Although full of joy and excitement, the perinatal period can be a tumultuous time for parents. Recognition of maternal mental health around pregnancy and birth (the perinatal period) is, thankfully, growing, leading to an increase in evidence-based interventions to prevent maternal mental health crises and to help mums navigate this challenging period of life. Fathers, however, are often left on the side-lines of perinatal healthcare, and parenthood, with the importance of their role in the family unit and their mental health underestimated and overlooked. As a PhD student focusing on perinatal mental health, this International Men’s Day, I wanted to focus my attention on the often-invisible Dads, to highlight the importance of promoting and supporting their role in parenthood to protect their mental health and that of the entire family unit. Societal Expectations of Dads Gender roles traditionally pigeon-holed women as caregivers and homemakers and men as breadwinners, excluding women from the workplace and men from the home. Expectations of men to provide emotional support and nurture their partners and children were scarce. A progressive shift in societal norms means that fathers are now expected and indeed wanting to be present in pregnancy, labor and birth and actively involved in child rearing, however, the necessary infrastructure to support them in this newfound role is not available. Men are therefore having to navigate an unchartered type of fatherhood, that is different to that of all previous generations, alone. The lack of support and education offered to fathers about the perinatal period, alongside damaging patriarchal hangovers expecting them to be ‘manly’, unemotional, ‘rocks’ of the family, prevents them from seeking help and from knowing how to lean on others for support in this challenging period. This has negative impacts on the entire family unit. Paternal Perinatal Mental Health Depression is thought to affect 8% of fathers in the perinatal period whilst anxiety affects 5-10%. The new-parent exhaustion combined with feelings of loss of control, inability to meet expectations, low resilience and disappointment have been reported by new fathers as contributing to reduced mental health. Furthermore, although not physically going through traumatic pregnancies and births themselves, fathers have a front row seat to the suffering of their partners, often feeling helpless or even a hindrance in delivery rooms when things go wrong. A 2017 study focussed on the experiences of fathers who found childbirth traumatic. The fathers vividly described their distress with one stating, “the really traumatic part was just, the sort of, the scream that came out of [my partners] throat was absolutely horrible too…it just really hurt to see her in so much pain.” So whilst research is increasing into the effects of traumatic births on mothers, we must also attend to the distress of the fathers. Fathers can feel alone and unsupported, hesitant to seek help due to internalized and societal stigma perceiving male suffering as ‘weakness’, perception of paternal mental health problems as less relevant (fathers can fear ‘overshadowing’ the birthing parent), limited capacity of specialist services, skepticism, and attitudinal reluctance. Furthermore, fathers may experience, report, and present mental health symptoms as stress or externalising symptoms, rather than emotional/ internalising symptoms. Compounding this, many measures used to assess mental health may not be sensitive to the symptoms in men, leading to their mental health struggles being overlooked and characterized simply as stress.. Indeed, men are less likely to receive a mental health diagnosis than women. Of concern, men experiencing perinatal depression have also been shown to have a 20 times higher risk of dying by suicide. But paternal mental health is not just important in its own right. Poor mental health of dads can also impact their babies. A recent study focused on stress in fathers, to try to capture their mental health in the perinatal period. They found that 7% of fathers presented with high stress in the perinatal period with this rising to 10% at 24months post-partum (Challacombe et al 2023). This stress impacted their newborns and was found to be associated with child emotional and behavioral problems at 24months, demonstrating that paternal perinatal stress and mental health problems may be an early sign of perinatal distress. Depression and post-natal depression in fathers has also been shown to be associated with their child’s depression at 18 years of age and appears to influence emotional problems in daughters, especially if the mother also suffers from depression. There are several ways that poor mental health in fathers may lead to these problems in their babies. Stressed fathers may have a reduce ability to parent and form attachments with the baby, have a reduced capacity for involvement in parenting and exacerbate the mental health of the mother. However, there is good news. Good paternal mental health can act as a buffer providing protection to infants of mothers suffering from Post-Natal Depression. This period may therefore provide an opportunity for early intervention and prevention of subsequent mental health problems for fathers and infants. Mental health interventions for fathers have shown to improve confidence, behavior and parenting style and increase the knowledge of child development, leading to greater interaction and heightened sensitivity to infant needs. Yet access to effective, evidence-based interventions specifically for paternal perinatal mental health is limited and requires GP appointments or self-referral to over-subscribed mental health services. Invisible Dads Adding to the difficulties dads can face in this period, fathers are often made to feel invisible in antenatal checkups, at the birth of their children and in postnatal checkups. A British survey of fathers called ‘How was it for you?’ found that during perinatal appointments over 60% of fathers reported that the medical staff did not talk about the fathers’ role. 25% also reported either rarely or never being spoken to directly by medical staff. And concerningly, only 18% of fathers reported staff talking to them about their mental health in the antenatal period. This invisibility can exacerbate fathers’ feelings of uselessness, and disempowerment, as they are made to feel less capable of caregiving than their partners. Encouragingly despite this low engagement by healthcare, 98% of the surveyed fathers attended the births. It appears that the issue is not an unwillingness of dads to engage with support and talk about their role and their struggles, but rather a lack of available spaces and platforms empowering and educating dads. Indeed, it has been reported that 3 in 4 dads think there should be more support for fathers. Thus, a gap exists between the support fathers are desperate to provide and the systems in place to facilitate this. It is understandable that mothers are often the focus of perinatal healthcare, given their role in carrying, delivering, and breastfeeding the baby. But dads are also having a baby, and thus they also require emotional support, education, and direction so that they can successfully fulfill their role and be the most supportive partners and fathers possible. Where do we go from here? To keep up the with the progressing role of modern fathers, we need to create a landscape where they can contribute equally to parenting. This requires systemic change in the way we view and support new fathers, starting with increased research into the experience of fathers alongside service providers better acknowledging and and advocating for fathers. Dads are the missing piece of the puzzle in the perinatal period. Mothers and fathers are 2 halves of a whole, therefore, there is no supporting mums, without supporting dads. My hope is that the increased demand from fathers to be involved will in turn lead to a change in the healthcare landscape where their role is celebrated and empowered with education and support. Until then, we must continue to support the fathers that we know and, at the very least, simply ask them: "How are you?".

An interview with Kate Marsh, a Midwifery Manager at Tommy’s on Word Prematurity Day Picture from the The European Foundation for the Care of Newborn Infants (EFCNI) Today, the 17th of November, is World Prematurity Day. The day was initiated in 2008 by the European Foundation for the Care of Newborn Infants (EFCNI), to raise awareness of preterm birth and the associated challenges. Then, organisations in Africa, the USA and Australia joined as well and made Prematurity Day an intercontinental movement. Currently, organisations from more than 100 countries come together to commit to improving preterm birth for babies and their families. Birth is considered preterm when a baby is born before 37 weeks gestation. Preterm birth is the biggest cause of death in newborn babies and the chances of survival and the risk of developmental problems depend on the gestational age at birth. Usually the earlier the birth, the higher the risk of problems. The small pair of purple socks, framed by nine bigger socks, has become the symbol of Word Prematurity Day. This symbolises that 1 in 10 babies is born preterm. The purple colour represents sensitivity and exceptionality. 