Today it’s Saturday the 4th of July: Super Saturday. This is the day when England re-opens! What will it be like? What will it feel like? I am a man in my 50s , and so my movies’ framework is pre-2000’s. With any luck, you will forgive me — especially since my age puts me at a higher risk of death due to COVID. So, what will it be like, today? What will it feel like? Will it be like in Awakenings (1990), where catatonic patients wake up from a long sleep of 40 years and wonder in a new world? Or like Madmax (the 1979 one), where violent gangs roam the streets after societal breakdown? The fact that I am even considering these as two hypothetical (hopefully unlikely) scenarios for today really says it all. What will it be like today? It will be a range of different, even extreme emotions, and everything in between. Anxiety: scanning the horizon for incoming passers-by in order to anticipate their trajectory and maintain distance. Concern: thinking of our parents, grandparents, older friends, now even more at risk than before. Elation: meeting our closest people for the first time in months. Fear: holding our hands up to stop people getting too close to us. Freedom: of doing the most normal things, like walking, shopping, drinking, eating, sightseeing. Frustration: being unable to hug and kiss the people that we love even if they are only a few steps away. Intimacy: retrieving the physical closeness needed for affection and friendship. Irritation: watching people taking little precaution and thus potentially spreading the virus. Powerlessness: being unable to plan for the future, to truly assess risk. Trauma: remembering news of caskets on lorries, overcrowded hospitals, overworked NHS staff, and bereaved people — if not remembering our own COVID illness, or that of our relatives. We will carry this range of emotions with us today, when we will be walking the streets, going to a restaurant, cutting our hair. So, today is not Independence Day (1996). Nobody should feel surrounded by martians, even if the temptation will be there to point the finger at those behaving differently from us. At people with masks, excessively attempting social distancing, disgruntledly keeping people at a distance Or, on the opposite side, at people too getting physically close, excessively relaxing with a pint, forgetting for a few hours of the tragedy around us. Today is instead acceptance day. Acceptance, first of all, of ourselves, our fears, our anxiety, our doubts, our powerlessness, our needs and wishes. And acceptance of others, their needs and wishes, and their decisions and behaviours that might be different from ours. A shorter version of this piece was printed in the Daily Mirror on the 3rd of July 2020, under the title Prepare for day of emotions.

Severe cases of Coronavirus are characterised by breathing difficulties. This is understandably discomforting; if you were to hold your breath for 20 seconds, you will experience discomfort. But why is it, that when a Black person’s breath such as George Floyd’s is deliberately taken, the pain, suffering and injustice is so difficult for some to understand? At face value, breath is known as a colourless reaction, like our tears. So why is it that people must place the value of these processes based upon colour? To breathe is a continuous motion of inhaling air and then pushing it back out into the world. From breath, we contribute to the existence of our own life, but also to the life of nature. Not only is breath a source of life, but it is also a force that is able to add to the movement of the mind. Take anger, for example; when we are angry, we often hold onto our breath which adds to discomfort. Breath is thus able to create, sustain and destroy, and works entirely unconsciously. When I have been thinking about the virus and the events that have followed it, I have noticed that some refer to the barbaric act of George Floyd’s murder as part of the chain of events of suffering that have followed the wake of COVID-19. To this I say the names of Ahamaud Arbery, Sandra Bland, Shukri Abdi, Tamir Rice, Breonna Taylor, Trayvon Martin and several other black lives killed prior to the outbreak of COVID-19. The pause on our daily routines that the virus has enforced, has driven us to attend to the bigotry, prejudice and discrimination that social systems have housed for years. What does this mean to me? As a student of Neuroscience, one principle that is stressed is that markers are needed to highlight cellular activity and structures that can easily remain hidden, due to the complexities of our biological environment. One key tool used to achieve this is a Green fluorescent protein (GFP), which marks the complexities of cellular structures and activity. Coronavirus is, therefore, an intruder that both impacts our pre-existing biology and highlights pre-existing social factors. I, therefore, consider Coronavirus as a GFP that marks what humans have done with our breath. The social systems that humans have built and implemented for years are not only responsible for taking life, but are also responsible for the way in which life is lived. The impact of COVID-19, for example, has been recognised as disproportionally higher amongst Ethnic minorities. This has