues left by the Duffer brothers that anticipate this. Haven’t you noticed that a doorknob shifts from left to right between episodes? It is certainly a signal for a mirror reality.   I am sorry, my friends. I am sad, too. I, like you, cannot imagine a life without El, Mike, Will, Dustin, Lukas… without Max, on whom I have written before . Because life without Stranger Things is simply sadder.   But no new episodes are coming. The story has finished. The supposed hidden clues are just technical mistakes. It’s time to understand the real motivation behind the Conformity Gate theory: we do not want to grow up.   At the end of episode 8, the Duffer brothers show, within the story itself, what many of us find difficult to accept. As Mike leaves his basement after what may be his last Dungeon & Dragons campaign with his friends, his 8-year-old sister, Holly, storms down the stairs with her friends of similar age. Having all just lived an incredible adventure, captured by Vecna, they start playing their own D&D campaign. Holly and her friends playing their first D&D campaign. Screenshot from Netflix, Stranger Things, Series 5, Episode 8   Mike looks at them, between a smile and a tear, as he realises that he is leaving this world behind as others step in to continue it. He turns and leaves the basement. He closes the door. The end.   And this was when I thought – yes, Mike, I am with you. I am you.     I am also grieving the child in me who remained in the basement, as I became (just a little bit more) an adult at the end of Stranger Things . The child in me who watched E.T.  and Ghostbusters and The Neverending Story  and Back to the Future ; who listened to Kate Bush and Diana Ross, played on local radio stations; who wanted to be James Bond or Indiana Jones or the Man with No Name cowboy. I left him playing in the basement when I closed the door with Mike, sharing his sadness. And as I am grieving Stranger Things,  I am also grieving that part of me, who could save the world by fighting evil because he could believe that the Upside Down world really exists.   I am not the only one with this view. My Italian friend and psychoanalyst, Laura Fonzi, whom I interviewed in preparation for this piece, is also a Stranger Things  fan. She confessed to having cried throughout the last episode, because of the nostalgia for her childhood that the series powerfully triggered through continuous references to her favourite movies. Moreover, she observes, “ E.T . and The Goonies  are movies where the children know more than the adults and save the world through their incessant ingenuity”. And then Stranger Things ends, and suddenly she is an adult again, with “the suffering that comes with growing up, when our child’s eyes, which could see (and believe in) the invisible, lose the spark, and we leave the epic adventures of our fantasy life for the ordinary of reality”.   As I remember my sadness, I can understand the people pursuing – hoping for, dreaming of – one more episode. Dreaming that the story is not finished, that the characters are still alive in the Duffer Brothers’ minds. Unfortunately, this is also not true. Yes, it is a disappointment, a painful emotion that is yet so important for growing up.    Indeed, I believe that this tension between fantasy and disappointment that I felt while watching Stranger Things  is what keeps us alive and creative. While I was watching, I could almost  believe it was real –fleetingly, ambivalently, romantically, knowingly and unknowingly, consciously and unconsciously, fluctuating between my inner world and the real world– I almost  could.  And then, at the end of every episode, every season, and now at the end of the story, I experienced the disappointment that comes when the bubble bursts. But isn’t this disappointment, as sad as it is, better than never experiencing these emotions? It is like when I wake up from a wonderful dream. This rude awakening is a price that I am happy to pay for the emotional aliveness that I feel when I completely yield to my imagination. Mike leaving the basement and closing the door. Screenshot from Netflix, Stranger Things, Series 5, Episode 8   By coincidence – or maybe not; as both the psychoanalyst Carl Jung  and Kung Fu Panda’s Grand Master Oogway  say, there are no coincidences – I am reading  The Book of Dust , the follow-up trilogy after His Dark Materials . The story, arguably so similar to Stranger Things , follows a young girl hero who saves the universe while travelling between worlds and meeting talking bear-kings and flying witches who can live for thousands of years. In this reality, humans have animal-shaped demons, a magic knife can cut between dimensions, gryphons dominate the sky, and a sentient dust permeates the universe.   And so, here is my advice for all of you, fellow Stranger Things  mourners. Stop wasting time and energy fantasising about impossible scenarios where a new mysterious episode is lingering in the darkness. Instead, embrace reality. Well, embrace a reality. Embrace a new  reality.   For me, at the moment, that reality is the Book of Dust .