1 in 10 babies worldwide, and 53.000 babies in the UK alone, are born preterm every year. These are very big numbers, suggesting that we should take this issue seriously, raise awareness and promote the well-being of both babies and families. I have been interested in understanding the experience of preterm birth for both babies and parents since I was at University. I worked on a research project and I used to go to the Neonatal Intensive Care Unit (NICU) of a hospital in Milan, to see babies, speak with parents to try and understand what they were going through. I remember it to be a very emotional experience and I am really happy today to have had the opportunity to speak with Kate Marsh, a Midwifery Manager working with families of preterm babies for Tommy’s. Tommy’s is the largest UK charity researching pregnancy complications, miscarriage, stillbirth and premature birth. The are many known risk factors, but sometimes reasons why preterm birth occurs are unknown. Therefore, I started by asking Kate what the main factors that increase the chances of preterm birth are. “I would split them into two sections - she said: the pregnancy factors and the more social-lifestyle factors”. The pregnancy factors include a previous premature birth or late miscarriage, or a medical condition associated with the current pregnancy (for example pre-eclampsia, gestational diabetes, low PAPP-A levels – a hormone detected within the placenta), the presence of too much or too little amniotic fluid or a baby genetic developmental condition. A pregnancy with more than one baby can also increase the risk: “The more babies you have in your pregnancy, the more likely they are to come earlier”. Lifestyle factors include smoking, the use of alcohol, drugs and certain medications, and being overweight. However, these are only risk factors, there is no causal association. Indeed, “sometimes preterm birth might happen and none of those things were at play during pregnancy. You can do everything as textbook and you still have a premature birth, it happens, and it is not anyone’s fault”. I asked Kate which pieces of advice could be given to women and birthing people to reduce the chances of preterm birth, when possible. “If you are planning a pregnancy, it is worth looking at lifestyle factors even before you start trying for the pregnancy and seeing whether there is anything you can do to increase the chance of having a healthy pregnancy, such as taking folic acid”. “Then, the main thing is booking your antenatal appointments as soon as you know you are pregnant and attending your appointments and making sure you are getting the support you need. It is also about knowing when is important to seek help- so being aware of the red flags symptoms- as things may happen out of the blue (e.g., bleeding, increase in blood pressure, water loss, pain).” Research has shown that mental illness and stress can increase the risk of pregnancy and birth complications, including preterm birth. This suggests that it would be useful to add these questions to the initial assessment in pregnancy. Considering my role as a psychologist and a researcher in perinatal psychiatry, I asked Kate about the importance of mental health. Kate highlights the importance for women with mental illnesses to be followed throughout their pregnancies so they can get the right support both antenatally and once their baby is born. While it is important to avoid “getting stressed about the fact that you feel stressed” and rather focus on receiving the right support, it is also important for women to know that if they suffer from, or have a history of mental illness, or if they are going through a particularly stressful time, this may put them at risk of preterm birth. Kate agrees and highlights how important it is for women with mental illnesses to “go back to the basics of eating properly, exercising self-care, talking to friends and family.. as these are impactful things”. This is very true: self-care is important for all women during the perinatal period. As I have said before, taking care of you means taking care of your baby too. We then talked about the type of support currently available for women and families at risk of preterm birth and for those who experience preterm birth. Kate explained that women and birthing people will discuss their risk factors and at what gestation the baby could be born with their midwife. “Often you will be offered a tour of the NICU to see what to expect, because sometimes it can be quite overwhelming and emotive. Being there with a potentially small, early, poorly baby, it is a lot of emotion”. Women and birthing people will usually be able to have a chat with the neonatologist and the paediatricians and there is often also a psychologist or psychiatrist. Picture by Alexander Grey on Unsplash There is also an App developed by Tommy’s (My Prem Baby App), which gives information about preterm birth as “it can be overwhelming loads of information to remember”. The App also allows you to keep track of your journey (e.g., tracking feedings and weight, recording the baby’s special moments and milestones), make your notes as this can help processing what is happening and get support for your mental health. Of course, anyone at risk of preterm birth will be monitored throughout pregnancy and might have extra scans and support. Then, if preterm birth happens, families continue to be supported by health professionals in the Unit. We know that preterm birth can be very stressful or even traumatic. Women may need to have an emergency c-section, require admission to intensive care or longer stay in the hospital. The experience of the NICU, with the associated separation from the baby, can also be emotionally devastating. Women and birthing people can feel guilty, have difficulties accepting what happened, and are faced with the potentially uncertain baby’s health. Indeed, parents of pre-term infants often experience higher levels of depressive, anxiety and post-traumatic stress symptoms compared with parents of full-term babies and these often remain higher through childhood and adolescence. Kate highlighted that, while there is lots of support available at the beginning, long-term support is currently lacking. “It may be that the baby is well, they are developing and they are fine, but the impact of having a premature baby or a small baby or poorly baby, being in a NICU, that stays with you and is often missed” The experience often remains un-processed over time, even when the baby is fine: “If you have a small baby, quite often you worry about their growth for a long time after any professionals stop worrying about it, it can be a couple of years of worrying about, if that baby is growing, developing, how that experience affected them”. “Seeing those babies in the NICU, seeing your baby, it’s not what most people imagine having a baby is like, so you are grieving for that normality and that loss of what you expected that initial period to have been like, and that really shouldn’t be underestimated”. Preterm birth has a strong emotional impact on parents and this may be aggravated by the fact that every family has their own background. “For example, it may be on the backdrop of having a long fertility journey, multiple losses, it may be someone new to the country, who doesn’t speak the language, and so lacks also that local support network”. It would be important to give parents more long-term support to help them process the experience, particularly if they are thinking of having another pregnancy. Parents may still be processing what happened two years ago, they may feel guilty that it was their fault. Although formal long-term support for parents going through preterm birth is not currently available in the UK, midwives at Tommy’s are available for support, even when the child is older. So if you feel you are struggling, that’s a place you can contact for help. As much as premature birth is stressful for parents, the same is true for babies. As well as the risks for the baby’s physical health, we know that premature birth can also have an impact on the baby’s emotional well-being. Children born preterm, particularly if very preterm (<32 weeks), are more vulnerable to mental health difficulties, particularly emotional and behavioural disorders, in childhood and adolescence. The negative outcomes that can be observed are similar to those described following adversity in childhood, which are ascribed to the experience of “toxic stress”. This is defined as “the absence of the buffering protection of adult support”. Parent-infant separation is indeed an important risk factor for the baby’s well-being. This is why, nowadays in most hospitals, parents are encouraged to spend as much time as possible with their baby to avoid the negative consequences of parent-infant separation. Picture by Anette Strømsbo Gjørv/Hospital of Southern Norway I therefore asked Kate what support is currently available to protect the mother-infant relationship and the children’s long-term well-being. Kate explained that it is very important that parents spend time with their babies as much as possible, have skin-to-skin contact (also known as Kangaroo care), unless the baby is not well enough to do it, and are involved in care (e.g., sanitizing bottles, feeding, nappy changes, comforting the baby). These are all very important things to help build parent-infant bonding in the early time period. Clinicians will be there to support parents in this process. We previously said that the relationship with the baby is not necessarily immediate, but rather a building process. This is even more so for parents of preterm babies. “They may be very traumatized, they might feel they are not bonding with their baby, and they may not feel that love and emotion straight away. It is having the reassurance that that’s OK, take tiny steps, be involved with your baby’s care, build confidence in supporting your baby”. Therefore, in most hospitals, parents can stay overnight, so they can be close to their babies, establish feeding and avoid parent-infant separation. If the mother is not well enough to get to the NICU, the birth partner can start going. When the mother can go, clinicians will make sure that she is well looked after, e.g., has food, pain relief, she is in a comfortable position. “It is important that parents get the support they need, also because we know that their mental health can impact their child’s mental health as well”. Picture by Alexander Grey on Unsplash Then, once babies leave the hospital, they usually aren’t referred for special psychological services just because they are born preterm. The care is rather tailored for each family. Each baby is followed up by a paediatrician for a period of up to two years, to check if they are developing well. Together with the paediatrician, either the health visitor, the midwife or the neonatal nurse will monitor the baby and will work with the family and decide case-by-case the support they may need, so which care pathway is appropriate for them. This depends on the baby’s age, how well they are and how the parents are coping. “It’s really important to individualize the care, to work with the family, empower that family and make sure that family has the support they need”. Experiencing preterm birth is in itself a risk factor for mental health difficulties in both parents and children, therefore, it is important to ensure that all families receive an individualized intervention, including direct psychological support for parents and early intervention programs supporting infant development and parent-child relationship. There is evidence that early interventions are associated with better parent mental health and can improve child emotional regulation and behaviour. The experience of preterm birth is indeed an important under-recognized issue and we should act to protect these families and these children in the long term, to make sure that their psychological well-being is also well looked after.

