There have long been calls to reform or change the way we look and talk about education in the UK, but never has it been talked about so much since the Coronavirus pandemic. What would have been an already stressful period for those leading up to taking exams, was amplified by disrupted learning and uncertainty. Yet, what wavered rarely during this period was the high standards of academic achievement that many students were held to. As someone who completed their A-Level ‘exams’ this year, but has struggled with academic pressure since I was about twelve, I had sleepless nights for weeks over how I would be graded. I was halfway through Year 12 in sixth form when the UK went into its first lockdown. Slightly startled by the sudden plunge into home-learning, I managed to maintain my hard-working attitude. I didn’t realise it at the time, but lockdown would make me rethink my entire attitude towards the education system. Learning vs. The Education System Ever since I can remember, I have always been a “pleasure to have in class”, a common buzz-phrase amongst teachers at parent’s evenings and meetings. As I am writing this, it is the day before my A-Level results day, and I am still hoping for a place at university. Despite all the reflection I have had about academia, the education system, and the pressure placed on myself, I am still extremely anxious, knowing the results I receive will undeniably impact my mental health. I worked tirelessly throughout the pandemic, as if it were a normal school timetable, waking up at 8am, working between 9am to 3pm, maybe up until 1pm nearer the end. This ultimately left me feeling extremely burnt out. I remember having a conversation with a friend as summer started to near, saying “I love learning, but I hate the education system”. And it’s true. I read constantly, both fiction and non-fiction, watch documentaries, listen to podcasts etc. and this isn’t a ‘look at me and everything I do’ brag, but to show that learning truly is a pleasure of mine. However, constant examinations, and being seen as a grade more than I am seen as a person, has naturally taken its toll on me. So, as someone who loves to learn, I started to do some research on academic stress and the impact of seeking validation from it. The Impact of Stress Having panic attacks the night before exams and feeling so nervous I couldn’t sit still are vivid memories of mine, as they are for a lot of my peers too. Leading up to big examinations, such as GCSEs and A-Levels, many will say that stress can be a good thing, the kick we need to remain motivated. But I wanted to check this theory out for myself. A 2020 study looking at the impact of stress on students in secondary school and higher education found that academic-related stress can lead to the development of mental health issues, such as depression and anxiety. It also found that academic stress can result in substance use, disrupted sleep, and an increase in developing physical health problems later in life. But what I found most interesting, and alarming, is the following finding: “students with higher perceived stress are likely to have lower academic achievement”. All this pressure I have placed on myself to do well could have actually hindered me, yet academic stress is extremely normalised within education. It made me wonder what we would see if students’ mental health was prioritised over exam results. Exams, Exams, Exams Prior to the Coronavirus pandemic, both GCSE and A-Level students were assessed by end of year exams, with some subjects also incorporating coursework. Years of hard work and learning boiled down to a two-hour exam in an eerie school hall. The examination system and the process of how grades are awarded in the UK mean that a student could be performing at an A-grade level throughout their course but end up with a C-grade if the day of the exam simply didn’t go their way. There are many sides to the argument about exams. Some argue we should have exams, others believe we should scrap them altogether, and many have points of view in between, but it cannot be denied that exams are having a negative effect on students’ mental health. Between 2015 and 2018, the NSPCC reported that the number of referrals by schools in England seeking mental health treatment for students increased by more than a third. A survey conducted by London Metropolitan University suggests that this directly links to the exam season. This year, the buzz phrase around results day was ‘grade inflation’: the idea that students had ‘got it easy’ due to the cancellation of exams and the way that grades were awarded. As an A-Level student myself, I find this point of view insulting, because my learning was far from easy. I argue that gathering a student’s classwork, homework, and past classroom examinations results is a more honest grade than a final exam at the end of your course. Perhaps we should be wondering if it’s time to rethink the way we grade students. My Experience Researching the effects of academic stress resonated with me deeply. It was a part of my life so normalised and accepted, that sleepless nights were expected. A few years ago, when I was struggling with severe depression, I began to heavily base my self-worth on my grades and academic achievement. Feeling useless and fed up meant that I became reliant on praise through my teachers and school. I often buried myself in schoolwork, using it as a distraction from my real problems, and a way to avoid spending time with friends or family. So, when I would inevitably burn out due to academic stress and unresolved mental health problems, my mood would deteriorate. I was stuck in a vicious cycle of feeling depressed and unmotivated, putting pressure on myself to do well academically, and if I did not reach my self-imposed standards, I would sink deeper into a depressive episode. Thankfully, after eventually getting help for my depression, I was able to sever the ties between my mood and my grades. But that did not mean that I still didn’t feel enormous pressure to do well when it came to exams. I just have to remind myself that there is much more to life than grades, and that’s something we need to remind students all across the world too. USEFUL Resources: Student Minds: https://www.studentminds.org.uk/examstress.html Young Minds: https://www.youngminds.org.uk/young-person/blog/how-to-look-after-your-mental-health-during-revision-and-exams/ Childline: https://www.childline.org.uk/info-advice/school-college-and-work/school-college/ NHS: https://www.nhs.uk/mental-health/children-and-young-adults/advice-for-parents/help-your-child-beat-exam-stress/

As a humanitarian, I have always wanted to focus on making a change and get talking about topics that are often ignored. This is one of the main reasons I chose a career in global health as a researcher, and another reason for co-founding a non-profit organisation, Identity International, a platform that aims to create social awareness regarding various topics that define our identities. Like many individuals, mental health has always been a part of my life, and a big part of my identity. As someone from an Iranian background, there is no doubt that my ethnicity and culture have affected the way I recognise and talk about my mental health. As a working researcher over the past year, it has also been difficult to miss the many negative impacts of the COVID-19 pandemic on the mental health of individuals around the world. Studies have noted that the pandemic has had a disproportionate impact on society’s most vulnerable, including those with pre-existing mental health conditions. This has also had a toll on the mental health of ethnic minorities in the UK, who were already facing significant mental health inequalities before the pandemic. BAME (black and ethnic minority) men and women have experienced a higher average increase in mental distress than White British men during the course of the pandemic. Financial cuts and limited access to mental health facilities and care during this time has also undoubtedly had a negative effect on this group. The Black Lives Matter movement during the summer of 2020 has also helped provide more information regarding young black people’s mental health. Recent research has shown that they appear to be at high risk, both in terms of COVID-19 and of experiencing poor mental health. Similarly, young Black men between the ages of 16–25 have been amongst the hardest hit by job losses, a factor that has led to higher levels of mental distress. Many of these factors inspired us to get talking about the topic at Identity International, leading us to create the “Minority Mental Health project”, as part of our #BeyondStigma campaign. The campaign involved us asking various individuals from different ethnic backgrounds about their mental health experiences in the UK. In particular, the project found various themes on minority mental health that must be addressed: Stigmatisation and lack of awareness It is undeniable that globally, individuals with mental health problems experience multiple levels of stigmatisation: social exclusion, discrimination and prejudice. This can have various negative impacts on an individual, such as causing low self-esteem, and can also stop individuals from reaching out for effective treatment and care. However, both our campaign and other research has found that this stigma towards mental illness is significantly higher among ethnic minority groups. As individuals from our campaign pointed out: “Therapy is often seen as “weird” or “unusual” or as a sign that someone is not normal, especially in Middle Eastern cultures, where therapy is a taboo subject, and stating that one wants to seek therapy is not usually perceived as something positive, but rather as something worrying. You will be told that therapy is not needed, and that you are just exaggerating and that a 5-minute conversation with your parents will sort it out” - Anonymous Another individual pointed out that: “I think the problem when it comes to mental health in ethnic minorities would be social stigma and stereotyping. I think there’s often this notion that when people come out as depressed or even with anxiety or schizophrenia, that they’re diseased, they’re mad, they’re crazy…” - Anonymous This topic of stigmatisation was highly evident across the majority of our submissions and has been a key aspect found in existing scientific research on the topic. Racism Research has also shown that experiencing racism and stigma regarding your race, ethnicity or religion has caused poor mental health and psychological distress for various ethnic minorities in the UK. In turn, this can influence the way you think about yourself, set difficult societal expectations, and