Trigger Warning: This piece contains references to sexual assault which some readers may find upsetting. I lost myself some time ago.  I searched in vain until I found her in my bedroom mirror. Nineteen years later. Photo by Nahid Hatami on Unsplash Electric. That’s the word she used to describe me. “You were electric,” she said. I would have related more to passive or casual. I have never thought of myself as electric.  Then again, she knew me when I was four. Four-year-old me danced on public sidewalks and kitchen tables.  Twenty-six-year-old me struggles to make eye contact.  The fairytale creature she claims I once was is a mystery to me. Someone I’ve only heard about in stories of fond memories.  That’s why I came back—to find that girl.  The Seed My parents met on a bus in Buenos Aires, Argentina.  I am the product of a young girl looking for a way to leave home and a boy who would have followed her to the ends of the earth.  We lived happily for three years until my mom decided, once again, that it was time to go.  The Uproot The life I left behind—the one I lived for 22 years—was paved with gold. It was the American Dream—you know, the one they all talk about in movies? It’s one of the reasons my parents moved to Florida. Argentina wasn’t economically poor at the time, but it was highly crime-ridden, and after almost losing our lives during an armed attempted robbery, it was a no-brainer.  So they left in hopes of striking rich and never having to face another loaded gun.  Little did we know, and little did I know.  I was too young to understand where I was, let alone where we were going. Toddlers don’t get a say in life-changing decisions. They go where they are taken.  My dad and my grandma have always been close, and according to them, she was greatly present in my life before we left. It must’ve been hard for her to see us go. Memories from that time are in flashes and fragments. Most of what I recall comes from stories and pictures I’ve seen.  Nonetheless, before I could speak in full sentences, I was on a plane traveling 4,420 miles from home to stay for good. The Replant Florida is paved with sand and folks who look for watches with their metal detectors. Not gold.  Sure, you can make a good living for yourself, like my dad did. After he and my mom got divorced, he started his own company, got remarried, and had two more kids.  We weren’t well-off, but we never went hungry.  I adapted well, made friends, and had enough family to practice my Spanish. I danced and sang in school plays and took after-school hip-hop classes. Things weren’t so bad.  But then, my mom got remarried to a monster who had a thing for seven-year-old girls. All he gave me was the end of a childhood.  My roots were poisoned, and my light went out. I walked through life like a zombie until I was a freshman in college.  That’s when I became a fireball.  Photo by Liana S on Unsplash The Decay  I burned too hot for my own good. I scorched everything and everyone around me, including myself.  The alcohol I doused myself in only made the fire grow taller, and the marijuana made me buzz like an old fridge. The only time you could find me dancing was three shots deep in nightclubs. There was nothing artistic or creative about it.  I had learned to play guitar at a young age, and after a college experience filled with betrayal, heartbreak, and confusion, I began dedicating more time to writing and composing.  I learned to express my sorrow and grief through my songs. I took fear and shame and filled entire notebooks with them. I think it saved my life.  But music and sex soon became a drug. I prioritized intimacy with men over real friends; the concept of real stopped short of the physical items I could touch.  All I remember is wanting to feel important—like I mattered.  One day, I looked around and saw that I was surrounded by ash. I had never figured out what mattered to me. The Healing When I started therapy, I questioned everything like it was a pastime. It wasn't conventional psychotherapy, but breathwork therapy.  For the first time, I stopped dead in my tracks, turned around, and woke up to my reality.  Burned down buildings, injured loved ones, and a four-year-old me waiting at the end of it all.  After two years of therapy, I moved out of my dad’s house. Again.  St. Pete is about three hours from where I grew up, and it’s always had its appeal. I thought I had finally found my place in the world. I thought I’d be staying for good.  I lasted four months.  I lived in my car for two months and came up with the money for an apartment for the other two. With an upcoming visit to Argentina, I was ready to go see my family for a short while and come back to my humble abode in Florida. It was hard not to want to stay in Argentina whenever I was there. It was like an invisible string that tugged at me.  The way life would have it, a week before my flight, I almost faced another brutal abuse by someone I knew (or thought I knew).  And no, we weren’t in cahoots. I genuinely considered this person a friend. Thankfully, I got out in time, but the fear and anger took over.  My illusion of everything came crashing down like a floor-to-ceiling window. I couldn’t trust anything or anyone.  Within a day I had my life packed into two large suitcases and I was on my way back to my dad’s. And within a week, I was on my much-awaited flight to Argentina for a four-day visit.  I never got on the flight back.  The Resowing  We move from one place to another to find that thing we are looking for. We walk the earth in search of answers—or simply for something better.  To think that my parents left such a beautiful country and charming city will always astound me. Of course, they had their reasons, just like I had mine to come back.  But there’s something about the movement within us that has recently captured my attention. The way it travels through our bodies when we aren’t thinking about it, because we’re completely in it.  There’s a vastness in it. It’s like losing yourself completely to find the purest part of yourself. The part that has no label or role. Neither a category nor an identity.  Photo by Alexander Krivitskiy on Unsplash That’s what I saw in the mirror that night. I saw myself without thought. Without judgement. Just pure energy in motion. Pure being.  It’s been four months.  I’ve never felt more sure about anything in my life. I feel at peace for the first time in a long time.  We still talk every day, my parents and I. I think we’re closer than ever.  It took 22 years and the journey of (what seems like) many lifetimes to finally understand.  Sometimes the answers are far away, and sometimes we have to travel thousands of miles to realize they are closer than we think. This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Disclaimer: All names used in this piece do not reflect the real names of the individuals involved.                                 The pillow was almost as flat as I was. Almost as hollow and thin. I had exceeded my college’s tolerated threshold of crazy and got locked up. Escorted to a stark white room on a unit by people with jangly keys and tired medical uniforms.   “I guess this is the pillow I deserve.” Order of operations: concern the people around you with bizarre behavior, submit to a drug test, have personal belongings seized, sign a stack of admission forms without reading them. Solution: a tedious clinical evaluation conducted by a clinician trying to get through the end of their night shift. For me, the tedium came from the litany of questions I had to answer while struggling mentally. I answered with words that floated into a distant sky like balloons released by a startled child one by one. **** As a licensed clinical social worker and psychotherapist comfortably into middle adulthood, I am acutely aware that my empathy and intuition in my work is influenced by my early experiences. When I was 21, my world shrunk to the psychiatric ward in building F, a state-run facility in New York for adults ages 18 and up who were temporarily deemed to be a danger to themselves or others. Photo by Adham Ragab on Unsplash Passively suicidal, they determined. I wasn’t going to jump in front of a bus, but neither could I stop thinking about it. Earlier that week I had wandered the hardware store in a disconnected daze and considered razors or rope. A staff member recommended hiding the change necessary for making phone calls under my pillow. It flitted across my mind that after receiving this tip, every would-be quarter thief would know to look there. My only point of reference to a psych ward was a partial viewing of “ Girl, Interrupted .” I tried to make my first outgoing call and alerted staff “ the phones aren’t working.”  She looked up from the desk sharply. “ It’s group time .” Too timid to ask, I waited an hour until the phones were connected again. My roommate spoke only Spanish. “ Frio, ” I commented to her, hugging myself and shivering. She smiled back and nodded in agreement. Having exhausted much of what I retained from high school Spanish, we did not speak again.   The first time I was handed a little paper cup with a pill in it, I wondered whether the prescribing doctor was behind a curtain somewhere, Wizard of Oz style. “ I’m sorry…what is this?”  There was a shuffling of papers before  “Lexapro ” was tossed in my direction. Much later I would learn this was the brand name for Escitalopram, an antidepressant often used to treat conditions like depression and anxiety.   My social worker was always drowning in paperwork. I was a social work major at college. I wanted to disappear from her caseload, just so she would have less to do.   My fellow patients and I gave disproportionate weight and attention to small things. “ Do you want to get snack together when it’s time?”  Planning the snack that would be doled out two hours later, and no more than thirty steps away, somehow did not strike us as utterly pointless.   