Unveiling the Power of Compassion Last year, I completed a master’s degree in health psychology at King’s College London. Now, I am a clinical psychology student at the Université du Québec à Montréal, where I am privileged to learn from Professor Julie Leclerc, a leading expert on child development and Tourette’s Syndrome. My educational trajectory has provided me with a nuanced understanding of various psychological stressors and their extensive implications, especially for those confronting mental health challenges. Through writing, I believe we can distill intricate research into relatable narratives, providing readers with a deeper understanding of diverse psychological journeys and the broader context in which they unfold. Ultimately, my aim is to cultivate a more compassionate and informed community, particularly for those navigating distinct challenges. In the realm of music and performance, there exist extraordinary moments that transcend mere entertainment, resonating with the depths of the human spirit and underscoring the profound power of compassion. Such a moment unfolded when Lewis Capaldi, the acclaimed Scottish singer, experienced an intense tic attack during his 2023 performance at Glastonbury. Astonishingly, the crowd united in a display of empathy, completing Capaldi's song for him. This act of compassion reverberated, not only among those present, but across various social media platforms. Capaldi's rise to fame has significantly increased public awareness and understanding of Tourette's Syndrome (TS), shifting societal perceptions, and promoting greater inclusivity and empathy towards mental health. Understanding Tics and Exploring Tourette’s Syndrome Tics are sudden, involuntary twitches, movements, or sounds that individuals perform repeatedly. While those with tics cannot control these actions, the manifestation varies across disorders. There are two primary disorders characterized by tics: Chronic Tic Disorder (CTD) and Tourette’s Syndrome (TS). In CTD, individuals may experience motor tics, like repeated blinking, or vocal tics, such as involuntary grunting. In contrast, those with TS exhibit multiple motor tics combined with at least one vocal tic. Both require the tics to last over a year for diagnosis. Whilst ~1.87% of people experience CTD globally, ~1% specifically have TS. While the symptoms of these disorders often stabilize or diminish after adolescence, approximately 0.08% of adults continue to exhibit persistent tics indicative of CTD. In contrast, about 0.005% of adults maintain symptoms consistent with TS. Despite their moderate prevalence, tic disorders are often neglected in terms of public understanding and research, highlighting the need for increased awareness and support. Indeed, Capaldi was diagnosed with TS at age 25, reflecting how many cases can go undiagnosed or misdiagnosed. Adding to the complexity of tic disorders, individuals with tics often face additional challenges. Over 90% of sufferers experience co-occurring psychiatric disorders, including anxiety and mood disorders which contribute to academic or occupational challenges and social struggles and can diminish overall quality of life. Furthermore, disruptions in daily activities and social interactions caused by tics can lead to feelings of discomfort, frustration, and embarrassment, further impacting an individual’s well-being. Tension, Time, and Release: Capaldi’s Parallel Journey with Music and Tourette’s As Capaldi’s TS symptoms persisted, they became entwined with his musical journey. To many, these appeared as simple quirks or eccentricities typical of an artist, masking their true nature as signs of a neurological condition. Capaldi’s success in the music industry, despite his previously undiagnosed condition, is a testament to his resilience and musical talent. From playing drums and guitar at age two, to singing in pubs by nine, Capaldi's early years were marked by fervent musical dedication which subsequently catapulted him into fame. However, whilst his career has boomed, he struggled with his mental health. In the documentary, "Lewis Capaldi: How I'm Feeling Now", he delves into his journey, intertwining his struggles with the pressures of the music industry and the challenges of his condition. A prominent theme of the documentary is Capaldi’s struggle with the demands of staying relevant in music. He states that, “the clock is ticking”, to create new music as successful as his first number one hit, ‘Someone You loved’. One can draw a parallel between Capaldi’s experience with his tics and the pressure of his fame. Individuals with TS often experience premonitory urges, a mounting tension before a tic manifests, which is only relieved by the tic itself. Thus, both aspects of Capaldi’s life bring an inherent sense of pressure and urgency, reflecting the daily struggles faced by many individuals living with tics. Throughout the documentary, Capaldi fearlessly embraces vulnerability, shedding light on the intersection of his extraordinary talent and the everyday realities of living with TS. His openness about his experience humanizes him, showing us that behind the captivating performances and chart-topping hits lies a person struggling with their mental health, acting as a reminder that even the most successful individuals are navigating their own unique challenges. Embracing Tourette and Tic Awareness: A Path Forward with Compassion Capaldi's journey in the music industry extends beyond his hits and stellar performances; it has become a narrative that illuminates the realities of living with tics and dispels their misconceptions. His viral performance was more than a display of talent but a genuine glimpse into the life of someone with TS, underscoring the resilience of those who live with the condition. Capaldi's forthrightness in sharing his experiences paves the way for a broader dialogue, emphasizing the importance of empathy, understanding, and compassion. Nonetheless, the conversation does not end with understanding alone. It is about fostering a society that moves beyond awareness, to active inclusion. A society where those with TS, or any condition for that matter, feel valued and seen for their inherent worth and contributions. Capaldi's story is a testament to the transformative power of compassion and the bridges it can build. As we reflect on his journey and that of many others with tics, let us actively work towards a world that not only recognizes but celebrates our shared humanity, in all its diversity. By doing so, we take a collective step towards a brighter, more understanding future for everyone.

A caregiver can be defined as someone who provides care for someone else in the form of time and labour-intensive tasks. These tasks can involve help in activities of daily living (e.g., bathing), medical tasks (e.g., medication management), and overall assistance where one may be limited in their ability to independently do something. I am currently an MSc student in Neuroscience, and I am working as a research assistant at the SPI Lab on the PRENAYOGA study, a prenatal yoga intervention for ethnic minority women. Last year, as a Summer job, I worked part-time as an Adult care and support worker for individuals with epilepsy and other complex needs. In this article, I want to discuss the mental health of carers and the lack of support available. This is important to me as working as a carer has provided me with insight into the experiences of other carers including my colleagues. Types of caregivers There are two subgroups of caregivers: formal and informal. Formal caregivers are those providing care in a formal setting such as a care home or hospital. Informal caregivers are usually family members providing care in a home setting and are generally not paid for their work. As my job was part-time, I received pay for my work and therefore I identified as a formal caregiver. Caregiver Identity The caregiver identity theory is a conceptual framework that outlines caregiving as a process of change and that changing caregiving roles emerge from a pre-existing relationship role. Examples of pre-existing relationship roles are a child caring for a parent or a spouse caring for their partner. This concept allows caregivers to make sense of personal experiences, actions, and emotions and helps guide subsequent behaviour because the theory explains the intricacy of caregiver identity and how it is related to multiple factors within experiences of caregiving. I feel this doesn’t apply to me as much as I was a formal caregiver, but I decided to add this, in hopes that those who are informal caregivers and are reading this blog may relate to and help make sense of their own experiences and identity. Mental Health of Caregivers Caregivers are affected mentally and physically when providing care. Alzheimer’s Research UK found that 48.4% of carers of people with dementia have a long-standing illness or disability, and 63.5% say they have had no to little support (mentally and financially). It has also been suggested that carers who are motivated by guilt, duty, or sociocultural norms are more likely to resent their caregiving role and undergo more psychological distress than carers with more positive motivations such as a sense of love or reciprocity and internal fulfilment. The main sociocultural motivations for caregiving are suggested to be cultural and spiritual beliefs, gendered roles, and willingness to provide care. In my personal experience, there are many diverse caregivers coming from different backgrounds with different norms and expectations. There was a colleague I worked with from African roots, and he was a joy to work with. He introduced his love for music and dance to me and the residents, and I could see he enjoyed providing care to the residents. Among the residents was someone whom only females could provide care for, and I could see that some of the male caregivers hardly interacted with her if at all, with the exception of this one male colleague. This showed the gendered roles and how they affected the relationship further than care. It is important to note that while the resident was 'female-only', it is not to say that male carers couldn’t have still provided entertainment or companionship. Furthermore, I witnessed the difference in the care provided by the permanent staff who had built a deeper rapport with the residents, compared to the temporary staff. This is not to say that all temporary staff are worse at providing care of course, but the more obvious differences tended to be from those temporary colleagues. The Weight of the Caregiver Role As a formal caregiver, I never felt any resentment towards my role, rather I had a more positive mindset and believed that the work and effort I was putting in would hopefully make my residents’ day better. I won’t deny that there weren’t any stressful situations where I considered quitting, but the happier memories outweighed that. One particular situation I remember when I considered quitting was the first few times I witnessed a seizure. I remember feeling scared and helpless and wondering if the role was right for me. The thing I found the most stressful was the lack of staff available, some days we would have a good head count for a shift, but other times it didn’t feel like enough, and I remember feeling like I was running around the care home trying to multi-task my residents’ needs while handling other duties such as cleaning. I felt especially guilty during these times as we couldn’t take our residents to activities due to being short-staffed. The majority of my residents had epilepsy so every shift was different. Some days there wouldn’t be any seizures, other days there would be multiple seizures which did make the shifts harder sometimes. I believe I identified positive aspects of my caregiving role, allowing me to keep going as the effort and care I was providing was hopefully improving the quality of life for my residents – the smiles and laughs were the best experiences. Researchers observed that caregivers who identify greater positive components of their role experience less burden, improved health, and relationships, and better social support. This expresses that there are both positive and negative aspects of caregiving which in turn can lead to different outcomes and feelings. I remember going for a walk with my residents around a lake and that was a great day out. I believe I got closer to my residents, and they seemed to enjoy the different environment instead of constantly sitting in the lounge and watching TV. I tried to keep a positive mindset and kept a smile on my face whenever I saw my residents as I believed they had it hard enough as it is and deserved to have more positive components in their day-to-day lives. I worked hard to build a personal rapport which I believe helped the trust between me and my residents. A Parting Note... In summary, caregivers offer more than just physical care to their patients, and this can include mental and financial support. There are a lot of tough times working in care and caregivers should be appreciated more for the work and effort they provide for their residents. It can be hard to remember to take care of yourself when you’re busy looking after others, so going forward I want to remind others who seem to have forgotten to take care of themselves to do so especially caregivers.

