Author's Note: This story was inspired by the idea that falling in love can 'fix' your mental illness. It can't, but being loved and supported can make dealing with it easier. I hope we can all find that. Thank you for reading. Photo by freestocks.com on Pexels I step inside the library and let the thick air, full of unread words, coffee, and aged paper hit me like a hug hello. It almost numbs the anxiety buzzing around my stomach like a hive of bees, but only just for a moment. The library is busier than I thought it would be, and the mere sight of more people than I thought makes my chest constrict, like an allergic reaction to being stung. I manage to reorient myself and make my way to my usual quiet corner, with its soft chair, worn and big, which envelops me when I sit, like I'm being hugged by a beloved family member. It's so strange that this corner is always empty, because it's the one place in the library with, in my opinion, the gold at the end of the rainbow. Even the old CDs glitter like silver if you twist them in the light, and the boxes of tapes sound like pieces of gold when you get them off the shelves. I know, I know, I know - why don't I just use an app and listen to the audiobooks from home? Well, I would, but they don't always have the best narrators, or the older books, and anyway... it's good for me to get out of the house sometimes. Isn't it? That's what I've been told, and over time, I think I've started to agree. I slip a CD carefully into the Walkman I managed to get for a bargain online, and let the soft silky voice fill my ears, gentle, and calm enough that it calms the buzz of anxiety within me, and blocks the noise around me - everything, around me. And soon, it's just me, and the words being read aloud. It's like magic. It's like medicine. It's almost like I'm meditating, and I trance as the words enter my brain and twist so that a story appears there instead. 'Excuse me?' a voice sounded - a different one than the narrators, more muffled. I opened my eyes and saw a new librarian - maybe a little older than me, with kind brown eyes, and a gentle smile, as if she was genuinely pleased to see me. No, my anxiety awoke in my chest and started to reverberate so loudly that it hummed in my ears. No, she's being nice because she has to be. She's going to tell you to leave; to go because you're in the way. What were you even thinking, coming here anyway? ‘S-sorry?’ I stuttered, as I awkwardly pulled out my headphones. Wow, you can’t even pull-out headphones properly. She’s going to think you’re so weird. I try to focus on her, to ignore the anxiety that grows increasingly louder every second, but I can’t look her in the eyes. Not right now. ‘Is everything alright? I notice you come here to listen to CDs and tape audiobooks a lot. I just wanted to say, you know you can take the audiobooks out if you like, to avoid sitting around with me when you can be comfortable at home,’ she adds, laughing a light laugh that sits lightly on my chest – a soft flower that the bees can get distracted by, just for a while. ‘Um, it’s okay,’ I managed to say. ‘I like it here.’ ‘Me too,’ she replied, with a soft smile. ‘But just don’t tell my boss, okay? Otherwise, he’ll make me work extra shifts.’ She grins, and I find myself smiling back. And when she squeezes my arm goodbye, I find myself thinking about the warmth of her touch far more over the rest of the day than anything my anxiety tried to tell me that I was doing wrong. I started going to the library a lot more often after that. Not every day, my anxiety got the better of me sometimes and I was too scared to leave the house, but I finished that audiobook much quicker than I had finished any of the others. I didn’t expect anyone to notice, but she did. ‘Finished with that book already?’ She asked one day, after I slid the last CD back into the case and the case back onto the shelf. Look at how weird you’re being, coming here so much - of course she’d notice a weirdo turning up at her workplace almost every day. The anxiety was so loud in my head today that all I could do was nod back at the nice librarian. ‘Did you enjoy it? I can order the sequel for you if you like,’ she said, smiling at me. Look, she’s having to hold back a laugh at how weird and pathetic you are. ‘I-I’ I started to say, so the silence didn’t drag on too long. Come on, idiot, get the words out. ‘I did, yeah.’ Her smile grew wider, despite my awkwardness. I tried to ignore my anxiety loudly repeating the fact that she was trying not to laugh at me. ‘Great! Would you like me to order the sequel for you? It should be here in a couple of days.’ I nodded again, smiling this time, thanks to hers being so infectious - I caught it like a cold. She nodded back, before walking over to the librarian's desk and gesturing me over. The way she moved was so light and quick that it was almost like she was moving through water, or if gravity had less of a grip on her. It was magical, and for a moment, I was able to ignore my anxiety about making a fool of myself in front of people and follow her to the desk. She smiled wider when she saw me walk up to her, and I felt a heat spread across my face. Brilliant, now you look stupid. She turned to tap at the computer in front of her a few times before turning back to me. ‘Right, I can definitely order it for you. I just need your library card.’ I nodded again, before passing the thin piece of plastic to her. Let’s just hope that she doesn’t see that your hands are shaking. ‘Olivia, is that your name?’ The librarian asked, the smile still on her face like she genuinely liked it. Don’t be stupid, she just acts like that with everyone she serves. ‘Yeah - Yeah. I uh, I prefer Oli, though.’ ‘Okay! Nice to meet you, Oli,’ she said, still smiling. ‘My name’s Jess.’ ‘Hi Jess,’ I said. She giggled, and I felt awful.; I opened my mouth to apologise before she reached out a hand towards mine, passing me back my library card. The warmth of her hand as it brushed against mine was enough to quieten my anxiety trying to tell me that I’d made a complete and utter fool of myself. ‘Hi Oli,’ she replied. ‘So, the audiobook CDs will be here in about a week. Maybe you could come back then? It- ‘ She stopped herself, and a slight pinkness, like a blossoming rose in the sun, spread across her face. She cleared her throat, before adding, quietly, ‘It - it would be nice to see you.’ ‘Really?’ I blushed then too. Fierce and red, like a fire. I didn’t mean to say it out loud, but I was so surprised that the word just slipped out. ‘Sorry, I- ‘ ‘No,’ Jess said, quickly. ‘Don’t be sorry. Really, really,’ she added, smiling slightly. ‘I love the physical audiobooks section, and hardly anyone uses them, apart from you. It’s nice to see someone who appreciates them.’ ‘Thanks,’ I replied. ‘It’s nice to see you, too.’ My anxiety started going haywire, telling me I’d just said the worst thing possible, but then Jess reached over to squeeze my shoulder again, and I was able to just about ignore it. ‘See you next week, Oli’ Jess said, and all I could do was nod; not because of the anxiety - even though it was still there, trying to get my attention. But for some reason, I couldn’t find the words I wanted to say back. It was like the air in my throat had just disappeared, taken away into the air between us. Next week came by quicker than I thought it would. It was like the days flew by, just as excited to get to that day as I was. But as soon as the day actually came around, my anxiety was so intense that I couldn’t get myself out of the front door. I felt awful, like I’d let Jess down, and after a lecture on how much of an idiot I was and how much Jess likely hates me now, I resolved never to go back to the library again, as sad as that thought actually made me. It was for the best, really - it at least took the weight off of my chest and, helped me breathe easier, even if it did add it back onto my shoulders. I’m not sure why, I didn’t even know Jess all that well, but the thought of letting her down and not seeing her again, made me feel sadder than I thought possible. I sat with that sadness for the rest of the day, feeling downright awful, until after 5 pm, when I heard a soft knock on my front door. Or, I thought I did. As soon as I heard it, my anxiety buzzed so loud in my brain that I was convinced that I’d somehow misheard it. That it wasn’t actually a knock on the door, but just the old bones of the house settling, or the dull footsteps of someone outside. It wasn’t until about an hour later that a car door slammed outside and my anxiety convinced me to take a look and make sure that everything was okay. It was only then that I saw something small on my doorstep, like it had been left there. I rushed to grab it so quickly that my anxiety didn’t quite have time to tell me what an idiot I’d been, or to not open the door at all. It was a carefully wrapped audiobook - the same one that Jess ordered for me a week ago. The one that I was meant to pick up today if my anxiety hadn’t stopped me. Underneath it was a note, written in careful and easy-to-read handwriting. It said: Oli - I missed you today. Hope you’re okay. I took this out for you using your card, and delivered it to the address on file. My number is below, text me to make sure it got to you, and I haven’t just dropped this off at a random person’s door! I’d like to hear what you think of it, too. I hope this isn’t too forward, but maybe we could talk about it over dinner sometime? Text me :) - Jess I finished that audiobook quicker than any other I ever listened to in my entire life and I drank up every word. I texted Jess too, and we talked every day. It was so easy to talk to her - maybe the texting aspect helped - but it was as if I’d known her for a long time; it was so easy to bounce off her, to talk for hours and for it to feel like minutes. To fall asleep texting her, even. I went on the first date of my life not long after. It was sweet - I didn’t expect it to be at my local library, but I appreciated that it was somewhere familiar to me, and it was Jess’ suggestion, anyway - she had a late solo shift organising the shelves and asked if I could bring some pizza and we could make a date out of it. As easy as that. Jess, made things easier, more effortless, in that my anxiety was much quieter, as if her just being there, close to me, made me calmer. I knew the audiobooks I listened to couldn’t be wrong. When people like me, anxious and scared of being around people, meet someone else and get into a relationship, then all the anxiety goes away. They help you be better. The date went great, and soon we went on another. I was elated, and things were great; better than they had been in years. I could sleep better, take