Many may have viewed nutritional psychiatry as a new interest in the field of medicine, but it was actually an age-old remedy along with exercise, dating back to as early as the 18th century. Studies have shown that certain nutrients may provide nerve-calming effects and help to boost our attention, or even lift our mood. For example, omega-3 polyunsaturated fatty acids, or fish oils, have been shown to improve attention in children with attention deficit hyperactivity disorder and to improve depressive mood. In addition, recent studies have also shown that exercise not only increases the nutrients for our brain cells and bodies, but also helps to fight against memory-declining disorders, such as dementia. One beautiful Saturday afternoon in March, I decided to pay a visit to the Bethlem Museum of the Mind, located in Bethlem Royal Hospital (BRH) in Beckenham. It was my first visit to the Museum. he BRH was founded in 1247 and was the first institution in the UK to specialise in the care of the mentally ill. It continues to provide in-patient care as part of the South Landon and Maudsley (SLaM) NHS Foundation Trust, and has been based in South London since 1930. The Museum was opened in March 2015, and prior to this, there was the Bethlem Gallery — an art gallery established in 1997 to support and exhibit artists who were current or former patients of SLaM. The Gallery is currently housed in the same building, shared with the Museum. The Bethlem Museum of The Mind currently holds a vast collection of archives and historical objects that tell the history of mental health care in the UK and how it has changed over the years. The museum also periodically holds exhibitions of art works and talks on mental health. The talk that I attended was given by Dr. Jane Darcy from King’s College London, and was part of the ‘The Anatomy of Melancholy’ exhibition. Dr. Darcy studies 18th- and 19th-century literature, with a special interest in the history of medicine. Her talk was on the diet and exercise strategies recommended by society doctors, including Dr. George Cheyne (1672–1743), to combat melancholy in the 18th century. Melancholy is not a new term in the modern society. Even Jane Austen’s Mrs. Bennet from Pride and Prejudice knew ‘it was all about your nerves’. In fact, possibly the most famous publication on melancholy, ‘The Anatomy of Melancholy’ by Robert Burton (1577–1640), was first published in 1621. Burton’s book uses melancholy, now termed clinical depression, as a lens to scrutinize the emotions and thoughts of individuals. He writes: ‘the subject of our present discourse, is either in disposition or in habit. In disposition, is the transitory Melancholy which goes and comes upon every small occasion of sorrow, need, sickness, trouble, fear, grief…, which causes anguish, dullness, heaviness and vexation of spirit, any ways opposition to pleasure, mirth, joy, delight, causing forwardness in us, or a dislike. In which equivocal and improper sense, we call him melancholy, that is dull, sad, sour…And from these melancholy dispositions no man living is free…none so happy, none so patient, so generous, so godly, so divine, that can vindicate himself; so well-composed, but more or less, sometime or other, he feels the smart of it. Melancholy in this sense is the character of Mortality…This Melancholy of which we are to treat is a habit, a serious ailment, a settled humour…and as it was long increasing, so, now being (pleasant or painful) grown to a habit, it will hardly be removed.’ So, how did the people of the 18th-century deal with melancholy? Dr. Darcy spoked about how Dr. George Cheyne, who was a strong advocate for diet and exercise for such condition, based his advice on personal experience. Cheyne was a popular figure of local social life and carried out his clinical practices with frequent visits to the local taverns, which was a common practice back then. But the frequent visits to the taverns with the large quantity of food and drinks led him to become obese and unhealthy. However, he was able to regain his health by carrying out a meatless diet with only milk and vegetables, and recommended this diet to anyone who suffers from obesity (today, he’s known for his contribution to vegetarianism). Cheyne also stressed the importance of exercise to his patients. In winter and in bad weather he would advise riding the chamber-horse. A chamber-horse or the exercise chair is usually made of mahogany and leather; it is a chair the simulates the motion made as you rode on a trotting horse. He also suggested walking, riding, fencing, dancing, billiards, tennis, football and digging in good weather. He also encouraged pregnant women not to be confined to their couches and beds, but to pursue air and gentle exercise to promote good health. He also gave advice regarding the time and duration of exercise, where exercise should never be performed on a full stomach and should be constant and orderly, but not violent nor long, until “not to Sweating, but to Warmth.” Another remedy for melancholy that became popularly prescribed by the physicians of the 18th century was cold sea water, whether the method was to bathe in it or drink it. Seaside resorts became where the place of serious healing. One of the therapies developed was sea bathing, which involved dunking people in the freezing sea repeatedly, until the double effects of cold and suffocation caused “revitalisation.” The patients would then be lifted from the water in their soaking flannel smocks (for women; men usually received the therapy naked), and were revived with intense back rubs and feet warmers before being carried to dry land for a warm cup of tea. The treatment plans could last from weeks to months. It was thought that the rise in adrenaline triggered by the sea bath therapy would help reset the balance in the patient’s body and calm their nerves. It is strange that three centuries later we actually believe that hot temperatures and sauna’s are good for depression. Although, there has recently been a case report re-examining the effect of swimming in open cold water in depression. Later on, the medical practice of drinking sea water (classically with honey, or sometimes with milk) was revived after the 18th-century physicians and scientists looked back at the texts of Hippocrates and Celsus. In sum, melancholy or clinical depression is not something new, it has appeared in writing as early as the 17th century. Diet, exercise, visiting nature and life style modifications are also not new ways to combat this illness in the 21st century — the methods have been around for more than 400 years and still prove to be effective. So, maybe today is the day to start a healthy diet, or an exercise regime, or to walk in the park to help us boost the nutrients for our brain cells and keep the mind-body balance. header image source: next episode

What can be done for people who do not respond to antidepressants: current guidelines and new perspectives I. Prologue: how I ended up being a psychiatrist Even people who have not suffered from depression themselves most likely have had a friend, a relative or a partner who has been struggling with it. Actually, the first time I considered becoming a psychiatrist was when I realized that people around me were suffering from mental health problems that they could not name and that they did not know how to seek help for. Yes, psychiatry can be challenging, as not only are the causes of mental disorders numerous and intertwining, but also patients do not always accept the treatments that we offer. And even if they accept the treatment, it may not help them. So why on earth did I choose psychiatry? The truth is: the therapeutic relationship with people with mental health problems, even when it is difficult, it is always rewarding and inspiring. And the very complexity of this science makes it intellectually fascinating. I know that worldwide there is a problem with too few medical doctors entering psychiatry, sometimes for fear of being overwhelmed by the clinical experience. But perhaps, to paraphrase Marie Curie, psychiatry is not to be feared, only to be better understood, and if we understand it more, we will fear it less. And that’s how I ended up being a shrink. Now, to the main topic of this blog — and to my main research and clinical interest: depression, and its treatment (especially when standard antidepressants do not work). The definition of “clinically significant depression”, for which antidepressant prescibing may be indicated, is relatively well known. In addition to persistent sadness, hopelessness and lack of energy, there is usually a clear change in social functioning (for example, people socialise less, or are unable to work or study at the usual level) and physical symptoms like lack of sleep or appetite. This, most people know. It is important to emphasise that antidepressant medications should not be prescribed for transient sadness in response to life events, and that these medications may have important adverse effects both at the beginning of treatment and when they are stopped. Nevertheless, as many patients have said before, these can be life-saving when prescribed appropriately. II. Treatment-resistant Depression: (mis)diagnosis and (mis)treatment However, less clear — sometimes even within the mental health professional community — is the definition of “treatment-resistant depression” (TRD). This is what I have recently discussed in a brief review published on “Cutting Edge Psychiatry in Practice”. In broad terms, around 50% of patients do not respond to the first antidepressant prescribed; however, TRD is defined as the failure to respond to two or more antidepressants, and, according to this definition, around 20%-30% of people with depression suffer from TRD, resulting in a significant burden for psychiatric services and for economy. However, before labelling somebody as “treatment resistant”, are we sure that our diagnosis is correct? For example, some people are diagnosed with major depression when in reality they are suffering from bipolar disorder. In this case, depression is just a phase of a disorder with periods of both low and elevated mood (mania). The standard treatment for bipolar disorder are mood stabilizers (for example, lithium) and antidepressants alone might be ineffective or could even