I have been captivated by flamenco since I graduated from the Laban Centre London where I trained in contemporary dance and ballet in the ‘80s. I am now the Creative Health lead at King’s College London and, in the spirit of living the wellbeing mantras I espouse, I attend flamenco classes weekly as a full work out for mind, body and spirit. Flamenco is a dynamic form of artistic expression that originated in Spain and has gained worldwide recognition for its cultural significance and emotional intensity. It emerged in the 18th and 19th centuries in the Andalusia region–an area known for its diverse cultural influences from the Moors, Jews and Romanies. The Romani people, also known as Gypsies, played a significant part in the development of flamenco as they brought their music, dance and folklore from India to Spain, although the precise origins of flamenco are still debated by scholars. What we do know is that Flamenco has evolved into a unique art form that combines music, dance and singing to express the pain, joy, sorrow and longing of the human experience, and serves as a catharsis for the performers and audience alike. It has also been used as a form of protest and expression of social and political values during times of oppression and social inequality, being a channel over centuries through which to call out social injustice. I discovered flamenco by chance, in Humberside of all places, whilst working as a community dance artist shortly after I graduated from Laban. My training in contemporary dance and particularly classical ballet had hardly equipped me for this encounter. What I witnessed was unbridled passion and an ‘unseemly’ outpouring of emotion. I joined a local class and immediately felt like I had come home. No standing in a straightened stance at a ballet barre poised for the next hectoring instruction on perfectly and uniformly executed steps, the flamenco class had a whole different feel–it was all about digging deep into visceral feelings; the power of the dance had to come from inside and learning the fiendish technique was the vehicle to express this. My training in the Martha Graham technique, in particular the dreaded ‘contraction’, had at least given me some preparation for flamenco’s dramatic and expressive qualities as it is based on the opposition between contraction and release - sharing much in common with the opposing tensions that make flamenco such an explosive art form. The renowned classical guitar scholar Robert Vidal once said: ‘I love flamenco because it is an art form, which you don’t listen to with your ears but with your intestines. First you have to feel the music before you can think about it.’ My weekly flamenco class is now essential to my wellbeing and an opportunity to explore and join up the different parts of myself, a powerful release from the stresses of daily life. The transformation begins as I change from my working clothes to the classic polka dot skirt (la falda) and elegant high heeled suede shoes with reinforced nails under the toes and heels designed to make as much noise as possible! I then go through the checklist of accessories and props: the fan, the shawl (manton) and of course the castanets which are so difficult to master as if the ferocious footwork is not enough. There will be no chance of switching off mentally or physically at the end of the working day as absolute focus and intensity will be required: no half measures. Arriving at the studio I hear the strains of the guitar and I’m about to enter another world. Class begins with the foot work as a warm-up, and to synchronise the feet with the complex rhythms of the guitar. Understanding just the rhythm (compas) is a lifetime’s study. Focus then moves from the footwork to the exquisite circle of the hands in harmony with the lyrical motion of the arms working deep into the back muscles. The skirt is used as an extension of the arms, one minute protectively wrapped around the body, the next hitched up coquettishly on the hips, then suddenly turning into the ripping, slashing movements of a bullfighter’s cape. Typical of flamenco, the class moves from ice to fire, from the introspective to the tempestuous, challenging the dancer to combine explosive footwork with subtle arm movements. There is always that feeling of drawing on emotions transmitted through generations. One of the most exciting aspects of flamenco is the interplay between dancer and musician, both working within a highly disciplined structure but responding to each other in the moment with space to improvise and interpret according to individual experience. To dance flamenco well you must strike the balance between being true to this most rigorous of forms and at the same time letting go and allowing other forces to take over. Each song evokes such a different mood, from the melancholy , profound mood of the Soleares and Siguiriyas (in the cante jondo category) to the more upbeat Tangos and Alegrias (Cante Chico). But the heart of flamenco is not a step or a rhythm or a song, it is the mysterious creative force called duende, an expression of soul and of struggle which are the life forces of flamenco and the threads that link generations of performers to their Gypsy roots. Flamenco dancing can certainly be a powerful tool for improving mental health and well-being. Research has demonstrated that engaging in flamenco dancing has positive effects on mental health, including reducing stress and anxiety, boosting self-esteem and confidence, and promoting mindfulness and emotional regulation (Dolores, 2017; Koch et al, 2019). The rhythmic footwork and music of flamenco can help to induce a state of relaxation, which in turn can reduce feelings of stress and anxiety whilst the physical activity involved in flamenco can release endorphins, which are natural mood-boosting chemicals (see Dunbar et al. 2012). This most challenging of dance forms can also help to boost self-esteem and confidence in building a sense of mastery over the complex physical movements which require such a high level of control and coordination (see Maraz et al. 2015). The sheer emotional intensity of flamenco allows individuals to express their emotions in a safe and supportive environment leading potentially to greater self-awareness and acceptance. The focus required to perform this technically and emotionally very demanding dance may also promote mindfulness and emotional regulation. At the centre of this art form is social connection and collaboration, hence participating in a flamenco dance class or group can provide individuals with a sense of purpose and meaning, community and belonging which can improve mental health and well-being The entire experience of flamenco dance training is a reminder to stay present, to keep a sense of the spontaneous and to let the spirit run free and untamed but at the same time adhere to a rigorous discipline. Not a bad lesson for life and one I keep firmly by my side in all that I do. British Choreographer Royston Maldoom once said ‘You can change your life in a dance class’ and so you can!

What comes to your mind when you hear the acronym TLC? For some (especially healthcare professionals), the first thought is "Tender Loving Care". But for me, as a researcher in mental health, it stands for Therapeutic Lifestyle Changes. I was first introduced to this term as a Master’s student in Developmental Psychology, and I have been intrigued to understand more ever since. I am a Research Assistant in Perinatal Psychiatry at the SPI Lab. Through the articles I write for Inspire the Mind, I aim to uncover the evidence base to support novel therapeutic interventions. In my previous pieces, I have discussed Play Therapy and Mindfulness for Childhood ADHD. What is the concept of Therapeutic Lifestyle Changes? For a few decades now, the benefits of exercise, a multi-nutrient diet, and spending time in nature have been discussed in the field of mental health. The concept of Therapeutic Lifestyle Changes (TLCs) was popularised in mental health research through a landmark paper in 2011, by Dr Roger Walsh. As the name suggests, this concept refers to making positive changes to one’s lifestyle for the benefit of overall mental health and well-being. The article highlights factors such as "exercise, nutrition and diet, time in nature, relationships, recreation, relaxation, and stress management…" as some of the most prominent TLCs. In this article, Dr Walsh also talks about the fact that there is evidence to show that the effects of TLCs are comparable to the impact of psychotherapy and medication for certain types of mental health conditions. What's more, studies in this field of research have investigated the impact of TLCs across various groups and age groups, from young children with neurodevelopmental conditions to veterans experiencing psychiatric symptoms. In today’s article, I will talk about some of these aspects, and the research evidence supporting them. Are nutritional and dietary changes associated with mental health? The gut-brain axis has been frequently investigated in mental health research, and studies have since looked at understanding how nutrition and diet can have a positive impact on mental health. In his article, Dr Walsh discusses the benefits of a "pesco-vegetarian" and "rainbow diet", integrating multicoloured fruits and vegetables, as well as fish such as salmon, which is high in omega-3 fish oils. Dietary interventions and their impact on mental health have been widely studied all over the world. For example, the 2017 SMILES trial investigated the efficacy of 7 individual nutritional consulting sessions for 12 weeks, and results found that the group receiving dietary support had significant improvements in depressive symptomology by the end of this intervention, after the 12 weeks. Being a "flexitarian" (someone who prefers to mostly eat vegetarian foods while occasionally consuming meat), I have been curious about the Mediterranean diet, which is mentioned by Dr Walsh in the article, and has been investigated in the context of mental health. Among the most recent is a 2019 study investigating the impact of a Mediterranean diet and fish oil supplementation on self-reported depressive symptoms. Three months after the intervention, the group receiving Mediterranean diet cooking workshops and fish oil supplements reported improvements in ‘mental health quality of life’ and reductions in self-reported depressive symptoms. With my research interest in perinatal mental health (that being mental health during pregnancy and for 12 months after), I came across a 2022 study looking at Mediterranean Diet adherence and mental health during pregnancy. Interestingly, results showed that greater