Since a young age, I have always been an investigator. My mother jokingly says, “Carola, you ask as many questions in a day as your sister does in a year”. Throughout my life, I have had an inner force or, for the neuroscience nerds, my Default Mode Network (a group of brain regions activating during mind-wandering, fantasising and self-referential thoughts) guiding me. I felt I was here with a purpose: to help others and reach greater depths of consciousness. I was lucky to cross the path of inspiring individuals with provoking out-of-the-box ideas who believed in my potential. They shook the ground under my feet. Yet I found new roots. I first trained as a yoga teacher and therapist to help people. I am now ready to bring the investigator out of me to expand my impact - this has led me to the SPI Lab, the research lab behind Inspire the Mind. Trauma as a Door to Self-realisation Trauma is not an event - it is the body-mind's response to the event. I believe trauma can be the catalyst for change. Gabor Mate - a well-known Canadian physician who survived the holocaust - argues that healing from trauma can transform into a spiritual experience and bring about awakening. I have inherited a hefty dose of transgenerational trauma. This sorrow translated into me knowing who I did not want to become. Personal and transgenerational trauma has, of course, been challenging. Yet it taught me the value of finding purpose, agency and owning myself. This understanding led me, at 17, to leave Italy, where I was born and raised, for the USA. I came back changed, wiser and knowing Italy was not for me. Happiness as pleasure and purpose My first idea of purpose was to become a diplomat or humanitarian worker. At 19, I relocated to London to study International Relations and Social Policy and Development. My enrollment in Paul Dolan’s Happiness, Behaviour and Public Policy class at the LSE was pivotal. He changed my life and taught me that happiness is made by pleasure and purpose. What you spend the most time doing in a day must balance both. According to Dolan, money doesn't buy happiness. Instead, health, living in a safe neighbourhood, nature, and not being married is more critical to happiness. What I learned from Dolan stayed with me. I became a successful growth hacker in the London start-up scene. If you are wondering what a growth hacker is, it is a multi-disciplinary professional often behind start-ups' hyper-growth, tied to business development and marketing. I was good at it, yet I felt no purpose. I often felt empty, sad, paranoid and tired. In my spare time, I ran a charity, Women for Rwanda. It all started as an action project during my BA. I pitched my final assignment to Aegis Trust, who loved the idea - yet they told me I needed to go to Rwanda to understand. Together with three other classmates, we started planning. Eight months later, two of us conducted ground research in Rwanda. The reality was different than we thought. Much rawer. It brought me plenty of joy and a sense of purpose. I later worked in the charity sector and became aware of its corruption and hypocrisy. The people around me did not mirror the morals that brought me to the profession. I knew this was not my final call. My search for personal purpose continued. The moment of truth I continued looking for the purpose (without much success), travelling, partying and changing numerous jobs. Eight years ago, I joined a local yoga studio as a student. My first class was a strange experience. I felt torn: deep down, I was inspired to become a teacher, yet my mind was resisting and in denial: “This is not for me. Someone with my background should not be a yoga teacher”. I was battling with my prejudices, indoctrination and social expectations. After three years of practice, I decided to lead my classes and start teaching others. Eventually, I embarked on a 200-hour yoga teacher training, and something started changing: I realised I had been living a life without purpose, without joy. I left growth hacking and started teaching lots of one-on-one yoga classes. I had a purpose and enjoyed teaching. The more I taught, the more I realised I did not know much. My clients, behind aches and bad posture, had an ocean of suppressed emotions, trauma and mental health challenges that my 200-hour yoga training could not address. Then, at a workshop, I met Mark Stephens. He changed how I teach and introduced me to yoga therapy. Seeing him in action inspired me to look further into yoga therapy. I dove into a 2-year yoga therapy diploma to learn how to use yoga therapeutically. Yoga Therapy is a contemporary evolution of yoga, informed by physiotherapy, somatics, counselling, psychology, neuroscience, anatomy, physiology, pathology and holistic medicine. A client-centric and science-based therapy modality promoting self-care, functional breathing and movement, and behavioural change. The Power of Emotions The more I applied the yoga therapy framework and methodology, the more I became curious about why it worked. Why do people get better? Why does the breath help clients become aware of emotional blockages? Why does paying attention to sensations bring about transformation? Why, if we become aware of how the breath mirrors emotions, do these become less overwhelming? Can repressed emotions transform into disease? This awareness brought me closer to understanding my purpose: I am here to be a bridge and help people connect with their feelings. Shortly after, I started looking into psychoneuroimmunology for answers. Fast forward 2 years, and here I am, finishing an MSc in Cognitive Neuroscience and conducting clinical yoga research at King's College London, studying yoga's effects on attachment and mental health in pregnancy. Succeeding in this endeavour showed me that I could be a bridge between Western and Eastern medicine. This realisation drives me and gives me pleasure and purpose. In yoga philosophy, this drive is called Dharma. Dharma is the reason you are here. As yoga has shown me, as I live my Dharma, I also guide my clients to find their Dharma to enjoy more fulfilling and happy lives. The future, hopefully, will allow me to fulfill my Dharma. I want to bring Mind-Body Therapies, such as yoga, on the table of evidence base care. I hope to continue this journey as a PhD and beyond.

Around 340,000 people in the UK live with Type 1 Diabetes. It is relatively rare in comparison to Type 2, and it is incurable. It is also an immense challenge to live with and it never, ever quits. I am a researcher in academic and cultural knowledge exchange and I was diagnosed with Type 1 Diabetes (T1D) 30 years ago, when I was 10, and this blog is about my experience of living with T1D. Research suggests there are genetic pre-dispositions to T1D, which can be provoked by a virus/infection or stress. It arises when the immune system attacks the insulin-producing cells in the pancreas. Insulin is a hormone which regulates the amount of glucose, or sugar, in the blood. Too much sugar in the blood over time can lead to multiple complications, such as kidney failure, nerve damage, blindness, liver disease, limb amputation and heart disease (to name just a few). Too little sugar in the blood leads to a complete shutdown of the body and ultimately, if untreated, death. In T1D, glucose cannot be properly regulated. It is life-limiting, typically taking 10 years off the life of anyone living with the condition. I was diagnosed with T1D on a family holiday in the summer 1993 after developing symptoms of Diabetic Ketoacidosis (DKA) – a life-threatening condition caused when there is severe lack of insulin in the body. I was rushed to hospital where I stayed for around a week and was given rudimentary instructions on how to inject insulin, how to test my blood sugars and what to do if they dropped too low into hypoglycaemia. This is quite a common event for most T1Ds, and it can involve feeling shaky, sweaty, hungry, confused and incredibly grouchy. For me, if my levels go really low, I lose my sight and memory. Then, I went back to primary school as ‘the diabetic’, my life dominated by routine and control. I’ve been told on countless occasions that I took the diagnosis in my stride, but the reality is that I found being able to control it was the easiest way to pretend that it wasn’t a problem. That I wasn’t ‘different’ or disabled, although T1D is classed as an ‘unseen disability’ under The Equality Act 2010. I rarely told anyone about my condition, and even moved to Mexico aged 18 and travelled around central America with a cool bag full of insulin attached to my backpack. Everything that enters my mouth has to be balanced out by a dose of insulin. But blood sugars are not only influenced by what you eat and how much insulin you’ve injected, but also by exercise, stress, caffeine, adrenaline, alcohol, illness, insulin resistance, how much sleep you’ve had and (there’s an additional load for women) the time of your cycle. Blood sugars are a moving target, and being able to control them perfectly requires an incredibly detailed understanding, not only of the condition, but also nutrition, biology, how to mentally calculate ratios, and of the very particular way your own body responds to life in general. Diabetes Distress It is estimated that Type 1 Diabetics have to make around 180 additional health-related decisions every day. So during my 30 years as a T1D, that’s nearly 2 million extra decisions. We are twice as likely to suffer from depression as those who do not have the condition, and we can also suffer from ‘Diabetes Distress’; anxiety, frustration, worry and even panic about future health. I have suffered from Diabetes Distress on two separate occasions, and it was crippling. One of those times was after I became pregnant at 33, and the full strain of living with the condition became unavoidable. In pregnancy the diabetic body behaves completely differently, and it changes from month to month – so everything I had learnt in 24 years became obsolete. If T1D is not well controlled during pregnancy the risks to the baby can be catastrophic. So I became obsessed with control; I measured every gram of carbohydrate that entered my body, did blood tests and injected around 15 times a day. Fortunately, with some excellent support from my healthcare team, my daughter was born healthy and only 3 weeks early. In 30 years of living with T1D I have seen enormous advances in the tech available to help manage it. Newly diagnosed children can now get a ‘closed loop system’ on the NHS, which has been hailed by Professor Partha Kar, NHS England’s Clinical Director for Diabetes, as the closest thing yet to a cure. I now wear a continual glucose monitor which sends my blood glucose readings to my phone in real time. Yet, I have never received any mental health support to help me manage the condition. I believe every T1D, and especially the newly diagnosed, should be offered professional psychological support. Although diabetes care in the UK is the best in the world, and free NHS prescriptions of insulin have kept me alive for 30 years, there is a huge gap in mental wellness provision for T1D in the UK. Psychological Wellness Practitioners can be made available to those who ask, but what do you think living with an incurable, life-threatening condition does to your sense of self-sufficiency and resilience? The Mind-Body Connection This is how I feel about my body: it’s trying to kill me. Day in, day out, hour upon hour, I am constantly at war with it. T1D means having 24/7 awareness of your body and its processes, constantly monitoring its behaviour and trying to control it. Some days that doesn’t take much, just adhering to a concrete routine (a mental drain in itself), but some days, the struggle is overwhelming and infuriating. Bearing this additional mental load and level of complexity doesn’t necessarily become exponentially worse or better as time progresses, it just never goes away. There will be no cure in my lifetime and the weight of that has to be borne alone. Awareness is perhaps where we need to go next, which is why I’m writing this blog on World Diabetes Day. If you know a Type 1 Diabetic, please take a moment to consider the amount of extra effort they have to constantly put into staying alive; how every meal out involves mentally calculating the carbs in each course before they’ve even seen it; how every walk, run, or stressful event involves a very complicated assessment of insulin vs food vs calories expended vs cortisol effect. How every episode of hypoglycaemia can be potentially life-threatening, especially if it happens whilst they’re driving. T1D needs to be recognised as a condition that requires both medical and psychological support. And all Type 1 Diabetics need to be celebrated as the warriors that they are.

