Questo articolo è stato scritto assieme ai colleghi Silke Pfitscher, Monica Greco and Giancarlo Giupponi. La salute mentale è parte integrante della salute e del benessere, lo si deduce dalla definizione di salute dell’Organizzazione Mondiale della Sanità (OMS) “La salute è uno stato di completo benessere fisico, mentale e sociale, e non semplice assenza di malattia o infermità”. I determinanti della salute mentale e dei disturbi mentali includono non solo caratteristiche individuali come la capacità di gestire pensieri ed emozioni, ma anche fattori biologici, sociali, culturali, politici e ambientali. (“Che cos'è la salute mentale - Salute.gov.it”) Ad esempio, il cervello umano in sé può essere considerato un sistema composto da una vasta gamma di elementi interconnessi, tra cui organi, tessuti, cellule, neuroni che generano processi cognitivi, emotivi e comportamenti complessi che a loro volta sono influenzati da fattori esterni come l’ambiente, lo stile di vita e le relazioni sociali. Sono uno psichiatra, Capo Dipartimento del Servizio di Salute Mentale di Bolzano, e sono stato sempre molto interessato nel modello di psichiatria personalizzata e di precisione, che enfatizza l'importanza di considerare un ampio spettro di fattori che influenzano la salute mentale, inclusi fattori genetici, neurobiologici, psicologici e sociali. Questi fattori non solo influenzano la manifestazione della malattia ma anche la risposta del paziente ai trattamenti. Per esempio, variazioni genetiche possono influenzare la metabolizzazione dei farmaci psichiatrici, richiedendo quindi un adattamento del dosaggio e della scelta del farmaco per ottimizzare l'efficacia e minimizzare gli effetti collaterali. L'approccio della psichiatria personalizzata e di precisione rappresenta una trasformazione fondamentale nel trattamento delle malattie mentali, spostando il focus dalla standardizzazione delle cure verso un modello che prende in considerazione la complessità unica di ogni individuo. Questo paradigma si basa sul principio che la personalizzazione del trattamento può migliorare significativamente l'efficacia terapeutica rispondendo più accuratamente ai bisogni specifici del paziente. Il modello biopsicosociale rivisitato integra la comprensione dell'essere umano come un'entità in cui biologia, psicologia e contesto sociale sono inestricabilmente intrecciati. Questo modello enfatizza come il cervello umano, nel processare emozioni, pensieri, comportamenti e bioritmi, funzioni simile a una stampante 3D, dove strutture e funzioni sono sempre più misurabili tramite ”biomarker, psychomarker e socialmarker” (Peckham et al., 2019). I biomarker sono misure dirette di processi biologici, come livelli di neurotrasmettitori (le sostanze chimiche attraverso cui le cellule cerebrali comunicano), attività enzimatica (i processi che attivano o disattivano i neurotrasmettitori), o cambiamenti nella struttura cerebrale osservabili tramite tecniche di neuroimaging come la risonanza magnetica funzionale (fMRI). Questi biomarcatori possono indicare la presenza di una malattia o di vari stati fisiologici e psicopatologici. I psychomarker si riferiscono a indicatori psicologici che possono essere misurati per valutare aspetti come la resilienza psicologica, la regolazione emotiva o i pattern di attenzione. Questi marcatori possono includere misurazioni di risposte comportamentali in test cognitivi o valutazioni di risposte emotive in ambienti controllati. I socialmarker sono indicatori che riflettono l'interazione dell'individuo con il suo ambiente sociale. Essi possono includere variabili come il supporto sociale percepito, la frequenza di interazioni sociali, o la partecipazione a gruppi comunitari, che sono stati collegati alla salute mentale e al benessere generale. Questi marker offrono uno spaccato di come l'ambiente sociale influenzi e moduli la salute mentale dell'individuo. Il trattamento psichiatrico deve essere modulato non solo per affrontare i sintomi ma anche per interagire con la capacità del paziente di rispondere ai trattamenti in maniera personalizzata. La malattia mentale, secondo questo modello, si manifesta attraverso un'ipersincronizzazione dei vari ambiti di funzionamento, il che può variare in gravità e manifestazione clinica. La nozione di ipersincronizzazione nei vari ambiti di funzionamento descrive come l'eccessiva coordinazione tra diverse aree cerebrali possa contribuire a disturbi mentali. Questa ipersincronizzazione può essere osservata in disturbi come il disturbo ossessivo-compulsivo o il disturbo dello spettro autistico, dove circuiti neurali specifici mostrano un'attività sincronizzata che non è tipica in individui che non hanno questi disturbi. La comprensione di questi pattern può guidare lo sviluppo di interventi più mirati, come la stimolazione magnetica transcranica (che usa un magnete esterno al cervello per cambiare l’attività elettrica di specifiche aree cerebrali) o terapie comportamentali specifiche per modulare queste reti neurali. Implicazioni Cliniche e Futuri Sviluppi Il riconoscimento di queste interazioni complesse tra i vari aspetti dell'essere umano ha diretto impatti sui trattamenti psichiatrici. Gli interventi sono sempre più orientati verso la modulazione dei circuiti neurali e psicosociali in modi che rispettano e promuovono l'autonomia individuale e l'adattamento all'ambiente (Greenwood & Lilienfeld, 2020). Questo si basa sull'idea che le disfunzioni nei circuiti neurali non solo influenzano la biologia del cervello, ma hanno anche impatti psicosociali che possono alterare significativamente la qualità della vita del paziente. Tecniche come la neuromodulazione, che include la stimolazione magnetica transcranica e la stimolazione elettrica diretta, sono esempi di come i medici possono intervenire direttamente sui circuiti neurali per correggere disfunzioni specifiche. La capacità di quantificare tali aspetti attraverso marcatori biologici e psicologici promette di migliorare non solo la comprensione delle patologie ma anche l'efficacia dei trattamenti psichiatrici rendendoli più rispettosi delle singole necessità dei pazienti e più efficaci a lungo termine. L'integrazione di approcci innovativi nel campo della psichiatria, specialmente quelli che riguardano la personalizzazione e la precisione del trattamento, rappresenta un cambiamento paradigmatico significativo nella cura delle malattie mentali. Le sfide future nel campo della psichiatria di precisione includono lo sviluppo continuo di strumenti diagnostici e terapeutici che possano integrare ulteriormente i dati biologici, psicologici e sociali. Questo processo richiederà un impegno costante nella ricerca e nello sviluppo di tecnologie che possano effettivamente tradurre queste informazioni complesse in piani di trattamento praticabili e personalizzati. Un'altra area di sviluppo chiave è la formazione medica e la sensibilizzazione; gli psichiatri e altri professionisti della salute mentale dovranno essere adeguatamente formati per utilizzare questi nuovi strumenti e approcci nel modo più efficace. Inoltre, c'è la necessità di una maggiore comprensione etica su come queste tecnologie vengano applicate, garantendo che l'innovazione sia equa e accessibile a tutti i pazienti, indipendentemente dal loro background o condizione economica. Il riconoscimento e l'adattamento ai complessi interrelazioni tra i vari aspetti dell'essere umano e la malattia mentale è fondamentale per andare avanti. L'equilibrio tra l'umanizzazione della cura e l'adozione di fondamenti scientifici solidi è essenziale per affrontare la "pancrisi umana" di Kant, garantendo che la psichiatria non solo curi ma anche comprenda e rispetti la complessità dell'essere umano. Sebbene Kant non abbia specificamente usato il termine "pancrisi umana", le sue teorie sull'illuminismo e sulla necessità per l'umanità di usare la ragione come guida per il comportamento etico e il progresso possono essere viste come un tentativo di rispondere a una crisi universale di moralità e ragione, una crisi totale che riguarda l'umanità intera, legata ai temi della moralità, dell'etica e della capacità umana di superare i suoi limiti e conflitti interni mediante il ragionamento e l'etica. Attraverso questo approccio, la psichiatria può sperare di non solo trattare ma anche prevenire molte condizioni psichiatriche, spostando il paradigma da uno reattivo a uno proattivo nella gestione della salute mentale.