adherence to the diet, with higher consumption of nuts, olive oil, fruits and vegetables, and reduced intake of red meat, was associated with lower levels of anxiety and improved overall mental health and well-being. Through my reading of the benefits of this diet, I will now go to my Pinterest board dedicated to healthy eating and add some exciting recipes to try this weekend! Do time in nature, recreation and enjoyable activities positively impact mental health? One of my New Year’s Resolutions has been to do an off-screen activity every evening when I get back from work. While this isn’t always the case, I have noticed that on days when I read a book or listen to a podcast, I’m more relaxed and fall asleep quicker. Of course, what also helps in the summer months is living 10 minutes away from a park, for after-work evening walks. These three aspects, time in nature, recreation, and enjoyable activities, have been identified as among some of the prominent TLCs, and there is no scarcity of evidence supporting their benefits (you can also find more information about the healing power of nature-based therapy in a previous article for ITM here). The benefits of immersion in nature have been investigated in the context of various mental health problems like stress and depression. More notably, a 2009 study investigated the role of walks in the park on symptoms of childhood ADHD (Attention Deficit Hyperactivity Disorder). Results found that 20 minutes of walking in the park was sufficient to elevate levels of concentration and attention performance, as compared to walks in downtown regions and participants’ neighbourhoods. In a 2021 systematic review specifically looking at nature-based interventions for mental and physical health, results from 50 studies showed that nature-based interventions like gardening, nature-based therapy, and "green exercise" (physical exercise in natural environments) were associated with improvements in mental health outcomes in adults. We’ve spoken about the benefits of nature, but what about the effects of recreational activities and their evidence base? The breadth of recreational types is wide, and their effects on mental health and well-being have been widely investigated (for example, you can read an ITM article about the therapeutic benefits of poetry here). One aspect I found particularly interesting in Dr Walsh’s article was the mention of the benefits of humour as a recreational activity. In a 2019 meta-analysis synthesising the efficacy of laughter/ humour-based interventions (with 10 trials, and 814 participants), results found that engaging in these interventions led to improvements in sleep quality, and decreases in the levels of mental health problems like depression and anxiety. In terms of the content of these interventions, they included comedy movies, laughter yoga, and humour skills training. In another 2020 study conducted among military veterans with Post Traumatic Stress Disorder (PTSD), a group recreational intervention with outdoor activities (such as equine care, angling, falconry, and archery) led to reductions in PTSD, depression, and anxiety scores, both after the intervention and at a 4-month follow-up. Conclusions: Are TLCs truly beneficial? The studies that I have spoken about today are just the tip of the iceberg in this specific field of research. Trials have investigated numerous TLCs across different populations, and most of them provide evidence supporting their efficacy. What I particularly find interesting about TLCs is that they can all be integrated into our daily routines. Whether it be through changes in diet, spending more time in nature, or getting enough physical activity, they can together become a part of our lifestyle. Further, these changes aren’t large changes that will significantly impact our routines. They can gradually be incorporated into our lifestyle, for the betterment of our well-being and mental health. Lastly, and from an implementation point of view, the evidence for TLCs is powerful. The ease with which they can be used as adjuncts to psychotherapy, medication, or any other form of intervention provides plenty of potential to integrate them into evidence-based practice for mental health and well-being.

Around 10% of the UK population is estimated to be affected by claustrophobia at some point during their lifetime, according to the NHS. Agoraphobia is a fear of being stuck in a situation or place where it is difficult to escape; some define agoraphobia as a fear of open spaces, but this is not always correct. Agoraphobia and claustrophobia have overlapping symptoms and triggers. The main difference is shown within the DSM-5 (The Diagnostic and Statistical Manual Of Mental Disorders, used by many mental health professionals), in which agoraphobia is listed as an independent psychiatric disorder and claustrophobia is a specific phobia. Both agoraphobia and claustrophobia can cause a fear of situations such as being in an elevator, a crowded room, or on public transport such as buses, trains, and planes. Think of a crowded bus on the morning commute. You are not able to get off the bus until it is at the next stop, and you are tightly packed in with a hundred other commuters. If you have claustrophobia, you may find yourself panicking in this situation, or even avoiding it altogether. If your fear of enclosed spaces persists and you begin avoiding these situations to the point it impacts on your daily life and wellbeing, then you may be diagnosed with agoraphobia. A fear of enclosed spaces may be relatively common, but once it begins to impact on your day-to-day life, then you must begin to look for ways to cope so that it does not control you. So, how do we manage a fear of enclosed spaces on public transport? There are a few tried and tested methods that are recommended by health professionals and people with lived experience. Exposure therapy If you are so fearful of public transport that you avoid it altogether, exposure therapy is a great way to ease back in and eventually overcome your fear without becoming too overwhelmed. If you are scared of taking a train, try travelling for just a few stops at a quiet time of the day when it’s likely to be less crowded. Many people find it easier to travel in enclosed spaces when there are fewer passengers onboard, as it is less crowded, and they are less nervous about who is watching them. As you continue to practice this journey, the anxiety will decrease as your brain learns that what you are scared of (panicking and needing to escape) doesn’t happen. Once you can do those few stops without anxiety, try travelling for longer, or at a busier time of day. Work your way up until you can travel on public transport at busy times without fear. Exposure therapy is hard work and requires resilience, patience with yourself, and the ability to talk yourself down when you do start to feel panic. Many of these tools are taught in Cognitive Behavioural Therapy (CBT), and you can learn more about how exposure therapy is used in CBT on the NHS website. If you are struggling to complete exposure therapy by yourself, consider speaking to a CBT therapist. You can usually self-refer to your local Talking Therapies service or you can speak to your GP who can refer you. Reduce anxiety in other areas of your life If your anxiety is not limited to enclosed spaces but is exacerbated by them, try working on your anxiety outside of public transport first. Whether it’s getting enough sleep, exercising, or practising good self-care, a positive routine can help lower your anxiety and make it easier when you do try exposure therapy. For some people, medication is a good way to reduce anxiety enough to begin exposure therapy, and once they become accustomed to the things that they fear, they can then reduce or stop taking medication. If you are unsure about this, speak to your doctor or another healthcare professional. Remember that anxiety is common According to the charity Anxiety UK, there were 8.2 million cases of anxiety disorders worldwide. When travelling by bus, train, plane, boat, or any other method of public transport that involves a confined space, statistically speaking, you are likely not the only person within that enclosed space who is frightened. Many people living with anxiety are afraid that they will embarrass themselves if they panic in a space they cannot easily leave, but in reality, the stigma around mental health is going down, albeit slowly, and people are more understanding. Imagine if you saw somebody else panicking on public transport. Would you be embarrassed for them, or would you be sympathetic? Envision the worst-case scenario What are you most afraid of happening? Let’s say that your fear of enclosed spaces is particularly high on aeroplanes because they’re crowded and you can’t get off whenever you want to. Now, let’s say you board the plane, the door closes, the plane takes off, and you’re suddenly struck with panic. You start screaming, crying, and hyperventilating. Everyone stares at you. That’s it. That is the worst-case scenario. No matter how terrible and endless it feels at the time, maybe you can take some comfort in knowing that the human body cannot sustain a panic attack forever, as it will run too low on adrenaline. The fight-or-flight response is designed to be a short-term reaction, which is why most panic attacks only last between 10 and 30 minutes. Aeroplane staff are well trained in handling nervous passengers and will be able to coach you through your panic attack. AnxietyUK estimates that one in ten of the population is affected by a fear of flying. On a passenger jet of 300 people, at least 30 are, statistically, likely to be nervous. Now that you’ve envisioned the worst-case scenario, ask yourself: how likely it is to happen? How many times have you screamed, cried, and hyperventilated during a flight? How many times have you seen any of the other 30 anxious people doing that? Often, we spend too long focusing on the "what ifs" of a situation that is very, very unlikely to happen. And if it does happen, so what? The most likely outcome is that the air steward will calm you down, the other passengers will be sympathetic, and nobody will remember it a month from now. To cope with a fear of enclosed spaces on public transport, remember that you are not the only one. Humans are in-built with a fight-or-flight survival response that tells us we are in danger, and sometimes that signal is misplaced. With exposure therapy, ongoing self-care and remembering that this is a common feeling among a significant percentage of the population, a fear of public transport can be managed, reduced and, with the right amount of work, eradicated.