When I decided to learn to swim in my mid-forties, I googled for inspiration but didn’t find many success stories. Scrolling back through my swimming journal documenting progress since then, I see many versions of the sentence "Feeling demoralised — still can’t swim". But I do go swimming now, and tonight I will try to swim a mile. I am sharing some of the things I have learnt in the hope that it will inspire other grown-ups to dip their toes into the water. I used to be embarrassed about my aquatic incompetence. I have tried to address it at various times over the years, but no real change had occurred in the past. Years ago, I went for lessons at a small local pool. By the end of the sixth week, it transpired that our goal had been to glide from one end of the pool to the other. I’m tall, and the pool was not long. Neither was it deep. I could practically traverse it in one stride, so I wasn’t left with a great sense of accomplishment. Some people have asked, why bother? Swimming involves so much getting wet, after all. For starters, swimming is great for your health and well-being. It would also be reassuring for me to know that I could avoid drowning in an emergency. And I do like a new challenge. Two years ago I decided to attempt to address my aquatic incompetence again, and anticipated that throwing money at the problem would be the most efficient solution. I booked a private lesson with Stephen Shaw, creator of the Shaw Method. I naively hoped to be dolphin-like after one dip, but Stephen laid the foundations of being at ease in the water, which I then built on with municipal lessons and lots of practice. I still have a long way to go with my confidence and competence, but I do love swimming now. I have learnt things along the way which I hope may be of use to other flailing, breathless grown-ups too embarrassed to venture to the public pool: Lesson 1: A lot of adults can’t really swim I used to be so embarrassed about not being a swimmer, and imagined that I was in the vast minority and had probably missed the boat (sorry) on learning. Since opening up and telling people that I have been learning, I have been amazed by how many have said they also lack confidence in the water. In fact, one in three adults in England cannot swim one length of a 25 metre pool. Let’s start talking about this more, and let any swimming-related shame float away. Lesson 2: You have to go swimming to get better at swimming and some others learning are not very good at it Before I started to go swimming I was worried that I would be surrounded by "proper swimmers" and revert to childhood horror scenes of spluttering humiliation in swimming lessons at school. In reality, all sorts of people go swimming for all sorts of reasons. Some are using aquatic therapy to rehabilitate from an injury by moving in the water to help with pain, mobility and balance. Some are walking lengths. Some people use floats, and that is no indication of whether they can swim or not, because — revelation… being "able to swim" is not a fixed endpoint. Lesson 3: Leave your self-consciousness in the changing rooms This follows from the first two lessons. One of the biggest barriers to swimming for non-swimmers is self-consciousness. Mirrors are not your friend when you start stepping out in swimwear, or after you have taken your goggles off and turned into a frizzy prune. Being older and wiser is a superpower here. Wear something you feel comfortable in, and if that means it has arm and leg coverage that’s fine. Lesson 4: Ask for a tour When you haven’t been swimming for a while it can be daunting to even go into the unfamiliar environment. So far, when I have asked someone working at a pool to show me the pool and changing rooms, nobody has looked me up and down with disdain. Ask if you need a coin for the lockers or can leave your stuff by the pool. Find out the lengths and depths of pools and where everything is in advance so you don’t need to waste nervous energy on it. Lesson 5: Relax Relax. Relax. Relax. Relaxing is like a miracle. I used to be able to get myself from one end of a pool to another, somehow, but I would be in such a breathless panic that it was not something I could call swimming. Relaxing is the answer to everything and the two go hand in hand.. Trying harder is counterproductive; swimming teaches us to struggle less. You don’t need to jump into the water and immediately swim lengths. You can walk, stretch, practice breathing out with your head in the water, glide, and practice landing gently back in an upright position. The joyful revelation is that relaxing helps you to swim, and swimming helps you to relax. Lesson 6: Find your cheerleaders I would have liked to have had a programme to follow (preferably with badges and certificates), but as adults, we have to set our own plans and find our own rewards. Telling people my goals and sending them updates has given me invaluable moral support. I have an encouraging note from my supportive niece stuck by my desk, reminding me of her slow and painful efforts to learn to drive. It took time, tears, and many tests, but now she drives all the time. This leads me to the final lesson… Lesson 7: Keep going! I had hoped that one expensive lesson would be a quick fix, but my improvements in swimming have taken time, practice, and a variety of different lessons. I have celebrated milestones along the way, such as the first time I braved a lesson at my now beloved Olympic-length lido and the first time I swam a full length there. I had a goal to swim a mile before my 45th birthday, which is in 6 days. By the time you read this, I may have swum a mile, or I may have just swum a bit more. Another cheerleader, my friend Sylvie, who has been motivating me along the way, sent me a message saying "A good try will be as good as a mile. Good luck. And there’s always tomorrow if today doesn’t happen". If swimming is something you want to try too, go for it!

Imposter syndrome, also known as imposter phenomenon, is a common behavioural psychological occurrence estimated to affect one-third of young people, and 70% of the population are likely to experience it at some point in their lives. It also disproportionately affects high-achieving individuals, particularly those in medicine and healthcare. Affected individuals may find themselves struggling to accept their successes, and may fear being exposed as a fraud. Interestingly, imposter phenomenon was first described in 1978 by psychologists Clance and Imes, who documented the phenomenon among high-achieving professional women. It is important to note that imposter phenomenon is more of a cultural concept rather than a medical diagnosis. Despite this, the overwhelming prevalence and impact of imposter phenomenon on individuals and their mental health renders it a crucial topic to explore. I’m Kiran and as I approach my fourth year of medical school here in the UK, I would like to share my experience of imposter phenomenon and include some thoughts from my peers. A series of unfortunate events As previously mentioned, imposter phenomenon is highly prevalent in the healthcare profession. And thus, as a medical student, I am no stranger to it. However, I believe that the disruptions caused by the Covid-19 pandemic have greatly worsened many students’ experiences of imposter phenomenon. In January 2021, when I was in my final year of sixth form, former UK Prime Minister Boris Johnson announced the cancellation of GCSE and A-Level examinations, along with the indefinite closure of schools. Two years of late-night studying and endless coffee suddenly felt tragically redundant. After lots of uncertainty and speculation, it was agreed that A-level results would be decided by our teachers. This initiated the beginnings of my imposter phenomenon. Ultimately, I do not feel that the A-level results written proudly on my CV were earned. Perhaps I would have achieved those results, but perhaps not. Unfortunately, I will never know as my year group were robbed of the opportunity to prove ourselves academically. Given that A-levels are crucial in determining admittance to university, these "fake" A-level results have amplified my feelings of being an imposter It felt strange arriving at university having not sat any physical A-level examinations. Many of my peers muttered that they may not have even made it to university if not for Covid-19, as they doubted their academic capability with no way of proving their competence, and I certainly related. Furthermore, our subsequent formative university years were largely online with no face-to-face examinations. Feelings of adequacy and success arise from positive reinforcements and formal recognition of accomplishments. The absence of in-person examinations and face-to-face interactions therefore led to a significant lack of academic validation, magnifying my sense of imposter phenomenon. A word from my peers I wanted to ask my peers about their experience of imposter phenomenon to capture the impact of the pandemic. I carried out in-person interviews, and sent open-ended questions to a handful of medical students. Here are some of their thoughts. For Kate, a 4th year medical student, her struggles began in medical school. She stated that, "there have been many times when I have felt out of place and inferior to my peers, despite generally performing well in examinations." Kate also wrote about the difficulty of, "being surrounded by so many intelligent individuals" and commented on how this made her feel inadequate, causing her to doubt her competence as a medical student. I also spoke with two 4th year medical students who had experienced imposter syndrome since the pandemic. Echoing my own insecurity, one of them stated that due to never sitting A-level examinations, he wonders if he, "would be in medical school, or any university for that matter, if not for the pandemic." The other student spoke about the negative impact of online teaching, stating that, "because of the pandemic, my former years of university were severely lacking praise due to no face-to-face interactions", and emphasised how this severely affected his academic confidence. I finally spoke with James, a final year medical student, who gave an enlightened perspective about how he has managed to overcome his imposter syndrome. He implied that being open about imposter phenomenon is vital, stating that, "recognising that it is a common and shared experience makes it a lot easier to stomach." Tackling imposter phenomenon Imposter phenomenon affects everybody differently, exemplified by a previous blog focussing on "Imposter Dad" syndrome. Considering the prevalence and overwhelming nature of imposter phenomenon, I thought I would conclude by suggesting some ideas on how young people can try to tackle imposter phenomenon. Young individuals, particularly students, often tend to downplay achievements as we feel that we do not know everything. But it is okay to not know everything, and celebrating successes is critical in helping to internalise accomplishments and diminish feelings of self-doubt. This is stated neatly by Valerie Young, an internationally renowned expert on imposter syndrome and co-founder of "The Imposter Syndrome Institute" who stated that "everyone loses when bright people play small." Furthermore, as medical student James stated, talking to others and sharing feelings may help to reduce feelings of isolation and encourage healthy discussions about one’s self worth. Maryam, the Founder of Neurominded, previously wrote an informative article on overcoming imposter syndrome which I would reccommend reading too. Fundamentally, it is important to note that whilst individuals have a role to play in overcoming their own imposter phenomenon, there are wider systems that play a crucial role. It has been found that imposter phenomenon is particularly prevalent amongst under-represented individuals, such as BIPOC (black, indigenous, and other people of colour) working or studying in a predominantly white environment. A lack of representation could be causing BIPOC people to feel as though they do not belong, but it has also been suggested that BIPOC can even feel as though their success is a product of affirmative action. Hence, changes in diversity and inclusion are essential to help tackle imposter phenomenon on a systemic level. Finally, it is possible that imposter phenomenon may have to be accepted throughout certain changes in life, such as a career shift. It is important to recognise that whilst feelings of being an imposter may arise, developing strategies to work through them and not letting them interfere with overall well-being is key.