worsen symptoms and trigger an episode of mania. In other cases, people with depression may seem not to benefit from antidepressants, but they may actually taking these medications at doses that are too low to be effective. Ideally, a diagnosis of TRD should only be done after an assessment from specialists or secondary care psychiatric services. III. If you are told that you have treatment-resistant depression, there are still plenty of things to do What can we do for those people who have an appropriate diagnosis and treatment of TRD, and they do not benefit from antidepressants? Several alternative strategies are available: Switching: if people fail to respond to one antidepressant, it does not mean that they cannot respond to others. Antidepressants include more than 30 different medications, with different mechanisms of action. So, trying a different antidepressant if others do not work does help some people. It is a pity that we still have to use a ‘trial and error’ approach, as we do not have any clinical or blood-test that can tell us in advance which antidepressant works best for the individual person (as, for example, we can do with antibiotics for infections). However, there are promising results in this direction, some from our own research group. Augmentation: if people fail to respond to more than one antidepressant, they may still respond if a different medication is added — either another antidepressant (combination) or other medications that have been approved specifically for the treatment of TRD (augmentation). Drugs used for this include drugs originally developed for bipolar disorder and later found to be effective in TRD. Psychotherapy: it is important to emphasise that augmentation with psychotherapy can be as effective as adding another medication, although it may work slower. Cognitive-behavioural therapy is the one most widely used, but other approaches (behavioural activation, interpersonal psychotherapy) are also effective. Somatic therapies: Finally, for people that failed to improve with numerous antidepressants, after switching and augmentation, there are the so-called “somatic therapies” which are not based on medications. Among these, electroconvulsive therapy (ECT), although historically controversial, is still considered the most effective antidepressant strategy for people whose life is at risk because of severe depression that is not responding to all other interventions. Another somatic therapy is “Transcranial Magnetic Stimulation”, which stimulates the cerebral cortex through magnetic fields and is better tolerated (but less effective) than ECT. IV. New frontiers The future for people with TRD may look brighter than the present, with many possible potential developments. Last month, an antidepressant of a new class was approved specifically to treat TRD. It represents a new hope for patients with depression who do not respond to anything else, as it has the great advantage of an almost immediate effect on depression. However, as the medication derives from a general anaesthetic that can be abused recreationally, there are concerns that this drug may have severe side effects (similar to other ‘hallucinogenic drugs”) and that it can be used as a drug of abuse. This is why it has to be administered under strict clinical monitoring. If anything, this medication should really be used parsimoniously and only in depressed people who do not benefit with anything else. There are also new exciting developments in our understanding of the biology of depression, and especially on the role of the immune system and inflammation. In some people, depression might be related to a chronic inflammatory response to stress, involving both the body and the brain. This new understanding of depression has two very important consequences. First, it reinforces the concept that depression is a medical disorder like all other disorders: not just in the mind, not just in the brain, but in the whole body, with inflammation being the bridge between the body and the brain. Second, new anti-inflammatory treatment strategies, targeting inflammation through medications, nutritional interventions or lifestyle changes, are currently been developed for the specific subgroup of patients with increased inflammation and who do not respond to antidepressants. Several clinical trials are trying to do this at the moment, with encouraging results. I am also working on this, thanks to funding from the UK NHS, so watch this space. V. Who am I really treating? Lessons that I learnt at my medical school: I never treat a disorder, I treat the people who are affected, and every single person is different. The clinical guidelines that are described here are only helpful if they are discussed with the patients, and if all the treatment decisions are taken together, collaboratively. It is extremely important to listen carefully to patients, and to understand what they really need. Of course, TRD is just one of the difficult scenarios in the treatment of depression. What about depression that affects vulnerable people, like adolescents? Well, this is an interesting story that I will tell you in my next blog. Disclaimer: My research work, and the work of our research group, is funded mostly by the UK National Health Service, and other governmental and charitable organisations. We also receive some research funding from pharmaceutical companies interested in the development of anti-inflammatory strategies for depression, or involved in the intranasal drug mentioned above; however, this blog, and similar blogs we post on these topics, are completely independent, and only based on the best scientific and clinical evidence.

You want to be happier in 2019, and new year’s resolutions will not help, so why don’t you try some ‘food for thought’ recipes? I have written this blog half-jokingly, inspired by my friend, Rachel Kelly, who writes about real food and real recipes. These, however, are spiritual recipes, inspired by my experience as a psychiatrist, or by stories that people have shared with me. Stories of healing and recovery. And I use these recipes, in one way or another, everyday. Gratitude smoothie Gratitude — thankful appreciation for what an individual receives — improves happiness. Every morning, pour milk into a high-speed blender, and add your most important fruits and vegetables: a roof over your head; food on the table; physical and mental health for you and the people you love; one or more close relationships; and a rewarding job or occupation. If and when you can find them, put a sprinkle of success, wealth or fame, but don’t let their taste dominate — these ingredients are capricious and disappear quickly. Blitz until smooth, and drink with joy. The ‘empty smoothie’ variant Do you want to feel happier? Focus on what your life would be like without what you have now. Try this variation, from time to time: just drink the milk, with nothing else. And focus on how plain life would taste without the fruit and vegetables that nourish you every day. Social contact salad Any social contact increases happiness: not only time spent with close friends or a romantic partner, but even just short interactions with strangers in shops and restaurants. Whisk together the ingredients for a marinade: motivation to go out; time to talk to people; and a large quantity of smiles. Prepare a face-to-face meeting with a friend, and marinate for 2 hours. This key ingredient cannot be substituted by text messages or by posting on social media. Keep mobile phones out of sight, otherwise they will strip all nutrients. When your friend is well marinated, grill on both sides. Describe how you are feeling and what has happened to you lately. Invite them to do the same. Drizzle the salad with a phone call to members of your family. Serve with a warm heart. Sadness in friendship wraps with patience mayo Bereavement, divorce, illness, redundancy, job or money worries — all can affect mental health, at least temporarily. If your mental health is still severely affected several months after a life event, and you are unable to go to work or to look after yourself and your family, this recipe will not work and you will need help with psychotherapy or antidepressants or both. But if you are almost managing yet are in the midst of a life-changing crisis, try this recipe. It was given to me at the 2017 Also Festival by a French cook who was listening to my talk on ‘happiness.’ In a bowl, combine mayonnaise, acceptance, patience, and lots of tissues for crying. Spread the patience mayo all over your best friends. Then tuck in their sides, and roll them up tightly around you, so that they wrap you up completely. Then get all together in the oven. Let everything negative in your life melt away. The job that is taking a toll on you without giving you any reward. The relationships that no longer work. The living place that you can’t tolerate anymore. Cook until you are ready to move on. But be patient, and prepare to wait for weeks or months. Yoghurt for people addicted to dairy There are many types of addiction: drugs, alcohol, caffeine, sugar, work, stress, bad relationships, social media, fame. Everything that compulsively distracts us from reality can become addictive. If the addiction has already affected your health, family, relationships or profession, this recipe will not work. And you will not make it by yourself. You will need to seek help. But perhaps it is not a true addiction yet. If you dip in and out of workaholism, or at times you drink too much, when life feels too difficult or too boring, then try this recipe. Start by recognizing that your dairy addiction is a problem. Every time you have some dairy product, you initially feel better, but then it leaves you worse off, nauseated, and empty. This means that you need some dairy-free yoghurt. You start by choosing a non-dairy milk. Mindfulness, spirituality or physical exercise works best. You then add a thickening agent, to make the yoghurt thick enough to fill the void inside you. One or two important relationships, and a few true friends, will give you the thickness that you need. And then add emotions, as they are the best probiotics. Happiness, sadness, fear, surprise, trust, anger. Experience your emotions full-on, without fear. And listen with empathy to people around you, and feel their emotions.