With International Children’s Book Day this past Sunday, the 2nd of April (around Hans Christian Andersen’s birthday), the Research Psychologist side of me was inspired to write an article about the role of fairy tales in children’s development. Fairy tales provide a framework for how to deal with the challenges and conflicts of growing up and psychologists and psychoanalysts have long described their importance in a child’s emotional and social development. Why fairy tales? Would it not work the same if we just talked to our children? Well, it depends on their age. Young children around 3-4 years of age experience fairy tales as real and not only would struggle to understand their meaning verbally, they would likely struggle to act them out. At ages 6-7, children tend to perceive fairy tales as too “make-believe”. Somewhere in between, there is a perfect balance between the experience of the reality of the story and its make-believe side, which allows children to enact the story and the feelings they experience as part of it. In his book The Uses of Enchantment: The Meaning and Importance of Fairy Tales, Bruno Bettelheim, a prominent Psychoanalyst, talks about the importance of vicarious learning through characters’ stories, in particular when it comes to dealing with one’s own anxieties or fears. Such implicit and not conscious learning helps a child resolve their internal conflicts in a safe and developmentally appropriate environment without feeling overwhelmed. Let me give an example. All children struggle with difficult emotions and internal conflicts such as jealousy or anger. When first experienced, a young child does not have the capacity to understand these concepts symbolically and as such to name them. Instead, they might feel a surge of uncomfortable emotions and one way to make sense of them is to visualise them as something bad or scary, often in the form of monsters or witches. This visual representation speaks to their imagination; it is developmentally appropriate. As such, by identifying with the struggles of, for example, Cinderella, Prince Cinders, or Snow White, and living through their stories, a child can process their own emotions and learn that these can be resolved (e.g.., in this case, rivalry and feeling inadequate or struggling to fit in). Through creative imagination, fairy tales facilitate the journey toward autonomy and independence. One such story is that of Goose Girl, a princess who was taken advantage of by others, as she set off on a journey without her mother. She struggles to stand up for herself until eventually, she does, and all ends well for her as justice is served. According to Bettelheim, it is going through the motions of injustice and anger together with the character that facilitates developmental growth. He compares the fairy tale to the folktale The Little Engine That Could and whilst both conclude with the hopeful ending where good prevails, only the stories that take us through the whole journey of good and evil will have a meaningful impact, because they can resonate with a wider range of emotions experienced by every child. In Goose Girl, these are feelings of exclusion, injustice, anger, struggles of becoming independent, and eventually a triumph once the evil is punished and autonomy gained. A different route to independence is also told in the story of Hansel and Gretel by the Brothers Grimm. Here, little siblings learn that greed won’t get them far and that it is through cooperation and selfless acts that they can win against the evil witch, and embrace self-growth. Fairy tales and coping with adversities Fairy tales are also used in therapeutic environments. They help process difficult emotions in safe and meaningful ways. For example, one study showed that children hospitalised in the oncology (cancer) ward benefitted from a fairy tale workshop in a number of ways. For example, through identifying with Snow White, they channelled their feelings of anger which they experienced as an aftermath of their illness, towards the evil stepmother who symbolised the illness, intrusive treatments, or medical staff that put them through those treatments. Other stories, like The Three Little Pigs, helped children explore their anxieties about their sickness, which was symbolised by the wolf. It is also therapeutic for children to identify with the negative characters, as it can help them release the negative feelings they are experiencing, including anger, fear, or feeling threatened. Fairy tales can serve a "mirror function". A study on eating disorders showed that it was easier to face and talk about one’s own difficulties when these were attributed to a fairy tale character as opposed to oneself. Through the characters’ victories, it was also possible to overcome one’s own struggles. As such, fairy tales served as an external vessel to therapeutically work through one's own struggles and find resolutions to them. Fairy tales in modern times Although old fairy tales carry universal teachings that can be applied in modern times as they talk about the experiences of growing up, some of them might feel out of date. One such example is that of gender stereotyping, where female characters are often portrayed as weak, passive, and "waiting for their prince" to save them, whereas men’s characters are strong and heroic, which in itself is a topic for a whole other article. Luckily, more and more up-to-date fairy tales are being released like Prince Cinders by Babette Cole, Politically Correct Bedtime Stories by James Finn Garner, and Goodnight Stories for Rebel Girls by Elena Favilli and Francesca Cavallo. My favourite bedtime story was Goldilocks and the Three Bears, and although it’s an old tale, it conveys a message that I find very relevant in current times — the journey of growing up, curiosity, experimenting, finding your own place, and most of all, finding a good balance in whatever it is that I do (sometimes work in progress!). Although fairy tales play a part in facilitating emotional, social, and moral development, it is not the only way, so it’s perfectly fine if you struggle to recall your favourite fairy tale, or if you’ve never had one.

While taking part in online meetings, I started to notice that, for most of the time, I look at myself onscreen. Surely not out of shyness, but more because I am trying to answer some questions: How do I look in this "public digital environment"? What does my expression, outfit and background reveal about myself? Can people see I’m distracted? Can I disappear? How can I make myself heard? Do I have to ask permission to speak? Do I have to write, to make myself visible? Thinking about this experience, I noticed that it is not dissimilar to writing. In fact, as a literature researcher, translator, and writer, every time I sit down to write something (even only partly autobiographical, like this article), I find myself asking similar questions: How much of myself should I put in the text? Should I blur the context? What point of view should I use? Who is the "I" writing the text: the person in front of the screen looking at herself or the one in the screen cell – a mirrored and limited version of myself? Both in online meetings and when writing, we always show a fragment of ourselves. We are the only ones to know what is beyond the frame of the cell, in front of the screen or outside the window beyond it. The body is the only connection between what is shown and what is left out. This explains why our existences and the way we talk and write about them are not neutral acts, but acts that have a political dimension that is informed by our mental health, which is itself determined both by our bodies and the socio-cultural context our bodies are immersed in. Writing and the body Point of view, distance, and the standpoint from where we write are both stylistic and political choices. Together they reveal the position we feel comfortable writing from (or willingly uncomfortable) and determine how much we want to unveil ourselves. Take some classic examples like Virginia Woolf describing her love for Vita-Sackille West referring to the fictional character Orlando, whose body changes gender over time. Take Gertrude Stein writing her own autobiography under the title Autobiography of Alice Toklas (the name of her lover and life partner). Both Virginia and Gertrude have written in disguise, but what is the distance between their real embodied self and the one in the text? Take the entire body of work of French writer Annie Ernaux who has produced over twenty autobiographical works, which taken together show that one person's self is irreducible to unity and a single narrative. Choosing how we write ourselves is determined both by external and internal needs (censorship, desire for experimentation, attempt to reconstruct a whole self in writing) and determines how we’ll be read. The body for women and queer people has a relevance that is hardly found in those produced by the male counterpart. It is a space of struggle between personal desires and societal pressures, the space where battles are fought, the only space we can’t be expelled from, even when attacked and invaded. The body is the ink on the page, the mark, the trace, the inevitable presence. A presence that can be made invisible only at the cost of acknowledging it. So, it is inevitable that the body ends up being, explicitly or metaphorically, the way to explore the relationship with the world, and writing ends up being the tool to negotiate it. In the memoir, The Body Where I Was Born, Mexican-French author Guadalupe Nettel recounts her upbringing between the two countries and her experience as a marginalised subject. In her book, she describes her sight deficiency and the attempts by doctors and the family to correct it. At the same time, she uses this as a metaphor to write about political oppression in Mexico. Similarly, Irish writer Doireann Ní Ghríofa in her genre-defying book A Ghost in the Throat has chosen to entangle the description of her post-partum depression and feeding experience with her obsession for the life of XVIII century Irish poet Eibhlín Dubh, suggesting a parallelism between nurturing a creature and writing poetry. As Doireann herself writes in the book, she was “inviting the voice of another woman to haunt [her] throat a while”, suggesting that the act of writing and that of inhabiting the body are symbolically embedded. Reclaiming the right to speak, and, by association, the right to write and to be read, means reclaiming ownership over our own bodies, it means acquiring visibility, refusing to be written out. This is why writing is so important for marginalised communities: writing is the tool to fight for the right to visibility and existence. The different ways in which writing and the body are imbricated can coexist at the same time, as in the work and life of poet and thinker Audre Lorde who has explored her own queer desire through sex and poetry ("my body / writes into your flesh / the poem / you make of me." [Recreation]), used verses to fight racism ("When we speak we are afraid / our words will not be heard / nor welcomed / but when we are silent / we are still afraid / so it is better to speak / remembering / we were never meant to survive" [A litany for survival]) and, in her later years, wrote a diary documenting her fight with breast cancer. The sick body as well finds space and visibility through writing. Writers such as Audre Lorde, Susan Sontag or Anne Boyer have reclaimed the existence of their sick bodies through their diaries and memoirs, in an act that is profoundly political because it challenges a neoliberal society that excludes and silences the ill-fitted as less-, or even non-productive subjects, and consider the sick body as something to be ashamed of and to hide. Through writing, they have opened up new ways of talking about the experience of being sick, freeing the language from an abundance of military metaphors ("fighting the battle", "surviving") that have often deprived them of subjectivity and reduced them to "losing fighters" who should almost be ashamed when the illness "wins". From theory to practice Writing can take many forms, from intimate journaling to poetry, novels, and essays. If embarking on a writing journey alone is too hard, sometimes creative writing courses can help. If you speak Italian, the upcoming creative workshop The body I live in led by Italian writer Rossana Campo at the Festival of Italian Literature in London (Coronet Theatre, Notting Hill) on Saturday 22nd April could be a good opportunity to share the journey. The festival is supported by Inspire the Mind, and other ITM writers like Gianluca Didino and Carmine Pariante are working with me in the organisation. Regardless of how experienced we are with writing, what is important is not to judge ourselves and try — at least once — to sit down and listen to our own pulse, follow its flow and see where it leads us. Whatever comes out, it will inevitably speak of us and our bodies.