Proces starzenia się, jest połączony z przejściem na emeryturę. To jeden z trudniejszych momentów w dorosłym życiu. Jutro nie pójdę do pracy ani następnego tygodnia, miesiąca … Nie będę spotykać większości znajomych, których do tej pory widywałam w pracy. Czym się zajmę? Jak wypełnię wolny czas? Czy nie zwariuję w domu? Czy to już naprawdę starość? Oddałem wszystko mojej pracy, a w zamian mam emeryturę, która nie wystarczy na podstawowe życiowe potrzeby? Takie pytania zadaje sobie zapewne większość starszych ludzi w Polsce - zarówno kobiety jak i mężczyźni. Często bywa, że jest to szok pomieszany z niedowierzaniem, że przed nimi już tylko powolne starzenie się, które nieuchronnie prowadzi w jednym kierunku… Nazywam się Sylwia Nowacka-Dobosz. Pracuję jako wykładowca w Akademii Wychowania Fizycznego Józefa Piłsudskiego w Warszawie i ostatnie lata poświęciłam na badania sprawności funkcjonalnej polskich seniorów. Wraz z innymi ośrodkami badawczymi wyznaczyliśmy zakresy referencyjne dla głównych zdolności motorycznych do 85 roku życia, które można znaleźć tutaj. Prowadziłam między innymi warsztaty edukacyjne dla seniorów „Aktywny Senior”. Szeroko propaguję wpływ aktywności fizycznej na funkcjonowanie umysłu. W polskim systemie edukacji, jaki i w wielu innych krajach, nie uczymy jak się samym sobą zaopiekować na emeryturze; nie ma instrukcji obsługi starości, nie ma szkoleń ani warsztatów jak się przygotować do godnego starzenia się. To wszystko spada nagle, po fakcie, gdy dociera do człowieka, że już jest w pracy niepotrzebny. Czasem otoczenie daje odczuć, że najlepiej jakby przeszedł na emeryturę szybciej. Większość, czyli około 75% emerytów wśród mężczyzn oraz 91% wśród kobiet nie jest aktywnych zawodowo. Problem narasta, gdy senior z różnych powodów jest sam. Partner zmarł albo senior nie zadbał o bliskie więzy rodzinne i czuje się wyalienowany społecznie. Kobiety w wieku emerytalnym 65-89 lat radzą sobie lepiej. Często są prospołeczne, udzielają się w organizacjach lub pomocy sąsiedzkiej. Uczęszczają do Uniwersytetów Trzeciego Wieku (150 tys. osób max.) oraz do Klubów Seniora. Starsi ludzie mogą też przebywać w Domach Pomocy Społecznej (ok. 1000) oraz w płatnych Domy Opieki Seniora. Na 9,7 miliona osób starszych jest to niewielka liczba. Wielu seniorów pomaga w opiece nad wnukami. Większość seniorów jest zdana na samych siebie. Około 35% ma niższą emeryturę niż 1500 pln miesięcznie. W dość trudnych warunkach materialnych ważne stają się pytania. Jak odnaleźć sens dalszego życia? Jak zachować zdrowie fizyczne i mentalne? Edukacja i postęp technologiczny Osobiście uważam, że należy wprowadzić do programów szkolnych edukację mającą za cel przygotowanie do okresu starości. Tak jak przygotowuje się dziecko do dorosłości. Na godną starość pracuje się od najmłodszych lat budując świadomość nadchodzących zmian. Podobnie jak uczymy się o dojrzewaniu powinniśmy uczyć się o przemijaniu. I o tym jak się do niego przygotować. Poczynając od rozwoju fizycznego poprzez higienę, odporność, sprawność fizyczną, dietę, uwzględniając tryb życia, a kończąc na kształtowaniu pozytywnej postawy życiowej - pełnej życzliwości do innych ludzi i samego siebie. W ostatnich 30 latach nastąpiło wiele intensywnych zmian technologicznych, dlatego niezmiernie ważne jest, aby uczyć seniorów jak wykorzystywać współczesną technologię, by ułatwić sobie codzienne życie. Wielu z nich zgłasza takie potrzeby, gdyż odczuwa utrudnienia w komunikacji społecznej. Korzystanie z komputera i Internetu ułatwia załatwienie wielu spraw: kontakt z lekarzem, urzędami itp. Dieta Wg badań seniorzy nie powinni dopuszczać do spożywania nadmiaru kalorii. Ważne jest zapewnienie odpowiedniej proporcji białka, węglowodanów i tłuszczy w diecie. Zaleca się żywność pochodzenia naturalnego, nie powinno być wysoko przetworzone, ale jednocześnie powinno być lekkostrawne. O ile to możliwe powinny się tam znaleźć świeże owoce i warzywa, ewentualnie gotowane. Jednym z największych błędów żywieniowych jest spożywanie tzw. pustych kalorii: słodyczy i przekąsek przygotowanych z wysoko przetworzonej mąki, syropu glukozowo-fruktozowego, poddanej długotrwałej obróbce termicznej z dodatkiem środków chemicznych, ze sztucznymi słodzikami itp. Takie używki najlepiej jest wyeliminować z diety albo przynajmniej ograniczyć ich spożycie. Seniorzy w Polsce mają okazję uczestniczyć w warsztatach promujących zdrowe odżywianie, coraz częściej dostępnych w Internecie. Ale sama dieta to nie wszystko. Aktywność fizyczna W Polsce systematycznie aktywnym ruchowo jest 28% społeczeństwa w wieku 15-69 lat. To bardzo mało. Badania pokazują że podejmowanie systematycznych spacerów, nordic walking, (marszu z kijkami) jazdy na rowerze, pływania oraz sportów, w których podejmowany jest dłuższy wysiłek fizyczny o średnim obciążeniu, angażujący duże partie mięśniowe dotlenia organizm, utrzymuje metabolizm w dobrej formie, przeciwdziała osteoporozie i chorobom cywilizacyjnym. Systematyczny ruch – nawet kilka minut dziennie przeciwdziała również takim chorobom jak depresja i choroba Alzheimera. W starszym wieku chodzi o zachowanie tzw. sprawności funkcjonalnej, która umożliwia wykonywanie czynności samoobsługowych.  Aktywność fizyczna spełnia również funkcję afiliacyjną -uprawianie sportów w klubach lub w parkach stwarza okazję do poznawania nowych ludzi. Chroni przed samotnością i wycofaniem się seniora z życia społecznego, które to często przyspiesza rozwój chorób i może prowadzić do przedwczesnego umierania. Dlatego dobrym pomysłem na aktywność fizyczną dla seniorów jest taniec i śpiew. Kontakt fizyczny, dotyk jest równie ważny dla zdrowia jak indywidualne ćwiczenia. Podnosi w organizmie poziom oksytocyny – hormonu, który na drodze biochemicznej wpływa na odczuwanie więzi, a tym samym poczucia przynależności, regulację poziomu stresu, zwiększenie odporności. Razem z hormonami szczęścia – serotoniną i endorfinami, wydzielanymi po wysiłku fizycznym, sprzyja odczuwaniu szczęścia i prawidłowemu funkcjonowaniu mentalnemu. Systematyczny ruch przeciwdziała również demencji. A więc jak się do tego zabrać? Najlepiej, żeby wysiłek był dostosowany do aktualnej kondycji fizycznej osoby, obciążenie należy zwiększać stopniowo i przede wszystkim systematycznie. Ważne jest też, aby zacząć od takiej aktywności, której wykonywanie sprawia przyjemność. Z moich obserwacji wynika, że im aktywniejsze ruchowo i towarzysko życie prowadzi senior, tym większą odczuwa satysfakcję i zadowolenie z życia. I oczywiście, ważny jest regularny kontakt z lekarzem zwłaszcza dla osób starszych podejmujących aktywność ruchową po dłuższej przerwie. Sen, aktywność społeczna i umysłowa Innym ważnym dla zdrowia aspektem jest długość j jakość snu jak mówi Dr Joanna Podgórska w wywiadzie „Bo Sen jest Ważny”. Seniorzy powinni zadbać o 6-7 godzin snu, gdyż ma on znaczenie regenerujące dla organizmu. Wpływa na jakość funkcjonowania wszystkich układów jak również na pracę mózgu. Od długości i głębokości snu zależą możliwości koncentracji i utrzymania uwagi. Również chroni przed depresją i otępieniem starczym. Dobrze, mam dietę, ruch i sen opanowane. I co teraz? Aktywnosc społeczna i umysłowa jest świetna na utrzymanie dobrego stanu psychicznego, a więc utrzymywanie dobrych relacji z innymi – rodziną czy też przyjaciółmi. Dodatkowo, uczenie się nowych umiejętności ruchowych, rozwiązywanie mentalnych zadań typu krzyżówki lub uczenie się języków obcych, czy też podróże w nowe miejsca są bardzo dobre na utrzymanie aktywności umysłowej. Chodzi o pobudzenie ośrodkowego układu nerwowego (OUN) nowymi bodźcami co powinno mobilizować do lepszej pracy umysłowej i utrzymania funkcji poznawczych mózgu na dobrym poziomie. Tak więc, podsumowując, proces starzenia nie musi oznaczać, że wszystko idzie w jednym kierunku. Mając świadomość jak można sobie radzić z wyzwaniami wieku starszego, troszcząc się o zdrowie fizyczne i psychiczne, możemy zapobiec przedwczesnemu starzeniu się i nawet cieszyć się tym pięknym czasem i złotym wiekiem.