Everybody is talking about adolescent boys and the fact that they do not express their emotions. In a recent interview, Prince Harry says that he regrets not opening up sooner about how his mother’s death affected him: “You can be as tough as you want on the exterior, and you can be someone who never shows any emotion, but inside there’s all sorts of stuff going on.” I wrote the first version of this blog in 2016 inspired by an article in the Guardian which discussed whether the teenagers’ view of masculinity, centred around not showing emotion and not asking for help, is leading to increased depression, suicide and violence. However, boys don’t start their lives as unemotional human beings. Male infants are as emotionally expressive than female infants, but a boys’ emotional expressiveness decreases as they age. The school environment may be the key. I believe that at school, emotions equal weakness. And, since the enjoyment of school is almost totally governed by whether a student is perceived as weak or strong by their peers, any public displays of emotion, whether crying, anxiety, or even extreme happiness, are to be avoided. Thus, suppression of feelings is essential to having a good time at school. Gender differences in emotional expression may be particularly evident in the school environment, where adolescents are with peers and respond to differing expectations of boys and girls: boys don’t cry, while sugar and spice and everything nice, that’s what little girls are made of. Society’s requirement that boys must hide their emotions has been extensively discussed since the 90’s. Research has also shown that suppressing emotional expression increases the likelihood of compromised socioemotional functioning and the risk of developing psychopathology. Keeping emotions under wraps at all times is therefore boys’ most-practiced skill, as a way of coping in their social milieu. But sometimes, unforeseen events do occur. Becoming much more aggressive and unpredictable at school, or even engaging in violent behaviour, may be the only way for an adolescent boy to express the despair for a family illness or for other personal suffering: the sheer rawness and unfamiliarity of these feelings lead to dramatic manifestation of emotions, which can no longer remain suppressed. Interestingly, the problem is not only about the affected boys learning to express emotions and to ask for help: it is also about other boys learning how to handle emotions and how to give help. I can recall situations where my peers and I should have talked to a friend in difficulty, but were unsure how to approach the topic. Communicating and talking through emotions is such a societal taboo amongst boys, that it was easy to leave the affected boy to his own devices, as not one of his friends knew how to even begin to talk to him about what he was going through. So what could be done differently? From a student’s perspective, it starts by removing the stigma attached to having mental health difficulties or even to showing basic emotions. We need to move away from the idea that, in order to be considered as having a ‘mental health problem,’ one needs to be suicidal, severely depressed or have completely lost touch with reality; instead we need to realise that any episode of persistent worry, stress, or sadness, could be a mental health issue. This cannot happen overnight, but one place that it must start is in schools. Schools are aware of this problem. The Good Schools Guide website reminds parents, who are approaching the website in search of school reviews and articles on education, that 1 in 10 teenagers suffers from a recognised mental health issue, and 1 in three teenagers reports feeling ‘sad’ or ‘down’ more than once a week. The website suggests that parents should find a school where children are loved and valued for their individuality and where the pastoral care is outstanding. Indeed, good pastoral care provision is essential for uncovering the causes of disruptive behaviour, and it gives the boy an outlet outside of the home environment to explore his problems in a safe space. However, this may be not enough. Mental health must be incorporated into the school curriculum, but not simply through conventional, sit-down Personal, Social, Health and Economic lessons (PSHE). Rather than the daunting prospect of having to book formal appointments with a relatively unknown school counsellor, more interactive, informal discussions and workshops in smaller groups could be far more productive. Perhaps, a ‘Mental Health Committee’ could be responsible for organising these initiatives, bringing also families on board, and inviting independent speakers to joint events with parents and pupils. The input into the curriculum must be spread throughout the school years, as there is no saying when a young person may be struggling with mental health issues. A recent report by the UK Department of Education on mental health and behaviour in schools highlights cases of good practice, with schools offering a curriculum promoting mental health and well-being, sessions for individuals or groups dealing with issues such as anger management and family break-up, and peer mentoring programmes where older students receive training and conduct one to one meetings with younger students under the supervision of an adult learning mentor. So what about us — researchers in mental health? A new emphasis on public engagement is bringing additional resources to do outreach work in schools. Prof. Carmine Pariante’s team has been involved in delivering Mind the Mind workshops by the European Federation of Psychology Student’s Associations, aimed at educating young people about the stigma associated with mental disorders, and in the Takeover Challenge initiative, where young people are invited to our NIHR Maudsley Biomedical Research Centre to learn about mental health and to exchange ideas with researchers. Let’s hope that more schools and more mental health organisations join forces, and that the Government provides more funding for these kinds of initiatives.

You may have never met one of us, but you will know someone who has been helped by one of us. The elderly mother of your best friend, who is developing dementia. The young girl in your daughter’s class, who has stopped eating. Your distant cousin, who had a car crash and has not been able to move on. Your neighbour, who has terminal cancer. Your old friend from school, who now has an abusive partner. The soldier you see marching in the street, who has just returned traumatised from a tour of duty. Your colleague at work, who has depression but is too ashamed to disclose it. The person sitting with you in the GP waiting room, who has stopped working because of anxiety. Your son’s mate in the football team, who has dropped out of school because he is hearing voices. The stranger sitting across from you in the pub, who almost died of a heroin overdose, perhaps it was accidental or perhaps it was a suicide attempt. All of them have been helped by a psychiatrist, or by a mental health professional working in psychiatric services. I want to dedicate this blog entry to our success stories: to the psychological and pharmacological interventions that are changing lives, and to the cultural and social initiatives that are changing public perceptions. An advertisement for what we do, as psychiatrists? Perhaps — but criticisms are coming from left and right: depending on who is criticising us, we are accused of being either too biological or not biological enough, either too social or not social enough. So, a little bit of PR, based on facts reviewed by experts, can only be a good thing. Did you know that psychiatry research has promoted an important debate on the potential harm of recreational drugs? We now know that individuals who start smoking cannabis early in their life, and smoke the particularly strong ‘skunk’ variety, are at increased risk of developing schizophrenia, a severe mental illness characterized by hearing voices (hallucinations) and developing false, often bizarre, beliefs (delusions). This is because some ingredients of cannabis induce these symptoms, and reducing cannabis abuse would prevent 1,200 new cases of schizophrenia every year in the UK alone. In contrast, other components of cannabis have beneficial effects on mood and pain. Treatment for heroin addicts is similarly contentious. Researchers have proposed supervised treatment for heroin addicts, but some of these treatment options have ethical implications, such as allowing addicts to take heroin while a doctor or a nurse is watching. Yet these approaches reduce crime and save lives. We do not provide all the answers, but we do provide the evidence for the debate. Did you know that we are developing and providing ‘talking therapies’? In 2008 the UK government launched the Improving Access to Psychological Therapies (IAPT) programme to ensure faster access to psychological therapies, now treating almost 500,000 individuals every year across the UK. But not just any psychological therapies, only those that are ‘evidence-based’, that is, those that have been demonstrated to be beneficial using the most stringent studies. And guess who has conducted those studies? Yes, psychiatrists and psychologists, working together; entire books have been written on what kind of ‘talking therapy’ works for whom, and specific approaches for specific disorders have been developed, mostly based on the so-called cognitive-behavioural therapy (CBT) model. For example, 80% of people with panic disorder (sudden, our-of-the-blue anxiety attacks) and social anxiety (intense fear over routine social interactions) now reach recovery; people with schizophrenia (and their families) are helped finding better ways of coping with their hallucinations and delusions; and people with anorexia are helped focussing on their cognitive and emotional characteristics rather than on the preoccupations with food and eating. Some of our work is preventative: for example, military troops returning from active duty receive a post-deployment mental health resilience programme that decreases risk-taking behaviour and alcohol misuse. And some of our work is about showing what does not work: researchers have demonstrated that, contrary to expectations, talking about a trauma right after it has occurred does not help. And did you know that psychiatrists inform policies that affects society? For example, by setting up a register of all suicides occurring in the UK (the largest database of its kind in the world), researchers have generated a number of recommendations, including the creation of 24-hour crisis teams and of multidisciplinary reviews following a patient suicide, now credited with saving 200–300 patient deaths per year. Also in the context of suicide, other research studies led to legislation for reducing the maximum pack size of over-the-counter sales of paracetamol from 100 tablets to 32, with a limit of one pack per sale; and this has led to hundreds fewer deliberate and accidental deaths. Public attitudes towards mental health have also improved thanks to efforts from psychiatrists through the Time for Change anti-stigma campaign; for example, in the last five years, fewer people with mental health problems have experienced discrimination in their social life or in securing a job. Not all we do, as psychiatrists, is perfect. But, for once, this is an occasion to talk about the good stuff. Read other examples of research, by psychiatrists, psychologists and neuroscientists in the United Kingdon, that makes an impact on how we understand, prevent and treat mental illness. Read what the Royal College of Psychiatrists — the professional medical body responsible for setting and raising standards of psychiatry in the United Kingdom — writes about mental health problems and treatments. If you are a medical student, consider a career in psychiatry. Yes, you may have never met one of us, but you will definitely know someone who has been helped by one of us.