The young man sitting next to me in the day room volunteered that he was an alcoholic. His shoes were ill-fitting and his odor pungent. Our conversation started out normally – “ what are you in for ?” Moments later, he lowered his voice and asked “ so…do you like to play games ?” I quickly scanned the room. “ Um…do you mean like board games ?” I asked. He clarified patiently. “ Naw. I’m talkin’ ‘bout, like…a b*****b .” The next morning, another semi-lucid individual asked me to marry him over a bowl of cheerios.   Photo by Author Emily Randall It was Frankie who taught me how to play war, and how to pass the time. He told me where he had stashed a razor and needlessly swore me to secrecy. He wrote down his Myspace information, urging me to overlook the overwhelming satanic vibes, and assuring me he wasn’t “ into that stuff ” anymore.   One day a middle-aged man asked me about my medication. “That’s baby stuff ” he scoffed. A recently fired chef with a temper to match his cooking, he often complained about being under a microscope. “ We’re like rats in a maze right now .” He pointed to a camera on the ceiling. “ They’re watching every move we make .”   I was not convinced the staff were that invested- underpaid and overtired attendants often came in hoping for an easy shift where they could eat their Chinese takeout in peace while we watched TV or played cards without fighting. In my experience, short-term facilities like these rarely foster long-term relationships: the patient populations turn over quickly, there are frequent “repeat customers,” and professional detachment is necessary to get through the work in such an intense environment. Witnessing psychosis can be striking; on at least two occasions a patient removed all their clothing for no discernible reason. But when no one threw a cafeteria tray or defecated somewhere that was not a toilet, it was a good day.     **** Seventeen years later, snapshots of grace still shine through the faded memories. Take the banana breakfast tray lady.   She was doing fifteen-minute safety checks my first morning. On the edge of my assigned mattress, I sat alone, blinded by a waterfall of tears.   “ Aw, you still cryin’?”  She was in the doorway, urging me to get something for breakfast. I was not hungry for food.   She coaxed me to the cafeteria before it was locked and fixed a tray with a banana on the side. I hate bananas. And I’m not a big fan of orange juice. I nibbled at a few bites of cereal.   Nevertheless, it was filling. A feast prepared by Love. I stopped crying.   Determined little tendrils of healing poked through in unlikely soil. Like ping-pong with one of the security staff.   “Do you wanna play ?” Normally shyness would have held me back. But this was a chance to escape into a game I love. I let the noise of the hollow ball transport me to happier places, far away from bare walls and industrial pipes. “ You’re pretty good.”  He won. But for ten minutes, I felt less like a liability risk and more like a regular person who could be trusted with shoelaces.   My soul, thirsty for belonging, was quenched with a cup of kindness. Photo by Joshua Sortino on Unsplash Grateful when my parents came to visit, I was equally relieved when they left. I didn’t want them to see me like this. Unwashed hair, chewed fingernails, classes traded for zoning out with dull eyes on the television suspended from the ceiling.   I’d asked my parents for reading material, figuring I would get what I thought I was worth, some old books, tossed carelessly into a paper bag. I’d never seen the crisp edges of a new paperback quite like that before, as orange and clear as a dawn sprayed over a desert ridge. I still have those three books on my bookshelf because they are tangible grace.   I happened to bring with me the assigned reading for a class on spirituality that semester. I devoured it in two days. Its message of mercy was like a salve from an aloe plant, cooling my skin, then over the dry land a softness grew, as from rain, deep underground, until it settled in my bones.   Sitting in that depressing room, I felt like a failure. Evidence around me supported the idea. But it was also there, with the raggedy shards of my self-worth torn and wilted through my fingers, that my Savior met me, and assured me that He loved all of me, even as the broken mess I was.  I still find myself sifting through the shards of an old self. Sometimes they are like the jagged edges of broken littered beer bottles. Others are closer to sea glass; smooth treasures collected in a child’s overalls during a day at the ocean. Tenderly, I wash away the dirt. Nothing is wasted. From the pieces a mosaic of possibility emerges: a growing enthusiasm, fairies fluttering sparks of hope, beauty in redemption. Light shines through and illuminates a new story. The hospital didn’t make me feel better, but that isn’t really the goal of a short-term psychiatric stay. What it did do was keep me safe, offering 24/7 monitoring and enough support to help me return to society, and for that I’m thankful. It represents the turning point after which I became determined to learn how to live in harmony with a brain that often colors the whole world gray and pointless.   It provided me with a steppingstone for ongoing treatment. In my own therapy over the years since then, I have received valuable support from other wounded healers. I am indebted to them for helping me be able to do what I love now – partnering with others to create new, more empowered stories for their lives.   This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Trigger Warning: This article briefly mentions suicide.   Every cat that I have helped has changed me in some way  On many occasions in my life, I’ve needed help. Suicidal ideation, self-harm, anxiety, and depression have provided punctuation for the years I’ve lived through. Now, looking after animals lets me concentrate on something outside myself.     An OCD diagnosis in my thirties helped me understand my brain much better. However, since this is more of a condition to be managed than cured, I had to think about what would truly help me. I’d never considered ‘animal therapy’ before, but I've been rescuing creatures since I was a child, so it felt natural for me to spontaneously gravitate towards it.     As a writer, fostering cats has been a lifeline to help manage my anxiety and OCD. I believe that there is nothing quite like snuggling up with a furry friend on the sofa.    As a child, school was pretty monotonous for me, and I was quite shy, so having my pet, Tara, was a window into a more loving world than the one that I inhabited. She was a West Highland white terrier that I unfortunately had to give up after only three weeks because of my mum’s allergy. So, once I bought my first house, I was desperate to have a pet of my own to make up for the childhood pet I always wished I could’ve kept.  Image taken by the author So, I felt like it was fate when, a few days after moving into my new house, a pregnant stray turned up at my back door. We never found the owner, and the cat walked into our house and gave birth to three kittens during an episode of Game of Thrones, and our barely unpacked residence became a hive of activity. Their presence made the house feel like a home, and they inspired hope in me for the future.     After the kittens were rehomed, I realised that I didn’t need to ‘own’ a pet to get enjoyment from the experience, but I did want the opportunity to make their lives better with rehabilitation. That’s why I signed up to be a fosterer. I helped cats with all kinds of problems, from those on end-of-life care to those dealing with skin conditions or victims of abuse. While this sounds completely selfless, I see it as a wholly symbiotic process, whereby I get just as much in return.     However, this doesn’t mean that it’s always an easy road. Feline recovery from trauma can come in fits and starts, as an abused cat needs someone with patience to teach them how to trust humans again. While it doesn’t happen overnight, I see big rewards from the work I do with cats, as even an aggressive animal can learn to love again.  Image taken by the author Fostering through my OCD    Keen to improve my mental health, I’ve tried all sorts of hobbies to distract me from my negative or intrusive thoughts, but I’ve found the best thing is to sometimes concentrate on something other than myself. My OCD involves internal compulsive thoughts and obsessions, so my priority is to focus on the ‘real world’ outside of the one created out of worry in my mind. This is where fostering cats comes in, as it is about dealing with a tangible problem that can usually be resolved or helped with time.     I chose to foster cats instead of adopting them, as doing so allows me to help more of them compared to if I owned a pet. It also stretches my understanding to resolve a different issue every time a new cat arrives.  Image taken by the author   After the stray cat and her kittens were adopted, I wanted to take on a bigger challenge so that I could help more of them and feel proud of that achievement.     When I signed up to be an official fosterer online, the charity responded immediately. They did a home visit to make sure I was suitable, and then a volunteer from the local cat charity arrived with a pet carrier. Inside were two terrified cats who had just been rescued from the home of a woman with addiction issues who had recently passed away. The brother and sister pair were in a sorry state - they were malnourished, flea-ridden, and their hair was falling out.    To avoid scaring them, I put a camera in their room and watched them slowly get braver and start to explore it. Their coats even began to grow back as a more peaceful environment allowed them to stop overgrooming themselves, and once they were in better shape, I took them to the vet for a checkup.     Coaxing them out of hiding    The visit to the vet was a step backwards as they went into hiding again, but at least they were slowly gaining weight and looking healthier.     