When I was in primary school, I was one of those annoying kids who enjoyed taking tests. To be clear, I was not superhuman: I had the same fluttering heart as those who hated tests. But for some reason, I felt an encouraging surge of energy for the task at hand: I wanted to show everything I knew. Conversely, what some kids found exciting, such as flying, made me pretty anxious. Emotions arise in us every day, and can, for some, feel automatic and overpowering. Generally, when there’s an event, we appear to react emotionally, seemingly without much control. Our emotional experiences can be unpleasant, even debilitating, and sometimes totally wonderful. But are emotions biologically hardwired? According to a growing, and to some, somewhat controversial, theory spearheaded by neuroscientist Dr Lisa Feldman Barrett, our brains create our emotions— meaning we, neuroscientifically speaking, have more power over them than we know. Debunking Emotion Myths There are many different theories, some dating back centuries, as to why humans have emotions. Plato, for example, mused emotions were useless, separate parts of the mind that had to be tamed by reason. In the classical view of emotions, emotions were similarly thought to be hard-wired, primal circuits, located in the limbic system. Emotions were long considered to be universal, meaning that every human experiences the same basic emotions. Today, we know emotions are essential, as they exist to give us guidance on whether we are safe or in danger. But according to Feldman Barrett, we aren’t born with pre-determined emotion circuits that are triggered automatically: in other words, humans don’t simply react to external events based on evolutionary wiring. Whilst current theories of emotions suggest the limbic system helps process emotions, it may be far from the only agent having a say in their appearance: research suggests several regions work across the brain to create them. Rather than arising from the limbic system, emotions are culturally specific, learned predictions, created every waking moment from a number of key ingredients. Here’s how that works. The Recipe for an Emotion It is intuitive to think the world exists out there, and that we discover it as it objectively is. But our experiences are created by our brains. Colours, for example, do not exist physically: light waves only become colour to us when our brain interprets them as such. In her book How Emotions Are Made, Feldman Barrett explains how human emotions work in the same way. To create an emotion, we need to have a mental concept for that specific emotion, learned culturally when we’re children. These can be vastly different across the world: a study showed members of the Himba, a Namibian tribe, interpreted facial expressions very differently from the study’s American participants, suggesting emotion concepts and expressions of emotions evolve culturally. Then, there’s our body budget, whose resources are allocated by the brain, guided by how well our biological needs are being met: our sleep, nutrition intake, and so on. Status updates on these are always being received by the brain, creating a representation of every sensation — called “interoception.” Low glucose levels, for example, creates a “mood” from low energy — an “affect,” something experienced by all humans. Calmness or agitation, for example, may arise from these, but not strictly emotions. Overlooking everything is the brain, the body’s command centre. The brain, sheltered in the skull, has no way of knowing what causes the sensations in the body, and therefore has to use our past experiences. With these ingredients — interoception; affect, influenced by our body budget; and our past experiences, including our emotion concepts — the brain cooks together a prediction about what the experience means, and voilà: an emotion appears. In a classroom where a test gets handed out, anxious memories from similar moments, a clear concept of anxiety, and a hungry stomach, make it more probable that a faster heart rate “becomes” anxiety — even when there’s no actual danger. In another context, the brain may create excitement from the same physiological event. Predictions, then, are not always correct: school tests are generally not life-threatening, and it seems strange that our brain willingly creates unpleasantness for us. Its task, however, is not to always create happiness, but to nudge us to make the right decision for our survival. Building your Emotional Life According to Feldman Barrett, many still misunderstand how emotions appear, and believe that certain emotional patterns are unchangeable parts of who they are. An important takeaway from the theory constructed emotion may be an encouraging one for some: that we are never doomed to feel any certain way, even if therapy is needed to build a new emotional life. The neuroscientific theory of constructed emotion, then, nicely complements some therapy methods proven to help people better manage emotions, such as Cognitive Behavioural Therapy. If emotions are not reactions to the world but created predictively by our ever-changing brains, we can teach our brains to predict fewer negative emotions. Knowing how key body budgets are, we can boost our body budgets through exercising, eating well, and sleeping enough. We can also rework our mental concepts. Recent studies suggest that working on your emotional vocabulary — having more words to describe your emotions — helps people change their experiences. Having a little more control than we thought, says Feldman Barrett, means we consequently have more responsibility over our emotional experiences. Rewiring can be a challenging task, however, especially in the wake of trauma. Emotions may not be hard-wired, but that does not mean they are illusions, deliberate, or changeable overnight: they are real and should be validated. In cases of trauma, therapy may be really useful to interrupt stubborn emotion patterns. It’s also important to remember that everyone’s brain and experiences are unique, meaning emotional regulation may demand more from some than others. A lot has changed since I found tests weirdly exciting. My adult brain often conjures anxiety from a fast heartbeat, and tests now stress me out. But I feel motivated to interrupt the narrative about myself as a fundamentally anxious person: maybe I could sometimes just as well be an excited, energised one.

Yoga is much more than just impressive poses. It’s a complete philosophy, as highlighted by the insightful article written by Dr. Carolina Estevao published here on Inspire the Mind. But do you ever wonder what is going on inside the brains of the 300 million worldwide yoga practitioners? Let's find out! I’m a research & development engineer working on brain-computer interfaces for a tech company. But during my off-hours, you'll catch me practicing headstands and feeling fantastic afterward. My interest in yoga started during the COVID-19 period as it was easily accessible to practice at home thanks to cool YouTube channels like Breathe and Flow or Yoga with Adriene. Now, I finally have the opportunity to connect with the vibrant yoga community in person. But after each session, I can’t help but wonder where all these positive feelings are coming from. Connecting the Dots: Getting the Full Picture In the world of brain research, there are two important non-invasive methods to study the brain: electroencephalography (EEG) and magnetic resonance imaging (MRI). EEG is like a quick camera that captures brain activity in real-time, but it's not so good at seeing deep inside the brain. On the other hand, MRI is like a detailed map that can show us different brain areas, but it's not as good at showing the brain's fast responses to things. Luckily, we can look at studies using either EEG or MRI and try to piece together the full picture of what is going on in all the brains of yoga practitioners. EEG – The Dance of the Brainwaves EEG is a method to see how the brain's electrical activity works. We use small sensors placed on a cap over the participant’s head. These sensors measure the brain’s electrical signals in a completely non-invasive manner. The signals come from lots of brain cells working together. We can find patterns in these signals, which we call brainwaves. There are four main brainwave patterns, each with a different speed: delta (very slow), theta (slow), alpha (medium), and beta (fast). These brainwaves help us understand what the brain is doing at different times. We can relate the activity of a certain brainwave to a mood or a state somebody is in – for example, if you’re feeling relaxed and calm that means your brain’s alpha waves, the medium waves, are more active. Let’s see what’s happening with those brainwaves when you decide to do yoga. To illustrate this, I will briefly summarize the results from an insightful systematic review, which is a synthesis of the existing scientific studies in the topic. First, you sit down and take a couple of deep breaths. Your mind is still a bit noisy – this means that your beta (fast) brainwaves are dominating. They will continue to dominate as you’re listening to the instructor’s cues and doing different poses. But as you’re approaching the end of the session and you become more and more relaxed, your slower brainwaves start to become more active – the alpha and theta waves. Delta has the slowest speed and it’s usually very minimal in an awake state. However, after an intense yoga practice that has an emphasis on meditation (such as yin yoga), some individuals might experience increased delta waves, contributing to feelings of rejuvenation and restoration. And it doesn’t stop there – experienced yogis reap the benefits of the practice even outside of the yoga practice in their daily lives. Regular yoga practice has been associated with reduced stress and anxiety levels. EEG studies have indicated that experienced yogis may exhibit higher levels of delta brainwaves and lower levels of stress-related brainwave patterns, such as beta waves, even when confronted with stressful situations in their daily lives. MRI – Cell Bodies and Their Connections Coming back to MRI, this is a special way to take detailed pictures of the brain using a strong magnet, radio waves, and a computer. It's like taking a super-detailed photograph of your brain's insides. The brain has two important types of tissues: white matter, which is like the cables connecting different brain cells, and grey matter, which are the cell bodies responsible for learning, memory, muscle control, and self-awareness. More gray matter in certain areas means better brain performance overall. The MRI scans of people who regularly practice yoga have shown something very intriguing. Doing yoga, with its postures, breathing, and meditation, increases the grey matter in parts of the brain called the frontal cerebral cortex, which is a part of the brain located in the area of your forehead. Moreover, the grey matter increases in the hippocampus, a structure deep inside the brain. These areas are responsible for focus, concentration, emotional control, and understanding rewards and consequences. Even more interestingly, grey matter usually shrinks as we age, but older people who practice yoga tend to have less of this shrinkage. So, it seems that yoga could be helping to keep your brain young and healthy! And the Full Picture? According to EEG studies, regular yoga practice can increase activity in the slower brain waves, leading to a sense of calm and a better response to stressful situations. Additionally, MRI research suggests that certain brain areas show more cell bodies after consistent yoga practice, which may improve concentration and emotional control. Moreover, there's evidence that yoga may even play a protective role against age-related brain shrinkage. While research on yoga's impact on the brain and body continues, weaving together these fragments to form a comprehensive picture represents a positive step. Ultimately, it helps us move towards a better understanding of the complete philosophy behind yoga.