Neurones forming synaptic connection in the brain superimposed to the Milky Way: is our understanding of the mind and the brain equally complex? The debate on Mind vs. Brain has figured prominently in the recent public press. But the debate is misleading: few dispute that mental life is grounded in the complex circuits of connections between neurons (brain cells) and in their constant interaction with the world outside. The question is really one of how psychiatrists, psychologists and social scientists can work together to link the mental and the neural, rather than fighting about which has priority. I co-authored this blog with Nikolas Rose, Professor of Sociology and Head of the Department of Global Health and Social Medicine at King’s College London. There is probably more in common between the different ‘camps’ of this debate than may at first appear. For example, most clinicians and scientists, even if coming from different disciplines, agree that mental health problems are best understood as processes that result from a person’s difficulties and ailments in the context of the reality of their lives and their personal and social relationships. Similarly, few would dispute the fact that the brain is crucial for all human mental functions, and that psychosocial factors — personal difficulties, life adversities, stress, social relationships — shape both the structure of the brain and the functional circuits that link up the millions of neurons through the synaptic connections between them. There are many pathways between the outside world, individual experiences and feelings, and neuronal processes — that is to say, between society, the body, the mind and the brain — such as via hormones and the immune system, epigenetics, neurogenesis, and the microbiome. Things becomes more controversial, however, when we try to model these dynamic relations and we try to decide where in this complexity our interventions should best be directed if we are concerned to reduce the incidence of mental ill health, or trying to treat those who suffer from mental disorders. One the one hand, many argue that the bulk of neurobiological research programmes are too reductionist in their thinking that mental disorders can be understood through an analysis of individual brain areas or deficits in specific neural functions. Much research has focussed on the role of individual neurotransmitters (the chemicals that allow brain cells to communicate), and many argue that we need to discard this highly simplified ‘neurotransmitter model’ of mental health problems that has guided much research and drug development for almost half a century. At least in part, this is because the drugs that have been produced on the basis of this model have been less effective than hoped, and few if any new drugs from this pipeline are in prospect. In contrast, contemporary neurobiology is demonstrating that it is the activities of highly distributed circuits connecting many dispersed areas of brain that are central to understanding the neural correlates of human mental functioning. The creation, modulation and activity of these circuits involve hundreds of different chemicals working in concert, like an orchestra and not like the string quartets favourite by research and pharmaceutical companies so far (for example, serotonin, dopamine, norepinephrine, glutamate). Yet it remains true that, despite the burgeoning of neurobiological research over the last half century, we still do not know enough about the development and functioning of these neural circuits, and how they give rise to mental states, nor do we know specifically how psychological and social factors map onto brain function at microscopic or macroscopic levels. Thus many argue, with some justification, that we need more reductionist research on the brain and its molecular mechanisms, not less. However, even then, we think this must be research that studies the ways that the brain develops, from conception onwards, in complex and dynamic relations with body and the world outside — for after all, that’s what brains were evolved to do, and that’s what they achieve over any individual’s lifetime. Neurotransmitters may well be a crucial key here, though in a much more complicated way than was previously imagined, because they form the links that create circuits between brain cells. It is quite likely that even what we conceptualise as ‘non-drug’ interventions, such as a probiotic, fish oil or psychotherapy, eventually converge on modifying the function of the neurotransmitter system. But we still do not know enough about how stress, poverty, isolation, adversity, in childhood or beyond, actually shape and reshape the hugely complex and dynamic internal world of the brain. As has been said before, there are more connections in the human brain than there are stars in our Milky Way galaxy — and those synapses are constantly in flux in timescales ranging from the millisecond to the decade. Of course, the ‘brain’ is an organ in the body, but its complexity, and its dynamic nature, make it a very different kind of organ than the heart, the lung or the pancreas. And indeed, we know that to understand the origins of all medical disorders, and to understand what may reduce their incidence, we cannot consider an organ in isolation. A heart attack attacks the heart, of course, and lung cancer is a cancer of the lung, but it would be a rash person to claim that the causes or treatments of either can be focussed on the heart or the lung alone. The brain requires an even more comprehensive approach: recent epidemiological research has shown rates of dementia to be lower than predicted, not as a result of any startling new intervention into the brain, but as a result of a range of long term transformations in lifestyle: reductions in smoking, treatment of high blood pressure, and improvements in general health care. We all should agree that we need to understand much more about the mechanisms by which ‘adversity gets under the skin’ and affects some of us and not others. But this can best be done by starting from the human beings as they live their life in a particular cultural, social and physical environment, and not only from the brain isolated in a laboratory model. And this is why it is so crucial that psychiatrists, psychologists and sociologists get together and collaborate in research to overcome the galaxy of unhelpful conceptual barriers.