Then the COVID lockdowns happened, and suddenly I was just as afraid as they were. I started working from home full-time, setting up my office in their room in the hope that they would begin to trust humans again. Whenever I felt worried, I thought about what they’d been through, and it inspired me to be positive.  Image taken by the author As I tapped away at my keyboard, they gradually developed the confidence to venture out. In this time, I learned that the key to gaining a pet’s trust is to be very still and avoid sudden movements.    After being allowed their time to adjust, they started to crave the company of my partner and me, approaching us for a tentative greeting or sitting next to us on the sofa. We watched a nightly film during the COVID lockdowns, and they’d lie between us, subtly pushing their noses towards our hands to request a head stroke.     It was an unbelievable transformation, as the only time I’d previously touched them was for the traumatic trip to the vet. Their recovery was a true lesson that proper nutrition, care, time and peace really do heal. I felt that in myself too, that their presence had taught me to be patient with myself for the pain I’d also been through.    Time for a forever home  After four months with me, they were ready to find their forever home. I was sad to say goodbye, but I was grateful for the purpose they had given me in a time of such instability and turmoil.  Image taken by the author Now their owner posts pictures of them happy and thriving, so knowing they got the second chance they deserve heals my soul. As someone who knows what it is to come back from trauma, I find peace in their peace.    Since then, I've fostered various characters, safe in the knowledge that each pet is going to a loving home. Then someone else will arrive, making it easier for me to let them go. Being the person who helps them trust again is a true privilege.      As someone with lifelong mental health issues, it's been incredible therapy to watch the change in them because with cats, much like humans, a little bit of love goes a very long way.  This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Good news! Young people in general are drinking less than older generations did and still do: around one-quarter of 16 to 24-year-olds don’t drink at all, compared with just over one-fifth of the broader adult population. We have also seen how young people are taking fewer drugs than previous generations, as discussed in my previous blog. Research suggests that young people worry about the emotional impact of alcohol, with mental health being a priority for many, as well as a desire to be socially responsible. In addition, there has been a shift towards the normalisation of non-drinking in adolescents, whilst they are also more self-conscious of how they appear on social media: they don’t want their exploits plastered over TikTok or Instagram. However, alcohol can appeal to teenagers for many of the same reasons that other drugs do: it can be enjoyable, addictive, and, unlike other drugs, widely available. Natural ingredients in alcohol act on GABA receptors – pleasure receptors in the brain – to give one that warm, two-drink feeling. It can make you feel uninhibited, relaxed, and temporarily reduce anxiety. In the Western world, many feel we are also culturally conditioned to associate being sober with being dull. Photo by Wil Stewart on Unsplash While teenagers drink for many different reasons, I've heard from teenagers that the chief appeal of drinking is fulfilling a desire to belong and feel connected, or even to feel happy and lovable. As one of my children said about why they began drinking: ‘I rely on drinking in social situations. I will always “pre” [when you drink ahead of an event]. If I’ve had some drinks, I’m way less self-conscious. Or if I’m nervous before a date, I will take a shot.’ As discussed in my blog on drug use, banning something makes it more alluring to the teenage brain, so once again, we are trying to help teenagers make good decisions by sharing the facts as best we can in a calm and non-judgmental way. Alcohol is not taboo in the same way as drugs because it is not against the law, at least after 18. The legal minimum age for drinking in a pub with an adult and food is 16, though a teenager cannot buy a drink themselves then. In physical terms, alcohol is toxic to the developing teenage brain. Teenagers respond in very different ways to alcohol. Some get instantly drunk (especially if they are smaller) while others don’t; some are more risk-averse than others. Photo by Alex Shuper on Unsplash Alcohol damages adolescent brain development in three main ways: it affects decision-making and impulse control because it slows down the brain; it affects memory, learning and emotional regulation; and finally, it affects movement, balance and coordination, which is why accidents and injuries are common among young people who drink. The symptoms of getting drunk include slurred speech and feeling emotional, drowsy, nauseous, happy, and uninhibited. However, alcohol poisoning can happen when you drink alcohol faster than your body can process it, and, in addition to the symptoms of being drunk, a sufferer may also be severely confused, seriously vomiting, falling unconscious, and turning pale. At which point, they need to go to hospital. How then to reduce alcohol consumption among teenagers? Let’s begin with how you behave around alcohol at home. The average age to have a first, unsupervised alcoholic drink in the UK is 14. However, doctors recommend an alcohol-free childhood; no alcohol until 15, and no unsupervised drinks until 18 due to the risk of disease and injury associated with alcohol use. Given the medical advice, a sensible approach is to wait as long as you can before you allow teenagers to drink at home. Psychologists stress that the earlier children are exposed to alcohol, the more likely they are to go on to misuse it and to have alcohol-related problems as adults. There’s something to be said for normalising drinking in moderation in a family context, at mealtimes or at family celebrations, when there is a controlled setting. If we don’t, drinking may happen in secret, with teens necking a bottle of Baileys out of our sight at a friend’s house, or on the street. If we offer alcohol in moderation when at legal age, teenagers get to choose if they accept, and they may not if the offer comes from us, as parental endorsement naturally makes alcohol less desirable. Photo by fauxels on Pexels While we need to be honest about how we behave, we can have high expectations about their behaviour. I found the work of Robert Rosenthal, a German-born American psychologist and professor, and Lenore Jacobson, an elementary school principal, helpful. They are best known for formulating the Pygmalion effect, also known as the Rosenthal effect: the psychological phenomenon that the greater the beliefs and expectations on individuals, including children and students, the better they function. This is self-amplifying in both positive and negative directions. If we expect that our teenager will be a moderate and responsible drinker when they are 18, then that is more likely to happen. By contrast, if we expect them to be out of control, drinking at age 13, and we criticise their drinking behaviour as well as alcohol in general, then they are more likely to be irresponsible. Suggest that your teen makes their first two glasses alcohol-free; maybe they will find they are having a good time without alcohol, and no one needs to know they are not drinking. Challenge the idea that they will get a feeling of relaxation the instant they take that first sip of an alcoholic drink. Alcohol doesn’t instantly get into the bloodstream. In fact, it takes around 10 minutes. We learn to associate the effects on our brain with the first sip, but we can also unlearn this. Another practical tip is to drink from a small glass. Go at the speed of the slowest drinker. See if they can restrict themselves to the drinks they really want and forget the rest; the best drink is the first drink. Subsequent drinks attempt to recreate the feeling that the first drink gave them, and it doesn’t work. With each extra drink, the benefits diminish, and potential harms increase. Examine their thinking around drinking; if they’ve had a difficult time with a friend or in a relationship, do they feel they deserve a drink? If they are nervous at a party, are there other things they can do to help? Are there other ways of bonding with people? Can they stay present to difficult feelings, without the need for the distraction of alcohol? If they’ve had a good day and are drinking to celebrate, are there other ways to have a good time? If they have had a boring day, again, are they just drinking to distract themselves from that? Teach them to notice their excuses. Can they find other ways of answering the needs that alcohol satisfies? A final PS on drinking, but a crucial one. How can our teenagers avoid becoming the victim of other people’s drunkenness? Having a pre-rehearsed response to challenging situations can minimise danger. For example, they might feel pressured to get a lift with someone who is about to drive while intoxicated. A prefabricated excuse can be helpful: perhaps, ‘I’ve ordered a taxi to pick me up at 10:30, so I need to wait for it’, or ‘I’ve agreed with my friend that they are taking me home.’ While drinking is on the decline, the dangers of underage drinking remain real, as any parent who visits an Accident & Emergency Department on Saturday night will confirm. But helping teenagers plan ahead with practical strategies of how to behave, and giving them clear information about the reality and dangers of alcohol, will make a hospital visit less likely - for both you and them. ----------------------------------------------- The Gift of Teenagers: Connect More, Worry Less by Rachel Kelly, published by Hachette, is now available at Waterstones, WHSmith, and online. The audiobook, narrated by Emma Fenney, can be listened to on Audible.