affect how you access services. This was mentioned by mental health nurse, Judy Thomas: “If you’re having to constantly worry about stigmas that are attached to your culture and/or race, the last thing you want is another stigma surrounding mental health on you too, so you may not take up any available services and you may not allow yourself to be seen” - Nurse Judy Thomas The COVID-19 pandemic has also fuelled Anti-Asian Racism and Xenophobia, causing a rise in reports of verbal harassment, insults and violent attacks in schools, workplaces and public settings. This rise in discrimination has led to increases in anxiety, depression and sleep problems amongst those who are targeted, even though access to mental health services still remains low for this group. Barriers to services Accessing mental health care and resources requires the overcoming of many cultural and social stigmas for many ethnic minorities. In turn, this means many are left without treatment and care, which can cause further distress in the long run. Muslim communities in particular are disempowered in the utilisation of these services, while older South Asian women are at high risk of suicide. Black women are also more likely to experience anxiety and depression than most other groups. Moreover, studies have shown that the relationship between ethnic minority service users and health care providers have been affected by many factors, including prolonged waiting times, language barriers, poor communication, power imbalances and cultural naivety, and insensitivity and discrimination from healthcare providers. As one of the submissions stated: “I think empathy is so important for patients, and being British Indian, I think I’ve experienced from different therapists, this inability to put themselves in my shoes. I think a big part of that is the lack of representation within the sector itself. I have gone to India to seek therapy, but then again there’s this issue there with them being unable to put themselves in my shoes because they don’t understand my identity from the Western perspective, whereas in the West, they can’t understand my identity from my Indian side” - Anonymous The Future During a time, such as the one we are currently living in, it is now more essential than ever to bring light to these inequalities. In order to overcome the barriers mentioned above, a wide range of actions can be taken. Personally, I believe the following steps can help ensure better mental health experiences for individuals from different ethnic backgrounds: 1) Culturally appropriate treatment and interventions: Providing mental health services to individuals from BAME backgrounds should be culturally appropriate and should be monitored in order to help avoid any problems which usually arise, such as power imbalances, insensitivity and discrimination. Where possible, it is great to provide healthcare providers with the appropriate training and education surrounding the topic. Other suggestions include meeting faith-related and religious needs, providing gender-specific services and staff, increasing diversity within the staff and improving language barriers, such as translating, interpreting and providing literacy support. 2) Reducing cultural stigmatisation towards mental health: It is clear that there remains a significant amount of stigma towards the topic of mental health within different cultures and ethnic groups. It is vital that community-level interventions aim to reduce these stigmas through their public messaging. The media can also play a significant role in reducing this stigma and cultural biases towards the topic. 3) Listening Many ethnic minorities often feel ignored and feel as if their health problems are not being addressed by the public, the government and health providers. It is time to address this by listening to individuals from different backgrounds, including refugees, asylum seekers and individuals from indigenous backgrounds, and encouraging them to take the lead on a variety of projects and interventions. You can access a number of resources and services which are available for the mental health care of different ethnic minority groups: If you want more information on the mental health of BAME communities, you can read more here. Organisations such as the Black, African and Asian Therapy Network (BAATN) can help you connect and speak to therapists from the same background as you, while The Black, African and Asian Therapy Network provides a directory of Black, Asian and ethnic minority counsellors and psychotherapists across the UK. Black Minds Matter UK also provide free mental health support for black people. For health professionals: ACA Therapy holds monthly therapy groups for Black Mental Health practitioners in order to discuss racial issues within the society. The Qalb Centre provides free counselling and support for Asian, African and African Caribbean people, along with a support group for women and couples. For London-based individuals: The Waltham Forest Black People’s Mental Health Association charity offers advocacy, wellbeing and day care services for Black Mental Health users. You can also access free services and support groups for Black and Ethnic minorities surviving mental health issues at Kindred Spirits in Southwark. They also provide frequent women-only support groups. For anyone experiencing language barriers, the Nasfiyat Intercultural Therapy provides intercultural psychotherapy and counselling services in over 20 languages. Enfield Saheli is a voluntary group run by women for women from Asian Descent.

Here's How I Improve My Body Image Trigger warning: The following blog contains discussions about body dysmorphia and explicit descriptions of body dysmorphia itself. Some readers may find this distressing. Body Dysmorphic Disorder (BDD) is something I have battled with for two and a half years, and at many points in my life, I thought it would never get easier. Thankfully, I am here to say that it does get better, as corny as the phrase is. Whilst BDD is experienced by roughly 0.5% of the UK population, so many still suffer from body image insecurities. The NHS defines BDD as “a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others.” The ‘flaws’ are different from person to person, but each case of BDD is a difficult as the last. As a student, coping with BDD whilst taking exams and studying sometimes became a real struggle. So, I decided to start writing published pieces, to help others who may be struggling just like I was. BDD started to really affect me during my GCSEs when I was 15 — coincidently the same age I started writing. In fact, parts of it were so traumatising that I can’t remember a lot of that year. As I progressed with my recovery, I found that writing about my experiences and emotions really helped me come to terms with what I was going through. Now, as I plan to go to university in September, I feel I understand how to balance my mental health and education. Over time, I have learnt what helps me personally combat my body dysmorphia. This is a discussion of my personal experience and does not reflect the experience of everybody who struggles with BDD. My Experience Everybody’s experience with Body Dysmorphia is personal, and I do not speak for every person who has ever suffered from BDD. But if I were to describe the experience in one word, it would be terrifying. It is unnerving to not recognise myself in the mirror, to have my perceived ‘flaws’ exaggerated by my mind. One way I try to describe it to people is this: imagine everywhere you look is like the hall of mirrors in a circus, where your reflection is heavily distorted. The ones that make your face droop, and make your body look spherical. That’s what I would see every time I looked in the mirror. I look back on photos of myself where I cried because I thought I looked horrible. Now that I’m in a much better, and healthier space, I can see that I look perfectly fine. BDD takes so much away from those who have it. I almost missed my best friend’s birthday party because I cried for an hour straight thinking I looked hideous and that I could not possibly go. Some of my favourite memories with my friends are from that night. What if I’d given into the disorder? Understanding the illness The one thing I have found crucial to overcoming my body dysmorphia is understanding the illness. BDD is so rarely talked about, that I didn’t even know what it was until I had conversations with mental health professionals. Once you start to understand that it’s a mental illness, and not a literal physical change to your body, you gradually become more rational when dealing with body image issues. But whilst physical features of your body aren’t changing like you may perceive, evidence suggests that BDD does have neurobiological effects. Research has shown that BDD can cause abnormalities in areas of cognitive functioning and may cause visual memory deficiencies. But how do you understand the illness? Well, therapy was what worked for me, but that’s not always accessible to everybody. Doing research on websites such as Mind.com and the NHS’s website, amongst others, could also be useful and help you grasp what’s potentially causing these thoughts, and how you can combat them. Cognitive Behavioural Therapy (CBT) Cognitive Behavioural Therapy, also known as CBT, was one of the crucial factors in helping me overcome my BDD. The NHS describes CBT as a “talking therapy that can help you manage your problems by changing the way you think and behave”. One of the main problems with BDD is that you get trapped in a cycle of negative thinking which perpetuates unrealistic and negative body image perceptions. I found that when I was in a negative mindset, I would perceive my body as ‘worse’ than I did when I was in a more positive mindset. Taking on CBT allowed me to talk through my thought process with a professional, who could then help me recognise the irrationality of my views, whilst also offering ways to help break the vicious cycle. Now, if I catch myself looking in the mirror, and can sense damaging ideas creeping into the back of my mind, I walk away and occupy myself with something else that isn’t harmful, perhaps reading, or watching a favourite movie. By cutting off the negative thoughts before they can even start to affect me, I begin to take control of my own mind, and weaken the damaging effect my BDD can have on me. Acceptance Like many illnesses, there are moments where I find my BDD completely overwhelming. In fact, at the time of writing this, I had moments like this only a few days ago. It’s a lot harder to try and fight against the disorder, than it is to give into it. Trying to muster up the energy to implement therapeutic techniques, and