I am from the UK, and this means that in just a few short weeks it will be exactly one year since our restrictions began with the first national lockdown. I don’t know about you, but this isn’t an anniversary I’ll be celebrating. Ever since this point, we have been living under such restrictions with little respite between. Lockdowns 1, 2 and 3 were sandwiched with tiers in the UK, meaning it has been a very long time since many of us have had even the slightest hint of normality. While I have only experienced lockdown here, much of the world’s population have been living under restrictions of varying degrees. Following the UK Prime Minister’s announcement last week, we may now be seeing the beginning to the end of our COVID-19 restrictions. This has come as welcome news to us all, but many are understandably airing on the side of caution. None of the past year has been easy, that is for certain, and many previous blogs on this platform have discussed the lockdown, from tips on how to staying sane at home and to sustain mental wellness , to an account of the dramatic situation during the lockdown in Italy , to lessons that the first lockdown taught us . But in this third, and hopefully final, lockdown, I have noticed that many, myself included, have been feeling the weight of lockdown 3 hard. Initially, we were encouraged by war-time rhetoric and many were inspired to start new hobbies, finding new ways to get creative to occupy time; now we are largely just trying to stay motivated. Even enthusiasm for connecting with friends on zoom has tapered off. Something about it has felt different and I think we have all collectively decided that the third time is in fact, not a charm. While we do our best to make it through these last few months, let’s look at why lockdown 3.0 has been so hard when in theory, it should now be our new normal. What is normal anyway? It is safe to say that despite us all following the same rules, we have largely all had very different experiences in lockdown. Some were furloughed and disappointed, some were furloughed and thrived, some started new business ventures, other businesses collapsed, new hobbies were discovered for some, whereas others continued to work and simply tried to stay afloat. Personally, I have worked throughout the pandemic. I am a mental health researcher (and writer and co-editor of ITM), my workload has remained, however, my new normal is working from home. The idea of something becoming somewhat of a ‘normality’ is what confuses me about the experience of lockdown 3.0. Last March saw our concept of normality turned upside down, flipped to the side and twisted in all directions. We might have thought that a year down the line, we would all be well practiced in a life in lockdown, but that doesn’t make it any easier. Then, what I want to know is why has lockdown 3.0 been so hard? There are many reasons suspected including disappointment during the promise of change beckoned by a new year, the time of year being more challenging for our mental health, but perhaps the most significant is our communal exhaustion. Pandemic Fatigue Simply put, we’re all tired. And being tired of it may just be why we have been finding things difficult — we’re experiencing what Public Health experts have termed Pandemic Fatigue. While the term hadn’t been coined this time last year, by January of this year it had been mentioned in over 200 million Google searches . Interestingly it has quite quickly become colloquial language both in academic and public spheres. The concept is defined as the state of being worn out or feeling overwhelmed by the restrictions and rules put into place as a result of a pandemic . Pandemic fatigue seems akin to burnout. Much like we can be burnt out from working hard for prolonged periods of time and the stress which comes with our occupational roles, we can experience similar feelings from the stress of following very strict restrictions for extended periods. Our constant state of high alert and compliance is exhausting and none of us are insusceptible to it. The longer we have had to comply, the harder it has become, which may explain why here, in lockdown 3.0, we have been feeling the weight particularly. The phenomenon has become just that — a phenomenon — so much so that the World Health Organisation (WHO) have even developed a document on how to ameliorate the effects of pandemic fatigue in order to reinvigorate populations to keep up adherence to restrictions . Pandemic fatigue hasn’t just been something we’ve been feeling, but something which may have actually affected the public’s ability to support the prevention of the virus. However, as WHO disclose, this growing mentality can be very damaging when all of us feel the affects of pandemic fatigue. What records do show, is that we’ve been experiencing pandemic fatigue long before the arrival of lockdown 3.0. While it is clear that it could have cumulative effects (the longer we experience restrictions, the more the effect had on us), I think it is safe to say that there are also other reasons why we have all been feeling the weight of this third, and hopefully final, lockdown. The timing, I strongly suspect, is one of these factors. Perhaps not surprisingly, this was the topic of a timely “ The Guardian Science Weekly Podcast” this week, featuring an interview with InSPIre the Mind editor, Carmine Pariante, on why are we all feeling burned out by the pandemic. Covid-19: why are we feeling burnt out? “ Ian Sample is joined again by Prof Carmine Pariante to discuss pandemic burnout and how to look after our mental health over the coming months” ‘2021 will be so much better’ Towards the end of 2020 there were plenty of ‘I can’t wait for 2020 to be over,’ and ‘2021 will be so much better’ ‘s vocalised. Lockdown 3.0 began right at the start of a new year — an occasion that usually brings with it the promise of change. It is a time of year where we reflect and set resolutions to improve things moving forward. This year, we all so desperately needed change and for life in 2021 to see the end of covid and lockdowns. Instead, we knew we were facing a second peak, we were grouped into various tiers and then placed in a third national lockdown just 4 days into 2021. Both optimism and motivation were squashed and instead of a fresh start we were hit with the realisation that 2021 may not be too different . Hopefully, our new plans for the end of restrictions six months in will begin to bring us new hope that 2021 can be salvaged. Summer of 2021 may have potential yet. January blues And it’s no coincidence I refer to summer —  lockdown 1.0 continued through the summer months of 2020. While most of us would have preferred to be on a beach or in a pub garden, I don’t think it is until now that we can fully appreciate that we had that good weather when we had not much else. January on the other hand brings shorter days, less sunlight and gloomier weather. While our restrictions in lockdown 3.0 have allowed us to go outside for fresh air and exercise, you had to be quite motivated to face the wind, rain and snow. We spent a lot less time enjoying the outside than we have previously been able to. I’m lucky enough to have a garden and spent much of my time in the first lockdown working outside whilst soaking up the rays. It is no wonder really that after spending a couple of months cooped up in my office and lacking the motivation to get outside and stretch my legs in the rain, I’ve found things harder. While the weather is a contributor, there are also other reasons that January may be harder. ‘January blues’ is a term for a reason — even without lockdown and announcements of daily death rates, it is a month that many find more difficult, mentally. It is the fallout of Christmas and the start of a new year which means that we’re typically getting back to work, suffering disproportionately financially, lacking motivation and feeling the pressure of change in the form of new years resolutions. Being in lockdown during the harder part of the year has been ill-timed. Those who usually struggle with the January blues or even seasonal affective disorder (aka SAD — a medical condition whereby mood is negatively affected by lack of daylight) will have experienced a particularly hard time. And many more of us may be able to relate, or at least empathise with this, somewhat more now. But as we arrive at the beginning of March, spring gets closer, the days get longer, and we start to see the sun more; we can start to appreciate that things will begin to get easier. A sense of normality has become a running theme in this blog and there is a final point that I would like to reflect on. As we approach June the 21st - the day the Government have set out to be the end of all restrictions - we should consider the enormity of change. There will be many who are exhilarated by the idea of reuniting with their friends, families and significant others in the pub for a drink, for a nice dinner or a big night out, but there will also be many who will find this quite daunting. Life in lockdown has been far from normal, but our pre-pandemic lives can seem like a distant memory — return to this can be a scary thought and may take some time to get used to. The term “ re-entry syndrome ” was introduced to discuss this fear when the first lockdown re-opened last year. Lockdown 3.0, in fact, the whole of this last year, has been really difficult for us all but what has been different this time, is that we have hope. Scientists around the world have been working tirelessly for a way out of this, and we are finally here, in the middle of a momentous vaccine roll-out which means that the end of our restrictions is in sight. Holding on to this hope I am sure will help us to get through these last few months of life in lockdown. But if lockdown 3.0 has left you feeling deflated, know you are not alone.