It is 2023, I am sitting in my living room in London, as a 23-year-old mental health researcher, and I am scrolling on Instagram. I see a post from my ballet school about their yearly student auditions, and I am immediately transported back to 2005, in Mumbai. I have vivid recollections of 5-year-old me telling my parents that I wanted to start ballet lessons. Even though ballet was still an up-and-coming dance form in India, we began our search for classes. A few rounds of auditions later, I was enrolled in the first ballet school in India, The School of Classical Ballet and Western Dance, a place that would shape me, give me some of the most wonderful memories and most of all, teach me some of the most important life skills I carry with me even today. Above all, I was lucky to have been taught by the wonderful Tushna and Khushcheher Dallas, the Founders and Directors of the school and my other amazing teachers. I have written this piece as a reflection of my journey through 15 years of ballet, for the occasion of World Ballet Day, celebrated on the 1st of November this year. The celebration of this day marks it’s 10th year in 2023, and allows viewers all over the world to watch the work of leading dance companies across the world (you can get access for free to this content here). Today, I hope to share with you a glimpse into the life lessons which ballet taught me, that I keep with me to this day. Discipline and commitment go a long way I must admit, the girls in my grade and I had the reputation of being quite a naughty bunch to teach. However, while it didn’t seem so in the moment, the discipline that was instilled in us went a long way, and subconsciously to this day, it has seeped into my work ethic, which I am happy to say I am proud of. Ballet also taught me the concept of commitment. As I advanced from grade to grade, ballet routines got harder, and I was simultaneously adapting to more intense workloads from high school. I took a break from ballet for a year while I prepared for the dreaded Standard 10 high school exams, but the following year, I jumped right back into dancing. The pointe milestone Every young child starting ballet someday sees themselves standing on their "tippy toes", that is, being "en pointe (a position in which the body is balanced on the extreme tip of the toe, wearing special pointe shoes)." This is a major career milestone for someone learning ballet, this happened 13 years after I started ballet, when I was 18. The day my pointe shoes arrived, I sat with them and had a few mindful moments, reflecting on how these shoes were a symbol of how far I'd come, and what I'd learnt along the way. And even though I don’t dance any more in London, I have carried my pointe shoes with me. They serve me as a reminder that consistency, passion, and hard work will help me to achieve my goals. My go-to during the COVID-19 lockdowns When COVID-19 hit, my ballet lessons moved online. Though my space was limited, and I had my bedroom instead of a large studio for adage sequences, my bi-weekly classes on Zoom were my outlet, breaking the monotony of staying at home and watching Netflix. Getting into my leotard, tights, and shoes, and seeing my teacher and peers — though through a screen — helped me in more ways than one. Above all, we had the chance to understand our bodies better, and it was during this time that I felt my most confident and most flexible, as I was committed to being proud of getting closer to my fitness goals. The story of friendship I have waited until this moment to tell you that I haven’t been alone in my ballet journey. My best friend and I began our journeys together as 5-year-olds, looking up to all the older ballerinas in our school, twinkly-eyed, aspiring to be as graceful as them. And now, as adults, when we look back, we fondly remember the car rides to and from class, which brought us even closer. We've laughed, we've cried, we've listened to our favourite songs, and it is these memories that I will always remember. A little bit of science Upon reflection, I have come to realise that ballet taught me a set of transferrable skills I use in my work as a researcher. The perseverance, attention to details, and teamwork I learnt through dance allow me to keep going whenever I face a roadblock in my work (particularly with statistical software!), and all in all, shape me to be a better researcher. I will now shift the gears a little bit and wear my researcher’s hat to share with you the research that exists linking dance with mental health. One arm of the Scaling-up Health Arts Programmes: Implementation and Effectiveness Research (SHAPER) study is the Dance for Parkinson’s programme, which involves a 12-week programme developed by the English National Ballet and researchers from King’s College London and University College London. This study aims to investigate the application of ballet as an adjunctive therapy for Parkinson’s (you can learn more about the SHAPER study here). In addition to Dance for Parkinson’s, numerous research exists on the effectiveness of Dance Movement Therapy (DMT) on physical and mental health conditions. For example, this 2014 meta-analysis found that DMT interventions led to moderate improvements in quality of life, and body image, and also highlighted the decrease in the level of depressive and anxiety symptomology. In addition, studies have shown the effect of DMT on biomarkers such as cortisol (one of the stress hormones in our body, and one of the most studied biomarkers investigated in the context of stress and mental health). For example, this 2019 randomised study found that healthy older adults who participated in DMT sessions three times a week for three months had lower values of cortisol (meaning that participants had lower levels of stress) as measured from saliva collections compared with participants who engaged in aerobic exercise (a form of physical exercise which makes use of our body's large muscle groups, and is rhythmic) and those who were part of the waitlist control groups. Where am I on my journey today, you may ask? I have now hung up my ballet shoes, and, while I have bid farewell to the active learning of ballet which has always been part of my life, I am incredibly grateful for the life lessons it has taught me. I’d like to take this opportunity to thank everyone who has been an integral part of my journey, especially all the teachers and staff at my ballet school. This piece is dedicated to each of you, and I hope this goes on to show the level of impact they have had as pioneers of classical ballet in India.

I find that the best kind of movies stay with me for a long while afterwards, often in the form of lingering images, thoughts, or feelings. Movies that successfully build gripping immersion, allowing you to completely lose yourself in their fabricated world, serve as one of my favourite forms of entertainment. But what about when that world is downright terrifying? Why would anyone want to lose themselves in a horror movie? Not many movie genres can claim to be as polarising as horror — cinematic marmite. Unlike heart-warming romance or light-hearted comedy, horror movies are designed to stir feelings of terror, eliciting fear and dread. Nevertheless, there are countless cult classics within the horror genre, and in 2021, horror was the fourth highest-grossing film genre in the UK. There are plenty of subgenres to choose from, with the most popular being demonic possession (or supernatural horror), paranormal, monster, slasher, zombie, gore (or splatter), witchcraft, vampire (Twilight, anyone?), psychological, and even comedic horror. As someone who absolutely loves a good horror movie (despite watching through my fingers a lot of the time), I wanted to answer the question: why are some of us addicted to the thrill of fear whilst others can't change the channel fast enough? My top 3 horror movies: Talk To Me (2022), Midsommar (2019), and Get Out (2017). The Thrill and Allure of Fear Fear isn’t all bad; we actually rely on fear for protection from potential threats. When we detect a threat or feel scared, our bodies prepare us through the fight-or-flight response, with the fundamental goal of survival, despite the fictional source of the threat. Neurocinematics research, looking at the impact of watching movies on our minds, has found that jump scares increase activity in the amygdala, the almond-shaped part of our brain responsible for detecting and responding to danger. Visually, psychological horrors and those based on true stories are perceived as the scariest subgenres — it seems that unseen or implied threats are much more frightening to deal with! And it isn’t just what we see (or don’t see) that’s important. Sound and musical score play a huge part in creating tension and suspense — think of the iconic shower scene from Psycho. Together, auditory and visual stimuli can tap into our innate instinct to survive, alerting our brain that we’re in imminent danger. It is no coincidence that we can feel both excited and scared when watching horror movies. When the feeling of fear has passed, without having to confront any real threat, we feel that adrenaline rush, that surge of excitement that we survived (well done us)! Here are the three primary reasons why we keep going back: Tension: This is what keeps us at the edge of our seats, that emotional strain, preparing for the next shock. Horror movies are typically great at building tension and anxiety within the audience. We enjoy the suspense, mystery, gore, shock, and bone-chilling terror — horror’s key ingredients! Relevance: Horror movies are relevant in various ways, whether it’s a thread of social commentary, addressing the unknown, or grappling with the concept of death. They can be surprisingly relatable, especially when the story implores you to empathise with the protagonist(s) in more ways than one. Unrealism: Ultimately, we know that horror movies are presenting a fabricated reality, that what we’re watching is meant for entertainment purposes. So even though our bodies are telling us otherwise, we know that we are in the clear when we leave the cinema. When we experience "recreational" or "staged" fear, our brain releases dopamine, a feel-good hormone associated with feelings of pleasure, reward and motivation. It sounds counterintuitive, but it’s this cocktail combination of fear and pleasure that increases our vigilance, our sense of accomplishment when we survive the scare, and our eagerness for the next one. The beauty of horror movies is that they elicit such diverse reactions from different people. It's a genre that taps into our deepest fears and insecurities, allowing us to confront them in a safe environment – even if that environment involves gripping onto the person next to us for dear life, or jumping out of our seats and spilling popcorn everywhere.

