Imagine living in a world where unpredictability causes distress, and routine changes are overwhelming. Imagine a place where everyday noises and lights are intense enough to the point of discomfort, yet for others, they are barely noticeable. Imagine navigating this world as someone with autism, in a society designed with neurotypical expectations in mind. How might that leave you feeling? Misunderstood…? Maybe even isolated...? Hello, everyone! My name is Isabella Molnar, and I am a Master’s Student at King’s College London. With Autism Awareness Day being on April 2nd, I have chosen to write about mental health in autism. We often talk about difficulties individuals with autism might experience, but not always consider the impact on their mental health. With my writing, I want this article to be a starting point in increasing interest and raising awareness of the importance of mental health in autism, so feel free to delve deeper and explore further resources. Mental Health in Autism: What’s the Current Situation? Starting with a brief explanation: Autism, also referred to as autism spectrum disorder, is a neurodevelopmental disorder that impacts approximately 1% of children and adults. Autistic individuals may perceive and interact with the world differently compared to their neurotypical peers. This difference can manifest as challenges in social communication and interaction, exhibiting restrictive or repetitive behaviours and interests, as well as being either hypo- or hypersensitive to sensory input. Beyond these unique experiences and challenges, individuals with autism face mental health difficulties at a significantly higher rate than the general population. In fact, research suggests that between 70% and 80% of children and adults with autism experience at least one mental health problem in their lifetime, including conditions such as depression, OCD, bipolar disorder and schizophrenia, phobias, and social anxiety. Among these, anxiety stands out as the most common issue, with around 50% of autistic individuals experiencing anxiety that significantly impacts their lives. Alarmingly, as many as 35% of individuals on the autism spectrum have experienced suicidal thoughts, and up to 25% have either attempted suicide or exhibited suicidal behaviours. But Why Do Autistic People Have Increased Mental Health Difficulties? As discussed, mental health challenges are a significant burden in the lives of autistic individuals, more so than in the general population. This begs the question: what are the unique causes that put autistic people at such an increased risk? Firstly, research has proposed that a core struggle for autistic individuals is fitting in with neurotypical peers. Difficulties with understanding and engaging in typical social interaction can lead to feelings of isolation, loneliness, and social anxiety. Moreover, misinterpretations of social cues and struggles with verbal and non-verbal communication can exacerbate these feelings. Due to fear of social rejection and negative attention, individuals with autism often mask or camouflage their autistic characteristics, in order to conform to societal norms. This can include suppressing stimming behaviours, forcing eye contact, or mimicking social cues. Whilst these strategies might be adaptive in the short-term, research has shown that this is simply exhausting, and can lead to identity confusion, anxiety, depression, suicidal thoughts, and the so-called "autistic burnout". Furthermore, people with autism are often subject to discrimination and stigmatisation, including deprivation of education and opportunities to engage in their communities, which lead to further feelings of isolation. It places these individuals in a situation of either being themselves or being accepted. Besides, this population also experiences an unjust deprivation of health care, specifically in terms of mental health treatment. Health care providers often have inadequate knowledge on mental health in autism, leading to a scarcity of suitable and adaptive treatments. Thirdly, sensory differences in autistic individuals can significantly impact their mental health due to the way they process sensory inputs – either with heightened sensitivity or under-responsiveness. For instance, everyday sounds and lights might be overwhelming, leading to sensory overload, which manifests as stress, anxiety, and physical discomfort. Such continuous sensory challenges often result in social withdrawal and meltdowns. Lastly, a concept called ‘Intolerance of Uncertainty’ also significantly affects the mental health of autistic individuals and refers to difficulties managing the uncertainty or unpredictability of future events. The need for predictability and routine is often significantly stronger than in the neurotypical population, and deviations from expected outcomes or routines can cause distress. The intolerance of uncertainty can manifest in various aspects of life, including daily schedules, social interactions, and even minor changes in the environment. For an autistic individual, the world can seem unpredictable and confusing, leading to a constant state of vigilance and anxiety as they try to anticipate and prepare for potential changes. And What Can We Do To Help? In order to improve the mental wellbeing in individuals with autism, it necessitates access to adequate and needs-specific, personalised treatments by overcoming barriers to accessing mental health services. Besides, schools, universities, and work environments should contribute to creating an environment tailored to not only neurotypical, but also to individuals with autism, through providing noise cancelling headphones, sensory toys, as well as sticking to provided schedules. In order for these strategies to be effective however, they should be implemented as early as possible. Therefore, early diagnosis of autism and comorbid psychiatric conditions is of utmost importance, specifically when considering the barriers to diagnosis in terms the female autistic phenotype. However, I believe that the current mental health crisis in autism is also partly due to the predominant medical view placing problems associated with autism solely within the individual, holding the assumption that the individual must be treated. As I've discussed in this article, interventions can be helpful in order to improve mental wellbeing and overall quality of life, nonetheless, according to the double empathy problem, challenges faced by autistic individuals often occur at the intersection of interactions between autistic and neurotypical people. Thus, the struggle to integrate into society stems not from their own social communication challenges, but rather from a mutual misunderstanding between autistic and neurotypical individuals. This calls for action for neurotypicals to increase empathy, acceptance, and understanding for differences. Essentially, we all contribute to the society we live in, and it is crucial that we strive to create a world where autistic individuals feel recognised and embraced!

Author's note: 'Vulgar Yellow Flowers' is a story about a person healing themself through creativity after a relationship that diminished them. It's about the beauty of wild nature, the way apparently small matters can have a significant impact on a person's wellbeing – in positive ways as well as negative ones – and how feeling 'seen' for who we are can enable us to blossom. This is its first publication. Alone in her alimony apartment, she’s adrift. She doesn’t know who to be, or where to go. She looks in the mirror at this person, and wonders who she is, now she’s no longer who she was. She sits. Drinks endless cups of tea. Watches out of the window. ‘You’re so refreshing, Chloe. Such a breath of fresh air.’ Ben’s kindness made the difference at that job. Temps are always a fish out of water, or overlooked, or both.  She was out of her depth in Ben’s office. Everything so understated, yet so competitive. So meticulous. It had to be. On the floor they made fortunes. Figures came first. It was a long time before she knew they ran a book on who could bed the temps, and by then she was under his spell. He whirled her off her feet. Champagne after work. Cocaine and cocktails. Complimentary tickets for Bruce Springsteen. What a first date. Then Glastonbury. A yurt. Hampers. Edinburgh, for the Festival, guestlisted for comedy shows that started in the middle of the night. He bought her a dress from a vintage shop, soft cotton, covered in yellow roses. They were new then. She thought that was who they were. She told him, quietly, that she hoped she could write poetry. He didn’t laugh at her. ‘Clever, quirky, Chloe,’ he said. She wore the dress the first time he asked her out with his work friends. His female colleagues were swans, as sleek and chic as a photoshoot. She was the ugly duckling in her Edinburgh dress, that had been so perfect at the festival. ‘You looked sweet,’ said Ben. ‘You looked like a poet.’ He took her to Harvey Nicholls at the weekend. She put on the pieces he picked out and looked at her reflection in the glass. The elegant woman who looked back at her was a stranger. ‘Beautiful’. It was the first time Ben said that. He bought the clothes, and she learned to wear the reflection’s mask. After they were married, it took all her effort, being that woman. The person who wanted to write poems couldn’t find any words. She put her notebook in a bag in the back of the wardrobe, with the dress covered in roses. Through lockdown, she’s on her own. No bubble, just her. She watches the leaves fall. Watches the rain. Sees her reflection in the window. This insubstantial face, this ghost woman, floating in glass. One day she notices two squirrels in a tree. Smiles at the sight of their funny little bodies, reckless, hurling themselves from twig to twig, suspended in the air, landing so deftly, so fearlessly. Two furry trapeze artists. The face in the glass smiles back at her. Who is that woman? she thinks. What does she like? She likes the squirrels. The tree. She likes the green shoots of the first flowers poking their way through the cold winter soil. Snowdrops, then crocuses, then daffodils. Yellow flowers, the colour of the sun. The colour of happiness. Sunflowers, turning their faces to the sun. She picks up a notebook, and a pen. Watches the woman in the glass make notes. She likes writing words, she thinks. ‘We’re going to make a fantastic team.’ That’s what Ben said in his wedding speech. ‘We’re going to achieve so much together.’ He was going places. His ambition was exciting. Later it was exacting. ‘It’s not quite… is it?’ each time she didn’t measure up. He was always kind, but she could tell how disappointed he was. It was easier to be what he wanted. Diamonds at her neck. On her fingers and in her ears. Platinum, of course. Stealth wealth, minimal elegance. No obvious status symbols. Those who know, knew. She wrapped herself in cream and grey and beige, wondering as she wore them that clothes could cost so much, and offer so little comfort. Their house was like her clothes. Muted. Expensive. Every shade of grey and nothing out of place. Black granite and white marble. Polished chrome. shining appliances. Ivory lilies on the central island. They reminded her of death. Once, she bought sunflowers. ‘I don’t like yellow flowers,’ said Ben. ‘They’re vulgar.’ She looks at the garden she hasn’t planted and notices dandelions and buttercups. Wandering buttercups, spreading joy. Bright yellow dandy lions, swashbuckling marauder of genteel lawns. Dandelion clocks. What time is it, Mr Wolf? She writes the words in her notebook. It was Ben’s house. He filled it. His ideas. His ambitions. His clients. They sat at the granite table and talked about commodities. She entertained them, and understood why entertainers got paid, because it was all such a performance. She put on the show he wanted and wondered if he could still see her. To stop herself becoming invisible she tried a lipstick called Strawberry Fair but her reflection in the bathroom mirror looked back at her with a clown’s mouth. Ben wouldn’t like it, said the voice in her head that always knew exactly what he wanted. She picked up the nude shade he liked and watched herself disappear in the mirror. It’s an act of courage, going to the poetry group. It’s just after lockdown, when people are starting to do things. She hovers outside. Nearly doesn’t go in. She thinks it will come off her in waves – that she’s empty and sad. Cast aside, with nothing to say for herself. Nothing worth saying, anyway, and no one to say it to. But she thinks of the squirrels. They fling themselves from tree to tree, never thinking they might fall. She takes a deep breath. Pushes open the door. Stands, for just one moment. Makes the leap. Doesn’t fall. She made an effort to match the clothes. The shining surfaces. The thick cream lily perfection. But she had so many shortcomings. Her body was unruly. Her hair was unruly. Her thoughts were unruly. She was unruly, and Ben was disappointed. Never unkind. Just, disappointed. Everything was hard edges, smooth surfaces. The perfect backdrop for the high achiever and his corporate wife. Sleek, and glossy. Except for her. Once she thought he liked that about her. There were to be no hard feelings. The settlement was more than generous. Ivana was what he needed, Ben said. At this stage of his life. She had the polish, the shine. ‘We wouldn’t want to hold each other back,’ he said.’ We’ll be friends’, he said. ‘We wanted different things,’ he said. But she didn’t know what she wanted. ‘Ah! A new writer,’ The voice has a welcoming burr but she can’t make out who it belongs to in the circle of new faces because her head’s swimming. ‘Hello. Please, find a seat. There are biscuits, somewhere.’ New lives don’t need to start with fireworks. Sometimes, a biscuit will do. She holds her biscuit in her hand, not daring to nibble it, listening to each person as they introduce themselves. Their name. What they write. When it gets to her, she shakes her head. ‘I’m new,’ she says. ‘I stopped writing for a long time. But I…’ ‘The words will come. And we’re glad you’ve come here to make a start.’ The warm voice comes from a woman in a saffron dress. ‘I’m Afsiyeh. This evening we’re going to think about what makes the start of something new.’ Afsiyeh’s a good teacher. For every person that reads out their fledgling lines, there’s a kind word, and a gentle suggestion. Something to amplify, something to take care of. Such attention to detail. She doesn’t read anything that first week, or the second, or the third. ‘When you’re ready,’ says Afsiyeh. ‘You can’t hurry something. Let it take its time. Be what it needs to be.’ She writes words in her notebook and wonders if she dares to read them out loud. Wonders about Afsiyeh, too. She’s open enough about who she is. Used to be a busker, then wrote lyrics. Then poems. A widow. ‘Finding my way through the fire. The only way though is through.’ She thinks about that, too. You can’t go back, she tells herself. Everything hurts but you’ve got to get to the other side. She’s alone, but as she writes in her notebook and watches the squirrels and drinks tea, it comes to her that she’s not lonely. Or not as lonely. She’s becoming, she thinks, and writes it down. She wonders if Afsiyeh is lonely. The next week, she reads a poem about becoming. The group all clap when she finishes and she feels absurdly happy, as if she’s won something. They aren’t just a group now. They’re Doreen, Andrea, Simon, Marcus, Imani, Ralph, Walter, Tom, Anni and Gaia. And Afsiyeh. When Walter suggests they go to the pub after their session, like he does every week, this time she doesn’t feel like a spare part. A tagalong. She could never handle her drinks. More than two and she starts to melt. A giddy puddle. ‘I’m such a weed’, she says. ‘I’ve got a fondness for weeds,’ says Afsiyeh. ‘They’re resilient. Survivors, even when they’re not wanted. Come on, you’re not staggering home on your own like that. Back with me.’ She hauls her to her feet. ‘Anyway, who gets to decide what’s a weed? They’re flowers with a mind of their own, that don’t want to do what they’re told.’ A vulgar yellow flower, that won’t do what it’s told. She thinks she says it out loud. The laughter ripples up from her in waves. ‘Come along, little weed.’ Afsiyeh holds out her coat. ‘Let’s get you safely bedded before you wilt. You need a good pair of boots.’ She points to her own well-worn Docs. ‘Hold you down to earth.’ Afsiyeh leads her behind the houses, off the beaten path. ‘Down the cut, and home. Nearly there.’ Down to the canal. A world of dark water. They walk past narrow boats with twinkling lights. Afsiyeh pulls a torch from her pocket to light the gangplank, and carefully hands her off the land onto her floating home. ‘This is me.’ She’s never been on a houseboat before. Afsiyeh lights lamps and a log in the burner. Puts the kettle to boil. They sit with their hands round mugs of hot tea in the lamplight. Two women, telling stories. ‘I came here five years ago.’ Afsiyeh points to a picture of herself, a young version in a bright print frock, with a man with wild, curly hair. ‘Thirty years. We were in the band together – that’s how we met. We never had any money but he gave me the greatest treasure. He made me believe in my words.’ The lamps in their holders frame Afsiyeh with light. She’s never met anyone so full of grace. Afsiyeh’s smile is full of crooked teeth that glint with gold. ‘It took a while for a different life to shape itself around me, but it did.’ In the lamp glow Afsiyeh’s weathered face takes on a goddess serenity. ‘I was so adrift after Rico died but on the water I’ve made myself a home. I didn’t think I’d be OK, but I was. You will be too.’ Such kindness, to a stranger. She’s still drunk enough to say her thoughts out loud. ‘But you’re not a stranger.’ Afsiyeh laughs. ‘You’re a friend I’ve only just met. And perhaps a sunflower. Who knows what little weeds might turn into.’ The next morning, she wakes on the bench, folded in blankets. Though it’s early, there’s no sign of Afsiyeh. She wraps one of the blankets round herself and heads onto the deck. Watches the sun make its way above the water, and the birds, and the canal people coming to life. That’s where Afsiyeh finds her. Afsiyeh has a canvas bag, and draws up a rickety table in front of her. ‘You unpack that. I’ll go below and get the kettle on.’ She lays out what Afsiyeh has brought. On the top, a bunch of buttercups and daisies and dandelions. Below, what treasures. Afsiyeh gives me butter, she thinks. She gives me honey. Ripe, crumbling cheddar. Fresh eggs. Afsiyeh gives me every golden thing. She writes down words, in a notebook. A poem perhaps? Or at least, a beginning. A weed, beginning to flower.