When Inspire the Mind asked me to write a new batch of history-based articles on mental illness, in the same style as my pieces on "Glass Delusion" and "The Well-Documented Mental Health Crisis of Ann Walker," this idea came to mind immediately. I first came across this story of Isabella of Parma while I was doing research on another princess — Margaret Theresa of Spain, the little blonde sprite from Diego Velázquez’s "Las Meninas" — whose health was incapacitated by a number of contributing factors. Being a historian of European royalty, I got more than a little invested, though the subject had little to do with the article I was writing at the time. At least, it wasn’t the same woman. But, when you really think about it, they were the same woman. They would both die at age twenty-one, their bodies sacrificed in the mission to procure heirs for their adopted countries. Trace up and around the Hapsburg family tree and the tip of your finger is bound to brush against the numerous brittle bits, ready to fall off the branches at the slightest prick. I’m talking about the fragile, malnourished, grossly mistreated, and odiously doomed young women of royal blood forced to have too many babies too early, whose physical and mental well-being took second place in the global game of politics. This was the ultimate fate of Isabella of Bourbon-Parma (1741-1763)., Princess of Parma, Infanta of Spain, and Archduchess of Austria through her marriage to the future Emperor Joseph II, the son and heir to the formidable Empress Maria Theresa. Though the multi-titled blueblood appears robust enough in her official portrait, the artist Jean-Marc Nattier most likely embellished the healthy rosy blush in her cheeks and the glow of her skin to protect the images of both the Spanish and Austrian royal families as being more tenacious than they really were. Princess Isabella was an ill young woman, not strong like the foundation of the Buen Retiro Palace where she was born in 1741, and famously prone to episodes of depression that made her ill-suited for the demanding role of the wife of the future ruler of the Empire of Austria. Isabella entered her arranged marriage with a broken spirit, a bad beginning that set the tone for its course. Her mother, Marie Louise Élisabeth of France, passed away at age thirty-two from smallpox in 1759, shortly after finalising her daughter’s marriage contract with Austria. The grief-stricken, vulnerable Isabella convinced herself that she would also die young. With this morose mindset, she failed to bond with her husband, Archduke Joseph, when she finally met him in person and married him to unite Parma and Austria. Though Joseph was infatuated with his new bride, Isabella considered the Grim Reaper to be her bridegroom instead. Isabella had what research journalist Elizabeth Jane Timms calls "a presentiment of her death". This has been identified nowadays as thanatophobia — or extreme and obsessive death anxiety — which overtook her personality and impaired her ability to function. The poet Emily Dickinson, as uncovered by scholars combing through the themes of her poetry, had this too, and although the two women lived over a century apart, they shared similar symptoms and causes: loved ones passing away unexpectedly, mood disorders, self-isolation, and a disoriented sense of identity in environments that didn’t suit them, which caused them to hyper-focus on the worst possible outcome for their situation. Isabella was miserable at the Austrian court, which she found too restrictive and misogynistic for her independent mind, which like Dickinson’s, was pristinely cultivated and didn’t adapt well to harsh censorship. Psychologists and historians have suggested that Isabella may have been a sufferer of bipolar disorder which is characterized by constantly shifting periods of acute emotion. In the eighteenth century, they called it "melancholia", and Isabella gained a reputation at court as "the melancholic princess". Her biographers Friedrich Weissensteiner and Robert Falvai both took a close look at the behavioural patterns she exhibited that fit the bill for the condition. Isabella would bounce back and forth between intense moods where she was either trying to prove her mettle by wearing herself out with sports or she would be too exhausted to even move, sitting in one place for hours, staring straight ahead and speaking to no one. This baffled and offended the court, which cherished her for her glittering conversation and her capacity to participate in a busy royal social life. As per the norm in this century, melancholia was considered a character flaw, a form of madness which rendered the sufferer an outcast from society. Isabella needed treatment and sympathy, and from the austere Austrian court, she got neither. Isabella attempted a personalized form of therapy by throwing herself into grandiose writing projects that, for a time, distracted her and alleviated her unhappiness. At one point she produced an impressive socio-political manifesto defiantly titled The Fate of Princesses, in which she vented her frustrations at being used as a tool in a pointless enterprise: cementing an alliance between two countries that wouldn’t last. It probably would have helped improve Isabella’s overall health if she had been left in peace to enjoy her intellectual pursuits, but as the wife of the heir of Austria, she had a crucial duty to perform. She had to produce the next generation of the House of Hapsburg. In the span of only three years, she would give birth to one living daughter, Archduchess Maria Theresa, and one premature daughter who wouldn’t survive infancy, along with two miscarriages. There was no term for it in the eighteenth century, but Isabella most definitely became susceptible to postpartum depression, a state of psychological stress caused by childbirth. Eighteenth-century obstetrics was a waking nightmare. Lyle Massey in his study of the subject remarks on how the century’s knowledge of childbirth, though an improvement on past eras, was still dangerously primitive. He is especially critical of the manuals that physicians at the time were using. “Stark, brutal, and fetishistically naturalistic, these eighteenth-century obstetric images medicalized and pathologized childbirth in an unprecedented way,” he writes. Isabella had every reason to rally against her fate in her writing. How could she be expected to be cheerful and stable as a person, when she was reduced to just a womb? While I was doing research on Isabella, I found that historians, journalists, and YouTubers (most especially the YouTubers) doing features on her life tend to focus mainly on the ambiguous relationship she had with her charming and livelier sister-in-law, Archduchess Maria Christina. I get it, there’s an enticing love story there, and in this age of Pride, we’re all grasping at the bits of LGBT history that didn’t get buried under an ultraconservative landslide. These were two young ladies who obviously had a very strong attachment to each other. But where I feel compelled to raise an objection is when people insist that the primary reason for Isabella’s melancholic state was her “gay angst,” or “gayngst.” – intentionally or not, they essentially reduce her life to that of a fictional character, as though she’s just the lead in a story like Portrait of a Lady on Fire. However, we must respect the history of women’s struggles by looking at all the elements of their circumstances and not narrowing it down to just one aspect. I do believe that, in the absence of queer literature and a community in which she could confide (the privileges of modern-day LGBT people), Isabella may have struggled with her sexuality, but I also believe that she was equally crushed by the loss of her mother, the demands of court life, her horrific experiences of pregnancy and giving birth, and her failure to connect intimately with her husband. Isabella's prophecy of her early death tragically came true. On November 27th, 1763, she contracted smallpox, just like her mother did, which forced her into early labour (she was heavily pregnant with her fourth child at the time) and brought on her swift death. As I mentioned before, she was only twenty-one years old. To me, this is overwhelmingly terrifying. When I was twenty-one years old, I was finishing my university degree. I ate a lot of Chinese food, and I was penning my own essays on what I thought was wrong with the world. I was certain of the many years ahead I would have to change those things. I am thankful for the privilege of being able to relay Isabella’s story now so that she doesn’t fade away into obscurity as a casualty of history’s unfortunate disregard for women’s health. If you are interested in reading more about Isabella of Parma and her life, below is the list of resources I consulted for this article: Falvai, Róbert (2012). "Izabella, Izabella! Aki igazán a sógornőjét szerette" [Isabella, Isabella! She Who Really Loved Her Sister-In-Law]. In Gottesmann, Péter (ed.). A Hofburg dámái [Ladies of the Hofburg] (in Hungarian). Duna International. Massey, L. (2005). Pregnancy and Pathology: Picturing Childbirth in Eighteenth-Century Obstetric Atlases. The Art Bulletin, 87(1), 73–91. Tamussino, Ursula (1989). Isabella von Parma. Gemahlin Josephs II [Isabella of Parma. Wife of Joseph II] (in German). Österreichische Bundesverlag. Timms, Elizabeth James (14 May 2018). "Melancholy Princess: Isabella of Parma". Royal Central. Vovk, Justin C. (2009). In Destiny's Hands. Five Tragic Rulers, Children of Maria Theresa. Lulu.com. Weissensteiner, Friedrich (1995). "Mária Krisztina. Mária Terézia kedvence" [Maria Christina. Maria Theresa's Favourite]. Mária Terézia leányai [The Daughters of Maria Theresa] (in Hungarian). Translated by Szántó, Judit. Fabula. pp. 63–74.