Author’s Note: As is the case with much fiction, ‘Hartman’s Hands’ was inspired by a dream. I always record my dreams, and many of them are not worthy of a short story or novel, however, in this case, I felt there was something there. I have experienced many instances where senior citizens lose their partners and struggle to deal with it mentally. It happened to my grandmother, and she was never the same. Sharing your life with someone for so long and then losing them must be devastating. I wanted to explore this with Bill Hartman. He is isolated, he struggles, and he is lonely in his grief, but finds solace in a series of unknown events. Magical realism is not a genre I have written since I was at university. I find it complicated and worry about over-usage. However, in this instance, I thought it was a powerful way of demonstrating Hartman’s mental health issues, but also the power of love. It appeared on her birthday. Bill Hartman had been finding it harder to maintain his garden. He was 76 now, and not as fit as he used to be. There was the arthritis in the hands, a wheezy chest from his past of smoking, and general aches and pains that limited his daily output. It was tough getting old. You have all the time in the world to do something, but the body won’t let you. Despite the pain, he kept trying. He had to keep it going for her. She was buried at the cemetery, but her heart was in that garden. ‘Get someone in,’ John had said, several times. ‘You’re getting too old for it, Dad.’ He didn’t want to get anyone in. He didn’t want anyone else touching her garden. This summer was the first full one he’d had to garden. Hartman tried his hardest to get ahead in the spring and keep on top of things, but by late May it was a different story. Keeping the flower beds going was fine. He’d done his reading since Hazel died, and he knew things needed a drink. He pruned the roses in the spring and sprayed them once a week to keep the black spot and flies off. The peonies and lilies did great. The clematis took care of itself but needed an occasional trimming. It was the mowing of the lawn, the cutting back of the bushes and the weeding that took its toll. And it always needed doing. The pain was constant. His hands were stiff and often clumsy. Tasks could make them ache for long periods. The painkillers didn’t do anything, and he was gaining an increasing tolerance to whiskey. What used to be an occasional indulgence had become a nightly routine. So what? There wasn’t long left for him. Who was going to tell him off? Although, his tortoiseshell cat, Zoe, gave him disapproving looks regularly. John kept talking about him moving out to Australia to be with them. Maybe it would be good for him. He would have loved to see them more, especially the grandkids, but he was too old for all that travel – it was too far. Plus, he didn’t want to be an inconvenience to anyone. Zoe wouldn’t like it on a plane, anyway. Hartman was torn between staying in a house he’d lived in for thirty years with everything that reminded him of his wife and heading down under to be with the rest of his family. Maybe it was the garden that was keeping him there. Keeping him and destroying him at the same time. Then it was Hazel’s birthday. He wasn’t going to bother getting up at first. He was sleeping in later than he’d ever done in his life, owed mainly to the whisky. That wasn’t what Hazel would want. She wouldn’t have him wallowing in self-pity. Zoe didn’t tolerate it either. She needed feeding and she’d always remind him, jumping onto his bed and pawing at his stomach with the faintest amount of claw. ‘Alright, alright,’ he groaned. With ache set deep in his bones and a fuzzy head, he rose and made himself a coffee and went to sit on the patio as he always did in fine weather. The first thing he noticed as he went through the sliding doors was the weeds that had sprouted up through the cracks in the concrete. A couple of days of bloody rain and it was always the same. He would have to get it re-grouted. Now that was something he would have to get someone in for. But as he sat down and surveyed the garden in its late-June mid-morning glory, he slammed his mug down on the table so hard it cracked and spouted Kenco. The lawn. Colour left Hartman’s face. He stared, unblinking, his shirt splashed with coffee. There was a hole in the garden. It was about a foot deep, three foot wide and perfectly circular. Exactly in the middle of the lawn. Bill looked around, blinking, but there was no sign of anything else. He looked at his neighbours’ fences. Sydney would never do a thing like that. What about the others? They didn’t even own a spade. They did nothing in their own garden so why would they sabotage his? But the strangest thing was there being no evidence of it even being dug. No spade marks, no soil in the surrounding areas of grass. No soil at all. A meteorite, maybe? But then there would be evidence, burn marks and such. Meteorites in his garden. It almost made him laugh. He fingered at his wedding ring with shaking hands. Nothing made sense. ‘It’s happening at last,’ he muttered to himself. Dementia, as he’d always feared, was kicking in. That, or pure insanity. This hole was a mirage, an illusion. Possibly he was dreaming still. He did the old cliché of pinching his arm, but it hurt and nothing else. Anger overcame him. On Hazel’s birthday, of all days. She would have been 72. Now there was a hole right in the middle of the garden. It was a violation, and the fact that he could not explain it infuriated him even more. Zoe crept from behind him, rubbing against his legs and walking through the space between them. Then she pounced into the hole, rolling around on her back and sides, purring loudly, like the soil was laced with catnip. ‘You’re a strange girl,’ he said. Zoe kept purring and rolling. Hartman stayed in the house that day. The anger subsided; he didn’t want to brew over it on what was already a tough day. But he couldn’t help it. Who had heard of a self-digging hole? It had just appeared for Christ’s sake. Maybe he’d have a chat with Sydney tomorrow, see if he knew anything or had any ideas. He tried ringing John, but he didn’t answer. It was hard to remember what time it was out there, and his son was often busy. He drank his whiskey earlier than usual and so his bedtime was earlier too. ‘Going for a pond eh, Bill?’ said Sydney, smiling down over the fence. ‘Thought you wanted less work!’ Hartman woke from his daydream and stared at his neighbour with a blank expression. ‘Pond,’ he murmured. Walking across the garden, he ignored his frowning neighbour. The hole had got bigger; it had doubled overnight. No evidence again. Where was the soil going? ‘Bill?’ asked Sydney. ‘Erm, yeah, a hole,’ he said. ‘I mean a pond. Yes, a pond. Always wanted to have one. Koi maybe.’ He kept staring down at the stain on his wife’s garden. ‘Oh, I see,’ said Sydney, still frowning. ‘Takes some work, that. You’ll need some help. I mean, you are better off getting someone in, but I can help if you want.’ ‘No, it’s fine. Thanks. I don’t want to get anyone in.’ ‘Well, if you need a hand-’ ‘No thanks, Sydney. I have hands.’ He flexed his tight fingers and dug his nails into his palms. ‘Ok,’ said Sydney, slowly, tapping his fingers on the fence. ‘You know what’s strange? I’ve been in all week. Thought I would have heard you make a start.’ ‘It started yesterday,’ said Bill, scratching his head. Sydney went to say something else, but Hartman turned abruptly, leaving the hole and his neighbour behind him, and went back into the house. His day was spent on the sofa. The tele was on, but he paid little attention to it. Zoe purred around and on him. He got up to use the toilet and to feed her, but nothing else. Only thinking. Sydney wasn’t involved then. It didn’t look like anyone was; there was never any trace of anything. Maybe he was doing it in his sleep, one of those weird sleep-walking things you would hear about? But where was the evidence? A drunk, sleepwalking man in his 70’s making clean cuts in the earth without leaving a trace. Hartman thought about the hole, and about everything. Chapters of his child and teenage years, meeting Hazel and all the times they had together – all came flooding back to him. It was like the hole had stuck a pin in his memories, and they were all leaking out. Whiskey went down quicker than usual and he crashed out on the sofa, tears on his cheeks. As he woke with a jerk the bottle fell to the floor, spewing its brown contents onto the carpet. All he wore were his boxer shorts when he left the house through the front door, not fazed about the summer night's rain that fell heavily. A pale security light flared on and highlighted the black smudges that were dotted all over the faded white door of his neighbour’s house. Flickering light from a television danced through the curtains of the living room window. Hartman knocked loudly. The rain trickled down his face. Clicking and scratching came from inside the house, and the door opened. ‘Woah there, fella. You okay?’ said the man. Hartman suddenly realised he’d lived next-door to them for a few years and he didn’t know their names. ‘My garden,’ he said, the rage ebbing away. He cleared his throat. ‘Have you seen anything strange in your garden, or mine?’ ‘The garden?’ said the neighbour, scratching his chin. ‘Nah. I don’t ever go in mine. It’s all overgrown.’ The man knew nothing. It was stupid coming over here like this. He swayed slightly on the doorstep. ‘Are you alright mate? It’s bit late, you know. And chucking it down.’ ‘I’m okay,’ said Hartman. ‘It’s just that, well I thought maybe you - oh don’t worry. I’m, I’m sorry to bother you.’ Hartman turned and nearly slipped as he walked down the path. He didn’t look back as he entered his home and slammed the door behind him. The neighbour stayed gazing into the rain. Hartmann stayed in the following day, as the rain continued to fall, not wanting to do anything. He didn’t even eat. There was a knock on the door once which briefly broke the spell. Peeping out the curtains, Hartman saw the neighbour with no name, staring at his door. He didn’t bother answering. That night the rain was still falling. Whiskey had been drunk again and Hartman’s feet were itchy. He had to look. The hole had grown again. Still no evidence of any digging as he raked the torchlight across the lawn. This must be what madness was. Sun shone through his windows the following day. He had made his decision. It was a short drive to the local hardware store where he bought a pickaxe, bamboo fencing and some wood screws. Once back, he lay the bamboo across all his fence panels in the garden and fixed them with the screws. It was much higher now; he would not be disturbed. Finally, he got a spade and a shovel from the shed to go with the pickaxe, along with a wheelbarrow. Hartman began to dig, attacking the hole feverishly. His chest was wheezing, and of course he was aching, but he carried on. The hole was now quite large after several nights of its natural growth and Hartman was adding to it, digging like he was twenty years younger. ‘What’s with the bamboo, Bill?’ Sydney called over, doing his best to peep through the fence. But Hartman, for so many years a friendly and chatty neighbour, did not answer. ‘Bill?’ Sydney could hear the spade piercing the ground, could hear the grunts of his neighbour, but there was no response. Hartman heard, but he paid him no mind. This was his work, his contribution to the hole with his own hands, and he did not have the need to talk to Sydney. After a while, he could not feel the aches. In fact, his hands felt looser than he could remember. He paused only to eat, making a cheese sandwich and sitting on the lawn next to the hole, Zoe beside to him. ‘We will see what this is all about, girl,’ he said, stroking his cat. Zoe purred back at him. He finished for the day when the sun began to set. Proud of the work, he dropped his spade and surveyed the rest of the garden, stroking his wedding ring gently. He would have to cut the bushes tomorrow. Nothing needed watering. And the lawn wasn’t going to be a problem anymore. Hartman beamed when he saw the garden the next day. As expected, it had grown again and was a very deep koi pond now. There was only a two-foot-wide perimeter of grass left surrounding the hole. He trimmed the bushes and got back to work. Sydney gave up calling. Hartman ignored his mobile that rang repeatedly until the battery died. When the house phone rang, Hartman carried on, immersed in his work. Again, Hartman only stopped for a sandwich and a drink, basking for a short while in the sun while Zoe rubbed her cheeks against the side of the hole. ‘Where will it end?’ he asked the cat, who continued rubbing herself along the edge of earth, craning her neck over, her white fur smudged into brown. ‘Where will it end?’ he repeated, staring into the hole. Hartman sat with his back to the wall of the hole, running his hands over the earth and looking at the dark, smooth interior, the stones and flints that were embedded around him twinkling like stars. He was exhausted and pleased. His hands were more alive than ever. Sometimes he would sleep with his cheek on the ground, breathing deeply. Zoe sat beside him, cleaning her ears. Two policemen knocked at Bill Hartman’s house. There was no answer. One of the next-door neighbours would not answer either, but Sydney did. He claimed that his neighbour, who was usually very friendly, had been acting strange for a while. He had closed himself off – the garden was obscured from view by the bamboo and nobody in the street had seen him leave his house for weeks. ‘All I have heard over that fence is digging,’ he told the police. ‘But I haven’t heard a thing for a while.’ The police decided to knock the door down. The house looked quite normal, if a little neglected, with a couple of untouched whiskey bottles in the kitchen. There was no sign of life, and a litter tray in the kitchen with no sign of a cat. When they got to the garden; however, they found it. The hole went from the edge of the patio to the edges of the flower beds. What amazed them the most was that it was so perfectly dug. Smooth edges rolled down into the darkness. They stood in silence. One of them broke the reverie, as he spoke into his radio. ‘We need some sort of specialist help here,’ he said. But there was no specialist that could help the situation. The policemen called down, to no response, their voices echoing off the perfect earthen walls.

I spent a ridiculous amount of time at my best friend's house when I was a teenager. Her mum would pop into her room to check on us or ask us if we wanted anything, and every time she left, my best friend would ask her, "I didn't shout, swear, or say anything rude then did I?" All three of us used to laugh at this. Even my best friend knew intellectually that she hadn't shouted, swore, or been rude to her mum. But she couldn't stop saying it. I constantly seek reassurance, too, but in a different way. I seek reassurance through rational self-talk. This is because, like my best friend, I experience obsessive intrusive thoughts. I don't mean TikTok's definition of obsessive intrusive thoughts (what if I dyed my hair blue?) I mean Mind UK's definition: thoughts that can be "frightening, graphic and disturbing" (what if I kill myself or someone else?). These thoughts aren't a reflection of my desires. I don't want to hurt myself or someone else. That's what makes them so frightening. I started looking for resources that might help me manage my intrusive thoughts and the anxiety they bring. I came across the book 'Needing to Know for Sure: A CBT-Based Guide to Overcoming Compulsive Checking and Reassurance Seeking' by Dr. Martin N. Seif and Dr. Sally M. Winston on Amazon. I'm a word person, I learn through reading, so I decided to order it. It's been life-changing. According to their profiles, Dr Martin N. Seif specialises in anxiety disorders, while Dr. Sally M. Winston specialises in treating phobias, panic, OCD, and other related disorders. Between them they have written numerous books. The book first explains the difference between productive and unproductive reassurance: productive reassurance is accepting doubts while unproductive reassurance is trying to eliminate them. The problem is, of course, we can't eliminate doubts. Nothing in life is ever 100% certain. So, we end up in a cycle of compulsive checking and reassurance seeking. For example, if I have a thought, "what if I kill myself or someone else?", I might respond to this by thinking, "you would never do that, you're not a violent person". I might accept this for a short time, but then, more doubts arise: "What if I stab myself or someone else in my sleep? What I've already killed someone and hidden their body under my bed, and I just can't remember doing it?". Before I know it, I'm checking under my bed for dead bodies. Dr. Martin N. Seif and Dr. Sally M. Winston distinguish between three different voices — Worried Voice, False Comfort, and Wise Mind. Worried Voice and False Comfort are fairly self-explanatory. Wise Mind accepts doubt and understands nothing can ever be certain. She knows that thoughts are just thoughts. They suggest that reassurance reinforces the need for reassurance the next time an intrusive thought arises. It makes us reliant on it, especially if the reassurance does lead to a short-term drop in anxiety (like when I look under the bed and see that there aren't, in fact, any dead bodies). I suppose this is akin to when I had eczema growing up — scratching felt satisfying in the moment but only led to more skin damage. The authors suggest using therapeutic surrender instead. This involves, and I'm oversimplifying here, embracing uncertainty when intrusive thoughts arise, avoiding reassurance, and avoiding distractions. In other words, sitting with the uncomfortable thoughts without trying to "fix" them. I've been implementing this technique for a few weeks, and I'm already starting to feel the benefits. I found avoiding reassurance immensely difficult at first. I want to comfort myself when I'm in pain. I want short-term relief, and refusing to reassure myself denies me of it. I found an exercise that helped me immensely in the beginning until I was able to tolerate sitting with the thoughts better. I would tell my body to make a particular movement while actively preventing myself from making it. For example, I would repeat the thought, 'stand up' over and over again in my head but choose to remain seated. This helped me to remember that thoughts have no power and no inherent truth. Now, when I have an intrusive thought, I imagine that it's a miniature boat, and I'm watching it pass me on a river. I don't yank it out of the water. I let it be. I still have setbacks. I still spiral sometimes. I'm using Dr Martin N. Seif and Dr Sally M. Winston's recommendation of having 'reassurance coupons' (in other words, only letting myself seek reassurance a few times per week), and that's helping. Hopefully, I'll soon get to the point where I don't need any coupons. My biggest takeaway from reading the book is that, contrary to most of what I've learned in my recovery, I don't have to control or eliminate my thoughts. I just need to recognise them for what they are. I would highly recommend it to anyone who suffers from compulsions and intrusive thoughts. At the very least, it will leave you feeling as seen as I did when I read this hilarious quote: "They [checking compulsions] can even seem bizarre: I know it makes no sense, but let me just check one more time that I did not lock a child in the refrigerator." (page 19). Everyone deserves to feel like they aren't alone in having a messy mind, and everyone deserves to feel like they aren't the only ones whose mind seems to work against them. This book gave me that. I hope it can give the same to you.