One of the manifesto pledges set by the Conservative Party in 2019 was to end the blight of rough sleeping. Ahead of the General election and campaigns this year, I wanted to find out more about homelessness as I have previously volunteered at Pecan Charity organisation and had many insightful encounters whilst working at their food banks. I am Gargi, a research assistant at the Stress, Psychiatry and Immunology lab, and I have previously written articles on the cost-of-living crisis and student mental health. I met Mr Chris Price, the former CEO of the charity, and I spoke to him about the various reasons behind homelessness and problems with temporary accommodation. I started by asking about the general trend. "Homelessness and people at risk of homelessness are on the rise", Chris confirmed. It is estimated that around 300,000 people, 14% more than last year, were in some form of homelessness (rough sleeping, temporary accommodation, etc.) in December 2023. The reasons for the incline could include the relatively high mortgage rates since 2022, affordability pressures on the rental market, and the long-standing shortage of affordable housing. Changes in private ownership and rentals Mortgage rates have significantly increased. High inflation pushed interest rates from around 2% to around 7% in less than two years (between December 2021 and July 2023), and the Bank of England announced that rates will be held at 5.25% this month. As inflation is at 3.4%, double the Bank of England target of 2%, it seems likely the mortgage rates may not change significantly in 2024. Not only will this impact people looking to get on the property ladder, but it will affect around 1.5 million homeowners whose fixed-rate mortgage deals will end this year, resulting in an estimated average increase of £2,900 a year on mortgage repayments. Higher mortgage rates would mean that more households would be struggling to make the repayments and may even result in property repossessions, and subsequent homelessness. The increasing costs affect renters because landlords may be able to pass their costs to the renters in some cases, thereby exacerbating the pressures of private renting in which people already spend 35% of their income, and must compete against all odds to find suitable housing. Chris explained, “Rents are no longer going up in line with people’s income. There is also a rise in private landlords who are getting out of the business because it's just becoming unaffordable for them, or they're having to put rents up quite dramatically. Landlords have also got the option of section 21 (no-fault eviction) notices, meaning that people are told to leave their homes within a couple of months.” Indeed, eviction from a private rented home is a leading cause of homelessness in England, and a survey by the housing charity shelter demonstrated that single parents are at a greater risk for section-21 notices. Chris proceeded to explain that one way to alleviate some of this monetary burden from renters (mostly young, working individuals) could be by considering peoples’ rental history by mortgage companies for first-time buyers. “Private rental always gets me; someone who's renting doesn't have the money to save up for a deposit because they're spending the money paying off someone else's mortgage, and I find it surprising that your rent history is not taken into account because if someone can make consistent monthly rent payments that are higher than the mortgage repayments, then they are less likely to default, so if that could be considered, it could be a game changer for first-time buyers.”, Chris mentioned. Rough sleeping and people in temporary accommodation There is an increase in rough sleeping in the central and outskirts of London. A study published by the Kerslake Commission on Homelessness and Rough Sleeping indicates a 26% increase in rough sleeping. During the pandemic, people were also allocated hotels, which was highly beneficial as support workers could meet them regularly in fixed locations. There was a temporary ban on section-21 notices which has been restored since May 2021, and the Renters Reform Bill which calls for abolishing section-21 notices has been postponed indefinitely. Chris also wanted to highlight that people in temporary accommodation and those sofa surfing are also homeless, and it may not always be visible. Government data published in November 2023 indicates that a record number of households with dependent children were in temporary and B&B accommodations. He indicated that one of the reasons for the increase in families and children in temporary accommodation could be due to the two-child cap, in which the government has restricted means-tested child tax credit to the first two children only, and families with third/subsequent children born after the 6th of April 2017 do not get any additional support. This policy has been strongly linked to the high rates of child poverty. Furthermore, there are numerous people in long-term temporary accommodation, which is when the council cannot house someone permanently for five years. Living in these conditions makes it difficult for people to have jobs, family/friends and support networks, and it can be especially hard for children. In a few cases, temporary accommodation becomes family homes for people, where they live for the entire lifespan and raise their children but are unable to pass it down to them. “The vulnerability of people in temporary accommodation really increases and you have that long period of time where you are not settled”, Chris explained. Lack of affordable housing The increase in the demand for temporary housing could also be a result of the lack of affordable/social housing. The net additional dwellings in England are just under 235,000 in 2022-23. However, only 9,561 additional social homes were built in England in 2023, thus the difference between houses for private sale and social rent is vast. Chris added, “Southwark Council (where the charity is based) is the largest social housing council provider in London. It is one of the best at trying to build new housing, but other boroughs are not pushing as hard as that and there isn’t a 50% social housing against 50% private housing being built, which what should be the target for every borough.” Few councils outside of London are aiming to adapt reformed housing strategies. Reading Borough Council is seeking funding from the government for their Housing First scheme in which they propose to buy six properties to re-home individuals. Additionally, Southampton City Council have undertaken a five-year initiative which focuses on prevention, intervention, building stronger partnerships and finding better housing solutions. The last question I asked Chris was how to keep motivated when trying to alleviate the burden of such a multifaceted issue as homelessness. Chris replied, “You have to see a person holistically; you cannot solve one issue without the other issues having knock-on effects. Homelessness is very hard for people, it can be depressing, but you have to remember that you can only do your best. In Pecan, we work with many partners to support people in the best manner, advocate for people, and give their opinions a voice.” This can help create a small difference, which can be a catalyst for a larger change.

Many people know what it means to be ‘invisible’, to be present but not seen; to be concealed from public knowledge. But what if this affected over half of the world’s population, in numerous situations? I want to open this article by saying that the invisibility of women in sports should be a discussion and an opportunity to shine light on some of our greatest athletes, heroes, and rule breakers. Whilst this is a very infuriating topic, I want to celebrate how many sportswomen challenge the status quo, and how we are changing lives through the power of sport. As a woman who has practiced many sport types throughout my life, including football, swimming, and various winter sports, I’ve witnessed, firsthand, the disparities and challenges faced by female athletes. However, at the same time, it wouldn’t be fair to not point out that, because of these, I grew up with some of the most powerful role models in sports history. To this day, still, there is an incredible sex data gap in sport and exercise research. Not to mention, the scarcity of health and safety research that considers women as a test subject. Today, women continuously remain significantly underrepresented in research, meaning that many results might only be applicable to one sex. This is a huge problem, as it can lead to major stress factors and longtime damage for female athletes who have been at the receiving end of negligence – both from research, and from brands. Serena Williams, for instance, is a tennis player who has loudly overcome the unfair gap time and time again. Others include the great Simone Biles in gymnastics, Megan Rapinoe in soccer, Naomi Osaka, Lindsey Vonn, and Allyson Felix to only mention a few. From car racing safety procedures to basic equipment considerations such as football boots, women have been invisible for far too long. As Caroline Criado Perez writes in her book Invisible Women: Exposing data bias in a world designed for men, “Imagine a world where your phone is too big for your hand, where your doctor prescribes a drug that is wrong for your body, where in a car accident you're 47% more likely to be seriously injured, where every week the countless hours of work you do are not recognised or valued. If any of this sounds familiar, chances are you're a woman.” Historically, and still to this day, car racing crash dummies have been modelled after male bodies, leading to safety features that are less effective for women. Plus, many sport equipment manufacturers not only produce limited sizes and styles for women, but many don’t even have a professional women’s line, leading to ill-fitting gear and increased risk of serious, long-term injury. Ever heard of the ‘Pink Tax’? Even financially, our professional athletes are being discriminated when it comes to clothing and equipment, from a very young age. For example, women’s sports apparel and equipment is priced higher than men’s despite the being of similar, and sometimes worse, quality. A study in 2023 showed that women pay an average $2,300 more, for the same goods and services than men per year! As it turns out, consumer reports found that sporting essentials, such as antiperspirant, razors, and body wash directed at women —through packaging, description, or name — can cost up to 48% more than similar products for men. Not to mention the already-existing stress of body image and the toxic attitude or prejudice about sexuality. Even in sports apparel, there is a huge tendency to depict sportswomen as overly feminine, as a way to counter ‘hetero-negativism’, or 'unfemininity'. There is also a large number of professional athletes who have been criticised about their open struggles with mental health. With professional basketball player DeRozan, saying "although I am encouraged by the number of people who have been coming forward about their mental health, an incredible stigma continues to be associated with mental illness, especially in sports. Despite the staggering statistics, mental health is a topic many shy away from in conversation and is not held to the same standard as physical health." Surfing, amongst so many others, is another sport that has seen far too big of a divide for far too long. While men's surfing events dominate the spotlight and receive more significant sponsorships, women's competitions often struggle for recognition and equal pay. However, professional surfer Carissa Moore has been confronting discrimination and advocating for change since her early career. Her achievements and activism serve as a beacon of hope for female athletes worldwide. So, as a society, let’s challenge these norms and advocate for equal representation and opportunities for women in sports. And as readers, let's be aware that girl and women athletes include straight, bisexual, and lesbian people, who might all like to see different kinds of images publicly. Role models can hugely help individuals who feel isolated and invisible to find strength and inspiration in pursuing their passions, regardless of gender or sexual orientation. It’s high time we shed a light on the invisible struggles faced by women and work towards creating a more equitable and inclusive athletic landscape for all. Let’s hear it for our athletic heroes!

