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

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

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

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

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

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

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

Taylor Swift’s world-famous Eras Tour arrives at the Wembley Stadium in London tonight. While I am a ‘Swiftie’ (A Taylor Swift fan), I unfortunately wasn’t able to buy tickets, which sold out in a matter of minutes when they were first released, following a protocol whereby only individuals with a ‘ pre-sale code ’  were able to purchase tickets. But, I have been following this concert virtually, and for those who, like me want to get the concert experience, I have linked a trailer to the Eras Tour movie, available on Disney+. Why is the Eras tour such a phenomenon? Most artists typically go ‘on tour’ when they release an album, performing songs mainly from that album. What sets the Eras tour apart, is that Taylor Swift performs songs from all the albums she’s ever recorded, spanning a career over two decades. It reflects different circumstances in her life, from love (the Lover era), heartbreak (the Tortured Poets Department Era), slander and reputation (the Reputation era) sharing with her fans the evolution of her personal and professional life (you can learn about each Era here ). The Eras tour has become such a phenomenon, that in 2023, she was recognised at Time Magazine’s Person of the Year . For context, this title in the past has been held by Popes, Presidents, and now, a Pop Star. My personal favourite part of the Eras tour is the tradition of the ‘22 Hat’. Part of her ‘Red’ era, she performs her upbeat song 22, wearing a black hat. One special fan is chosen from the audience to personally receive the hat from Taylor during the performance, and most of these fans have been young girls who have dreamt of seeing her perform all their lives. At one of the first shows, that is featured in the Eras tour film, the hat was given to the late basketball legend Kobe Bryant’s daughter, Bianka Bryant . One of the other recipients at one of the Australia eras Tour shows was 9 year old Olivia Scarlett, who bravely fought a brain cancer diagnosis,  and unfortunately lost her battle in April 2024 (you can watch this moment here ). Taylor Swift has sung about mental health and societal issues Taylor Swift has never shied away from talking about mental health. One of her songs, the ‘Anti-hero’ talks about her low mood and depressive symptoms, with lyrics such as “ When my depression works the graveyard shift ,  all of the people I've ghosted stand there in the room ”. In her documentary “Miss Americana” on Netflix, she also opened up about her experience with disordered eating habits . She is not one to shy away from politics and societal issues either. Her song “Miss Americana and the Heartbreak Prince” referred to the tumultuous US political climate of 2018. In fact, the song has been heralded the “Great Protest Song of Our Time” . From the same album, her song “The Man” tackles issue of gender inequality. She talks about how, if she was a man, people wouldn’t question her talents, and success success, nor would they judge her every outfit and action. The central lines of the chorus are: “ I’m so sick of running as fast as I ca n Wonderin' if I'd get there quicker if I was a man ” “You need to calm down” is yet another song  from the Lover era, which essentially claps back at haters who anonymously post rude and hateful comments online. In one of the verses, she promotes LGBTQIA+ rights: " And control your urges to scream about all the people you hate 'Cause shade never made anybody less gay " The controversies around the Eras tour Whilst I have addressed the stardom of Swift and magnitude of the Eras tour, it is important to also talk about issues that have risen ever since the tour was announced. From an environmental perspective, Taylor Swift has made headlines due to the sheer amount of carbon emissions caused from flying the world over. For example, when she flew in her private jet from Toyko to LA in time for the Superbowl (in which her sportsman boyfriend Travis Kelce was playing), she is likely to have produced more than 50 tons of carbon emissions . While some argue that her carbon emissions are disastrous for the environment, others defend her, citing that someone’s plane travel is a private matter, and should not be tracked, as this violates the privacy of those in the limelight. In fact, in 2022, she was reported to be the number one celebrity CO2 polluter , with emissions estimated to be over a 1,000 times those of others. However, in response, her publicist has mentioned that Swift uses carbon offsets, referring to investment in environmental activities to balance her carbon footprint. You can learn more about this here. One glaring problem is the excruciatingly high prices of tickets, set by Ticketmaster, a ticket sales and distribution company . A number of additional problems were then associated with the platform, such as cancelled sales due to the website crashing, those with presale codes being in virtual queues for hours, and skyrocketing resale prices. In fact, this fiasco has now become a legal matter being heard in the US Senate .   Some of these controversies have also been discussed in the academic setting. On the 12th of June, ahead of Swift’s performance in Liverpool, the University of Liverpool’s Department of Music hosted ‘ Tay Day ’,  an academic conference dedicated to “ discussing and debating all things Taylor Swift ” . They essentially took a balanced stance on this worldwide topic discussing her role as a feminist and LGBTQIA+ rights activist, as well as the problems she has been criticized for, such as her carbon emissions. To sum, Taylor Swift and her tour have undoubtedly made the headlines for both good reasons as well as some concerns. While I am a fan of her music and applaud her success and concern for social issues, I am also aware of the controversies I have discussed in today’s piece. As with supporting any celebrity or artist, it is important to be aware of both their positive, as well as negative qualities, so that we can apply critical thinking and ensure that we don’t blindly idolise them. I am now ending with a fun fact for all our readers from within KCL: did you know that Taylor Swift’s first ever show in the UK was held in the Vault at the Strand Campus in 2008?