If you find yourself tossing and turning at night, your mind buzzing with thoughts — among them why you are not asleep — you are not alone. Sleep problems affect most people at some point in life. They can develop from temporary stressors, such as having children, or appear out of the blue. Though common, some people seem to face more sleeplessness than others. Women are more likely to struggle, alongside other population groups. Single parents and people of colour, for example, appear to get less shuteye on average. I am Livia, a science writer and regular contributor at Inspire the Mind, and I have also battled my own sleep on and off. What eventually helped me the most was Cognitive Behavioural Therapy for Insomnia, also known as CBTI. It works by changing learned behaviours and thought patterns that obstruct good sleep, and has been championed by sleep experts as the most effective way to beat the problem. Though it sounds a bit clinical and scary, CBTI can be designed to gently help you relax your thoughts around sleep and thereby pave the way for sleep to return to you. If you happen to be somebody who does not get enough sleep — despite putting your best efforts into it — a totally new approach may be just what you need. The Magic of Sleep When we sleep, much work gets done by our brains. Every night, our most complex organ busily completes different tasks, such as processing experiences and chucking out cell waste we no longer need, so that we wake up refreshed and ready to take on a new day. Not enough shuteye means that we have not had the chance to recover enough, and concentration, memory, emotions, and energy levels are all affected. Though not a guarantee, the risk for mental health problems, such as depression, may become bigger. Effortless fun can suddenly seem hard, and everyday demands do not become easy to face, either, because sleep appears needed for the prefrontal cortex to recover — the part of our brain that helps us handle stress. Sleep, alongside water, oxygen, and food, is something humans, as biological creatures need. Not getting enough deserves sympathy — especially when one bad night becomes many. Solving sleep It’s understandable, therefore, that many who suffer from sleep problems try to alleviate them quickly. Often, they can be more easily helped by simply enough daylight and exercise, and keeping a regular sleep schedule, to help the natural circadian rhythm that humans have. Some might discover that buying a weighted blanket helps, as new research has shown that weighted blankets boost melatonin production. Others start to use the bed only for sleep and sex, and ban screens from the bedroom, as per some common sleep hygiene rules, and for some, the answer could well be to just start leaving your phone outside your bedroom. But for some people, sleeplessness stays. No matter how hard they try, the bed never feels comfortable. A new way to sleep Rather than subject poor sleepers to tough rules and elaborate routines, some sleep coaches design CBTI to help them enjoy involuntary wakefulness and relearn a more relaxed, natural approach to sleep. Daniel Erichsen from BedTyme, for example, actually sees insomnia as a psychological fear, even phobia, of being awake at night, rather than a problem that would be solved by enough sleep. Those types of bad sleepers, he means — I would count myself amongst them — have become hyper focused on sleep. The urge to Google and read every book has become hard to stop, and they try herbal teas, screen bans, whatever might work, to get more. In other words, they start to chase rest. Meanwhile, experts say that good sleepers do not check boxes, but actually pay next to no mind to how they sleep. Researcher Colin Espie at Oxford University, for example, says that they have no clue what they do  — sleep just happens. It may sound outrageous to people who try so hard, but effort, as far as sleep is concerned, does not equal reward. Your sleep does not want your attention A path to help poor sleepers get to that cozy place may therefore be to care less, and do what actually takes the focus away from sleep. To accept the deal, get up, and stream a good sitcom  could be much more effective than trying to force sleep and getting frustrated when it does not come, an unpleasant place to be that makes us dislike our bed more. The blue light from your screen does not keep you awake, your thoughts do, sleep coach Camilla Stoddart says, and should screen bans and other efforts only make somebody focus on sleep, they should abandon them. To cultivate a more carefree attitude, Stoddart suggests that we even stop reading about sleep altogether. Granted, changing your mindset can be hard, and takes practice. It is also worth noting that this may not work for everybody, as poor sleep can be fuelled by different things. Illness, for example, can affect sleep, which is why you should always check in with your GP if problems persist. For some, a few simple lifestyle tweaks may do the trick. Not every sleep problem needs the same remedy. But for those who hyperfocus on sleep and even fear the small hours, learning to enjoy them could undo that type of insomnia at the root and help you love your bed once more, as we are meant to. When we no longer worry about sleep, Erichsen means, sleep just comes naturally. Sweet Dreams The key takeaway from this particular approach can be summed up by the mantra that we cannot control sleep, so we may as well stop trying. That type of relaxed — and pretty counterintuitive — therapy has been the answer for me and for some who have had enormous fears to overcome. When I struggled, I needed the comfort of my best Netflix show,  even though screens are often preached as bad for you. When we feel overwhelmed, we are allowed to relax and do whatever our gut tells us we need. Sleep should not feel like a chore. Remember that even though scary statistics say that the risk for various health problems appears to become larger when we sleep poorly over longer periods, they are not guaranteed to happen, and that you control your lifestyle long-term. Sleep is a natural process that the body never forgets, and the fantastic healing capacities means that the body can catch up and restore the sleep that has been lost. So, should you be one of the many sleepers out there who does everything right and somehow still struggles, great news. No need to try more, or work harder, to solve your sleep. From now on, you may put that worry to bed — no pun intended — and start to do whatever makes you relax, and let sleep find you.

An interview with our new columnist, a psychologist and a mother, Dr Alessandra Biaggi Image source: Photo by Dominika Roseclay on Pexels Ahead of the launch of the new column “The Perinatal Journey - Walking through the first years of life” on Inspire the Mind, I sat down with its creator, Dr Alessandra Biaggi, to learn more about it. I first met Alessandra a few years ago, when she worked as part of the perinatal (the time between pregnancy and the first year of life) psychiatry research team at King’s College London, and we shared a passion for the importance of early life experience in child development. Dr. Alessandra Biaggi “I've always been interested in the perinatal period and in particular, child development. I developed these interests when I was at the university, so that was a long time ago” she says, “and since then, I’ve always worked with parents and children.” Dr Biaggi is a Research Psychologist who recently became a mum herself, which inspired and motivated her to start this column. "When I myself became a mother, I thought I knew many things related to this period (perinatal), but I realized that there were some things I did not know about, and that this information was not easy to find. Parents often rely on online information, which can be great but often it isn’t evidence-based and there is a risk then that they get the wrong information. So, I thought it would be helpful if I created an evidence-based column that would help parents access what they need to know." She gives us a glimpse of the future content of the column, which will "have a strong focus on mental health – of mothers, fathers, and babies”, but also cover a wide range of topics related to parenthood and baby development, such as the transition to parenthood and infant nutrition and sleep. She wants to challenge the unrealistic expectations that surround the transition to parenthood in order to take the pressure off of parents. “We really need to learn to practice some self-compassion… the caregiving role is demanding and requires effort.”, she comments. This brings us to the topic of parenting. I ask her what the hallmarks of good parenting are, and two key terms come up, “sensitive” and “good enough” parenting. “Each baby comes with lots of needs that ought to be met. They communicate these needs in ways they can, which is often, but not only, by crying. It might be that the baby is overstimulated or understimulated. It might be that they need some physical comfort, they’re hungry or need sleep, have a dirty nappy and so on. And the role of a caregiver is to listen to this communication and try and make sense of it because it's not always straightforward. And then, of course, to respond to the baby. This isn’t always easy and means adjusting the behaviour until eventually, the infant feels happy, secure, and satisfied.” Image source: Photo by Jonathan Borba on Pexels She goes on to explain the concept of “good enough parenting” as understanding that mistakes will happen and that “Babies don't really need perfect parents, but they need parents that try their best. It only becomes a cause for concern when parents repeatedly fail to respond sensitively to their babies”. I ask her about the long-term impact that parent-infant interaction can have on a child, and later, an adult. Alessandra says that parenting is like building a lens which influences how the child will see the world around them, how they interact with the environment, and manage emotions and stress. She talks more about "good enough parenting" and how it helps the baby develop cognitive and social competence in the future, minimising the risk of developing problems at school or psychopathology during their lifetime. “The early relationships are taken in, internalised, by a child, and create some sort of “imprinting” in the baby's brain, which functions as a guide on how to be in the years to come. Obviously, this is not deterministic, so there will be lots of other factors that will come about and affect the child’s development including genetic predispositions, but certainly, the early experience plays an important role.” She also stresses that fathers have an important role in infant development and that luckily, there has been increasingly more interest in the topic. Image source: Photo by William Fortunato “Interactions with fathers usually tend to be more physical, tend to involve more active play, and are more stimulating compared to interactions with mothers, and this is really important because it promotes the development of competencies like attention, risk-taking, exploration of the environment, and ability to problem-solve, which are all important aspects for the child’s development. So, I think the role of the father is key, not to mention the fact that it has an indirect impact by supporting the mother. But this is another chapter”, she says smiling, “I will need to do an article only on fathers!” Before we conclude, I am curious about an earlier statement about her concern for when parents repeatedly fail to respond sensitively to their babies. And I wonder, can this be rectified at a later stage? She nods and says that our internal model – the lens created in early childhood – can change when we are older. “One such way is, for example, through psychotherapy. One of the mechanisms of psychotherapy is really to recreate a sensitive and positive relationship with the therapist who will help you and will support you in a way that, perhaps, your parents didn't. Through that positive relationship, it is possible to change the way of relating to others. I think a similar process can happen through other positive relationships in life”. She concludes by saying that it is really important to become aware of any negative dynamics we might find ourselves in when relating with others; and from then, we can make decisions to do something about it. Raising awareness, whether about your own way of relating as an adult, how you were parented or how you are parenting your child, is certainly a step in the right direction, and I am confident that this column will achieve just that. So, keep an eye out for the first article on the 23rd of March 2023! I will.