better care of myself, and then actually leave the house without too much constant terror buzzing around in my head - like the bees had moved on to another cranial orchard. That is, until a few weeks later. Jess had invited me to a bar to meet a group of her friends. She was so excited to introduce me to them, even if she didn’t actually say it - I could tell. And while her happiness usually made me happier, this time, it terrified me. As soon as I realised how important this night was to her, the bees found their way back to my brain in abundance. They’re all going to hate you. You’re going to be awkward and do something stupid and Jess is going to be embarrassed to be with you. She’ll break up with you on the spot. Don’t go, you idiot, you’re going to ruin your relationship. Eventually, even with Jess around, all of the anxious noise was hard to ignore. Even impossible. When the time came to get ready, I just couldn’t do it. Even picking out the clothes I’d planned to wear out of the wardrobe made me burst into tears. In the end, all I could do amidst the crying and shaking and buzzing anxiety was text Jess I’m sorry, I can’t make it, and sit crying in the shower, feeling like I’d ruined everything. I almost didn’t hear my door knocking over the rush of the water from the shower. But when they knocked again, louder this time, I turned off the shower, hurriedly dried myself, and pulled on some clothes. By the time I got downstairs whoever was at the door was so desperate to see me they were knocking so hurriedly that it almost matched the buzz of worry in my brain. I was going to hide and pretend I couldn’t hear it, like I was doing in the shower with my anxiety. However, I somehow heard her voice, shouting through the wood of the door and despite how awful I felt, I couldn’t just leave her out there in the cold. I had to open the door. Contrary to what my anxiety told me, Jess didn’t look angry. She looked worried. Even scared. ‘Oli! God- ‘she said, throwing her arms around me. I pulled her inside and just held her. ‘I was so worried about you - are you okay?!’ It was when she pulled away and the cold hit me again, and it was the tears in her own eyes that made me burst into tears again. I don’t remember much of what else happened that night, but after I woke up the next morning Jess told me that I basically cried in her arms and told her how terrified I was to meet her friends. When she said that that was normal, I broke down and told her just how much anxiety I felt daily, from every time I left the house, and especially every time I had to interact with people. I told her about the bees, and how I’d been doing okay lately, but was really struggling and embarrassed to tell her, for fear of me losing her completely. ‘That’s the thing that hurt the most,’ said Jess, as she put a cup of tea down in front of me in my kitchen. ‘That you felt like you couldn’t be honest with me, and that if you were, that you’d lose me.’ I started to say something, but she stopped me. ‘No, you don’t need to say anything. You haven’t upset me. I’m just sorry you felt that way, and that I wasn’t able to help you.’ ‘But you have,’ I said. ‘You held me all night last night, and ever since I met you it’s been so much better. You helped me be better.’ Jess shook her head, a soft smile on her face. ‘Oh, Oli.’ ‘What?’ I asked, confused. ‘I didn’t help you be better. You helped yourself. Whether I was around or not, you still did things that meant you felt better.’ ‘Oh,’ I said, realising that she was right. Sure, I showered more and took better care of myself because she was around. But I still took better care of myself. Me. ‘Yeah, and by the way, none of what happened last night would ever make me want to break up with you. I care about you Oli, and I know things seemed magically better for a while, but sometimes they get better and bad again and then better, and it’s no -one’s fault. Whatever happens, I’m going to be here for you. We’ll get through everything together, me and you. But don’t forget all of the stuff that you do, too.’ Jess said, before squeezing my hand and sending that same amazing warmth through me. Even though I still felt terrible after all of the crying, and I had felt better for a while before, this was the first time in a long time that I actually felt hopeful. That I could do this, bad days and all. I wanted to say all of this to Jess, there and then, over a cup of tea, but what ended up coming out in a jumble of words was - ‘Thank you, Jess. I will. I love you.’

Throughout most of my career, I have been held back by my introversion. Contrary to popular misconception, introverts don’t hate being around other people entirely. For the most part, I enjoy working in an office, surrounded by my friends and colleagues. I even enjoy the occasional social gathering with colleagues. However, when it comes to my day-to-day working life, my introverted self will show. I do not speak up often in team meetings, even if I have a good idea. I do not willingly volunteer for group work or to lead a project. I prefer to work alone to get an important piece of work done with my headphones on, focused only on the task at hand. I might only attend one out of three social events. My extroverted colleagues are popular. They speak up in meetings, even if their ideas aren’t brilliant. Yet they are praised for it, and rightly so. They contribute. They make people feel good. They make newcomers feel welcome and they make managers feel like their work is in capable hands. Office life seems to be built around extroverted people. Collaborative workspaces, team meetings, icebreakers, networking, and open-plan offices… it is designed for us to socialise and build relationships. This is great news for extroverts, but not so much for the others who prefer a quieter pace of life. As my career progressed and I moved into more senior roles, I found my introversion becoming a problem. Suddenly, I was struggling to get promoted, or being told that I needed to contribute more, or that I was coming across as disinterested. I was told that I was too quiet and didn’t leave much of an impression on others. The quality of my work was irrelevant because it was how I came across to other people that mattered. After much introspection about why I was developing a negative reputation despite consistently providing the same quality work, I identified the problem. My introversion was holding me back. I wanted to find a way to keep up my good reputation and enjoy being in a social environment without changing my personality at work. Nothing is more exhausting than pretending to be somebody you aren’t for nine hours a day, five days a week, and why should anyone feel the need to change themselves for their job? Instead, I opted for different tactics, some of which I will discuss in today’s article. Educating others on what it means to be an introvert In job interviews when people would ask me what my greatest weakness was, I would tell them it was my shyness. Nowadays, I have stopped thinking of my introversion as a weakness. Instead, I try to educate people on what it means to be an introvert. Whenever I have a new manager, I tell them that I am a quiet person and prefer to work alone. I tell them I am not unhappy to be part of a team, but that I am uncomfortable in certain situations such as teambuilding exercises in large groups, and that back-to-back meetings for eight hours will drain my energy something fierce. An experienced manager should know how to look after all types of people and should understand the individual differences that make a person great. Unfortunately, not all of them do. If you’re also a manager, it’s important to engage with your team and find out their working preferences. Introverts make wonderful managers, as we know the struggle of working in an extroverted world and can empathise with our introverted team members. Find out what your team does and doesn’t like about your work environment and help to build a space that makes them comfortable too. Focus on the quality of their work, and identify when the quality may suffer as a result of their environment. Speak up about what makes you uncomfortable Speak up? As an introvert? Yes, it sounds counterproductive. However, speaking up just a few times can be beneficial. In my most recent workplace, the newly appointed director was eager to build up team relationships after years of working from home, and their plan involved away days, nights out, and putting people on the spot during meetings to tell everyone a fun fact about themselves. During a one-on-one meeting with them, I advised that not everybody is comfortable with this, and the chances are that the introverted team members will avoid the away days, and then feel isolated. I suggested alternatives, such as asking everyone in the team to write a one-slide profile about themselves that everyone else can view on their own time. That way, the team can get to know each other without a spotlight on any one person. If your management is not experienced with introverts, they will only learn with feedback, and if they don’t learn, the introverts will become more isolated and less likely to progress in their careers. Ask yourself: Are you in the right job? There is always the possibility that the career you are in is not introvert-friendly and never will be. It doesn’t necessarily relate to the number of people you talk to, either. I enjoy jobs where I work directly with members of the public, which might sound like an introvert’s nightmare, but it’s the one-on-one communication that I enjoy as opposed to working with large groups. If you’re having to deliver presentations to fifty people every day and spend every other working minute in meetings, then perhaps your career isn’t aligned with your personality. Take the time to think about what motivates you at work, what gives you energy, and what inspires you. If your heart isn’t in it, then this may explain why you haven’t progressed as much as you’d like. When it comes down to it, introverts can sometimes struggle with career progression. It often feels like the entire world is built for extroverts. If left in an environment that makes us uncomfortable, we tend to withdraw, isolate ourselves and shy away from confrontation. Because of this, others may perceive us as aloof, unfriendly, or unwilling to engage in teamwork. By communicating clearly about our preferences and sharing knowledge on introversion, we can showcase our true skills and ensure we do not miss out on the progression that we deserve. I recommend Susan Cain’s book, "Quiet: The Power of Introverts in a World That Can't Stop Talking" for further insight into how we as introverts can find our comfort in an extroverted world.