Have you ever signed up for something, knowing it was a bad idea then worried about it for months on end only for your fears to be totally well-founded? My advice: if you are worried don’t do it! I’ve learned this the hard way, crashing into a wall of rocks at speed.   Last October, I was happily having lunch with a couple of friends from university. We all met at Queen Elizabeth College in Kensington back in 1983 (now King’s College London- I haven’t moved very far!) - it was great to catch up and reminisce. Someone (I think it may have been me) said something like “ hey -do you realise it was was exactly 40 years ago this week that we met?” The conversation then turned to how we should mark this momentous occasion. One chap, a very keen cyclist said “ are you guys up for cycling in the alps next summer? I’ve been thinking of doing this ride from Courchevel to Antibes .”   I had taken up cycling during the covid years having bought a bike under the ‘cycle to work’ scheme just before lockdown when bikes became as rare as hen’s teeth, so, spurred on by the Chablis, I agreed enthusiastically. Our other pal did too but said he would only do it on his electric bike. It was a done deal. The route was planned with a professional company that provide back up (a man in a van and a guide), flights were booked, and the date (Sept 2024) was set.   At first, I was excited about the prospect. What a great way to get fit, lose some weight, and keep me occupied throughout the winter. I had been looking for a challenge as I was entering my 60th year so this seemed to fit the bill. I already had a turbo trainer and Zwift subscription, so I planned to ramp up my training through the winter months. Things ticked along, friends I told thought I was mad, but as it was far in the distance, I didn’t start to worry about it until around May. At that point my fears were mostly about getting up the mountains - I changed the gearing on my bike and bought all sorts of new kit in the hope that I was fully prepared. By this time other people had been recruited to the challenge and we agreed to a couple of training rides out in Berkshire, at which I was hopelessly outclassed.   Even so, I pushed on with the training, gave up drinking in a bid to lose 7kg so I would have less to ‘carry’ uphill, and started to panic. In July that panic shifted from fear of going up to fear of coming down. We had been sent the route by the company - Day 1: Le Col de Madeleine . Basically, uphill for 25 km then 25km down the other side. Add in another 40km to and from the hotels and that was the gentle introduction. Day 2: Two mountains; La Croix de Fer  followed by l’ Alpe D’Huez . And so, it continued for 7 days. I was showing my son the route when he said rather unhelpfully, “ Dad, you’re probably going to die on the way down ”. This, though obviously said in jest, did not help. He saw the panic on my face. Later he had a quiet word with his mum saying he was worried because he thought I was terrified.   I phoned my mum - not a good idea. I told her about the trip. “ You’ll be careful coming down the mountains, won’t you? ” Not what I needed. This request was repeated every time I spoke to her in the lead up to my departure, and by now I was in full ‘anticipatory anxiety mode’. My son Seb came up with another pearl of wisdom “ Dad, why do old men (note not middle-aged men!) feel the need to take up cycling? ” A good question. I said something along the lines of “ we all get fat so some of us take up exercise- running hurts our knees so cycling seems a better option ”. There’s obviously a lot more to it than that, and that’s probably another blog in itself. I denied I was having a mid-life crisis on the grounds I was beyond ‘mid-life’. Throughout this, I mentioned ‘anticipatory anxiety’. I have suffered from this before. When I was 22, I went to the US, and I was convinced I was going to die. I was plagued for months - I left sealed ‘goodbye’ messages to my family. I even ‘knew’ the day on which it would happen - a day I was flying from Chicago to Los Angeles. Turns out, I got so drunk the night before I left Chicago that I was horrendously sick on the plane but at least I’m here to tell the tale. Since then, I would never describe myself as a worrier. Day 1 – Le Col de Madeleine By the time I left for France with all the ‘be careful’ messages ringing in my ears, I was a nervous wreck. As soon as we got to Courchevel we built the bikes and went on a short test ride over to Meribel . I felt much better to get going and my legs felt great. The next