From lithium's (re)discovery to a gold standard in treatment: how an Australian psychiatrist's bold experiment reshaped psychiatry Photo by Towfiqu Barbhuiya on Unsplash During the last few years, my studies focused on the lithium mechanism of action  in bipolar disorder . Despite its usage in modern psychiatry started over 75 years ago, lithium  is still a widely used mood stabiliser recommended in all major treatment recommendations. I am Kosma Sakrajda, a researcher focused on neuroscience and psychopharmacology and a Board Member of   ECNP Early Career Academy (ECA ). Today, I want to tell you how it all started – or maybe just re-started? In 1936, Dr John Cade (1912–1980), then a 24-year-old son of a psychiatrist, who spent all his youth living within the grounds of mental health facilities and observed patients struggling with mental illness daily, began his tenure as a Medical Officer at Beechwood Mental Hospital (Beechworth Lunatic Asylum, State of Victoria, Australia). John Cade in 1974. First person to test lithium treatment for bipolar disorder. Credit: News Ltd/Newspix However, the 1930s were not propitious. In 1939, Australia joined Britain in World War II and in 1941, John Cade joined war efforts as an army doctor. During the war, he became a prisoner of war for three and a half years in the Changi prison camp in Singapore, and set up a mental health unit. Cade carefully observed fellow prisoners of war (POWs) falling into strange and vacillating behaviour, which he later described as similar to that he had followed in Beechwood Hospital. That experience led him to the idea that mental illnesses – schizophrenia and manic depression (nowadays called bipolar disorder ) – might have an organic, physical cause. That was in contrast with the long-held belief that mental conditions were caused by a poor upbringing. Demobilised in 1946, Cade became medical superintendent and psychiatrist at Bundoora Repatriation Mental Hospital. At the time when insulin shock therapy , electroconvulsive therapy  and lobotomy  (that is, a neurosurgical procedure used for mental health conditions) were the standard treatments in psychiatric disorders, Dr Cade started his pioneering experiments, leading to a breakthrough in modern psychiatry. His idea was that during a manic episode, certain chemicals are released, which leads to metabolic disturbances and manifestation of the disorder (such as elevated or irritable mood, agitation, impulsivity, decreased need for sleep). Using the kitchen of the unoccupied ward as his improvised laboratory, Cade injected the urine from manic patients into the abdominal cavities of guinea pigs, which caused a lethal effect. John Cade first believed that extensive amounts of uric acid – a metabolite whose elevation is caused, among other things, by kidney failure  or gout . caused the observed effect. As uric acid doesn't dissolve in water by itself, to help it dissolve, Cade added lithium, creating a solution called lithium urate.   The lithium salts administered to animals resulted in reduced toxicity and also a calming effect. Later, he obtained the same calming and tranquillising effects using lithium carbonate, which has been used in medicine to treat gout since the nineteenth century. Bundoora Repatriation Mental Hospital, Melbourne, Victoria, Australia.   View of the old homestead adapted for an open ward. Credit: Unknow Author / Australian War Memorial Similar results were previously obtained but overlooked by science. In 1886, a Danish scientist named Carl Lange suggested that a buildup of uric acid in the blood might cause recurring depression. He advocated using lithium carbonate as a potential drug to normalise the uric acid levels in the blood. His claims were discarded by the psychiatric community of his time, and the lithium treatment of mood disorders was abandoned, till Cade's experiments. Surprisingly, although his concept of a role of the uric acid was later abandoned, Lange's proposed treatment used doses of lithium that are comparable to those currently used in psychopharmacology. Cade's primary results led him to start testing the pharmacological use of lithium treatment. He started testing the safe dose on guinea pigs and also on himself. After that, Cade began lithium treatment of ten manic patients, and in September 1949, he reported improvements in all of the patients in an article published in the Medical Journal of Australia . Unfortunately, Cade's discovery remained mostly unnoticed at that time. Cade abandoned further studies in 1950 as a result of the death of one of his patients, William Brand, due to lithium poisoning. In retrospect, the effect observed in his guinea pigs’ experiments is suspected as a first symptom of lithium intoxication (that is, too much lithium in the body causing harmful side effects, including lethargy (feeling very tired, or lacking energy) which is now considered a warning sign of lithium overdose. Therefore, it is suspected that Cade was wrong when concluding that guinea pigs were tranquilised by lithium.  But his accidental rediscovery of lithium use in psychiatry became the basis of a modern mood disorder treatment. More about Dr Cade's life and work can be found in the video published by Bundoora Homestead Heritage . Fortunately, Cade's experiments on lithium treatment and his 1949 paper were followed in the next decades by, among others, Danish psychiatrist Mogens Schou (1918–2005). From the 1950s, intrigued by Cade's results and in order to help his brother, who had bipolar disorder, he described the preventive effect of lithium in manic-depressive illness. After teaming up with Poul Christian Baastrup (1918-2001), they conducted a study that confirmed their preliminary results. They claimed that lithium is " the first prophylactic [that is, it can prevent] agent against major psychosis ". Later criticism of the proposed lithium treatment from the British psychiatry led Shou and Baastrup to conduct a study where neither the participants nor the researchers knew who got the real treatment or a placebo, and the results were tracked over time. This was the first in-depth analysis of the lithium treatment effect on bipolar disorder patients and was published in The Lancet in 1970 . From left: Poul Christian Baastrup, John Cade, and Mogens Schou in 1970Credit: International Network for the History of Neuropsychopharmacology Today, over 75 years after Cade first introduced lithium into contemporary psychiatry, and after 75 years of extensive research on its effect in affective disorders, lithium carbonate is a commonly used drug. Its strong antimanic and moderate antidepressant properties, and also described effectiveness as an augmenting agent for antidepressants, are well-proven and have revolutionised the treatment of mood disorders, contributing to the psychopharmacological revolution. However, scientists still don’t fully understand the exact ways lithium works, and many research centres are continuing to study it.  As research advances, lithium remains a key treatment in mental health care, offering hope and improving the lives of patients around the world.

Creating space for survivors of abuse: in a one-day workshop on coercive control, we explored what it means to reflect, create, and reclaim space – together. In January 2024, the Violence, Abuse and Mental Health Network (VAMHN) hosted a one-day creative workshop at King’s College London, co-designed and led by survivors of coercive control. VAMHN is a cross-sector network that brings together people with lived, practice-based, and academic expertise to reduce the impact of violence and abuse on mental health. This article is a collaborative reflection from three contributors: one, Sian Oram (Professor of Trauma and Recovery at King’s College London, and co-director of the VAMHN), who helped organise and facilitate the workshop, and two w ho took part as survivor-artists (Emily and an author who prefers to remain anonymous). It draws on our different roles to tell the story of a day centred around three themes identified by survivors working with the VAMHN as priorities for research and advocacy: understanding coercive control , justice for survivors , and recovery . Together, we used art to explore these themes in ways that felt safe, supported, and collectively owned. Beginning with Conversation The day opened with a roundtable discussion. We were invited to reflect on the themes of understanding and justice, both individually and as a group. Some of us contributed sticky notes, some spoke, and others listened. The ideas were gathered visually and discussed in dialogue – a way of ensuring all voices could be included, even if not spoken aloud. This created a foundation for the arts-based sessions that followed. The sticky notes, questions, and exchanges helped us map shared concerns and multiple viewpoints. These have since been summarised into visual concept maps that will inform future research and learning. Zine-making: Finding our voice through collage Image by Dr Sharli Paphitis Lisa Ward introduced us to zine-making – a practice with roots in social resistance and self-expression, often used to challenge systems of power and amplify voices excluded from mainstream platforms. She explained how zines have historically amplified voices excluded from the mainstream. We were shown classic techniques like collage and given access to magazines, art materials, and space. For one of us, this was the first time being encouraged to create without instruction. “This kind of freedom felt strange. Freedom and choice aren’t things I’m used to.” Growing up with rigid rules and emotional abuse, freedom had often come at a cost. The workshop felt like a new experience – not just in using unfamiliar materials, but in being told that you have the freedom to do whatever you want. “I sometimes don’t know what I want. Making decisions – especially ones that are just for me – can be intimidating. But this gave me space to explore.” For another of us, the exercise revealed unexpected insights. As we browsed old women’s magazines to make our collages, we were surprised by how many of the relationship stories contained explicit elements of coercive control. Stained Glass: Fragility and focus Image by Dr Sharli Paphitis In the glass painting session, led by Sharli Paphitis, we worked with stained glass as a symbol of vulnerability and transformation. We chose panels and painted our own designs onto them, focusing on themes of justice and resistance. “I was nervous. I can barely paint on paper, let alone glass. But the focus on detail became meditative. I painted the word ‘LIBERATION’.” This process offered something different from speaking or writing: a chance to step outside familiar ways of making meaning and allow emotion to take shape visually. The individual pieces we created were later brought together into a collaborative artwork. Poetry and Crochet: Stitching experiences together Image by Dr Sharli Paphitis The final sessions focused on healing and recovery. Led by Ariel Collier, we began by co-writing a poem, with each of us contributing a single line drawn from our own strategies, practices, or resources for care and coping. We read and re-read the poem aloud, listening as it slowly became something more than the sum of its parts. Crochet followed – a tactile, repetitive activity that offered a sense of calm and embodied reflection. Our individual pieces were stitched together into a collective creation. “I’ve always used words to make sense of things. But taking part in something non-verbal let me access a different part of myself.” For some of us, this was the first time engaging with crafts in any setting – particularly one that centred lived experience so carefully. There was no pressure to share details of our stories, but where stories were shared, they were held with care and connection. What it Meant This workshop wasn’t just a creative exercise. It was a structured yet flexible space to be – to explore complex experiences, to learn new ways of expressing ourselves, and to be in community without demands. “Through years of therapy, I’ve learned how deeply ingrained a lack of choice has been for me. This workshop offered me a safe space to explore, question, and even start to believe that my voice is worth sharing.” “It was important for me to have an opportunity to go beyond language, connecting to a different part of my experience and a different part of my self.” The impact of the day is still unfolding. The works we created continue to be exhibited to engage others in thinking differently about coercive control – not just in terms of what it is, but how it feels, and what survivors want the world to know. Our hope is that these artworks open up conversations, challenge assumptions, and shift how coercive control is seen and responded to. This article was collaboratively written by Sian Oram (director of the VAMHN) and two Lived Experience Action Group members and workshop participants: Emily and a participant/member who prefers to remain anonymous. It reflects our shared experience of the VAMHN Coercive Control Creative Workshop, held in January 2024. You can see the full output by visiting: https://heyzine.com/flip-book/b8e20e68bb.html To learn more about the Violence, Abuse and Mental Health Network or join the newsletter, visit vamhn.co.uk