A conversation on women’s safety and the potential to make change At 9pm on the 3rd of March 2021, Sarah Everard left a friend’s house in South London and began to walk home. Sarah did everything that society has told us — women — to do: she left early, wore bright clothes, walked a well-lit route, and called her partner. But Sarah became the victim of something terrible. She didn’t make it home. A week on from her disappearance, we were heartbroken to hear that Sarah’s body had been found. A Metropolitan Police officer has been charged on suspicion of her kidnap and murder. Sarah Everard was a 33-year-old Marketing Executive living in London; she was a daughter, a partner, a friend. Her family have described her as someone ‘strong and principled and a shining example to all of us.’ This tragedy has caused an upsurge of anger and distress sparking societal conversations on women’s safety. The loss of Sarah is awful. It has understandably resonated with many women— a devastating reminder of our lack of safety. We all know the fear of walking alone at night, many of us have had experiences with harassment, maybe being followed, sadly, maybe worse. Sarah could have been any of us and this is haunting. She was just walking home. The last two weeks have been unsettling for women, it’s been a period of constant reminders of our own experiences, myself included. Not long ago I had a terrifying incident being followed, and these memories have come flooding back. I won’t go into details, but I do consider myself very lucky for how the situation ended. I share this to show that nearly all of us have a story to tell. For many, even as young women like me, there are countless experiences we can list. Some encounters aren’t always recognised as harassment, sexual or otherwise — actions such as catcalling, inappropriate remarks, even continued persistence for a number or a date despite a clear negative signal. It’s become a period of awareness for what we tolerate. But it’s also been a time of reflection among women — I’ve spoken to my mother about her experiences, she’s told me things that have happened to her mother, my grandmother. Through generations, nothing has changed. I sat down to talk to Professor Paola Dazzan, a woman, a psychiatrist, and academic at King’s College London. Paola and I can both relate to how many women are feeling currently. On realising we shared a joint passion for speaking up about this, it seemed like an opportunity for us, as women from different generations, to reflect on Sarah’s loss, the issue of women’s safety and what we, as a society, can do to make change. It seems to me that the loss of Sarah Everard has affected people more than any other case I can personally remember. So, I opened our conversation by asking Paola if she remembers any other cases which have had such an impact? Paola: As a woman I feel deeply touched by what has happened, and like you, I don’t remember a similar reaction to a dreadful event like this. In the past we have had terrible occurrences of girls, even younger than Sarah, who have unfortunately been assaulted and even killed, but for some reason this time seems to be somewhat different in how this has engaged the collective sense of fear and need for change. There must be aspects of what happened to Sarah that’s made us all identify with her. The fact that she was a 33-year-old woman, an adult, walking at 9pm, a normal time, and used the precautions all of us have learned while growing up. We’ve all identified with the ‘normality’ of what she was doing, she was just walking home. We all felt that ‘this could be me,’ my daughter, mother, or partner. And this is just one aspect. The other aspect is the fact that the person accused [ charged, not yet convicted ] of killing her is a police officer, and the meaning of this is very important. The person who has supposedly killed her is from a profession we see as protecting us — it has almost characterised this terrible event with a double layer of vulnerability. By chance, on the day Sarah’s body was discovered, a study by UN Women UK published results showing that 97% of women between the age of 18–24 have been sexually harassed. A further 80% of women of all ages reported experiencing harassment in public. What do you make of these statistics? Paola: To be honest, personally, they don’t surprise me — I would be in both categories. I remember being subject to catcalling in the streets at a very young age, just being 12, walking to school. I was also harassed on a bus as a University student. I think these experiences make us grow up with the sense that we just must get on with it and that it’s our responsibility, and ours only, to protect ourselves. As all women, I learned tactics — go for bright streets with other women and children walking by, for example. But I should not have to do this just because I am a woman: this is a restriction of my freedom. I think what is surprising is that we have known the statistics you mentioned for a long time. We have all reported it to our family members and friends, maybe teachers, who can offer individual support, but also tell us that this is ‘normal’, that we must accept it as just what happens in public. Sarah’s loss seems to have brought to the attention of men the extent to which women have to think about and fear their safety, what do you think could come from this? Paola: I think it could be what we have been hoping for a long time — that society, and men in particular, realise that it is not just women’s responsibility to remain safe when they are in public. What I hope is that will start shifting the way we, as a society, see where responsibility lies. I recently read a letter to the Guardian where a woman recalled being at an all-girls secondary school and given a specific lesson in how to avoid attack, yet, in an all-boys school, her brother wasn’t having similar lessons. It’s like society has accepted, until now, that the responsibility for women’s safety should lie with women. If this terrible event changes anything, hopefully it will be accepting responsibility of us all as a society. Men, women, young and old, teachers, politicians, or cultural figures — it is everyone’s responsibility, and this is the change that I hope will come. Currently, there still seems to be a culture of fear — in light of what happened, we are being reminded of the ways to keep ourselves safe. We’re sharing how to hold our keys in our fists, how to set up emergency SOS calls on our phones, and of course this is all vitally important, but is this narrative changing the issue? Paola: No in fact, you are right, it is not changing the issue, it is just reinforcing that it is our responsibility. I grew up as a woman, walking in the streets, often travelling abroad alone and of course I would do anything I can to protect my safety. However, just telling women that this is what they should do leaves all responsibility with us. But we should all worry about the harassment and the violence that is happening to other members of society, whether women, men or children. How do you think we change things moving forward? Could women’s safety benefit from keeping the momentum and having this at the forefront of societal conversation or do we need more? Paola: I think this is a very good start. It’s important that the emotion and the conversations of these days are something we build on. We must do this first out of respect for the victims. And then we should recognise this is a problem for society. Talking about it needs to be followed by action. There are things that we, as a society, can do moving forward. Firstly, there are actions men can take when they see a woman walking alone in the street, for example, making their presence obvious from a distance rather than walking silently behind, or crossing the street to keep distance. We also need to promote the involvement of councils in making sure our streets are safe. For example, in the 1980s, following a series of sexual assaults in Toronto (Canada), a Metropolitan Action Committee on Violence Against Women and Children was created to address public violence against women, with women and girls walking around public spaces in their neighbourhoods, often with a city official or police representative, to identify areas that felt unsafe. The findings were used to develop recommendations for the city. Councils and local police could identify existing areas which are particularly dangerous or need redesigning, or where more lighting may be needed for women coming home in the dark (which in the UK can be as early as 4pm in Winter). Incredibly, street lighting has been reduced during the recent austerity period in the UK, without considering the safety implications. Finally, I think that just looking at the statistics reporting the number of specific events (whether harassment or violence) can’t capture the fear and anxiety that all women constantly have when they feel potentially unsafe, like when simply walking home, like Sarah. The fear is not something that we’ll see measured by statistics, and yet is something that creates distress and, even worse, limits women’s freedom. Note: since our conversation we have heard news from Downing Street that ‘immediate steps’ for improving our safety in being established . These steps include doubling budgets available for Safer Streets which includes lighting and CCTV and the launch of pilot schemes to place safety in popular nightspots. “Victim blaming” has led to decades of women feeling guilty when harassed — being in the wrong place at the wrong time, what they were wearing, being too polite because maybe they inadvertently invited conversation with a smile. And we’ve seen this victim blaming with unwarranted comments questioning why Sarah was walking alone at night. Do you think we are now seeing a shift towards anger over victim blaming? What do you think the impact of this could be in making change? Paola: It is very easy to place blame on the victim. It is a quick way to refuse taking responsibility. It’s very sad that this happens, and because of this we see in the statistics that although the number of rapes has increased over the last few years, the number reported to authorities has decreased. In the last year the Crime Survey for England and Wales shows that 151,000 people — including 144,000 women — were victims of rape or attempted rape, but only 55,000 cases were reported to police. I think it’s because women (and victims in general) are fearful that the blame will go to them or they will not be believed, thus going through a second trauma — not only going through what you have suffered but re-living it and not being believed. The culprits who commit the crimes then feel they can get away with it because most victims do not report, out of fear of not being believed. It is a double failure. And walking is one of the few freedoms we still have left in the pandemic. What do you think the impact is of Sarah being abducted during this time? Paola: I think it’s a time which almost creates the perfect combination of factors for something like this to happen. Walking is the only thing we can do, and we’re not supposed to walk with friends because we shouldn’t meet with other people. It’s also a time when there are less people around to ask for help. People feel the only thing we can do has been used to bring blame to the victim, and this may explain why this event has been particularly impactful in the emotions it has caused. The loss of Sarah has been understandably very triggering for many women, it might remind us of previous experiences or tap into our biggest fears. What would you say to women who are feeling the impact of these conversations? Paola: I would say that the data — and indeed my and your experiences described in this blog — show that you are not alone. Most of us have been through the experience