A Brief History of the Irish Language Many outside of Ireland are unaware that the Irish have their own ancient, vividly descriptive, and deeply romantic, native language. Up until the 18th century, Irish was the predominant spoken language of the Irish population, but a combination of a policy of repression of Irish culture, by the then ruling British, and the double whammy of the Great Famine of the mid-19th century, saw rural communities decimated by death or emigration. In those dark years, Ireland lost a quarter of its Irish population. Indeed, Ireland's population only recently returned to the pre-famine level. The Irish language declined greatly as a result of these struggles and, by the end of the 19th century, the number of Irish speakers had declined to 600,000. It was in danger of complete extinction. Fortunately, the economic boom of the mid-1990’s and 2000’s in Ireland, known as the ‘Celtic Tiger’, ushered in a new era of pride and interest amongst Irish people in their music, literature and language and it became ‘cool’ amongst young people to embrace their ‘Irish-ness’ once more. This also helped to draw the attention of the rest of the world to Ireland’s unique language and culture. However, the Irish language still remains on the critical list, as relatively few people maintain their interest after leaving school, where irish language lessons are compulsory. As of 2022, ~1.9m people in Ireland were estimated to be able to speak the language, however, in reality at most ~80,000 people are truly fluent, with the bulk of those living in the Irish speaking (Gaeltacht) areas of the country. Although official documents and signposts are often written in both Irish and English, if people don’t want to engage with the language further, they don’t have to. For me, there was no question of letting my proficiency ‘slide’. My parents were very passionate about keeping the language alive and, although we did not speak it much at home, it was always encouraged, and attainment in the subject in school was seen to be very important. After moving to the UK in the 1980’s, driven by a huge economic depression in Ireland, I have remained determined not to forget my culture, nor my native language. Indeed, maintaining my ability to speak the language represents a visceral link to my heritage, of which I am immensely proud. “Thirty-Two Words for Field” Irish is a very romantic, poetic language and it is practically impossible to translate directly to English. There is no word for ‘yes’ or ‘no’ in Irish. An answer in the positive or negative is qualified by its context, e.g. ‘An bhuil tú cinnte?’ (Are you sure?) would be answered ‘Táim’ (I am). Or ‘Nach bhuil an lá go hálainn?’ (Isn’t it a beautiful day?) might get the response ‘Sea’’ (It is). The language also reflects an intimate knowledge and connection between Irish people and their surrounding elements and land. In Manchán Magan’s “Thirty-Two Words for Field” he describes how single words can convey a sense of place, function and history. Magan describes it beautifully here: "Separately [Irish words] may seem outdated, and awkward to pronounce and spell, but together they make clear how ancestral languages can steer us back to what truly matters; allowing us to make sense of an increasingly chaotic world by reintroducing us to the mysterious glories of the natural world and the subterranean existence to all things." Magan discusses how nowadays we might look at a landscape and see a nondescript field, but, when the language was in its heyday, you might have used any of at least 32 words to identify a single field e.g. ‘branar’ (a fallow field), ‘plásóg’ (a sheltered field in which a mare might foal), ‘réalóg’ (an untended patch of good land in the middle of a ‘créig’ (a stonier area of limestone)). It’s not difficult to see how Ireland has produced a slew* of writers and poets of note, given the richness and lyricism of their native tongue. Indeed, many Irish words have passed into everyday use in the English language. Slew (as in a slew of people) derives from ‘slua’ (crowd); clock from ‘clagan’ in Old Irish, ‘clog’ in modern Irish (clock or bell); galore from go leor (until plenty); to name but a few. Oppression of the Irish language The thought that Irish might not survive, given the challenges it has had to overcome in Ireland’s often tragic and troubled history, is truly heart-breaking. Ireland was under British rule for many hundreds of years (starting in 1167). One particular period was especially punitive to the indigenous culture, when what were known as Penal Laws were introduced in 1695 by the British occupiers. This worsened the injustices against the native, almost entirely Catholic, population. Religious freedoms were removed, almost all land holdings were seized, Catholics could not enter a profession, possess arms, study medicine or law, but more importantly they could not speak or read Irish, or play Irish music. But the Irish refused to be cowed by this and persisted in educating children in what were known as ‘hedge schools’. These were gatherings that occurred, literally, behind hedges in fields, out of view of the ruling powers. The laws were repealed in 1782, but many people continued to send their children to hedge schools, since there were not enough suitable school premises. The ongoing tradition of singing, playing musical instruments, such as ‘fiddle’ (violin) and bodhrán (drum), in homes and at social gatherings grew out of the necessity to keep the oppressed culture alive. The habit of telling stories and retelling myths by the fireside was one of the only means of entertainment, since all gatherings were prohibited during these dark times. That the Irish should have valued their language so greatly back then, to have been willing to risk imprisonment or death to ensure that it was passed on to their children, only to potentially let it slip away back into the mists of time now, is indeed sad. Hope for the Future However, all is not lost. There do appear to be signs of a burgeoning interest in Irish culture. On recent visits home, I have noticed a growing number of TV and radio programmes conducted solely in Irish. Traditional music also seems to be becoming very mainstream, so perhaps my pessimism is somewhat misplaced. One can only hope. A word to the wise When I travel abroad with my sister, we use Irish as our secret weapon. Few things give me more pleasure than being able to break it out, when surrounded by a babel of different languages. No matter where you are in the world, one always has to assume that at least some of your fellow passengers, or other diners in a restaurant will understand English. The silence that descends on our neighbours as they attempt, in vain, to figure out what we are saying, or where we are from when we speak in Irish is priceless. That being said, one can never take for granted that in any situation somebody else might understand it. This was demonstrated to a friend of mine some years ago, when she was travelling on a bus, in a remote part of Greece. A young man got on the bus and sat down in front of her. Over 1500 miles from Ireland, she assumed she was safe and so remarked to her friend, in Irish, how good-looking he was. Some time later, the chap stood up to leave, but just before getting off the bus he turned to say, ‘Go raibh míle maith agaibh, a chailíní’ – “Thanks very much, girls”. A dying language it may be, but it is certainly not yet dead. I hope that this article can, in some small way, contribute to reviving this primal and profound language.

«Wie geht es dir?» Wenn man diese Frage stellt, dann bekommt man als Antwort sehr oft zu hören: «mir geht es gut», oder vielleicht «ja, mir geht’s», manchmal auch «ich habe Kopfschmerzen» oder zum Teil auch «ich habe Rückenschmerzen». Neben der körperlichen Gesundheit gibt es aber auch die mentale Gesundheit, die man auch seelische, geistige oder psychische Gesundheit nennen kann. Mein Name ist Lea und ich arbeite seit zwei Jahren bei ‘Inspire the Mind’. Unser digitales Magazin bietet eine andere Perspektive zur psychischen Gesundheit als andere Zeitschriften, nämlich die Sichtweise von Klinikern, Forschern und anderen Fachkräften, die in diesem Bereich arbeiten. Wir möchten die persönlichen Erfahrungen vonMenschen durch wissenschaftliche Erkenntnisse ergänzen und erklären. Gleichzeitig informieren wir unsere Leser über laufende Forschungen und klinische Arbeit, Diskussionsbeiträge und die Verbindung zwischen Kultur und psychischer Gesundheit. Unser Ziel ist es, das Verständnis für die psychische Gesundheit zu verbessern und deren Stigmatisierung zu reduzieren. Im Rahmen unserer internationalen Woche möchte ich darauf hinweisen, was psychische Gesundheit wirklich bedeutet und was deutschsprachige Menschen, die der englischen Sprache nicht mächtig sind, für ihre eigene psychische Gesundheit tun können. Mentale Gesundheit Die Weltgesundheitsorganisation definiert psychische Gesundheit als «einen Zustand des psychischen Wohlbefindens, der es den Menschen ermöglicht, mit den Herausforderungen des Lebens umzugehen, ihre Fähigkeiten zu erkennen, gut zu lernen und zu arbeiten, sowie einen Beitrag zur Gesellschaft zu leisten. Sie ist ein wichtiger Bestandteil von Gesundheit und Wohlbefinden und unterstützt unsere Fähigkeit, Entscheidungen zu treffen, Beziehungen aufzubauen und die Welt mitzugestalten». Psychische Gesundheit ist ein grundlegendes Menschenrecht und spielt eine entscheidende Rolle für die persönliche, soziale und wirtschaftliche Entwicklung. Psychische Gesundheit ist mehr als die Abwesenheit von psychischen Störungen. Sie ist vielmehr ein komplexes Spektrum, das jeder Mensch anders erlebt und verschiedene Schwierigkeiten mit sich bringen kann. Psychische Erkrankungen umfassen Störungen und Beeinträchtigungen, die mit großem Leidensdruck, Einschränkungen der Funktionsfähigkeit oder dem Risiko von Selbstverletzungen verbunden sind. Menschen mit psychischen Erkrankungen haben oft weniger psychisches Wohlbefinden, aber das ist nicht immer der Fall. Im deutschen Fernsehsender «ZDF» wir der erwähnt, dass , «man bedenken muss, dass die wenigsten Menschen durch ihr Leben kommen, ohne einmal eine psychische Erkrankung zu haben. Genauso wie man eben auch körperlich erkrankt.» Besonders in Krisen und schwierigen Zeiten ist es wichtig, auf das seelische Wohlbefinden zu achten. Das Thema mentale Gesundheit wird immer wichtiger, auch um psychische Probleme frühzeitig zu erkennen und zu behandeln. Durch gezielte Übungen und Achtsamkeit im Alltag kann man psychische Gesundheit verbessern. Was tun die meisten Leute für ihre mentale Gesundheit? Viele Menschen versuchen sich zu entspannen. Dies kann auf verschiedene Arten geschehen, wie zum Beispiel sich mit Freunden treffen, Sport treiben, sich in der Natur aufhalten. Gewisse Aktivitäten wie das Lesen oder Meditieren helfen, den Alltag zu verarbeiten und ein Gefühl von Kontrolle zu bekommen. Viele erwähnen auch das die Familie eine mentale Stütze ist, die ihnen hilft, schwierige Zeiten zu bewältigen und sich unterstützt zu fühlen. Mit der Familie zu sprechen kann eine sichere und unterstützende Umgebung bieten, in der man sich ausdrücken, bestätigen und ermutigen kann. Ebenso kann durch das Gewinnen von neuen Perspektiven oder dem Gefühl der Zugehörigkeit zu einer besseren psychischen Gesundheit beitragen. Andere suchen gerne Hilfe bei Psychotherapeuten oder Coaches. Das Führen von Gesprächen kann ofthelfen, Probleme zu bewältigen. Mit professioneller Unterstützung können offene Gespräche geführt werden, um den Kopf freizubekommen und um viele Themen proaktiv zu behandeln. Was mir persönlich hilft, sind Routinen. Routinen können aus verschiedenen Gründen gut für die psychische Gesundheit sein. Erstens geben sie dem täglichen Leben Struktur und Stabilität, was hilft, Gefühle von Chaos und Unsicherheit zu reduzieren. Zweitens verringern Routinen Stress, indem sie Entscheidungen und den Denkaufwand minimieren. Wenn Aktivitäten zur Gewohnheit werden, benötigt man weniger mentale Energie, um sie auszuführen. Drittens ermöglichen Routinen regelmäßige Erfolgserlebnisse, indem sie es unsermöglichen, Ziele zu setzen und zu erreichen. Dies schafft ein Gefühl der Erfüllung und Zufriedenheit, was wiederum das Selbstwertgefühl stärkt. Insgesamt fördern Routinen also Stabilität, reduzieren Stress und schaffen Erfolgserlebnisse, was alles zu besserer psychischer Gesundheit und Wohlbefinden beiträgt. Wie auch immer wir unser Leben gestalten und leben wollen, wichtig ist einfach, dass man seinepsychische Gesundheit nicht unterschätzt, um ein Gefühl des Wohlbefindens zu erreichen.