Image source: Riswan Ratta on Unsplash Streaming services have dominated the television and film distribution space over the last decade. With its rise, streaming powerhouses like Netflix, Prime Video, and Disney+ brought with them a novel release method: entire seasons aired on the same day, at the same time. Despite how commonplace it feels today, it was only in 2013 with Netflix's House of Cards and later Orange is the New Black that whole-season same-day digital releases became the new exciting way to publish shows. Now, twelve years on, the novelty is wearing off, and audiences and creators alike are noticing the flaws in the system and the impact it's had on their media engagement and enjoyment. I'm Melisa Kose, a neuropsychiatry PhD student at King's College London, and if you know anything about me beyond that, it’s how much I love to talk about television, cinema, their creation, and their impact. Frankly, it's all I talk about, outside of my research, if the articles I've written for Inspire the Mind  over the past six years are anything to go by. In this piece, I want to talk about trends I've noticed in binge-watching culture and the psychology behind how we watch and talk about entertainment. Image source: Laura Segaz  on Unsplash The cultural shift away from week-to-week waiting for the next episode to consuming entire seasons in one sitting brings with it psychological consequences – from changes in mental wellbeing to how our brains process building narratives. So, what are the trade-offs, the epic highs and lows, of binge-watching vs. traditional weekly viewing? The Dopamine Highs & Depression Lows From a neuroscience perspective, binge-watching taps into the brain's reward system, particularly the neurotransmitter dopamine . Dopamine affects a range of functions, including movement, coordination, cognition, and most notably, pleasure. Simply put, when you do something that you like, your brain releases a rush of dopamine. This “feel-good” chemical reinforces behaviours that give us pleasure to encourage us to do them more. This mechanism is exactly what drives us to click “Next Episode” every time the credits roll. It feels good, so why not watch another? Dopamine is closely tied to addiction behaviours. The more you watch to satisfy that craving of “just one more episode, then  I’m done”, the more the craving grows— mirroring what we see in addictions . This is exactly what makes it so tough to put the remote down, even when there are errands to be run, schoolwork to be studied, and sleep to be slept. Of course, we should be conscious of how we use the word “addiction” in this context, lest we trivialise the disorder. A systematic review published in 2020  found that “excessive forms of binge-watching can involve symptoms of addiction, such as lack of control, negative health and social effects, feeling of guilt, and neglect of duties”. There also seems to be a distinction between unproblematic and problematic binge-watching, measured by how much it is impacting your daily routine (e.g., sleep, eating, work, school) and the motivations behind it (e.g., as procrastination and avoidance or social connection and curiosity). As it stands, though, the definition of “binge-watching” is, expectedly, broad—it is not meant to describe a disorder, despite the use of “binge” in the name, but rather to merely indicate watching at least two episodes in one sitting. Paralleling the effects we’re noticing with spending hours mindlessly swiping on TikTok (or whatever your short-form video sharing app of choice is), binge-watching is significantly impacting our attention spans. Over time, engagement with content that doesn’t offer immediate satisfaction or resolution—like the couple you want to see together doesn’t come together right away, or the antagonist isn’t defeated quickly—can feel frustrating. Even though changing stories to prioritise audience retention over building solid narratives could be to the detriment of the series, audiences, particularly those hyper-active on social media, seem to be far less patient than they were only a decade ago. This can mean producers are incentivised to push writers to wrap up storylines before they are ready and scrap character development in favour of attention-grabbing quick hits. The quick death of the slow-burn storytelling we used to see more of with 20+ episode seasons. Furthermore, results from a survey  found that binge-watching was also associated with poorer sleep , avoiding thinking about real-life problems, and a way of easing an upsetting emotional state. Likewise, the phrase “post-binge-watching blues” has gained traction over the years to describe the depression-like mood following the end of a “binge” that some individuals experience. Particularly, it is individuals with excessive binge-watching behaviour (i.e., skipping meals, sleep, daily tasks, work) who report experiencing low mood, feeling lost, and guilt about perceived misuse of their time. The current state of research suggests that motivations behind binge-watching  (i.e., the reasons one does it) are the biggest determinant of how such viewing habits will impact your mental health. Those binge-watching socially and out of curiosity typically report more positive outcomes, whereas those doing so for escapism and avoidance tend to experience more negative outcomes. Particularly in my teens, I certainly turned to the nearest comfort show, watching for hours on end until I was tired enough to sleep. It was a way for me to escape; if I was busy worrying about what happens next in the fictional characters' lives, I wouldn’t have to think about my own. Nowadays, I try to make any marathon or "binge-watch" a social thing—I've hosted so many movie nights this year alone that I think I might have accidentally made myself incapable of watching a series or film alone, without having someone to gush about it with after... Interestingly, it’s been shown that in some people who self-identify as binge-watchers , despite their acknowledgement of binge-watching as an addictive behaviour, they denied that they themselves were addicted. This is in spite of admitting that their watching behaviours impact their daily routines. During my early teens, half my lifetime ago now, I remember staying up late to watch the latest episode of Supernatural or Glee or The Vampire Diaries (because the only way to watch the actual day it aired, instead of months later when it officially aired in the UK, was through shady livestreams of American channels at 1 AM). I'd be antsy with excitement to get to school in the morning, just so that I could talk with my friends all about what had happened. In our frantic, and I’m sure incoherent to anyone overhearing, talking over one another during lunch, we’d discuss theories and hopes for what should come next. Of course, the world and I have both changed since those high school days – but so has the way we discuss media. Now, with shows that release seasons in one go, it feels harder to be on the same page. For some, since eight episodes at once is a far greater commitment than one, they’ll avoid it for months. Others will watch it all in one sitting, only to have few to none to discuss episodes with. And some will simply take their time with it. None of these are inherently incorrect ways to engage with a show, but it does affect the overall conversation surrounding it. Where the weekly format allows audiences to spend more time carefully considering details and choices made in individual episodes, bulk releases favour discussions of the overall season, often with greater focus on the finale – less about the journey, and more about the destination. In an age where social media metrics define the success of a show almost as much as ratings from critics, Netflix and its competitor channels are remembering how useful sustained engagement rather than a short-term spike is. Fandom engagement is practically free promotion for productions, and so not only does it serve the story  to be built steadily, but it also serves the networks to keep audiences talking about their shows and coming back week after week. So surely, weekly release is superior! Personally, yes, I would say so. Weekly release is better in my opinion. However, from a business standpoint, there are still plenty of positives that outweigh the considerations I've discussed. The binge model enables increased subscriber acquisition and a spike in viewership over a shorter period, which looks great in headlines. The binge model continues to work wonders for Netflix ; the company reported $3.13 billion in profit  for the latest quarter alone. It also means there's a reduced risk of negative buzz; the longer audiences have between episodes, the more likely they are to discuss things they don't like. Poor feedback can affect the show’s overall perception and cause fewer viewers to tune back each week. Image source: Laura Segaz on Unsplash So, is there a definitive answer to which is better: binge-watching or weekly episodes? Nope, and it depends on who you ask. Writers and creatives would probably prefer the weekly release structure for the freedom it gives them to pace their stories as they like, whereas studios and publishers would prefer the bulk release for the instant gratification of metric spikes. As a neuroscientist and TV/film enthusiast, I can’t help but notice the mental health effects as well as the media literacy effects that binge-watching culture has had on audiences. But there are absolutely positive aspects to binge-watching, including convenience, increased sociability, and satisfaction. The positive and negative outcomes are not mutually exclusive. Although I think a mix of both is perfect, I can’t deny how much more fun  watching a series feels when there's the anticipation of “what happens next?” inspiring discussion and theories amongst fans. But trust that I’ll also be binge-watching the final season of Stranger Things when it drops later this year. Research has suggested that watching with intentionality is a good protectant  from the negative effects of binge-watching. Rather than letting the hours simply pass you by, as you watch episode after episode, be honestly mindful of the time you are spending and why you are spending it this way. As with any form of entertainment, it is our responsibility to ensure our engagement is considerate of our well-being and mental health.