day we left the chalet at 8.30am and dropped down into the valley before tackling the Col de Madeleine. We all got up okay and had a nice lunch at the top before dropping down the other side. Most of the gang took off at great speed, I was more conservative. I was so tense gripping the brake hoods that my neck was soon in agony. I knew the problem but just couldn’t relax on the bike. I was so glad to get to the bottom in one piece and the pain eased as we rode on the flat. That night, I got so much conflicting advice on how to descend my head was in a whirl. Day 2- Le Col de la Croix de Fer This mountain is a brute - it’s 28km up to a height of 2067m. The first 2km have an elevation of 8% so it’s immediately tough. There’s a relative respite between 12-20km (4-5%) and ramps up for the last 8km (8-9%). I experienced a huge sense of achievement and relief when I finally got up there. There was a well-earned lunch at the summit, but we were soon back on the bikes for the descent to Le Bourg-d'Oisans. The descent starts with long sweeping curves, and you can see a good few kilometres into the distance. It then gets tighter with more switchback chicanes. Again, I was gripping on for dear life but strangely enjoying the first 10km. The roads were busy in both directions- about 10 Porsches came past at speed – all in a line and groups of motorcyclists hammering down the mountain. I was constantly talking to myself, concentrate…concentrate. We were hitting speeds of between 50-70km/h on the open stretches. I remember slowing for a double chicane, congratulating myself for negotiating it safely - then it happened. I was accelerating after the chicane (I reached 40km/h according to my Garmin), the next corner arrived quicker than anticipated and I hit the brakes. My back wheel slid, and I managed to keep upright but now I was heading for the rocks. The front wheel hit the first one and I went over the handle-bars. It is a cliché to say it all happened in slow-motion, but I really did have time to think- ‘ oh, this is going to hurt .’ I slammed into the rocks, my ribs on right side were the first point of contact then my left hip and head. I lay there stunned and motionless for an indeterminate length of time. A German couple got to me first. They helped me extract myself from the rocks and I explained I had friends behind me on the mountain who could call the support van, which by this stage was waiting at the bottom. I was lifted into the van having refused a trip to hospital.   As we drove down 3 ambulances were on their way up - one of the Porsches had hit a motorcyclist knocking him down the mountainside, and a young girl in a cycle race had come off at the corner after the one I hit and lay unconscious. It is a crazy, dangerous place! We got to the hotel, but I couldn’t walk. I shuffled to the bar and called my wife. My wife is a consultant physician, so I got a practical and unemotional assessment.  Once she was happy that I didn’t need to go to hospital (i.e. she was happy my hip wasn’t fractured) she said, “ well, you have to try to get back on the bike tomorrow- you don’t want to spend the rest of the week in the van ”. The guys were quite stunned at this, especially the next morning when I asked two of them to lift me on to the bike. I rode 60km that morning before retiring to the van after lunch. It was agony for the most part – upper body suffering but although I couldn’t walk very well, the pedalling motion was fine. From there I didn’t look back. Although, in constant pain, I tackled one more big mountain, Mont Ventoux. The last 5km of Mont Ventoux is fairly bleak- well it was on the day we were there. About 1 km from the summit is a memorial to British cyclist Tom Simpson who collapsed and died there during the 1967 Tour de France. We stopped at the memorial on our way down. It is a stark reminder to respect the terrain. The weather closed in and after coming down the first 5Km on the bike, I refused to go down any further so got in the van. I’d completely lost my nerve on the descents After Ventoux, we were into Provence so the big hills were behind us.The sun came out and  we cycled through the incredibly scenic Gorges du Verdon . At last, I was able to enjoy the ride (almost). On day 7 , we made to the beach at Antibes!   I have never been so pleased to reach anywhere else. Looking back, was it a coincidence that I crashed, do I have insight or was my anxiety about crashing the root cause making it inevitable? I’ll never know but I do know I’m not very good at predicting future outcomes.