Being a writer, I have explored and am still exploring many mental health concepts and solutions for better wellbeing. In today's times, where we are fast-moving and stressed, scream therapy has caught my attention because of its unique approach and ability to provide an unconventional yet potentially cathartic release of stress and tension. That’s when I thought to dig deeper and share the potential of scream therapy, aka primal therapy, out there. Scream therapy might be a new term for many, but the idea of catharsis is well known to the world, and scream therapy is no different from it. It is all about “letting go of the steam.” According to research, if we continue to ignore our emotions, they can eventually intensify and become stronger. This may affect our relationships, physical health, and general well-being. It was also reported in a 2019 study that hiding emotions is a barrier to good physical health. In a 2008 interview with Dr. Phil McGraw, Oprah Winfrey said, "I was screaming for my mother, I was screaming for my father, I was screaming for all of the things that had ever happened to me that I had never been able to express. And it was the most cathartic experience of my life." So, it's clear that managing our emotions is a good thing. Just like Winfrey, releasing yourself from past traumas can be soothing for all. To explore this further, let's talk about “scream therapy”. What is scream therapy? Scream therapy, also known as primal therapy, occurs when a therapist helps a patient remember and relive a traumatic childhood experience. The patient then expresses their emotions through screaming, crying, or other physical outbursts. It opens a door to confronting emotions such as anger, sadness, and fear. Origins of scream therapy Dr. Arthur Janov first developed scream therapy in the 1970s in his book. Soon after that, his books started to revolutionize psychotherapy and became the talk of the town for every psychiatrist, researcher, and medical expert of that time. His theory was based on the idea that childhood trauma is often the root of many mental health problems, such as anxiety, depression, and post-traumatic stress disorder (PTSD). In his interview, when asked about his approach to accessing these emotions, he explained that patients become more open as they go through therapy. They gain more access to their feeling centres in the brain, which is crucial for healing. Dr. Arthur Janov believes that scream therapy is much more effective than any cognitive therapy. However, it is important to note that this is based on his personal opinions rather than on research evidence. According to his opinions, primal therapy goes deep into the emotional centres of the brain, while cognitive therapy remains in the left frontal area, focusing on ideas. Emotional release, not just cognitive ideas, is essential for wellbeing. How does scream therapy work? Scream therapy is a way to release all the negative emotions that you've been holding inside. The process can be intense, but in the end, it offers closure to a long-standing emotional stack. According to Dr. Ryan C. Warner, Ph.D., psychologist and founder of RC Warner Consulting, this step-by-step breakdown should make it easier for you to comprehend: Step 1: Regression In this stage, you will be reminded of the difficult phases of your life with the help of your therapist. It’s important to allow yourself to feel the exact emotions without fearing or feeling embarrassed about any of them. Step 2: Release Next comes the reaction. Allow yourself to express your feelings. Release them in physical form, which can be talking, crying, screaming, or shouting without any judgment. It is important to have a safe and supportive environment around you. Step 3: Integration The third step is placing the pieces of your present life together. Understand and accept the effect that trauma causes on yourself. Acceptance helps you integrate your emotions and experiences and helps you identify the real you. Step 4: Resolution In the final step, you discuss the actionable steps to create an impact in your present life. People often notice a change in dealing with difficult phases after this final stage. They feel better and stronger than ever. Benefits of scream therapy: Is it helpful for you? Screaming is a primal urge that can release repressed childhood trauma and give people a sense of calmness. The scientific evidence about its effects is rather anecdotal; however, Dr. Warner explains how it has been beneficial in specific ways: 1. Emotional relief Some people who have attempted scream therapy report feeling at peace after expressing their feelings. It's as though they have finally tackled decades-old issues that have consumed them. 2. Addressing childhood trauma If someone has had a challenging childhood, scream therapy can help them reclaim their happiness. This can be especially helpful if they have never felt comfortable discussing their experiences or coping with attached emotions. 3. Coping with recent challenges Scream therapy may also help you process recent challenging events, such as a difficult divorce or the sudden death of a loved one. It can help you deal with your emotions and move forward. Limitations of scream therapy Scream therapy can evoke assertive emotions, but this is not necessarily a bad thing. Releasing these emotions is part of the healing process, and it only removes the extra baggage of emotions. However, its effectiveness can be varied based on a person’s emotional capabilities, as re-experiencing painful memories or traumas can be triggering for some people. That said, here are some other reasons Dr. Warner explains why people often feel confused about it: 1. Limited scientific evidence and a lack of regulation There is limited scientific evidence to support the claims made about its effectiveness. Due to this, there is no regulation around scream therapy. Therapists may use a variety of different techniques, some of which may be ineffective. 2. Group setting and the potential of harm. Scream therapy is often conducted in a group setting, which can be overwhelming for some people. Some of the techniques used in scream therapy can be emotionally and physically demanding, and there is a risk of re-traumatization. 3. Chances of relapse Some mental health professionals believe that scream therapy can be harmful because it can trigger some people's flashbacks, panic attacks, and other negative reactions. How can you try scream therapy? Knowing all about scream therapy might tempt you to start your healing journey but doing it unsupervised is not a good idea. Dr. Warner recommends consulting your doctor and discussing things accordingly. However, once you decide to practice it, here are a few things to look out for: Warm up your vocal cords by humming, singing, or doing other vocal exercises. Start by practicing it for a short period of time. Take breaks when needed to avoid getting overwhelmed. Don’t worry about how you sound or what your therapist might think about you. Scream therapy is beneficial for managing your emotions. Just remember, it can be different for everyone. Give yourself time to heal.

Trigger warning: This piece contains a description of miscarriage and mentions pregnancy loss and may be distressing for some readers. Pregnancies, like stories, are supposed to have a beginning, a middle and an end. So what happens when a pregnancy ends before you even knew it began? It’s 3 am, the morning after Mother’s Day and suddenly I’m awake. Thick with sleep, I stumble bleary-eyed to the bathroom, galvanised by gnawing stomach cramps and an urgent need to pee. Sitting slack-kneed on the loo, I feel a rush of something heavier, warmer than wee. The toilet roll is ruby-dark with blood. I’ve always had heavy periods so this isn’t unusual, but still I pause before reaching for a tampon. Pushing it in is weirdly easy. A mini alarm bell rings faintly somewhere, before I silence it. On my way back to bed, I grab an old towel from the cupboard and, lying back down, press it between my legs. My boyfriend murmurs in his sleep as I listen to my heart thump, eyes wide in the darkness. I feel the persistent flow pulse between my legs. Still, I wait. The need to wee and the cramps continue; when I go back to the loo, the tampon falls out in a mass of blood and mess. The ambulance comes soon, with two friendly paramedics asking questions, taking my blood pressure. And then, in a blur of swapping pyjamas for tracksuits and trainers, we’re in our car, heading to the hospital. Still the blood flows, soaking through the giant, nappy-thick pads the paramedics gave me. In the brightly lit A&E ward, a man snores loudly, raspily, his legs and back splayed against the uncomfortable blue plastic chairs. Apart from El Snoro, we are the only people there. I frown at the snores, comical under any other circumstances, and the high-pitched beeps emitting from the hospital bowels like a deranged heartbeat. It feels lonely, deserted and sad, and I decide we won’t be there long. “It’s probably nothing,” I whisper to my partner. A nurse gives me a small plastic tub to take to the toilet and pee in. Containing the gush of blood and other stuff into that little pot is a challenge. More alarm bells. As I wait to be seen, I feel increasingly peculiar. I’m hot, dizzy and clammy, and suddenly lying down on the cold floor is the only thing to do. I’m used to fainting, and know to follow the warning signs and get low, the sooner the better. So that’s how another nurse finds me, face-planted on cement, when she walks past. Her voice floats down to me from above: “Why is she lying like that?” From the cool, quiet floor comes my reply: “I was about to faint.” “Well, she can’t stay there,” she says, ushering us over to a row of seats, gesturing for me to lie down. A little later, we’re taken to a curtained cubicle where a nurse tells me I’m having a miscarriage. As she speaks, I black out. The next faint is a little later, when I’m in a wheelchair, being taken for a scan to see if anything “viable” is left inside me. I slither out of the chair and onto the floor like a drunken worm, giving the orderly a fright. Faint number-three happens in the crowded waiting room; I regain consciousness with a bouquet of concerned faces looming above me. We hadn’t had a clue I was pregnant. “Eight to ten weeks,” confirms the kind-eyed gynaecologist. They decide to operate on me to stop the blood loss and make sure that “everything is removed”. I’m wheeled to the operating room and given a general anaesthetic. I fall asleep to the sound of the surgeon’s quiet voice, gently asking me inane questions that I never get round to answering. When I wake up, dazed and dozy with morphine, the gynaecologist comes to see me. She asks if I want to see what was removed, holding up what looks eerily like a tub of beetroot hummus. I look away quickly. “No thanks.” My boyfriend goes home to sob, walk the dog and source some lunch for us. He returns later that afternoon, bringing a champion’s feast sourced from a local Italian deli: panini bursting with thick slices of mozzarella and tomato, golden-crusted arancini, fizzy pop, crisps, even a fistful of cannoli with vanilla, lemon and pistachio fillings. He has always expressed love through food; I have always gobbled both up. We smile as a visitor opposite us chats about plantain and curried chicken to her bedridden friend on a liquid diet. The sounds and smells of the hospital wash over us. Life goes on: mundane, tragi-comic, precious, painful. A month after the miscarriage, I feel raw and bruised, as if a layer of me has been forcibly removed. Walking around like a wound, tender and tight. Perversely, I seem to have become a baby magnet: they’re suddenly everywhere I look: in films, on the streets, in friends’ arms, all over Instagram. Two months later: I remember what happened with something akin to awe, recalling the immediacy and shock of it all, the bright lights, the mass of blood, the juddering blood pressure, the faints, the floor’s embrace and the hospital bed. Other things come to mind, too: the nurses’ kindness, the flowers sent by family and friends, turning our kitchen into a mini hot house, the notes floating like doves through the letterbox, the texts received, the hugs given. The card I took ages to send to the A&E team: ‘Thank you for being absolutely bloody brilliant.’ I wonder if they remember me when they finally read it. Five months later: the wound feels thinly scabbed over. I get an occasional ache in my lower left side: hello, ovaries. The grief remains close to the surface, oozing out unexpectedly. On the radio one morning, a presenter discusses a new government review into enhanced support for parents who have lost a pregnancy before 24 weeks’ gestation. Suddenly I’m back at the hospital, dizzy and disorientated; my cheeks wet with tears. Work feels jarring. Friends feel far away. Rebuilding strength I decide to start PT sessions to burn through the funk and to shift the belly-wobble reminder of what wasn’t. A reminder that means some of my clothes don’t fit. When I turn up to meet Hannah, my trainer, a session for new mums and babies is taking place in the gym. Fuzzy-haired, velvet-skinned babies as plump as Botticelli cherubs, sitting amid dumbbells and kettlebells like ducklings that got lost. In a fiercely air-conditioned studio, I start crying as I explain why I’m here. Our training sessions help. Despite my puny arms and seeming inability to hinge instead of squat, lifting weights feels like medicine. There’s satisfaction in the muscle aches, hunger and tiredness the following day. I want to take back control of my body, deadlift by deadlift, goblin squat by goblin squat. No beginning, no middle, no end; just life in its constant, irregular waves, moving through me.