The path through mental illness can be isolating, disorienting, and equally profoundly transformative. For those of us who have navigated the complexities of psychosis, crisis care, and prolonged interventions, the search for understanding, community, and meaning becomes real. It was this very search that led me into the world of Patient and Public Involvement (PPI) – a realm where lived experience is not just acknowledged but actively embraced as an invaluable asset in shaping the future of mental health research. Recently, I have started a PhD Studentship in Patient and Public Involvement and Engagement funded by the NIHR Maudsley Biomedical Research Centre at King’s College London. I am investigating how to improve the informed consent process for people with a diagnosis of schizophrenia to participate in clinical trials. Before this PhD, my own path into PPI began after a period of intense mental distress, including psychosis and involuntary hospitalisation, followed by three years within an Early Intervention Service. I desperately sought ways to comprehend my “unusual experiences” and connect with others who had walked a similar path. Fortuitously, my local mental health trust ran an active "expert by experience" programme. This initiative was a lifeline, offering opportunities for patients and carers to engage in various activities: meetings, focus groups, quality and safety reviews, and even interview panels. Crucially, there was a dedicated research involvement programme, where I joined the psychosis research theme group. Here, I began to advise researchers on their ideas, development, and applications for funding their research projects. This created a step into a world that would soon become central to my advocacy. Photo by the author, Jason Grant-Rowles Since those initial days, my involvement in research has expanded exponentially, touching institutions across the UK, including Sussex, Kent, Surrey, Manchester, Sheffield, Nottingham, Bristol, Oxford, Cambridge, City, UCL, and King's College London. Beyond those institutional boundaries, I've contributed to national advisory boards, regional health organisations, and even global mental health startups. This extensive engagement has solidified my belief that PPI is not merely an optional add-on, but an indispensable component of meaningful research. From my vantage point, PPI brings an unparalleled value to mental health initiatives, particularly within programmes like the Mental Health Implementation Network (MHIN). We inject a crucial understanding of the lived reality for individuals grappling with mental illnesses. More than that, we offer fresh perspectives and innovative ways of seeing things, drawing directly from those most impacted by the issues under investigation. My early involvement on the MHIN advisory board allowed me to sense-check ideas, contribute to discussions, and serve as a "critical friend" to the executives. This direct access to the highest levels of decision-making within the programme has been vital. It enabled me to contribute to idea generation and topic selection for systematic reviews, and to work collaboratively with colleagues to humanise various aspects of the work – ensuring that the science remains grounded in the human experience it aims to understand and improve. Photo by authorJason Grant-Rowles As the PPI Lead for MHIN, I've had the privilege of working at a strategic level to shape and influence the programme's extension. My impact has been tangible. For instance, I suggested incorporating "career conversations" into the mentoring offer, shifting the focus from general guidance to specific professional development for mentees. Another impactful suggestion was to replace traditional conferences with "celebration events." This subtle but significant change encourages colleagues to bring their positive selves which fosters a more upbeat and engaging atmosphere for presentations and knowledge exchange. These seemingly small contributions have helped to create a culture of collaboration, recognition, and genuine engagement. Lived experience brings a depth of insight that theoretical knowledge alone cannot replicate, highlighting practical challenges, overlooked nuances, and the true priorities of those who navigate mental illness daily. Furthermore, PPI significantly aids in the dissemination of research findings to the public. Most PPI members are well-connected within their personal and professional networks, allowing research findings to reach audiences that academics might not typically access. This organic dissemination is invaluable for bridging the gap between scientific discovery and public understanding, ensuring that research benefits the widest possible community. Creating a culture that truly embeds lived experience in research requires conscious and concerted effort. Several key steps are necessary. Firstly, accessible training opportunities for individuals interested in PPI and lived experience research are essential. This equips individuals with the necessary skills and understanding to contribute effectively. Secondly, fostering knowledge exchange through articles, events, and conferences that showcase lived experience contributions is crucial for validating and celebrating their impact. Thirdly, adequate and transparent funding for PPI activities is non-negotiable. This includes covering practical costs such as internet access, childcare, travel, and, critically, fair remuneration for people's time. PPI members need to understand precisely how their contributions will be utilised and how they will make a tangible difference to the overall research programme. Lastly, and perhaps most importantly, there must be proper acknowledgment of people’s contributions. This means crediting individuals on websites, in presentations, naming them in publications, and formally acknowledging their input in any end-of-programme activities. Photo by author Jason Grant-Rowles In essence, embedding lived experience within research is not just about ticking a box; it’s about enriching the research process, humanising its objectives, and ultimately, ensuring that scientific advancements translate into meaningful improvements in the lives of those they are intended to serve. It's about recognising that the expertise gained through navigating mental illness is valuable and that true progress in mental health research hinges on this profound collaboration between the research community and members of the public.

When someone receives a cancer diagnosis, the emotional and psychological toll can be just as profound as the physical journey ahead. However, while medical treatment plans are often initiated promptly, the psychosocial consequences of such a diagnosis are frequently less visible and, unfortunately, less addressed. Amidst the investigations, treatments, and conversations with healthcare teams, many patients experience a phenomenon called cancer ghosting. The term ‘ ghosting’  is a word which typically refers to the abrupt end in communication with someone without explanation. It is most commonly associated with romantic relationships and the use of dating apps, however can also refer to friendships, or relationships with colleagues. On the other hand, the term ‘ cancer ghosting ’ is a term that has been coined by the cancer community, and refers to the withdrawal or reduction of contact by friends, family members, or colleagues, to a person affected by cancer following the disclosure of their illness. Photo by Kateryna Hliznitsova on Unsplash When a close friend of mine was diagnosed with cancer, they explained this isolating experience was happening to them, however at the time I did not know it was a common reality, or that there was a name coined for it. As a doctor interested in psychiatry, I started thinking about the mental health impacts cancer ghosting can have, and if other people with cancer had faced similar experiences. With further reading and conversations, I realised cancer ghosting is sadly a common experience amongst many diagnosed with cancer, despite this being a time where support is one of the most important needs for a person.  One patient, interviewed for a piece in the Independent a few months ago, explained , “I did have a few very kind friends who reached out, who kept in frequent contact, but I lost 90 per cent of my friends to my cancer diagnosis… The pain of losing my friends was in equal difficulty to receiving treatment.” A cancer diagnosis can be a painful, isolating experience; therefore, it is important to understand why ghosting may take place, and what we as friends, family or healthcare professionals can do to support those going through a cancer diagnosis. What Causes Cancer Ghosting? Understanding why people distance themself in the face of someone else’s illness is complex, and often unique to personal circumstances. However, several common themes can contribute: Fear and Discomfort : Many people don’t know how to react to a cancer diagnosis. They fear saying the wrong thing or feel unequipped to handle the emotional weight, so they withdraw. Emotional Challenges : Witnessing a loved one’s suffering can trigger personal anxieties and distress. Some may distance themselves as a form of self-protection. Guilt and Helplessness : If someone feels they can’t fix the situation or don’t have the right words, they might retreat, wrongly believing their silence is better than showing up without solutions. Anxiety around communication : A lack of knowledge about what to say or how to act often leads individuals to say nothing at all—people may not realise that disappearing or not being present can be more isolating for that person than showing up ‘imperfectly’. Misunderstood Intentions : Some people assume that the person needs time and space, or believe that others are offering sufficient support, thereby believing their own absence is better than their presence. The Impact on Patients For those living with cancer, ghosting can feel like a betrayal. It disrupts their sense of belonging and support at a time when they are most vulnerable. When patients experience cancer ghosting, they often describe  feelings of shame, abandonment, and confusion, adding layers of distress on top of an already challenging experience. Importantly, social isolation can negatively impact  not only a patient’s mental health but also their physical health outcomes, including treatment adherence and recovery, which further highlights the importance of a strong support network. Photo by Jon Tyson on Unsplash How can we support those with a cancer diagnosis? As a society, and for myself as a doctor, we can try to encourage understanding, compassion, and connection through education. Here are a few tips on how we can begin to address and prevent cancer ghosting: Consistent Support: There is no “perfect” way to support someone with cancer, and no one expects us to know exactly how to support them. However, any form of consistent presence - checking in, offering a home-cooked meal, or just sitting in silence – can mean a huge amount. Whilst these acts may seem small, this support can be life-changing for someone going through treatment. Practical and specific support is often the most useful, such as ‘I’m making X for dinner tonight, I will make an extra portion for you and drop it round’. Being comfortable with not knowing what to say: It’s ok if you don’t know what to say - a simple, but regular check-in, such as “I’m thinking of you”, can make a big difference. We don’t have to know what to say, and it’s ok to admit to this. It may help some to read about the experience of patients, however, if this is overwhelming, even just addressing that you’re thinking of your friend can be significant. Utilising Support Networks: Support groups, charity events, and counselling through the NHS can help provide emotional and social support, alongside other support systems. As a friend, you could ask the person with cancer if they are aware of these options, or even see what is available in your local area to suggest. Macmillan Cancer Support , Cancer Research UK  and Teenage Cancer Trust  have lots of information on their websites. Online communities or support groups can provide a shared understanding of an illness that friends and family may not be able to offer. Doctors, nurses, and social workers should proactively ask about a patient’s support system during appointments, but you can do so as a friend. Offer to go with them, so that they do not feel alone or overwhelmed by the idea. Learn what support works best for that person: Ask the person what they find helpful, and encourage them to express their needs to their support network. Helping them find language around boundaries and expectations may help them feel empowered to advocate for themselves. Photo by Belle Co on Pexels What can we take away? If someone in your life has cancer, it’s important to remember you don’t need to have the right words to say or offer solutions. Just showing up, even if you don’t know what to say, can be a lifeline. And if you are a patient who has experienced ghosting, know this: you are not alone, and the problem is not you. The silence of others is often a reflection of their worries or discomfort, not your relationship. Having reflected with my friend on his experiences, he says it was those one or two consistent people, who checked in through messages, dropped off a home-made cake, or sat in his hospital room, often in silence, that meant the most. Whilst small, these experiences had a profound impact on his feelings of support. He often didn't have the energy to talk or actively do something; however, it was the presence, even in the moments of silence, that made a difference.