Running a small independent business is already a challenge with small margins and the ever-increasing inflation. Try doing that under the constant shelling and outages of critical infrastructure. Ukrainian business owners are showing real miracles of survival to the world, constantly adapting to the fluctuating reality of the war and still staying afloat. The harshest period came this winter, when attacks on critical infrastructure frequently left people without water, heating and electricity, in extreme winter temperatures. As the winter is slowly subsiding, in the second part of my mini-series, I talked to the very inspiring Karina Kachurovskaya - an owner of the best Ukrainian private gallery coupled with a restaurant and a natural wine bar Avangarden - about her experience of living it. Her story below is told in the first person. Karina, an owner of Avangarden gallery & wine bar We just opened Avangarden, my life’s dream project, shortly before the war started. So when, after a few months of closing due to the war, we accumulated a lot of debt, I thought: “Ok, let’s try to reopen, and if I do not meet my financial goal by the end of the year, I will close it down, sell all the art, sit down on the floor and cry a river”. Reopening at this time is downright crazy. I will not lie - things are bad, things are terrible, but we are still in business. The amount of problem-solving we have to do daily is bordering on the absurd. Power outages are not the biggest issue; we put candles all around and invite people to experience the “romantic atmosphere”. The lack of technical water is much worse. Without it, all of our business processes stop. The worst problem is the bathrooms. We are in the very heart of the city so there is nowhere to go when our bathrooms are closed! We jokingly tell people to come with empty stomachs and a lot of patience, and in the worst-case scenario, I still have some of my daughter’s diapers…Somehow we still have full seating on most days and secret bathroom spots became a hot conversation topic in the room. I think our reopening has worked out because the atmosphere in Kyiv is very different from what it used to be in the early days of the war. People that left are more worried than those who remained. Everyone is very determined and prepared for everything. Our team had training in tactical medical help, an algorithm of action for a chemical or nuclear attack… All the things you never wanted to learn. We've already had six nuclear attack threats! One day was especially scary. I got a call from an influential client that claimed the nuclear attack would definitely happen tomorrow. I had to gather a whole team and tell them the situation. I was leaving, we were closing the place, and they should leave too because I do not want them to wake up to a big bright cloud in the sky. As a leader, it is a huge challenge to find a balance between encouragement and keeping spirits high, whilst also being realistic about the horrible, brutal reality of things happening around us. In the service industry, everything is about people and emotions so communication is extremely important. I feel that I can share the information and let everybody make their own decision. In the end, the nuclear attack did not happen, and a week later my employees were begging me to reopen. Working is one of the only things keeping our sanity. I understand that my hyperactivity is a way to suppress emotions. When I am always doing something, there is no time left to reflect on how bad things really are. However, I cannot live any other way. I spent the first few months of the war in the West of Ukraine which were objectively much calmer, yet I did not feel at peace there. I felt out of place, living a life that didn’t belong to me. I came back to Kyiv to work on my project, in my city, with my people. It is very tough but we are in this together and people understand and support each other by all means. When there is no power to call for a taxi in another part of town, I know I can hitchhike a police car, or any car, and people will stop and help me. I find it harder to look at the events from a distance than to be in them. I stopped counting the days that we woke up to explosions. I am already able to tell which sound is a rocket, which sound is a drone, and which is the air defense system. It is a damn lottery. No way to tell where it will hit next. I know that we pep ourselves up but our mental state is very unstable. We jump up from every loud sound, we wear a million layers going to sleep. My husband bought a gas heater but then we saw on the news that these sometimes explode so now we are too afraid to use it. There is no possibility to relax for a few days, to breathe out. We are all condensed energy and determination. Reflection will come next, now is the time of pure faith. People are coming to our space against all odds. No one was ready for this scale of aggression and violence but now we all understand what is important in our lives. We did not choose this war but we can choose a life-affirming outlook. Everything in Kyiv is soaked in this life force: love, freedom, creativity, self-education, and exploration are in the air. This December, in Avangarden, we decided to have a manifesto of life. We had an event almost every day: a jazz concert, art exhibition, poetry evening, improvisational theater, yoga and meditation, and even a lecture on quantum physics. Each of them fundraised for a specific cause and initiative. I do not want to create an illusion that war is far away and we are here enjoying ourselves and drinking wine. At these events, I am trying to build a mature dialogue about what is happening around us. There is a war in our country and our future depends not just on our army and politicians, but on each and every one of us. This time is about synergy. Everybody wants to help, everybody wants to do something. We find our power and use it to lead, or join an existing initiative. This approach brings us an endless flow of people with ideas. We are a real cultural hub - one of the only ones in Kyiv at the moment. I think it is very important to support the artists and let them have a place to exercise their real passion. And for the visitors, these events are therapeutic. We gather together with people who share the same historical moment, and emotion. It is a collective experience and I have cried many times during our events. We also use a lot of humor. It is the only way to tackle these scary topics. Speaking about the scale of this catastrophe and the destruction in a serious way feels like a trap. Sometimes I lay down, I look at my daughter, and I start thinking about death. These thoughts are inevitable. And I think: “Wow, I’ve lived a fantastic life”. And then I think that I should give access to my bank accounts to another person, in case I die today because I forgot to transfer the donations from yesterday. *laughs* I would love to go on holiday!

Chat GPT is the AI chat bot that is taking over the internet. At first glance it seems amazing and feels almost straight out of a Sci-Fi movie. It seems like a total game-changer. As a researcher and PhD student at King’s College London, my days consist of balancing my time between lots of different projects. From basic admin to data analysis and writing papers, on numerous different projects. When I first started to use ChatGPT I was trying to write some code that would help me analyse my data. I couldn’t work out why it wasn’t working, and previously I would have spent potentially hours re-writing and fiddling to make it work. But on this day, I copied the code into ChatGPT and asked it what the issue was. Within 5 minutes my code was working, and I had saved myself time and effort that I could now put towards the next task on my list. To me, this felt priceless, I saw a future where this technology could massively help with my workload, productivity, and wellbeing. By saving time on easier tasks, it can give us the space and time to focus on what really matters in our work. As a researcher in mental health, I was keen to investigate if there are any potential uses for this technology for improving mental wellbeing, above and beyond helping with productivity. I decided to ask an expert, ChatGPT itself. This is what this sophisticated AI model had to say about the pros and cons of itself and its’ potential impact on our mental wellbeing. OpenAI's ChatGPT is changing the game of ‘natural language’ processing as we know it. This powerful model has the ability to understand and process ‘natural language’ input, making conversations with ChatGPT almost as seamless as talking to a real person. Trained on a massive amount of data, ChatGPT's responses are often so human-like that it's hard to tell the difference between its responses and that of a flesh-and-blood conversationalist. With ChatGPT, the possibilities for language learning and communication are endless. As we continue to witness the impressive advancements in ‘natural language processing technology’, it's clear that ChatGPT and models like it will continue to reshape the way we interact with and understand language in our daily lives. How can ChatGPT help with our wellbeing? The emergence of ChatGPT has the potential to transform the mental health landscape in several ways. First and foremost, it provides a safe and non-judgmental space for people to discuss their mental health concerns. Many people find it difficult to open up about their struggles with mental health, even to friends and family members. ChatGPT can provide a confidential and anonymous platform for individuals to share their experiences and seek advice. In addition to providing a safe space for discussion, ChatGPT can also offer valuable insights and resources. The model is capable of analysing a user's input and generating personalized responses based on their unique needs and circumstances. For example, if someone expresses feelings of anxiety, ChatGPT can provide coping strategies and recommend resources such as meditation apps or therapy services. One potential concern with ChatGPT is the risk of over-reliance. While the model is an impressive tool, it is not a substitute for human interaction and support. It's essential to remember that ChatGPT is an AI system and not a licensed therapist or medical professional. It's crucial that individuals seek professional help if they are experiencing severe mental