Our new MSc in Psychology and Neuroscience of Mind-Body Interface offered by the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London aims to answer this question. The blood has many functions, including, most notably, the spreading of oxygen to all our organs through red blood cells, and the distribution of immune cells (white blood cells) to the site of an injury of an infection. However, its most important function might well be the communication between the mind and the body by carrying hormones, that is, chemicals released into the blood that transmit signals between the brain and the body. As part of our newly established MSc in Psychology and Neuroscience of Mind-Body Interface, we are producing a series of ITM pieces dedicated to educate and inspire students on the psychology and the neuroscience underlying brain/mind processes, and their connection with physical symptoms. We already have two pieces by the MSc lead, Dr Alessandra Borsini, on how this knowledge can project the clinical and academic career of students, and on the many mechanisms connecting the brain, the mind and the body. Today, we will talk about one such mechanism: hormones, and the blood that carries them around. Today, we read hormones’ names routinely in our blood tests: cortisol, T4, oestradiol, testosterone... But this name was only created at the beginning of the 20th century, by two physiologists at University College London, William Bayliss and Ernest Starling. Until then, the prevailing understanding of bodily functions was that nerves – i.e., direct connections originated in the brain through the sympathetic and parasympathetic nervous systems – are needed to regulate how organs, like the stomach, heart, and intestine, work. However, in their 1902 experiments, Bayliss and Starling found that the duodenum (a part of the intestine) releases a substance in the blood that reaches the pancreas (the organ that controls glucose levels) and stimulates the section of the digestive substances. This was an incredibly original and creative discovery at that time. Three years later, Starling created the term “hormone”: from the Greek participle ὁρμῶν (hormôn), the present participle of ὁρμάω (hormáō), that is, "setting in motion, to excite or arouse”. The discipline that specifically investigates the bidirectional communication between hormones and the brain is called “psycho-neuro-endocrinology”. This discipline studies how some brain cells are part of both the nervous system (i.e., receive direct communication from other brain cells) and the endocrine system, as they secrete hormones in the blood to reach other parts of the brain or other organs. These psycho-neuro-endocrine mechanisms are very important for emotions and behaviours. More recently, this concept has been expanded to include the communication between the brain, the endocrine, and the immune system, as often discussed on ITM. Immune cells are both moving targets of hormones and moving sources of hormones (called “cytokines” or “interleukins”) which not only interact with other immune cells but also with other organs, like the brain, the muscles, and the liver. The effects of cytokines on the brain are one of the most exciting recent developments in our understanding of emotions, behaviours, and mental health, and a central tenet of mind-body interface. There are more than 50 hormones in the body, and so a summary of their names and function is necessarily quite limited. Here is my attempt to do it. Adrenaline and cortisol are the two life-saving hormones that give us the energy and the concentration to deal with stressful situations. High levels of these hormones are good in the short term (minutes or hours) but bad in the long term (days or weeks), and they are involved in fear, arousal, anxiety, and sadness, and thus contribute to a range of mental health problems, from depression to panic attack and post-traumatic stress disorder. FSH, LH, and progesterone regulate the physiology of the menstrual cycle and the preparation of the body for pregnancy. They are also particularly important for the instability of mood – the mix of sadness, agitation, and irritability – experienced during the days preceding the arrival of the menstrual period or the days following childbirth. Interleukin-1 and interleukin-6 are examples of hormones secreted by the cells of the immune system. These hormones not only regulate the immune response, facilitating the elimination of viruses and bacteria during an infection, but also reach the brain and shut down our interest in social activities, as well as increase our fear of the external environment, so that we naturally go into “social isolation”, and thus the infection is contained as much as possible. These cytokines also affect the brain in situations of psychological stress unrelated to infections, contributing to mental health problems such as depression and anxiety, and can be targeted by anti-inflammatories as treatment for mental health problems. Leptin and incretin decrease our appetite while ghrelin increases it. They are produced in different parts of the body (Leptin in the adipose tissue, ghrelin in the stomach, incretin in the intestine), reach the brain and regulate appetite. They are relevant to the cause, and potentially the treatment, of problematic eating behaviours and of metabolic disorders, such as anorexia, bulimia and obesity. Other hormones that regulate blood sugar levels, like insulin, also regulate hunger, while vasopressin regulates thirst. Oestradiol and testosterone are the two types of sex hormones, present predominantly in, respectively, women and men, while prolactin is the breastmilk-producing hormone. These hormones have an important role in our sexual development as well as our sexual desire – and in the fact that different mental health problems are more prevalent in males or females. These hormones also regulate brain areas relevant to sexual desire, and the anticipation, preparation, and experience of sexual activity. They also have a role in abnormal emotions and behaviours leading to excesses of depression (in females) and rage (in males), or in sexual problems such as low libido or erectile dysfunction. Oxytocin and vasopressin tell the brain when we are in love, or prepare the brain for having a baby. Vasopressin explains why some animals and humans, but not others, choose to be monogamous in long-term relationships. They are relevant to mental health difficulties related to social interaction, such as autism. Pregnenolone and allopregnanolone belong to the wider class of neurosteroids, which protect the brain from injury, help brain cells survive physical trauma or lack of oxygen, and stimulate the growth of myelin, the protective sheet surrounding peripheral nerves. They have a role in dementia and stroke. Triiodothyronine (T3) and thyroxine (T4) regulate virtually all aspects of our body and give us the energy required to live. Their abnormalities can manifest as both overtly low (hypothyroidism) and overly high (hyperthyroidism), and both can make us feel very tired, although the former makes us feel tired and cold, and the latter makes us feel tired and hot. Thyroid hormones are very important in depression and bipolar disorder, where are sometimes prescribed as medications. As we conclude this piece, it is important to emphasise that the notion that substances circulating in the blood can affect our emotions and behaviour has permeated our culture for centuries, starting from the “humours theory” of the Greek philosophers. Now we finally know how hormones are essential for mind-brain-body communication and can contribute a strong, holistic, destigmatising message about the reality and physicality of our mental process.