I distinctly remember my first introduction to One Direction, when I was 11 years old. It was the “What Makes You Beautiful” music video , with Liam Payne singing the opening lines. Little did I know that from this moment on, supporting the band would shape a key aspect of my pre-teen and teenage years. A little over 10 years later, on the 16th of October I woke up to a one-word message from my best friend. Under that, was a BBC announcement that Liam Payne had tragically lost his life, aged 31 in a hotel in Buenos Aires, Argentina. I spent much of yesterday re-living all my memories of when I was a Directioner (a One Direction fan). I grew up in Mumbai, and sadly, the band never performed in India. Merchandise was not available either, and I distinctly remember my father buying me a few t-shirts and books from one of his work trips abroad, which, as it happens, I have to this very day. My time after school, when not doing homework, was dedicated to listening to their newest music, watching their famous “video diaries” , and dreaming about the day I would finally watch them live. I am aware that recently, before his passing, Liam had been in the news because of a fictional book published by his ex-girlfriend based on her relationship with him. It discussed aspects of their relationship such as abuse, harassment, and details which might be triggering to some readers. Eventually, she issued a cease and desist against him last week due to harassment from him. Further, after the band split up, stories about Liam being violent with his mates emerged. So,  like many other celebrities, Liam too had negative qualities about him. On my commute yesterday, I started scrolling on X, where my timeline was all about his passing. Sadly, I saw a few tweets that said he ‘deserved to die’ because of everything he put his ex-girlfriend through, and others which trolled his fans for mourning his death. And this made me very upset.  It is rather complicated to deal with these conflicting feelings, when someone who I have respected so much as an artist in my teenage years has then done horrible things. When he was part of One Direction, he was young; but, as he grew, he became quite a different person, who caused harm to others. This brings me back to what I discussed in this article a few months ago, where I said that we cannot wear rose-coloured glasses when we support celebrities, . We need to be aware of their negative qualities, and, when they do bad things, we do not need to defend them. Liam was part of a band that broke records and made history. He was a great musician, who, according to reports , was making a conscious effort to mend his life, such as his relationship with his son. He was an important part of so many of our lives growing up. Seeing that pictures of his body had been acquired by TMZ , and the fake videos circulating, at a sensitive time when his family was coming to terms with his loss, infuriated me. Where is the empathy? Just because he was a celebrity, no one has the right to violate his privacy, especially in death. In 2019 , he opened up about his experience with loneliness and poor mental health, often resorting to alcohol and other substances as a coping mechanism. In relation to his death, news reports said Argentinian police was responding to reports of ‘an aggressive man who may have been under the effects of drugs and alcohol’ based on a phone conversation with the Manager of the hotel where Liam was staying. As I reflect, I realise that so many stars who rose to fame in their teenage years or early twenties, fell victim to alcohol and substance abuse as adults. like Amy Winehouse , and Demi Lovato . Coping with fame can be a challenging experience anyway - coping with the pressures of adolescence coupled with constantly being in the limelight can undoubtedly affect mental health. Liam is one such celebrity who sadly fell victim to this. My fondest memories of One Direction One of the reasons why I have written this article is to reflect on the amazing memories I have made because of One Direction, and to celebrate the life of Liam. If you, like me, grew up with them, I’m sure some of these will bring a smile to your face. I am currently writing this piece as I listen to “Night Changes”, feeling particularly emotional. Here is a photograph of 12-year-old me, proudly posing with my newly acquired One Direction book. As I mentioned earlier, merchandise in India was unavailable. I distinctly remember my dear dad, in between a jam-packed day of meetings on a work trip, went to a pop-up store in New York city, just to buy his tween daughter merchandise of this boyband she loved so much. I can just imagine how he might have been the oldest in the shop by many years, in a suit and tie, surrounded by other tween fans. I remember when their This is Us movie was released, and how my best friend and I were two giddy girls off to the theatres like grownups. Now that I think of it, not even the Taylor Swift Eras tour film instils the same feeling in me. Just like every other Directioner, when I hear words like “Kevin” and “No! Jimmy protested” my mind automatically plays the infamous video diaries in my head. Back then, we didn’t have streaming services like Netflix and Prime. When music awards were scheduled, due to time differences, I could never watch them live. So, I’d record them onto my tv and watch them so passionately when I got back from school the next day. As I think about all these memories, I can’t help but be emotional. I never expected that we would lose someone from the band so soon. I always imagined a potential reunion decades later, when I would be a grown woman, perhaps a mother, telling my child about all these amazing memories. But, for now, I can only say, “Just how fast the night changes” . Last evening, all the members of the band put out a joint statement honouring Liam, and it was so sad to see that they had reunited under such sad circumstances.   Rest in peace Liam, you will forever be remembered.