been associated with health and socioeconomic factors such as underlying illnesses, lack of healthcare access, living in deprived neighbourhoods, and occupational status as ‘frontline workers’. Coronavirus itself, however, does not attack based on colour, region, gender, political or social status. It is non-discriminatory, unlike the reaction to this. For instance, many of those who are middle class or upper class may be using their time during this pandemic to invest in other areas of their interest. To read more, exercise more, or even to reflect. The state of the world is, therefore, an opportunity for self- development. Meanwhile, those in a state of poverty are experiencing greater concerns, struggling to find a means to source food or valid medical equipment to treat patients. In some countries, such as Pakistan, patients that have survived COVID-19 are still being held in hospitals with patients yet to recover. In other countries such as India, many rural migrants are faced with growing concerns about how they will pay for basic necessities such as food. In England, NHS staff are treating COVID-19 patients without adequate personal protective equipment (PPE). This reminded me of the words Neil DeGrasse Tyson “the luxury of time not spent on mere survival” enables the chance to dream, to question and to doubt the workings of the world and the universe. The act of dreaming and abstract thinking is a privilege. A privilege I recognise as having, to be able to write this article. Those experiencing great suffering during this crisis, are too preoccupied with the survival of reality to even question what reality is. Is all of humanity bad? It should not be forgotten however, that during this crisis, millions of current and previously retired NHS staff are working endlessly to treat patients, millions have volunteered for the NHS to support non-medical tasks to aid others who are self-isolating, and several charities are working tirelessly to provide basic necessities to others. This practise of altruism is not just an example of human empathy and compassion, but it also embodies a flexibility in skill. Designer companies, for example, have directed their efforts towards manufacturing masks, gowns and hand sanitisers instead of purses and perfumes. Such companies are pioneers of design, but the output of this expertise can vary. In the same way, many of us share the same abilities: the writers must structure their writing so they are conscious of what effect this will have on their readers, just as though the scientists must structure the design on their clinical trial, whilst being conscious of the effect this will have on their patients. One skill, thus, never has one output. What happens with this information now? These are just words and I have learnt that the power of reading is often overvalued. There was a time in my life when I felt deeply lost and confused about every aspect of my life, from my purpose in life, to what defined my existence, and so I began to read one of the ancient Sanskrit scriptures known as the Bhagavad Gita. Of the abundance of wisdom these scriptures have provided me, the most revolutionary has to be the philosophy of the ‘Self’. This Self is within every form of life and is a form of existence that is beyond our physical body and our mind/personality. Therefore, unlike the physical body which can be impacted by diet or our mind/personality, and that can be conditioned by our surroundings, the Self is neither dependent nor altered by environmental interactions. The Self is an energy, meaning that contrary to the laws of nature that all is temporary, the Self is indestructible. When I first read about this, or even as I am writing this now, I am overwhelmed with a sense of empowerment, an inner reasoning that I should have no fear because nothing I am challenged with in this world can cause harm. Pain, suffering and fear are all mere artefacts. There are spiritual leaders who have been presented with several challenges yet are not tempted to forget about such philosophies and cave into the attachment to their difficulties. So why is it that even after learning about this powerful philosophy, I still endure times where I am hurt, and I feel pain and let this hinder me? Upon contemplating on this dilemma, my mind answered me one day through visualization. Picture this: an empty bowl, and now you are placing tulips inside of the bowl. The bowl can be seen as superior to the flowers, for the strength and material of this bowl will determine how these flowers will be held, and the duration that they are held. The end result is that you now have a bowl with tulips inside, but what you do not have is an integration of the tulips and the bowl. They are both separate. The reasoning for this is obvious, both are different phenomena and vary, therefore deliberate interference would be needed to combine both together, changing the nature of both. I have named this ‘False integration’ which is the belief that, by mentally repeating statements of optimism and motivation, we are integrating these into our mind and thereby overcoming our emotional battles. Knowledge only sits in our mind, but to integrate it into our mind requires understanding of what our human nature is composed of, and the cause of this composition. For example, the words ‘I can overcome this’ do not hold power when what needs to be overcome is not well understood. These fears and elements of trauma compose the base of our mind but are often undermined. My hope is that the words I have shared here can be used to understand the foundations of humanity, so that, when more knowledge is found, it can truly integrate into the policies and values that underlie the formation of our social systems, and our minds and humanity can prevail. Header Image Source: Max Bender on Unsplash