Do you spend time in your ‘soothing’ system? Or know what that is? And are you aware of how understanding the ‘three systems’ model might help your psychological well-being? Let me explain how these ideas have helped me. In my quest to look after my mental health ever since I suffered two serious depressive episodes in my thirties, I am always on the hunt for fresh psychological approaches to manage my own tendency to anxiety and low mood. Recently I came across the ‘three systems’ model developed by psychologist and professor at the University of Derby, Dr Paul Gilbert. I had vaguely heard a bit about the Prof’s work. He’s a big cheese in the mental health world, who has contributed to the government's National Institute for Health Care Excellence (NICE) guidelines for depression and has published over 100 academic papers. But hitherto I hadn’t properly investigated one of his main findings: the idea we switch between three systems to manage our emotions - the threat, drive and soothing systems. Nor I had I applied his ideas to myself. Dr Gilbert argues that the threat system involves external and internal threats. External threats might be someone jostling you on public transport, or someone shouting at you, but also encompass internal threats such as looming deadlines for a piece of writing in my case, or the prospect of an event at which I am speaking, or a piece of feedback from an editor or a publisher. Internal threats are more about the negative ways we talk to ourselves – ‘I’m such a loser!’ ‘I always get things wrong!’. When we are threatened, we typically then go into the ‘fight, flight, freeze or submit’ response and produce lots of adrenaline and cortisol. The drive system, meanwhile, is about pursuing and achieving stuff. It’s accompanied by the pleasurable brain chemical dopamine. We experience a flood of dopamine whenever we get something done or achieve success. So for me, that might be having an article accepted for publication, or even something more everyday like cleaning out the fridge or sweeping the garden. Finally, the soothing system is when we feel calm, safe and relaxed. There are no threats to defend against or goals that must be pursued. This system produces feel-good chemicals such as oxytocin and endorphins. All systems are valid and important, and ideally, we would circle easily between all three. But many of us end up ping-ponging between the threat and drive systems, and not spending enough time in the soothing one. This is because we can get stuck in our threat system, for two main reasons. The first is that evolution has designed us like this: the threat system saves us from being eaten by a lion. The second reason is that negative information captures our attention, thinking, and memory more powerfully than positive information (this is referred to by researchers as a ‘negativity bias’). For instance, we feel the sting of being reprimanded more powerfully than we feel the joy of praise. I always remember the articles that were rejected, not the ones that were published. Given how unpleasant it is to feel threatened, the obvious answer is to escape by switching to the drive system for a pleasant whoosh of dopamine. We oscillate between the torment of threat, and the temporary relief provided by the drive system.  In the short term, this can be rewarding. After all, we are pain-averse, pleasure-seeking creatures. However, this cycle can become exhausting in the long term because it leaves no space for failure – which is an inevitable part of the relentless pursuit of achievement. Not all our endeavours will work. It’s impossible for all my articles to be accepted. Do more, be more, have more – these ambitions are all very well, until the moment you fail - and trigger the threat system again. Many of us are, therefore, in a vicious cycle with no space for peace and contentment with what ‘is’. What I’ve come to realise is that this is a pattern I recognise in myself, especially because we expect ourselves to achieve so many goals in an achievement-driven world – publish more articles! Write more books! In other words, we want to busy in our drive systems, especially if, like me, you went to a competitive London girls’ school (St Paul’s Girls’ School in West London); and then Oxford University. The answer for me has been to understand that switching between the two systems is unhelpful, even though temporarily I might be distracted and get a hit of dopamine. Instead, I need to become better at accessing my soothing systems if I feel threatened. The more I am able to support, nurture and soothe myself, the more I am capable of being there for myself if I fail (and I will eventually fail or make mistakes, because nobody is perfect 100% of the time). This means I will be able to handle disappointment without spiralling into self-criticism, and avoid the dreaded threat/drive ping pong. This model has made complete sense to me because that's just how I often feel.  I'm as guilty as the next person of falling into a cycle of threat/drive, which I like to think of as the psychological equivalent of the economy's boom and bust. But I've developed some soothing strategies. Many studies have found that slow, rhythmic breathing can make us feel calmer and less stressed, as it stimulates the parasympathetic nervous system, which is linked to the soothing system. A second approach I now use is to become more attuned to the presence of soothing emotions my own life. The more I’ve become aware of such feelings, the easier I’ve found it to engage with them. What are the activities or events which prompt me to feel calm and at peace? Once I know what kinds of things prompt soothing feelings, I can deliberately start stimulating them. I might indulge in a smell that leaves me feeling comforted and calmed. As I inhale, I ask myself to savour the scent and notice the way my body feels as I do this. Lavender oil works for me; so too does hugging our dog Sammy for my favourite eau de chien.  Sometimes it’s as simple as wrapping myself in a thick duvet and feeling its warmth and the sensations of being held. Or listening to some music that makes me feel at ease – I love musicals including Matilda or Guys and Dolls. Experimenting with some gentle touch, like a hand massage, helps me too; or going for a walk anywhere green. Each of you will have your own ways of spending time in your soothing system. And please let me know ideas which have helped you! It’s time to spread the word.