of being harassed to various extents. One thing that I believe we can say is that fear has affected 100% of us — even if we haven’t been harassed, we’ve all felt scared walking alone in the dark, we all live with the restrictions of what we can and cannot do. I would say: by all means, put in place whatever kind of safety measures you need to keep safe, but at the same time do keep talking about this: how unfair it is that you are restricted in your freedom. You need to talk about this in whatever context you can — talking to family, partners, colleagues, local politicians; and get involved in any organised action. As a society, we need to understand that this is a problem for all of us. In our conversation, we touched upon some statistics, and as shocking as these are, both Paola and I wanted to emphasise that fear is not captured in these numbers. We’ve all felt the constant threat, we have used the vigilance required to keep safe, and now we have all been reminded of this fear after hearing the shocking loss of Sarah. I feel sadness in knowing many have multiple experiences to recall; the horror of this should not be lost. I would like to thank Paola for sitting down and having this powerful conversation with me. As Paola said, I hope we can honour the memory of Sarah Everard and all women affected by, and lost to, such appalling crimes, by making the change that is so desperately needed. The conversation has started, let’s not let it go back. We should all be able to make it home safely. Our thoughts are with anyone close to or touched by Sarah Everard. If you feel particularly affected by the conversations happening and feel that you need help, please consider reaching out for support. This has been a very triggering time for many, depending on the level of distress, it may be helpful to talk to a professional or support group who will be able to help you. List of resources: Victim support  — Free confidential support for victims of crime or traumatic events Samaritans  — Support for anyone struggling Shout  — Text messaging support service for anyone struggling to cope Women and Girls Network  — supporting women and girls affected by gendered violence Ascent Advice line  — information, advocacy and support for gendered violence and abuse Rape Crisis  — Confidential and emotional support for victims of sexual violence Survivors Trust  — Directory of local support

A little over six months ago I wrote a piece called ‘ Sarah Everard was just walking home: a conversation about women’s safety and the potential to make change .’ I wrote this following news of the tragic murder of 33-year-old Marketing Executive, Sarah Everard. Sarah was walking home in South London but didn’t make it back . Her case became very high-profile, and her name became synonymous with discussions on women’s safety — sadly, lack thereof. Heartbreakingly, we now find ourselves in a similar position, mourning the loss of another young woman, Sabina Nessa. Investigations are very much on going , but from the information available so far it appears that Sabina, left her home at around 8:30pm on Friday 17th September 2021. She walked through a park to meet a friend at a nearby bar. Sadly, she didn’t make it to her destination. During what should have been a 5-minute walk across the park, Sabina was tragically attacked. Minutes from her own doorstep. Sabina was a 28-year-old, family-oriented, Primary School Teacher. At a vigil held on Friday 24th September, Jebina Yasmin Islam, Sabina’s older sister, spoke bravely to a crowd of hundreds as she described her ‘amazing, caring and beautiful sister.’ Watching the clips of Jebina speak was devastating and I can scarcely imagine the pain her loved ones are experiencing. “Say her name. Sabina Nessa. We will never forget” were the words that echoed the vigil. Sabina — just like Sarah, just like all of us — should have been able to safely walk alone. However instead, we mourn for her. The parallels of these two young women in South London, simply trying to get from-a-to-b, taking all the precautions instilled in us from day one, are harrowing. This is not just another case, this is another life, not lost but taken. In my previous piece, myself and Professor Paola Dazzan, a woman, a psychiatrist, and academic at King’s College London, sat down to discuss the issue of women’s safety and how society can change. We discussed the normality of what Sarah was doing and this reflects with Sabina’s death too. We all walk through parks, we all go to meet our friends in bars, restaurants, coffee shops and we should. But we shouldn’t have to live with a fear that we won’t make it there, or home. Sabina, just like Sarah, could have been any of us. When we hear tragic news like this, we are haunted with reminders about safety precautions we can take — staying in well-lit areas, holding your keys in your fist, sending your location. The list goes on. But the truth is, we don’t need reminding. These ‘precautions’ are second nature to women, used all the time to protect ourselves, but this horror still occurs. As the seasons change and the evenings get darker earlier we are all the more vulnerable, almost on curfew. When crimes of violence against women occur, a conversation is started on social media — we discuss our own experiences, our concerns, our condemnation for the crime. Over the last few days many relating to Sabina Nessa have gone viral. One instance was an Instagram post sharing a Whatsapp conversation between friends. They discuss concerns over their driver, sharing locations and making sure the man doesn’t know which house they are going into. It’s such a common conversation to have and the comments make clear that so many of us understand. In the caption the writer dismays on the warnings of what is safe for women to do; it is the violence against women that needs to change, not what we, as women, can do to prevent it. What Paola and I discussed previously was how a shift is needed from responsibility being on women — until we, as a whole society, take action, this will not change: It’s like society has accepted, until now, that the responsibility for women’s safety should lie with women. If this terrible event changes anything, hopefully it will be accepting responsibility of us all as a society. Men, women, young and old, teachers, politicians, or cultural figures — it is everyone’s responsibility, and this is the change that I hope will come. The death of Sarah Everard caused a huge drive in the fight against gendered violence. But statistics suggest that little has changed beyond the conversation. A Femicide Census demonstrates the severity of the issue, reporting that on average, one woman is killed by a man every 3 days in the UK alone. Counting Dead Women , a UK based campaign, reports that 77 women have been killed between the deaths of Sarah and Sabina. We also know that women are more likely to experience sexual assault than men: according to a crime survey in England and Wales a reported 4.9 million women have experienced sexual assault in their lifetime compared to 989,000 men. Furthermore, women of colour are more likely to be victims of gendered violence . Harrowing facts. Following the death of Sarah Everard, No10 announced ‘immediate steps’ to tackle the issue, with £23 million put toward street lighting, CCTV and plain clothed officers in public spaces . Many argued that this is not enough. The day of Sabina’s attack, Her Majesty’s Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) published a report on police response to tackling crimes against women and girls after commission by the Home Secretary. On the government website a policy paper can be read on this strategy: “ These crimes are deeply harmful, not only because of the profound effect they can have on victims, survivors and their loved ones, but also because of the impact they can have on wider society, impacting on the freedom and equality we all should value and enjoy ” the report reads, before setting out ambitions for change, including increasing support for victims, increasing the number of perpetrators bought to justice and prioritising prevention by means of investment in the Safer Streets Fund, as well as national awareness campaigns, investment in understanding best prevention, and implementing changes in the education system. Speaking after Sabina’s attack, Mayor of London Sadiq Khan spoke of a need for a fully-joined up policy and urged the government to make the harassment of women a criminal offence . In the same spirit as her vigil, we should honour Sabina Nessa by using her name to continue and push forward not just the conversation, but also action. She deserves justice. The investigation is still ongoing and at time of writing police have just announced that a man has been arrested on suspicion of her murder . Our thoughts are with all those affected by her untimely loss. Rest in peace Sabina.

This blog has been written on behalf of the Inspire the Mind Editorial Team. Like so many across the globe, we have been so saddened to learn of the death of Her Majesty Queen Elizabeth II. There is no one among us who hasn’t spent most of their life with The Queen reigning, and her passing marks a sad and significant moment in history. As the world comes together to commemorate Her Majesty, we want to reflect on her life and steadfast commitment to her service, with particular reference to her role in promoting health and education. At just age 25 she was crowned, and The Queen then served for over 70 years — not only as the longest reigning British Monarch, but as Head of State for 14 more countries across the globe, the Commonwealth Realms. Being part of King’s College London, where Her Majesty was our Patron , we have seen a clear sense of pride regarding this relationship, and her frequent visits to us are being reflected on fondly. The Queen was often joined by her late husband, His Royal Highness Prince Phillip, who was himself made a Life Governor of King’s College London back in 1955. The Queen’s most recent visit to us was in 2019 when, joined by Her Royal Highness the now Princess of Wales, she visited the opening of our Bush House Building in the centre of London. Since 1972, Her Majesty visited the University on a number of occasions, meeting our Principles and commemorating building openings, as well as holding a number of meetings with NHS staff at King’s College Hospital and opening wings of the hospital. Several King’s College London staff have also been recognised on the Queen’s Birthday Honours list throughout the years for their services to social care, the NHS, research and education. As we have seen in the time since Her Majesty’s death, so many have been sharing similar reflections — fond moments, personal anecdotes, and celebrations of her life and work. While Her Majesty’s work covered a great spectrum of duties, she had a clear passion for care and philanthropy. Her Majesty has been linked with around 600 charities, including Cancer Research and Great Ormond Street to name just a few, and was reported to be one of the largest supporters of charity in the world. Throughout Her Majesty’s reign, she consistently demonstrated immense support for the NHS, famously demonstrating support for healthcare workers and key workers during the COVID-19 pandemic. A prominent quote that has been resurfacing over recent days seems fitting on this occasion. Speaking in September 2001 after the 9/11 attacks in New York, Her Majesty remarked “Grief is the price we pay for love.” We extend our sincerest condolences to the Royal Family, and all affected by this profound loss. Editors note: We understand that many will have been affected by the death of The Queen and it may have brought up some difficult emotions. We would like to highlight that several charities are offering support. You can find more information here .