Psychedelics, plant medicine and ceremonies in the Amazon jungle — could this be the future of psychiatry? Ayahuasca, a brew of plants native to the Amazonian region, has been widely used in traditional indigenous medicine. The body of evidence for ayahuasca keeps building, with promising effects in anxiety and depression, in the short and the long term. Disclaimer: This blog is by no means an endorsement, nor is it advocating illegal activities. It is purely a discussion about the growing interest in psychiatric research on the potential of psychedelics in novel treatment approaches in mental health. It should be noted that the use of recreational drugs such as psychedelics is, under law, a criminal activity. Psychedelics should only be used within the legal framework of one’s county and under the supervision of a clinician expert in their use. Inspire The Mind is no stranger to psychedelics, we have recently published an overview of the history and evidence on the use of psychedelics in psychiatry and we have also introduced our readers to what is known about the new trend of microdosing. If you have read my previous blogs on the potential of yogic practices and the power of nature on mental health, you won’t be too surprised that I am also fascinated by plant medicine and its potential in psychiatry. I’ve been talking to Dr. Simon Ruffell, a psychiatrist and researcher who has spent the last few years conducting studies on psychedelic drugs in the realm of psychiatry. Simon is based at the Maudsley Hospital in South London where he works clinically as a psychiatrist. Simon is currently completing his PhD looking into the Amazonian use of ayahuasca and its psychological effects, as well as working as a Senior Research Associate at King’s College London looking at the use of psilocybin in treatment resistant depression. I started by asking what the most interesting finding of his research in the last few years is. Simon: One of the most exciting things that we’ve seen in the effects of ayahuasca on mental health are improvements in areas such as depression or anxiety. Depression and anxiety scores seem to not only be affected in the short term — immediately after ayahuasca retreats, but we’re beginning to find that these improvements are maintained at our long-term follow-up (which is a 6 month follow-up), and that’s without taking any additional psychedelics. And so that in itself is really exciting! Carolina: Did the participants in your research have any previous experience with psychedelics? Was that something you controlled for? I’d imagine that someone would participate in that kind of research has a predisposed openness that might mean that they might respond to treatment differently. Simon: This is definitely true, the research that we do is observational in nature. The set up that we have is a research centre based in the Amazon rainforest where the participants come to do Ayahuasca retreats so obviously there’s a certain type of person that goes to the rainforest to participate in these retreats…so there is a big bias when it comes to the sample that we’re collecting data from. And that’s something that we need to be aware of when doing this research. Carolina: You had a paper come out a couple of months ago on Psychopharmacology, on the effects of ayahuasca in personality: “Modulatory effects of ayahuasca on personality structure in a traditional framework”. In this paper you investigated short- and long-term effects on personality traits after ayahuasca administration. Can you tell us a bit more about the findings? Simon: We found that neuroticism (a personality trait associated with emotional instability) decreased both in the short term and in the long term, and agreeableness (a personality trait associated with empathy and altruism) slightly increased in the short term. We weren’t too surprised to find that neuroticism decreased, after spending two weeks in the forest, unplugged from society, spending some time with yourself. What was particularly interesting was that 6 months later, when the participants had returned to their normal lives, those decreases in neuroticism were maintained. In the future we would like to look at even longer term follow up. We also found that the decreases in neuroticism were linked to the degree of mystical experience- the participants thought that they had undergone — which is a broad term to describe overarching connectedness to everything, to the universe, having an appreciation of nature. Carolina: So interesting and so challenging as well to then potentially try to embed it in clinical practice, which takes me to my next question which is: as a psychiatrist