A helping hand from wearable tech? Rare is the adult who looks back on their adolescence and recalls years of calm sensibility and smooth control of behaviour and emotions. But for those with attention deficit hyperactivity disorder (ADHD), the difficulties navigating the teenage years can go drastically beyond the usual stroppiness. At this particularly vulnerable time for young people with ADHD, they also need to transfer from child and adolescent mental health care to adult ADHD services. But data from the UK show we have a major problem here: most youth with ADHD do not successfully transfer to adult services, despite real needs for ongoing treatment. So, many young people with ADHD are not getting the help they need, when they may need it most. Why wearable tech? As a mother of teenagers, I am fully aware of the potential distraction of smartphones and other gadgets. But modern tech is here to stay – so why not make it work for us? As a scientist, I am fascinated about the opportunities wearable tech – smartwatches and phones – offer for collecting long-term, real-world data and for developing digital interventions. Some years back, when working from a rented cottage in Cornwall during a summer “holiday” (I remember this well), I contacted a colleague at our Institute, Prof Richard Dobson. I had heard that Richard and his team had developed a mobile-health platform called RADAR-base and data collection apps for remote monitoring studies on depression and other conditions. I nearly couldn’t believe my luck: this was the solution I had been searching for, for our ADHD research! The solution to the limitations of conventional longitudinal research methods and the gateway to novel interventions. And here we are in 2024. Having developed and piloted a remote measurement system for adolescents and adults – ADHD Remote Technology (ART) – we have now received large research grants for remote monitoring studies on ADHD. The very latest project to receive five years of funding, from the Medical Research Council, is the research programme on the transition to adulthood and adult mental health services. This is a real labour of love that brings together decades of our past research, method development, sweat and perseverance. Why focus on transition to adulthood? Many people with ADHD have additional conditions and difficulties, such as depression, delinquency or substance misuse, and these often first emerge in the late teenage years. Our focus should be on trying to prevent such difficulties from developing. At this age, there are also major life transitions – leaving education, starting work or moving out of the parental home – that lead to new demands and changes in available support networks. Due to their ADHD, young people with ADHD often find these changes particularly hard. When we then add the observation that most young people with ADHD disengage from clinical services, we can see that there is a real risk for problems snowballing. Yet: all is not bleak. We know that outcomes for people with ADHD are highly variable. We need to understand better what those individuals do differently who have more positive outcomes. Recent research also reveals that ADHD often fluctuates more over time than what we used to think in the past. So, although ADHD is linked to a biological vulnerability, how severe the symptoms are and how impairing they are, can vary over time. Such fluctuations may be related to environmental factors. This means that to improve prevention and intervention, we need to understand what predicts improvements or worsening in the ADHD symptoms and difficulties over time. Enter remote technology and our project, ‘ADHD Remote Technology and ADHD transition: predicting and preventing negative outcomes (ART-transition)’. In this research programme, we address three core questions: (1) What changes take place in the transition to adulthood for individuals with ADHD?; (2) What predicts these changes?; and (3) How can we prevent negative outcomes and support healthy lifestyles? What will it be like, taking part in ART-transition? Each of the 250 young people with ADHD will participate in the remote monitoring for two years. They first participate in two individual online assessments, with a research worker. The participants are then given a wearable device that collects data on physical activity, sleep and physiological measures, such as heart rate and breathing rate. They are also given smartphones with purpose-built Active and Passive Apps. The Passive App collects ongoing data from smartphone sensors on measures such as social interactions, digital usage, relative location and other changes in the environment. The active monitoring involves the participant completing questionnaires and a speech task on the Active App, and completing cognitive tasks on a home computer. At the end of the two-year remote monitoring period, the participants are invited to an online interview with a research worker, so they can give feedback on their experiences of participating in the study. We will then use the findings from the study to inform the next phase of the research, where we will work with young people with ADHD to co-design a prototype for a new ADHD-transition smartphone app. App components may include personalised feedback, personalised educational components, prompts, alerts and data sharing with clinicians. The aim is to prevent negative outcomes and support healthy lifestyles by facilitating self-management, personalisation of treatment and engagement with adult services. We aim to give young people greater autonomy in how they manage their ADHD, in collaboration with their clinician, and place an emphasis on modifiable environmental factors. It takes a village We all know it takes a village to raise a child, but what does it take to put a research programme like this together? It takes a big team, with wide-ranging expertise. Our local team at the Institute of Psychiatry, Psychology and Neuroscience at King’s (Amos Folarin, Ewan Carr, Johnny Downs, Nick Cummins, Richard Dobson and myself) will work closely together with external team members from the University of Nottingham (Maddie Groom and MindTech colleagues), the ADHD support organisation ADDISS (Andrea Bilbow), software engineers from the Hyve and collaborating clinicians. At the core of this village is, however, the young people with ADHD. They provided input at the initial focus groups during the planning stage of the research. As study participants, they will provide their time and effort for two years – a huge thank you, in advance. As app co-designers, they will share their expertise and ideas, to help other young people with ADHD in the future. We cannot wait to get going! Take-off for ART-transition is on 22nd April 2024.

Did you know that prolonged abuse at the hands of a “narcissist” can sometimes be associated with the development of Post Traumatic Stress Disorder (PTSD), due to the complex trauma experienced? In fact, narcissistic abuse, a form of emotional abuse perpetrated by someone with narcissistic personality disorder (NPD), can be quite devious and overwhelming because it can be hard to identify at times. However, keep in mind that not everyone with an NPD diagnosis will be or is abusive. As a personal development life coach, I’ve been helping survivors of narcissistic abuse overcome the trauma they experienced while they were stuck in unhealthy relationships. For the past 4 years, I’ve coached people who were shocked to recognise how they’d been trapped in an abusive relationship for so long, suffering emotionally, mentally, spiritually, and even physically, without a way out. I utilise methods such as counselling, cognitive behavioural therapy, relaxation techniques, trauma coaching, and reframing experiences, to help people navigate their journey and rebuild their lives. After years of helping these survivors, I realised that although they were strong enough to walk away from the abuse, the effects of their agonising experiences still lingered. This is because there’s a link between narcissistic abuse and PTSD. Narcissism is clinically recognised as a personality disorder and is one of the mental conditions listed in the Diagnostic and Statistical Manual (DSM) for Mental Disorders, as a cluster B personality disorder. In other words, narcissists exist and their abuse is very real.  However, to be clear, not all narcissists (individuals with NPD) are abusive and not all abusers are narcissists by default. Individuals who are in a toxic relationship with a “narcissist” may notice that they sometimes feel anxious, stressed, numb, or restless whenever they’re around. Emotionally, an individual displaying narcissistic behaviours can have a negative effect on those around them, making people feel unsure, discouraged, hopeless, and miserable when in their presence. Now, imagine feeling like this continuously for months or years at the hands of a person with NPD before cutting them off. Chances are, people who finally manage to walk away from the “narcissist” are left with a lot of trauma that sometimes manifests itself in the form of Complex PTSD. Complex PTSD is a mental health condition that one can develop after experiencing chronic trauma for a long period of time. How PTSD Symptoms Manifest After Experiencing Narcissistic Abuse Complex PTSD symptoms can show up differently from one person to the next, depending on the type of narcissistic abuse they experience. The symptoms can occur as intense physical or emotional trauma reactions whenever the victim gets triggered by something that reminds them of what they went through. So, what are some PTSD symptoms individuals may experience after narcissistic abuse? Flashbacks This refers to instances when individuals suddenly relive moments from a traumatic event vividly, in the present. For survivors of narcissistic abuse, the flashbacks can be triggered by strong emotions or intense situations that remind them of how they felt when they were with the abuser. For example, let’s say a survivor of narcissistic abuse is in a situation where someone is gaslighting them, that is, using manipulation tactics to make the victim question their own sanity or reasoning capabilities. This type of situation can be so triggering that it brings back the sensations and emotions the survivor once felt when the “narcissist” would gaslight and manipulate them. If the survivor would get angry whenever the “narcissist” tried to distort their reality by lying, then having a flashback could make them lose their temper easily in the face of manipulation. Intrusive Thoughts Another common PTSD symptom after exposure to narcissistic abuse for too long is experiencing intrusive memories and thoughts. These are disruptive thoughts that invade the mind and are usually associated with negative emotions. A brain that’s been through chronic trauma resulting from narcissistic abuse is in a highly overactive state, which can cause it to generate involuntary unwanted thoughts. For a survivor who’s trying to heal and gain back their power, intrusive thoughts may sometimes creep into their mind. They could be having a great time with their friends when suddenly a dark and distressing memory or feeling resulting from the abuse intrudes their mind. This may cause them to immediately withdraw or feel like harming themselves. Whenever the intrusive thoughts come storming in, I recommend grounding yourself to draw your mind back to the present. Take deep breaths and remind yourself that you’re no longer trapped. You’re free and you’ll get past this. Remember that intrusive thoughts are just thoughts. You don’t have to act on them, and they certainly do not determine the kind of person you are. You have the power to make your mind think of other pleasant things to distract yourself. In case the intrusive thoughts grow persistent and more violent, I recommend seeking therapy treatment from a licensed therapist. Nightmares Maybe you’re thinking, “everybody has nightmares. How can that be a symptom?” Well, in some cases, survivors may experience nightmares that replay their traumatic events in various ways. For example, they might dream about having a confrontation with their abuser, and feel trapped and powerless in the dream. As a result, disturbing dreams can leave them feeling emotionally drained and anxious when they wake, triggering their stress levels to heighten. Additionally, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders describes nightmares as dysphoric dreams that occur after experiencing a life-threatening event or feeling like your emotional or physical safety is in danger. Interestingly, most nightmares are replicative, which means that an individual will re-enact the trauma they experienced at the hands of a narcissist. Hypervigilance and Paranoia In some more extreme cases of narcissistic abuse, individuals may feel hypervigilant and paranoid when they’re around people. They might find themselves in a heightened state of alertness, scanning for dangers and suspicious behaviours, and overall find it difficult to trust those around them. Furthermore, scientific research shows that people who experience PTSD after living through traumatic events such as abuse, experience amygdalar hyperactivity in their brain, resulting in hypervigilance, panic, paranoia, dissociation, and flashbacks. The amygdala is the part of the brain that processes emotions. Final Thoughts Have you been dealing with some of the above PTSD symptoms after leaving a narcissistic relationship? Experiencing trauma caused by a person with narcissistic behaviours takes its toll on one’s body and mind. That’s why abuse survivors get easily triggered sometimes, and are left feeling anxious, paranoid, and on edge. Luckily, there are many ways you can deal with PTSD symptoms to heal from your trauma. You can seek trauma therapy, which will help you re-regulate your central nervous system. This treatment can be effective in dealing with nightmares, intrusive thoughts, anxiety, and flashbacks. Additionally, you can try journaling or meditating. These are both great ways to understand and control how you are feeling in the moment. You can also seek evidence-based approaches for treating PTSD such as cognitive therapy, brief eclectic psychotherapy, and drug therapy among others, with the help of a licensed professional. Don’t give up, brighter days await you.