Hello reader! I’m Sofia, a twenty-one-year-old bachelor’s student with a passion for Neuroscience. Ever owned a diary? Sceptical about having one? Let me share how I stumbled upon journaling, where thoughts find a home, and self-discovery transforms into a puzzle of words on each page. I’ve lost count of the number of unfinished diaries that lie in my childhood bedroom. My journey as a journaler began at the ripe age of five. The truly interesting ones barely made it to the fifth page. Fast forward to thirteen, and my journals start getting more and more interesting. When middle school started, I decided that writing in my diary looked cool, so I embraced it. Is there a difference between a journal and a diary? Personally, I think "journaling" just has a better ring to it. Check out this video to see what Greg from 'The Diary of a Wimpy Kid' thinks! The more I wrote, the better I felt. Maybe that's what's so mysterious about journaling, the peculiar sense of release. That’s the magic of writing, suddenly the pen takes on a life of its own, and things you didn't even know you were thinking appear on paper. There's a moment of surprise you experience when you finally get to read what you wrote. Once you let go of the reins of your thoughts and feelings, your brain allows you to put them out into the world. Confusions and worries suddenly clearer. Once I passed the age of fourteen or fifteen, I stopped writing. Life events, teenage peer pressure, and a new cellphone made me forget how much I enjoyed journaling. Then, when I was eighteen, the pandemic hit and despite its challenges (I know it’s not a popular opinion), I found the "locked in your house with nothing to do" thing strangely beautiful. Granted, it was thanks to my privilege and the safety of my family and friends. I chose to resurrect my journaling habit. That moment opened the door to a new and fun way to spend time with myself. At first, it was just a "so I can reminisce when I'm old" thing, but it quickly became much more than that. In the beginning, my entries were more descriptive of what I was doing, who I had met, and the places I had been. Then it became the possibility to confront my own thoughts. Suddenly, I felt like two people: the Sofia pouring her heart out, unfiltered, and the Sofia reading it, analysing, discussing, processing, and feeling all the written emotions in a more detached and aware manner. During my bachelor's degree, a friend of mine started sharing her journal with me, opening up her magical world of words and drawings. It allowed me to see her in a new light. I started to know her better and empathise with her experiences. I started to take inspiration from her emotional freedom and found new ways to do something with mine. The stigma of the "secret little private diary" disappeared. I began sharing my thoughts with close friends. The more I journaled, the more it became an indicator of my own well-being. Still now, when I catch myself not writing for a few days, I know something's up. Maybe I can’t pinpoint it, but I can sense it. It's like when your friends go silent for a while, you start to worry. In this case, my diary is my friend. Might sound off to some, but to me, it’s anything but sad. When that happens, I try not to be too hard on myself but still try to put down something, even if it’s as mundane as what I had for breakfast. Gradually, the words flow again, and I start feeling better. Living abroad for the past few years has meant finding new ways to connect with my closest friends back home. Voice calls are fantastic, but sometimes they're not enough. Journaling has helped with this too. To the question "How are you?" I sometimes just read them a journal entry. This way, they can step into my shoes and understand what I’m going through. It's a very bonding experience. On the other hand, not all thoughts I have I want to share, even with my closest friends. Being able to express them without necessarily having to tell someone else helps with not repressing feelings, and slowly processing them and then dealing with them more constructively. Being a Neuroscience student, I find the science behind it particularly interesting. There’s plenty of literature on how mindful journaling improves well-being. One study found that positive affect journaling three times a week improved mental distress levels, anxiety and perceived stress over only three months, imagine what can happen if it is sustained over a longer period of time. Another article makes an interesting point about the value of journaling; the author notes that the meditative act of journaling, by creating a space for vulnerability and self-awareness, is, in a way, a form of art, as it’s accompanied by the attention to detail we seem to lose in our day-to-day life. The artist's brain is reached through rhythm—through rhyme and not reason. By paying attention to detail, we enhance our capacity to be creating artists. I guess what I'm trying to say is that journaling has transformed my life. Intrusive thoughts can now be stored somewhere, without hijacking my day. Worries can be written down, giving me space to take a break. Writing letters to my feelings, like "Dear Mister Envy," has made me grateful for them instead of afraid, and gratitude is such a strong antidote to depression. In moments of discomfort, reading back old entries make my day start with a smile. Seeing how much we grow gives me hope and makes me eager to see what the next page will be about. Sure, there are countless mindful practices that enhance mental health, but which one can you do snug in your bed? Journaling. For beginners, I highly recommend the MUJI 0.38 pen. Once you start with it, there’s not turning back. Trust me, there is no such thing as journaling with an annoying pen.

By the time I was diagnosed with endometriosis, I was told that my disease had progressed to moderate organ fusion from scarring and re-scarring. Despite complaining of debilitating pain and concurrently being dismissed and gaslit for 10 years, my diagnosis came when I had stage 3 endometriosis. I was angry, dejected, and without favourable treatment options. Unfortunately, when it comes to endometriosis and other disorders affecting women, symptom dismissal and delayed diagnosis are fairly common. As Samrina discussed in her article published last week for International Women’s Day, there is blatant gender bias within healthcare settings which leads to de-prioritisation and neglect of women’s health issues. As both a sufferer of endometriosis and a scientist, I frequently wonder how we can educate the wider public and health practitioners about the need for management strategies for a disorder that is incurable, misunderstood, and seemingly invisible. My name is Seyi, and I am a clinical research assistant at SPI Lab, an artist, and new writer for Inspire the Mind. For this interview, I combined my interests in arts and health to shed light on reproductive disorders. With the help of my two creative friends *Sophia, a photographer and fine artist who was diagnosed with polycystic ovary syndrome (PCOS) and *Ava, a mixed media artist who was diagnosed with endometriosis, we discuss the realities of these disorders and how creative outlets, such as art, can bring visibility to our hidden struggles. I decided to start at the beginning and ask how they detected their disorders. Sophia explained how she presented the tell-tale signs of PCOS such as cystic acne, abdominal fat, and mood swings, “These symptoms made me feel very self-conscious of my body growing up, especially since I didn’t know what was causing them. Once I was diagnosed it felt like a huge relief to have an explanation for everything.” Ava agreed with feeling relief from her endometriosis diagnosis. Like me, she had struggled for years with painful and irregular menstrual cycles and eventually reached out to her doctor for help when the pain and mood swings became “too much to bear”. Ava also shared how the sustained pain and body disassociation from her endometriosis created secondary problems that she didn’t expect. She developed vaginismus, a pelvic floor disorder which makes vaginal penetration of any kind extremely painful if not impossible. While vaginismus is curable, it requires both physical (such as stretching and dilation therapy) and emotional work to overcome it. While discussing this aspect of her journey Ava was visibly emotional as she relayed the shame and judgement she has endured, “It’s made me isolate and avoid romantic relationships so I don’t have to explain my limitations or face rejection”. Seeing how impassioned Ava became, I pressed her on what care she felt was absent from helping treat her endometriosis and vaginismus. She explained how her rehabilitation included no consideration of female comfort and pleasure, “A lot of this disorder is linked to the mind, not just the body, however doctors address vaginismus, and even endometriosis, on a level that feels emotionally sterile and mechanical, almost like I’m just a vessel.” She elaborated that in the context of a disorder which causes painful intercourse, female pleasure has never been discussed or prioritised in her treatment. Instead, everything has been addressed from the standpoint of being able to reproduce. Shaking her head she said, “It’s frustrating that a disorder that affects my body is only important in the context of preserving it for another body.” Sophia agreed and stated how her PCOS is constantly blown off and reduced to “just a woman thing”. She added how people often forget that PCOS isn’t just a menstrual illness, but a chronic disorder affecting her hormones. Doctors didn’t give her much guidance on how to manage her symptoms, so she had to learn how to navigate it herself, “I do feel it has made me more intuitive and accepting of my body. I pay attention to what it needs at any given moment and honour that feeling. I feel that for better or for worse, I’m much more in tune with my body than the average person.” Due to our disorders, the three of us have all developed an increased awareness of our bodies and their unique needs. As experts in our experiences and creative individuals, I asked what type of art they would create to inform individuals who don’t, or can’t, understand the mix of emotions, pain, and intuition that our illnesses have sparked. Sophia immediately perked up with this question and smiled as she put together her idea, “I would use photography to show the externally visible symptoms of PCOS and painting to represent the more abstract internal manifestation. The painting would be a multi-layered flower where each petal has a distinct shape to symbolize the complexity yet interconnectedness of the reproductive system. To me, PCOS in an artistic sense means understanding that the female body, disorder or no disorder, is multifaceted and unique.” I turned to Ava who jokingly admitted that she had a less concrete idea, but that she would want to create something that is multisensory, “Perhaps a figure of a human body that looks normal from the outside but feels different to the touch. I would try to capture this through using abstract and unexpected materials. My goal is to embody the idea of invisible illness where the audience would be able to interact with the art as an oblivious observer and then also experience some of the nuances of having endometriosis through senses beyond sight.” Talking about our ideas created an air of lightness where we held more autonomy over the perception of our bodies and disorders. Seizing this sentiment, I concluded by asking Sophia and Ava why they think art is effective in expressing some of the difficulties we’ve faced. Ava explained the uplifting aspect of art and how it can shift her out of the fight or flight state. Sophia expanded on this, by adding how it explains an experience in a way that is universally accessible. Without the barrier of language, experience, or medical understanding she can bridge a knowledge gap through creative connection. Although not everyone is an art enthusiast, we want to show how one of the most healing aspects of our journeys is creating a community where we feel truly heard and uplifted. Because while we may be navigating illnesses that are hidden, we want our experiences to be seen. * names have been changed to maintain anonymity