challenge the thoughts in my head, can be exhausting. Whenever my BDD starts to become challenging, I feel almost ashamed, like I should be fine now, that the disorder shouldn’t be able to affect me. But sometimes I just have to accept the thoughts, not believe them, but accept them. Accept the fact that I do not feel okay at that moment, and that there is nothing wrong with that. Instead of trying to bombard myself with positive thinking, I will make neutral comments about my body, such as “I have a stomach that allows me to digest food”. I may cover up the mirrors in my house, to avoid any self-scrutiny. In these moments, I have to become bigger than the illness, and nurture myself. Because even if I don’t feel amazing all the time, I still deserve love and happiness, to feel as comfortable as I can in my body, and you do too. If you are struggling and are in need of support, below are a few incredibly helpful organisations that provide both resources and direct help: Shout Crisis Text Line — you can text Shout to 85258 if you are experiencing a personal crisis, are unable to cope and need support. Talk to the Samaritans — they offer 24-hour emotional support in full confidence. You can call them for free on 116 123 Mind — find out more about Body Dysmorphic Disorder on their website — you can call the Mind Infoline on 0300 123 3393 / info@mind.org.uk, the Mind Legal Advice service on 0300 466 6463 / legal@mind.org.uk CALM (Campaign Against Living Miserably) offers a chat and hotlines service from 5pm to midnight 0800 58 58 58 Papyrus/HOPELINEUK (Suicide Prevention Charity) offers similar service for adolescents and young adults under the age of 35 from 9am to midnight 0800 068 4141 / pat@papyrus-uk.org Talk to your GP or Find out more about Body Dysmorphic Disorder on the NHS website

A huge issue facing us following the outbreak of COVID-19 is the number of people suffering from ongoing symptoms or long-COVID. Over 500,000 people in the UK have self-reported long-term symptoms following an infection. Long-COVID is characterised by ongoing symptoms even after the infection is cleared, and these can last months or even years! It has been described by doctors as having parallels with other chronic conditions called myalgic encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS), which are long-term syndromes categorised by intense levels of fatigue, often brought on after a viral infection. I am a researcher in mental health at King’s College London with personal experience of managing CFS and therefore have a vested interest in the way that this and similar conditions are discussed in the public sphere currently and how this may change after COVID. I was diagnosed with Lyme disease in the summer of 2018 and have been experiencing bouts of debilitating fatigue ever since. A few months after I was bitten by a tick on Clapham Common, and I stupidly ignored the subsequent rash on my leg, my whole body started to feel like it was breaking down. It hurt to move, and I couldn’t think straight. I found myself confined to my flat as even the walk to Sainsbury's left me feeling as if I had run a marathon. My body took about 3 months and a huge course of antibiotics to finally feel back to ‘normal’. After this ordeal, I was so grateful to finally have my life back and be able to work, socialise and exercise again. However, the familiar symptoms soon crept back. I spent hours in doctors’ offices trying to work out what was happening. It was no longer a Lyme infection or any other illness that could be easily diagnosed. So, what was wrong with me? After a few months, I finally got an answer. A case of post-viral chronic fatigue syndrome. I was told that there was no treatment to be had; ”Just try to be as healthy as possible” — easier said than done! Of course, there has been research into possible treatments and therapies for chronic fatigue. A study called the ‘PACE’ trial published results in 2011 showing promising effects of Graded Exercise Therapy in the treatment of CFS/ME. However, this study raised a huge amount of controversy in the media, partly due to the fact that it seemed to emphasise that these conditions were psychiatric in nature and could be treated as such. This led to frustration and anger from patients and advocates who once again felt the biological nature of their illness was being undermined. More recently, the NICE guidelines for CFS/ME have been adjusted to advise patients to “stay within their energy envelope” to avoid a flare up of symptoms. Interventions such as graded exercise therapy and cognitive behavioural therapy are no longer recommended. The chronic balancing act The 3 years that followed my infection have been a constant balancing act. I have periods of normality and, honestly, almost forget that I am sick. I start to fall back into my normal London life of working full-time with dinner parties, netball matches, pub trips and exercise classes filling every spare hour I’m not sleeping or working. And then it hits me again. Suddenly, I can no longer get up the stairs to my flat without feeling breathless; my brain feels like cotton wool and by 3pm my body is aching as if I have been doing hours of manual labour instead of sitting at a desk. Once this happens, I must stop. I cancel everything I can afford to and live a life of the ‘bare minimum’. This can last for weeks, but thankfully over the years these ‘flare ups’ have started to become shorter and more sporadic, for which I am incredibly grateful. In the world of CFS/ME this is referred to as ‘post-exertional malaise’ where periods of too much, or even ‘normal’ levels of activity result in a relapse of symptoms. Understandably these periods of symptom flare-ups have a huge impact on my mental health. It kills my self-esteem to suddenly be unable. My performance at work temporarily declines and I see myself as a terrible friend having to cancel on birthday dinners, workouts, and everything in between. I am suddenly worse at everything: making mistakes due to the inability to think straight, and not having the strength to do everything I want to do. The key to managing CFS/ME is to never overdo it and to “stay within your energy envelope”, as described in the newly updated NICE guidelines. Nisreen Alwan, an associate professor in Mental health, explained in a recent blog about Long-COVID in the BMJ “you have to drop your baseline by 90%; you are a different person.” Obviously, this is a very difficult thing to accept. Going from a healthy person to constantly adjusting to make allowances for your health on a long-term basis makes the psychological impact of these conditions enormous. Living with the stigma One of the hardest things about dealing with CFS/ME is not being understood and facing the huge stigma that follows these ‘invisible’ conditions. “But everyone’s tired”, “It’s all in your head”, “It’s not a real illness” are comments I have heard regularly over the last 3 years. As explained by Eleanor Byrne, in a recent blog for Inspire the Mind, a large part of the stigma around these conditions comes from the fact that they are not understood on a biological level. There are currently no diagnostic markers in the body that Doctors can pin-point to diagnose or treat CFS, which leads a lot of people to (wrongly) assert that the symptoms are purely psychological — it’s all in your head! However, progress has been made in research to point out clear physical changes that seem to be linked to the development of CFS including a reduced level of the stress hormone Cortisol, or an increase in inflammatory biomarkers such as TGF-β. This indicates that there are clear biological underpinnings to these conditions — even if we do not fully understand them yet! In my experience, the high rates of stigma and misunderstanding around these conditions are a huge social barrier to adequate management and symptom recovery. I have put off seeking medical help for my fatigue due to bad experiences with doctors in the past and fear of not being believed or taken seriously. But stigma is not limited to the medical field. I have forced myself to work and socialise when feeling at my absolute worst due to being too embarrassed to explain how I was feeling. After enough cynical comments, I convinced myself I was just lazy and not deserving of any help or recovery time, so I tried to push through the fatigue and force myself into my normal routine. This only made my flare ups last longer and become more frequent. One of the largest contributions to the stigma, I believe, is that chronic conditions aren’t linear. I can feel great for months before having another flare up. During a flare up, I can push myself to work extra hours on a project but then need to collapse on the sofa all weekend. I can understand why some people then find it difficult to comprehend, and struggle to accept, that I am not able to do everything. They question the legitimacy of my decisions to cancel certain obligations over others. Unfortunately, with CFS it is inevitable that compromises must be made, and at some point, I have to sacrifice somewhere, whether it be work or socialising. This can be very emotionally difficult as I also suffer from a chronic case of FOMO (fear of missing out). The emergence of Long-COVID When I first heard about long-COVID and the huge numbers of people struggling with debilitating fatigue following a coronavirus infection, it sounded all too familiar. This is just like me. And selfishly, I felt… relieved. Developing chronic fatigue has completely changed my life and Long-COVID will be a massive challenge not only physically, but mentally for those who have developed it. Adequate mental health provision needs to be put in place swiftly to support people with managing Long-COVID and other similar conditions to enable them to live functioning and fulfilling lives in society. However, from my experience, the most helpful thing we can all do in the short term to help individuals like myself with long-term fatigue is to treat them with understanding and empathy rather than cynicism. This will not only empower people to manage their condition in the way that suits them, also go some way to mitigate the huge psychological challenge that comes with developing these conditions. The emergence of ‘Long-COVID’ has sparked a lot of conversation in the public sphere around related conditions including ME/CFS including in a piece for the Guardian by Professor Carmine Pariante. I hope that the small silver lining of the pandemic and future challenge of Long-COVID will be more conversation, awareness, and research into these poorly understood conditions, and will result in, at least, more understanding and acceptance from the medical community and public as a whole.