Our names are Riddhi and Kristi, and we are researchers in Perinatal Psychiatry, interested in trying to improve mental health during and after pregnancy. In this piece, we are excited to present a new project we have been working on, called HappyMums. The goal of this project is to understand, predict, and treat depression in pregnancy, in order to improve mental health outcomes for both mothers and their offspring. HappyMums is a research consortium, funded by the European Commission, bringing together research institutions and other organisations interested in perinatal mental health, from many countries across Europe, plus the United States. Depression during pregnancy, also known as antenatal depression, is estimated to affect close to 30% of pregnant women and birthing people around the world. Some of its symptoms include low mood, sadness or being tearful, feelings of irritability and guilt, a loss of interest in daily life, an increase in negative thoughts, and feelings of hostility towards partners and/or babies. It is especially important to treat antenatal depression, as it is associated with negative outcomes in both the mother and the baby. In the mother, for instance, it increases her risk of developing postnatal depression. Numerous studies have also investigated the role of antenatal depression on offspring-related outcomes. Among newborn babies for example, untreated depression in pregnancy is associated with a lower birth weight, or being born preterm. These effects are also said to continue as the child grows, in the form of childhood depression and anxiety, and sleep problems in infancy and toddlerhood. The outcomes associated with untreated antenatal depression highlight the need to examine the evidence base of treatments which include Cognitive Behaviour Therapy (CBT), yoga, mindfulness, Omega-3 supplementation, and bright light therapy, to name a few. While depression in the perinatal period as a whole (the period of pregnancy up to the first year after birth) has been widely investigated for decades, a specific focus on antenatal depression is now emerging. However, there still remains a gap in the literature about the biological, and psychosocial, mechanisms underpinning antenatal depression, and what factors in a person’s life or environment might reduce or exacerbate their risk of developing depression during pregnancy or after birth. Here at King’s College London, we are proud to be one of the partners involved in HappyMums, this important research project. Here’s more about what we hope to achieve: Understand The consortium comprises researchers who study perinatal mental health in many ways, and we hope that by coming together, we can build a broader understanding of pregnancy and mental health. For example, to study the role of the placenta, we have researchers who work with human volunteers who donate their placenta for research after birth, and this knowledge can be combined with that of other research teams, who study the placenta in different species of fish! We believe that it is important that researchers who study a topic in different ways can combine and share their knowledge, to move our understanding forward more quickly. Predict So that we can better predict the development of antenatal depression, the consortium will also bring together a number of cohort studies (longitudinal research that follows participants over a number of years), which have recruited families from across Europe to collect data about pregnancy and the postnatal period, and what factors might be related to perinatal mental health. For example, these include pregnancy health, stressful life events and biological measurements of hormones and the immune system, as well as genetics. By studying antenatal depression in so many participants, across many countries, we hope to gather understanding of which factors are most important in protecting someone from developing depression (for example good social support), and which can be most detrimental. Treat Following on from learning to predict antenatal depression in a more effective way, if we can do this, we can also become better at treating antenatal depression, by identifying it earlier, and by being able to target intervention and support to those who most need it. One way we are doing this in HappyMums, is by developing a mobile app, which will be used to gather information from pregnant women who volunteer to be part of our pilot study. We will use this information, after they have given birth, to build programmes capable of predicting who was most likely to develop antenatal depression. The study will be run across 6 countries in Europe (UK, Italy, Germany, Croatia, Poland, Finland), and will recruit over 1000 participants in total. The app will also be used to gather information from volunteers in 3 ways: asking volunteers to complete questionnaires about their mental health in the app; giving volunteers access to game-like activities, which involve asking them to speak aloud, or type answers to daily questions, to see if information can be gained from the tone of someone’s voice, or the way they type on their phone; by collecting information which is already passively collected in most smartphones, for example light sensors, step counters, and GPS locations. As well as being used as a data collection tool, the app will also give users access to a “mum-to-be wellbeing course”, which will provide information about pregnancy and childbirth, curated by experts in the consortium. There will also be space in the app for users to monitor their own pregnancy and health. We hope that we will learn more about if and how women would like this information to be used by their doctors or midwives to improve their care, and what information would be most helpful to provide to clinicians so that they can do make the best decisions for their patients. As you can see, the HappyMums consortium is working hard to bring together many research groups to improve the experience of women during and after their pregnancy, and to support mental health during this very important time. You can find out more about our progress on our website, www.happymums.eu, or by following us on Instagram and Twitter. We will also be recruiting for our pilot study of the mobile app soon, so please feel free to email us at happymums@kcl.ac.uk if you would like more information.

The first time I end up in the psychiatric ward at the age of 16, I swear it'll be the only time. It happens after confessing to my mother that I'd rather die than go back to school. Over-dramatic, perhaps, if she hadn't found me stashing away the pills. In the juvenile ward in Nowhere, USA, we do talk therapy and art therapy. The doctors test out different combinations of meds, and I end up feeling dazed, but no longer suicidal. It's enough to convince them that it's just depression. Just depression. As if a week of suicidal intent is like a cold or a fever. Just a bit of coughing. Just a minor infection. Just a touch of not wanting to live. When I get my period on the ward, I spend the entire day trying to hide the blood. Soon enough, they release me back to my parents with an SSRI prescription and orders for weekly follow-ups with a therapist. Everything's fine, except for the monthly flow that I can never seem to deal with properly. As far as I know, though, that's not anything out of the ordinary. This will turn out to be important late In 2023, nearly 30% of Americans reported having been diagnosed with depression. Together with Bipolar, depression is a mood disorder, the second most common diagnosis for people suffering from mental health issues after anxiety. But mood disorders are nothing new. As early as 500 BC, the ancient Greeks recorded symptoms of "melancholia", a sort of long-lasting despondency. Even older is the distinctly feminine illness of "hysteria", described by the ancient Egyptians with symptoms similar to a panic attack. For the ancients, these diseases were thought to originate in the body - through imbalances of the humours, or the movements of a wayward uterus. Nowadays, psychologists know better; mental illness is a result of disordered thinking, imbalanced brain chemicals, maladapted mechanisms for coping with trauma. But perhaps things are more complicated still. Over the next five years, I'm sectioned three more times - sometimes closer to and sometimes further from attempted suicide. Every time, the doctors assign new pills to quell the storm. But the meds never seem to work for long. Within three weeks of a new dose, I'm back to sobbing in my therapist's office. The fourth time I find myself in the hospital, the doctor looks over my paperwork, notes the persistence of my symptoms, the turbulence in my relationships due to my emotional instability. Even then, he doesn't notice the pattern that dictates my incandescent anger, the despair. "I think you might benefit from a different kind of therapy," he tells me. He has a suspicion that the tide of my emotions, the fleeting swells, and horrific crashes, aren't entirely due to depression, or even bipolar. This time, I leave the ward with an appointment for Dialectical Behaviour therapy (DBT) - a type of cognitive therapy developed for people with personality disorders - along with a new diagnosis: Borderline Personality Disorder (BPD). Unlike mood disorders, personality disorders are relative newcomers to the field of mental health, arising alongside more scientific analyses of both personality and mental disorders through the early 20th century. The Diagnostic and Statistical Manual of Mental Health (DSM) - the main tool used to diagnose mental illnesses - defines personality disorders as patterns of thoughts and actions which "deviate markedly from the expectations of the individual's culture". Perhaps because they are so culturally bound, diagnoses of personality disorders are also far more likely to stigmatise those who seek help for them, as previously discussed on ITM. This makes it difficult for sufferers to get the support they need. In some ways, the diagnosis of a personality disorder can feel terminal. This isn't an illness that can be confined to one part of your life, compartmentalised and hidden away and maybe cured. The problem, according to everyone you interact with, is your entire personality. The DBT doesn't last very long. A few weeks in, I'm frustrated by the group lessons, the focus on identifying triggers that don't seem to exist, at least not consistently. I end up moving half-way across the world to the tiny country of Malta, cast-away in the middle of the Mediterranean. My new psychiatrist reaffirms my BPD diagnosis, but I'm starting to suspect there's something terribly wrong, not just with my psyche, but with my entire body. Every month, there are two weeks when I’m fine - when my triggers aren't triggers, when I am calm, controlled, even content. But then there are the other two weeks, when depression and rage and the raw angry hurt sweep over me like a wave. These dark days always come just before my period. But I'm not able to connect those dots, not yet. The connection between "mind" and "body", when it comes to mental health, is far from fully understood. When it comes to diagnoses, both psychiatrists and psychologists focus primarily on thoughts, feelings, and self-report. After all, there's no blood test that can tell a doctor you have depression - even though there's good evidence that the brains of depressed people fire differently. But considering how intimately psychiatrists know that small changes in brain chemistry can create huge differences in feelings and behaviour, why isn't more done to look at mental health as part of a holistic approach? One that considers the mind and body to be one, instead of two different elements with separate diagnostics, separate pathologies, divided experiences? Three years after I leave Malta, I’m sitting through an intake session for a new round of therapy in the UK. The nurse going over my history takes in the litany of meds and sectionings, as well as my other medical experiences - the overly heavy monthly flows and debilitating cramps. "Have you considered you might have PMDD?" she asks me. Premenstrual Dysphoric Disorder (PMDD), she means: a particularly horrific form of premenstrual syndrome, which can make you feel like a different person in the latter half of your cycle. Over the next few months, I record my moods religiously, tracing highs and lows over the ovulation and menstruation predictions of a period-tracking app. The pattern of peaks and troughs, the swells and ebbs, makes my diagnosis startlingly clear. It’s only taken two decades to discover it. I have PMDD. PMDD lies in that strange, unexplored space between mind and body. On one hand, caused by shifting hormones during the latter half of the menstrual cycle, it is understood as a sort of hormonal disorder. On the other hand, its diagnostic criteria are included in the DSM, where it is classified as a depressive disorder. My mind rebels, but the cause lies deep within my body, within my ovaries and the chemicals that run my reproductive system. It is my body that is imbalanced but my mind that suffers. It’s hard not to regret the decades lost to misdiagnosis and stigma. But the knowledge that my pain has a cause, that my despair is a result of identifiable processes, makes it easier to deal with. Now that I know where the storms are coming from (and when), I can try to ride the waves.