Trigger warning: This article discusses childhood traumatic experiences and may not be suitable for some readers. It is suggested that around one in five adults may have experienced trauma in their childhood . I am sure you will agree that these are concerningly high statistics. The reason that this is a ‘suggested’ numeric is due to the nature of childhood trauma, meaning that it’s hard to pinpoint the extent of what is happening. Those who have experienced childhood trauma may not want, or be able, to open up about what they went through, some may not recognise their experiences to be trauma. Childhood trauma is any experience of a distressing situation in the early life, such as low socioeconomic status (perhaps living in poverty), bereavement, bullying, emotional or physical neglect, physical and sexual abuse, and more. The effects of such experiences can be carried through life, increasing the risk of negative health outcomes throughout adulthood . It is therefore really important that we conduct research to improve our understanding of such consequences so that people who have had these experiences can be best supported. Research looking into depression frequently finds that a significant number of depressed adults may have had childhood traumatic experiences . This is an area of research that I am very interested in. Alongside being a Writer and Co-Editor for Inspire the Mind (ITM), my day-to-day work is as a researcher at King’s College London. Much of my work has been looking at childhood trauma and depression and how they may or may not be connected through something called ‘inflammation.’ I recently began a PhD looking at exactly this. Last year I had the opportunity to write a short review looking at what current research is telling us about how inflammation and childhood trauma may come together in depression. This paper was called ‘ Navigating a complex landscape — A review of the relationship between inflammation and childhood trauma and the potential roles in the expression of symptoms of depression .’ Inflammation is a function of our immune system. When we face injury or come into contact with germs, bacteria and viruses, our immune system puts up defences and triggers lots of different inflammatory cells which try to protect us from the threats of injury or illness. In some cases, however, we find that people have inflammation levels in the body that are elevated even in the absence of threats such as germs. Researchers have identified that some people who had experienced childhood trauma had higher levels of inflammation than people who had not, and that there was a pattern with more trauma associated with higher inflammatory levels , which was also more prominent in people who later developed depression . Depression and inflammation is an area of research of considerable focus over the last couple of decades as we tend to see that a subgroup of people with depression have higher levels of inflammation. We do not yet fully understand the exact reason for this relationship or how it comes about biologically. But, with evidence indicating that childhood trauma increases a person's risk of developing depression later in their life, and childhood trauma and depression being associated with higher levels of inflammation both independently and together, it is important to understand how these three factors come together. So in my paper, I looked at the literature available from previous research to see what evidence has been found to navigate, or at least try to navigate, what appears to be a very complicated landscape. Childhood trauma, inflammation and depression When researchers want to look at inflammation we often do so by looking at small samples of blood to observe levels of inflammatory markers which can tell us if inflammation is higher than we may expect. Researchers have shown that some of these markers, in particular, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF- a ), are higher in people with depression, but do not seem to be associated with whether these people with depression had or had not experienced childhood trauma . Interestingly though, there were some links between higher levels of these markers and more severe experiences of childhood trauma, and sexual abuse in particular. Previous reviews have found that sometimes these specific markers, IL-6 and TNF- a, can be increased in people who had experienced childhood trauma, but that this may be different depending on the type of trauma which was experienced  — possibly with more physical forms of abuse such as sexual abuse specifically. But, other reviews have not always shown this same pattern so more research is needed to determine how exact this relationship is — this research was covered in a recent ITM blog . IL-6 and TNF- a are not the only markers of inflammation however, and some studies have looked at a bigger selection. However, where higher levels of inflammation were identified, depression appeared to be driving this association, rather than childhood trauma . Severity of depressive symptoms Depression isn’t of course something you just have or don’t have — symptoms can be experienced at different degrees of severity. It has been found that p eople who had experienced multiple types of childhood trauma tended to experience more severe symptoms of depression . But does inflammation come into this too? Comparing people with depression to people without depression, associations have been found between the severity of depression, the severity of childhood trauma and inflammatory markers, suggesting that childhood trauma impacts the immune system which then increases risk of developing depression . This work was however a small study and larger studies would need to look at this to give us more confidence in how true it may be. What about the type of depressive symptoms? What appears to be lacking is investigation exploring whether childhood trauma and inflammation may affect type of depressive symptoms. We see more and more research is beginning to explore these different ‘clinical profiles’ or ‘subgroups,’ as, like symptom severity, this too varies. Different types of childhood trauma may be associated with different symptoms of depression. One study, for example, has found that emotional neglect specifically may be associated with more severe symptoms of depression which see an absence of positive mood (the technical term for this is anhedonia, that is, the inability to experience pleasurable things). Other studies indicate that people with a history of childhood trauma and depression (or siblings of people with depression) were more likely to experience symptoms of cognitive and psychomotor disturbance (for example difficulties with attention and memory, and slower movement). The study didn’t appear to find significant differences in symptoms based on the type of trauma experienced, nor did it explore inflammation. Different profiles of depressive symptoms are often explored in the context of inflammation, with atypical depression (characterised by symptoms of over-eating and weight gain) associated with higher levels of inflammatory markers including C-reactive protein (CRP), IL-6 and TNF- a in comparison to melancholic depression (where we see an opposite profile of appetite and weight loss). However, these findings are not consistently found by others. It would be interesting then to see these two lines of research converge. What I set out to explore turned out to be possibly more complicated than I imagined — we know that inflammation is associated with depression, and inflammation is associated with childhood trauma, and childhood trauma increases risk of developing depression, but we still need to focus more research on how this all comes together. It is especially important to do so particularly knowing the risk that is later carried through life so that we can look at how best to support the people who present this way. I hope that it won’t be too long until there is a breakthrough in our understanding. The important thing is that there are many researchers trying to untangle the threads and will continue to work on this until we are navigating known territory, not a complex landscape. Resources Support for survivors of abuse: The National Association for People Abused in Childhood (NAPAC): Phone: 0808 801 0331 | Email: support@napac.org.uk |Website: napac.org.uk Victim Support: Phone: 0808 168 911 | Website: www.victimsupport.org.uk Support for children and young people facing abuse: Childline : Phone: 0800 1111 | Website: childline.org.uk YoungMinds : Parents helpline: 0808 802 5544 | Crisis Messenger for young people (text the letters YM) : 85258 | Website: youngminds.org.uk

I don’t know about you, but for me, 2022 has flown by. As unprepared as we may feel, November means the holiday period will be with us sooner than we know. As tinsel and trees appear, so do invites to work Christmas parties and family gatherings. Social calendars are filled quickly by catch-ups with friends returning to hometowns and trips to festive markets. Our social batteries are put to the test. For some of us, the holidays may see a considerable rise in our alcohol intake — and subsequently, the amount of time spent hungover. But, it’s not just a few too many drinks that can leave us waking up feeling foggy — social interactions can leave some of us feeling like this too: enter the ‘social hangover.’ When lockdown was lifted, I noticed patterns in how many of us dealt with social interaction (more on this later), and was fascinated to learn the term ‘social hangover’. When I’m not acting as writer and co-editor for Inspire the Mind , I’m working full-time as a mental health researcher and completing a part-time PhD. So, embracing that very researcher spirit, I decided to roll up my sleeves and investigate. In this blog, we look to answer questions on what exactly is a social hangover, who may be susceptible, and what it can mean for our mental health if this becomes an ‘introvert burnout’. So, what is a social hangover? Many of us over the age of 18 know what an alcohol-induced hangover feels like: a pounding headache and the kind of nausea that makes you feel like you can’t risk leaving the safety of your own bed typically describes it well. Aside from these tell-tale signs, one too many glasses can leave us feeling very tired, struggling to concentrate, and maybe feeling a bit achey. Coincidentally, the last three are also symptoms of a social hangover — where no alcohol is needed, nor can it be blamed. In short, a social hangover is the label given for a kind of temporary burnout experienced after lots of social interaction . For some, a party with friends or gathering with lots of new people can be overwhelming, and the overstimulation of interacting with others can have us feeling physically and emotionally drained the next day, and maybe for a couple of days after. Aside from feeling very tired, struggling to concentrate, and maybe feeling a bit achey, this type of hangover may also leave us feeling a little more irritable than normal, perhaps emotionally overwhelmed, and we might even get a headache! Sometimes dubbed the introvert hangover, guess who is most susceptible? If the title didn’t give it away, that did. Introverts may be more akin to struggling after an evening out. ‘Introvert’ and ‘extrovert’ are commonly used terms to describe different personality types. An introvert is typically someone who may be relatively shy and maybe quieter. Most confident in smaller groups, or one-on-one interactions, they differ from their extrovert counterparts who tend to be more outgoing and thrive in social situations. This terminology is well embedded in our everyday language, but was originally described by a Psychiatrist called Carl Jung, nearly 100 years ago . In the years since, many Psychologists have redefined the terms, and one major consideration is whether we can put people into the two categories or whether it is more of a spectrum . Many of us probably fall somewhere between the two extremes. There is a common misconception that introverts are not sociable and tend to be more isolated, but this is not the case. Humans are a social species inherently, we just thrive in different types of interaction. So many introverted people do enjoy socialising, they may just need a little time alone after. And while it may be a more common occurrence for those on the left of the continuum, anyone can feel the ill effects of a social hangover. But why do we get hungover you might ask? What it seems is, it is just a way of your body telling you that you could do with some time to reset. Those who have experienced it will understand that need to recharge. And, it makes sense when we think of the demands that socialising has — we have to listen, respond, observe, learn… it actually takes a lot for our brains to have a conversation, and really works our cognitive capabilities. Not to mention different types of conversation have our brains doing different things to different degrees . The term seemed to start generating more attention after lockdown — presumably as more of us could relate. We simply weren’t used to the demands of communicating with real faces rather than digital ones. My own interest was sparked after I noticed myself feeling more tired than I used to after an evening of socialising, and many people clearly related. But, even when Corona was just a beer, social hangovers were a very real thing! And while we have been re-exposed to socialisation for some time now, there are still many people who experience this. If you are one of those people, it is helpful to know the value in taking that alone time to recharge, perhaps spending the day indulging in a bit of self-care and doing your best to relax . These social hangover cures are a personal thing so it may be different for everyone but the long and short of it is, find what works for you. On a larger scale, we can experience ‘introvert burnout.’ What I learnt in my deep dive into the topic is that the temporary, shorter-term experience is dubbed a hangover, but there can be implications when the symptoms last a little longer than a couple of days — there is a risk of experiencing an ‘introvert burnout.’ Most of us think of burnout as a work-related phenomenon — the point of complete mental and physical exhaustion that may be met after working tirelessly without a resting period. Well, an introvert burnout isn’t too far from that. If you are the type of person who feels tired after socialising and needs their reset time, socialising for continuous periods without that much-needed break can lead to a point of exhaustion. A type of stress, introvert burnout can cause symptoms such difficulty sleeping, experiences of anxiety and low mood, and loss of motivation. Like burnout, this isn’t a recognised diagnosis, but a very valid and common experience with profound implications for our mental health. So, as we inevitably get busier over the holidays, be kind to yourself — much like drinking alcohol, it’s important to know your limits and embrace them. Whether introvert, extrovert, or somewhere in between, adapt to what works for you and don’t shy away from giving yourself the time you need.