Neuroscientists are making strides in mapping and understanding the human brain, but like many other scientific fields, neuroscientific research has suffered from gender bias: men have been studied far more than women. Since it came on the scene, magnetic resonance imaging (MRI), where a magnetic camera looks through the skull and captures pictures of a living brain, mountains of neuroimaging studies have been made by scientists eagerly delving into the most complex organ we have. It’s led to amazing discoveries and insights, and revolutionised our understanding of how we function. But the neuroscientific investigation into brain health in relation to conditions only affecting women, girls, and people who have or have had menstrual periods, has been comparably pitifully small. My name’s Livia. I’m a freelance science writer and journalism student, and I found myself diving into this as I wondered why hormonal birth control, several decades after its invention, still causes negative effects on many users’ moods and well-being. Shouldn't somebody have looked into how our brains get affected when we go on the pill — and created something better? It turns out that this large neuroscience knowledge gap leaves billions of people in the dark about the organ that creates their lived experiences, affects drug development, and is bad for science, generally. It’s time for neuroscience to catch up. Half of one percent Neuroscientists know fairly little about how pregnancy, menopause, hormonal birth control, and pms or premenstrual dysphoric disorder — to name but a few — affect the brain, compared to other health conditions. Out of around 50,000 neuroimaging studies completed since the mid-90s, only 0.5 percent have focused on health issues specific to women, says Dr Emily Jacobs, director of the new Ann S. Bowers Women’s Brain Health Initiative at the University of South California, Santa Barbara. Representation, Jacobs says, has not been a problem. With gender participation in neuroimaging studies remaining at ca. 50 percent, women are just as keen as men to contribute. Instead, the problem appears to be that many researchers do not study conditions hampering the well-being of people who menstruate, and funders are typically not funding research investigations into health as much as they need them to. In a 2021 study, mathematician Arthur Mirin showed the National Institute of Health in the United States was not funding the country’s medical research on the grounds of the burden of disease alone — a measurement used to determine how many healthy years are lost to the disease in question — but generally favoured more generously funding illnesses dominated by men, even though their burden of disease was overall smaller. Dinosaurs and male pattern baldness As a result of this disparity in neuroscience, Ann S. Bowers Brain Health Institute jokingly estimates humankind knows more about dinosaurs and male pattern baldness than the brains of women and people who menstruate. It’s tragicomical, but perhaps not surprising when you consider that 80 percent of tenured neuroscientists operating MRI machines are men, as Jacobs says, and the fact that the scientific paradigm of biology and beyond has considered men the baseline standard for decades. For over 50 years, animals of the biological male sex have been the default in medical research labs across the world, chosen due to concerns that female hormone cycles would affect their behaviours and skew results (a concern later rejected by researchers at Harvard, who showed that female mice actually had more consistent and stable behaviours and should have been used). The bias of neuroscience has had repercussions for our overall understanding of the human brain as well as drug development and treatment of debilitating illnesses. Certain drugs developed to combat Alzheimer’s, for example, as well as common, over-the-counter drugs, including ibuprofen, appear to work more effectively for men. Women also seem to deal with adverse drug reactions and face side effects more often than men. And, in the high-stakes spaces of emergency rooms and assessment rooms, women are at greater risk of being misdiagnosed, across conditions ranging from stroke to ADHD. Neuroscience for all The good news is that, while much unexplored ground remains to be covered, there’s an avalanche of knowledge gathering and progress waiting to be made now — and more neuroscientists are signing up for the work. Jacobs says the Ann S Bowers Brain Health Institute, for example, plans to collect large amounts of data on the brains of women, trans, and non-binary people, and the U.S. government recently announced they have dedicated 12 billion dollars to women’s health research. We’re learning more about the brain and menopause, hormonal birth control, and other conditions — and slowly crawling closer towards knowing how to more effectively treat conditions that have historically been shrugged at, dismissed, or considered unsolvable mysteries. Recently, for example, neuroscientific evidence has helped us understand the brain on birth control, suggesting why low mood might occur when on the pill. According to a recently published study, an oral contraceptive pill, widely prescribed for decades, can change brain anatomy. In the study, the authors, who used magnetic resonance imaging to scan the brains of participants, found that only participants taking the pill had a slightly, yet noticeably, thinner ventromedial prefrontal cortex compared to those who were not on the pill (the effect was, however, reversible). Previous research has shown that the thicker that area is, the better emotional regulation works. Structural changes can also be observed inside the brains of people who go through menopause, alongside changes in brain connectivity and overall energy production, according to a study from 2021. Researchers have also uncovered hints of potential sex and gender-based differences in depression. Women are around twice as likely to be diagnosed with depression, and it can be incredibly complicated to detangle various causes for depression, with both biological components, such as hormones, and social factors, such as support, likely playing a role. In terms of how depression expresses itself in the brain, a recent review of neuroimaging studies suggests that there may be sex and gender-based hormonal and social factors at play — potential information that could prove to be useful for helping us develop more effective treatments. While more needs to be done, revealing neuroscience studies into conditions experienced by women and people who menstruate help validate people’s reported experiences. They also give hope that we might soon develop better treatments for things like endometriosis and depression, for example, or hormonal birth control that does not risk chipping away at people’s well-being, which can be deeply intertwined with the health and functioning of our brains. Changing science to become more equitable requires an enormous shift in the way science operates. But, in this case, what’s good for women and people with menstrual cycles happens to also be good for science. An inclusive scientific paradigm and practice will start to build a bigger, more comprehensive, and more detailed picture of evidence — leading to healthier brains and lives for everybody.

For many people worldwide, psychotropic drugs, which are medications used to treat mental health conditions, are beneficial in improving mental health and overall well-being. Nevertheless, at some point during or after the recovery process, the desire to quit may become stronger than the wish to continue. The decision to quit (or 'discontinue') can be challenging, raising important questions. Is this the right time to quit my medication? How quickly should I discontinue? What are the chances of relapse? Will discontinuation affect my work or social life? Recently, we have seen increasing interest in the topic of discontinuation, both in science and in the general media. As a PhD student and clinician myself, learning about the effects of psychotropic drugs, the working mechanisms, and the side effects, is an important part of my clinical training. Yet, I have noticed that I often struggle to answer a common clinical question: ‘How long should I keep taking this drug?’ I have felt that the topic of discontinuation is equally important to making informed prescribing decisions (both for patients and clinicians), but that for most drugs, we lack sufficient knowledge. In a paper published this year in the scientific journal Molecular Psychiatry, we summarised the evidence on discontinuation of psychotropic medications grouped into six different classes: antidepressants, antipsychotics, benzodiazepines (a type of sedative medication), opioids (usually prescribed for persistent or severe pain.), mood stabilisers, and stimulants (medications which enhance brain activity). For each class, we went over three essential questions: Who can discontinue, when can they discontinue, and how can they discontinue? We also discussed similarities and differences between classes and concluded with several recommendations for further research. So, what is the evidence, and how should we move forward to ensure we have proper guidance for both clinicians and patients? Let’s look at some of the key results. Before we go any further, it is important to answer one question: Why do people discontinue their medication? The pros and cons may differ from person to person. For some, the side effects may have become too bothersome, especially after their mental health symptoms have improved. For others, it may be that they wish to live a life without medication. Another reason could be that the circumstances in someone’s life have improved so using medication feels no longer necessary to them. Fear of dependence or societal stigma are other commonly reported reasons. On the other hand, people may have doubts or face barriers that prevent them from discontinuing their medication. Common is the fear of experiencing relapse, the reappearance of mental health symptoms after improvement, or discontinuation symptoms, especially if previous discontinuation attempts were unsuccessful. Clinicians may also be reluctant about discontinuation, for example, they might be afraid that their patient may relapse or have prior negative experiences with discontinuation. A lack of guidelines or knowledge may also prevent clinicians from initiating a discontinuation attempt. That being said: discontinuation is not a goal in itself, there may be many valid reasons to continue medication, and the individual’s well-being should remain the ultimate clinical ambition. Now that we have looked at some of the considerations for discontinuation, we can cover the evidence we presented. Discontinuation symptoms Discontinuation symptoms are a common and challenging clinical occurrence while using psychotropic medications. In the case of selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant, symptoms are sometimes abbreviated with the acronym FINISH: Flu-like symptoms, Insomnia (when you aren't sleeping as you should), Nausea, Imbalance (the loss of balance or unsteadiness), Sensory disturbances (such as brain zaps), Hyperarousal (that is when the fight-or-flight response is constantly engaged in a state of increased responsiveness to stimuli). We know that quick (for instance, <2 weeks) or abrupt cessation (ending suddenly) increases the risk of experiencing discontinuation symptoms, as well as using rapid-acting drugs, meaning that they are quickly excreted from the body. While for most patients discontinuation symptoms are mild, in some cases, they can be very debilitating. It is therefore important that we understand who is at risk of developing these symptoms.  Although no clear risk factors have been identified yet, previous failed discontinuation attempts and long-term use of the drug are often mentioned in scientific literature for antidepressants, for example. Another common problem, both in practice and in research, is that it can be difficult to distinguish if someone experiences discontinuation symptoms or a relapse of the mental health condition the medication was prescribed for in the first place. This is important as both problems require different approaches and treatments. Discontinuation symptoms are often temporary and disappear after increasing the dose again, while a relapse might require longer treatment. Slower discontinuation is (usually) more effective For many psychotropic drugs, it is not advisable to go ‘cold turkey’ (stop abruptly), as it increases the risk of relapse or experiencing discontinuation symptoms. Gradually reducing the dose is generally recommended. Some rapid-acting psychotropic drugs (benzodiazepines, opioids) can be switched to long-acting agents of similar classes, so the drug is more gradually excreted from the body. While, as mentioned, a longer discontinuation approach is usually more effective, it may not always be feasible for everyone. It is therefore important that we investigate the pace at which patients can safely discontinue, while at the same time identifying those who may benefit more from slower, tapering approaches. For scientific research, this means conducting studies that compare different discontinuation strategies to find optimal dosing strategies. Many people can successfully discontinue Another finding is that most medication classes are effective in preventing relapse, so continuing them after remission is still a valid option. For example, continuing antidepressants decreases the risk of relapse by 50% compared to placebo (a treatment without active properties, e.g., a dummy pill), and for antipsychotics, this percentage is even higher. Nevertheless, many people are still able to successfully discontinue without experiencing a relapse. While relapse rates can be used to make an informed decision, often other more personal considerations are discussed between the patient and the clinician (such as previous discontinuation attempts, their personal circumstances, etc.). Ideally, the decision should be shared with the patients, who should have their values centralised, and feel properly equipped to choose a personalised trajectory with their clinician. Family members and other support systems may also be involved in the decision-making process. A personalised treatment plan could be helpful in identifying early signs of relapse or discontinuation symptoms. So, how should science move forward to guide both patients and clinicians? Here are some of the recommendations we presented: First, future research should provide insight into effective discontinuation strategies as well as learn from individual patient’s experiences. While relapse is an important outcome measure, we should equally focus on other patient-relevant outcomes, such as social functioning and overall well-being, and gather more relevant clinical patient data, such as previous discontinuation attempts and medical history. Another recommendation is to investigate the outcomes of dose reduction strategies compared to full discontinuation and not limit clinical trials (research projects aiming to investigate the efficacy of treatments) to only patients with a specific diagnosis. Overall, the amount of evidence on discontinuation is still quite limited compared to the vast amount of research that has been conducted on the effectiveness of psychotropic drugs. However, it is becoming increasingly clear that discontinuation is an important topic that merits serious consideration. Ideally, both the patient and clinician should feel well-equipped to create a personalised discontinuation plan through shared decision-making. To ensure that this is the case, it is necessary to have not only sufficient clinical evidence, but also effective interventions that can be readily applied in clinical practice. While current evidence provides a general direction, much more work needs to be done to ensure not only evidence-based prescription but also the discontinuation of drugs in psychiatry.