During my clinical training as a psychiatrist, I had access to the emotional worlds of my patients in every aspect. This could be challenging, as the person may not always recognise what they have, emotionally, going on. In this article, I will try to explain what it means for some people to be unable to recognise or express their emotions, a diagnosis called ‘Alexithymia’. One of the most common questions psychiatrists ask their patients is "How are you?" . This question may appear trivial, but when we ask a person how they truly feel, we attempt to gain access to their daily life and emotional world. As much as we try to tiptoe into this dimension the “how-are-you-question” can sometimes be a source of distress, especially when someone struggles to access their feelings. Not having access to their emotions frequently leads to a lack of words to express what is happening. Therefore, the response to the question “How are you?”  might be “I don’t know” . This inability to grasp what they are feeling or why they are experiencing certain feelings can lead to somatising the emotions. This means feeling emotional states through bodily symptoms. For example, when asked: "How are you?" , they may respond with: "I always have headaches" . This difficulty in recognising and expressing emotions can become a persistent condition: alexithymia. So, what is alexithymia? Alexithymia , or emotional blindness, is a term coined by John Nemiah and Peter Sifneos in the early 1970s to describe a set of characteristics found in "psychosomatic" patients – i.e. patients whose organic pathology (e.g., headache, difficulty swallowing) is a symptom of unexpressed psychological distress. The word alexithymia comes from the Greek “a-“ (“lack”), “lexis” (“word”), and “thymos” (“emotion”), which literally means “lack of words to express emotions”. Alexithymia is the inability to recognise and verbally describe one's own emotional states and those of others, as well as to distinguish emotional states from physiological perceptions. People with alexithymic traits often struggle to identify their emotional states, express their feelings, or comprehend the emotional condition of others. Failure to characterise emotional states can result in a decline in imaginative, dreamy, and introspective capacities. For this reason, people with alexithymia tend to have behaviours that conform to the masses. They mirror the emotions of the crowd and experience these emotions physically in their bodies. Experiencing an emotion purely on a physical level prevents its cognitive processing, making it difficult to articulate or fully understand. As a result, the emotion is perceived, but not recognised, which may loop back around to further feeling emotions through physical symptoms.   Not a disorder, but a personality trait… Alexithymia is a common personality trait in conditions where the expression of mental pain and discomfort also passes through the body, such as post-traumatic stress disorder, eating disorders, dyspepsia (a feeling of fullness or bloating during and after meals), dysphagia (difficulty in swallowing), certain sexual disorders (e.g., erectile dysfunction), anxiety disorders, and substance abuse. Another aspect of alexithymia is the difficulty in showing empathy toward others. The less a person is aware of their own emotions, the less they will be able to be empathetic. This should not be confused with the clinical deficit of empathy, which could be present in other disorders. In fact, alexithymic individuals can sense empathy. However, they understand empathy through physicality and, thus, cannot directly recognise it.   Is alexithymia spreading in our generation? From a broader, more global perspective, it's hard not to notice how recognition and expression of emotions have changed dramatically in the age of the internet. In the presence of a screen, and the possibility of starting or interrupting communication at any time, people are less concerned about how they are perceived – in other words, they are more likely to establish superficial relationships. Additionally, interactions often only occur between two persons, displacing people from group dynamics which have differing emotional loads. Considering these factors, the quality of online connections differs from that of connections formed offline.   