When we think of inherited genes, we usually think of things we can see. Eye colour, hair colour, height. We get these things downloaded from our parents, and our parents’ parents, and we can trace it back far down the line. Some things we get from our environment. Usually, we chalk things like work ethic and political beliefs up to our surroundings. Things we can’t really see but pick up from watching what’s around us. But truthfully, we don’t have a great sense of all the things that come from each source. Genes and environment, they get a bit blurry. This year, my father and I met my grandmother — his mom — for the first time. I’m a writer. I’ve always loved storytelling and now my whole life revolves around it. When I met my grandma, I knew I needed to tell this story. I could write books about her fascinating life — and maybe one day, I will. While the three of us lived astonishingly different lives, there were parallels beyond what any of us could’ve predicted. Today, I’d like to write about one of those parallels. Hope. In 1939, my grandma was born. She lived a traditional life, raised in a nuclear family with conventional roles. Her father was a wine steward to the stars and a host at a fancy country club in California. He was tough and strict, and Joy needed to act right, to look right. Rules were important. Protecting their image was valuable. When she was 16, she got married off to an unkind man. Her mother thought she’d be in safe keeping with him, but it didn’t go as planned. Joy would come home, and her husband would have her peel the wax off the floor and redo it. If she made dinner and he didn’t like it, he’d turn the plate over on the table and dump the food off. He was just plain mean. Around the time she was wed, she decided she wanted to go to beauty school. She was tired of traditional high school and had dreams of creating art that pushed beyond what was expected of her. She didn’t want to play a traditional role — she wanted to be an artist. So, she went to her principal and asked if she could finish her high school degree by going to beauty school. They said yes, so long as she held straight-As the entire time. Joy told me it was hard. She memorized dozens of facial muscles and an endless number of hair-cutting and styling techniques. She spent hours and hours practicing. At 18, she got her license and her high school diploma and began styling hair at her mom’s shop. It didn’t take long for her to tire of the routine at the shop and, once again, dream beyond what she saw. So, she entered a national contest. She took part in the fantasy division of the competition. Joy lit up when she told me this story, describing in detail how she coloured hair blue and made it flow like a waterfall, counter to gravity, counter to nature. She won the contest and laughed when she relayed the details. “They gave me a trophy with a blue sapphire. They said it was a real jewel, but it disintegrated eventually.” At 16, Joy was seemingly trapped in a painful marriage for life. But instead of succumbing to what was around her, she followed a voice that told her there had to be something beyond what she could see. In 1962, my dad was born in northeast Kentucky. After a few months at an orphanage, he wound up in Corbin, Kentucky — home of Kentucky Fried Chicken and little else. He grew up in a small house built by his adoptive father, surrounded by two tough sisters and a rigid Kentucky culture. Corbin was a place built on doing things the way they had always been done. But my dad was a bit of a dreamer. He started playing piano young and quickly outplayed the teachers within his radius. With delusions of grandeur and a desperation to escape the life around him, he headed to college at 18 to study piano. If you’ve ever known a music major, you know that studying piano is no small feat. He showed up to school and flunked out so badly that he had no option but to change course. He jumped from studying music to learning about its more playful cousin — theatre. Theatre, while a passion, didn’t satisfy him. He graduated with a directing degree and spent some time traveling with theatre troops, playing piano on cruise ships. But again, he got tired of what he could see. So, he went back to school. My dad got a Master’s degree and then a Ph.D. in organizational psychology. He joined corporate America and jetted around the world as an executive for Daimler Chrysler. It’s an understatement to say the path from Corbin to a Ph.D., to a global executive, had been pretty much uncharted before my dad. He, time and time again, pursued the only thing he knew: that there had to be something beyond what he could see. I was born in 1999 to two parents who wanted me to think for myself. I don’t think I needed that reminder — I came out of the womb screaming and didn’t stop until sometime this year. I’ve never been able to tolerate misery, nor have I ever been able to keep to anyone else’s proposed plan of action. While my early life included a lot of traveling around, my middle- and high-school years were spent in a snooty town full of rich people who worked 9-5s and coached their son’s soccer teams in the evenings. It was as suburban, as white, as wealthy as you would imagine. Once I graduated, I went to school for theatre… then for psychology… then for nothing… then for political science. I completed my degree quickly, with plans to attend an Ivy League law school. One day, as I was waiting to hear back from schools regarding my application, I decided it would be good to work for a law firm. I applied to — literally —100 law firms that afternoon and moved away to my first grown-up job a few weeks later. It didn’t take long to realize that working for lawyers is not particularly pleasant. So, with rigidly high standards and a desperation to have a life I like, I revoked my applications and quit my job after six months, with no other ideas for the future except that I wanted to like it better. I looked around my town, full of white-picket fences, of people living perfect lives with perfect families. I thought, there had to be something beyond what I could see. In conclusion. Our three generations each lived exceptionally different lives, but when we met, we were all struck by the astonishing similarities. The sense of familiality was obvious and we all had one prevailing leader in our lives: hope. Hope as a rebellion. Hope as an act of desperation. Hope as a willingness to believe there’s something beyond what we can see. Hope, inherited.

Recently, there has been increasing recognition of the role of schools in mental health provision, and the prevention of mental health problems through psychosocial education. This blog will outline how we have optimized a new preventative mental health intervention: “building resilience through socio-emotional training” (ReSET), to be delivered in schools, and the benefits of school-based interventions for young people at risk of mental health problems. The ReSET project is based at University College London (UCL). I am a Research Assistant at UCL, working on the ReSET intervention which is focused on building resilience through socio-emotional training in schools. I have a background in Developmental Neuroscience, Psychopathology and Psychology and my work on ReSET involves conducting research assessments at schools across Greater London, as well as supporting dissemination through social media and blog posts. The ReSET project is a longitudinal trial, even though we are waiting for the final results, the feedback so far has been incredibly positive from students and staff members. This blog is intended to outline more about the ReSET project, what we are doing in schools, and why integrating mental health support into education systems is so important. Adolescent mental health and the role of schools In the UK, emotional problems such as anxiety and depression are the most common mental health issues experienced by young people. Mental health problems typically begin in adolescence, and almost half of psychopathology emerges before the age of 18. Poorer mental health in adolescence increases the risk of experiencing other types of mental health problems both during adolescence and into adulthood. Given the amount of time that adolescents spend within a school setting, schools are an important factor in understanding and supporting wellbeing in this age group. The school environment plays a key role in the development and maintenance of peer relationships. Inclusion in peer groups and a sense of school belonging are important predictors of mental well-being, such that positive peer relationships may act as protective factors against mental health issues. In contrast, lower-quality peer relationships in adolescence are associated with feelings of loneliness, and poor mental health outcomes such as depression and anxiety. Integrating mental health support within schools can provide a unique opportunity to support adolescents in a setting where they are exposed to experiences that can be beneficial or detrimental to their mental health. The potential for school-based interventions has been reflected both in the UK and internationally, by an increasing focus of government policies directed at improving mental health outcomes through school-based programmes. School-based interventions are advantageous as they can reach young people who might otherwise be missed by mental health services. A review of child and adolescent mental health services outlined common barriers that young people face when accessing services, which include difficulties taking children out of school to attend treatment sessions, navigating complicated referral processes, and lengthy wait list times. School-based interventions can overcome these barriers and reduce the number of steps needed to access mental health support. Stigma is another barrier to accessing services, and young people may perceive accessing mental health support through schools as more acceptable and less stigmatizing than engaging in conventional mental health services. Challenges associated with school-based mental health interventions While delivering mental health support within schools is important, the process itself is not without challenges. School-based interventions require a high degree of communication between mental health services, school staff, and, in the case of clinical trials, the research team. The most frequently cited challenge for school-based interventions is logistical difficulties. Practitioners and researchers must consider the timing constraints of the academic term, and school day, as well as finding a physical space suitable for the intervention. Another challenge is engagement from teaching staff, which affects the extent to which interventions are delivered correctly and to completion. Many of these factors are related, for example, if students are not engaged in an intervention, teaching staff are less motivated to continue with delivery. Similarly, teachers may be more accepting of an intervention that cuts into teaching time if they believe it will benefit their students. Successful interventions tend to be those which include the support of senior leadership teams in schools, protect staff time to participate in supervision and training, and have an intervention manual that is clear and easy to follow with good quality support materials. The ReSET project The ReSET project is a new 8-week school-based preventive intervention that aims to promote resilience in students through group workshops. Our intervention focuses on two mechanisms: emotional processing and social relationships, both of which are implicated in mental health outcomes during adolescence. The intervention aims to strengthen protective factors related to emotional processing and social relationships and promote well-being generally. Unlike most other mental health interventions for adolescents, ReSET focuses on preventing a range of mental health outcomes, rather than targeting specific diagnoses. The intervention is aimed at young people aged 11-14 (Years 7 –9) who show elevated risk of mental health problems. This age group represents a major developmental stage of both biological and psychological change, and coincides with a changing social environment – students transition from primary school to secondary school, which comes with larger class sizes, increased academic pressure, and, crucially, increasing dependence on peers over family. In order to students who are suitable, we conduct a short wellbeing questionnaire, which is delivered to the entire year group. Those identified as having an elevated risk of mental health problems, based on scores on the Strength and Difficulties Questionnaire, are invited to participate. The intervention consists of 8 weekly group sessions, run by a trained mental health professional. Eligible students meet over the course of one academic term and develop skills in regulating emotions and managing relationships, in groups of 8-10 students in the same year group. How we used process evaluation to integrate ReSET into schools Interviews with young people and school staff have provided unique insight into how to best integrate this project within the school day and have played a crucial role in the development of ReSET. We received feedback that the study could be time-consuming for staff, so we implemented measures to reduce the pressure on them. School staff noted that “the fact that external staff were coming in and delivering the intervention was really helpful, due to the lack of resources that we had within the school”. Another insight was that the language used to describe school-based intervention is important, in terms of how it is received by parents and students alike. Based on feedback from young people and their parents, when we introduce the intervention, we are careful to highlight the groups as an opportunity to learn more about social-emotional skills, rather than describing it as a form of mental health support. In conclusion, schools are not organized in the same way as mental health services, and teaching staff are not trained mental health professionals (nor should they be). Structural challenges of integrating mental wellbeing into schools such as finding confidential spaces to meet, and lack of equipment, resources, and time, have all been identified as barriers to implementing interventions in schools. Therefore, interventions must continue to adapt and be flexible to meet the needs of schools to be as effective as possible when supporting young people experiencing mental health problems.