I was a student at the University of Texas (UT) at Austin just two years ago, where my college experience was similar to what you would see in the movies. People walking with iced coffee to class, attending lectures from revered professors, and cheering loudly at college football games. Now, I live abroad, and through various news outlets, I’ve seen that the landscape I once knew has shifted. On Monday, April 29th, law enforcement officers, many dressed in riot gear, arrested 79 pro-Palestine protesters- utilizing flashbangs and pepper spray to disperse the crowd. Protestors gathered in front of the UT Tower, an emblematic symbol of the university, at 12:15 pm, according to an Instagram post from @txstudentsfordei. About an hour later, the university’s police department posted on X that a dispersal order had been issued, and protestors should “leave the South Mall area immediately.” Gathered on the main lawn of my alma mater, students chanted “Free Palestine” while linking arms in solidarity. They held signs saying, “Divest from genocide”, and “UT supports war crimes”, whilst state troopers, carrying batons, face shields, and zip ties came to the scene. This demonstration and subsequent arrests follow a similar protest from the previous week, during which 57 individuals faced arrest on charges of criminal trespassing. These conflicts aren’t confined to the UT Austin campus. The encampments started at Columbia University, inspiring universities across the country to do the same. The arrests at UT coincide with Columbia University in New York City issuing warnings of suspension to students for their participation in protest encampments and refusal to disperse. Protestors are advocating for their universities to divest from the conflict in Gaza, specifically urging them to sell investments in companies they deem complicit in the war. Through these demonstrations, students are asking universities to stop investing in companies engaged in business directly with Israel, in weapons manufacturers providing supplies to Israel, and in companies domiciled in Israel. Despite students and faculty insisting demonstrations have been peaceful, their protests have been met with increased police presence and violence. At UT, protestors have reported being ‘handcuffed’ with white plastic ties, being pushed by officers with batons, and being pepper sprayed whilst delivering water to those suffering from heat exhaustion. At the same time, as protests sweep American college campuses, concerns have arisen regarding the increasing instances of hate speech and antisemitism directed at Jewish students. According to a Jewish advocacy group, the Anti-Defamation League, anti-Semitic incidents have “spiked nationally in the final three months of 2023” since the Israeli occupation of the Gaza Strip. There are reports of Jewish students being intimidated by protesters: for example, one Jewish student at Columbia University reported that she had been called a "murderer" and was told to "go back to Poland". However, there have also been reports of Jewish students joining the peaceful protest. In the UK, where more students are starting to set up camps to protest against the Gaza war, the Union of Jewish Students has warned that the UK occupations are creating a “hostile and toxic atmosphere”, yet there are also Jewish staff and students taking part in the protest camps. Moreover, pro-Palestine protest organisers have reported being “subjected to Islamophobic and racist remarks” by those counter-demonstrating. In Texas and nationwide, demonstrations in support of Palestine have tested the commitment to the First Amendment, the right to free speech, by state and university leaders. The University of Texas released a statement on the day of making close to 80 arrests, saying the university “strongly supports the free speech and assembly rights of our community. Similarly, New York University, amidst its own series of arrests, emphasised the need to “continue to support individuals’ right to freedom of expression and…the safety of our students and maintaining an equitable learning environment remain paramount.” Four years ago, the Governor of Texas, Greg Abbott, signed a bill, enshrining free speech protections on college campuses. In a 2019 video, he says, “Some colleges are banning free speech on college campuses. Well, no more. I’m about to sign a law that protects free speech on college campuses in Texas. Shouldn’t have to do it… First Amendment guarantees it.” When the demonstrations happened recently, Abbott said student protestors “belong in jail” and should “be expelled” in a post on social media platform, X. Additionally, in October of this year, UT Austin held an annual weeklong celebration of free speech. University President Jay Hartzell said, “The freedom to speak, think, and express is at the very heart of any world-class academic institution.” However, stances have shifted from protecting free speech towards condemning student protestors. The university and state leaders have had a heavy-handed response towards demonstrations, with Abbott deploying the Department of Public Safety to crack down on campus protests and Hartzell telling the campus community he had “credible indications'' that demonstrators would try and use the “apparatus of free speech and expression to severely disrupt campus”. I asked students how they felt about these protests, the divisiveness present on campus, and the response that university administration had to them. A current student of the University of Texas, who requested to remain anonymous, said, “[Our President’s] response shows a clear reason why he cannot continue to be the president of UT: not only has he shown a clear political stance, but he has attempted to silence those with thoughts different from his.” A student at New York University, who also requested to remain anonymous, said “The response to the protests have been a reminder that in America, free speech is contingent on upholding the status quo…as soon as you start questioning the entire system, you are repressed, often violently.” She said, “anyone who has been to the protests knows not a single person who has come close to being violent or aggressive. In fact, it is the police who have endangered students…the irony is incredibly frustrating.” UT students have been dealing with the fallout and violent response to their protests whilst dealing with their end-of-year school commitments and final exams. Reportedly, students were seen with their study notes whilst occupying the university’s main lawn, or with their laptops putting final touches on their assignments. The University of Texas student I spoke to said the response to the protests “completely changed the atmosphere for finals”, and “having students and peers [she] knew being arrested was extremely difficult to watch.” In the midst of exams, she mentioned, there were “texts from police on safety alerts” and “speakers in the dining hall stating there would be action against people who protested.” My recollection of the university was one of fostering free-thinking, with the university’s motto, “What starts here changes the world” serving as a compelling reason to even attend UT Austin. However, witnessing deployed police force, and considering how student voices have been stifled over these past 2 weeks, has severely altered my perception of my former campus. The university’s actions contradict their professed values, leaving students, alums, and faculty pondering: Whose free speech is truly protected?

As a South Asian girl studying Psychology, when asked what I study by extended family and other people in my community, I’m met with a lot of judgement. This ranges from the people that think they’re hilarious by asking, “Can you read my mind?”, to people who make no effort to hide their disapproval, “Why would you want to work with ‘crazy people’?” I’ve since given up trying to argue with every single misinformed person I talk to, but these interactions have really opened my eyes to how much stigma there is around mental health in the South Asian community specifically. Stigma is when a lot of people express disapproval around a specific topic. In society, there is a lot of stigma around mental health, which makes it difficult for people to open up when they experience mental health problems because they’re afraid of being judged. As this article is based off my own personal experience as a South Asian person, I’d like to explore some factors that I’ve seen contribute to stigma in the South Asian community (and also society more generally), and some ways we can do our part in breaking down mental health stigma. It’s important to remember that what I write about isn’t reflective of the South Asian community as a whole! Research shows that, in a UK study, South Asians, including Indians and Pakistanis, were more vulnerable to mental health issues and even experience more symptoms of mental health disorders than their White counterparts. This makes the stigma an even bigger problem because it means so many people are suffering in silence. But why are so many South Asians struggling to speak up about their mental health? Generation gaps As a young person myself, I’ve often heard older people in my community dismiss mental health struggles. Research even shows that mental health is a taboo topic within older generations and so, they may feel less comfortable talking about mental health issues. Within my community, their favourite phrases to use are, “but so-and-so have it a lot worse, so why are you depressed?”, “there’s nothing to be anxious about, it’s all in your head” and “we had it a lot harder and we’re fine, you’re being sensitive”. Hearing these things every time you try to open up about your mental health can be very discouraging, so with time, you learn not to talk about it. It’s important to know that you shouldn’t be scared of speaking out and seeking the help that you need, no matter what older generations say. Sometimes older doesn’t mean wiser! One way we can address this is to have conversations. Openly talking about mental health means people feel more comfortable about the topic. This can help more people talk about it without feeling afraid of being judged, embarrassed or ashamed. Therefore, having open discussions about mental health can help to reduce stigma. Lack of education Sometimes stigma occurs because people aren’t taught how to talk about their mental health. People just may not know how to communicate, or the kind of language to use when talking about their struggles. Maybe they don’t know enough about mental health disorders in general. This shows how harmful stigmas can be. Not talking about it, means that people can’t learn about it, which in turn, makes it even harder to talk about. However, this is something that a lot of younger people are getting better at as schools have started to teach students about mental health, and today, social media can be used to facilitate conversations and raise awareness. This means we have other places to gain information from, rather than having to only rely on the elders in our community. Learning more about mental health, including good mental health and mental health issues, means that we have the language to talk about it and can also help others understand. There are many useful websites available such as: Mind, Kooth, Mental Health Foundation and the NHS websites, to name a few. Inappropriate treatments Because of the stigma, a lot of South Asians struggle to get help and if they do get help, it isn’t always right for that person. Research shows that South Asians can find it hard to get mental health help because they often don’t trust a non-South Asian professional to understand their specific struggles and they feel scared of being judged by others. This shows that stigma is so harmful that it can stop people from getting the help they need. It also shows how important it is for people-of-colour (POC) to get jobs in the mental health sector so they can represent their community and make other POC feel comfortable enough to access help. Ignoring mental health issues increases stigma. If you feel like you’re struggling with your mental health, it’s best to get help. Some options include contacting your GP or a mental health professional, talking to someone you feel comfortable with and getting information from mental health websites, charities, and organisations. Despite the stigma, a lot of South Asians are beginning to break down the cultural barrier. Great British Bake-Off winner, Nadiya Hussain, has openly talked about suffering with anxiety and panic disorder. She describes her struggles with being honest about her mental health due to stigma and her experiences with getting help in her BBC documentary. Journalist and author, Sathnam Sanghera, has also talked about his dad and sister living with schizophrenia. He describes how mental health is taboo in his culture and how he received backlash from the community after talking about mental health in his book. Well-known people, like Nadiya and Sathnam, speaking publicly about mental health and stigma can spread awareness and reduce shame, helping more South Asians to open up about their own experiences. In the South Asian community (and as a society in general!), we should carry on having conversations about our mental wellbeing and trying to be non-judgmental when others speak about their mental health. It’s important to remember that everyone has mental health, and we all experience ups and downs in our lives- being open about this is the first step in normalising mental health and eventually breaking down stigma.