where would you see your research transform everyday practice, where do you think, in an ideal world, things could change? Simon: This is a great question. We are running clinical trials using magic mushrooms (psilocybin), based at King’s College London. You don’t need to go to a shaman in the jungle like with an ayahuasca ceremony. For example, you can have people with treatment resistance depression, being referred to a special unit, through the NHS and being offered treatment with psilocybin. We may well see that within the next few years. That all depends obviously how the rest of the research goes. When it comes to ayahuasca it’s not quite as simple. The main component is DMT, dimethyltryptamine, which is a serotonin receptor agonist (at a molecular level, works similarly to anti-depressants) and that’s very similar in structure to psilocybin. The main difference comes with the tradition surrounding ayahuasca: there’s a huge emphasis put on the ceremony, put on the role of the shaman, and for many people that involves going to the jungle. I don’t think that we’re going to see ayahuasca with a shaman in a ceremony on the NHS any time soon. And, you know, maybe we shouldn’t, but I think that there’s certainly could be a role for it as an alternative therapy. Perhaps a little bit like we see acupuncture used in the west, where it can’t be prescribed on the NHS but it’s part of complementary and alternative medicines. It’s quite a good comparison because over the last year or two we’ve began to see plant medicine decriminalised in many places around the globe. A good example would be Oakland in the US and in Brazil you can legally drink ayahuasca for religious reasons, and in Peru you can drink ayahuasca for similar reasons too. Carolina: Okay so what are the biggest barriers in conducting research with psychedelic drugs? Is it the strict regulations around these substances? Is it recruiting volunteers? Simon: There is a problem when it comes to diversity, recruiting a diverse population. And that’s not just with psychedelic research but I think it’s a problem with research in general. It appears to be a very, kind of white, male dominated culture, and there’s a big lack of other people in research. There is a hell of a lot of red tape, and when it comes to using psychedelic substances, I know that many studies looking at specifically psilocybin have been massively delayed due to this. I think getting the work taken seriously is quite a big thing. That’s beginning to change now, because of psychedelic research departments in places like King’s College and Imperial College London. But it’s still seen as quite leftfield, and maybe quite rightly so, we’re still in the early phases of this research. It’s easy to get carried away and excited about this work, but then equally it’s easy to discredit it, and just thinking that psychedelics are just something that were used by the hippies in the 60’s. Carolina: My next question is about misconceptions around using ayahuasca. There’s a lot of buzz around the potentials, especially for depression, of using ayahuasca. I’m sure you also want to give a balanced view of limitations, in terms of what can be expected clinically, and the cautions. Simon: It’s quite easy for people to think of ayahuasca as a magic bullet, I mean there is no magic bullet. There are certainly conditions that ayahuasca can help more with, and conditions that it should probably be avoided, at least through a western lens. Ayahuasca is particularly good for conditions like depression and anxiety, things related to trauma, and in my experience things related to neurotic conditions. We need to be particularly careful when dealing with conditions that may result in psychosis, so that can be anything from schizophrenia to bipolar disorder and personality disorders. There certainly have been reported cases of people having negative experiences when they suffer from these conditions. But again, this is a western way of thinking about treatments, and if we looked at it through the paradigm that the Shipibo’s use in the jungle, they would certainly have a different way of thinking about mental illness and treatments. They wouldn’t necessarily perceive, for instance, psychosis, in the same way that we do. That’s getting onto a whole other area, transcultural psychiatry (branch of psychiatry that focuses on with the cultural, ethnic and geographic context of mental disorders diagnosis and management). Carolina: Just to close this I wanted to ask you, is there anything else you’d like to close this interview with? Simon: I’d like to say a thank you to the rest of the research team, who’s Nige Netzband and WaiFung Tsang. We have been doing this work together for the last five years. And then also more recently we’ve started looking at epigenetics — so the way that DNA is expressed as a result of ayahuasca — and I’d like to say a big thank you to Professor Celia Morgan, Emma Dempster and Merlin Abraham. That later study looking at epigenetics, depression and anxiety should be coming out soon! I will keep you posted. Thank you, Simon, for your time and we’re looking forward to hearing more about your research! Thank you, Celeste, for the excellent job of transcribing this interview!