The war in Ukraine is still ongoing but more and more people are organizing conferences and building platforms to address an important question: what comes after the war? A lot of these efforts are concentrated around rebuilding the cities and infrastructure, but an issue I find equally important is what will happen to the country’s public health sector and the mental health of our generation after years of battling constant stress, which for many people will be combined with complex PTSD. I became especially curious about this issue after writing my recent mini-series about people living through the winter of power, water, and heating outages. My interviewees admitted to feeling overwhelmed and worried about the influence of these extreme conditions on their children. In my effort to understand the consequences of power outage-related stress, I spoke to a Ukrainian psychologist, who specializes in trauma, Illya Poludonnyi, and checked the data on other countries that have been going through frequent outages in the past. Illya’s commentary below is given in the first person. Illya Poludonnyi, a psychologist “How are outages influencing people’s morale and mental health?” I think morale stays strong. If anything, there is a higher drive to resist. However, mentally, people are extremely exhausted from a combination of frustration multiplied by the huge amount of necessary adaptation. In order to imagine what life is like in Ukraine at the moment, one would have to do an experiment, in which someone is constantly turning off their lights, gadgets, elevators, internet, and phones at random. It is a complete chaos and for the average modern person, it leads to a massive frustration of needs. We are used to a certain living standard and when it gets taken away from us, the quality of life steeply declines. Every simple convenience, such as ordering things online, disappears and we start to understand just how much our life depends on electricity. It takes a lot of energy to adapt to the new reality. People have to fit in all the house chores, work responsibilities, and private matters into the two hours of electricity per day. The biggest effect on the body is total exhaustion - physical, mental, and emotional. The process of adaptation adds a long to-do list on top of an already busy schedule. People are adapting as months go by, but most of my clients report their exhaustion: they sleep 15 hours a day, they have trouble concentrating or staying productive, and they become forgetful. These are all normal adaptive responses of the organism. Children are mirroring the stress and tension their parents are going through, which often spills out through sickness, tantrums, bad sleep, or deviant behaviour. My hypothesis is that people will keep getting better at adapting, we are already seeing it happen, but it will take some time. However, when the war ends, and let’s hope that it will happen soon, the healthcare system will be overflooded by patients with depressive episodes. There is a price to pay for the constant “fight or flight” mode and the huge amounts of cortisol (the body's stress hormone) our bodies are releasing daily. It is similar to the cases of cancer survivors who had depressive episodes after they were cured. I recommend everyone try their hardest to manage their sleep and rest now, no matter how challenging it is in these extreme conditions". A systematic review of the impact of power outages mentions the same big issues that Illya has pointed out - without power, people also lose light, temperature control, transport, access to clean water and sewage disposal, food storage, transport, means of communication, and a possibility to use life support devices. Taken together these factors have an enormous impact on mental health. Surveys of people living through the power shortages often report spiking rates of stress, anxiety, and PTSD flashbacks. Specific vulnerable groups such as pregnant women, children, the elderly and people with psychiatric or physical conditions are especially affected. However, not all hope is lost. Experience from other countries that have been going through frequent power outages (like Puerto Rico, Finland and Sweden among others), show that picking good strategies for handling power outages helps to greatly reduce their negative psychological consequences. Governments are advised to provide clear public communication warnings about the possibility of power outages and how long they might last. People themselves are recommended to control their levels of preparedness, information seeking, and communication with others. If those strategies are followed, some people can even experience positive emotions related to the outages, as they can give a sense of “cosiness” through family closeness, which is also something that my interviewees commented on in previous articles in my series. Darya, the mother I interviewed in part 1 of my series, said that her family felt closer than ever having to spend evenings talking to each other instead of using external entertainment. Karina, a business owner from part 2, noticed that the visitors to her restaurant found the evenings with candlelight very romantic. Of course, it feels wrong to romanticize hardship, however, trying to maintain a positive attitude, relaxing in time, and helping others is one of the best coping strategies, according to research. Parental warmth, availability, and involvement are also important protective factors, shielding children from the effects of war, and contributing to their future resilience. More than a month has passed since my interviews, and by now outages in Ukraine are rare, as the country adapted to new energetic demands. Avangarden (Karina's private gallery and restaurant) has continued to thrive despite the hard times and still holds events almost daily, that are always full of visitors. Darya’s baby is growing every day, and Darya herself decided to become a psychologist. The government of Ukraine has also launched the National Program of Mental Health and Psychosocial Support, which has a special focus on teaching how to care about yourself and others in periods of stress. It gives me hope that this was the last dark winter.