The Importance of Physical Activity on Your Mental Health: An interview with Michael Watson, MBE In my life, I have battled a gambling addiction and a brain tumour — and alongside these I experienced depression. Exercising through those tough times has helped me focus and keeps me moving forward. The British ex-boxer Michael Watson, who uses exercise as a tool to manage his mental health, was a hero of mine as a youngster. Seeing how he has dealt with adversity encouraged me to approach his agent, Brendan O'Connor, with a request for an interview. Recently, I was able to sit down for an intimate chat with Michael, where we discussed his brain injury, the positive impact of physical activity on his mental health and the MBE he was awarded. He also had plenty of advice for anyone struggling. Michael suffered a life-changing brain injury in a fight with fellow boxer Chris Eubank that left him unable to walk or speak for the following eight months. The biggest fight of Michael’s life was not in that one in a boxing ring, but the recovery that followed, described by his neurologist Peter Hamlyn as "extraordinary". In my previous blog, I presented my interview with Charlie Duffield who talked about his battle with a gambling addiction. Now I am focusing on telling the story of Michael Watson and his recovery from life-changing injuries. The night Michael's life changed Michael Watson had the W.B.O (World Boxing Organisation) Super-Middleweight world title in his grasp, ahead of Chris Eubank on points as the bell for the 12th and final round sounded at White Hart Lane in September 1991. In the 12thth round, Michael’s life changed in a second: Chris Eubank, from the brink of defeat, unleashed a devastating uppercut that made Michael collapse in the ring. Unbelievably, there were no ambulances or paramedics at the event, and as a result of the delay in his care, Michael's brain was deprived of oxygen for 8 minutes. Overall, there was a nearly 30-minute delay until Michael received care in a neurological unit. Subsequently, he spent 40 days and 40 nights in a coma and had six operations to remove a life-threatening blood clot from his brain. Now 56-years-old, despite receiving life-changing brain injuries, Michael has dedicated himself to helping other disabled people in sport and was awarded an MBE in 2012 in recognition for his excellent work for disabled sport. Michael's MBE was awarded due to his consistent campaigning for disability sport, calling for improved disabled access to gyms and fitness centres. Michael described the feeling of receiving an MBE as “the proudest moment of my life”. The positive effect of physical activity on mental health According to the Mental Health Foundation , participation in physical activity can help improve mental health. It provides countless benefits, both physical and mental. The benefits of physical activity on mental health is endorsed by the NHS , especially for people experiencing mild to moderate depression. "I spent a long time in a coma and then had a lot of frustration when I came out of the coma. I had to keep the faith and draw strength from somewhere”. Michael continued: " Muhammed Ali [the boxing legend] visited and told me that he knew I would recover. It resonated with me and gave me extra determination to prove the doctors wrong who said I would never walk again. Eventually, I learnt how to walk and talk again." Then Michael added: "I even managed to complete the London Marathon, which took me over six days. Completing the marathon made me so proud and helped me with my state of mind. I wanted to show people even when the worst thing happens, so much can still be achieved." Many sportspersons, including Tyson Fury , have proven how having an exercise schedule continues to help them overcome their mental health woes. Michael, like Tyson, sticks to a rigid exercise schedule every day, which has helped him avoid falling into further mental health problems. Michael has set himself goals to achieve such as lasting longer on the static bike and walk further daily to push himself. Michael’s experience of overcoming mental health issues through sport Michael Watson — The Sun (Getty images) — 23/2/17 "I think sport is great for adults and children and teaches discipline and teamwork", Michael continued. "Studies have proven that it releases endorphins, making it a great and productive outlet to improve mental health. The feeling I get when I work out every day is unrivaled. I am determined to push myself. I want to test myself when I walk and work out on the static bike every day. The feeling I get from working out is phenomenal. It works wonders for my mental health." Seeing Michael finishing the London Marathon, and noticing how exercise, in general, has helped him deal with his life-changing injuries, is truly awe-inspiring. Despite Michael’s struggles, hearing how he wants to inspire others despite his battles is a truly inspirational message. Mental health woes in boxing Boxers and other sportspeople seem to have an issue retiring when they are at the peak of