Photo by Luwadlin Bosman on Unsplash Today marks International Women's Day, a global day which celebrates the achievements of women from all walks of life. One of the key missions of today is to empower women to take charge of their health and make informed decisions regarding their well-being. As a woman, I often find myself in situations where I have to speak louder to be heard or mould myself to be more palatable to garner the same respect as my male counterparts. Although many of us have learnt how to navigate through a male-dominated world, gender bias remains a pervasive issue, with statistics revealing an alarming 90% of global gender bias against women, perpetuating discrimination across various contexts. Concerningly, the healthcare sector is one such place. While women have equal access to GP surgeries, doctors, and hospitals, this does not automatically ensure an equivalent standard of care compared to men. Throughout generations, women have faced healthcare challenges due to deep-seated historical gender inequalities in medical research and practice, which have excluded women in the production of medical knowledge.  Despite progress, a lingering patriarchal influence frames healthcare as being “made by men for men”, influencing the training doctors receive and centring on the male body as the standard ‘human body’, relegating female bodies to reproductive parts. My own experiences with the healthcare system, combined with being a psychology student, have sparked my interest in delving deeper into the mental health repercussions of the gender health gap for women. Invisibility of Women in research Discrepancies within healthcare start with clinical research. Women are often excluded from preclinical and clinical trials due to the layer of complexity that hormonal fluctuations experienced during menstruation, pregnancy and menopause add, making research more time-consuming and costly. Such exclusion brings into question the generalisability of research findings to women, leading to an inequitable and unequal healthcare landscape due to the neglect of female physiology, preventing optimal treatment and posing risk. The underrepresentation of women in clinical research has produced mounting evidence demonstrating the profound effects of hormonal fluctuations on drug treatments. Due to hormonal differences and body composition, the way males and females metabolize drugs differs significantly, leading to potential toxicity when women are prescribed the same dosages as men. A study analysing United States Food and Drug Administration (FDA)-approved medications found a disparity in dosing for 86 medications, one of which was a sleep medicine called Ambien which showed higher blood concentration levels and prolonged elimination times in women, contributing to increased road traffic accidents the morning after consumption. Higher doses of drugs can induce more side effects, affecting the psychological well-being and overall behaviour of women. Photo by Pina Messina on Unsplash The research gap in understanding disorders Moreover, research has predominantly focused on a male-centric perspective, creating a significant gap in understanding symptom manifestations in females. This bias in studying disorders has resulted in a shortage of literature documenting female experiences, contributing to healthcare professionals frequently attributing symptoms to anxiety or stress. This, in turn, leads to delayed diagnoses, or misdiagnoses across a spectrum of over 700 disorders. This issue is particularly prevalent in autism spectrum disorder (ASD). Traditional stereotypes of autism are rooted in male presentation, resulting in a biased perspective that associates specific behaviours with the condition, often diverging from societal expectations of femininity. As a consequence, diagnostic criteria are primarily based on observations and research of male presentations, contributing to an alarming 80% misdiagnosis rate in females at age 18. This high misdiagnosis rate is exacerbated by a lack of clinician awareness regarding the unique presentation of autism in females. Autistic traits in women often manifest as internalizing behaviours, such as withdrawal, diverting doctors’ attention to treating perceived social anxiety rather than recognising the underlying autism. In the absence of research guiding clinical practice, women find themselves compelled to engage in discussions about their symptoms with doctors rather than receiving the support they need. My personal encounters with healthcare professionals have heightened my awareness of systemic issues within the healthcare system. Numerous visits to the GP clinic left me feeling unheard and dismissed. Instances like being told knee pain was merely growing pains when, in reality, physiotherapy and knee surgery were viable options, or having typhoid brushed off as the flu, leading to hospitalization in a foreign country, and enduring excruciating period cramps- all underscored the overarching issue of my voice not being taken seriously. This struggle is not unique to me; it’s a shared experience faced by 4 out of 5 women in the UK and many others worldwide. One disorder where women are particularly overlooked in healthcare is called endometriosis, a condition that affects 1 in 10 woman globally. This disorder induces severe pain, as tissue resembling the uterus lining, grows in areas such as the abdomen, ovaries, bladder and bowel. Endometriosis develops during early adolescence and progresses into adulthood, and is often dismissively labelled as mere 'women's troubles,' perpetuated by the normalization of menstrual pain within healthcare. Due to this outdated notion that has persisted through generations, endometriosis demonstrates an average delay of 8 years between the onset of symptoms and diagnosis for women in the UK. This delay leads to women accepting the belief that the discomfort they experience is an inevitable aspect of ‘being a woman’; a phrase I’ve often heard when seeking clarity about the normalcy of the pain and its impact on my daily life. Photo by Alex Vamos on Unsplash Despite possessing extensive knowledge about the potential causes of pain, many women, including myself, face dismissal by doctors—a widespread issue. Women often find themselves not just educating themselves through extensive Google searches but also burdened with the responsibility of informing the supposed "experts." Instead of receiving a thorough examination, we risk being misinterpreted as hypochondriacal or perceived as overly emotional, hysterical, or dramatic. While self-diagnosis may seem a viable option, the persistent dismissal by doctors can discourage women from developing hormonal health literacy. This cycle of suffering has profound implications, including increased concern, feelings of worry and anxiety, relationship difficulties, reduced quality of life, financial strain due to time off work, and consequently lower socioeconomic status compared to men. Addressing the suppression of women's voices in healthcare requires a fundamental shift in clinical research practices. The inclusion of more women in trials is essential to accurately inform clinical practice and eliminate the need for women to plead, argue, or resort to legal action for their health concerns. The healthcare system must recognize women's bodies as equal to male bodies in their own right, moving beyond reducing them solely to reproductive parts. It's time for a comprehensive re-evaluation to ensure equitable representation, understanding, and care for women's health globally.