A few years ago, a group of scientists from different parts of the world met and discovered that they shared the same aspiration- they wanted to understand what made some adolescents more likely to develop depression than others, and whether it was possible to identify those at risk and help them before they became depressed. They also agreed that it was important to understand this in the context of low-and-middle-income countries (LMICs) because 90% of the adolescent population worldwide lives in LMICs, which is a lot! In fact, the term 'vast majority' would be an understatement. And yet, most research comes from high-income countries (HICs). With that in mind, the IDEA project was born. It stands for Identifying Depression Early in Adolescence and I was lucky to be part of it from the beginning. I am a postdoctoral researcher at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London and I have spent the past decade trying to understand the biological and environmental risk factors of depression across different populations. With the support from the MQ Mental Health Research, the IDEA project started in 2018 and it involved five countries: Brazil, the USA, the UK, Nepal, and Nigeria. It had (and still has) several sub-projects investigating the topic from different angles, but for the purpose of this blog, I will talk about the aspects of the project I was directly involved in. These included systematic reviews and meta-analysis – reviewing and analysing the existing scientific literature on the topic - as well as my research investigating how biological markers, specifically increased inflammation, were associated with the risk and presence of depression in a newly recruited group of adolescent participants in Brazil. What we know so far From the studies in adults, we know that chronically higher levels of the stress hormone, cortisol, and chronic low-grade inflammation, are linked with depression. We also know that prolonged and severe experience of childhood trauma increases the likelihood of developing depression later in life. However, studies in adolescents are less common. Considering that 1 in 4 adolescents worldwide experience depression, we thought it was a good idea to get a better understanding of the risk factors for depression in that period of life. So, we looked at all the studies published worldwide so far on the topic (systematic review), and we focused on how early life experience interacts with biological changes leading to depression. First of all, we found that there were very few studies from LMICs, which confirmed that there was a need for more research in these settings. We also found that increased inflammation in the body and some changes in brain function, like lower activity in response to reward and changes in the limbic system (the region responsible for emotional activation) were associated with depression in adolescents, but mainly in the context of early life stress. We published our results in the Journal of Psychiatric Research, and in a blog as part of Inspire the Mind (ITM). As the majority of the studies looking at biological changes in depression included cortisol, we had enough studies to look at these results in more detail and do a meta-analysis. Our results showed that adolescents who developed depression had higher levels of morning cortisol prior to becoming ill, compared to those who did not go on to develop depression. Interestingly, we did not see differences in cortisol levels between adolescents who were already depressed and those who were not, suggesting that higher cortisol might be more of a marker of future rather than current depression. We published our results in Psychoneuroendocrinology, and as a blog on ITM. The results from the systematic review and the meta-analysis gave us an idea and an overview of what was out there and informed us where to go next. Sex-specific inflammatory makers of depression – results from our study As Aristotle once said: “The whole is greater than the sum of its parts”, perfectly describing one of the main concepts behind the IDEA project, which was not only to look at risk factors for depression but to look at them together. We know from other fields in medicine that it is only when we combine multiple factors together that we can increase the accuracy for identifying individuals at risk, and in our case adolescents at higher risk of depression. And so, as part of the IDEA project, we developed a composite risk score based on 11 different sociodemographic factors, including early life stress, child abuse and neglect, difficult relationship with parents, and drug use, to name a few. Using this composite risk score, we recruited adolescents in Brazil to take part in our study. The idea was to look at whether inflammation in the body, measured by proteins present in the blood called cytokines, was associated with the risk and presence of depression. We ended up with 150 adolescents in total, 50 were at low risk for depression, 50 were at high risk for depression, and 50 were currently depressed. We found that cytokines associated with depression in adolescence were sex-specific. Boys at low risk for depression had lower levels of a cytokine called interleukin (IL)-2 compared with those who were currently depressed. Instead, girls who had more severe depressive symptoms had higher levels of IL-6, but not IL-2. We published our results in the Journal of Affective Disorders. So, what do these recent results tell us? IL-2 and IL-6 are both produced when there is inflammation, although, they also differ in what they do. IL-2 is mainly responsible for activating cells that fight pathogens, like viruses or cancer cells, in other words boosting immune activity, and it has been used commonly in immunotherapy to treat conditions like cancer. IL-6 on the other hand has a wider range of functions and is produced by a variety of cells. It regulates immune response including acute infections, and when excessive, it is associated with inflammatory conditions including autoimmune disorders. So, how does it tie in with our results? The short answer is we don’t know yet. However, we now do know that it is important to take into consideration sex differences when looking at the biological mechanisms underlying depression development, in order to find the best tailored prevention and treatment plans and achieve equity in treating individuals with this condition. And of course, we must also remember that so far these findings are only for adolescents in Brazil. But what about the main question – can we predict and prevent depression development based on inflammatory markers? We just finished analysing the data to answer this question and will be publishing it soon, so stay tuned because there is more to come! Editor’s Note The research discussed in the blog can be found in a journal article published by the Journal of Affective Disorders. This blog can also be found co-published in the MQ Mental Health Research.