Trigger warning: This article contains discussions about violence and abuse which may be difficult for some readers. As a woman, safety is something that is always at the back of my mind. It's a frequent consideration in the decisions I make. I think it's safe to say it is the same for most, if not all of the women around me. It's not the first time I've written on this topic. Three years ago, I wrote an article following the horrendous crimes committed against Sarah Everard, a woman who was just walking home. It felt important to raise the discussion on our platform, but I hate that I ever had to write it. Only 6 months later, I wrote another one. This time following the horrendous crimes committed against Sabina Nessa, another woman who was just walking home. I hate that I had to write that piece too. I also hate that I have lost count of the number of times I could have easily regurgitated the same words about our worrying lack of safety. Because it happens so much. Each time serves as a stark reminder of what these women have experienced, how terrified they must have been, and how they couldn't have done anything to stop it. What's worse? The thought that behind every Sarah and Sabina are hundreds of women whose cases we didn't even hear about. I hate it all. We all do. This March was the third anniversary of the tragic loss of Sarah Everard. Marking this poignant date, the BBC aired a documentary on her case, 'Sarah Everard: The Search for Justice.' I watched the documentary and was hit particularly hard by how it concluded. On just a black screen were some facts. Facts which showed how little has changed in our safety. Facts showing things like, in the year since Sarah's murder, 138 women were killed by men, or the main suspect was a man (from Femicide Census). Facts showing that in the same year, 798000 women experienced sexual assault in England and Wales alone. It begs the question, when will there be actual change for women’s safety? Are the conversations staying just that, or is action being taken? What more will it take, if not the lives of countless women? Did you know that in the UK a woman is killed at the hands of a man every 3 days? That’s at least 350 since the murder of Sarah. The point where we thought there might finally be change. The statistics show no such reduction since before her murder, leaving many questioning whether the discussions on tackling this issue have been futile empty promises. Exposure and experience of such violence is undoubtedly life-changing and damaging for anyone affected. The Royal College of Psychiatrists recently conducted a survey which showed that Psychiatrists in Britain believe abuse and violence of women and girls to be the main reason for higher rates of mental ill health than men and boys, which is on top of any physical health consequences faced. And the risk and constant threat of danger is also an issue. United Nations Women highlight the reduction of freedom, the limits imposed on women and the impact on health and well-being. Of course, no one is immune to the risk of violence, however, women and girls are disproportionately affected. It can be argued that a culture of sexism and misogyny (prejudice against women) has been deep-rooted, but causes far more damaging consequences than is often dismissed as humour. What these attitudes do is influence attitudes to women and girls which can become a ‘catalyst’ to the more serious forms of gender-based violence. Following the murder of Sarah Everard, conversations on such issues were sparked globally, questioning how society can take control of the ever-growing issue of women’s safety. One idea was to formally state misogyny as a hate crime, punishable by law. However, it has not been considered a law previously due to concerns about principles of equality. The Government and prominent groups agree that there could be inadvertent harm in actioning such a law, demonstrating the complexity faced in trying to tackle issues at a societal level. Further attempts for changed have also been made, including a bill to make sexual harrassment in public, such as catcalling, deliberate obstruction of path, walking too closely, and driving vehicles slowly near a person, criminalised offences with tougher sentences up to 2 years imprisonment. Sources suggest there may have been some hesitancy driving the motion forward, however at the time of writing, the legislation has been backed by MP's and is in consideration with the House of Lords, leaving such harrassment currently illegal but not a punishable offence just yet. While many appear generally supportive of the legislation, some have questioned how effective it will be to actually implement changes in behaviour. So how else is change being made? In the case of Sarah Everard in particular, a case which really seemed to shift discussions of women’s safety, it is hard to ignore that part of the unrest stemmed from the perpetrator, Wayne Couzens, being a serving Police Officer who abused that position of power to commit these heinous crimes. The people who are supposed to keep us safe, protect us, and serve justice for us, can also disrespect, abuse, and murder us. It’s a harrowing thought. Issues in the police service was a significant part of the BBC documentary as they explored the warning signs pre-empting Couzens’ violence and the damaging comments made by fellow officers surrounding the treatment of women. On the 24th February 2024, Lawyer Lady Elish Angiolini, published an independent inquiry urging for a ‘radical overhaul’ in police recruitment as she found that Couzen’s had a 20-year-long history of sexual offences and should never have been allowed to be a police officer. The inquiry highlighted a further series of failures which meant that on numerous occasions where Couzen’s should have been caught, oversights were made, that could have been an opportunity to prevent further offences. These failings within a system established to enforce law and protect the public do nothing to assure us that we can be kept safe. The report, while focussing on the police service specifically in this case, also looked to wider systems, arguing that the sexism and misogyny embedded into society, as well as policing, are enabling for escalation to such acts further along the spectrum. Following the inquiry, Commissioner of the Metropolitan Police Sir Mark Rowley responded, echoing the horror of the ‘betrayal of trust’ from an officer abusing their power to commit such terrible crimes and reflected on the damaged relationship between the police and the public as a consequence. Following Mayor of London Sadiq Khan publicly highlighting the failures of police following the Angiolini report, Sir Rowley supported the recommendations made in the inquiry and pleaded for equal funding from future governments for tackling violence against women as for terrorism, comparing the issue to a national security threat. Sir Rowley remarked that the enormity of the issue is of such scale that while progress is being made, it can only be done with support in resourcing. While there is clear motivation to drive change, it is clear that we still face barriers which need to be overcome to truly make action come to life. I ended my article about Sarah Everard 3 years ago by writing, “I hope that 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.” It is a heavy realisation that that single ray of hope through that darkness 3 years ago so far has not surmounted to change in the number of women still affected, however, it seems the intention for change is shifting. Words alone are no longer enough. However, we must remain hopeful that we can reach the point where action is taken and tangible movement in society is made so that women and girls can have the basic rights of safety and freedom they deserve. If you feel particularly affected by the conversations surrounding women’s safety, some resources are freely accessible for support: 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

We change so much in our journeys from infancy to adulthood, that it almost seems like we’re completely different people. So, have you ever wondered what experiences stay with us as we get older? I’m studying a master’s in psychology at Kings College London and, as part of my course, we learn a lot about how humans grow from infants to adults and the parents’ role in this process. We also learn about how things that happen to us as babies can affect us even as we get older- this might sound hard to believe seeing as most of us don’t remember anything from when we were babies. So, in this article, I’m going to introduce you to the concept of attachment styles, and how an experience from infancy can have a significant impact on various aspects of your adult life. What is attachment? Attachment is the emotional bond formed during early life with, usually, a parent. There are 4 main attachment types, known as: Secure Anxious Avoidant Disorganised Attachment theory says that your attachment type as a baby also affects the relationships you form throughout your life. ITM writer, Alessandra Biaggi, goes into more depth on why early attachment is so important in her article, but some brief examples of how attachment styles can impact you include: how you express your emotions, how you control your feelings, how you handle arguments and how you set boundaries. As it can affect so many different parts of your socio-emotional wellbeing, it is helpful for you to know a little about the different attachment styles and which one you think fits best for yourself. It’s important to know that there’s no right or wrong attachment style and you might not fit into just one type. Let’s have a closer look at the different types of attachment. Secure attachment A secure attachment style is when a parent responds quickly and regularly to an infant’s needs. This stable emotional bond encourages the baby to think, ‘I am safe to express my feelings because my parent listens and supports me in the way that I need’- this sets up their worldview on how relationships work and how to express emotions. Because of this, securely attached adults tend to express and manage their emotions in a healthy way and have healthy relationships. Although it is normal to have some conflict within relationships, a securely attached person can usually work through the situation in a healthy and productive way. It’s important to note that this attachment style is not about having perfect socio-emotional wellbeing all the time (which is unrealistic). Instead, it’s about being resilient (bouncing back when things get hard) and taking responsibility for your emotions. Anxious attachment An anxious attachment style is built when a parent quickly responds to an infant’s needs on some occasions but doesn’t respond at other times. This can lead to the baby feeling confused about relationships, ‘when I signal a