I am in my twenties, and I often find myself having the same conservations with people of a similar age – we all question whether we are at the right stage in our lives. Or, more accurately, we worry that we aren’t. And in 21st Century life, social media serves as a constant reminder of this worry. A comparison to the lives of others literally in the palm of our hands, as we are exposed to the successes of others with every swipe and scroll. Societal pressures tell us what we should be doing and when. It’s like a constant battle against the clock. And I can’t help but think about Alice in Wonderland . Not just because navigating life in your twenties feels a bit like free falling down a big rabbit hole and trying to land feet first at the bottom, but because of the White Rabbit and that obsession with his pocket watch. Are we the White Rabbit, and is social media our pocket watch? Anxiety and ticking time Let me start with an actual citation from Alice in Wonderland . You really need to read it all to fully grasp what I mean. “… suddenly a White Rabbit with pink eyes ran close by her. There was nothing so very remarkable in that; nor did Alice think it so very much out of the way to hear the Rabbit say to itself, ‘Oh dear! Oh dear! I shall be late!’ (when she thought it over afterwards, it occurred to her that she ought to have wondered at this, but at the time it all seemed quite natural); but when the Rabbit actually took a watch out of its waistcoat-pocket, and looked at it, and then hurried on, Alice started to feel her feet, for it flashed across her mind that she had never before seen a rabbit with either a waistcoat-pocket, or a watch to take out of it, and burning with curiosity she ran across the field after it, and fortunately was just in time to see it pop down a large rabbit-hole under the hedge.” Despite Alice being the central protagonist, and while the story reportedly represents her transition from childhood to adulthood, it is not her I want to focus on. Instead, it is the White Rabbit, and his trusty pocket watch of course. The whole story is full of rich symbolism and deeper meaning. While the author, Lewis Carroll, has famously left the book open to interpretation, years of analysis have led to many arguing that this curious bunny with a penchant for time keeping is a deep-rooted symbol of anxiety about societal time pressure bestowed on him. This opening chapter is merely the start of his hurried rush for fear of falling behind. Aside from the constant checking of the time, the White Rabbit is frequently described to be running around exclaiming things such as “I’m late! I’m late! For a very important date!” Thinking about what Carroll may have been trying to imply, we can definitely sense the stress and urgency from this character when it comes to time passing. In fact, this might not just be a fear of getting from place to place on time. The character is always seen adhering to, and being somewhat obsessed by, the rules. Combining the two is how we reach the idea that it is a representation of people feeling trapped by societal pressures and rules bestowed on them and keeping up with the timelines expected . The White Rabbit is seemingly embodying the anxiety that many of us face about meeting societies expectations on time, especially as we age. Pocket watches and iPhones The original work of Alice in Wonderland was penned in 1865, so, granted, the societal pressures felt by the White Rabbit may have been a little different to what we experience today, but he felt them then and we feel them now. In 21st Century life, your twenties are a hugely transformative decade. One where we are essentially expected to figure it all out. We must try and figure out what we want to do in our lives, and then do it. Careers, finances, partners, property, family. It is subliminally ingrained in us to work towards the future. But quickly. The big 3-0 is dangled overhead like a constant threat – the pinnacle of maturity and the marker of when we should have it all together. It's a lot, and it’s stressful. Rather than being imprisoned by a pocket watch like the White Rabbit, we now typically check the time on our phones. We have a similar reminder of the passage of time. And what else do we have on our phones? You guessed it – social media. Fuel to the fire when it comes to societal pressures. At our fingertips is a constant reminder of what the people around us are doing or have already done. An easy way to compare ourselves to our peers and add to the pressure we experience to be doing it all. On any given day I can scroll through my social media feed and in only a few minutes see others my age who seem to be doing the things which I am supposed to. On a day where you see the engagements, babies, promotions, and people climbing the property ladder, it’s hard not to feel beaten down by the pressure. Should I have bought a house by now? Should I be thinking about starting a family? Am I doing enough? Surely it is not good for our wellbeing. The impact of time pressures Just like our friend the White Rabbit, it is perfectly understandable that these societal time pressures can cause anxious feelings. It’s its own phenomenon: ‘ milestone anxiety ,’ the pressure to meet traditional milestones in life by certain ages. Milestones, like the age you think you will or should have children, or the age at which you expect or are expected to buy a house, are all around us. UK based charity, Relate, conducted a survey and found that 83% of 16-24 year olds and 77% of 25-39 year olds are experiencing such pressures . Trying to meet, or ‘failing’ to meet these constructed deadlines, can inevitably impact our wellbeing, leading to feelings of nervousness, stress, and disappointment. Whether Gen-Z and Millennials are facing milestone anxiety so much is due to their age or other factors is unknown, but one thing these groups do have in common is social media use. When experiencing anxiety to meet or disappointment at missing life milestones, comparing yourself to the milestones being met by others has undeniably got to add to the pressure with a constant stream of comparison at our fingertips. It is like social media is telling us “We’re Late! For a very important date!” Let’s end on a positive note One thing I would like to make clear is that while societal pressures are unfortunately going nowhere, and likely nor is social media, the content I seem to see also tells me that everyone is doing wildly different things. Yes, some people are married, and others are single, some are climbing the corporate ladder, and others are in education, some have multiple children, and some have none. Our twenties are the first time we really see ourselves going in different directions. Previously, we were all following the same path, climbing the years and grades at school, then you either stayed in education or went out into the world to get your first full time job. Now, we are all on our own unique paths. There is no set timeline to life. As long as you are happy, there should be no time pressure to do anything at all – and remember, you don’t see what isn’t being posted. Even the people living out your future goals might too be feeling pressure to be on the path you are, and experiencing the same milestone anxieties. So, rejecting the inner White Rabbit, let’s try and stop worrying about what the pocket watch tells us and trust that you are doing just fine. “'Would you tell me, please, which way I ought to go from here?’ ‘That depends a good deal on where you want to get to,’ said the Cat. ‘I don’t much care where—’ said Alice. ‘Then it doesn’t matter which way you go,’ said the Cat. ‘—so long as I get somewhere ,’ Alice added as an explanation. ‘Oh, you’re sure to do that,’ said the Cat, ‘if you only walk long enough.’” Chapter VI, ‘Alice in Wonderland’ by Lewis Carroll

Is a sense of humour an important ingredient in changing our highly polarised world into a happier and healthier one? Well, it probably helps us to carry on in times of crisis. I am a consultant psychiatrist currently working at a large psychiatric hospital in Stockholm. For me, looking at life events from a more humoristic perspective helps me to cope with challenging times. “Humour” and “sense of humour” have always been related to health and wellbeing. We can be “good-humoured” or “ill-humoured” and we can be “in the best of humour” or “out of humour”. The Nigerian-born writer Chimamanda Ngozi Adichie unexpectedly lost her father during the pandemic lockdown. In her book “ Notes of Grief ” she writes, “There is laughter in grief ”, emphasising her need to laugh and remember her father’s sense of humour. Most countries and cultures across the world encourage humoristic literature and shows such as stand-up comedy shows in the UK or USA, or the rakugo   in Japan (a traditional Japanese comic storytelling). However, people around the world might have different attitudes towards spontaneous humour . Spontaneous humour is part of day-to-day conversations and can be well-received by the other participants in the conversation. Sometimes, however, it can be misinterpreted and misunderstood. Spontaneous humour is regarded differently worldwide depending on culture, level of education, and home culture. In Western countries, having a sense of humour is encouraged, and is considered a positive personality trait, while in Eastern Asian societies ,  attitudes towards the sense of humour are more ambivalent. In some cultures , such as Anglo-Saxonian, self-irony is highly appreciated while in other countries such as Italy, and France regional satire is more encouraged. Queen Elizabeth’s sense of humour   was said to be contagious -The Guardian News What is humour and sense of humour? According to the Oxford English dictionary ,  humour is “ the quality in something that makes it funny; the ability to laugh at things that are funny ” while a sense of humour is more of “ an ability to see the funny side of life ”. The origin of the word “humour” is from the Latin “ umor ”, which means “bodily fluids” such as blood, phlegm, yellow bile, and black bile. Physicians from ancient Greece and Rome believed that the balance in these four humours determined a person's temperament and