This blog was written together with my dear friend and colleague Katie Hazelgrove, who is a postdoctoral researcher in the Section of Perinatal Psychiatry at King's College London. Katie has a particular interest in understanding early infant behaviour. Photo by Kelly Sikkema on Unsplash Building a relationship with the baby: Understanding their cues We have already discussed how a parent-infant relationship where the baby feels understood and secure is important for their development. However, it’s not necessary to always understand perfectly what babies are saying and what they need. Babies don’t need perfection but rather parents that are emotionally connected with them. So don’t be afraid of confusing tiredness with hunger: this is not a problem! The important thing is to communicate that you are there for the baby and you are trying your best to understand their language. Understanding baby’s cues isn’t always straightforward and parent and infant often need time to get to know each other. After a period of adjustment, parents improve their ability to understand the baby, and usually from birth to 12 months, the level of parent-infant attunement improves. However, in some situations, difficulties in the parent-infant relationship can persist or become more severe. Some parents in fact can have more difficulties in understanding babies’ signals and respond sensitively. Also, if parents themselves experienced a difficult relationship with their parents, or had traumatic experiences in childhood, these can re-emerge in the relationship with the new-born and influence the way parents care for their baby. In fact, the baby’s signals of distress may create additional stress in the parent and make it difficult to respond sensitively. This is why interactive styles and difficulties may remain stable across generations. However, if parents are aware of these dynamics, they can put strategies in place to avoid difficulties being transmitted to their children. The amazing abilities of the new-born Until recently, it was thought that new-born babies were a blank slate, unable to see or hear and only capable of responding with reflexive behaviour. Yet, we now know that babies can react to stimuli from pregnancy and are born with a well-developed sense of touch, taste, and smell, as well as the ability to see, hear, and interact with their caregivers. Babies can see from birth, and initially can focus on things that are about 20-30cm away; that’s about the distance from their face to their parent’s face when being held. This is no coincidence, as babies love to spend time looking at their parents’ faces and interacting with them. Indeed, babies have clear visual preferences for faces; particularly faces with their eyes open and those with a direct gaze. They can also recognise, and show a preference for their mother’s face. Photo by Jonathan Borba on Unsplash Furthermore, even at just a few days old, babies can imitate gestures and facial expressions, initiate interactions, and respond, demonstrating their willingness and ability to interact with their caregivers. Babies are indeed social beings from the moment they are born! Parents may notice that their baby is fascinated by their eyes or hairline. This is because babies can focus more easily on visual contrasts, like black and white. As such, they may also enjoy looking at black and white pictures or other high contrast objects. However, this does not mean that babies can only see in black and white. Indeed, contrary to popular belief, new-born babies can see some colours, as long as they are vivid and in certain shades (e.g., red). Babies can also hear and locate sounds. In fact, they can sense the sounds of their mother from pregnancy, and at birth can already recognise, and prefer their mother’s voice. Importantly, hearing the mother’s voice activates brain areas that are important for language development. Furthermore, the caregivers voice and face provide the baby with security, comfort, and stimulation. These strengthen the mother-infant relationship and support the baby’s social-emotional and cognitive development. Given the importance of these early interactions, faces and voices are considered the baby’s best toy! New-borns can also recognise and prefer their mother’s smell. Furthermore, familiar smells, such as that of the mother or their breastmilk, can have a calming effect, and can even reduce pain in the new-born. During pregnancy babies also begin to learn about flavour by swallowing amniotic fluid, and at birth show preferences for sweet tastes like milk. Finally, new-borns are also extremely sensitive to touch, like the light pressure of a hand on their tummy, and this can help soothe and reduce distress and pain. As we have previously discussed, mother-infant skin-to-skin contact has positive effects on emotional and behavioural development and the mother-infant relationship. The new-born’s well-developed senses are just part of their amazing abilities. New-born’s behaviour also has an organised structured with a predictable pattern, so it is not just reflexive. Indeed, new-borns have six behavioural states (groups of behaviour with similar characteristics): three sleep states and three awake states (see picture below). These behavioural states can help us understand the baby’s behavioural cues and identify their needs. Photo 1 by Tamara Govedarovic on Unsplash; Photo 2 by Masood Aslami on Pexels; Photo 3 by Helena Lopes on Pexels; Photo 4 by Adele Morris on Pexels, Photo 5 and 6 by Antoni Shkrab on Pexels Understanding new-born language and behaviour: What is my baby saying? Dr Brazelton, a pioneer in Paediatrics, said, “A baby’s behaviour is his language… and you can trust that language”. Indeed, babies communicate and expect their caregivers to respond. Of course, all babies are unique, with their own characteristics and some babies’ cues might be more difficult to interpret than others. So, how can we better understand babies’ signals and what they are saying? Photo by Kelly Sikkema on Unsplash Firstly, spending time watching the baby and noticing their behavioural state helps us understand how best to respond to their needs in the moment. For example, the best time to talk and play with a baby is when they are in a quiet alert state. In this state their eyes will be open, and they will be calm and focused. Parents can use this opportunity to hold their baby face-to-face, talk in a gentle, "musical" voice, or make different facial expressions (e.g., smiling or sticking their tongue out). The parents’ "musical" and infant-modulated voice, also called "motherese", supports language development. It is important to give the baby time to respond. Indeed, if parents wait, they may notice how their baby joins in with cooing and gurgling sounds or even copies them (e.g., poking their tongue out). Parents can then respond by copying their baby’s facial expressions and sounds. This will keep them engaged and show them their parents are watching and listening to them. Babies will let us know when it’s time for a break. Interactions are hard work for babies and they may only manage a few minutes of face-to-face interactions! Signs such as looking away, fussing yawning, spitting-up, hiccupping, sneezing, and changes in skin colour (e.g., becoming more pale or red) can signal that things are getting too much. When this happens, it’s important to respect their need for a break. Parents can slow things down or stop what they are doing. Once babies have had a break, they might signal that they are ready to start interacting again. Parents’ faces and voices are often all they will need in the first few months, although babies will also enjoy looking at books, listening to stories and music, or hearing their parents’ sing. Photo on Freepik After the first few months, babies will start becoming interested in playing with objects. Therefore, it's important to provide infants with stimuli that are developmentally appropriate, which we will talk about in the next blog. As previously discussed, one of the main ways a baby can communicate with their caregivers is through crying. A baby might cry to let their caregivers know they’re hungry, tired, have a dirty nappy, are too hot, or that things are too much. Sometimes babies will be able to self-regulate, and so may suck on their hands, focus on something, or touch their ears or hair to help soothe themselves. However, this does not mean that we should leave a baby crying, as most of the time they will need our help to settle. When you respond to a baby crying, you are saying that you are there for them and they can rely on you to feel safe and secure. In this way, you can create the basis for a trusting relationship. Therefore, when your baby is crying, ask yourself: what are they trying to say? What might they need? You can think of the list of needs they may be expressing: Hunger? Tiredness? Do they need comfort? Are things too much for them? And so on. You can then try your best to comfort the baby and satisfy their need. If you think the baby does not need to be fed or changed, there are various steps you can take to try to soothe the baby (see picture below). Photo by Craig Adderley on Pexels Much of what we discussed above is based on the work of Dr. Brazelton, who developed the Neonatal Behavioral Assessment Scale (NBAS), the most comprehensive assessment of new-born behaviour available. The Newborn Behavioural Observations (NBO), a relationship building tool, was subsequently developed by Prof. Nugent and colleagues from the Brazelton Institute. Both tools are designed to support parents in "getting to know" their baby, understanding baby behaviour and promoting healthy parent-infant relationships. Why is all this important? In conclusion, understanding infant language and behaviour is crucial, as this is the first step for parents in providing a sensitive response to the baby. For babies, the experience of being understood helps them develop trust in the people around them and in themselves. It is also the start of them gradually making sense of their emotions and, later, those of others. We need to always think of the adult that this baby will become, because, as previously said, the early experiences set the stage for their future development.