I woke up to the soothing pitter-patter of raindrops last week. Trees were swaying in an exhilarating dance on the music of rustling winds. With a mug of coffee, I sat on the balcony to witness the play of nature. The whiff of petrichor blended with the coffee aroma. How just a day ago, I was annoyed and huffing and puffing on life’s little inconveniences and the next day, it all seemed so inconsequential. The thunderstorm and rain sounds and visuals always work like therapy for me. It is a magic potion for my writer’s block as well. "Your roots should be connected to the soil for the blue sky to lush you green", I penned down. Nature works for me, but I cannot summon the perfect weather every time; it comes with its own fury–just like life. I am a writer with Inspire the Mind and other magazines and also an HR professional. Dealing with workplace conflicts and grievances closely over the years, I have seen how a similar work-related issue would yield opposite responses from different individuals; both in terms of reactions and coping mechanisms. For example, deadlines bring out different personalities and the different tones of voice determine the outcomes for the same situation. What does it take to cope with life? Coping Mechanisms Stressors are either internal–fears, insecurities, negative self-talk, striving unrealistic expectations– and more such thoughts and emotions that stem from within us, or external, the situations that we have no control over–loss of a loved one, financial adversity, illness, accident and more. Our coping skills mainly fall under these categories: Problem-focused, emotion-focused, meaning-focused, support-focused, or a combination of these depending on the situation at hand. One situation might require leaving unhealthy situations and setting boundaries (problem-focused), another situation might be unchangeable and might require channelling your energies into something calming like journaling that would make you resilient to stress over time(emotion-focused). People discover value and experiences in seemingly bad phases of their life (meaning-focused) and sometimes we may seek support from our friends and communities (support-based). Coping strategies can be healthy or unhealthy and we all understand the damaging ones yet we often fall for them for short-term relief. Retail therapy, overeating, undereating, alcohol-binging, venting, and defensiveness, are a few unhealthy coping tools. These are avoidant-style mechanisms because another activity takes centre stage to avoid dealing with the stressful situation, which gives us the illusion of comfort for a short time at a bigger risk of spiralling down a long winding path. With any stressful event, adrenaline and cortisol hormones are released. They increase our heart rate, blood pressure, and even glucose level in our bloodstream. The body prepares itself for the fight-or-flight physiological response to stress. There is a third response: freezing. When our brain cannot comprehend to choose either fight or flight, it ‘plays dead’, in hopes that the predator would wander off on its own. Stress manifests physically in our bodies as headaches, insomnia, irritability, or cognitively as issues with focusing, memory and more. Long-term stress can impact our physical as well as mental health and should be taken seriously. How do we cope with life’s constant stress-inducing nature? Talk it out It’s not just a saying, science agrees that verbalizing our feelings eases the stress load on our hearts. Our overflowing dam of emotions finds a release and we are able to function and think with more clarity. You can also keep a journal to pen down your feelings. Word of caution, talk to only trusted and close people. Not everyone deserves your innermost feelings. If there are a lot of pent-up emotions that need non-judgmental space, counselling and support groups could help. Talk therapy helps develop the tools to deal with your present as well as future stuff. It is proven that psychotherapy acts on specific brain regions, changing your brain for good. Mind sky Some days can be cloudless, beautifully blue, while others might be sparsely filled with white floating clouds or at times covered with dark grey clouds. The same is with our minds and thoughts. Our mind might feel completely chock-a-block with grey gloomy thoughts some days. On other days, it might be at ease with a few drifting silvery thoughts. There would be bright sunny days too with no forecast of clouds. The sky would still remain the sky. The obstructions; the elements on top of it are temporary but they sure make the experience versatile. The acceptance of one’s mind as an everchanging sky can bring a lot of peace on stormy days. Respond not react This golden rule is one of my life mantras. Paraphrasing Rumi, if you keep reacting to each rub-off, you won’t ever be polished. Reacting is impulsive; responsiveness is thoughtful. This pause makes a huge difference in not only tackling the situation well but also doing wonders for one’s peace of mind. It comes with practice. No matter how much we try to dodge it, hostility will often meet us on any life path we take. Learn to disengage it. I do not give any fodder to people or situations that try to belittle me. I tell myself how they are fighting their own inner demons and right now, the only answer is to walk away and let them be. Of course, it takes a lot of deep breaths to do that. But it works! Trust the process Do you see how a 4-year-old kid might be panicking about how their soft toy is going in circles inside the washing machine but you are aware that it’s good for both the toy and the kid? You were once that kid who couldn’t see from the larger perspective. It all turned out to be well. The turmoil of life is nothing but a cleansing ritual of the universe. You will get through it. Gently hold the hand of your inner child and tell them that no matter how big the trouble-monster looks, it’s just a play mask. Life’s Toolkit Older adults report lower stress compared to younger adults concerning emotional regulation ability and problem-solving because older adults have had more time to develop coping skills and resilience. The young ones have more resilience related to social support. Life provides a toolkit to all of us- no matter what stage of age or experience we are in. It is up to us to hone our skills with it. One adjusts the sail before the storm and not in the midst of it. Coping is a life-long learning process. Not every strategy or coping mechanism would work for everyone. Find out what works for you. Your mind will get trained gradually. Humour can work for some, aromatherapy would work for others. Progressive muscle relaxation might work with anxiety, therapy would work for traumas. Life is going to tumble us dry or drown us in a pool of overwhelmingness. Our life jacket of mind control will let us survive; until it’s time to wear another body suit for another journey. Or paradise. Whatever we might want to believe. But for the time we are here in this lifetime, let's be grateful for all the adventure life is going to throw us into. We signed up for that. May we realize the inner strengths we carry within!

How Your Mental Health Affects Your Skin For as long as I can remember, I have always been incredibly ticklish. This was a curse when I was younger; as soon as people found out where my weak spots were, they would relentlessly tickle me. If you’re like me, you know that being tickled isn’t a pleasant experience, despite the uncontrollable eruption of laughter and perceived enjoyment from the perspective of the tickler. In fact, being tickled can be excruciatingly uncomfortable, almost painful for some. In the last few years following my grandfather’s passing in early 2020, coupled with the unfolding of the pandemic, I noticed a drastic increase in my sensitivity to being touched. Any form of touch has become ticklish to me. This is especially the case when the touch is unexpected. At first, I didn’t acknowledge or process this change and nonchalantly shrugged it off, but recently it started to negatively impact and actually prevent physical intimacy with family, friends and worst of all, my husband. I realised this wasn’t something I could comfortably ignore. I'm Maryam Matter, a Neuroscience and Mental Health Specialist and the Founder of Neurominded, offering speaking, coaching and writing services. Mental health is my why and neuroscience is my how. I care deeply about improving mental health literacy for all - with the science to back it up. After looking into this a bit further and digging into the research behind my experience, it became clear that this extreme sensitivity, or hypersensitivity, to touch can be a symptom of heightened anxiety. This was reassuring as I could attribute this sudden change to the immense stress and anxiety I have been harbouring. It also spurred an interest in the different ways in which anxiety and stress can actually impact our skin. If you have had similar experiences to mine or seen changes to your skin which you’re finding difficult to explain, the culprits may well be stress or anxiety. In this article, we’ll be exploring some of the various ways in which poor mental wellbeing can manifest when it comes to our skin. If your experience is affecting your daily life or your quality of life, make sure to speak to your GP or a health professional, such as a dermatologist, before making any conclusions. Why does our skin react to anxiety and stress? Anxiety and stressful stimuli can trigger our fight-or-flight response. When we perceive a threat, our bodies gear up to face it through the release of various hormones, including cortisol, the ‘stress hormone’, and adrenaline. A number of physiological changes happen such as raised heart and breathing rates, increasing the circulation of oxygen around our body, and preparing us to bolt out of the situation or stay and fight. This is also why we sometimes experience hot flushes, sudden and intense heat rushing through our upper bodies, when we receive a shock to the system, like hearing bad news, for example. The stress response can cause an inflammatory response in our skin, contributing to and leading to the psychosomatic, uncomfortable and sometimes debilitating conditions and symptoms we might experience as a result of our anxiety. What might these reactions look like? Hypersensitive skin unfortunately isn’t my first experience of high levels of stress and anxiety evincing themselves physically, specifically through my skin. In the past, I have developed mild eczema, a skin condition that causes inflamed and itchy skin, on my eyelid during exam season. Prior to this, I had never had eczema, so I was surprised to hear from a pharmacist that my dry, itchy eyelid was in fact an eczema flare-up triggered by elevated stress. Luckily, I was able to easily treat my eczema, using a sensitive skin moisturiser recommended by the pharmacist. I take solace in the fact that