health. Later, the word humour was associated with the meaning of mood and temperament . The sense of humour is a personality trait and a complex social cognitive construct. Both humour and a sense of humour are associated with laughing and are highly beneficial for health . Humour helps us to socialise and communicate our needs, reduces our stress levels, and boosts our psychological and physical wellbeing. Humour and laughter, for example, have been shown to increase heart rate, and enhance endocrine and immune systems. Briefly, the endocrine system is the body's internal messaging system, which uses hormones to contribute to a variety of functions in the body such as metabolism, reproduction, mood, cognition, and stress response (of which the main hormone is cortisol, a “stress hormone”). The immune system is the body’s defence mechanism, and it helps us in fighting infections and other threats. Interestingly, laughter has been associated with cortisol reduction and augmentation of dopamine and serotonin, two chemicals important for mood regulation. This leads to positive effects such as reduced stress levels, and increased resilience  after experiencing a psychologically traumatic event. Humour is also important in a clinical setting, particularly in establishing a good therapeutic alliance between a clinician/ psychotherapist and patient. Laughter, or humour therapy, is a non-pharmacological intervention with beneficial effects in reducing pain, anxiety, and stress. It can be helpful across different age groups, and it is often used in institutions for palliative care  units and nursing homes for older adults with and without major neurocognitive disorders . Clown therapy   is a form of laughter or humour therapy often used in paediatric wards with children. What is going on in the brain? The underlying biological mechanism of humour and the appreciation of humour is complex and not fully understood. Some studies suggest that some personality traits, such as having a sense of humour ,  can be influenced by our genetics. Interestingly, much of the international research efforts are allocated to understanding negative emotions such as fear while positive emotions seem less researched. Fear is probably easier to induce and implicitly study in humans and animal models, while positive emotions such as humour are more complex. However, research using functional magnetic resonance imaging (fMRI - a brain scan looking at which parts of the brain are active) has provided some insights into the neural and physiological mechanisms that underlie humour and the perception of humour. Several studies have been conducted on patients suffering from conditions which affect the perception of humour such as frontotemporal dementia , autism , schizophrenia   or brain traumas . Some studies suggest that patients suffering from depression  or severe anxiety have difficulties using their sense of humour although their susceptibility to react to funny or humoristic   situations seems unaffected. Surprisingly, humour is more complex than it might be perceived. I want to give you an overview of this complexity by explaining the main and various areas of the brain involved. Several studies  have shown that humour activates a widespread network of brain regions such as the frontal cortex, temporal cortex, amygdala, and the reward system. The frontal cortex   is involved in decision-making and cognitive control, and it is thought to play a role in cognitive processes underlying comprehension and the appreciation of humour. The temporal cortex ,  on the other hand, is involved in processing language and semantic information, which is important for understanding verbal humour. The amygdala   is part of a brain region called the limbic cortex. The limbic cortex  includes the hippocampus which is involved in storing memories, and the amygdala is involved in processing fear and emotions. The amygdala is also involved in selecting the most relevant information from a stream of inputs and is thought to be involved in detecting basic incongruity, a key element of many types of humour. The reward system , which includes the nucleus accumbens and other brain regions, is activated by humour and laughter. This system is involved in the experience of pleasure and reward and is thought to reinforce the behaviours and cognitive processes associated with humour and laughter. Our sense of humour keeps us afloat in times of constant crises, and laughing might be a breath of fresh air. I worked in a hospital in the North of Denmark for a few months last year. The whole experience of being in a new country and speaking a new language was somehow refreshing. I wanted to learn more about hygge , the magic of valuing the small things in life, but I ended up binge-watching stand-up comedies and developing my self-irony. Although I am not particularly good at making other people laugh, I often try to laugh at myself and the world around me.

Content warning: This article contains mentions of suicidal ideation It starts with a silent video of Winston Churchill with more and more loud voices and clips from the news and media accumulating on screen, talking about mental suffering and suicide, piling up in my head as I watch.   Suddenly, all goes quiet. The images transition to an animated post-apocalyptic scenario where a solitary figure with bright eyes tries to repair the cogs in their brain.   Then, the interviews begin.   This is The Mind of Others , a feature documentary that aims to challenge societal perceptions of mental illness and to humanise those we often hear as nothing but statistics. Directed by Luke Mordue, who has himself lived experience of mental illness, The Minds of Others takes viewers on an emotional journey as it explores the lives of individuals affected by various mental health conditions, and provides information on relevant clinical and scientific evidence. It uses captivating storytelling and fascinating animation to invite viewers to confront what they think they understand about mental illness, regardless of whether they have their own lived experience or not. We at Inspire the Mind are delighted to have co-produced The Mind of Others , and I am honoured that the documentary features me as one of the clinical experts. Today, we are very excited as The Minds of Others  is now available for all to view on YouTube .  This touching, warm, and compassionate documentary is a auditory, visual, and intellectual roller-coaster, alternating personal stories with evidence-based information, interspersed with short, compelling animations bringing a pictorial representation of mental health difficulties.    The film features diverse perspectives, including individuals with depression and anxiety disorders, bipolar disorder, schizophrenia, eating disorders, and obsessive compulsive disorders. All individuals open up to candidly and truthfully tell their stories about their experiences with medications, therapy, diagnosis, public perception, and, at times, suicidal acts. Some are public figures in the world of mental health activism and advocacy; all are household names: the poet and broadcaster, Lemn Sissay, the author and vlogger, Jonny Benjamin, the writer and advocate, Rachel Kelly, the psychological wellbeing practitioner, Rachel Bailey, the solicitor and writer, Sam Dalling, the mental health activist, Adam Torr, and the director himself, Luke Mordue. They provide valuable insights into the societal, cultural, and systemic factors contributing to mental health stigma. Besides me, we also hear from other clinicians and scientists: the general practitioner, Dr Emily MacDonald, the professor of clinical psychology, Peter Kinderman, the psychotherapist, Antonia Murphy, and the consultant psychiatrists, Dr Derek Tracy. Together, we provide thought-provoking discussions regarding how we treat mental illness, each with our own perspectives. We do not agree on everything, and there is a breadth of opinions on potentially controversial topics that are relevant to me, such as psychiatric medications and the biology of mental health problems, but the views are all complementary and are expressed respectfully, based on scientific and clinical evidence.   This documentary was intended to be filmed and completed in 2018, but, in the director’s own words, “somewhat understandably and somewhat ironically”, time had to be taken out from post-production due to another fall in Luke’s mental health. Between 2019 - 2020, Luke was at his lowest, partly due to the lockdowns but in January of 2021, during the third and most harrowing lockdown, Luke decided to give it all one more go, and he had our full support. Luke calls this documentary “a call to action” to fight back against this consistently pushed, black-and-white narrative of the world that is becoming so prevalent in society; to understand people's differences and to look a little deeper into what is going on in the minds of others , to remind us of the complexity going on in others’ lives, whilst also reminding us – and here I am using Luke’s words again –  “that we are not crazy for feeling what we do … (that) we all have far more in common than we often remember.”   The production team hope to reach audiences globally and inspire a renewed commitment to understanding and supporting those affected by mental illness, and, most importantly, to a deeper level of empathy.   I am fond of a quote that Luke shared in the press release for the documentary: “It was ten years ago now that I planned to take my life. I was lucky in that I could stop before I crossed the line of no return; I was also fortunate that I had people around me who would put up with far more than I could and should have ever asked for until I got myself back on my feet.”   And this is ultimately the true message of The Mind of Others . It is not all dark.   The documentary finishes with a series of uplifting, courageous declarations from the participants, on the importance of helping people and of connecting to others.   And, at the end, the animation fills up with persons and animals surrounding the solitary figure, while the darkness dissipates as light appears in the streets and colours emerge where before it was all pitch-black.