The importance of “reconnecting” with ourselves Alexithymia may have significant impacts on the lives of those experiencing it. Therefore, therapeutic interventions geared at recognising and improving emotional processing may be powerful tools. A first step towards emotional recognition could be to start being mindful of physiological responses (for example, to concentrate on the heartbeat and recognise its variations during different situations). Psychological treatments such as cognitive behavioural therapy (CBT), group therapy, and psychoeducation can aid the recognition and verbalisation of one's emotions, resulting in increased emotional awareness, more meaningful relationships, and a higher quality of life. For example, a study on a psychoeducational intervention  found that teaching adolescents in a school environment to recognise their emotions can assist in reducing bullying, racism, and homophobic behaviours and attitudes. One suggested reason for this is empathy; when kids are taught to experience and recognise emotions, they gain different perspectives on reality and a greater understanding of the consequences of their actions, particularly how they impact others. Furthermore, several factors have been identified to assist clinicians in supporting individuals in exploring emotional themes . Psychotherapy incorporating specialised strategies to promote emotional awareness and use symbolic components of emotional systems could help reduce alexithymic features. Changes in alexithymia appear to be connected with assigning meaning to emotional experience, relating feelings to events, or accessing new perspectives. A message to keep in mind: "negative" emotions are just as important as "positive" ones. So, learning ways to identify emotions doesn’t mean working against "negative ones" but working with them to live a life we can feel (and recognise) in every aspect. So, how are you?

Like catching up with an old friend or, during a spontaneous deep clean of the entire house, stumbling upon a trinket that you thought you’d lost lifetimes ago, there’s such a sweet comfort in rewatching one of your favourite TV shows or films years later. This past Christmas, my brother – the youngest of the three of us – gifted me nostalgia in the form of a 23-disc box set. Doctor Who, Series 1-4. Not unexpected, given his out-of-the-blue “btw do you guys like the 11th doctor? Or just 10?”  text in our siblings' group chat in early December. For two nerds who spent their early teens charmed by David Tennant’s performance as the time-travelling spaceman, the answer from my sister and I was a no-brainer and an immediate “obviously, 10”. Not long after gifts had been opened and Christmas dinner devoured, we three made plans to rewatch this beloved show from our childhoods together. My TV, my sister’s PS4, and my brother’s snacks all made their way to our parents’ room to take over the space. Three overgrown children squished together on the bed for a Christmas movie night, popcorn and drinks in hand. Right away, my sister and I began our excited whisperings, pointing out foreshadowing and throwaway lines that would come back to haunt the characters, and practically cheering at iconic quotes. Thankfully, our brother is a patient man and paid no mind to our incessant yapping, instead focused on the story unfolding before him that he had been too young to understand the first time around. Although I genuinely love exploring unfamiliar worlds in new stories, I can’t deny how thrilled I am when a loved one tells me “Oh, I’ve never seen that. Would you want to watch together?”. And I’m hardly alone if all the nostalgia talk and endless reboot after remake after sequel is anything to go by. But why is that? Why do we enjoy revisiting the stories – the “old friends” – we love so much, instead of just seeking out the new? What is Nostalgia? Nostalgia is a concept I’m sure you’re all too familiar with – the bittersweet ache of memory, the moment of melancholy, the wave of familiarity and ensuing mourning. Often paired with a wistful sigh, nostalgia is “a feeling of pleasure and also slight sadness when you think about things that happened in the past” . When it comes to stories, one of the most entertaining aspects of rewatching a favourite show or film is the fun of noticing details that you missed the first time around. The foreshadowing and “how on earth did we not notice that?” hidden-in-plain-sight Easter eggs. With every revisit to a beloved “old friend”, there are new truths discovered and depths revealed. In a well-crafted piece, it’s a chance to find a greater appreciation for the artists and their artistry. Research shows that we are comforted by familiarity and expectedness compared to the unpredictability and perceived risk of trying something new. This is also true for the stories we read and watch. How many times have you felt down and leaned on a romcom or classic for comfort? It’s comforting and familiar stories are far less cognitively demanding in times we already feel overwhelmed. In a world of unpredictability, the predictability of our “old friends” can provide that much-needed sense of escaping and stability. Sometimes it helps to just have an episode of a show you’ve seen countless times playing in the background as you think and deal: a small consistency during moments of turbulence. Alongside escapism, in particularly high-stress