Archaic portrayals of mental illness still bleed into the mainstream media of today. As exemplified by the uninspired notion of “crazy equals evil” recently seen in the hit Netflix original Bird Box (2018) and M. Night Shyamalan’s Split (2016), in a lot of modern science fiction these negative stereotypes subtly hinder the significant progress in stigma made in the last decade. On the contrary, drama films, like The Party’s Just Beginning (2018) or Short Term 12 (2013), deal with depression and trauma in ways which are more genuine to real-life sufferers of these afflictions and are far better instances of progressive depictions of individuals and their relationship with their mental health. Is genre the ultimate frontier for better depiction of mental health in films? The hit Netflix film Bird Box (2018), starring Sandra Bullock, takes place in a post-apocalyptic world with supernatural creatures of unknown origin driving people who see them to suicide. The plot is fairly straightforward and familiar to its genre; everything was great until The Big Bad Thing happened! Arguably an overdone schtick but it’s an enjoyable movie regardless. A pivotal development happens towards the end of the first act; there are a group of people who are immune to the persuasions of the monsters… Who are these people? Oh, of course! They are the patients who have broken out of an asylum for the criminally insane. How are they able to override the monsters’ influence? They’re just crazy, that’s how! It’s a superficial choice to explain a plot point which is irrelevant to the goal of the film and boils down to just creating a redundant secondary obstacle for the characters to overcome. Narratively, the impact that the writers intended (but failed) to create could have been made more meaningful; instead of writing a stigmatising plot point which villainises an already vulnerable population, they could have focussed on the individuals trapped in the house together, and their dysfunction. The film does do this for a bit, but it falls apart quickly with its unoriginal and predictable choice. Moreover, adding the sweet little detail of these people being criminally insane rather than your typical neuro-divergent folk, is just as perfect. That way, the fact that the protagonists want to defeat them is fine and justified. After all, they are violent criminals: all logic would point to the protagonists having to defend themselves. These words paint a scene in which “crazy people” are just as blood thirsty and evil as the Big Bad alien monster — a disgusting falsity. M. Night Shyamalan’s 2016 filmSplit is also guilty of further perpetuating the stereotype that people with mental illness are violent. Though a considerably better film, with the definitive feel that actual effort was put into making the writing coherent, when asking the question of how does this affect people’s view of mental illness, it’s hard not to pick-up on the issues. The film tells us that the dissociative identity disorder (DID, i.e., “multiple personalities”) is the reason for the character being murderous and destructive. The disorder is presented as the root of this, not the character himself. Moreover, the way that film’s clinicians discuss this character, paired with the writer/director’s critical acclaim, makes it seem as if it were grounded in truth, even though it is not. The film adds fuel to the fire of the stigmatisation of mental illness. The irony in all of this is that science fiction is a genre where the viewer goes in expecting dissonance from reality, yet negative portrayals of characters with mental illnesses do still influence the way that we perceive the people around us, even if we — the audience — are not fully aware of it. Comic books, and their movie counterparts, are famously known for their “crazy” villains. The fictional city of Gotham and it’s Arkham Asylum solely exists to remind you of that fact: mental illness and violence go hand in hand. Yet, when we step back into reality, we forget that this is simply untrue. Unlike with the science fiction and action genres, mental health in dramas is a far more prevalent plot point. Likewise, it is more honest and relatable to audiences than the offhand comments about how sick and evil a character often seen in those genres. Short Term 12, starring Oscar Award winner Brie Larson, delves deeper into the personal experiences of living with Post Traumatic Stress Disorder (PTSD). This is the story of social worker Grace and how she lives with her PTSD, brought on by years of abuse at the hands of her father. We see what triggers her PTSD and how this culminates in emotional outbursts, panic attacks, numbness, the inability to be intimate with her fiancée, and self-destructive behaviour. The film presents the messy and disruptive nature of PTSD without romanticising the character’s pain, and she is never ‘cured’ of her PTSD in order to be happy. Thoroughbreds (2017), The Party’s Just Beginning (2018), and another Brie Larson film, Room (2015), are three more examples of candid and compassionate portrayals of living with mental illness. Though these four films differ in their stories and the mental disorder that they cover, they are related. The four female protagonists have all experienced some sort of traumatic event, but — reflective of real life — they all respond differently to the trauma. Some become self-destructive, or emotionally absent, while others seek help. Some get better, some get worse. This sort of range is incredibly rare in films outside of the drama genre. Of course, drama movies do not do this just for the sake of being “true to life”. Drama writers are driven to create stories that are believable yet emotionally challenging. As audiences, we seek to relate to characters on a personal and emotional level, even if it means crying watching an actor’s “raw” performance. However, undoubtedly, the ultimate result is a more genuine depiction of human suffering and mental illness. Why is there such war between genres? Drama tends to focus more on emotional and relational development, whereas science fiction prioritises the overarching plot over the single character arch. This is why we typically see more vivid portrayals, of mental health and personal stories in general, in dramas, compared to action or science fiction flicks. However, although these films are somewhat limited by the constraints of their genre regarding the level of emotional depth they can convey, storytellers have a fundamental responsibility to depict characters’ experiences honestly. In fact, a good storyteller can push at these very boundaries and tell stories that go beyond the expected format. But, does this ever happen? We will discuss this in my next Episode, “Merging Genres for a Stronger Story”.