Angst, love, heartbreak, and serious growing pains: whether they were over yesterday or decades ago, chances are you remember your teenage years vividly. I am Livia, and I remember often being overwhelmed by powerful emotions, swinging like a pendulum from one to another, and confused as to why, exactly. Though memorable, the teenage experience often evokes lots of mystery. Whilst the concept of the tricky transitional space between childhood and adulthood has been around for thousands of years, knowledge of brain development was long speculative. Experts reasoned human brains had to be completed in childhood and adolescent dispositions were consequently blamed on culture, and teenagers stereotyped as moody, self-centred, and sensation seeking creatures that were hard to understand. But once Magnetic Resonance Imaging (MRI) — where living organs can be observed through magnetic cameras — was invented, a fresh, neuroscientific story about the teenager emerged, changing the way we see the teenage brain and the lived experience it creates. A race car engine with bicycle brakes Contrary to what was previously believed, the new MRI studies demonstrate that the teenage years are an enormously eventful phase: though teenagers’ brains do not grow larger, the way that the brains of young children do, they do undergo complex structural changes. In early childhood, a fatty substance called myelin, or white matter, starts to spread across the brain and cover axons, which are wires that help connect neurons. Neurons are nerve cells that send messages through the brain and body, granting us the ability to function. As myelin slowly expands, the various brain regions are able to transmit messages between each other faster, creating an overall better-connected system. Myelination, as the process is called, begins at the back of our brain, wrapping up at the front, by the frontal lobes, when we reach our mid-to-late twenties. According to Dr Frances E Jensen, the fact that the frontal lobes, where the prefrontal cortex happens to be located, become the last to be myelinated is key to demystifying the teenage experience. The prefrontal cortex is believed to play a part in executive function, a group of cognitive skills that include, for example, the capacity to control what we say, regulate what we feel, and, interestingly, to evaluate the outcomes to things we are about to do. As this handy brain region waits to be myelinated and become as powerful as it can be, however, other parts, such as the limbic system, widely thought to be important for emotion and motivation, for example, have already matured. Teenagers, specifically, happen to be in the midst of the slow myelination process, and the discrepancy between regions that have not matured to the same level likely explains why their machinery resembles a race car with bicycle brakes: as teenagers experience emotions, they have yet to gain enough cognitive control to steer calmly through the storm. Vulnerability and Opportunity With myelination under way, teenagers find themselves in a period of greater neuroplasticity, meaning that the brain changes more in response to new experiences. On the downside, the greater sensitivity of a more malleable brain makes teenagers extra vulnerable to stressors and mental health problems. Negative emotions can be challenging without matured frontal lobes to help regulate them. In some cases, they may be exacerbated by other challenges faced by modern teenagers: a small research study suggested that teenagers’ brains may have matured sooner due to Covid-related stress, whilst a World Health Organisation report showed adolescents reported more mental health concerns during the Covid-19 lockdowns, for example. Importantly, however, the report also found that teenagers were generally resilient when supported by teachers, family, and peers. The same neuroplasticity also gives many reasons why the turbulent teenage phase is a once-in-a-lifetime period of opportunity. The brain retains information more effectively as it matures, meaning that teenagers are allowed temporary mental perks, such as better memory and faster learning. Parallel to myelination, the teenage brain sheds connections it no longer sees necessary, a process called specialisation: whereas children are keen to learn about everything, teenagers’ brains prune away neural connections they no longer use. Altogether, these processes make the teenage years an excellent time to shape your own identity. A Product of Evolution Every brain is a product of evolution, developed to help us survive, and every neurodevelopmental phase, the teenage years included, plays a critical role. By encouraging teenagers to explore through risk-taking, the teenage brain prepares them to become grown people. Increasingly more independent, they adapt to the dynamic, uncertain time and place waiting for them — namely, the world as experienced by adults. Many risky moves, such as declaring your love for a crush or chasing adrenaline rushes, are more often than not neurodevelopmentally healthy, as they usually reflect teenagers searching for new experience and change. Even when they do not go as planned, the bravery behind these endeavours leads to knowledge about our world — and who we can be in it. Seen from that perspective, even an underdeveloped prefrontal cortex that promotes healthy risk-taking has a function. In fact, researchers have recently argued that both neuroscientific research and societal views have been influenced by stereotypes, and that there generally is more good than bad to teenagers’ dispositions. Now, experts focus on separating behaviours that are part and parcel of a normal teenage experience from any that could be connected to future mental health problems. The Time of the Teenager? Neuroscientific things considered, it may well be an exciting time to be a teenager. As the research develops and keeps changing the old story about teenagers, society can help teenagers cope with challenges and make the most of this significant period of opportunity. If they are supported, teenagers are perfectly placed to develop awareness, self-care tools, and healthy coping mechanisms they can rely on for lifelong mental wellbeing. Simply learning about the teenage brain might go a long way, too; despite our many challenges, today’s teenagers are part of a lucky generation to have modern neuroscience that keeps on demystifying how brains work. I know I would have been grateful to have science reassure me when emotions overwhelmed my teenage self. The teenage phase is thankfully temporary, but what happens then can resonate for years to come. If you had a particularly challenging time as a teenager, however, don’t fret. Thanks to the lifelong neuroplasticity of our brains, it is never too late to start mending lasting childhood wounds. Regardless how old you are, being understood — both by yourself and others — makes a world of difference.

People open up to me. They feel comfortable sharing some of their deepest secrets. This awareness has been with me for a while. It happened on many occasions at a party or gathering that someone I did not know would sit down and tell me their life story within a few minutes. A stranger once told me she saw her father shooting her mother when she was 8 years old. I somehow knew how to listen and hold space for such heavy truths. As a yoga teacher, you quickly realise that people trust you and find it safe to share what is going on in their lives. Since I trained as a yoga teacher, I knew I had to gather more training to hold this space better. Students often expect a teacher to have counselling skills not covered in basic teacher training. However, things changed when I met Mark Stephens, who introduced me to yoga therapy — his influence and my private clients inspired me to embark on this training journey. After undertaking the 2-year yoga therapy diploma, I felt I could counsel my clients. The Wounded Healer Often the best healers are the ones that have suffered the most — the myth of the wondered healer. To be a good yoga therapist, you need to do your work. You need to dig. The more you unravel, the more you can hold space. Even if you do not advertise it, you will get clients with similar experiences, questions and troubles. In yogic traditions, we do not find the wounded healer concept. Indeed, yoga was a practice of solitude, self-contemplation and hardship (tapas). Traditionally, yogis were not going about healing people. They were more busy working on transcending the cycle of life and death. Yet, if you speak to yoga teachers or yoga therapists, you quickly realise that yoga has been healing for them. It helped them overcome suffering, challenges, and find purpose. What is yoga therapy? Yoga Therapy is a contemporary evolution of yoga, grounded in research and informed by ayurveda, biomechanics, somatics, counselling, psychology, physiotherapy, neuroscience, anatomy, physiology, pathology and holistic medicine. Yoga means to yoke, to unite. Indeed, yoga therapy combines disciplines from the West and the East to provide a holistic complementary modality. Yoga therapy looks at the client as a whole. It analyses what are the underlying needs behind symptoms and diagnosis. It assesses the client’s body, breath, attitudes, habits, tendencies, likes, aversions, thought patterns, and emotions, and guides clients to become aware of their symptoms' roots. It is a client-centric therapy modality, where the therapist is an attentive and non-judgmental guide rather than the solution. It fosters clients’ independence and agency: they are empowered to be the masters of their healing, promoting self-care, functional breathing and movement, and behavioural change. Goal-driven and subjectively measurable allows for accountability and enables the client to track progress. The yoga therapy approach is based on multiple models. Models are like maps. They are a representation of reality, not reality itself. They help us navigate the world and identify relevance. These models include the gunas, doshas, vayus, koshas, and chakras. These models have roots in the Upanishads (late Vedic texts that form the basis of Hinduism, even though yoga is not religion-based). These models have been reinterpreted and transformed through the centuries. For example, the koshas' symbolism and practical application are contemporary. The Koshas represent the five elements or layers of our being. The physical, the energetic or breath, the mind and emotions, our wisdom and ability to be in bliss. The chakras mentioned in most 20th-century literature are an evolution of Carl Jung’s interpretation and Satyananada Saraswati (founder of the Bihar School of Yoga) expansion in the 1960s. The yoga therapy models help the yoga therapist to analyse their client’s presentation, fragilities, and strengths and pinpoint emotional blocks and breath restrictions. With this information, a therapy plan and home practice are crafted, answering clients' priorities and goals. Is yoga therapy rooted in contemporary research methods? You bet it is! Modern yoga therapy is intertwined with clinical research. It finds its roots in the 1920s in India with Shri Yogendra, Swami Kuvalayanada and Tirumalai Krishnamacharya as the grandfathers of yoga therapy. Shri Yogendra and Swami Kuvalayanada founded India's first two yoga research centres to investigate yoga’s neurophysiology, and Krishnamacharya was one of the first to offer individualised yoga therapy. In his youth, Krishnamacharya promoted a rather acrobatic form of yoga and is likely the founder of modern postural yoga (what we think of when we think of a yoga class). Later he started working individually with people with various diseases. His son TKV Desikechar continued his work and founded viniyoga, a form of dynamic yoga (hello vinyasa yoga group classes!), marrying movement with breath. One of his students, Gary Kraftsow, took this further and started scoping yoga therapy. As yoga reached the West in the 1960s, some practitioners happened to be healthcare providers. Some witnessed the benefits of the practices on themselves and then applied them to their patients. One of the earliest examples is Dr Dean Ornish. In his 1998 work, "Intensive Lifestyle Changes for the Reversal of Coronary Heart Disease", he suggests yoga, diet, and stress reduction techniques to improve cardiovascular disease outcomes. His work, together with other doctors, set the foundations for yoga therapy in the West. What happens at a yoga therapy session? Ahead of the first session, which lasts 90 minutes, the yoga therapist sends a health form and asks for priorities and reasons to seek yoga therapy. The session starts with discussing the health questionnaire and establishing goals and priorities. The interview is followed by a postural, breathing, and movement assessment, moving into a guided restorative experience. The yoga therapist uses the yogic models to identify imbalances and the client’s underlying needs, such as being heard or feeling safe. These often match with symptoms and tendencies. These insights will be woven into a home practice, co-created with the client at the end of the session. Home practices range between 1 and 20 minutes to ensure manageability. The home practice is discussed, reviewed, and modified according to the client’s needs at follow-up sessions. The yoga therapist actively listens to the client and provides motivational interviewing. Yoga therapy is not a panacea. Yet, if used in conjunction with medical care, it can give patients a space to be heard, to work with emotions via movement and breathing, to improve awareness and support them towards healthier and fuller lives. The best way to understand yoga therapy is to experience it. Find below a 15-minute guided emotional enquiry. Play with it. If you have any questions, feel free to get in touch.