I’m Sorcha, a PhD student at Imperial College London leading the PsilOCD study – which explores the use of a low dose of psilocybin to treat obsessive-compulsive disorder (OCD). Psilocybin is a naturally occurring psychedelic compound found in several species of mushroom, eliciting gentle emotional and perceptual changes at the dose we’re administering. As well as assessing clinical symptoms, we’re studying an array of different outcomes related to OCD’s specific cognitive features, which I'm going to talk about in this article. OCD: Driven By Anxiety or Cognitive Deficits? Characterised by anxiety-inducing thoughts (‘obsessions’) and mental or physical attempts to quell the anxiety they generate (‘compulsions’), OCD has traditionally been viewed as an anxiety-spectrum disorder. Neurobiologically, anxiety is at the crux of OCD, evident in overactivity of the amygdala (a brain region strongly involved in fear p rocessing), and the comorbidity between OCD and other anxiety conditions is undeniable. Although its manifestation can range from contamination-centric worries to concerns about harming others, patients always fear specific thoughts, feelings, and outcomes. But recently, research has shifted towards focusing on OCD’s cognitive underpinnings , which  might represent more influenceable – and therefore targetable – elements of the condition. Cognitive Inflexibility: Entrenched Thought Patterns & Perspectives The main cognitive deficit seen in OCD is cognitive inflexibility, the decreased ability to adapt and switch between different tasks, strategies, or perspectives. While anxiety naturally makes attention more rigid , patients also display this deficit in psychological tasks. A subdomain of cognitive flexibility is ‘set-shifting’, describing the ability to shift focus between different ‘sets’ of stimuli . OCD patients score notably poorly , accompanied by reduced connectivity between two involved brain regions. OCD patients’ unaffected relatives also score poorly in set-shifting tasks – pointing to it as a potential inherent genetic trait or ‘endophenotype’. Reversal learning  - the ability to modify behavioural strategies following feedback – is also affected. It is subserved by the orbitofrontal cortex (OFC), one of the core brain regions affected in OCD. Patients display prominent deficits, reflected in abnormal activity in the lateral OFC that is also seen in their unaffected relatives . Compulsions Prevail: A Tendency to Form Habits Another cognitive hallmark of OCD is the dominance of the brain’s habit-formation system . Although compulsions are habit-like, patients are also prone to developing compulsive habits in generic tasks . The habit theory of OCD is neurobiologically plausible – goal-directed control relies upon two key brain regions affected in OCD: the caudate nucleus and medial orbitofrontal cortex . One study reported abnormally high activation of the caudate nucleus in OCD patients  during habit learning, which correlated significantly with their urge to perform these behaviours. The OCD brain may be less efficient at starting and maintaining purposeful ‘goal-driven’ actions, allowing habitual compulsive behaviours to prevail . Decreased Confidence Hinders Decision-Making The third core cognitive feature seen in OCD is decreased confidence, concerning not only the individual’s specific fears, but also their performance in unrelated tasks. They  exhibit lowered confidence across diverse cognitive areas  like memory, perception, and action. Naturally, this disparity between competence and confidence hinders decision-making ; by causing them to seek unnecessary additional information, it raises their decision-making threshold. Can Psychotherapy Treat the Cognitive Features of OCD? Exposure Response Prevention (ERP) is the gold-standard intervention for OCD, granting about 60% of patients significant symptom reduction. Participants expose themselves to their triggering thoughts, symptoms, and situations, while ‘accepting’ their feared outcomes and refraining from performing compulsions . Effective ERP represents active ‘re-learning’ : it tests and ultimately disproves the brain's irrational hypotheses (the outcomes it believes will transpire if compulsions are not performed). Only then can 'fear extinction’ occur, involving part of the prefrontal cortex receiving contextual ‘safety’ signals, and, in turn, inhibiting the amygdala’s fear response . Interestingly, ERP’s effectiveness may be attributable to its ability to improve confidence. One group of researchers suggest that invasive deep-brain stimulation (DBS) works by increasing self-confidence, and ERP seems to do this under normal circumstances . When successful, it weakens dysfunctional beliefs , as well as normalising patients’ excessive feelings of responsibility and confidence in their memory . During ERP, the patient temporarily dares to ‘test’ whether negative outcomes can occur. The brain generates prediction errors  when they don’t, prompting it to reappraise previously feared thoughts, sensations, and outcomes as unthreatening and/or irrelevant. Initial discomfort is always part of ERP; the amygdala needs to be ‘online’ for the cortex to start suppressing it, and compulsions – mental or physical – preclude this process . Do Established Medications Treat OCD’s Cognitive Features? Viewing OCD through a cognitive framework sheds light on why current pharmacotherapy is less effective than ERP. The most widely prescribed medications for OCD are serotonin reuptake inhibitors (SSRIs), which enhance synaptic serotonin concentrations . This increases serotonin’s effects on its receptors, including those involved in OCD.   However, only 40-60% of patients respond adequately . SSRIs are often viewed as tools to dampen anxiety , bu t serotonin is a highly multifaceted neurotransmitter  with roles far beyond emotion regulation. Serotonin seems to aid reversal learning , with one study finding medicated patients to change strategies more nimbly . But, SSRIs can also blunt cognition – with chronic use potentially impairing reversal learning in healthy humans .     SSRIs might not precisely or reliably target OCD’s cognitive features, pote ntially explaining their modest efficacy. New Directions for OCD Pharmacotherapy The newest wave of exploratory pharmaceuticals mainly act on glutamate, the brain’s major excitatory neurotransmitter – which is dysregulated in OCD . Biohaven Ltd. is conducting research on a glutamate-modulating drug called troriluzole. And another glutamatergic drug, topiramate, can be helpful for compulsions – but may also induce OCD-like symptoms .   Ketamine, a short-acting anesthetic, blocks the activity of glutamate across the brain and causes various nuanced downstream effects. It can improve  performance in set-shifting and reversal-learning tasks in animal studies, but its impact on human OCD symptoms is less clear. One study deemed it ineffective for OCD while another reported immediate symptom improvements .   Another possible candidate to target OCD’s cognitive features is psilocybin, which we’re exploring in PsilOCD. Psilocybin has shown promise in treating various psychiatric conditions and   a small 2006 study reported low-moderate doses to be safe and effective for OCD. It primarily interacts with 5HT2A serotonin  receptors, enriched in the cortex. This temporarily weakens the brain’s entrenched models of the world, priming it to revise them in line with incoming information .   Collectively, psilocybin’s brain effects highlight it as a potential tool to support ERP– potentially by tapping into OCD’s cognitive aspects. By making beliefs temporarily more malleable, psilocybin could facilitate the neural process by which patients’ confidence is increased – possibly via enhancements in cognitive flexibility.