health concerns. Chat GPT can also be a useful tool for individuals who struggle with time management or organization. The model can help break down complex tasks into manageable steps and provide guidance on how to approach different types of assignments. This can help reduce stress and anxiety associated with feeling overwhelmed or unsure of where to start. Additionally, it can assist with research and fact-checking, which can help reduce stress and anxiety associated with completing tasks that require a high level of accuracy and attention to detail. By providing accurate and reliable information, Chat GPT can help individuals feel more confident in their work and reduce the risk of errors or mistakes. However, if individuals become too dependent on the model, they may struggle to develop their critical thinking and problem-solving skills, which can negatively impact their mental wellbeing over time. Additionally, relying solely on Chat GPT can lead to a lack of engagement and satisfaction in one's work, which can contribute to feelings of boredom or burnout. It's important to strike a balance between using Chat GPT as a tool and developing one's own skills and abilities. Individuals should use Chat GPT as a supplement to their own knowledge and expertise, rather than a replacement for it. By doing so, they can reap the benefits of the model while also maintaining a sense of agency and ownership over their work. So that’s what ChatGPT thinks about itself, what do I think? I think Chat GPT has the potential to be a powerful tool to transform our daily lives. For mental wellbeing I think AI models like this could be useful for basic signposting, providing resources and even strategies to individuals who are experiencing difficulties with their mental health. It is not a million miles away from the use of computerised CBT programmes such as Silvercloud in primary care mental health services in the NHS. The main difference is that the advice is given by an algorithm, not a professional. In fact, AI chat bots have even been shown to be reliable as a tool for assessing clients seeking mental health support, potentially opening up a role for this technology in mental health triage. Inevitably though, a huge part of mental health care relies on the therapeutic relationship between a client and a practitioner. Therefore, I think the uses in this area will be extremely limited. But what about for our over-all wellbeing? AI models like ChatGPT have the potential to reduce occupational stress which can happen when the requirements of a job do not match the our own capabilities or resources. By providing ‘short cuts’ for time consuming, but menial tasks, ChatGPT can help to extend our time and resources, and potentially reduce our occupational stress. The negative impact of occupational stress on our mental health has been widely reported, with special focus being placed on ‘key worker’ occupations such as teaching and nursing. Therefore, implementation of ‘productivity hacks’ using AI models like ChatGPT to decrease our workload has the potential to improve workers’ and students’ wellbeing. However, I am acutely aware of the downsides to this technology. Firstly, no AI model is perfect. ChatGPT will make mistakes and its’ inability to think creatively or critically clearly limits the potential for what it can create. While it can write a semi-decent blog, it can’t write your whole PhD thesis for you, or any other piece of work which requires independent or critical thinking. Over reliance on technology like this will inevitably lead to poor outcomes and it is important that we are disciplined enough to put in the effort to create unique, independent and creative work.

When you hear ‘eating disorder’, there’s probably a particular image that comes to mind – a white, teenage girl, emaciated, anorexic. While, yes, this is reality for many young women, it’s also an extremely unhelpful stereotype of these deadly illnesses, and an eating disorder definitely isn’t ‘one size fits all.’ These mental health disorders come in all shapes and sizes, all backgrounds, all genders, all races, all sexualities, and all ages. Eating disorders don’t discriminate. The fact is: perpetuating myths and stereotypes relating to eating disorders only prolongs suffering. It prevents people from seeking help because they believe they aren’t sick enough. It continues to allow young people to grow up in a society where toxic relationships with food are normalised and promotes the idea that you have to fit a certain mould to have a problem worth treating. It’s hard, of course it is. Dismantling stereotypes and your own biases takes time. As someone with an eating disorder, who has written several articles now for Inspire the Mind on the topic, and who has been in active recovery for many years, dissecting my own harmful beliefs about my illness has been challenging. I’ve had to completely shift the way I look at my recovery to understand that I actually am sick, and that has been brutal to come to terms with. I’ve opened my eyes to the various forms an eating disorder can take, which now only makes me angrier that these misconceptions are so prevalent. So, let’s do some myth busting. MYTH: Only girls get eating disorders. FACT: Eating disorders don’t discriminate by gender. Eating disorders are not exclusively female illnesses. It’s reported that 25% of sufferers are thought to be male, and even that percentage is likely to be inaccurate, given that not everyone feels able to seek help. In fact, 1 in 3 men say they’ve never even tried to get treatment for a potential eating disorder, and 1 in 5 men have never spoken to anyone about their struggles. Alas, stereotypes around masculinity and ‘strength’ are so aggressive, and they teach us that to be diagnosed with a mental illness is to be ‘weak.’ This isn’t the case and dismantling this idea will save lives. Also according to a report by eating disorder charity Beat, 4 in 5 men have actually said that raising awareness about the reality of eating disorders will allow more men to access treatment. MYTH: Eating disorders mostly affect white people. FACT: Eating disorders can affect any race. Research in various forms over the years has shown that people incorrectly believe eating disorders are much more common in white people. As a result, Black, Asian, and minority ethnic groups feel less confident than white people in seeking help for their eating disorder symptoms. Black women specifically are statistically less likely to receive treatment for an eating disorder than their white counterparts. Eating disorders are, by nature, such secretive illnesses. So, when you add other factors on top of that, such as ethnic stereotypes and cultural expectations? It’s a cocktail for disaster. Eating disorders aren’t a white person’s illness – they transcend race. The sooner this is recognised, the sooner everyone can be helped. MYTH: Only straight people have eating disorders. FACT: The rates of eating disorders amongst the LGBTQ+ community are alarming. Mental health struggles are increasingly common among the LGBTQ+ community – and eating disorders are no exception. Studies have shown that young LGBTQ+ people are more likely to suffer from an eating disorder. It’s difficult to identify their exact causes, however, there’s no denying that LGBTQ+ folk may be at greater risk of experiencing low self-esteem, anxiety about their identity or body dissatisfaction, which can, and does, worsen an existing eating disorder or lead to one developing. Sadly, 37% of lesbian, gay, or bisexual people have said they would not feel confident seeking help for a suspected eating disorder, compared to 24% of straight people, Parliamentary research has found. As a queer person myself, I know all too well the fears that come with being honest with professionals about who I am, yet I also understand that secrecy and anxiety only allows my eating disorder to thrive. MYTH: Eating disorders are children’s illnesses. FACT: Anyone of any age can have an eating disorder. I will never forget the woman in her 60s under my eating disorder service. I never met her, nor did I ever speak to her, but a previous nurse would often mention her to me during our sessions, and my heart would ache every time for how much time this illness had stolen from her. I often wonder where she is now, and if she’s able to freely enjoy life with her grandchildren as she hoped. Many people believe eating disorders predominantly affect young people, but this is incorrect. In fact, research from the NHS information centre showed that up to 6.4% of all adults have displayed signs of an eating disorder. So, we need to change this mistruth, especially as early intervention is key. Eating disorders aren’t something you ‘grow out of.’ Suggesting as such completely trivialises and undermines their severity. Whether a person struggles with an eating disorder from adolescence through to old age, or their eating disorder develops in later life as the result of a traumatic event, these illnesses don’t discriminate by age. These ailments must be tackled with the same commitment and compassion in teens and older adults. MYTH: Anorexia and bulimia are the only serious eating disorders. FACT: The Diagnostic and Statistical Manual (DSM-5) recognises seven classifications of eating disorders. You’d be forgiven for assuming there are only two types of serious eating disorder, as anorexia and bulimia tend to be given the spotlight most often. Whether it’s in documentaries or fictionalised portrayals in movies, those two are typically painted as the deadliest. The DSM is a diagnostic tool and reference book classifies mental disorders using standard criteria. It is used by healthcare professionals as an authoritative guide to mental illnesses. As of the latest version, the DSM-5, seven types of eating disorders are recognised: Anorexia nervosa (restricting food intake to keep weight as low as possible). Bulimia nervosa (eating large quantities of food, and then trying to compensate for that by vomiting, taking laxatives or diuretics, fasting, or exercising excessively). Binge eating disorder (BED) (regularly eating a lot of food over a short period of time until uncomfortably full). Avoidant restrictive food intake disorder (AFRID) (avoiding certain foods for reasons other than weight/body image). Pica (eating things not usually considered food). Rumination disorder (chewing food, spitting it out, re-chewing). Other specified feeding and eating disorders (OSFED) (symptoms similar to one or more eating disorders, but not meeting all the criteria). The National Institute for Health and Care Excellence (NICE) also reports that atypical eating disorders are actually the most common, whereas anorexia nervosa is the least common. So yes, it is true that anorexia and bulimia often lead to people being very physically unwell, and they do cause fatalities. But treating them as the only eating disorders worthy of treatment means others suffer in silence. MYTH: You must be underweight to have an eating disorder. FACT: Eating disorders do not have a weight limit. The very thin image associated with eating disorders is pervasive. Admittedly, it’s the first thing that comes to my mind when I think of an eating disorder, subconsciously. But you cannot tell if a person has an eating disorder merely by looking at them. In fact, fewer than 6% of people with eating disorders are medically classed as 'underweight'. Of course, weight is often used for guidance in treatment, and this can be absolutely necessary, but eating disorders are not solely weight disorders. Suggesting as such shuns those who actually gain weight as part of their symptoms. Furthermore, suggesting that you must be underweight to have an eating disorder implies that recovery is simply about putting weight on and learning how to eat again. This couldn’t be further from the truth. Recovery is a long, complex process full of ups and downs. MYTH: Having an eating disorder is just about wanting to be skinny. FACT: An eating disorder is not a choice. Vanity plays a role in my eating disorder. I will admit that. But, my eating disorder is not a lifestyle choice. It is not comparable to a diet or the latest TikTok wellness trend. Over time, it has also snowballed into a whole entity beyond my comprehension. Even if it started as vanity, it is now so much more complicated than I could’ve ever anticipated. An eating disorder can derive from stressful life events and is often a coping mechanism for trauma. Therefore, when we tell people that they have ‘chosen’ to engage in disordered eating behaviours, we are telling them that they are choosing to suffer. We are placing the blame onto them. We are telling them it is their fault that they are sick. And this is never helpful when a person is trying to get better. Ultimately, what I want to make clear is: there isn’t one way to have an eating disorder. Suggesting otherwise only increases the shame and stigma attached to them, and with people’s lives being taken by eating disorders on a daily basis, we can no longer afford for this to happen.

A prospective interdisciplinary curriculum integrating arts, health, and humanities at King’s College London A group of academics at King’s College London are working together to develop a new flexible interdisciplinary curriculum focused on arts, health, and humanities to provide students with a diverse sub-set of skills and experience after graduation, and for employability. Last summer, a two-day workshop called ‘FLEXchange’ took place at King’s College London. The event provided a unique space to listen and receive feedback from King’s students, academics, as well as prospective students, on their views of the development of this new prospective interdisciplinary curriculum. Inspire the Mind reported on the event — we had a presence there to collect input from attendees. Our previous blog Reflecting on Day 1 of FLEXchange: An Interdisciplinary Curriculum Development Workshop in Arts, Health and Humanities at King’s College London, discusses in detail of the presentations and activities that were held on the first day of this two day workshop series. We have written a full report on the overall outcomes and this article aims to summarise the report. A quick recap of day 1: Artist Celia Pym shared a beautiful story about how her passion for knitting to mend clothes for her loved ones gave her a profound experience to reflect on the memories that they had together, Celia described that “garments tell stories and a narrative of physical body and the person themselves, the memories of the person i.e., occupation, gender — ultimately who they are”. We also heard from academics including Dr Alex Mermikides and Dr Flora Smyth–Zahra, on various student led projects incorporating arts, health and humanities. An example shared of art interventions was the SHAPER Project with its ‘Melodies for Mums’ programme, aiming to help mothers experiencing postnatal depression, and how this has been integrated into healthcare services. The first day to the workshop was nicely concluded with a great example of a collaborative research project bringing together scientists and artists presented by Professor Seb Crutch, and artist Charlie Harrison. They told us how drawing could be used to help understand the progression of neurodegenerative diseases such as Dementia. A rundown of day 2: Day 2 of the workshop was once again filled with great guest speakers, presentations, and creative art activities for participants to practice — but this time, with a particular focus on how this interdisciplinary approach has been implemented into many different employment sectors. The morning started with a presentation from organisations ‘Creative UK’ and ‘Breathe’ — an NHS led intervention group incorporating arts into the healthcare sector, giving the spotlight to their recent project called Breathe Magic. This initiative helps children with hemiplegia (a condition that causes paralysis on one side of the body) to perform a variety of different magic tricks to help improve their hand coordination. It provides an innovative method from standard physiotherapy by incorporating creativity, and its fun for the children to do. In the afternoon, a group exercise had participants rolling up their sleeves once again, this time to design their own interdisciplinary project focused on healthcare. How have arts, health and humanities helped students in their own learning? Part of Inspire the Mind’s role, throughout the event, was to conduct a series of interviews where we listened to the feedback from participants, including current university students, prospective students, and academics, all sharing how they felt about the possible curriculum, and providing their own ideas on what they would like to see it become. When we spoke with current students from King’s College London, it was interesting to hear about their own experiences of learning about art, health, and humanities, and how this had provided a useful tool in facilitating their own learning journey. One student mentioned that drawing had helped them to understand difficult concepts in science classes and further suggested that using imagery would be useful for students who are visual learners. A medical student mentioned that undertaking film and photography subjects — studies which were vastly different from their ongoing medical degree — helped them to better understand the impact of health on daily life. They also noted that such opportunities enabled them to enhance core skills such as communication and a better insight into their work profession, when they become a doctor after graduation. Another student beautifully highlighted: “Everyone has different hobbies and interests, and to learn something new out of your profession makes you a more complete human being” It is very clear by speaking to students that where they have had the opportunity, art, health and humanities has only helped them with their studies and demonstrated how easily and beneficially art can be used across different subjects. It was also important to listen to prospective university students who could share how an interdisciplinary curriculum would be important for them as they look to apply for, and begin degrees. One prospective student shared their experience of learning humanities at school and how this gave them the tools to be able to better discuss important topics on societal matters. They also suggested that when starting university, they would be interested in using this interdisciplinary approach to understand wellbeing for students. This reflects back to the presentations delivered by Professor Carmine Pariante and from Breathe on how different forms of art, such as singing interventions, have been implemented across mental health. Finally, a key question that we asked academics about this interdisciplinary curriculum was how we could bring science and art communities together. It was interesting to listen to the responses of academics who have highlighted that there needs to be a shift, by academics, to be able to explore areas that are outside of their initial interests. One academic highlighted that collaboration between scientists and artists is not a novel concept: “Artists and scientists have been collaborating for a very long time, especially when it comes to health discipline and health sectors. I mean for a very long-time, scientists, biomedical scientists, have been thinking about ethics, literature, philosophy, and humanities in general and how it feeds into the medical practice”. They also mentioned that digital technology could contribute to enhancing this drive forward — which was an interesting reoccurring theme that came up in group discussions throughout the event. Overall, the feedback from participants gives a nice snapshot of how the interdisciplinary approach would be very welcomed by both students and academics, and how implementing artistic crafts could be beneficial for students’ own learning at university and self-development. It was interesting to also receive feedback from prospective students on topics they would be interested in exploring within this curriculum. Thank you to all the attendees for their valuable feedback about the development of this new curriculum and to the organisers for arranging such an insightful workshop. I just want to conclude with a statement from Professor Shitij Kapur, President and Principal at King’s College London that nicely illustrates the FLEXchange initiative: “At FLEXchange we hope to demonstrate that this way of working is incredibly valuable, not only because of the outputs that will emerge, but the unique experiences and insights people have gained from these collaborations. If successful, FLEXchange will act as a blueprint for curriculum development across King’s”