times – like the first year of the pandemic – nostalgic thinking can promote optimism and act as a buffer for deteriorating mood . Nostalgia as a Social Experience We are all sentimental about something. Whether it be the “good ol’ days” or chocolates we had as children. This missing what once was is a shared feeling allowing us to feel closer connected to those around us . In this way, nostalgia is a social experience  and more than just a yearning but also a way to strengthen our sense of belonging, identity, and self-regard. This collective nostalgia is often utilised in politics , particularly in more conservative groups, in which the dissatisfaction with present-day events motivates a mission to turn nostalgia from just reminiscing into a world necessary to return to. In contrast, studies in the United States shortly after Donald Trump’s election into office found that “Obama nostalgia” predicted political engagement and voting intentions . Though nostalgia and how we engage with it can certainly be a form of avoidance, research also suggests that nostalgic thinking regulates avoidance and motivates action . Of course, the world of politics is by no means the only way collective nostalgia is utilised... Nostalgia as Marketing In advertising, relatability and sentimentality are exploited. Our nostalgia is targeted as a marketing  strategy every day – and sometimes, nostalgia for times we weren’t even alive for . And it works! People will heavily dispute the quality and necessity of the Star Wars sequel trilogy, but we all spent the money on cinema tickets and saw those films. Why? Because it’s Star Wars! Of course, you’re going to watch the ‘nth new show for the chance they’ll throw in a cameo or line about a character you’ve been attached to since you were a child . It’s a story you grew up with, that so many love, you’d be a fool to miss out on seeing something this important together, right? As cynical as it sounds, targeting your love for the story and the childhood attached to it worked and the goal of the production was met: to make as much money off an established brand as possible. For better or for worse, trust that you and your grandkids will be seeing new Star Wars films and TV shows  until the end of time. And what does this tell us, as audiences? Nostalgia sells – originality just doesn’t. Of course, there are always exceptions to the rule but generally, this seems to be the stance taken by production companies. Look, for example, at the rate of cancellations of new series  over the years. Netflix is becoming increasingly known for how soon after a first season is released, they announce its cancellation . This isn’t an exaggeration and Netflix isn’t the sole culprit; just recently, Amazon Prime received criticism for its similar response to the series My Lady Jane , released on June 27th and cancelled just over a month later on August 16th . More often, audiences are asking ‘What’s the point of starting something new if it’s going to get cancelled before I get a chance to even finish watching the 8 episodes they have out?’. Instead, we then turn to shows that concluded years ago and, conveniently, paying for licences to host these shows rather than paying for full original productions ( except reality shows ) is far more cost-effective for streaming services like Netflix and Prime. And so, we end up trapped in a nostalgia-fed time loop. Nostalgia and You This doesn’t mean we should stop seeking new stories ourselves or that we should feel bad for nostalgic thinking or enjoying the latest remake reboot sequel. As with most things, there is nuance to the topic and no distinct right or wrong answer. Revisiting “old friends” is also a chance to reflect on how we and the world have changed in the years since that first watch. However, in cases where that change may be upsetting or uncomfortable, studies have shown that nostalgic thinking can positively impact self-continuity , which in turn can promote "meaning in life" (i.e., that the events in one's past connect them to who they are today, providing coherence). As we mature, our perspectives shift, as do our interpretations of the same story. To younger-you, what once was a simple comedy may now, to adult-you, reveal profound bittersweet insights into what it is to be human. Or perhaps a theme that went right over your head as a child now hits like a ton of bricks, leaving you an emotional wreck for hours after. Revisiting “old friends” is more than a nostalgic trip down memory lane. It’s finding new appreciation for the craftsmanship, finding solace in familiar stories, connecting with loved ones, or reflecting on how you’ve changed. It’s a timeless joy. So, the next time you find yourself in need of a pick-me-up, why not dust off that old box set and embark on a journey back to the stories and worlds that captured your heart years ago?