their ability, and those that do retire are often tempted back. "A lot of sportspersons struggle to retire; many have to continue for financial reasons." Michael added: "Some make comebacks because they miss the adulation. Some will not know how to function without competitive sport." According to Dr Margaret Goodman (Neurologist and former ringside Physician), depression is a big problem for boxers . "Depression is quite prevalent among boxers," says Dr Goodman. "It is almost never diagnosed until it’s too late, and it manifests itself in so many negative ways." Retirement is a difficult option to take for any sportsperson. Michael, due to his injuries from that night in 1991, didn’t have a choice when retirement happened in his life. Michael Watson — Daily Mail — 23/07/21 Michael continues to show us every day that, even when the hard times come, we can all continue to lead productive and healthy lives. When asking Michael why he is passionate about helping others he said, brimming with pride: “It makes me feel alive when I help others”. Having survived a brain tumour I remember feeling a sense of loss during that time in my life. It often felt like the old me had died following the tumour and that was challenging to deal with. Michael has shown how powerful having a sense of purpose can be in combating mental health woes. He has a determination which is so apparent when talking to him. Whether he’s working out for longer than the day before, or he’s helping disabled people in sport through his campaigning for better access to sport for disabled people, there’s a clear fire burning bright in him - and that fire in him is infectious.

Exploring social determinants of health and bodily systems in Schizophrenia. The question surrounding the innate and cultural forces that can shape an individual goes as far as biology and social sciences go. Psychiatry can be understood as a hybrid medical speciality. While biological factors, such as genetics, hormones, and brain structure and function, play a crucial role in explaining the mechanisms of mental health disorders, the field is also deeply shaped by social influences. Our environment and life experiences profoundly affect how we feel and, by extension, our mental health.  Despite this, current approaches in psychiatry and neurosciences mostly focus on biological determinants. This has allowed for the development of medications that help improve mental health outcomes. However, focusing solely on biological systems does not encompass the breadth of the human experience, which is inherently social. Therefore, exploring the interactions between our social environment and biological systems would strengthen our understanding of the underlying mechanisms and offer new areas for treatment. As a psychologist and PhD student in biomedical sciences, I have always been fascinated by the interface between our social environment, our bodily systems’ response to it, and our mental health. In this article, I will present how I tackle this in my doctoral research, focused on social determinants and bodily systems in Schizophrenia. What are social determinants of health? The World Health Organisation defines social determinants of health as “the conditions in which people are born, grow, live, work, age, and people’s access to power, money and resources”. This is a broad definition, so here are some examples in relation to mental health. Economic hardship (at the individual and societal scale) is associated with lower reported well-being, higher rates of mental health disorders, substance use, and suicide rates. Education is a strong protective factor against mental health disorders. Social interactions and support are powerful protective factors against mental health disorders. Access to mental healthcare is essential as it allows for timely treatment. Universal health care access is also associated with better emotional well-being and allows the prevention and promotion of mental health. How do they influence mental health? These social determinants can be understood as long-term stress factors. Chronic exposure to stress can keep the body’s stress system constantly activated, eventually throwing it out of balance and degrading other bodily systems at the same time. Therefore, acting on social determinants of health, through policies reducing inequalities and promoting access to care, education, and healthy social interactions, is a powerful way to improve mental health. Why are social determinants left aside? As evoked earlier, many factors can influence mental health, but assessing all of them properly would require large samples. Biological research is particularly expensive when considering the cost of analysing blood samples, brain scanners, etc. These costs oftentimes limit participants' recruitment, restricting the number of variables researchers can realistically include. As such, a method that condenses various social determinants into a smaller set of variables would make it far easier to incorporate them. This is exactly what I am doing in my doctoral