My psychiatrist prescribes me medication for ADHD, and my therapist doesn’t believe in it. Confusing? Yes, but also no. My name is Sonia and I have struggled with distractability, fatigue, and memory problems for as long as I can remember. Inside my head can feel a bit like owning a car with broken windshield wipers. Even when I really want to drive, depending on the weather that day, I can have a hard time seeing the road. So, when I was diagnosed with ADHD last year at age 27, at first I felt relieved. It felt good to have an explanation for something that I had always assumed was a personal failing. More recently, though, researching ADHD started to do more harm than good for me. Reading I had done, such as on social energy limits, made me over-aware in social and work situations. I felt like I was reducing myself to a diagnosis, rather than using it as a reference for well-being. In Berlin, Germany where I live, I now see both a psychiatrist, who prescribes me stimulant medication for ADHD, and a therapist, who does not believe in medication for ADHD, but rather that my symptoms come from a faulty coping mechanism that can be unlearned over time. Navigating two differing medical opinions may be overly confusing for some, but I find that for me, it has provided a balance of ideology that feels appropriate for the moment. Although I don’t feel quite ready to give up on medication yet—there are still times when I feel a jumpstart is necessary for me to have the day I need to have—I also believe that there is nothing fundamentally wrong with me, and that with time and healing, there may be a point in the future where I’ll be able to comfortably live medication-free. What the research says I am just one of many women in recent years who has received an ADHD diagnosis as an adult. Between 2020 to 2022, the percentage of women newly diagnosed between 23-29 and 30-49 nearly doubled. One reason, experts say, is there has been a deepened medical understanding of symptoms and how they may differ between genders. In men and boys, ADHD often presents as externalised symptoms such as hyperactivity, disruptive behaviour and physical aggression, whereas in women and girls, the signs may be more subtly exhibited in symptoms such as inattention, feeling overwhelmed, and emotional dysregulation. As a result, many women later diagnosed with ADHD report masking symptoms until, once seeking help, receiving diagnoses of conditions like depression and anxiety. While they may feel symptoms synonymous with these conditions, they may in fact be factors of living with unaddressed ADHD symptoms, such as feeling depressed about not meeting set goals. While current research suggests that ADHD is caused by the dysfunctional conduct of neurotransmitters, including dopamine, the “feel-good” hormone, the root origin of this deficiency is not fully known. While many studies point towards a significant genetic component, including an observed trend of ADHD running in families, environmental factors such as adverse prenatal conditions and psychological trauma have also been shown to be viable causes. What happened to me Up until middle school, I did not struggle with my grades, but I did struggle with feeling like I was the odd one out, socially. Once I switched schools in 7th grade, to a rigorous exam school, these feelings suddenly switched. I had friends that I felt accepted me for who I was, but I began to struggle with my grades. From what I can tell now, this was because of two things: school got harder (more obviously), and (less obviously) my time- and memory-related tasks increased. It was suddenly solely my responsibility to get to class on time, remember assignments, and study on my own schedule, which eventually became unmanageable. Although my parents did what they could to help me, I began missing school on a regular basis, and barely graduated my senior year due to accumulated absences. During my undergraduate and master’s programs I performed better than I expected, mainly because I had created compensatory strategies in high school that helped me hustle to the finish line (such as letting the adrenaline rush help me stay up late into the night before a deadline). But life has changed since then. When I started trying to juggle a new freelancing career, writing fiction, and learning two languages, I kept finding myself on the couch watching Gilmore Girls on repeat instead of working. Why? Because I was not facing an external threat, which used to be my main driver. It was only when I saw a TikTok (I’ve since deleted the app) about ADHD that I considered getting a medical opinion. I found a psychiatrist in Berlin who diagnosed me, but only tentatively, after I reported that my grades were not an issue as a young child. I then started seeing my current psychiatrist, who prescribed me medication, and my current therapist, who also has recently introduced deep-tissue massage into her practice. The presence and clarity I feel one-hour post-massage is deeper than anything that I have ever experienced on my medication. But not every day can start with a massage, and I am not at the point yet at which I can get to this feeling on my own. So, for now, here’s what works for me in moments when the windshield is foggy. What helps when the windshield is foggy This is one I am not so good at yet, but I am working on doing it first and foremost. That is, asking myself: “What inside me feels stuck?” to check in with my body. I try to focus on those physical parts (for me, it’s usually chest and shoulders), and take deep breaths to give the feeling space, allowing myself to move on from it. I also use FreeCBT, a psychotherapy app which allows you to write down your thoughts, check for cognitive distortions, and write an alternative thought in its place. If I’m struggling to start a task, I will sometimes use a “mousetrap” action, which gets me from zero to a point of starting. For example, if I’m dreading writing an email, I will, with as little thinking as humanly possible, quickly address the email and write the subject line. I recently started using an online planner. I find it especially helpful for organizing my day, breaking down big projects, and goal setting. (I use Evernote which annoyingly requires a monthly subscription, but I find the customisable features are worth it for me. Trello has a free version). I try to integrate “anchor points,” or times when my routine involves another person, into traditionally more challenging parts of my day. For example, I struggle to wake up in the mornings, so I recently joined an online writing group that starts at 9am. I also try to regularly exercise, whether that is at-home yoga, a 20-minute run, or going bouldering with friends.

Have you ever found yourself on a train or waiting for a friend, and discovered you don’t have a book on you? The horror! I always keep a paperback or my Kindle on my person, however tiny my bag or busy my schedule for the day might be. I feel anxious without one. What if books and reading offer more than a way to pass the time or keep you company when you’re sitting alone in a cafe? What if they are intrinsically good for us? Books — and here, I’m talking about fiction or other forms of written story — have been an important part of my life since I was very young. Lifelong readers like me find comfort and inspiration in old picturebooks as much as shiny new paperbacks, often remembering significant stories and reading moments from childhood and drawing pleasure from them well into adulthood. I remained an avid bookworm into my teenage years and my passion for young adult novels eventually led me to a PhD on the topic and further academic research exploring the power of reading in the context of adolescent mental health. These days, I sink gratefully into narrative worlds conjured by books when my own reality is demanding or dull and I eagerly soak up the new ideas and other lives portrayed within their pages. They often make me feel better. Reading during difficult times And I’m not alone. Reading fiction, or reading for pleasure more generally, is claimed by many researchers to have significant benefits for wellbeing. In fact, books and reading are often suggested by healthcare professionals as a form of therapy for individuals facing health challenges or difficult times. A survey of British adults from 2015 found that readers reported fewer feelings of stress and depression than non-readers and more recently, during the chaos and crisis of the Covid-19 pandemic, many young people also reported turning to books to give them a sense of ‘refuge’. This latter fact is especially significant, since reading amongst children and adolescents has been in decline for decades. Fewer than half of 8-18-year-olds in the UK enjoy reading in their spare time, the lowest figure since 2005; and boys and adolescents are the least likely to admit to reading for pleasure. These data reflect an international picture of decreasing interest in books amongst young people and a turn towards gaming, social media, and other forms of media. At the same time, researchers have revealed increasing rates of adolescent loneliness, anxiety, and other mental health problems in the twenty-first century that reached a high during the pandemic and periods of lockdown. In 2021, I received funding to run a study exploring how books and a specific form of social reading might help young people cope with those difficult times. I set up a series of virtual book clubs that encouraged teenagers from different parts of England to read a series of contemporary young adult novels and then come together online to talk about them. The choice of books was important — they had to reflect something of the reality of the readers’ own worlds — and the mode of interaction was crucial – so that reading became an activity about belonging. The research from the Reading for Normal project focuses on adolescent needs and responses but it highlights broader ways that books and reading can help all of us stay well. Bibliotherapy Books are so brilliant and life-enhancing, they can be prescribed to individuals on the NHS. They can act as a form of non-clinical support to meet the practical, social and emotional needs affecting patients’ health and wellbeing. The Reading Agency’s Reading Well programme is a good example of resources put together by literary and healthcare professionals, offering a series of booklists designed for readers of different ages to help improve mood or understand their mental health. The list designed for young adults contains mostly information books, but also includes fiction featuring characters who have particular physical or mental health conditions — such as chronic pain, anxiety, or body dysmorphia. These stories can go further in offering individual readers guidance and solace as well as information. In the Reading for Normal Book Club, some of the young people shared that they had experienced panic attacks and they found it useful to read about a character like Jimmy, in Alice Oseman’s I Was Born for This, who describes his social anxiety and panic attacks in detail. In other words, reading can help us improve our wellbeing literacy generally, but if we are also trying to manage our health, the right books can subtly point us in the direction of appropriate self-help methods and provide reassuring representations of people like us, going through the same kind of things. However, a warning note should be sounded. For acute or chronic conditions, books can only act as complementary tools alongside professional care and advice; they can’t replace other forms of treatment. In some cases, reading about disorders can trigger discomfort and — if the book being read includes unhelpful portrayals — even lead to harm. So, what about a less clinical approach…? Empathy and social reading Wellbeing extends beyond specific healthcare needs to include a general quality of life. It can mean finding a sense of purpose and meaning. Books are especially effective in equipping us for a life lived well in this respect, especially if we spend time reflecting on their impact and meaning after we have read them. Wellbeing is tied to feeling connected to others. Again, books are excellent tools. For a start, stories involve characters and often lead us deep into emotional worlds in ways that mimic real-world interactions and, potentially, improve feelings of empathy. Thinking about the needs of others, as well as understanding cultural or political difference, puts us in a great place for engaging with real people. Finally, books offer up a range of inherently interactive opportunities that bring benefits. Book clubs, literary festivals, BookTok, Goodreads — these are all examples of reading as a social activity. And talking about books together is good for us. This is true for the very oldest in our society, who face severe levels of loneliness and who can find community and meaning in reading together. It can also be true for young people. In the Reading for Normal Book Club, the teenage participants related their own feelings of isolation during periods of pandemic lockdown and explained how they found points of connection with each other through reading — as they recognised cultural references and identified with characters in books like Danielle Jawando’s And the Stars were Burning Brightly. One reflected on how it was important to find company through the online book discussions, "bothfrom people who [were] sitting in the meeting and also from the characters of the books". It may be worth questioning the claims that researchers who love reading themselves make about the power of books — perhaps its just too attractive a proposition. But books are increasingly viewed as a crucial ingredient for a better world. And that – more than being stuck on a train with nothing to read — is definitely the world I want to be living in.