need to my caregiver, I get mixed messages where sometimes I am listened to and other times, I do not receive what I need’. Anxiously attached adults may be more likely to have unstable relationships during adulthood, where they feel uncertain about the emotional connection. If you have an anxious attachment, you might feel hyper-sensitive to the emotional tone of the environment and feel anxious during arguments. You may try to cope with this anxiety by needing reassurance and feeling like you need to fix things right away. Avoidant attachment Infants with avoidant attachment styles may have similarly experienced inconsistent caregiving, where the parent didn’t respond to the baby’s signals for attention. The infant begins to think, ‘when I signal a need, my parent doesn’t respond so I cannot rely on them to meet my needs’. If you have an avoidant attachment type, you may feel like you must always do everything by yourself and feel frightened of relying on others for support. You might hide or ignore your emotional needs to avoid feeling disappointed by other people. During arguments, you may feel irritated by others’ emotions and feel like you need space in your relationships to cope with this. Disorganised attachment A disorganised attachment style is when the parent becomes a source of fear for the baby. This attachment type is a mixture of the anxious and avoidant attachment styles because the parent is unpredictable and inconsistent. The baby naturally looks for comfort from their parent, but they also know that they cannot depend on them to meet their needs. Adults with a disorganised attachment style might feel scared of emotional connection and expect to feel disappointed in their relationships. To cope with this, they might put up walls to avoid expressing their feelings, even though they want to experience an emotional connection. So, I hope you’ve learnt a bit about how different attachment styles develop from when we’re babies and can even affect us when we get older (your memory as a baby is better than you thought!). As a reminder, parts of different attachment styles may fit you and there’s no wrong or right attachment style. If you find that you display more insecure behaviours, there are lots of ways you can learn to have healthier relationships and express your feelings in a healthier way. Some examples include: Practising emotion regulation - this is especially important to do when emotions are high (such as during arguments). Some techniques to manage your feelings are: - Take space away from the situation for a specific amount of time and come back when you feel calmer. - Grounding techniques, e.g., breathe in for 4 seconds, hold breath for 7 seconds, breathe out for 8 seconds. - Identifying how you feel (e.g. label the emotion) and giving yourself space to sit with that feeling. Setting healthy boundaries - Giving your mind and body time to rest when you feel tired/burnt out. - Not pushing yourself too much and saying no when you don’t feel comfortable. - Respecting other people’s healthy boundaries. Being vulnerable - Being honest when talking about your thoughts and feelings. - Listening to others empathetically. - Work on problem-solving during arguments, instead of getting defensive and blaming. Even though attachment theory says that your type stays mostly the same over time, modern research has started to suggest that you can change your attachment style- this means you can always improve the quality of your relationships and emotional wellbeing. So, the relationship you have with a parent as a baby can influence how you think and act as an adult. But this doesn’t mean everything stays the same from infancy to adulthood; therefore, if you don’t have the best start to life, it can always get better. The main takeaway message of this article is that our experiences as a baby don’t define the rest of our lives! As you grow up, you have more control over how you develop as a person- if you notice yourself displaying insecure behaviours which have been impacting your life, you can always make positive changes (like the examples above) for healthier emotional wellbeing.

Social anxiety can take many forms. A common misconception is that social anxiety is an interchangeable term for being shy, but it is much more complex and debilitating than shyness. It can have a serious impact on aspects of your life, from social events, to the workplace, or simply being out and about in public, having to interact with other people or be noticed by them. What is deipnophobia? Deipnophobia is a particular form of social anxiety that relates to eating in public or around other people. Its prevalence is not well known, as it has not been studied as extensively as other forms of social anxiety. A person suffering from deipnophobia may suffer from symptoms of anxiety and panic attacks, as found with other forms of social anxiety too, but this specifically occurs when eating in the presence of other people. It is not necessarily related to an eating disorder, but social anxiety and eating disorders are frequently comorbid, meaning they co-occur. For example, people with a history of eating disorders who are conscious of their body image may feel uncomfortable eating in front of others, especially if they have a history of feeling pressured to eat, or if they feel people will judge their eating in relation to their body image. Deipnophobia can also stem from another anxiety disorder such as agoraphobia - the fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong. Here, eating outside of the home or being in a public place would have caused them anxiety. When we suffer from anxiety in public, our fight or flight system kicks in and makes us feel sick or leads us to need to use the toilet. This fight or flight system is trying to aid our escape from a perceived threat, and it does not work well with eating. Our bodies are telling us not to eat but rather to focus on survival, and so eating can become a stressful experience as we are fighting against our bodily instincts. What do we know about deipnophobia? One case study of deipnophobia was published in 2022, which discussed a woman who experienced it only in the presence of her partner, with no history of eating disorders or social anxiety in other situations. The paper refers to the cause of the anxiety as fear of embarrassment, being judged, and loss of control. The woman in the case study experienced the fear both at home and when in restaurants, and as such it is important to note that deipnophobia is not restricted to being out of the home or outside of a safe space. It is directly related to eating in the presence of others, regardless of location. A restaurant might be more stressful than at home due to the sheer number of people in the building, but this will vary from person to person. The case report by Das et al. highlights the fear of being judged and being embarrassed, a common theme reported by sufferers of social anxiety. Someone suffering from deipnophobia may experience anxiety symptoms such as sweating, dizziness, shaking, increased heart rate and shortness of breath when eating in front of others. These physical symptoms, alongside not being able to eat when feeling anxious, can lead to individuals feeling embarrassment. My experience with deipnophobia My personal experience with deipnophobia came as an extension of my agoraphobia. It began as a fear of eating in restaurants with others due to feeling trapped. This was not a fear of being physically trapped like you might experience on a bus or a plane where you can’t exit the vehicle until you reach the destination, but rather a social fear of not being able to just get up and walk away without having to explain myself. Like many anxieties, the fear is not rational, as there is no need to get up and leave the table, but simply not having the option can make you feel trapped. As a result of this anxiety, I would immediately lose my appetite in any restaurant or setting that involved eating. Being anxious would lead me to feel sick, and before I knew it, I was completely worked up about having to order something to eat. Because of this, I stopped going to places where I’d have to eat in front of others. Bars were fine because there was no social obligation to eat, and places where you can control the amount of food you receive were fine too – for example, a buffet or a meal that involved sharing a platter instead of one meal for myself. It was all related to the social expectation that I should order and eat an entire meal to myself. As with all phobias, exposure is often a great way to resolve and overcome the fear. I find that as soon as I start eating, the anxiety subsides, and I can get through the meal. However, it’s no fun to dread an upcoming meal with a friend or panic for a week solid about going to a restaurant with colleagues. By continuously going to restaurants and learning that I will be fine once the food comes and I start eating, I have been able to reduce the anticipatory anxiety that comes with it. How can it be treated? Deipnophobia is treated in the same way as other social anxiety disorders – via cognitive behavioural therapy (CBT), medication, or a mixture of both. CBT is cited by the NHS as the best form of treatment for social anxiety. It focuses on a combination of cognitive and behavioural elements, challenging our thoughts and beliefs encouraging us to change our behaviour through exposure therapy and reducing avoidance of the thing we are afraid of. For deipnophobia, a CBT therapist might encourage you to think about what it is you are afraid of when eating in front of other people, how likely it is your fear will come true, how important it is in the grand scheme of things, the likelihood of whether you are being judged or not and guide you to consider a more positive outlook. For example, thinking ‘My friend is going to judge me for not eating my food’, can be reframed as ‘If I don’t eat all my food, I will take the rest home. My friend won’t judge me for not being hungry, and we will still have a nice time.’ The behavioural element puts this into practice, exposing yourself to the situation and testing these new thoughts in the environment. Once you discover that the anxiety is reduced, you can feel more confident about eating in front of others the next time. Further research is needed to understand the many different causes of deipnophobia, but the likelihood is that it’s a common issue found in sufferers of social anxiety, generalised anxiety, and people with eating disorders. It can feel debilitating, but it can be treated. I still get nervous when going out to eat with people I don’t know as well as my close circle of friends and family, but I know to stay in the situation and face the fear head-on, so that the next time I face it, it’ll be a little bit smaller and a little bit easier to manage.