project. A proposition to include social determinants of health in biomedical research French sociologist Pierre Bourdieu offered an interesting theory to determine how individuals are disseminated across the social space. In this theoretical framework called “La théorie de l’espace social” or “the theory of social space”, he posits that one’s position in society can be defined through 4 different dimensions. These dimensions are understood as “capitals, ” referring to them as quantifiable in some way. Therefore, every individual in society possesses a quantity of social, economic, cultural, and symbolic capital. But what exactly do these terms mean? Social capital : Defined as the value of belonging to a group of people who share common traits and are connected through stable, meaningful relationships. In other words, it can be understood as the crossroads between the size of someone’s social network and the support they receive from it. Economic capital : Defined as the economic resources of an individual, which can be a factor of income through work (i.e., active income) or other sources (i.e., passive income), as well as movable and immovable property. Cultural capital : Defined as an individual’s cultural knowledge and resources. presented in three forms: (1) embodied form, referring to the culture an individual has internalised (e.g., vocabulary used); (2) objectivized form, referring to the possession of cultural goods; and (3) institutionalised form, which reflects how institutions recognise a person’s own cultural knowledge (e.g., university diploma). Symbolic capital : Defined as the prestige, honour, or recognition that an individual receives through the different “labels” they hold, often derived from other forms of capital. For example, the CEO of a large company or a university professor carries symbolic capital that reflects their status rooted in their economic, social, or cultural capital. Perception plays a key role here: symbolic capital depends on how others interpret and value these labels, which can vary across social groups and can be influenced not only by one’s other forms of capital but also by individual characteristics. Interestingly, the social determinants of mental health fit within these capitals. Going back to the examples provided earlier, social interactions and support fit within the social capital, while the economic inequalities can be mapped within the economic capital. This approach could therefore offer a way to explore the interaction between social determinants and biological indicators. My current project In my doctoral project, I am investigating the ties between status and position within the social space and the severity of schizophrenia through biological alterations. Essentially, I aim to understand how the social becomes biological and pathological. To do so, I measure the capitals among patients diagnosed with schizophrenia and healthy controls in a large dataset (Signature Biobank). This biobank is composed of data from over 2000 patients who visited the emergency room of the largest psychiatric hospital in the Canadian province of Québec. Photo by Author Enzo Cipriani To quantify Bourdieu’s capitals, I explored the different sociodemographic variables in the biobank and adapted them, creating four scores for each participant. I then investigated how these scores relate to various biological indicators and symptoms. I mainly focused on immune system activity, given the growing evidence that the immune system has an essential role, potentially explaining the emergence and severity of the disorder. The immune system is also tightly linked to the body’s stress system, which means prolonged stress can directly influence immune functioning. To do so, I measured concentrations of 9 cytokines, which are indicators of the immune system’s activity. These cytokines can be divided into three categories when considering their properties: pro-inflammatory (increases inflammation in the body), anti-inflammatory (reduces inflammation), and chemotactic (recruits immune cells to an infection site).  What have we learned so far in my project? So far, preliminary results identified that a better social capital (i.e., being in a relationship, having children, living with relatives, and having friends) is related to less severe anxious, cognitive, and depressive symptoms, while a better economic capital is related to less severe delusions. These dimensions are also related to participants’ immune profiles. People with higher social capital had higher concentrations of anti-inflammatory cytokines, showing a potential protective effect through attenuation of immune inflammation. So, the social seems to become biological and pathological through the immune system. In the next steps, I will investigate deeper how the social determinants and immune systems act individually or in synergy to explain schizophrenia’s severity. If you want to go deeper, you can go read a two-page document detailing a bit more of my methods or go read a book chapter I wrote that was recently published .