Trigger warning: This article makes reference to sexual violence against women. Whilst we talk about abuse to women, our support extends to all victims. Although, like most women, I am no stranger to casual sexual harassment, the impact of catcalling on women’s freedom of movement became startingly clear to me when, after an 8-year hiatus, I re-started my running journey in November of 2022. Catcalling, or street harassment, a form of sexual harassment, can vary from making kissing noises, whistling, making sexist and/or degrading comments or beeping a car horn at someone. Whilst anyone can be a victim of catcalling, it is something that nearly all women report having experienced. Indeed, a 2021 UN Women survey found that 97% of women aged 18-24 years old had experienced sexual harassment and 70% had experienced harassment in a public space. Upon rediscovering running in November, I quickly became obsessed with the "runners high", feeling empowered and healthy. But, at the beginning of May this year I went out for a run, for the first time, in shorts. I was quickly reminded of the reality of being a woman in a public space, daring to show their limbs. I was catcalled whilst waiting at a traffic light by a man who incessantly beeped his horn and sneered, craning his neck to stick his head out of the window, shouting something unintelligible but no doubt disrespectful. I felt trapped, unable to get away from him whilst waiting for the light to change. Then, after he drove off, I was left frustrated that I couldn’t defend myself against my harasser. Mortified, I was suddenly acutely aware of my body and what I was wearing. I had gone out for a quick run before a PhD funding interview to calm my mind. Instead, I had been left angry, upset, and ashamed. But of course, as all women have had to learn, I shook it off, finished my run and attended my interview. Later that day, post-interview, whilst out for a walk to get some fresh air and headspace, I was catcalled a further 2 times by separate men driving past me. The cowardice of this ‘drive by’ harassment, which ensures they will not be apprehended or confronted, infuriated me. The next morning, I went out for another run, this time in leggings (I had learnt my lesson) but once again I was catcalled by two men in a car. I was so startled and upset at yet more harassment, in such a short space of time, that I tried to cross the road and nearly stepped out into oncoming traffic. Being catcalled whilst running is a common phenomenon, 60% of women report experiencing harassment when running. Although catcalling is not experienced exclusively in warmer months, the intensity and frequency of this sexual harassment at the beginning of spring is unbearable. As women opt for less clothes to remain comfortable in the heat, it feels as though there is a sense of entitlement to objectify and comment on their bodies. The internal battle of not wanting to be influenced by the behaviour of these perpetrators whilst being aware that you need to keep yourself safe is exhausting. However, at age 25, like many women, this is not my first experience of sexual harassment. At school, our teachers ensured we wore leggings under out sports skirts when walking home. Whilst this was a precautionary and protective method, it taught me, from age 11, to expect my body to be objectified and degraded by strangers whilst going about my day. Sadly, they were right, as my first memory of an adult stranger catcalling me extends back to when I was a pre-teen. It is now September, and the novelty of seeing women’s limbs seems to have somewhat abated and the catcalling and sexual harassment, in my experience, has lessened (of course not entirely). Yet, I have run only 10 times since the start of May. What had become my daily escape became anxiety inducing. I didn’t feel comfortable running in shorts and so, rather than overheat, I opted for other forms of exercise, away from public spaces. By necessity, women like me have had to learn to ignore street harassment and get on with our days. But the injustice and upset caused by such experiences should not be underestimated. In fact, catcalling can signify greater danger, tragically demonstrated by the rape and murder of 19-year-old Ruth George in 2019 in Chicago, by the man whose catcalls she had ignored. Indeed, part of the sinister nature of catcalling is that its victims can’t distinguish acts of attention seeking or bravado from more threatening behaviours indicative of violent intentions. Thus, those trying to "flatter" their victims inadvertently "mask" those who have violent intentions. At best, women can hope to leave such encounters belittled, dehumanised, and angry. At worst, they can end up dead. Following the horrific murder of Sara Everard in 2022, there is a renewed focus on women’s safety in the UK. The Government has backed a bill to make catcalling an official crime punishable by 2 years in jail. Furthermore, the murder of Zara Aleena in Redbridge by a stranger who followed her, has led to the introduction of new roving police squads to target men catcalling women. Similar squads are likely to be rolled out across other boroughs of London. It is a relief to see criminal action being taken against catcalling alongside Government campaigns. I am often horrified by my mother’s stories of workplace harassment in the 80s, including quitting her job after being told she would be "frisked" by her male colleagues after having passed her probation period. I feel fortunate to live in a time where positive action is being taken to change the culture around treatment of women. Promisingly, in 2020, the government introduced a compulsory relationship, sex, and health education (RSHE) curriculum for primary and secondary schools which covers sexual harassment and sexual violence. It is essential that young boys are made aware that catcalling will not get them positive attention from women and girls. Furthermore, they need to understand that silence is compliance and that if they opt for inaction, women feel alone in their struggle and the perpetrators remain unchallenged. Men are essential to tackling violence against women and it is their responsibility to help alleviate the weight of harassment from women’s shoulders. The vast majority of men do not objectify and offend women. But often they feel unsure how to stand up for women. Indeed, it is difficult and uncomfortable to be the one person to stand up in a meeting or a social setting when a colleague says something inappropriate about or to a woman. One perfect example of a man enacting positive change and empowering his male peers to tackle sexual harassment is Richie ‘Reseda’ Edmond-Vargas. Whilst incarcerated for armed robery in a Californian prison, Edmund-Vargas developed a curriculum on patriarchy and toxic masculinity, which he delivered to his inmates, introducing them to intersectional feminism. Now out of prison, Edmond-Vargas runs a non-profit organisation called Success Stories which delivers the curriculum to state prisons. I am hopeful that by having these conversations in workplaces and starting education early in schools, alongside changes in policy and laws, young boys and men will be better educated and will know how to stand up against catcalling and sexual violence, feel able to call out their friends and actively contribute to shifting the previous cultural acceptance of harassment against women. In the meantime, should you see someone facing catcalling, the "Enough" campaign suggests four simple ways to step in safely: Say something. Tell someone. Offer support. Provide a diversion. Together, we can relieve the burden of sexual harassment that weighs heavy on women and work towards the end to sexual violence against women and girls.