How is it that Daniel Radcliffe playing an undead amnesiac with superhuman abilities for 97 minutes in Swiss Army Man (2016) is somehow a better representation of the complexity of depression and mental illness than most other movies ever made? In my previous piece, I discussed how restraints and expectations within movie genres result in often stigmatising tropes about mental illness being presented to audiences, and how this impacts our perceptions and attitudes towards those with mental health problems. Conventional scriptwriting rules state that science-fiction and action flicks are comfortably full of unrealistic storylines, whilst drama leans more to ‘reality’. However, a great storyteller should be able to use such discrete genre conventions in a less rigid way. If staying true to life is the goal, then surely this fluidity would only help do that better. A fantastic movie, and an example of this, is the aforementioned Swiss Army Man. The film’s romanticism of life is mixed with humour, fantasy and simply odd premises — yet this exists without belittling the genuine feelings associated with depression. This is the story of Hank, a severely depressed castaway, attempting to commit suicide, and of how his hopelessness, helplessness, and desperation reanimate a washed-up corpse with absurd super-human abilities, whom Hank names Manny. Once Hank realises that he can maneuverer the corpse much like a swiss army knife (if a swiss army knife could chop down trees and shoot pebbles as bullets from its mouth), the two make plans to escape the island and get back to civilisation. Throughout the film, we see their growing, albeit strange, friendship. Manny doesn’t remember anything about his life before death, nor about much else, and Hank responds to the childlike Manny by teaching him about all sorts of concepts of life. Hank opens up to Manny about why he wanted to end his life — his pain, misery, and loneliness, even before becoming stranded on the island. Manny, through Hank’s incessant talking, learns again how to speak, and starts to express the same existentialist content and deep melancholy that Hank had expressed. As the movie progresses, a shift in their dynamic occurs. Noticing Manny’s growing hopelessness, Hank is now the one telling him about all the things that make life worth living. This is a life-like portrayal of depression: Hank teaching Manny about all the things that make people happy whilst he himself does not find peace in these things, reminds us of the fact that people with depression are aware of what should be making them happy, but simply knowing is not enough. Writers and directors Daniel Scheinert and Daniel Kwan manage to do this so well because they comfortably blur the lines between genres; there’s comedy, drama, fantasy, and science fiction A huge role is even played by the film score which acts almost as narrator, seamlessly transitioning one scene to the next. The demand for more honest stories, regardless of genre, has become significantly more apparent over the last decade. While mediums which allow our wants and opinions to be shared with the world have existed for some time, none come close in magnitude nor rapidity to social media. In the age of Twitter, Tumblr, and YouTube, content creators can see what audiences want with almost no difficulty. That being said, transparency to this degree comes with just as much bad as good; there is a risk that creators take advantage of knowing what audiences want, and use this information for monetary and social gain. In cinema, this pandering often results in uninteresting, one-dimensional side characters with mental health problems whose entire identity is ‘the one with depression’ or ‘the one with bipolar disorder’. It may seem silly, but Power Rangers (2017) handles this really well. When Billy, AKA the Blue Ranger, tells Jason, AKA the Red Ranger, that he is “on the spectrum” — an accepted lay term to indicate that someone may be living with autism — he states simply that “my brain doesn’t work like yours”. Throughout the movie, this fact is continually brought up; Billy is a kid with autism, and also a superhero. The movie does this with empathy and respect for kids like Billy. It sounds so simple because it is. If a children’s superhero movie, the first superhero movie to have an autistic superhero, can do it with such ease, then why not all other science fiction films? For example, what about the infinitely more popular Marvel movies? While fan speculation on social media often suggests that some characters struggle with some degree of mental disorder, the “canon” material most familiar to audiences itself very rarely confirms this. Captain America’s life-long friend Bucky Barnes has suffered traumatic experiences which are often linked back to the brainwashing he endured for years as The Winter Soldier. Throughout his appearances across the series, he becomes more and more sullen, as most recently evident in Captain America: Civil War (2016) and then in Avengers: Infinity War (2018). But, there’s only so much character exploration you can do when given 24 on-screen minutes out of a total of 296 minutes across two films. James ‘Rhodey’ Rhodes, AKA War Machine, faces similar treatment after his accident inthe Civil War movie. Tony Stark/Iron Man in Iron Man 3 (2013), is the only actual example of a Marvel Cinematic Universe movie attempting to portray a mental disorder. What’s unique here is the accurate portrayal of post-traumatic stress disorder (PTSD). We see Tony’s PTSD symptoms being triggered by the young boy’s questions about The Battle of New York. His hyperventilation and panic attack brought on by the questions is realistic and relatable to audiences. Throughout the film, we see him triggered repeatedly by different situations, highlighting the diversity of a condition like PTSD. However, much like with Bucky Barnes, and Rhodey, by the time we see Tony three years later in the Civil War film, this sophisticated plotline is forgotten, and never again shown in the same way. Undeniably, regardless of writer and director intent, the final decision on storylines and characters portrayal comes down to the studios and executives leading the production. Though it may seem cynical, what it boils down to is that the film must attract the largest audience and the most profit. In contrast to the familiar genre-based format, films like Swiss Army Man showcase the superfluity of dividing genres in this way. If staying “true-to-life” is really the goal, even if only partially, then I would argue that blurring the lines of science-fiction and comedy could show more emotional and candid portrayals of people living with mental illness. In these first two episodes, I have discussed how poor depictions of mental illness in the movies that we watch can affect the ways that we interact with actual real-life sufferers. But what about poor depictions of psychiatrists and other mental health professionals? What are the consequences of movies vilifying medical professions? I will discuss this in Episode 3: The “Mad Scientist” trope.

Murderous, unstable, and practising medicine; how do the ways that films present psychiatry, psychology, and neuroscience affect both patient and doctor? In my previous two episodes, The Divide Between Genres and Merging Genres for a Stronger Story, I talked briefly about how damaging negative portrayals of mental illness in film can be on sufferers. So, what about the misconceptions of psychiatrists and mental health professionals? Could it be that the harm caused by inaccurate writing is so far-reaching that those working in the field are impacted too? Archetypes have been at the heart of character building and development since the beginning of the art form. Providing a model of traits and behaviours associated with a role or a character-type, these archetypes are a comfortable and familiar format to audiences, in turn, leading to the creation of stereotypes. Not harmful on their own, it’s when these stereotypes are used (even unintentionally) as weapons to harm a particular group that they become troubling. In this case, psychiatrists, or other mental health- or brain- or science-related professionals. Certain cues have corresponding expectations; however, storytellers must keep in mind that audiences may go on to expect those same behaviours from perceived cues in ‘real-life’. The ‘crazy is evil’ trope is a textbook example of this happening, as discussed in my previous blogs and by other writers in InSPIre the Mind. As with our perceptions, tropes and archetypes can also change over time. Science fiction of the ’70s and ’80s popularised “The Mad Scientist” — a figure who messes with forces they cannot understand only to fall victim to their own egos. This is such a familiar and timeless trope that it’s even recognised by some as its own sub-genre. In extreme cases, science fiction/horror movies such as Reanimator (1985), but even comedies like Back to the Future (1985), often present this “mad scientist” as a socially and emotionally incompetent, repressed, awkward man who knows everything except how to relate to people. Some audiences recognise particular cues to suggest that these characters may be coded by the writers as having a form of behavioural disorder, like ‘being on the spectrum’, albeit a very stereotypically presented one. However, the word ‘coded’ implies intent on the writer’s part. In most of these ‘mad scientist’ films, we do not know if this is the case, or, rather, if the writer just perpetuates stereotypes in which scientists are described as marginalised people, with all the features that ‘real’ marginalised people have. By linking these negative characterizations to attributes associated with mental disorders, we prime audiences to respond to people they come across in the ‘real world’ in the same way that heroes in these movies respond to their ‘mad’ villains. So, we meet a scientist, and we think that he (they are usually a he) must be, at best, odd, and at worse, a killer. Cinema of the ’90s and ’00s saw this ‘mad scientist’ evolve into a more subtle villain — the doctor or the psychiatrist with nefarious motives, preying on vulnerable patients simply because they can. Movies which focus on this harmful dynamic paint psychiatrists as dangerously sociopathic, and this is simply untrue. The most well-known character that comes to mind is Dr Hannibal Lecter from Silence of the Lamb (1991), and recently re-proposed in the NBC series Hannibal (2013–2015). This a villain who time-and-time again disregards the well-being of his patients completely, focusing instead on how he can manipulate them to do his bidding. Here we have a doctor, a psychiatrist, a man well respected in his field, and, of course, he is also a serial-killer-cannibal-manipulator-sociopath. In the psychological thriller, Unsane (2018), we see a woman wrongfully committed into a mental institution, when her stalker takes advantage of his position at an asylum. The clinicians and staff are also tricking people into voluntarily admitting themselves, for an insurance scheme. The film sets up the faculty administration as cold, apathetic, and willing to torture people for some quick cash. It implies, that they cannot be trusted. M. Night Shyamalan’s Glass (2019) presents a similar dynamic. Yet again, there’s a larger conspiracy at play. The psychiatrist, Dr Staple, continually manipulates the three men under her care, convincing them to believe that they are psychotic and unable to distinguish reality from fiction. What ties these films together is the irredeemable psychiatrist or doctor who gaslights and tortures the protagonist. This is not a character to empathise with nor to admire. The audience never roots for Dr Staple, nor the staff in Unsane. Such cinema feeds into the false idea that psychiatrists eagerly wait for the opportunity to misdiagnose people and lock them up in asylums. All it would take is to trust a doctor once, admit to being occasionally sad or scared, and then BAM, you are locked up! These negative and dramatised versions of clinicians have significant real-life consequences, and not just through patient mistrust for doctors. Across the board, medical fields are struggling to fill the increasing vacancies, and although applications to psychiatry have increased over the last two years, the amount of posts actually being filled is still inadequate. Research investigating which factors may influence recruitment into psychiatry shows that negative opinions relating to the respectability of psychiatry deters medical students from specialising in this field. In this 2017 review, researchers found that 30% of medical students choosing their speciality are discouraged to choose psychiatry due to the stigma around the field. Similarly, 53% of students are discouraged by the (alleged) lack of scientific bases in diagnosis. In another study, most medical students were uninterested in pursuing psychiatry due to the negative attitudes towards psychiatrist from other doctors and health professionals. As I’ve discussed over my three episodes, such social and cultural perceptions are inarguably influenced by the media that we consume. They affect the ways we respond to things in the real world. When we continually see people of a particular group characterised as evil or villainous or emotionless, we inadvertently link those same negative traits to real people of that group. Prospective students repeatedly see psychiatry and psychology portrayed as an illegitimate science, where sadistic doctors turn to as a way to feed their manipulative egos. This is incredibly damaging. It creates an atmosphere of distrust by patients and the general public. So, we have come to the conclusion of my 3-episode series on cinema and mental health. What does the future hold? In my blogs, I have constantly encouraged scriptwriters to write more true-to-life accounts of mental illness — both of sufferers and of professionals involved with it. But the audience, as well, should be more critical and informed. We should be able to distinguish fiction from reality. We should know, when watching Bird Box, that psychiatric patients are not criminally insane that can escape an extra-terrestrial invasion by colluding with the killing forces. We should know, when watching Hannibal (the movies, but more so the series), with its unending list of shifty clinicians, that psychiatrists are not impatient, arrogant cannibals. We should know, when watching psychological thrillers, that things are hyperbolised for dramatic effect. If the audiences think more critically about the content they consume, the stigmatising harm done will be minimal to non-existent. But the data I have discussed above shows that this is not always the case — even for a well-informed audience such as medical students. Of course, things are getting better. Audiences are increasin gly informed and conscious of the media that they consume. Through social media, we can leave immediate feedback, engage in discussion, provide commentary. If the content of a movie or a TV series is truly over the top, patients and professional organisations complain. But there is still a-way to go. The solution is to depict mental health and mental illness in all its breadth, complexity and diversity. There are still people, within both the film industry and the general public, who stand in the way of progress, claiming that diversity is pandering. But diversity isn’t pandering. Diversity is reality. It’s about time that the films we watch reflected that reality properly.