Image Source: Owl Illustration Agency on Unsplash The healthcare sector’s overwhelming complacency with current female hormonal contraceptives has resulted in a lack of innovation for new methods. Between 2017 and 2020 , pharmaceutical companies funded no more than 25 clinical trials worldwide for contraception options, with most studies focusing on incremental changes to existing hormonal contraception options. This is staggering in comparison to 2019 alone, when industry funding supported around 3,100 cancer drug trials and 600 cardiovascular drug trials. For some women who use hormonal contraception, serious side effects can emerge, and alternative options are often limited or unsuitable, restricting full agency over their bodies. Many medical professionals’ perceptions of these side effects can push aside women’s experiences and perpetuate institutionalised misogyny  and medical bias . This gap in research is failing women; impactful changes are needed for female reproductive health to become a priority in medicine. Stories Told by Female Friends I spent the entirety of my education at an all-girls school, where frequent open discussions among my peers about the obstacles we faced as females took place: from one friend throwing up during her Intrauterine Device (IUD) insertion, to stories of catcalling and stalkers. A recent example was my female friend’s visit to a General Practitioner (GP) to start a conversation about changing her contraceptive pill; a story which she is happy for me to share with you. Over the last several months, she had noticed a change in her mood and an increase in her tendency to suffer from anxious and depressed mental states. Within a couple of minutes, sat opposite a male GP, she’d been prescribed antidepressants, along with the dismissal that her contraception wouldn’t be to blame. She left the doctor’s office feeling deflated by her experience of being undermined so swiftly. Dissatisfied with her unwanted new prescription, later that day she phoned to make another appointment to see a female GP. Image Source: Owl Illustration Agency on Unsplash Since recently finishing my Master’s in Psychiatric Research, in my own time, I have been investigating pitfalls in our scientific knowledge, corroborated by stories told to me by the women in my life. In particular, the inadequacy of female contraceptives has been at the forefront of these conversations, understandably so since my friends and I are in our mid-20s. My friend’s account of being patronised in a medical environment is one of many that I have read in books or online, which have infuriated me enough to motivate the writing of this article, in the hope of bringing more awareness to this issue. Although my friend has faced negative side effects, the freedom that hormonal contraception provides for women to have control over their fertility is irrefutable; many women have positive experiences. However, while ‘mood swings’ are known to be a commonly reported side effect of hormonal contraception, information provided on the NHS website  is vague; simply stating that if side effects become a problem, a different contraception may be better suited. In g uidelines from the National Institute for Health and Care Excellence, which advises healthcare providers on the topic of hormonal contraception, there is only a very brief mention of the mental health implications, stating that the manufacturers of hormonal contraceptives are aware of the possible risk for suicide and suicidal behaviour. Across 13 years, a large prospective study  of over 1 million women living in Denmark tracked the association between their hormonal contraception use and risk of depression. The study found that women using hormonal contraception had a slightly higher risk of depression and were more likely to be prescribed antidepressants compared to non-users. But this is one of the very few studies that examines the mental health implications of hormonal contraception.   Fury in Forums and Coercive Consults A quick Google search of depression and hormonal contraception reveals floods of forum posts recounting women’s experiences of side effects, with many describing feeling like an entirely different person. Despite these serious concerns from users over their wellbeing, research into how these side effects can be managed and the development of alternative contraceptive solutions is limited. The lack of research has left a gap in the knowledge of medical professionals, evidenced by my friend’s experience of a GP not taking the time to listen to her concerns about side effects.   Image Source: Owl Illustration Agency on Unsplash Feeling dismissed in healthcare settings is frequently reported by women. Concerns regarding the side effects of contraceptives are no exception. A recent survey  of 188 women found that 43.6% had experienced mood changes as a side effect of their hormonal contraception. The survey also found that side effects were the most common reason that women switched or discontinued their hormonal contraception, with the majority reporting that their healthcare provider had not adequately discussed the possibility of psychological side effects. Furthermore, it was revealed from a study examining women’s lived experiences during consults with medical professionals that many felt a patient-professional power imbalance existed, the relationship even being described by some as coercive when discussing contraception options. Continuing with this kind of research is crucial to identifying the shortcomings and spreading awareness in the medical field in order to bring about change.   A Call for Better Care I expect you’ll be pleased to hear that my friend’s second appointment was much more positive. The female GP showed compassion and empathy for her experience, even to go as far as to apologise upon the retelling of her appointment with the other GP. Taking the time to listen to my friend’s concerns and give her the attention she deserves, the GP thoroughly went through the options available and signposted her to information that would be helpful. The conclusion was to change the contraceptive pill she was taking, and to follow up in a few months to see how her mood was progressing. The GP’s awareness and education of the topic led my friend down a completely different route in comparison to the outcome of the previous appointment.   Image Source: Owl Illustration Agency on Unsplash While my friend had the resilience to advocate for herself, this is not something that should be required of women in order to have their reproductive health concerns addressed sufficiently. The healthcare system’s lack of meaningful advances to improve female contraceptive options is baffling. Urgent funding, research and education are needed in order to expand the medicine available for women to ensure they have autonomy over their reproduction. Until then, women are left with no other choice than to use trial and error with the hope of finding a compatible option, far less than they deserve.