Thinking errors, also known as cognitive distortions, are thoughts and beliefs that are biased, irrational, and unhelpful. This is why they are called errors, as they give us an inaccurate view of ourselves, the situation we are in, or the world around us. Persistently engaging in thinking errors can cause or exacerbate our anxiety. By listening to and believing our irrational thoughts, we may end up changing our behaviour in a way that allows our anxiety to persist and convince ourselves that our thinking errors are right. This is a vicious cycle, and it might help to know some of the most common thinking errors so that you can spot them. Black-and-White Thinking Black-and-white thinking is a common thinking error in which we think only in extremes — there are no grey areas. When we engage in black-and-white thinking, we tend to focus only on the absolute negatives of a situation and disregard any of the positives. Imagine that you are a student and you have just received results back from an exam. You passed the exam, but you scored slightly lower than you expected. If you engage in black-and-white thinking, you may be telling yourself "I’m a complete failure! I can’t believe I did so poorly on this exam. I should just give up". Engaging in black-and-white thinking on a regular basis can harm our self-esteem, our relationship with others, and our mental well-being. When you find yourself stuck in black-and-white thinking, challenge the thoughts. Ask yourself if there are other explanations or a more positive way to view it. For example, with the exam, you could instead think, "I still passed the exam, but I didn’t get the score I wanted. However, I still did well considering all the stress I’ve been under lately. I will study hard for the next one, and I won’t give up.’ Catastrophising When we catastrophise, we expect that the worst-case scenario is going to happen. We focus only on the most negative possible outcome and magnify the likelihood that it will come true. An example of catastrophising could be: "I am going to mess up my presentation at the big meeting, and then I’m going to get fired. This is going to ruin my life". In the example, the thinker leaves no room for any positive outcome and typically places unrealistic weight on a single negative outcome. They simply tell themselves that the worst-case scenario will happen. This increases their anxiety and makes them more nervous about their big meeting. To reduce catastrophising, we must recognise when we are doing it, and then practice more positive thinking. A much healthier and balanced outlook would be: "This is an important meeting, but I’ve prepared so well for it. Even if I mess it up, my colleagues will understand. Anxiety in meetings is very common". In cognitive behavioural therapy (CBT), you can combine evidence from exposure therapy to reframe your thoughts. You might start by attending smaller, less stressful meetings and noting down how you feel at the start and end of the meeting, and slowly build up to attending all meetings that give you anxiety. After each successful exposure, write down how you felt afterwards until you retrain your brain to understand that the situation is not a threat. Then, you use this evidence to invalidate the thinking error; "I used to avoid all big meetings, but the past few that I have done have gone well and the evidence suggests I won’t freak out". Mind-reading Mind-reading is another common thinking error where we assume we know what other people are thinking. This can manifest in many different situations but can be particularly stressful for people with social anxiety, agoraphobia, or health anxiety. For example, "Everyone here thinks I’m weird!" or "If I have a panic attack on this bus, everyone is going to laugh at me and think I’m crazy". It is important to remember that we cannot mind-read what others are thinking. A helpful way to reframe mind-reading thinking errors is to imagine what you would do if the situation was reversed. If you were having dinner with some new friends and one of them was nervous, would you think they were weird, or would you assume that they were just shy? If you see someone panicking on the bus, are you going to laugh at them, or are you going to feel empathetic towards them? Overgeneralisation Overgeneralisation thinking errors are when we take one incident and claim it happens all the time. For example, "I had a panic attack once on this plane, so I’ll always panic on planes! I’ll never be able to travel again". This way of thinking can convince us that our anxiety or depression is far more prevalent in our lives than it really is, and so can be very detrimental to well-being and daily life. When challenging overgeneralisation thinking errors, you should first look at the evidence. Do you always panic on planes, or was it just one isolated incident due to additional stress? Are you using words such as "never" or "always" to describe an incident that has only happened a handful of times? The above is not an exhaustive list and there are many other types of thinking errors that can occur. Thinking errors can keep us anxious or depressed or feeling stuck if we do not identify them and challenge them. A core focus of CBT is to challenge and reframe thinking errors. One way to do this is to keep a journal of how you perceive a situation that frightens you, and then write down how you perceive the situation after you have done it. So, let’s say you have a presentation to deliver at a big meeting and you’re feeling nervous. In the morning you write in your journal, "I am going to mess this up. I always do". You then go to work, attend the meeting, and give the presentation, despite the fact you’re very nervous. When you get home you write in your journal again: "Even though I was still nervous, I didn’t mess up the presentation. I hesitated a few times, but overall, it went well. I feel good!". This helps us challenge our thoughts the next time, as we have evidence that our thinking errors aren’t factual, and eventually, we stop believing them. When you notice a thinking error, challenge it. Remind yourself that your mind is not always telling you the truth and that we can make errors in our judgement of a situation or feeling. Note it down, find evidence to disprove it, and reframe it into a positive thought.

I don’t think of home the way most people do. Born in Brazil to American members of a new religious movement/cult, I moved frequently. "Homes" were the many communes in which our group’s members lived. A week after my nineteenth birthday, I left the group and country I’d spent my whole life in and flew to the United States — my parents’ home country, but one I knew only from movies. Fourteen years later, "home" still doesn’t conjure an image of any one place. Where is home, I wonder, and do people like me ever feel like they have one? Moving “Home” “Third Culture Kids” (TCKs), usually defined as people who grow up abroad because of their parents’ career choices, often feel they have no home. They adapt well to new environments, appearing to fit in yet only really feeling a sense of belonging among others who also grew up across cultures. When I crossed the U.S. border at nineteen, the customs official’s cheery "Welcome home!" as he stamped my American passport was the first of many startling incongruities. I quickly learned no one suspected I was from somewhere else. My English was unaccented, my blonde hair and white skin led many to tell me I "looked Midwestern." But I didn’t want to “look Midwestern”. I didn’t understand U.S. social norms, didn’t dress in the right ways, know the proper small talk, or move through space in the way everyone else did. I found ways to mention I was from Brazil, to avoid others thinking I was stupid. But you’re American Once in college, I discovered I didn’t like the foods my peers did, and didn’t know the movies or references they grew up with. I’d laugh along as though I knew what they were talking about for a while, then disappear into my phone, messaging friends back in Brazil. Early research notes that TCKs often feel like immigrants. I often wished I could call myself a foreigner, but I’d held U.S. citizenship since birth. Except for my occasional odd grammatical constructions and mispronunciations, I spoke perfect English. I knew I was lucky not to face the bureaucratic, xenophobic, and linguistic barriers actual immigrants confront, yet I envied their sense of identity and their easy categorisation. My classmates never seemed bothered when international students discussed their home countries, yet expected me to simply be American. But I didn’t know how to be American or understand their social world. My stories had all happened somewhere else and after a few too many "in Brazil…" tales, a classmate started calling me "Brazilian hipster". Not a Happy Homecoming TCKs often feel more positively towards the culture(s) where they grow up than their parent's home culture. My parents were encouraged to "become one" with their mission place, adopting its food, language, and customs, so though I was home-schooled in English and we often spoke it in our communes, we didn’t do much else that was strictly American. While the Fourth of July was just a date to me and Thanksgiving a description in textbooks, I have fond memories of wearing flouncy dresses with pen-marked freckles on my cheeks to winter São João parties (held, of course, in June wintertime). Researchers have found that feelings of disconnection, grief, and loss are common among TCKs who repatriate for college, along with feelings of frustration, and, most prominently, anger and depression. How Third-Culture People Perceive Home Whenever I’m asked where home is, I feel a wave of discomfort. For others, home evokes a specific place with streets full of childhood scenes. A city with a house where they gather for holidays, the corner of the world where they feel most completely themselves. I have no place like that. Many TCKs feel a constant state of restlessness as adults, life on the move is their only familiar "home". Some develop a serene acceptance of their outsider status as a unique insider. Amy, a TCK I interviewed while writing this article, was an adolescent when she reframed a growing sense of "I belong nowhere" to "I can belong everywhere". Her take reminded me of an image I made soon after arriving in the U.S., on a green and yellow world map I overlaid in script, "Always remember: if you can’t succeed here, there’s the whole rest of the world to try your luck on". I spent my first decade in the U.S. desperate to leave the rural towns where scholarships led me and make my life in a place that better resembled the bustling urban landscapes where I grew up. I thought maybe that would make me feel at home. Today, I’m a writer and researcher with a PhD in cognitive psychology, living near D.C. in a neighbourhood that epitomises the adult life I imagined. And yet I don’t see the U.S. as home. It doesn’t awaken my early memories, doesn’t give me the sense of ownership, belonging, comfort, expert knowledge, and fluid, self-assured movement that I associate with the idea of home. What I Have, in Place of Home Sometimes I wish I had a single place that would elicit all the feelings home conveys. One place I could point to and claim. More and more, though, I feel that adopting one place would require a renunciation of everywhere else that’s important to me. The impulse to resist the adoption of a single place, to see it as betrayal, isn’t just in me. Although TCKs are often characterised in terms of their global citizenry and adaptive flexibility, they are also described as unable to commit. I see this in myself, in my unwillingness to embrace one place, and let it be home. In talking with Amy, I found she doesn’t think of home as the street-you-know-everyone, where-all-your-memories-are way I feel people often want from me. She told me, "Today, I think of home in a less literal way of just where I can be fully myself, and there are very few people and places and it’s mostly by myself". She shows others the true aspects of herself, just not everything, not all at once. "We are rarely fully ourselves with anybody and that’s just part of life and everybody lives a version of that, but some of us more than others". Since arriving in the U.S., the people to whom I feel closest are those who can be defined as cross-cultural: international students, Americans who grew up as racial minorities or traversing cultural and class boundaries, children of first-generation immigrants — people who heard another language at home and who can’t find their favourite childhood foods in regular grocery stores. I find we share a similar sense of both belonging to multiple places and cultures and not fully belonging to any. I may not have one place that is home, but a beach, anywhere in the world, gives me a sense of comfort and belonging. So does curling under a blanket with a book, dancing with friends, and running through a city park. Every morning in my U.S. apartment, I bake homemade pão de queijo. The warm, distinctive smell, the crunch of crust and the chewy, steaming center, every day, feels like home.