“Since man’s construction is from both his soul and his body, therefore, human existence cannot be healthy without the ishtibak [interweaving or entangling] of soul and body.” -Abu Zayd al-Balkhi In my last two articles, I wrote about the father of pediatrics, Al-Razi, and the father of experimental medicine, Ibn Sina. To conclude my series, today I will be writing about Abu Zayd al-Balkhi, the father of cognitive therapy. Introductory psychology classes often take the time to talk about the history of the field in order to understand where different ideas came from and how they came to be. But every psychology class I have taken has glossed over the Islamic Golden Age in favor of modern, Western scholars, like Sigmund Freud or Carl Jung. While these figures are, of course, important to our understanding of history, they were far from the first to suggest the benefits of psychotherapy. Al-Balkhi (850–934), born in what is now Afghanistan, was one of the most important figures in the history of psychology. Like many ancient scholars, he was a polymath, working in a variety of fields during his lifetime including geography, mathematics, and philosophy. While mental illness had been written about for many centuries, al-Balkhi was significant in that he described the concept of mental health and well-being. He is most known for his manuscript Masalih al-Abdan wa al-Anfus, or Sustenance for Body and Soul. It was written in accessible, non-scientific language, so that it could be understood by a lay person. In this work, he wrote that mental illness could have both physiological and psychological origins. He believed that the mind and the body were connected and that they could each make the other one sick. In order to maintain your overall health, al-Balkhi believed that the body and the soul must be in balance with each other, and that taking care of both is essential to maintaining that balance. Some of Al-Balkhi’s advice included eating a healthy diet and drinking plenty of water, maintaining an active social life and sharing your feelings with those close to you, and appreciating beauty in the world. He focused on not just curing disease, but also working on maintaining your mental health the same way you maintain your physical health, by practicing everyday acts of self-care. Al-Balkhi also advocated for the benefits of music therapy, nature therapy, and exercise therapy. He also believed that it was important to talk about your thoughts and feelings with others. He advocated that people should reflect and understand their own feelings so that, over time, they can reshape their negative thought processes into positive ones. He believed in keeping a “first-aid kit” of healthy thoughts to employ in times of distress. This is, perhaps, the first documentation of what we know today as cognitive behavioral therapy, or CBT. Al-Balkhi defined four types of mental illness: anxiety, anger, obsession, and depression. He further categorized the latter into depression caused by internal factors (within the body) and external factors (such as environmental or social factors). The idea that depression can have multiple complex causes is something that is still being unraveled by scientists today. Al-Balkhi also wrote about phobias, defining them as different from fears. His description of phobias is remarkably close to the diagnostic criteria in the DSM-V, the text that doctors and researchers use to define mental illnesses today. Al-Balkhi’s description of mental health and mental illness was profoundly ahead of its time. In all the classes I’ve taken, I have never heard even a mention of Al-Balkhi, Ibn Sina, or Al-Razi. Even when their ideas are discussed, they are attributed to European or American scholars who lived centuries later. It is essential that today’s scientists learn of the work of those who came before us, so that we can understand the cultural and historical context of where ideas grew. To only teach the history of Western medicine is to leave out a massive and significant portion of history. It not only does a disservice to those who are forgotten, but it does a disservice to students who are learning an underrepresented, Euro-centric version of history. When we tell the history of science, it is essential that we remember whose stories we’re telling, and whose stories are being forgotten.

If you fell off a bike, would you feel ashamed that you were hurting? And if this happened to your friend, would you judge them for seeking help to treat their wounds? Recently, I read a Tweet which referred to a “psychotherapy cult” when commenting on Prince Harry talking openly about his mental health struggles. When I read it, I knew I had to say something about it. On January 10th, The Independent published an article that voiced the concerns of “a source close to” the Royal family over Harry’s behaviour, claiming he was “kidnapped by a cult of psychotherapy”. As much as it is heart-breaking to see any family struggle, and, as always in such cases, everyone has their story to tell, unfortunately, the publicity of the Royal family means that nothing goes unscrutinised. And sadly, I see “mental health stigma” written all over the recent comment referring to the psychotherapy cult, and I am not the only one. I am a Research Psychologist, and in this blog, I would like to talk about the stigma that surrounds psychological therapy. First of all, the word “cult” cannot be more distant from what psychotherapy is. The definition of a cult, as per the Cambridge dictionary, is “a religious group, often living together, whose beliefs are considered extreme or strange by many people”. Contrast this with the definition of psychotherapy, for example, according to the American Psychiatric Association: “Psychotherapy is a way to help people with a broad variety of mental illnesses and emotional difficulties through talking to a professionally trained and certified therapist. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.” Within the scientific and clinical community, the term “psychotherapy cult” was used in the 80s with reference to, in the authors’ words, some “bizarre groups of mental health professionals” operating in the 1960s. How and why this term has been resurrected today is a mystery. And a concern. Psychotherapy is an evidence-based practice, which means that rigorous studies have shown that it works. These studies are similar to those used to test whether a medication works, and are conducted by established scientists and published in scientific journals. There are different types of therapy suitable for different conditions. In England, the NHS offers a wide range of therapies. In 2008, the NHS launched Improving Access to Psychological Therapies (IAPT) programme aiming to make mental health support more accessible to people. However, the NHS is not the only source of psychological therapies available. These can be sought from other sources so long as the psychotherapists have professional accreditations. Currently, in order to become a certified psychotherapist, you need to undergo professional and stringent training which includes supervised practice with senior therapists, allowing you to receive accreditation from a professional body such as the British Association for Counselling and Psychotherapy (BACP), or the United Kingdom Council for Psychotherapy (UKCP) in the UK, for example. Even when you practice, you continue receiving supervision. You can read more about it in my previous blog on psychological therapy for depression. There are heaps of studies showing that psychotherapy is effective for various conditions. Several meta-analyses, which is a method of looking at the results from many studies grouped together, showed that psychotherapy is effective in treating depression, personality disorders, or eating disorders, to name a few. Out of almost 1.5 million people who were referred for psychotherapy through IAPT in 2021, 75% of those who have completed the course of psychotherapy showed considerable improvement in their well-being, and half made full recovery. Now, I would like to go back to what I felt this piece of news conveyed, and that is perpetuating mental health stigma. Mental health stigma has been covered extensively by our Inspire the Mind writers in the past. We talked about shame and misconceptions about mental health from a medical student’s perspective. We heard from Melisa Kose about how movies can perpetuate stereotypes of “mad scientists”, people with mental health difficulties being villains, and psychiatric institutions being scary and not to be trusted. Yet, with a growing awareness that mental health stigmatisation can lead to social exclusion and discrimination, as a society, we are taking steps to evolve and begin to speak up about mental health difficulties. It begins to feel like mental health, the underdog of health is catching up with its counterpart, physical health, and that maybe one day, they can co-exist, with equal rights. It feels hopeful. But the “battle” isn’t over as we take many steps backward by villainising psychotherapy as done in the recent article by The Independent. And I