The Importance of Young Voices in Mental Health Research and Beyond There are many stories I’ve held in my head and heart when it comes to young people struggling with their mental health. From intentional overdoses, to first episodes of psychosis, to disordered eating. As a Trainee Psychiatrist and Mental Health Advocate, I am dedicated to finding solutions to improve the current mental health crisis that devastatingly exists within our youth. As someone who struggled with their mental health in their early twenties, I share my lived experience of Clinical Depression publicly, in the hope of reducing the stigma and normalising what has been a taboo conversation for far too long. Ultimately, I tell my story as a doctor who has always dreamed of looking after other people’s minds, yet has struggled with her own, to make others feel less alone and dissolve the divide between US (Doctors) and THEM (Patients). I am both a doctor and patient, and I am proud of that. There need not be such a crude divide between the expertise of the service-providers and the service-users. Undoubtedly, clinical expertise is paramount in aiding the recovery of mental illness but let’s never overlook the power of lived experience. Experts by Experience, also known as Patient Champions, can be empowered to speak out and educate the healthcare workforce to better understand their experience with illness and improve therapeutic relationships with their treating teams. With this, it should come as no surprise that I attribute high value to the practice of co-production, whether used in charities, Mental Health Services or within research. I am honoured to be an ambassador for the CELEBRATE Project which incorporates co-production into its research. For this project, I recently spoke as an ambassador on their panel at their event at King’s College London. So, what is Co-production? To me, it centres around bringing the ‘US’ and ‘Them’ closer together to benefit the system itself, those whom it cares for and those who work within it. The National Co-production Advisory Group (NCAG) define co-production as: “A way of working, where everybody works together on an equal basis to create a service or come to a decision which works for them all. It is built on the principle that those who use a service are best placed to design it.” Co-production is underpinned by inclusivity and trust, it empowers service-users to have a voice and gives them an active role in improving the health service that they use. Through the lens of young people, this means that they can advocate for the changes that matter most to them, and that they would like to see. This is emphasised by the popular mantra within co-production: ‘nothing about us without us.’ The Social Prescribing Academy believe that the key principles of co-production are: Developing trust and relationship building Sharing power and decision-making Make sure all voices are included, valued and listened to Ensuring that there is something in it for everyone Reflective and reflexive practice So, when it comes to young people struggling with their mental health, what does co-production look like in practice? And how do we ensure young people who are involved in the research are seen as tokenistic? Young people’s involvement in mental health research is invaluable. It benefits the research, the young people themselves, and has a ripple effect on their communities and future generations to come. Let’s take a look at some case-studies using co-production: The Celebrate Project Professor Paola Dazzan is the Principal Investigator of CELEBRATE, which aims to ‘Co-produce a framework of guiding principles for Engaging representative and diverse cohorts of young peopLE in Biological ReseArch in menTal hEalth’. The project is collaborative with contributions from researchers, young people, parents and teachers from London, Birmingham, and Bradford. The purpose of the framework is to guide researchers doing biological research on mental health in adolescents. It is hoped that this will help overcome the barriers around getting young people involved in this kind of research, keeping them involved, allowing them to have active roles if they wish, and seeks to understand how else they can benefit from taking part. Co-production is pivotal within the CELEBRATE project. Their Youth Expert Working Group (YEWG) is comprised of 10 Young People who share their views and perspectives. The group’s remit is to work alongside the research team to design and deliver a research project that is relevant and meets the needs of young people. The CELEBRATE YEWG's involvement is led by Niyah Campbell (researcher and Senior Public and Patient Involvement and Engagement Lead at the University of Birmingham). I asked Niyah what the benefits of taking a co-production approach are: "As a research team, we have benefitted extensively from working with the CELEBRATE YEWG. In each meeting, they bring perspectives and insights that add value to the project; be that validating or being critical of approaches. Their input has genuinely shaped many aspects of this project, proving to be a sterling example of the importance of involving young people in research". D-CYPHR Dr Anna Moore (Clinical Lecturer of Child Psychiatry at the University of Cambridge and Consultant Psychiatrist) is the Clinical Lead for D-CYPHR, a new programme which represents the DNA, children and young people’s health resource. It was launched by The National Institute for Health and Care Research (NIHR) BioResource in partnership with the NHS, Anna Freud, and the University of Cambridge. Co-production is also essential towards D-CYPHR’s work, with parents and children both being actively involved. Suzie, a mother and D-CYPHR participant, said: “I saw my daughter Sophie's journey from a very unwell newborn with significant health challenges, to a vibrant and active 7-year-old, enjoying life to the fullest. D-CYPHR is an opportunity for us to support research that might give answers to other parents in our situation, as well as create better treatments for millions of people.” D-CYPHR is open to any young person aged 0-15 in the UK. With parental consent, they donate a saliva sample and answer a health and lifestyle questionnaire. This is crucial in launching new treatments for all health conditions that affect young people, from genetic conditions, to metabolic health (how the body processes food), to mental health, and everything else in between. Professor Lucy Chappell, Chief Executive of the NIHR commented: “We want to ensure that our children and young people can access the power of genetics to transform diagnosis and treatment through this research. Children and young people have shaped this work throughout, and by encouraging interest and involvement in the research process, we hope to inspire the next generation as participants and scientists." Through my own work with Nutritank, which focuses on nutrition education within healthcare and my mental health advocacy work, I’m honoured to also have been invited to become an ambassador for the D-CYPHR programme (see post). “It is the biggest health initiative of its kind in this country and a world first-a new national childhood DNA health resource for research from birth through adolescence.” Comics Youth, Liverpool Comics Youth (CY) CIC is a youth-led organisation focused on delivering comics-based literacy, publishing, and social prescription projects to young people aged 8 – 25 who experience marginalisation and are on the waiting list for Child & Adolescent Mental Health Services (CAMHS). They are partly funded by the Youth Mental Health grant-giving charity Chimo Trust, for which I am a trustee. Their mission is to provide a voice for hard-to-reach young people including but not limited to: global majority youth, looked after children, LGBTQIA, neurodiverse youth, young carers, and young people experiencing mental ill-health. Comics Youth provides their service-users with the tools for self-expression and improved mental health through creating and publishing comics about lived experience-led issues. Co-production is at the core of their work, as they support young people to take ownership of their narratives and lived experiences through social action and creative comics therapy, which is used as an innovative tool to spark change in the young people’s life course. I asked Rhiannon Mair Griffiths MBE (Co-founder & Managing Director of Comics Youth) what the benefits of taking a Co-production approach are: "Co-production enables trust to foster mutual respect and shared ownership, and helps us reshape services to be more person-centered, inclusive, and at higher quality for the young people we serve. We truly believe that young people’s voices and experiences need to be at the forefront in developing and delivering our workshops, to ensure they are culturally relevant and offer alternative solutions for young people who struggle to access ‘mainstream’ mental health services like CAMHS. Our programmes are aimed to provide wraparound support for young people who struggle within key transition points when mental health can be impacted. By providing young people with a supportive and preventative intervention at these stages, we seek to equip them with a diverse range of arts-based coping strategies and solutions, that ultimately increase their ability to adapt and remain resilient during uncertainty and change. Whilst our inclusive programmes offer universal support, we are deeply committed to reaching and engaging the most marginalised young people who face barriers in accessing mental health support, often for reasons beyond their control. Ultimately, no one knows better than a young person who has faced such heightened barriers, how they’d like to be supported.” As demonstrated by the several case-studies, whether national research projects or charitable organisations, co-production is invaluable when it comes to improving youth mental health. It provides opportunity for service-users to contribute to the design of the mental health treatment and services that they intersect with. It leads to durability and sustainability of services, as it ensures that the systems or treatments are person-centered, so will work more effectively for the people they are created to support. Ultimately, it allows for young people to feel valued, appreciated and gives them purpose from their pain, and empowers them to turn their struggle into strength to help not only themselves, but many others to come.