it is usually much easier to reach a pharmacist for advice, especially when it can sometimes take several weeks to see a general practitioner. A slightly more distressing symptom of anxiety for me and one which reoccurs, particularly when I’m lying in bed, is formication. Formication is a tactile hallucination where it feels as if small insects are crawling on or underneath your skin, an unsettling prickling (creepy, I know!). Formication originates from the Latin word, "formicare": crawl like an ant. It is an unusual skin sensation, to say the least, and anxiety is amongst its potential causes. As somebody with moderately severe arachnophobia, the first time I experienced formication on my arms, I was absolutely terrified and furiously smacked my arms in the dark, just to realise nothing was actually there. My anxiety tends to peak when I'm in bed, as I am forced to reckon with my most unsettling thoughts and worries. My brain likes to replay a stale slideshow of my most embarrassing memories. Another nighttime offender is restlessness and restless legs syndrome. When trying to fall asleep, I sometimes find myself frantically kicking my legs in bed, trying to shake the overwhelming feeling of needing to move them and the build-up of energy. At times, the only way to release the energy and dispel the discomfort is to get out of bed and wait until the feeling subsides, making it much more difficult to fall asleep later. Another symptom of restless legs syndrome is the sensation of crawling or tingling. It can be super uncomfortable and unpleasant, feeling so restless, on edge, and unable to relax. Restlessness is a widely recognised and common symptom of anxiety, more prevalent amongst young people. Anxiety itch, or psychogenic itch, is an itch caused by psychological factors like anxiety, stress, and depression, rather than an existing skin or physical condition. Itches arise from an interaction between our skin cells and skin-associated nerve cells. Sometimes having irritable skin can be a result of heightened stress or anxiety, and feeling itchy or the urge to scratch can elicit great discomfort. My anxiety itch tends to emerge during important presentations, interviews, and other situations which evoke nervousness, specifically along my forearms. Some anxiety itches are irresistible and I can unfortunately end up with very long and red scratch lines ahead of stress-inducing situations. One obvious way in which anxiety can manifest itself is dreaded breakouts and sometimes acne flare-ups, which, annoyingly, is not exclusive to our teenage years. The most common association between anxiety and breakouts is the release of stress hormones during the fight-or-flight response. These hormones potentially increase the production of skin oils and in turn clog our pores, allowing bacteria to build up inside the pore leading to unwelcome red, angry swelling spots. During the more stressful periods of my life, such as exam seasons or big life changes, my face lights up like a Christmas tree and out comes my arsenal of Sudocrem and spot patches. Research has shown that mental distress can also exacerbate pre-existing skin conditions, like acne. The skin symptoms of anxiety discussed in this article are by no means exhaustive. There are many other ways that anxiety and stress can show themselves through our skin. In fact, research has demonstrated that the relationship between our mood and skin goes both ways. Those with existing skin conditions, such as eczema, acne, and psoriasis, may be at a higher risk of experiencing or developing higher stress, anxiety and depression disorders. This is due to consistent discomfort, itch and perceived stigma surrounding visible skin conditions, leading to issues with self-esteem. The elevated stress and anxiety consequently exacerbate the existing condition, feeding into a vicious cycle. Our emotions and mental wellbeing are clearly very much connected to our skin, giving us tangible stress signals, indicating we need to address our levels of anxiety. It is crucial to both the health of our skin and wellbeing that we find different ways to manage our anxiety and stress, and this looks different for everybody. As aforementioned, if your mental wellbeing or skin conditions are negatively impacting your quality of life, please reach out to relevant health services and seek support and treatment where necessary, whether that be in the form of medication, therapy or something totally different.

From despair to action Spring is coming. A strong sun warms my back and burns away the morning’s frost. One of the many things I love about my daily walks with my cockerpoo Olive is noticing the little seasonal changes occurring around my London neighbourhood. Hackney in East London is the third most densely populated borough of London, but it is also one of the greenest, with 58 parks and green spaces to enjoy. This is where I live, and when I am not teaching occupational therapy students or doing rehabilitation research, this is where we roam. As Olive the dog stops to sniff for local gossip, I pause to enjoy the delicate snowdrops, dangly catkins, and purple crocuses bursting up through the grass. But joy is tinged with concern. Our native birds, butterflies and hedgehogs are in trouble, and I know the strong sun does not feel right at this time of year. With plenty of sources informing us about the worrying loss of our native wildlife, I stop to hear from a local hero, Sam Silverlock, who is taking action to increase biodiversity in this urban area. Balancing the needs of humans and wildlife Sam Silverlock looks after West Hackney Recreation Ground. At home, we decided to call this ‘the Rec’ to distinguish it from our other dog-walking destinations, but it’s certainly no wreck. The Rec won a big Lottery grant in 2014, which, along with other funding, enabled the restoration of the park and Sam’s ongoing employment to sustain the changes. Sam is a good person to talk to about nature, and I find him up a ladder pruning poorly cherry trees. I first started encountering Sam at his work in lockdown, when many people emerged from their surrounding homes to enjoy the Rec as a communal garden. A benefit of the lockdown was that nature reclaimed the spaces humans left, but we invaded nature’s spaces too. The Rec became more popular, but Sam explains his mixed feelings about balancing the needs of humans and wildlife. “It’s always a challenge running a park because my idea really was to create a haven for wildlife and to increase biodiversity here, and trying to accommodate everybody’s needs in quite a small space is actually quite difficult. You have dogs trampling on the beds and digging things up, and the young people love the park but trample on the beds.” I feel guilty, remembering how many of us really started appreciating the benefits of nature for our mental health during the lockdown, but also realising how detrimental human disturbance can be to the very habitat that is soothing us. Nevertheless, nature is doing well here. Many people love and respect the space, and Sam points out one passerby who hugs the great London plane every morning. As we sit on a bench and talk, the traffic on the one-way system growls behind us, but the birdsong makes triumphant competition for the sound space. Sam has boosted birdlife here by imagining the area from their perspective, planting mid-level shrubs and hedgerows that they can fly into easily for cover. Pesticides are out of the question, and instead, the aim is to attract insect predators like ladybirds, lacewings and wasps. I ask Sam which birds come here now, and I tune into their different songs as he talks me through an extensive list. “Well, you can hear the great tits, the blue tits, the parakeets all on cue; we’ve got a family of crows that have been residents here for a while, we’ve got goldfinches, the odd chaffinch, a wagtail, dunnocks, robins, wrens, blackbirds, thrushes, starlings, we get some seagulls, and then the odd long-tailed tit comes down — they’re quite social, so they usually tag along with the other tit crowds — and they come and eat the insects from the lime and the willow tree. And then occasionally, you get an odd bird of prey coming over. A sparrow hawk I’ve seen, and a kestrel. And the swifts in the summer.” From climate anxiety to action It’s uplifting to learn that our small patch of green is an oasis, but Sam still worries about the decline of our birds, insects and plants. He has noticed how the extreme surges of hot and cold weather confuse the fauna and the flora. Everything is out of sync, and nothing is predictable. There is a nature and climate emergency. Last year’s extreme summer heat killed a lot of plants in the Rec, so now Sam is choosing plants that will be resilient to the heat and produce flowers for the pollinators. He is also helping the wildlife by leaving leaf litter, wood piles, and wild areas with long grass and nettles, which have encouraged grasshoppers and butterflies. “If you don’t have nettles, you don’t get butterflies. We’ve got tortoiseshell, peacock, comma — they’ve got beautiful brown ragged wings — the common blue, the red admiral. In here, there are a few nettle patches which are enough to sustain them.” I admit that I get a bit of climate anxiety (also known as eco-anxiety), despairing at the harm we have done and the future consequences. For me, it can feel like a choice between denial and dread. I ask Sam if he gets anxious about it, and he says yes, all the time. “It’s quite a good thing, I think, to actually notice how anxious you feel. But it’s good not to be on your own with it. So, anyway that we can find people that feel similarly about it, have some sense of urgency about it, that’s good.” We can take action in lots of ways, from creating hedgehog highways and helping our garden birds to campaign for change and taking eco-action. We can also stay still. Being in nature is soothing, and for Sam, it is where he has always found a connection with a benign universe. When we take an interest in the wildlife around us, it is good for us and good for nature. “It’s really good to stay still sometimes and not move around so much. And you could focus on a particular spot that you like, or a plant that you like, and learn about that, and look at it, watch it, see what happens to it, see what comes to it. That’s always a good thing. I have this idea that we should adopt some sort of plant life or animal life in our minds. And if everybody adopted one thing and learnt about that one thing, then it would make a big difference I think, to ourselves and to everybody.” Readers of my previous piece on arachnophobia will know that I have not always had an easy relationship with creepy crawlies, so perhaps I should adopt an insect. I will also adopt the hazel trees, and on my walks with Olive this spring, I will go treasure hunting for the small, red, female flowers that hide alongside the dusty, long, male stems. How about you?