can’t help but wonder, what effect will it have on people who were already ashamed of seeking help for their mental health struggles? Do we want to live in a society in which we marginalise people who need help? I certainly don’t. Luckily, celebrities are speaking publicly about their experience with mental health problems and psychotherapy. Here are two quotes, and more are available at this link: “I’ve been going to therapy for about five years and it has really helped my mental health incredibly. And it’s a really wonderful thing to be able to talk to someone who doesn’t judge you, because I don’t think a lot of people have that. I encourage it.” — Katy Perry “I kept meeting service members and military spouses who were hesitant to ask for help because they thought they should be able to handle it themselves or that seeking help meant they were weak or broken,” … “But of course that couldn’t be further from the truth … Our service members, veterans and their families are some of the most courageous, resilient folks I have ever met, and asking for help is always a sign of strength.” — Michelle Obama According to the Mental Health Foundation report, in 2014, 37% of those experiencing mental health problems sought and received professional help. This was almost twice as much in comparison to the figures from 2000. These are promising results, although they also mean that the vast majority of people living in England do not seek help or do not have access to it, still. For that reason, we need to work together — scientists, psychotherapists, other mental health professionals, people with lived experience, politicians, media, celebrities, and everyone else for that matter, to raise awareness about mental health. We need to normalise it, to break the stigma surrounding it, and to make it more accessible for everyone to receive treatment . So, I am glad that people like Prince Harry are speaking up and fighting for this cause. I hope that going forward we will see more and more accepting attitudes toward mental health and seeking therapy. I also hope that collaboration within society will prevail over polarisation and bias. I would like to conclude with a quote from Kerry Washington, an American actress, and director, which echoes the beginning of this piece: “It’s really important to take the stigma away from mental health. My brain and my heart are really important to me. I don’t know why I wouldn’t seek help to have those things be as healthy as my teeth. I go to the dentist. So why wouldn’t I go to a shrink?” — Kerry Washington

Mathematics, from the perspectives I have encountered for my entire life, is the subject where, when studied, people feel some of the strongest of emotions; from “I hate Maths so much” to “Maths is so easy, I love it”. As a current A-level Maths and further Maths student (as well as an aspiring Maths university student!), I thought it would be interesting to look into this phenomenon. Over the years, the term “maths anxiety”, or also called Maths phobia, has grown, and it refers to the anxiety that one feels when doing maths. It is also believed by some that there is a link between Maths and mental disorders, especially seen through mathematicians such as John Nash (who had schizophrenia), Kurt Gödel (hypochondria and iophobia, that is, fear of being poisoned) and Grigori Perelman (depression). Nash himself also implied that maths is the reason for his mental health issues, and that other great mathematicians went through the same. This was also discussed in Karim Lekadir’s article for Inspire the Mind. For me, in a world that keeps evolving, where life is so unpredictable sometimes, Mathematics keeps me secure, partially because of one of the most essential facts about how this field works: what you learn will always be a fact. It’s virtually impossible to encounter a situation in Mathematics where, as the years go by, something we thought was true gets debunked. Mathematics is also a subject where you get the chance to engage your brain actively to solve problems. Mathematics for me also represents an abstract world that is completely different from my daily life, and into which I can escape whenever I feel like it. So it could be argued that Maths forms different reactions and relationships with everybody, from happiness, to anxiety, to mental illness. In this article, I will be exploring why we may respond so differently to maths, what maths anxiety is, and how we can reduce it. Why do some students perform better at maths than others? It’s believed by many that some people naturally have a biological advantage in excelling in Maths, and such beliefs could be backed up by a study that took place in Stanford University. The study found large improvements in 24 kids’ aged 8–9 years old maths skills after 8-week one-on-one Maths tutoring sessions, with some students improving more than others. The best predictor of improvement was the volume and structure of the hippocampus (an important memory centre in the brain). However, one may also argue that although it is naturally easier for some to improve in Maths, the hard work and mindset of a person can outdo any biological disadvantages that they have, related to their hippocampus or their arithmetic processing. Animals, including humans, have developed the skill of what is called the approximate number system (ANS), which is a way of estimating the quantities of what is around us “as imprecise, noisy mental magnitudes without verbal counting or numerical symbols”; for example, estimating which of two dot arrays contains more dots. A study on the relationship between our ANS and our Maths performance was carried out by psychologist Elizabeth Brannon of Duke and her colleague Joonkoo Park. Fifty-two adults were recruited to participate in solving multi-digit arithmetic problems, then half of them spent 10 sessions working on their ANS, while the other half were used as a control group. After they were asked to solve some arithmetic problems again, and the half that did the 10 sessions performed much better than the control group, regardless of their different natural skill levels. The overall conclusion made was that the number sense of individuals can improve maths performances, especially arithmetic. Maths Anxiety Research from the company Cuemath has found that UK students experience the most Maths anxiety out of 20 participating countries. Some of the main results captured from this are that globally many students believe they cannot do Maths (33%), and that female students struggle with Maths anxiety more than male students do. The results reveal that it’s common for students to stress over Maths studies. In recent years the child mental health crisis in the UK has become an increasing concern, with almost 20% of students in the classroom struggling with mental health problems. While exact figures of UK students experiencing conditions such as anxiety and depression are unknown, the same study suggests stress and low self-esteem are commonplace, increasing the risk of mental health problems. Although there are many complex factors contributing to young people’s mental health, and Maths is clearly not the root of all problems, many young people find Maths to elevate feelings of low self-esteem. How can we shed a positive light on Maths and reduce maths anxiety? While it brings anxiety to some, there are many positives to engaging in maths. Mathematics can boost brain power, and engaging with mentally stimulating activities such as logic puzzles and problem-solving also reduces the risk of developing Alzheimer’s disease. Another study by researchers at Stanford University attempted to understand the neural mechanisms behind academic achievement in children. They found that having a positive attitude towards Maths was associated with increased engagement of the hippocampus during the performance of arithmetic problems and that this was then associated with higher academic achievement in Maths. The study mentioned earlier concerning our ANS also raises the possibility that interventions aimed at the ANS could benefit children and adults who struggle with Maths. A large study from 2018, the Programme for International Student Assessment (PISA), involved over 600,000 students across 78 countries and discovered that there is a positive correlation between your mindset and performance. It was found that students who disagreed or strongly disagreed with the statement “Your intelligence is something about you that you can’t change very much” scored 32 points higher in reading than those who agreed or strongly agreed, even after the socio-economic backgrounds of the students and schools considered. Overall, there is no single solution for combating Maths anxiety, but strategies can be used to support the reduction of Maths anxiety such as mindful and diaphragmatic breathing as a step towards feeling physically relaxed, addressing and erasing unjustified beliefs that one can never succeed in Maths, writing thoughts on a journal and most importantly, building a positive mindset. Through a positive mentality and other personal strategies, anyone can succeed in it.