First described in 1908 by the Swiss psychiatrist Eugen Bleuler, schizophrenia is a severe mental disorder characterised by loss of contact with reality . This includes hearing or seeing things that are made up by the mind (hallucinations), and unusual beliefs in something that is not real (delusions). In addition, individuals with schizophrenia often present with so-called “negative symptoms”, which include a lack of motivation and interest, difficulty in experiencing pleasure, and an inability to experience emotions fully. Over the decades, researchers have tried to establish the causes of schizophrenia and to identify the best strategies to prevent and treat the disorder. However, due to its complex nature, the biological mechanisms behind schizophrenia are still not fully understood. I am a postdoctoral researcher in the neurobiology of mental disorders and, in this article, I will walk you through the most relevant findings in schizophrenia research and the exciting future directions of the field!   Genetics If you have watched the movie “ A Beautiful Mind ”, you will know that John Nash was a brilliant mathematician with schizophrenia who won the Nobel Prize in Economics in the 90’s. You may not know that he had a child, Johnny Nash, who inherited from his father, not only his math skills but also schizophrenia. This is because schizophrenia is a heritable disorder that tends to run in families. However, the genetics of schizophrenia are extremely complicated, and having a parent with schizophrenia does not mean that the offspring will also present the disorder. In fact, only around 1 in 10 children of people with schizophrenia will also present with this disorder if they have one affected parent, and almost 1 in 3 if both parents are affected.   Over the last few years, genetics studies have demonstrated that schizophrenia is highly polygenic , which means that there are thousands of genes which are responsible for the illness. In particular, the risk of schizophrenia is associated both with common genetic variants that minimally increase the susceptibility to the disorder and a few rare genetic variants that, differently, increase the risk substantially. In addition, genes associated with the risk of schizophrenia are not disorder-specific but also observed in other psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, bipolar disorder, major depression and obsessive-compulsive disorder. In other words, if someone in a family has schizophrenia, up to 1 in 20 relatives will present with another psychiatric disorder.   Genetic research in schizophrenia is making substantial progress, and big groups like the Psychiatric Genomics Consortium are enabling rapid advancements in elucidating the genetic basis of schizophrenia. However, current genomic strategies only explain around 40% of the heritability of the disorder and several challenges lay ahead . The application of new technologies to large and diverse samples will hopefully allow scientists to overcome the limits of current genetic research and help clarify the pathway between genetic risk and the expression of symptoms in schizophrenia. Neuroimaging Have you ever hurt your knee and your doctor has prescribed you an MRI to see if your ligaments were damaged? That same MRI scan can be used to see if the brains of people with schizophrenia present differences in terms of structure or activity compared to the brains of people who do not have schizophrenia. Unlike the knee though, this cannot be done by simply looking at one image, rather researchers need to look at brain images of many individuals with schizophrenia to see if they differ from brain images of people without schizophrenia.   This was first done in 1984 on a small sample of 14 individuals . Since then, thousands of MRI studies have identified changes in brain structure and activity in people with schizophrenia compared to people who do not present with the disorder. These studies have been fundamental to advancing our knowledge of the brain abnormalities that characterise schizophrenia, which include a loss of volume of the outermost layer of the brain (also known as grey matter), higher activity of the seahorse-looking structure called the hippocampus and abnormalities in how different areas of the brain communicate . However, so far, MRI studies have not been able to provide useful information to identify the disorder or guide treatment in a single person.   But here comes the exciting news! Thanks to recent advances in artificial intelligence techniques, researchers have started to use brain images not only to distinguish people with schizophrenia from people without schizophrenia but also to predict the course of the illness and response to treatment . This represents a huge step forward which might potentially revolutionize the field by providing new methods for the diagnosis, treatment, and prevention of the disorder. Scientists are not there yet, but hopefully one day the diagnosis of schizophrenia will not be very different from the diagnosis of a problem with your ligament in the knee. And even more importantly, by studying how the brain develops over time, we will be able to prevent the disorder before it appears. Neurotransmitters and pharmacological research Neurotransmitters are chemicals in our body that allow neurons to communicate with each other. Among these, dopamine is considered the most important neurotransmitter in schizophrenia, responsible for delusions, hallucinations, mood changes and cognitive problems . In addition, other neurotransmitters like glutamate , GABA , acetylcholine , serotonin , and norepinephrine play a central role in the development of the disorder.   Pharmacological research in the field of schizophrenia is in continuous evolution, and several new drugs (also called antipsychotics) are being developed. While dopamine receptors have been the main target of antipsychotics in the past, new antipsychotic drugs mainly focus on multi-target combination therapy . Among these, there is brilaroxazine, a drug currently under study that acts on both serotonin and dopamine receptors but in a different way from other antipsychotics . In addition, in the present psychiatric pharmacological pipeline, new medications act via novel mechanisms of action. Some of the most promising antipsychotics include drugs that activate the muscarinic acetylcholine receptor , a receptor that is also involved in regulating the heart and other body functions, and that has proven particularly useful in improving cognitive deficits in neurological and psychiatric disorders. In addition, scientists are developing and testing trace amine-associated receptor (TAAR1) agonists , molecules that influence the neurotransmission of dopamine, glutamate, and serotonin. Either as a single agent or in combination with other molecules, TAAR1 agonists have proven to be effective in the treatment of negative symptoms and cognitive deficits of schizophrenia. Furthermore, new positive results come from the study of voltage-gated sodium channel blockers , drugs which inhibit sodium channels located in the membrane of neurons, where they regulate neuronal electrical firing and can normalise excessive release of potentially neurotoxic brain chemicals, like glutamate. And that’s not all. New advancements in genetics have allowed researchers to identify biomarkers that are able not only to match people with schizophrenia to the most effective medications but also to measure response to treatment .   This is very exciting, but let’s keep in mind that the path from the lab to clinical practice is long and difficult, and not all these new drugs will be approved by regulatory systems. Nevertheless, the field is moving forward fast and new drugs with the potential to help millions of people with schizophrenia will soon become available.   Future Directions Since 1908, huge steps have been made towards a better understanding of the mechanisms that cause schizophrenia and the best ways to prevent and treat it. However, there is still much to understand, and advancements in technology will help researchers reach this goal.   First, greater integration of large biological datasets (the so-called “omics”) will clarify the path from genes (genomics) to gene readouts (transcriptomics) to proteins (proteomics) involved in schizophrenia, ultimately unveiling the complex biology of the disorder . Then, advanced artificial intelligence techniques will allow researchers to analyse large datasets and develop models based on clinical, cognitive, biological and neuroimaging data able to predict the disorder, its course, and response to treatments. This will improve early intervention and prevention strategies and will allow us to create a personalised psychiatry, where treatment plans will be tailored to a person’s specific genetic and biological profiles.   Overall, schizophrenia research is making significant progress. By understanding the underlying causes and developing more targeted treatments, researchers are working towards a future where prevention, early detection and effective treatment of schizophrenia will be a routine reality.

Are our Accident and Emergency Departments (A&E) in the UK tailored for our mental health? Or are they only for our physical health? I am Antonio Ferreira . I am a mental health activist and anti-racism campaigner. My endeavour is aimed at changing the way the UK views and addresses mental ill health, particularly within minority communities. I write this article considering the recent experiences I’ve faced in A&E. I am not writing this article to shame accident and emergency departments. Instead, I intend to raise awareness of some of the bad experiences and use these experiences to motivate society towards a better understanding that will provide better outcomes for all individuals. Nobody should have to beg for support. In my case, as a promoter of seeking support — I cannot emphasise enough the need for reform towards the support provided during a mental health crisis within A&E — to not increase the fallacy that individuals with mental health issues are not worthy of support. Recently, I was faced with extreme neglect when attempting to gain support during a mental health crisis at an A&E department. Since I was a young teenager in mental health services, I had it drilled into me that if I felt unable to keep myself safe, I should take myself to A&E for support. I have practised this again and again and, for years, this has worked out in my best interest. Ergo, I genuinely advocate for seeking support — especially in those dark moments when you no longer feel you can float like a butterfly and sting like a bee. Until most recently, I faced the most difficult experience of all my experiences at A&E. As aforementioned, I had had a mental crisis following an experience of an earthquake in Morocco (sorry, no time to indulge you in the details of an earthquake experience). Upon returning home, I was troubled with still fresh memories of that experience. So, I knew it was time to do what I’ve always done best: seek support. As I presented myself to Accident & Emergency, I was met by the receptionist to whom I explained (very articulately, if I do say so myself) how I felt and what I was experiencing. To cut another article short, unfortunately, this time, my needs were not met. Instead, I was neglected and not attended to. As a result, I had to manage and cope on my own. Additionally, I was defamed to be portrayed as violent, aggressive, and intimidating. As an individual who has worked with the Media, Schools, Workplaces, Charities, and the Government to break down the perpetual stigma surrounding mental health in minority communities, I do not believe I got this far by being an individual who is violent, aggressive, and intimidating.   The NHS has displayed research on violence within acute medical hospital settings. In that research, the results portrayed that at least 80% of assaults against staff were due to an individual's clinical condition at that moment and not intentional or reckless behaviour . The individuals in those situations need clinical interventions to address their medical conditions and unmet needs. Again, I want to make it very clear that I am not writing this article to shame A&E departments. Instead, I intend to raise awareness of some of the bad experiences and use these experiences to motivate society towards a better understanding that will provide better outcomes for all individuals. Together, we work better towards positive change. It is my due intention to begin campaigning for better treatment within "acute medical hospital settings" for those with mental ill health. Let this article be the gun that goes off at the start of a race. Furthermore, the NHS, including its staff, is under constant pressure. I am not pointing the finger, then passing the buck and piling the pressure. I am open-palm, holding my hand out and asking for an opportunity to change what one may not realise when attempting to look out for others. Community and individual experiences are pillars of our development. Without these, we could not improve, as we would be completely blind to our environment, our actions, and their effects on others. Nor would this article be of any interest!   To end, I would like to remind all readers, firstly, don’t stop seeking support — support is available — and that everyone is entitled to support. Yes, I had to beg for support, but don’t forget that support did eventually arrive and because of that support, I am here able to share my experiences and motivated to change the way the UK views and addresses mental ill health. Of course, without errors, we activists, advocates, and changemakers, would cease to exist. So, maybe it is possible that our A&E departments were inconsiderate of mental health. But that is no reason for it to have to remain the same.