Author's Note: This short story is about feeling extremely out of place while experiencing a significant life event. In it, I explore the roles of nature and the senses in remembering and connecting. It's also about expressing emotions and what is or isn't deemed 'acceptable' at family occasions. 'The Noise Is Mine' was long-listed for the European Writing Prize in 2023, under its previous name 'Funeral Dance'. The kitchen table vibrates. Cold, congealed porridge stares back at me grayly from its bowl. My frozen fingers are wrapped around my cracked coffee mug, they don’t seem to belong to me any more. I stick my tongue out at my mobile phone, which is petitioning for me to leave the house, with its insistent flashing and buzzing. I programmed it to do this, setting multiple calendar reminders, yet I deeply resent how it mocks me today. “I am too weird to leave the house right now,” I tell it aloud. The handset’s screen and its disembodied voice begin to recommend helplines and links to websites about agoraphobia.            “No, no, no!” I berate my handset loudly, and flip it over with a thunk, forcing the phone to lie face down on the table, its assorted lenses staring vacantly at the kitchen ceiling. Porridge abandoned, I begin to create a new breakfast from the contents of various brown glass bottles and blister packs: St John’s Wort, beta-blockers, Rescue Remedy, Sertraline, and a small collection of dehydrated liberty caps. I consume each element of the unconventional meal methodically, washing it all down with cold coffee and chewed-up hangnails. At length, I finally do leave my flat and as I walk I taste the rain. Petrichor, car fumes, and second-hand cigarette smoke flood my lungs. I dawdle, enjoying the dank day and noticing the increasing heaviness of my dress as it soaks up puddles. I can hear the church’s distant bell. My pace quickens. Black-clothed humans gather and protect, like ravens, dark umbrellas for wings. As I get closer, I smell pine, strangers’ perfume, incense, and candle smoke. The bright, poisonous, yew tree guarding the graveyard gates has lived here, regally, for hundreds of years. It symbolises rebirth, resurrection, and immortality. It has the job of warding away evil spirits: a tradition adopted from Druids and moulded into Christianity, as with so many lores. We – the yew and I – have passed one another on a multitude of occasions. Today, however, I meet this ancient yew as if for the first time. We connect. It breathes deeply and noticeably and then takes me by surprise as it slowly begins to dance. Its branches move quite gently at first, almost imperceptibly but with rhythm, and I respond by mirroring its subtle gestures with my body, head, and fingers. We ignore the swelling congregation. The church bells seem to slow down and fade. A large black shiny car has pulled up on the quiet village street outside the ancient walls. I keep moving gently. “I want to stay here with you,” I tell the tree, confidingly, as my fellow mourners huddle towards the large oak door. I touch the yew’s trunk, placing the flat of my hand against its bark and tuning in to its breath. The yew leans softly towards me, and we continue to be locked in a slow dance with one another, transfixed and accompanied by the organ’s melancholy notes, which emanate from the church’s depths. I sense that the yew is offering itself up to me and so I ask if I might accept one of its branches to bring inside: “Would that feel all right?” It bends towards me, acquiescent, and I thank it quietly as I break one thin, pretty, branch apart from the rest of the tree. Concerned about any hurt I may be causing, I kiss the yew’s open wound with my lipsticked mouth and become quite enchanted by the bright berries adorning its dark green tips. I choose a single berry, dissect it, and taste the soft pink-red flesh, avoiding the deadly seed. It’s sweet and good. “I have to leave you now,” I tell the tree reluctantly as the church bells resume clanging in my ears and older relatives fake cough in my direction. Clutching the branch firmly in my left hand and brushing raindrops off my curls with my right, I turn and move deliberately towards the large open door, heels of my boots clicking and splashing satisfyingly up the path, yew needles lining both sides, like a rural version of a red carpet. I sense its magic. My Nana walked this path on saints’ days and Sundays for decades, mischievous and kind in equal measure. I can feel her here with me as I finally reach the door, I’m late and muddy but not yet scolded. I don’t think she wants to come in, she’s—uncharacteristically—not ready either. Nana always liked to be ready and prepared for everything, sparkling and twinkly, smelling of soap and neatly combed, with a packet of mints in her bag and spare clean handkerchiefs. “We gotta do this Nana,” I whisper, “C’mon.” Speaking not to the wooden box being bourne slowly up the familiar path by formal strangers, but to her spirit, ethereal and warm. Brandishing my branch, I attempt to enter the church, but an unfamiliar woman with blue-rinsed hair thrusts a leaflet out, stopping me in my tracks. I smile and give her 20p from my coat pocket but she looks confused, continuing to offer me the leaflet, which has a photo of Nana’s face on it. What does the blue-rinsed woman need? I fumble and find a pound coin but she looks even more confused and presses Nana’s photocopied face into the hand that isn’t holding a branch. I look up and immediately ignore my mother’s silent flappy gesticulations from an overcrowded pew across the aisle, instead moving towards my favourite cousin Judy, at the back of the building. She has a face like an angel and smells of cinnamon. I intend to sit and nestle into her, but her cherub-like son is already hiding his pink-cheeked face in her long skirt. Cousin Judy kisses my cheek and gently takes my branch from me, placing it on the stone windowsill so carefully that neither I nor the branch mind too much being separated for now. Singing and incense waft around me and everyone rises. Nana had a sweet sense of humour and has, my cousin whispers, requested the Archers’ theme tune, from Radio 4, to accompany us all out of the service at the very end. Apparently, there was some sort of altercation with the vicar about Barwick Green not being a religious tune but my grandmother, who was well aware of her imminent demise, held up her end of the argument with weighty donations to the church roof fund, and insistence that she’d listened to The Archers for decades with reverence. So I’m not surprised when the service eventually concludes and I hear its jolly tones, ringing out across the pulpit, as the coffin disappears, once again, into the cold porch. However, I am surprised to hear loud laughter bellowing out, over the top of the familiar tune. Loud laughter coming from… my own open mouth… increasing in volume uncontrollably as the faces of fifty or so quietly tearful mourners turn to look at me like sad little lollipops. “Ha, ha, ha, ha, ha…” The noise is mine but unowned. I listen to it curiously without a sense of connection to my voice… I can’t find the ‘off’ switch to my volume or to the shaking of my body. I mean it IS funny… this jolly Radio 4 melody marking such a solemn moment, macabre in some ways, but my laughing seems to be the jarring sound, not the clunky CD player ringing out the familiar: ‘doo de doo de doo de doo’s of the well-known signature tune. I remember hearing it at my Nana’s house throughout the decades: from being bounced on her knee in my infancy, to my teenage revision at her dining room table; to more recent days, as I helped to wash her hair and apply cream to her hands and feet. She’d often hum this tune early each morning as she opened the curtains. As age crept up on her, she’d also insisted on hearing the repeats of each episode too. My laughter crescendos and tails off. Someone is crying now. Really noisily. Ah. Also me. In certain cultures, crying to mark and celebrate death is highly encouraged and respected, in fact, professional people are hired to lead the mourning. Mourners show status, they can embody goddesses at funerals, and their role is respected and powerful. Yet here, my noisy mourning seems to stimulate shared embarrassment among Nana Ethel’s friends and relatives, who all appear to have their collective shit together. Even those with dementia. They are stoic, silent, and calm. What are they thinking as they gaze on my snotty face? Does my streaked mascara make them feel discomfort? Is my wet hair unacceptable? My angelic cousin Judy is gently holding on to one of my shoulders with one hand and cuddling her little son, who’s balanced on her hip, with the other. She’s carrying a huge bag brimming with expressed milk and eco nappies and is still pulling off elegance and composure. Cousin Judy steers me slowly out of our church pew. We get washed into the steady flow of black-clad humans in the aisle, and I turn sharply and begin to wrestle against the tide to return to the pew and retrieve my yew wand. Wading through elderly women, dummy-mouthed toddlers, and stodgy middle-aged husbands, I manage to get back to the shore of the stone windowsill and reunite with my branch while the congregation spills out into the autumn afternoon. “It’s ok, it’s ok,” my cousin has reappeared at my side and I’m unsure if she’s saying these soothing words to her little son, or me or herself. The funeral flowers in the window where Nana used to sit each week have pollen-filled stamens and an overpowering scent. They pulse and breathe. Distracted, I stroke them softly and they respond to me. My mother appears. She takes a breath and emits words staccato: “We don’t think you should come to the wake.” I silently nod. They don’t think I should come to the wake. This is true. Her statement is not incorrect. But is she banning me? Denying me the chance to refuse tiny triangles of white bread with margarine and Cheddar cheese in? Am I barred from helping pour tea from hot metal pots for unfamiliar mouths? I begin to hum the Archers’ theme tune, which morphs into me laughing and crying simultaneously. To steady myself, I hold one hand in front of my face and move my fingers slowly, I notice the pattern of whorls and loops. I’m fascinated. I remember to breathe. The constant feeling of being unwanted, which accompanies me daily, has manifested itself. My crime? Attempting to balance out my mood. In the same way that others may iron a shirt for such an occasion—and, perhaps, scorch the fabric in their nervous grief state—well, I just go and accidentally microdose a little too generously. No biggie. An hour ago, the wake was what I was determined to avoid. Yet now, if I don’t get my share of the collective post-ceremony awkwardness, well, my day will have failed. With a new-found sense of purpose, I navigate my way out of the ancient building and quicken my step in the direction of Nana’s house. I am Maleficent, the unwanted witchy guest. I wield my branch and move determinedly towards the wake. Obstacles appear to get out of my way along the puddled streets, and the weak November sunlight begins to shine on me through the clouds. A rainbow. I stop. I am soaked, cold, and crying. An arm appears around me. The new vicar. “Let’s get you a cup of tea, eh?” she says, kindly, as she unlatches the little gate to the house. Roses are still hanging on in Nana’s garden. And so am I.