My Dad was such an interesting character. I remember as a kid, he had this incredibly soft side, where he would bounce me on his knee and sing me nursery rhymes (his own rude versions). He also showed me how important it is to work hard. He was stubborn, almost to a fault, but was also incredibly loving and caring. He used to go to the off-licence and buy his six-pack of Budweiser every Friday and give me the six-pack rings, which he called ‘beer chains’. He used to watch me rip them apart and tell me how big and strong I was getting. It’s such a normal thing, but it’s stayed with me forever. When I look back on situations like that, it was his way of giving me confidence. I always remember his desire to provide for us all. He worked tirelessly, sometimes juggling 2 or 3 different jobs at a time. He never had any friends but was incredibly social. He adored all his family, especially his twin brother Ken, despite Ken being a little taller (family joke). He adored my Mum. He wouldn’t often say that out loud, as it wasn’t his style. But he would be there when it really mattered. He loved Christmas, especially when my brother and I were younger. I remember the year I realised Father Christmas wasn’t real when I opened my eyes and saw Dad sneaking out of my room after leaving presents. I couldn’t ever say to him that I’d caught him. He always wanted to make Christmas special. The diagnosis He was diagnosed on 15 August 2021, with a large tumour in his oesophagus. Despite the shock and my Dad being in his late 70s, I refused to believe he could die. Nothing can prepare you for the process of watching a loved one become more ill fighting such a terrible disease. Following numerous hospital visits, we received the terrible news that my Dad’s diagnosis was terminal, and due to his age, there was nothing they could do. The news hit me like a sledgehammer. I knew he was tough, and for the next 18 months, he fought the biggest battle of his life. The effects of the tumour Dad was adamant he would fight despite the hospital insisting he would be lucky to live 12 more months. He showed me and everyone he was stronger than any of us ever knew. For around six months, his weight remained stable, which was great to see, and Dad continued to fight and amaze the hospital with his attitude. His use of Supreme CBD also helped immensely during those first few months as he struggled with anxiety following his diagnosis, but the CBD enabled him to keep to a sleeping pattern and feel more relaxed during the day. As the tumour grew, his hunger diminished, and his love of food lessened. Dad became weaker and lost a lot of weight, which was difficult for all of us to see. He went through cycles of catching urinary tract infections (UTIs), making him extremely weak. During these UTIs, my Dad exhibited dementia symptoms such as confusion and delirium, which was particularly upsetting. You can visit the Alzheimers Society for more information and advice on symptoms such as delirium from urinary tract infections. Towards the end, he would often say ‘I can’t believe I’m dying’. He had a lot of expected ups and downs as the months went on. When I look back, I just wanted to take him away from those feelings, and I tried to keep his mind elsewhere, but it must have been so difficult for him as time went on. Bravery During one particular infection, his strength and determination amazed me more than ever. It was 28th May 2022, my Dad and I were watching the Champions League final on TV, and he disappeared near halftime, but I could hear him opening draws, so I knew he was ok. Then he appeared, and had showered, got himself ready, and walked with the aid of a walking stick to see my Mum and their friends. The bravery he showed that evening — will stay with me for the rest of my life. He was in so much pain, but he knew how important it was for him to fight. He showed during his 18-month fight what it really means to battle every day and the importance of fighting for yourself and all those around you. Even during his toughest times, he still loved to see his granddaughter Lily and grandson Arthur play football. He was so proud of both of them, and I will forever tell them how much he loved them. These moments showed me how much he adored all his family. The Future I think about my Mum a lot and how my Dad’s passing is impacting her. They were married for over 40 years, and the void in her life now that he’s gone is immeasurable. She is undoubtedly the person who will need the most support. Her bravery during my Dad’s fight against Cancer has shown me what love really is. She was there till the end, leaving no doubt in his mind about how much my Mum loved him. The support of Tony and Sandra and the rest of their close friends definitely eased his worries about my Mum after his passing. I am determined to keep my Dad’s memory alive and talk about him as much as possible. He had a wicked sense of humour, combined with his lack of a filter and huge heart, which made him a complex, loveable, intriguing individual who commanded any room. Every time I make a cup of tea — I can still hear him shouting: “leave that tea bag brewing a bit longer.” His funeral was by far the most challenging day of my life. There were over 150 people there from different parts of his life. This just showed how fondly people remembered him. I am eternally grateful for all the kind words people have said about my Dad since his passing. Despite my sadness and feelings of loss since my Dad’s death, I know that means I experienced love. I will be forever grateful for having a Dad who never tried to be perfect. He embraced imperfection and was unapologetically himself. The void my Dad’s passing has left is unfillable. But I know he would not want us to suffer. I will forever do my utmost to make him proud of me. I love you, Dad. The NHS offer advice and support to anyone affected by the loss of someone close to them.

Last week, I wrote about Al-Razi, father of pediatrics. In this article, I will be discussing one of my favourite historical figures, Abū-ʿAlī al-Ḥusayn ibn-ʿAbdallāh Ibn-Sīnā, known in the west as Avicenna. Ibn Sina (980–1037) is considered to be one of the most renowned scholars of all time, and rightly so. Said to have memorized the entire Qu’ran by the age of 10, Ibn Sina began his study of medicine when he was 13. He famously treated many royal figures, including the Sultan of Bukhara, Nuh Ibn Mansour and Prince Emir Shams al-Dawlah of the Buyid dynasty. He lived a chaotic life, moving from city to city seeking knowledge and fleeing persecution. In his book ash Shifa, Ibn Sina discusses the connection between the body and the mind. He believed that there were ten senses, five internal and five external. He refers to the sensus communis, which psychologists now refer to as executive function, the ability to consolidate sensory and perceptual information at a central point in the mind. He discussed imagination, intelligence, and instinct as psychological qualities. He understood that our knowledge of the world informs our intelligence and intuition, and impacts the way that we experience the world around us. Early Muslim psychologists referred to the study of psychology as Ilm-al Nafsiat, translated as “self-knowledge,” emphasizing the connection between psychology and philosophy that was intrinsic in a great deal of ancient thinking. Ibn Sina is credited with writing over 200 works (along with an estimated 200 more which were lost to history), including possibly the most comprehensive book of medicine up to that point Al-Qānūn fī al-ṭibb, also known as The Canon of Medicine. It contains over a million words and is perhaps the most widely used medical text in world history. There are parts of the Canon of Medicine describing the importance of preventative medicine, such as proper nutrition, regular exercise, and hygiene in maintaining good health. One of the most significant themes in The Canon of Medicine is the idea of conducting experiments in order to assess the efficacy of a treatment. Ibn Sina outlines seven conditions that an experiment must meet in order to be an accurate measure of a drug’s effect. He states that the drug being tested must be pure and untampered with. It was well-known at the time that the chemical properties of a drug could be altered by temperature change or poor storage, so Ibn Sina dedicated an entire chapter of his second volume to the importance of proper chemical storage. He also stated that medicines should only be tested on participants with a single ailment, so that if improvement does occur, it can be attributed to the drug, and not another condition. This is the first known use of exclusion criteria in a scientific study. He built upon Al-Razi’s idea of a control group, suggesting that medicines should be tested in multiple patient groups to ascertain their effectiveness in treating different illnesses. Ibn Sina wrote about something that scientists today refer to as the dose-response effect. He writes that: “The strength of the drug must be proportionate to the severity of the diseases…in these instances it is better to test the drug in low quantities, and test it in increasing quantities to determine its effect and to prevent untoward effects.” He also stated that experiments should go on for a long period of time and in as many patients as possible, “for if its effect is real, then it will be seen continuously or in many instances.” His final point emphasized the importance of human trials over animal trials. The extent to which these values are reflected in modern clinical trials exemplifies the sheer influence of Islamic scholars on the field of medicine. An abridged Latin translation of The Canon of Medicine known as The Medical Poem made its way around Europe during the Middle Ages and is thought to be responsible for the transmission of Islamic knowledge to the rest of the world. This article only begins to explore Ibn Sina’s influence. He was not only a physician, but a philosopher, astronomer, mathematician, and all-around polymath. While Ibn Sina certainly revolutionized the idea of a clinical trial, he was not the first to attempt them. In my next piece, I will write about Abū Bakr Muḥammad bin Zakariyyāʾ al-Rāzī, who is considered by many to be the father of clinical trials and experimental medicine. Recommended Reading: The House of Wisdom: How Arabic Science Saved Ancient Knowledge and Gave Us the Renaissance by Jim Al-Khalili