In my last article, I talked about the importance of parental response to the baby and, in general, of the parent-infant relationship for the infant's long-term development. But what do we mean by the parental response to the baby? Babies rely completely on their caregivers and have many needs that need to be met. These go from more “practical and basic” needs such as being fed, cleaned, dressed, and changed, to more complex and “psychological” needs such as being cuddled, comforted, held, and touched, and receiving the appropriate-age stimulation so that the baby is kept engaged and attentive but is not overstimulated. These “psychological” needs can sometimes be neglected and considered not as important as the “practical” ones when in reality, these needs are fundamental for the baby's wellbeing and development. In this article, I will discuss the baby’s need to maintain proximity (physical contact) with their caregiver; in my next article, I will talk about the baby’s need to be comforted when crying. Photo by cookie_studio on Freepik The Need for Physical Contact and Touch: The first nine months of life One of the most important “psychological” needs for a new baby is being in close, physical contact with their caregiver. Many readers may not know that the first nine months of life are called "extero-gestation", a term that refers to the period of gestation that occurs outside, following the nine months of pregnancy, which are referred to as "endo-gestation" or "utero-gestation". Compared to other mammals, human babies are born very immature, much before development is completed, because the head can only grow until a certain size in the womb to be able to pass through the birth canal. This does not mean gestation is completed. In fact, during the first year of life, the baby brain doubles in size and then continues to grow significantly, reaching nearly the adult size at 3 years old. Babies of all species are programmed by nature to stay in contact with their caregivers, as parental proximity ensures care and protection. Furthermore, babies are suddenly born in a bright and noisy environment, which looks very different from the dark and quiet intrauterine world, and they need to eat, digest, breathe and thermoregulate by themselves. Therefore, the first months postpartum are considered a sort of continuation of pregnancy, wherein babies learn to adapt to the new environment. During this first 9-month period, the baby’s need for contact with the caregiver is very high, and then it progressively reduces, although it still remains for at least the first three years of life. Taking care of the baby in a way that resembles pregnancy offers the baby the optimal environment to develop. There are multiple ways to increase the level of proximity with a new baby, including skin-to-skin contact, babywearing, infant massage, and contact naps. These practices are much more common in many African and Asian cultures, which value extended contact with the caregiver and infant-led separation. For example, babies are carried by mothers for prolonged periods of time and sleep with their parents. In these cultures, close proximity with the caregiver in the first three years of life and beyond is considered normal. In contrast, many Western countries pursue the idea of early physical separation, with the aim to promote the baby’s safety and independence. For example, babies are carried in prams, often stay in baby chairs and are placed to sleep in their cots. Photo by Doraj Mandal on Unsplash When I was pregnant and was trying to picture how my life as a new mum would be, I thought that a few weeks after delivery, I would have been able to work a little bit on my laptop, while the baby was asleep in the cot. Of course, the reality was different. My daughter would sleep very little in the cot by herself during the day. She would immediately realize when she was not being held in someone's arms anymore. Although I was fully aware that babies need to be close to their parents, I did not know that babies could need so much contact. I continued to keep her close to me during her day naps, telling myself that, if she has this need, I have to respond to it. It was only when I started reading about this topic that I realised my baby was behaving just as many babies do. I realised that what I was doing "by instinct" was the right thing for her at that moment. I relaxed and just enjoyed the time spent with her. With time, she started to sleep in her cot independently. The Importance and Benefits of Parental Proximity This need for contact from babies has been demonstrated to be even more important than the need to be fed. In 1958, in an experiment conducted by the American psychologist Harlow, baby monkeys were separated from their biological mothers and were offered two alternatives: a surrogate mother made of wire and wood who had a milk bottle, and a surrogate mother covered in a soft cloth without any food. Harlow found that baby monkeys preferred the soft mother which provided physical comfort, despite not providing any source of food. Harlow's experiment This demonstrated, for the first time, that parental touch and proximity are fundamental for a new baby (in this case, a monkey), and that the relationship with the mother is based not only on the satisfaction of physiological needs but also, most importantly, on the fulfilment of emotional needs. Since then, many more studies have been conducted, and we now know from an extended body of literature that the experience of touch and proximity not only in the very first hours after delivery but also beyond the immediate postpartum period (for example for the first months/year of life) has multiple long-term benefits for both mother and baby, including infants’ improved quality of sleep, reduced movement and heart rate, less crying and colic problems, better cognitive development, and improved mother-infant interaction, bonding and infant security. In addition, it also lowers maternal depressive symptoms and stress and improves breastfeeding. Therefore, although responding to the babies’ need for contact can sometimes be highly demanding for a new parent, it is very important for baby development and has positive effects also on parents’ health. In fact, maternal contact and touch function to regulate the baby’s stress response, while maternal-baby separation is associated with increased levels of baby cortisol, the hormone released during stressful situations. Studies conducted in severely deprived children have shown that an extreme lack of contact had a negative impact on babies' development as well as on their immune system, which protects them from infections. Photo by Mateusz Dach on Unsplash Contrary to what people may think, responding to the babies’ need for physical contact will not "spoil" them and will not obstacle their independence, but rather will help babies independently progress to a new stage of increased autonomy after the first years of life, as they will have gained trust in other people and in themselves. Just as we would not expect a baby to eat solids before the age of six months, to walk before one year, or to speak properly before two years, we also cannot expect a newborn baby to not require physical contact with their caregiver. In their own time, babies will eventually require less extended contact and be able to console themselves and sleep independently. However, the comfort and reassurance received from physical contact with the caregiver in the very first period of their life will provide the basis for developing security in the world and in themselves.

An under-appreciated harm arising from burning fossil fuels is the mental health effects of pollution. This is one of the issues explored by the international science-poetry collaboration Earthsong, presented at COP26. At COP26, scientists, politicians, and activists from around the world came together to negotiate action to avoid exacerbating climate change and reduce the harms of our fossil-fuelled economy. As part of this, Poets for the Planet and Imperial College worked together to set up online workshops where poets and researchers from across the world gathered for conversations about the scientists’ research and the poets’ cultural experience. This provoked a huge variety of amazing poems in many languages, resulting in a mix of live and videoed performances. Mental health was a major theme in several of the poems, both from a scientific and cultural perspective. One of the researchers involved in our project was Professor Carmine Pariante, Professor of Biological Psychiatry at King’s College London, who researches (among many other things) the impact of pollution on the mind. While there is growing awareness of how inflammation from air pollution is harmful to lung and heart health, it’s less widely known that it is also associated with lower temporary cognitive abilities, lower cognitive development, depression, anxiety, ADHD and dementia. You can find out more about this research in a previous article on this site. Coming across this research directly inspired two poets, Sindiswa Zulu of South Africa (writing in isiZulu and accompanied with a musical bow instrument called a umakhweyana) and me (writing in English). You can watch our poems below. Sindiswa said of her experience: “As artists, writers and documenters to be specific, we have a huge responsibility to take so that we create and inspire a positive change in our communities, countries and the world. Being involved in this program has advanced my understanding of a role a poet can play in the betterment of our lives and those of the generations to follow. This is not just based on wanting to sustain the beauty of trees, rivers etc.. It is actually going deeper on what benefits us if the ecosystem is balanced and the environment has less toxins. The project has taught me a lot about how industries should care to make a thorough research not just comply for documentation sake but make sure that the balance in the economy is aligned with environment being protected because after all, we are ones to suffer. The workshop I attended with scientists and poets had so many subtopics but my main interest was on environmental racism and effects of air pollution. I feel that these topics are not well unpacked to the society at large.” Several of the other poets discussed mental health issues provoked by climate change and the burdens this imposes, particularly in the global south. Pieta Poeta of Brazil writes about the racially-concentrated impact of climate change on farmers in the Brazilian semi-arid region, and how this, combined with structural racism, harms the mental health of the land’s inhabitants. There is evidence, for instance, that heat waves can affect mental health, and climate change is making these more frequent. Since these poems were written, the London authorities have brought about legislation to limit air pollution. We know that similar attempts have worked in the past, so hopefully we will soon find this is too! If so, it can provide a template for how other cities may solve their local problems and contribute to the global solution. While the mental health effects of air pollution and climate change may be harder to see than dramatic heatwaves and droughts, they are no less important. Also, the impact of air pollution is more localised, since smog travels less than carbon dioxide. This means there’s more pressure on politicians tackling air pollution at home rather than blaming climate change on other people. While we hope that poetry and international community-building exercises like this will promote cooperation on global heating, with air pollution it’s in all our direct interests to take action now! Header image by Jaroslav Devia on unsplash