Pregnancy and Postnatal Outcomes of Women with Intellectual Disability. This article is co-written by Ayeshah Mateen Allahwala and Vaheshta Sethna. Ayeshah Mateen Allahwala is a final year psychology student at the University of Karachi, passionate about mental health, human rights, and education. Beyond her studies, she volunteers with NGOs working with children from underserved communities and writes to make mental health knowledge accessible for all. In this blog, she draws on recent research to explore what pregnancy and life after birth are like for women with intellectual disabilities, and how care during and after pregnancy can be better tailored to support them.   Vaheshta Sethna is a Senior Lecturer in Family Perinatal Mental Health (Education) at the Social Genetic Developmental Psychiatry Centre, King’s College London. Her research focuses on the health and needs of families during pregnancy and the postnatal period. She is especially interested in how psychological and social risks, as well as sources of strength, shape a child’s development. Through her work she aims to guide more compassionate and effective support for vulnerable families and foster hope in their care journey. In this piece, she shares insights from her recent work into pregnancy and postnatal outcomes for women with intellectual disabilities and their babies. Photo by Aditya Romansa on Unsplash The moment they meet the world, but it meets them differently   Surrounded by echoes of doctors, nurses, fluorescent lights beaming above, the clatter of medical equipment, a flurry of instructions, sensations, reassurance, overflowing emotions, she lays there as her body and mind are going through unimaginable things, an embodiment of strength, ready to give birth. She feels confused, senses judgement and thinks: “ How will I be able to do this ?”   Motherhood is often seen as a time of significant personal change, filled with both joy and challenges. These challenges can be even more pronounced for mothers with an intellectual disability . What is intellectual disability? Intellectual disability is a neurodevelopmental condition that affects brain development and functioning. It is a lifelong condition that begins before adulthood. Globally, the prevalence of intellectual disability is estimated at 1–3%, with higher rates seen in low- and middle-income countries where access to early intervention and healthcare is limited. According to an internationally recognised framework for diagnosis (i.e. the International Classification of Diseases, 11th Revision ( ICD-11 )), intellectual disability is referred to as a disorder of intellectual development . It is characterised by significantly reduced intellectual functioning and limitations in adaptive behaviours, such as communication, social participation, and independent living. Individuals with an intellectual disability learn and understand things more slowly , and need extra help with daily activities throughout life. When preparing for motherhood, these challenges can turn a healthcare setting into a confusing maze of unfamiliar terms and decisions. For women with an intellectual disability who become mothers, the experience of pregnancy and birth is profoundly shaped not just by their condition, but by how society and the healthcare system respond. And yet, these women carry the same hopes, the same love. Pregnancy & intellectual disability When a woman with an intellectual disability becomes pregnant, she may encounter a distinct set of challenges that impact her physical health, emotional wellbeing, and ability to navigate the healthcare system. Having an intellectual disability often involves difficulties with comprehension, memory, communication, and decision-making; skills that are essential for engaging effectively with healthcare services. Photo by Hans for Unsplash+ The Many Facets of Challenges   Women with an intellectual disability may face multiple barriers in accessing antenatal care (also called prenatal care), the medical support a woman receives during pregnancy to keep both her and her baby healthy. It includes regular check-ups, blood tests, ultrasound scans, advice on nutrition, and guidance on what to expect as the pregnancy progresses. These challenges include communication difficulties, fear of judgment or stigma, and a lack of tailored support. For example, medical advice may be delivered too quickly, in technical language, or without checking for understanding. This can leave women feeling vulnerable, not only medically but emotionally as well. Some women with an intellectual disability have reported inadequate treatment by healthcare staff, including limited understanding of their needs, and insufficient support during pregnancy and childbirth. However, this is not universally observed, suggesting that while negative experiences are reported, they are shaped by differences in staff awareness, training, and healthcare system practices. Therefore, inclusive perinatal care , i.e. care during pregnancy and after giving birth that is flexible, patient-centered, and communication-sensitive, is essential for supporting pregnant women with intellectual disability .   Research Evidence   A recent research study examined pregnancy and postnatal outcomes for women with an intellectual disability to shed light on maternal and infant health outcomes.   The authors used a systematic review study design - a type of scientific study that doesn’t collect new data, instead it is a careful and thorough way of looking at existing published evidence on a specific question to understand what the overall evidence shows.   