The evolutionary function of loneliness is believed to be a signal from the brain to change lifestyle and increase social connections, similar to how hunger and thirst tell us to eat and drink. But, when chronic, loneliness can seriously impact our health and wellbeing. As a society, we have become increasingly isolated. We live alone or in small family units, and many of us work remotely and alone, limiting socialising to the weekends. We don't know our neighbours. We remain silent on public transport. At the shops, we use the self-checkout. Children no longer play in the streets, and many don’t have access to parks. We are social animals that thrive on connection with others and sharing a mutual purpose. But opportunities for social connection are being eaten away, and the ones that remain are often unaffordable or inaccessible. Loneliness has become widespread across all ages and genders. According to YouGov, 1 in 10 adults in the UK don’t have close friends, 1 in 10 have no friends at all, and 14% of 10 to 12-year-olds report "often" feeling lonely. The Department for Culture, Media & Sport commissioned a Loneliness Monetisation Report in 2020, which estimated the wellbeing cost of severe loneliness to be roughly £9,537 per person per year. Now, more than ever, we desperately need community spaces, yet many (limited as they were) are being eroded, with more than 4,000 publicly owned spaces sold off per year. I myself have felt this impact. I came out of covid feeling more lonely than during the lockdowns — at least there had been a reason for the isolation then. I’d moved to a new town (and country), was living alone, and working remotely. I met people at the pub but found that only seeing them at parties or out drinking felt superficial. I was in desperate need of a real sense of community, belonging and connection, but had little opportunity to find it. Many towns, villages, and cities now have almost no accessible or affordable community spaces for people to come together with a shared purpose and to get the connection and meaning they desperately need. Historically, churches provided community space, they allowed for intergenerational interactions and brought people together with a shared purpose. But now that many people aren't religious, there's no alternative being provided. In rural areas and small towns, there are almost no communal facilities, and although cities have more opportunities to join classes, events, and other social activities, they are often inaccessible due to the cost. For many people, the only place they have to congregate are pubs, and while catching up with a friend over a pint can be wonderful, we need alternatives that aren’t centred around alcohol, if we want meaningful connection. Funding for parks is also down £330m a year since 2010 and nowadays many children don’t have parks within walking distance from their homes. Roads have become too dangerous to play on, limiting locations outside of school for connection and play. We hear complaints that children aren’t spending enough time outdoors and that their screen time is too high. But with limited space to socialise, it is unsurprising they are moving online to seek much-needed connection. Those wishing to reduce their loneliness struggle to find new ways of connecting with other like-minded people. Affordable opportunities are required to facilitate the development of connection and a shared sense of purpose. It is fantastic to see the UK government working to resolve these issues with their Tackling Loneliness Annual Report. There is hope in social prescribing — one of the methods the government is implementing as a result of the report — in which health professionals refer patients to a range of local, non-clinical services to support their health and wellbeing. But without the spaces to enact this transformative method, implementing it effectively across varied communities will be difficult. Undoubtedly, there is a desperate need for new community spaces, but with housing crises and limited funds, where do we find the space to house community events and projects? Libraries, for the most part, have become outdated, with many closing, or going largely unused — a shameful waste of resources in the face of homelessness and loneliness. But by turning libraries into community centres with co-working spaces and cafes, making them inviting places to visit, like those seen in Scandinavia, we can keep them alive, while also providing a warm and enjoyable place for people to form meaningful connections. Community gardens and allotments are another way of bringing people together with a shared purpose. The joy of growing something from seed and being surrounded by nature can have a profound impact on wellbeing, giving a sense of achievement, and boosting self-confidence. By enhancing this with the powerful effect of a sense of community, green social prescribing has a promising future in providing much-needed relief from loneliness. I dream of community centres with gardens and co-working spaces, free (or at least affordable) art, dance, and music classes — spaces where people are encouraged to move joyfully, express themselves creatively, and learn new skills — all while being surrounded by a vibrant community of people from all walks of life, ages, genders, and identities. Our goal should be to revive community, to put it at the forefront of all we do and in doing so, bring people together and end the burden of loneliness.

Last July, I had a panic attack at Boston Logan International Airport. I was flying home to Manchester after a month in New Hampshire, and I'd just found out that my connecting flight out of Iceland was delayed by ten hours. I want you to picture the scene here: there were people in Winnie-the-Pooh pyjamas, people who had been drinking vodka since 9 am, and others sleeping on beach towels on the floor, but it was me, crying at the gate, that attracted looks of utmost alarm. We aren't used to public displays of vulnerability. There seems to be an unwritten rule that negative emotions should be confined to private spaces, and even positive emotions must be moderated in public ones. The only thing you can express in all its glory is apathy. Anything else is indecent. But as with any societal norm, there are some people that disregard these ideas, like the kind stranger who, only a few hours after a hundred people at the airport gate had looked at me like I had two heads, took my hand during takeoff because she could see I was nervous. I'm openly vulnerable in every area of my life. I don't hide the fact that I'm mentally ill (anymore) from the people I spend the most time with. Everyone in my closest circle knows I have severe anxiety and depression, and I know that when they ask me, "How are you?", I don't have to give a sanitised, socially acceptable answer. I can ask for support when I need it. More importantly, I can say "no" to things without feeling guilty or having to come up with an excuse. A few months ago, I had a debilitating flare-up with my mental health, and I had to take time off. I was honest with the people I was working with at the time, not because I felt "ready" to open up, but because I was too unwell to think of a lie. I can't put into words how much this has improved my work and relationships. I'm a journalist, and I mostly write people's real-life stories. I talk to women who have had unimaginable things happen to them, and I feel I have an obligation to create a safe space for them to share their stories. I can't do that if I: one, can't relate to how they feel in their vulnerability, and, two, remain cold and detached. I also feel I have an obligation to the publications I write for and the editors I work with. That means delivering projects to a high standard and on time. However, the way that I work is not the way a lot of other people work. I don't often work to tight deadlines, nor do I often work entirely independently; I will ask editors for advice, direction, and, in some cases, reassurance. Finally, and perhaps most importantly, I have an obligation to myself to keep myself healthy. I spend the majority of my time working, so I can't afford to take liberties and stretch myself too thin. These three obligations are all connected, and I fulfil them all through vulnerability. If I'm not feeling well, I tell the people I'm working with so they're not anxiously awaiting my email. If I'm worried or unsure about something, I tell my editor. This reduces conflict. I don't mean with the people I work with; almost all of them have been wonderful, patient, and understanding. It reduces conflict within myself. I don't have to pretend to be okay when I'm not. I don't have to have a facade of coolness. I get to be wholly myself. When I first adopted this approach, I thought I would be working less. I thought that by permitting myself to say, "No, I can't do that. I'm not well enough," I would lose out on commissions. The opposite has been true. Knowing that I don't have to hide anything allows me to show up more often and be more present when I do. My work is better; I'm more creative, both in my ideas and my delivery, and I don't get burnt out from the exhaustion that comes with hiding a mental illness. Furthermore, you'd be surprised by how open people become when you're open with them — when you show people that you're willing to let them see and know you. They may find the confidence to say, "Thank you for being honest about your anxiety. I'm also anxious right now, and it would help me if we could..." Suddenly, working together no longer feels like a battle where you're each waiting for the other to do something unintentionally hurtful, harmful, or stress-inducing. I'm not saying that I no longer have any work-related stress. I do. But now I have a community that can support me through that. And I get to be that person for other people. Humans are not meant to be solitary. We are meant to collaborate. It's how we find joy, and it's how we stay sane. So, don't be like the people at the gate. Be like the people on the plane: be willing to take someone's hand, and be willing to let them take yours.