Let’s begin with good news. Young people in general are taking fewer drugs: around 17% of 16–24-year-olds took drugs in 2022–23, compared to 21% in 2019–20. Photo by Mart Production on Pexels However, such activities may be catastrophic for some teenagers, whose developing adolescent brains may never recover from taking toxic substances. Understanding the world of drugs is tough. Few parents – certainly not this one – are likely to fully grasp the ever-increasing and changing array of drugs on the market. Additionally, it is hard to understand why drugs might appeal, and psychologists that I spoke to stressed how complex substance misuse is. Nonetheless, there are some clues about why they appeal to the adolescent brain, which I will discuss in the third blog for my adolescent mental health series. The Lure of Risk Taking Firstly, drug-taking is influenced by young people’s economic circumstances and where they live. Whether that is in inner-city poverty, where gangs and drug-taking are commonplace, and young people may have little choice, or in smaller towns, where there is little else to keep young people occupied, especially given the lack of funding for youth services, or among wealthy elites, who have money to burn, literally. Several factors underpin the appeal. Next, there’s the attraction of something new, illicit and risky. Experimenting with new things and taking risks is normal in teenagers, as the teenage brain is drawn to novelty and risk-taking as they strive for independence and discover who they are. Then there’s the way drugs may ease the process of finding their tribe and interacting with others. Drugs and drinking may be used by teenagers as ways to reduce anxiety around the social challenges they may encounter, constituting what psychologists call ‘negative coping strategies’. This reflects the tendency of individuals to take on strategies that can lead to negative outcomes when they encounter stress. For example, a teenager might feel anxious about meeting friends or coping with relationship problems. Others may be suffering from mental health problems. Drugs act as a distraction strategy, so they temporarily feel more carefree, alert or excited, masking the unpleasant emotions. Photo by Wolfgang on Wix Additionally, drugs are easy to get hold of – easier to acquire and cheaper than alcohol in many cases. As one of my teenagers put it to me: "Parents do not seem to even realize how common it is. It’s so easy on your phone. You just text. It’s like a website. The website puts the name of the drugs, there are lots of emojis. There’s a price list, the numbers of grams. They come in a car, you get in the car with them, exchange the drugs and money. It’s called ‘picking up’. Or you just meet them in the street and just brush hands. It doesn’t feel illegal, or sordid – there’s not a meeting in a shady alleyway." Perhaps most obviously of all, drugs are pleasurable and addictive. Taking drugs floods the brain with surges of dopamine, creating a desire to repeat the experience. When these behaviours develop into habits, the brain starts to produce less and less dopamine each time, which is why addicts often explain that their drinking or drug use no longer actually provides them with the pleasure that it used to. If you add together those reasons – the desire for experimentation and acting against parental control, teenagers feeling part of a group, feeling a relief from social anxiety, and that they are easy to get hold of and addictive – it’s no surprise that teenagers can gravitate towards taking drugs of some kind. You might be thinking, well, I might as well give up then. But no. There are things we can do as parents to make drugs less attractive. 1. Being sympathetic to the pressure they are under To reduce the appeal of drugs, we can first acknowledge how alluring they are. If we say, ‘Drugs are bad, drugs will kill you’, our teenagers are unlikely to listen. The conversation will be over before it has begun. Instead, we might say, ‘I understand why you might want to do this.’ We get the pressures they are under. We are trying to establish an authentic connection with them on the topic, through active listening and validating their feelings. 2. Sharing information in a straightforward way We want to share reasons why drugs are a bad idea in a non-dramatic way that acknowledges our ignorance of specifics, while sharing our broad concerns. For example, the damage they can cause to developing brains, that people can become aggressive when high on drugs and not realize, the danger of getting into debt and crime, and the mental health implications. Our tone ideally should be one of ‘Let me pass on some information, so you can make good decisions.’ The most effective can be real stories of individuals who took drugs, such as a friend’s child who developed psychosis after taking drugs at a festival. The stories are more impactful without any advice from us about the conclusions they might draw. Sharing the less alluring side of drug-taking can be powerful too. Ketamine, for example, can cause the bladder to shrink to the size of a 4-year-old’s, and lead to a life of incontinence pads. It was this kind of physical detail that made an impact in my own discussions. ‘It’s suddenly not so cool to take something that might make you incontinent,’ one of my teenagers said. 3. Appealing to their desire for autonomy and social justice We can stress their autonomy, too, taking advantage of their natural desire for independence. They don’t have to do what everyone else does. What strategies can they employ for themselves not to be tempted? We want to position them as responsible and independent. This approach may appeal to the rebellious side of our teenagers: they may not like the concept that drugs and their dealer could control them, rather than the other way around. Their life could quickly revolve around drugs and making sure they can get them. We can also appeal to their concern for the environment and social justice. Wide-scale drug production is environmentally damaging. Cocaine production, for example, leads to soil erosion as large areas of forest are cleared for coca cultivation. Additionally, the production of chemical drugs such as crystal meth leads to the dumping of toxic waste. Photo by PokRie on Pexels Drug-taking also means endorsing an economy that wreaks utter misery on the poorest, most disenfranchised communities. It leads to gun and knife crime, prostitution, gang violence and people smuggling. The same teenagers who support Black Lives Matter may see the hypocrisy involved in their drug-taking, which leads to disproportionate numbers of deaths among young black men. While in general, young people are taking fewer drugs, substance abuse is a real and present danger. Our best bet is to understand the appeal of drugs and talk openly about the topic in a straightforward, non-judgmental way, trusting our teenagers to work out their own conclusions. No one likes being bossed around, least of all our adolescents. The more we say "no" to something, the more appealing it becomes. Instead, we can arm them with sensible information, alerting them to the dangers of peer pressure and situations that elicit emotions and arousal. Thus equipped, and knowing their desire for autonomy, they may make better decisions. ----------------------------------------------- The Gift of Teenagers: Connect More, Worry Less by Rachel Kelly, published by Hachette, is now available at Waterstones, WHSmith, and online. The audiobook, narrated by Emma Fenney, can be listened to on Audible.

We are not O or X. We are not built to stay still. Beliefs bend. Allegiances shift. When systems demand certainty, it’s our capacity for change that keeps us human. No Ju-han/Netflix When Squid Game first premiered in 2021, it shocked and thrilled the world with its simple yet brutal premise: 456 people in desperate financial circumstances are invited to play deadly versions of childhood games for a ₩45.6 billion prize, approximately £24.5 million (or €29M / $33M). The catch? Losing means death. It became a cultural event, not just because of its violence or suspense, but because it reflected something deeper: the way modern society divides people, turns survival into competition, and hides control behind spectacle. With Season 3 arriving this June , I wanted to re-examine Season 1 and 2. International viewers praised its cinematic scale and intensity. But in Korea, reactions were mixed. Why the divide? What is the real message of the show as it nears its conclusion? The answers lie not just in the plot, but in the shapes, structures, and spaces that define the Squid Game world, and our own.   Understanding Squid Game : For New Viewers The story centres on Seong Gi-hun, a man weighed down by debt and despair. Along with hundreds of others, he enters a secret competition where participants play traditional Korean children’s games, like Red Light, Green Light or Dalgona , for a massive cash prize. But failure means immediate death. The games are run by masked guards marked with simple shapes (circle, triangle, square), while a mysterious figure known as the Frontman oversees it all. The show quickly shifts from a survival thriller into a symbolic narrative about capitalism, social inequality, systems of control and the human cost of competition.   Geometry and Power: Why Shapes Matter No Ju-han/ Tudum by Netflix One of the show’s most consistent visual themes is geometry. The guards are ranked by the shapes on their masks: ● (circle) for workers, △ (triangle) for enforcers, and □ (square) for managers. These aren’t decorative. They reflect status through shape complexity. The more vertices, the more power. At the top sits the Frontman, whose angular mask suggests absolute control. Even the games themselves are constructed from circles, triangles and squares. And the players? They have no symbol. They’re nameless, powerless, and expendable until perhaps one survives and joins the very system that erased them. Director Hwang Dong-hyuk described the series as “ an allegory of modern capitalist society… a depiction of extreme competition .” But it’s also about who draws the lines and who is forced to live within them.   Controlled Spaces: The Architecture of Fear Chae Kyung-sun / Interiors The set design in Squid Game isn’t just background. It shapes the story. In the Red Light, Green Light arena, a painted countryside masks a massive doll and an artificial sky. Only Il-nam, the elderly player who later reveals himself as the game’s creator, looks up. He knows the truth: the sky isn’t real. Set designer Chae Kyoung-sun described the goal as creating “ a sense of disorientation… as if the players were mice in a maze. ” That design echoes a larger theme. The spaces we inhabit in modern life, both physical and social, are often constructed to limit choice and obscure control. In Squid Game , scale and perspective are manipulated to remind players they are small, replaceable, and never truly free.   