Can early-life stress be the cause of the coexistent development of psychological, cardiovascular and metabolic disorders? The EarlyCause project The World Health Organization has identified mental disorders (including depression), cardiovascular diseases (particularly heart attacks and strokes), and diabetes among the six major non-communicable diseases (not transmissible directly from one person to another, like infectious diseases). Alone, each of these groups of diseases represents a burden at the individual and population level. Depression alone is the single largest contributor to global disability, accounting for 12% of total years lived with disability with more than 300 million individuals affected per year. While cardiovascular diseases remain the prime cause of mortality worldwide, type 2 diabetes and related metabolic dysfunctions, including obesity, are a major public health challenge, with an average prevalence of over 8% in the general population. In addition to their separate complexity, existing research has shown important multi-morbidity between these diseases, where multi-morbidity is defined as the simultaneous presence of two or more chronic conditions at the same time. This means that two or more illnesses or diseases occur in the same person at the same time. For example, patients experiencing depression are more likely to have multi-morbid cardiovascular diseases, type 2 diabetes, or both. However, the reasons or causes of this coexistence of psychological, cardiovascular and metabolic diseases is not well understood, which limits the development of effective preventive and treatments. Interestingly, it has been suggested that many mental and physical conditions find their origins in exposure to early-life stress. I am a researcher at the Stress, Psychiatry and Immunology Lab (the team who brings you the InSPire the Mind blog) trying to understand the role of stress and inflammation in depression. Currently, as part of the EarlyCause project, I investigate the role of early-life stress in the development of diseases in adulthood using cellular models of early-life stress. That means that I treat cells from the brain and from the heart with molecules related to stress in order to study their effects on the cellular models. With this blog, I want to explain to you what early-life stress is and its importance for our mental and physical health, before introducing the EarlyCause project, showing how this ties in to improving our knowledge and possibly improve the ways to cure and prevent the development of early-life stress-related multi-morbidities. What is early-life stress? Early-life stress refers to the experience of stressful or adverse conditions during a child’s development, beginning anywhere from pregnancy to adolescence. When occurring prenatally (during pregnancy), early-life stress may be experienced because of maternal stress during pregnancy (job loss of caregiver, illnesses, death of a relative), whereas when occurring after birth, it can result from adverse events such as child abuse (sexual, physical, emotional) and neglect (emotional, physical), parental loss (death, separation), disease, accidents, prepubertal bullying, as well as victimisation or violence by peers. Stress experienced in the early stages of life is common and pervasive, affecting up to 75% of pregnant women (and their unborn babies) and nearly 50% of children, with long term consequences for development and health. Why is early-life stress important? “It takes Wonder Woman courage and Superman strength to heal the wounds of our abuse… because it brings change… and we are inclined to hold on to the stability we created in the chaos of our past experiences.” — JEANNE MCELVANEY Early-life stress can have a long-lasting impact on a child’s development, health and wellbeing. For example, early-life stress can affect a child’s neurodevelopment, hence increasing the risk of cognitive, emotional and behavioural problems. Neurodevelopment is the brain’s ability to develop the neurological pathways responsible for the normal functioning of the brain and the ability to learn, focus, develop memories and social skills, etc. In addition, early-life stress can dysregulate important physiological functions, affecting the way a child may respond to future stressors. Importantly, early-life stress is a key determinant of health, not just early in life, but across the lifespan. It is known to dramatically increase the risk of developing a mental or physical illness and has been repeatedly associated with health problems such as depression, anxiety, and personality disorder, as well as cardiovascular diseases, obesity and type 2 diabetes, and possibly cancer. However, the biological mechanisms through which early-life stress affects health remain unclear and this limits the development of measures that can prevent or treat this. What is the EarlyCause project? The EarlyCause project is a Horizon 2020 project funded by the European Commission under grant number 