In this case, the researchers identified previously published global studies, with the aim of finding out:   ● The health risks women with an intellectual disability face during pregnancy ● Potential complications their babies experience.   Through this information, the study aims to provide a clearer, more reliable picture of the challenges- which will help point the way forward for better care.   The researchers screened 103 full-text articles and ultimately included 9 articles (encompassing data from 8 distinct cohorts) that fulfilled the study eligibility criteria (i.e. studies were only eligible if they focused on women with an intellectual disability, defined according to internationally recognised manuals used to identify and describe mental health conditions).   What did the authors report? Women with an intellectual disability are more likely to experience health issues such as urinary tract infections in mid to late pregnancy, gestational hypertension (a condition characterised by high blood pressure that develops after the 20th week of pregnancy in a woman who did not previously have hypertension), and postpartum haemorrhage (heavy bleeding after birth). They are also more likely to experience postpartum haematoma, which is a collection of blood or internal bleeding that happens after childbirth. Women with intellectual disabilities tend to stay longer in hospital after giving birth and are more likely to be discharged to somewhere other than home. Additionally, their babies are more likely to be born premature, at less than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks.  Some babies may require extended neonatal care . Notably, the limited number of studies reviewed showed mixed results regarding the association between intellectual disability and outcomes such as birthweight, congenital conditions (health problems present from birth), Apgar scores (which assess a baby’s health right after birth), stillbirth, and neonatal death. Importantly, the systematic review highlights significant gaps in robust, up-to-date data on this topic. The included studies were limited to high-income countries and the groups of women with intellectual disabilities were much smaller than the comparison groups without disabilities. This smaller sample size may have made it harder to detect rare outcomes, like stillbirth, and as a result, the patterns seen in the data weren’t strong enough to confidently say they weren’t due to chance. Finally, the study only looked at how children developed during their first year of life, indicating that any results related to later development or long-term outcomes weren’t included in the study. Photo by Getty Images for Unsplash+   Why this Review is Significant   This study confirms the urgent need for larger more inclusive studies so we can better support women with intellectual disabilities who often face health inequalities and rely more on services. It provides empirical evidence advocating for change, urging policymakers and pushing for inclusive health strategies such as using simple, easy-to-understand information, providing extra time and support during appointments, and ensuring accessible and patient-centred maternity care – thus, empowering women to make informed decisions throughout pregnancy and childbirth.   Time to Change the Narrative   Ultimately, every mother hopes for a safe birth and a healthy baby. Women with intellectual disability share the same dreams, but the system often meets them differently. By listening more closely, adapting care and treating them with better understanding, healthcare providers can help rewrite this story - one where strength, love, and equity guide every birth.

Disability due to chronic pain is a massive issue in the UK, with millions of people across the country unable to work, see their friends, or perform everyday tasks because of their condition. As an individual with experience in researching chronic pain and educating others about it, I am passionate about understanding the holistic impact pain has on individuals and how this can be managed.  While working at an NHS chronic pain management service, I had many discussions with people living with chronic pain. Service users often expressed how their pain felt invisible to others, and that the public, as well as healthcare professionals, have a very poor understanding of chronic pain. This increases the stigma around pain conditions, causing people with pain to feel isolated, misunderstood, and ignored, negatively impacting their quality of life , both through social isolation, as well as a lack of appropriate support from others. Because of this, I will discuss what chronic pain is and who it most affects, aiming to give you a better understanding of chronic pain in the UK.  Photo by Aarón Blanco Tejedor on UnSplash What Is Chronic Pain?    According to the International Association for the Study of Pain (IASP), pain can be defined as an unpleasant sensory and emotional experience, associated with, or resembling that associated with, actual or potential bodily harm . For pain to be considered chronic, it must persist for at least three months or more . Chronic pain is also categorised into primary and secondary  pain.  