Drawing the Line: When Rules Decide Who Lives Squid Game constantly returns to the idea of a line, literally and symbolically. In the game Dalgona, break the shape’s edge and die. In tug-of-war, cross the line and fall. On the glass bridge, one misstep is fatal. Lines divide space, but also people. They define who belongs and who doesn’t. In nature, boundaries are fluid. In society, we draw them with precision on maps, between classes, or between ideologies. No Ju-han/ Tudum by Netflix Season 2 builds on this idea. It shows how systems that appear democratic, like voting, can be used to divide. Players are asked to vote to quit the game. But the vote is public, labelled and spatially divided. O or X. Red or blue. Once everyone knows your choice, trust erodes. Blame takes over. The game doesn’t need to punish players. They do it to each other. What should be private becomes a badge of loyalty or betrayal. In this world, freedom becomes performance, and democracy is redesigned as a mechanism of control. It ’s not just fiction. It’s a sharp reflection of today’s polarised political reality, where voting becomes a public test of identity. Why Korean Viewers Responded Differently Left : Im Si-wan in Misaeng Middle: Gong Yu in Goblin Right: T.O.P in Bigbang / NAVER While Season 2 impressed many international viewers, Korean audiences , including myself, were more divided. One reason might be the casting. Season 1 featured mostly unfamiliar faces, which made it easier for us to connect with the characters. Season 2 brought in major celebrities. For Korean viewers, actors like T.O.P or Im Si-wan carry strong associations with past roles, making our immersion harder. What felt fresh abroad felt overly familiar at home. Then there’s the setting. Scenes that may look dystopian to global audiences, drinking vending machine coffee or sitting outside a convenience store, aren’t metaphors in Korea. They’re real. These are everyday spaces tied to economic hardship. For local viewers, the symbolism may have felt uncomfortably close. Finally, Season 2 leans further into systemic critique. The tension isn’t driven by games, but by public voting, forced group identity, and moral pressure  — s tructures, Korean society knows well. For some, that made the story more powerful. For others, too real to escape into.   Humanism Among the Ruins Despite its brutality, Squid Game is a profoundly human story. Tender moments stand out: players sharing ramen in the rain, a grandmother gently reminding others to eat when they're hungry, and rest when they’re tired. She becomes a symbol of humanity, a quiet force against the engineered chaos around her. Another scene shows a player, isolated after a vote, being invited back to eat. “Come eat with us, bro.” It’s a simple line. But it reminds us that your vote isn’t your identity, but your humanity is. Season 2 Ends in Collapse, but by Design Season 2’s ending may have felt like a letdown for those expecting victory. But the collapse was intentional. Director Hwang revealed that Seasons 2 and 3 were conceived as one continuous story. As it expanded, it was split, ending Season 2 at the point when Seong Gi-hun’s hope crumbles. “Season 2 ends when Gi-hun’s hope is broken. The full message, and the story’s resolution, are in Season 3,” said the director Hwang. Throughout Season 2, Gi-hun tries every possible path: diplomacy, rebellion, democratic voting, and even external rescue. All of it fails. His closest ally dies. The system prevails. The season doesn’t offer redemption. It withholds it, making room for transformation. Collapse isn’t the conclusion. It’s the turning point.   We Are Not O or X As a Korean viewer, I noticed details others might miss. The cultural codes in coffee vending machines, the weight of convenience store tables, and the emotional baggage of casting choices. But Squid Game is no longer just a Korean story. It’s global. And it reflects how systems divide us intentionally. How democracy can be manipulated. How freedom becomes symbolic. And how, even in small moments like sharing food, showing care, asking “Have you eaten?” , people reclaim their humanity. We are not O or X. We are stories. That’s what makes Season 3 so important. This June, Squid Game returns. But it was never just a game. It’s not about who wins. It’s about who we become when the game ends.

Recently, I have started a great job in communications, set up a decent writing business, and earned a journalism degree. I am also dating the most beautiful woman in the world, who has all three: the cheekiest smile, hair that smells like black castor oil, and my full commitment to becoming her husband. I'm absolutely terrified. Not terrified in a 'the first day of college' or 'preparing to wear a pink suit to my office end-of-year party' kind of way. I’m not jittery, nor are there any butterflies in my stomach. I am terrified. As in, I stay up till 2 am, biting away at my mind and wondering what could possibly be wrong with my life.   My name is Tezor Dedam, a journalist contributing to a peculiar anxiety experience that challenges conventional views of anxiety and “happiness culture”. This discourse is important because it aids contemporary narratives on embracing joy while presenting relatability on hyper vigilance and what it even means to be happy. Photo by Helio E. López Vega   on Unsplash The White-Dress Complex After wondering what could be wrong with my life for 28 years, I've come to the conclusion that I have a problem with good situations, circumstances, or phases. We could think of it as reverse anxiety or an anxiety of good things. I always feel the fear of an impending bad thing when good things happen: What if I lose it all? What if I'm getting excited too early? What if she's only infatuated, not in love, with me? Why am I under so much pressure to maintain this positive situation? What if this is the universe's compensation for the storm that's coming? I have found that I am not only unable to enjoy these good things, but they, in fact, make me feel worse than if nothing were happening at all or even if everything were falling apart. I have come to explain this with a white dress complex; if I were in a fancy ballroom full of people in immaculate white attire, I would constantly be concerned about whether my dress was dirty or how it could be stained at any second. But if the room were a mud splash scene, I would fit right in, with a sense of comfort and ease of mind, no matter how much of a mess I was. Photo by Kazuo Ota  on Unsplash Documenting my White Dress After realising my white dress complex, I went to do some research of my own, and I found a much less interesting name for it – Happiness Anxiety. While there is not a lot of accessible academic research on this issue, research from the Educational Policy Analysis and Strategic Research journal has attributed it to a host of reasons, such as being part of a social culture which does not place enough value on happiness, positive and negative sensations, and a belief that evil will follow happiness, among others. Further research from the Derbyshire Healthcare NHS Foundation Trust  attributes happiness anxiety to traumatic childhoods, cultural backgrounds, and even alexithymia, an inability to identify emotions. So, I’m drawing two things from where I am at so far. First, that there’s practically no science behind it, and second, that it consists of several emotional layers. Let’s talk about these layers.   First of all, I have had traumatic experiences throughout my childhood, I have been disappointed a lot in the past, and I live in a country with socioeconomic woes that constantly put me on edge and convince me that I'm one misplaced policy or economic meltdown away from crashing and burning. These things have formed into a layered system that has caused me to see happiness as a fleeting high. One that seldom comes , but when it does, it is likely to quickly go. So, I usually shoot for a more lukewarm, level-headed approach to life, focusing on achieving a mild sense of fulfilment: having my bills paid, keeping food on the table, and maintaining a basic social network. It works for me – calm, void of expectations, involves fewer life changes, and is stationary yet progressive in its little ways. Bowing Out of the Ballroom I once heard an analogy on the advantage of being a warrior in a garden over being a gardener in a war (last metaphor, I promise). I've been obsessed with it ever since. According to the analogy's reasoning, a warrior in a garden is over-prepared for the clean air, chirping sparrows, and the floral bliss before them. But at least they are at peace. Meanwhile, a gardener on a battlefield would not be so fortunate. Because of this perspective, I have reconciled myself to the reality of being at war internally, even when everything around me is beautiful and garden-like. Thus, preventing me from enjoying it. A warrior in a garden is not always at peace. A Self-Examination of My Anxiety Look, I just don't want to be blindsided by life. It's brutal, and it will punch you in the gut while you're leaning back with your eyes closed, taking in that fresh sunny beach air. I'd rather brace for impact, or for that punch and take it in stride when it comes. Because of this, my mind has always resisted peace, even when it was right there to bask in. So, unless I know what is at the tail-end of this wave of happiness, I feel like I will continue to be uneasy. But don't worry, it's not all doom and gloom on this side. Mostly, because I have started a more reflexive approach to everything. For example, I constantly ask myself what a "tail-end" of happiness would entail, or why there should even be one. I now question why I consider myself a struggling journalist when I'm doing well for my circumstances and progressively growing. When Liverpool goes up 1-0 (big fan by the way), I ask myself why I am suddenly uneasy and look at it as a lead to be lost instead of an advantage on course to a victory. I ask myself, why is my white dress even dirty in the first place? I have said I prefer to have a soiled dress in a room full of soiled dresses to having a soiled dress in a room full of clean ones. But why did I not extend myself the grace of a good laundry day for 28 years? If you're waiting for a big transformation reveal after I asked myself these questions, then I’m sorry. Though, to be honest, I at least now have a sense of empowerment from interrogating these thoughts that have always bothered me. At least I now have the vantage point of reflection and awareness of my situation. I could order every self-help book on Beyonce’s internet, I could hike through Hawaii to “find myself”, or I could talk myself through all these metaphorical gymnastics like how the shadows only loom larger because the sun is shining brighter in my life. But I know it will only get better if I accept that happiness sometimes is, in fact, fleeting. And there’s no point in seeking certainty through all of it when I can just enjoy the moments of each fleet. I know this. Believe me, I actually do. I just have to find a way to implement it in my life. But I’m getting there. Photo by Sepehr Sajjadieh   on Unsplash This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.