848158 which investigates how early-life stress causes diseases in adulthood. You can find more details in our recently published paper. Its approach is original and novel because it examines which aspects of early-life stress are linked to the concomitant development of psychological, cardiovascular and metabolic diseases together, which is responsible for the increased mortality linked to early-life stress. Furthermore, the EarlyCause project assesses whether these risk pathways can be diminished or prevented by clinical and lifestyle interventions to avoid the development of diseases. The project combines studies in large groups of people across Europe with validated animal models of early-life stress of prenatal and postnatal (just after birth) stress as well as cellular models of early-life stress in various tissues (including human brain and heart cells) to identify the chain of molecular and biological events that are activated in the brain and body by early-life stress and which result in clinical symptoms. In addition, the aim is to quantify the role of key factors such as sex, socioeconomics, and lifestyle in the association between early-life stress and the development of diseases to find potential intervention strategies that could reverse causative mechanisms and reduce the effect of early-life stress in individuals at high risk of developing multi-morbidity. We will analyse the largest set of European cohorts, with longitudinal human data which include rich information on early-life stressors and biological data as well as depressive, cardiovascular and metabolic phenotype (characteristics that result from the interaction of the total genetic inheritance with the environment). Longitudinal data means that the data has been repetitively recorded over a long period of time. The generated data, tissue samples, experimental protocols and cell lines as well as best practices will be compiled into a new research platform accessible to everyone to support future researchers in the field. Our ideal end-point will be to publish evidence to inform the future development of more efficient and optimised ways to cure and prevent the development of multi-morbidities, thus improving decision-making and clinical management of patients with early-life stress-related multi-morbidities. If, while we are carrying out our research, you wish to stay up to date on our progress and publications, you can follow the EarlyCause project on Twitter and on its website.

Endless SOS cries on Twitter pleading for oxygen, essential medicines and hospital beds are deafening. These aren’t calls just from terrified people but from the hospitals as well, because they are frequently running out of oxygen supply while hundreds of their patients are on oxygen support. People are gasping for breath, waiting in the bleak hope of getting a bed and oxygen in overflowing hospitals. We are at a staggering 21.8 million cases by 8th May 2021. Nearly 250,000 deaths. Unfortunately, that is just the reported data. It is apparent and claimed by many data scientists and journalists that the actual numbers are far greater. Eight to ten times. Even higher than that in some states. The queue of people drenched in sweat, enduring the sweltering heat in front of one of the few oxygen refill stations is miles long and probably a Covid hotspot. And then, there is another kind of never-seen-before queue. Bodies are waiting in endless rows in crematoriums for their turn. Pyres are burning incessantly, so much so that the chimneys are melting and falling down. Because they are burning 24 by 7. Much like the collective mental health of this country. I am helplessly witnessing this tragedy sitting in the capital city, New Delhi. I often wrote about how nature therapies helped with my anxiety concerns. The gravity of this pandemic seems to be higher pulling everyone into a dark space. I spoke to a few frontline workers to understand the on-ground situation and mental health impacts. WHERE WE STAND In this developing nation, mental health awareness is limited and the government allocates barely 5% of the total healthcare budget, out of which a large portion remains underutilized. It is not considered an issue worth spending money on for counsellor’s sessions or medical intervention and is often ridiculed with stereotypes or superstitions. According to the WHO, there are 0.3 psychiatrists and 0.07 psychologists per 100,000 people in India. The desirable number is above 3. With this pandemic, the mental health crisis has just deepened this abyss. Death, anxiety, fear, panic, survivors’ guilt, future uncertainty, job loss, financial instability, depression, lockdown’s loneliness and more is debilitating people. Everyone seems to be on an edge, tumbling from one nervous breakdown to another. Almost everyone has lost someone they knew. On-ground volunteers, frontline workers and healthcare professionals are trying to hold the fort. They, and the people who were already suffering mental health issues before