Primary  chronic pain often has no clear underlying cause. Pain is the main clinical concern, and examples of this include conditions such as fibromyalgia or chronic low-back pain. Alternatively, secondary  chronic pain initially starts as a symptom of an underlying disease, such as cancer, but can persist once the disease that causes pain has been treated. It is important to note that primary  and secondary  chronic pain can exist simultaneously, and that the causes behind chronic pain can be very complicated, making them very difficult to treat. Types of Chronic Pain   Nociceptive pain is pain that arises from actual damage to non-neurological tissue.  This mainly includes conditions like osteoarthritis, where pain is experienced in joints where the cartilage is worn away, no longer cushioning your bones, causing pain and stiffness. Although some joints, such as your knee, can be replaced to reduce pain, other joints, such as those in your back or hands, cannot be replaced, resulting in long-term pain. The second type of chronic pain is neuropathic pain, where pain arises from nerve damage or dysfunction . This can include direct physical trauma to nerves, the result of infections such as shingles and HIV, or also as a consequence of other health conditions like diabetes and cancer. Pain can exist in the location of nerve damage, but it can also extend to other parts of the body that the nerve communicates with. Neuropathic pain is also often associated with other non-painful symptoms, like pins and needles, numbness, and muscle weakness. Lastly, nociplastic pain manifests when the brain and spinal cord are reorganised to be overly vigilant towards threats , causing them to generate painful sensations in the absence of actual bodily harm, seen in conditions like fibromyalgia. This excessive threat perception has multiple causes, including the sensitivity of nerves that perceive pain from the environment, changes in the nerves in the spinal cord that communicate pain, and alterations in brain areas that evaluate pain. Unlike the other two categories, nociplastic pain can change location, and is often widespread across the body, with the location of the pain unable to be fully explained by neural or non-neural damage. This type of pain is poorly understood by scientists, so  clinicians tend to focus on pain management, as opposed to curing pain , using psychosocial therapies, like cognitive behavioural therapy, to improve quality of life. Photo by Towfiqu Barbhuiya on Pexels Who Lives With Chronic Pain?   Due to chronic pain’s complex and varied aetiology, it is very difficult to treat. A meta-analysis estimates  that in the UK, chronic pain affects around approximately 28 million people nationwide. An estimated 8 million people live with moderately to severely limiting forms of chronic pain, indicating that disability due to pain is a prominent health burden in the UK. Chronic pain tends to more frequently affect older populations, with 62% of the 75-year-old-and-over age group living with pain. When factoring in the UK’s ageing population, the prevalence of pain may further increase, becoming an even greater issue than it currently is, showing the need to conduct research to combat this. As well as older people, women typically report chronic pain more frequently than men. A research study of 19 countries , including the UK, with nearly 30,000 participants found significant gender inequalities in chronic pain, with women experiencing more pain than men consistently across most countries. This study suggests that women may be more susceptible to developing chronic pain than men, and although it is not fully understood why this is, it’s important to recognise this increased risk, particularly by clinical staff when making decisions for patient care.  Socioeconomic factors are also shown to impact the distribution of populations experiencing pain, with those living in deprived areas being more vulnerable to chronic pain. In the UK, there is a higher prevalence of moderately and severely limiting chronic pain in the north compared to the south , mirroring the distribution of other health inequalities, such as obesity, diabetes, and cancer. This can be associated with the north-south divide in the UK, where government policies have led to higher levels of deprivation in the north, resulting in less funding for public services. The lack of access to chronic pain services, such as occupational therapy and return-to-work programmes, for those living in deprived areas of the UK  may further amplify this pain inequality .  Photo by Edward Jenner on Pexels What is the Future of Chronic Pain?   Chronic pain is clearly a very significant issue for the UK, affecting millions of people, and having a significantly detrimental impact on their quality of life . Despite this seeming pessimistic, it’s important to remember that scientists are constantly researching and developing new treatment options for a wide variety of chronic pain conditions, with the aim of eventually curing chronic pain.  As of October 2025, the UK’s Engineering and Physical Sciences Research Council (EPSRC) has started a 6-year funded programme of £11 million focusing on new engineering technologies for chronic pain. These will hopefully include an adaptive brain implant, which responds to pain processing in the brain, as well as special drug delivery systems to help prevent addiction to painkilling drugs. Even though we are still a long way from curing chronic pain, funded research is the way forward in helping people who live with it. Technologies such as neuroimaging, neurotechnology, and pharmaceutical therapeutics will continue to evolve, improving our understanding of chronic pain and, hopefully, enabling us to better support sufferers and reducie the number of people disabled by chronic pain in the future.