Content warning: This article mentions suicidal thoughts, which might be distressing to some readers. I moved to the United Kingdom from the United States four years ago and have been working as an Editor. I prepared for everything when I found out I was pregnant. Labour, birth, and taking care of a newborn. But, I was not ready for the postpartum period — the period after childbirth. Doesn’t this only happen to people with traumatic births or difficult pregnancies? No, it doesn’t. It can happen to anyone, and it happened to me. I’m staring into the face of my newborn and I feel empty. This is what nobody talks about, what nobody warns you about. This is my experience with postpartum depression. Two weeks after delivery The first two weeks after delivering my first baby were a blur. I remember struggling to nurse, endless night wakes, and sleepy newborn snuggles during the day. I remember midwives visiting, focused on how much the baby weighed and how my second-degree tear was healing. I remember family and friends coming to see the baby, and I remember each day it felt like I was slipping further and further away from myself. Around two weeks is when everything changed. I can only describe what happened inside of me as a crash. Like when you get to the top of the rollercoaster and then come racing down, it happened in an instant, and instead of at the end of the rollercoaster when you laugh at how scary and fun a ride it was, I was left broken. Around this time, we were issued a health visitor. She came to introduce herself and get us set up in the system. She asked how everything was going. “I can’t stop crying,” I told her. “Something feels not right, I’m very emotional.” She seemed so sure of her advice that I didn’t think to question her. “Mothers often feel weepy around this time, you’ll start to feel normal soon,” she also added, which I will never forget “Make sure you are resting enough.” Resting enough? Hilarious. As if she didn’t see me sitting with this newborn baby in my arms. Everything starts to feel scary At this point, I was another person watching myself go through the day. I looked in the mirror and, even though I could see myself looking back, I swear I was looking at a stranger. I was looking at a body that I didn’t recognise. My eyes were swollen and red from the constant crying, and my stomach was stretched out, saggy, and covered with stretch marks. My chest was heavy and sore. Physically, you could say that I was fully recovered. My tearing had healed and I was no longer taking Tylenol and ibuprofen for the swelling and pain. But mentally, everything was falling apart. I couldn’t bring myself to do basic things. I couldn’t shower, I was barely brushing my teeth. I felt gross and disgusting but also couldn’t bring myself to care enough to do anything about it. I took care of my baby. I struggled with nursing every day and this weighed heavily on my mental health. Feeding your baby should be an instinct, so why can’t I get him to latch? What am I doing wrong? I can’t believe I am failing him already. Everyone with their good intentions and advice only made me feel worse. This led me to hide deeper within myself. Every bottle I had to prepare in front of someone else brought me such shame and guilt. One particular day, a day when I had already spent hours crying, someone said that I just needed to “try harder,” and this broke me. The darkest downward spiral My brain started to feel cloudy, everything around me looked foggy. No matter how hard I tried, I couldn’t see anything. I was taking care of my son, obsessing over everything he needed or did. Is he sleeping enough, is he getting enough tummy time — every question I got about his development felt like a personal attack. Having visitors at this point was crippling to me. I would stay around people for as long as I could and then hide and cry in another room. It was so overwhelming to have to pretend to be okay in front of other people that I couldn’t take it for very long. Then the intrusive thoughts started getting stronger. It was my own voice that I could hear telling me that my baby would be better off if I wasn’t here, that my husband would be happier, that they would both thrive with me gone. The more I fought against these thoughts the louder they got. By now, my son was around twelve weeks old and, despite my health visitor’s assurance, I was not feeling better. At this point, I knew something was really wrong. My husband tried to help me, comfort me, and understand. He asked what he could do to help, but how do you tell someone that life just feels like too much right now? A glimmer of light Around the time my son was six months old, I knew that I couldn’t carry on like this anymore. He needed me, and I couldn’t be here for him if I couldn’t show up for myself. For my own mental health, I stopped pumping breast milk and switched to solely using formula. Maybe it was a combination of stress and not being able to get my baby to latch but my supply was drying up and I knew that mentally I couldn’t handle this anymore. It was time to let this go and move on. I made small daily tasks that felt manageable. I made it a priority to wash my face every morning. Once I was able to do that, I made it a habit to start getting out of the house. Up until now, I would only leave the house if my husband also came, I was convinced I wouldn't be able to soothe the baby if he started crying while we were out. But in getting outside I saw my baby and myself come alive. Now, don’t think a little skincare and fresh air was a magic fix. It wasn’t. There are still lingering effects of this time that I carry with me and struggle with. But I have a wheelhouse of tools that I lean on to get through. Mantras, which I thought were a little ridiculous before, help me refocus myself when I start to spiral. A favourite of mine is, “This is hard right now, but I can get through this.” My husband and family, whom I can lean on when things feel like too much, and my religion, Islam, which keeps me grounded. I sincerely hope that in sharing my experience, at least one person will know that they aren’t alone. That it is okay if you feel this way. You haven’t done anything wrong, it’s not your fault and it is okay to get the help you need. There are options that you can go through with your midwife team which are free to use. So please don’t be afraid, don’t wait to feel better, and seek the help you deserve.

Introduction Life is an incredible journey, and for those of us on the autism spectrum, it can be a uniquely enriching yet occasionally challenging adventure. My name is Asifa. I am a first-year PhD student at King’s College London, and I am on the spectrum. Autism Spectrum Disorder (ASD) is a condition that affects how people interact with others and experience the world. It can lead to challenges in social skills, communication, and behaviour. ASD varies widely from person to person and is typically diagnosed in childhood. As ASD affects each person differently, my experiences offer insight into the diverse ways this condition manifests and evolves over time. In this article, I want to share my journey, focusing on the challenges I've encountered and the transformative process of finding and embracing my authentic self. A Rhythm All My Own My childhood was marked by an unmistakable rhythm, even though I couldn't quite grasp its significance back then. I always felt like I was on a quest to find where I truly belonged. Even from a young age, I knew I was different from my peers, but understanding the nature of that difference eluded me. While my neurotypical peers seemed to glide through social situations effortlessly, I found them to be extremely anxiety-provoking. I remember scripting conversations and creating mental flowcharts each night before school, attempting to anticipate every possible social interaction. I did this just so I could try to be a part of the conversation, to fit in, even though it felt like I was deciphering an alien language. The fear of saying the "wrong" thing made me quiet, and I often withdrew into my own world. Social interactions felt like a daunting maze, and I struggled to navigate them with ease. Instead of joining in on conversations and forming connections, I sought refuge in the pages of books or threw myself into my studies. While these pursuits brought me solace, they also meant that I didn't have many friends during my formative years. I had always dreamt of being part of a close-knit friend group, but the challenges of speaking to and understanding others made it seem like an unattainable goal. The isolation I felt was further exacerbated when I began to experience bullying from my peers. Being unable to fully grasp the intentions and nuances of social interactions made me an easy target, and it was a difficult period in my life. Despite the hardships, I held onto hope that someday I would find my place in the world and forge meaningful connections. Little did I know that my journey would lead me to a deeper understanding of myself and the unique strengths that come with being on the autism spectrum. The Autism Revelation My journey toward self-discovery took a significant turn when I attended a psychology class that covered autism. It was there that I began to explore the possibility that I might be on the autism spectrum. The more I learned about autism, the more I saw reflections of myself in the descriptions and characteristics. In particular, I remember my teacher making us do a ‘Reading Mind Behind the Eyes’ task. This task is supposed to measure a person’s ability to understand others’ emotional states, by choosing which word best describes what the person in the picture is thinking/feeling. I remember being extremely confused and in disagreement with what the right answers were. As soon as I got home, I spoke to my psychologist about seeking an ASD test. The pieces of the puzzle started fitting together, and my late teens brought the revelation of an ASD diagnosis. The moment I received my autism diagnosis was both liberating and profound. It was like finding the missing puzzle piece that completed the picture of who I am. Suddenly, the challenges I had faced throughout my life began to make sense. My anxiety in social situations; feeling that sounds were too loud; my disdain for certain textures or materials; and I embarked on a new chapter of self-discovery. Nevertheless, there was still a part of me that resented being on the spectrum. The idea of having a lifelong condition that made me perceive the world differently than most people was a source of internal conflict. Acceptance did not come easily, and it took time for me to realise that being on the spectrum was just one aspect of my identity. As I embraced my diagnosis and began to understand myself better, I started to appreciate the unique perspective it offered. My way of thinking, my attention to detail, and my ability to focus deeply on my interests became strengths rather than limitations. Ironically, focusing on learning new languages became an important part of overcoming that initial resentment, and allowed me to move forward on my journey of self-discovery with a newfound sense of acceptance and even pride in who I am. While being on the spectrum presents its own set of challenges, it also brings a wealth of strengths and perspectives that make me who I am today. Being Myself My journey with ASD has been marked by challenges and personal growth. While the difficulties have been significant, they have also contributed to my resilience and determination. Discovering that I was on the autism spectrum was like finding the key that unlocked the door to a deeper understanding of myself. It was an epiphany, a pivotal moment that forever changed my perspective. Suddenly, the seemingly insurmountable challenges I had encountered throughout my life began to fall into place, each one a piece of a puzzle that was finally making sense. Yet, as liberating as this revelation was, it did not come without its share of internal conflict. The idea of having a lifelong condition that set me apart from most people initially led to resentment. I questioned why I perceived the world differently, why social interactions felt like mazes, and why sensory sensitivities were so overwhelming. Acceptance, I found, was a process that required time and introspection. As I reflect on my journey with ASD, I've learned invaluable lessons that I believe can benefit others facing similar challenges. For those navigating their own path with ASD, I want to offer words of encouragement and support. Embrace your uniqueness and celebrate your strengths, for they are what make you truly exceptional. Seek out a supportive community or network where you feel understood and accepted. Remember that it's okay to ask for help when you need it and to prioritise self-care. Above all, never lose sight of the incredible potential that lies within you. Your journey may have its obstacles, but it is also filled with moments of growth, resilience, and triumph. Keep moving forward with courage and determination, knowing that you are never alone. My experiences with ASD have shaped me into a more empathetic, adaptable, and resourceful individual. Every obstacle I've faced has taught me valuable lessons, and I'm grateful for the opportunity to share my journey with others. By embracing our differences and focusing on personal growth, we can lead fulfilling and meaningful lives, regardless of the challenges we may encounter along the way.