Content warning: This article contains discussions on addtiction and substance abuse. I have been writing history-based articles for Inspire the Mind for some time now, and up until this point I have been working primarily with easy-to-access source materials. No roadblocks have sprung up to impair my ability to produce the most concretely accurate pieces of research that I can produce. I have written with confidence about Hapsburg princesses, medieval kings, royal doctors, famous heiresses, and horror fiction authors. This time, however, is a different story. This time, it is a story. A fictional one, with an unknown author whose identity remains one of the most mind-racking mysteries in the history of Russian literature. He, or even perhaps she, disguises themselves behind a pen name but still manages to write one of the most harrowing, most disturbingly intimate portrayals of substance addiction that I have ever read. My challenge presents itself in the form of M. Ageyev’s Novel with Cocaine. As long as writers continue to turn to drugs, they’re going to write about it. A writer and their addiction are inseparable entities, entwined in a bitter working partnership. When Thomas de Quincey published his ground-shaking Confessions of an English Opium Eater in 1821, he started a pivotal "chicken and egg" conversation. What comes first for the writer: their addiction, or the idea for a book about addiction? Should the author, starting off strong and healthy, plunge themselves headfirst into their own form of research — think Jean-Paul Sartre and his mescaline (a hallucinogenic drug) episode, the backstory behind his Nausea and other works that explore drug-induced hallucinations — or should they only write the book after the addiction has already ravaged their bodies and minds, like with Dorothy Parker when she penned her brutally realistic short story about alcoholism, “Big Blonde?” M. Ageyev’s 1934 Novel with Cocaine continues this discussion with a new angle. How does the book’s meaning change when the author, remaining anonymous, doesn’t reveal anything about their own self-sabotage? With the author determinedly camouflaged, how much of this book is trustworthy and real, and how much is imagined? Does it take a confirmed addict to write about addiction, or are we willing to take this cloaked individual’s word for it? There is an intriguing ongoing theory that the secret author is Vladimir Nabokov, the mind behind the controversial 1995 novel Lolita, but Nabokov vehemently denied this in his lifetime. His son, too, deflected the accusation in the afterword of his English translation of his father’s novel The Enchanter, maintaining that the true culprit was the lesser-known literary figure, Mark Levi. Nevertheless, there remains the question of how effective a novel about teen addiction Novel with Cocaine really is. The novel follows the first-person narration of the protagonist Vadim, a moody, cynical, spoiled, and insecure adolescent living in the equally insecure post-Revolution era in Russia, which contributes to the novel's tense and bleak atmosphere. Vadim fancies himself a great intellectual but accomplishes nothing worthwhile with his supposed intellect and psychoanalytical prowess. He is Holden Caulfield before Holden Caulfield existed; one can even go as far as to identify Vadim as Holden’s spiritual ancestor. The beginning of the novel presents Vadim as a deeply flawed but, on occasion, endearingly relatable and redeemable young man. He is rude and demanding to his struggling single mother and his nanny, he has casual sexual encounters with women he picks up off the street, and he doesn’t take his rapidly approaching future too seriously. Later on in the story, he attempts to comfort a despairing classmate and intervene on their behalf when the classmate is threatened with the damning prospect of school expulsion. Vadim, pre-addiction, is fully capable of caring. But then the cocaine dependence sets in, and the last lingering traces of Vadim’s humanity are overpowered by what can only be described as the monster that is chemical enslavement. The author foreshadows Vadim’s vulnerability, and subsequently his addictive personality, in this rather ominous passage close to the halfway point of the novel. Vadim goes out for a long vodka-drinking binge with his friend Yag. Nothing (not even Soviet Union prohibition culture which, like in America, seems to have only succeeded in having the opposite effect on young people) stops them from their wild bout of self-indulgence. Vadim’s thought process here precisely captures the all too recognisable and universal starting point of teen substance abuse: competition with peers. The moist vodka burn — especially the one immediately after a swallow, when the breath, cooling a fiery mouth and throat, takes on the revolting odor of alcohol — filled me with disgust. I drank vodka because intemperance was considered one of the components of bravado and because I wanted to prove — to whom and for what reason I cannot say — that I had the ability to drink more than anyone else and remain sober longer. Heartbreak and the desperation of depression that ultimately push Vadim over the edge and make him turn to cocaine for relief and comfort in the absence of meaningful relationships to fill the void. Again, here is a representation of another painfully common teenage experience: substances serving as a destructive substitute for parenting, solid friendships, and counselling in a young person’s formative years. It’s all too easy for Vadim to feed his habit and watch it grow like some demonic plant as he continuously seeks out his next high (at one point even stealing his mother's brooch, her only valuable, to fund a fresh stash). He has enablers instead of mentors, and a streak of adolescent selfishness rather than mature moral resolve. At home and at school, he has no responsibilities, and therefore no real external consequences for his self-deprecating actions, except for the sharp decline of his overall health. While reading Novel with Cocaine I couldn’t help but wonder if the author meant for this book to serve as a warning. Growing up, I was reading contemporary series' about teenagers like Gossip Girl where teen substance abuse was glamorised, and young readers were seduced rather than appalled by scenes of hard-partying New York kids getting drunk and high behind their parents’ backs. Novel with Cocaine, refreshingly, doesn’t take this route. Vadim’s situation is painted to be tragic, not a desirable state of affairs. In the style of psychological Russian novels, he executes mental summersaults to justify his actions, but all the self-reflection in the world cannot stall his impending doom. Here is an excerpt demonstrating just how far Vadim will go to rationalise his addiction for the readers' benefit: Not until I first tried cocaine did I see the light; not until then did I see that the external event I had dreamed of bringing about — the result I had been slaving day and night for and yet might never manage to achieve — the external event was essential only insofar as I needed its reflection to make me feel happy. What if, as I was convinced, a tiny speck of cocaine could provide my organism with instantaneous happiness on a scale I had never dreamed of before? Then the need for any event whatever disappeared and, with it, the need for expending great amounts of work, time, and energy to bring it about. But however thorough a fictionalised investigation of addiction Novel with Cocaine is, the great mystery still remains. Is it true? From a reader’s perspective, it is all too detailed and too gruesome to not be true, but unfortunately, the author carried that secret to their grave, which the novel's translator (Michael Henry Heim) speculates was likely at a Soviet Union death camp. The "chicken and egg" riddle, in this case, has no answer.