this pandemic, are the most vulnerable ones and one can only imagine their suffering. “It’s so bad it’s like a war. We are just crawling through it like zombies. I had a public breakdown recently.”, Midhat Kidwai, a frontline volunteer tells me. “Maybe we are just a voice to tell those lonely people dying helplessly that they are not abandoned in their last moments of struggle. Most are beyond help. Just a day before, I had to tell my friend how to prepare his father’s body for last rites because he was clueless”, he chokes up. Midhat was one of the few who responded to my cry for help when Covid got hold of my whole family last month, and I hit the panic button one night because my father was having trouble breathing. All my nightmares spun around me while I dialled all the emergency numbers possible, to no avail. Thankfully, his condition improved over a few days after seeking advice from doctors on call. After ten days of fever, chest congestion, fatigue and an alert watch on oxygen levels, he is Covid negative and is gradually recovering to full health. I, on the other hand, still wake up with a jolt at night, feeling as if my family is calling me for help even though they have recovered. The doorbell or a phone’s ring gives me a panic attack of a few seconds. I hear mourning voices. When my mother asks for the reason for my tired eyes, I say it must be the weather. The pandemic weather. And I am not the only one on the edge. People are. Doctors are. Innocent kids are. Nimisha Shukla, a counselling psychologist in Delhi, tells me about a kid who recently lost both parents to Covid. “He felt abandoned, isolated himself from his other relatives and refused to speak to anyone. Such events can be very traumatic for children and have a long-term effect on their mental health.” With adults, anxiety-related stress has increased post Covid. “I often hear people mentioning, I am losing hope for my life.” She urges people to reach out to counsellors if they do not feel well mentally. It certainly makes a difference. Hesitations due to stigma and lack of affordability prevent that from happening. 1 in 7 Indians suffers from mental health issues. There aren’t enough professionals. There isn’t enough average income to support long-term therapies. The horrors of this catastrophe are taking a significant toll on healthcare workers. Long hours of duty, witnessing many deaths, dealing with the aching agony all around, no training prepared the frontline workers for this humanitarian crisis. Final year post-graduate students are being called for duty early to tackle the shortage of doctors. “I took my final exams in these conditions and two days after we finished, the examination hall was turned into a makeshift Covid ward.”, Indranil Sen from Goa Medical College shared. Along with the physical implications, Doctors are seeing all stages of grief including rage after losing their loved ones. “We lost a patient to Covid, and a relative broke a ventilator in anger as well as abusing staff present in the ward.” This just dampens the spirit of the hardworking healthcare staff when they already are short on resources. Sucheta Tiwari, a psychiatrist, and other group therapists, have started ‘Helping our Healers’ that provides free sessions and low-cost therapy for healthcare workers. She adds, “The fallout from the current wave in India on mental health remains to be seen. I suspect it will show its ugly face when the crisis is over. We must learn to acknowledge emotional pain. Only then we will be able to seek support. In such a moment of crisis, it is a normal human response to be overwhelmed and stress. There is support available out there, you just need to reach out for a helping hand.” AFTERMATH We hope that sooner or later this too shall pass. But clearly, the after-effects are here to stay. Anxiety, depression and survivor’s guilt might make it feel like we are walking on a tightrope. The number of PTSD and other stress-induced conditions is already rising. This is an alarming situation and must be dealt with utmost care and concern. Unless mental health is considered an essential part of the recovery action plan in this pandemic, with a public-private-social partnership, it will have grave reverberation that might stretch way into the future. Corporates and private organizations, too, have to come together to tackle this. Even if you care only about the productivity of your employees, you have to invest in their mental health — therapies, insurance, counselling and perhaps training in empathy for leaders. Governments should come up with affordable mental healthcare policies along with understanding the socio-economic triggers and their solutions. The stigma needs to be lifted. The financial setbacks need to be compensated. The preventive strategies have to be implemented. NGOs and community-led approaches to improve both access and care on offer are desperately needed to tackle the storm that is brewing. The virus and system may have left us isolated but the outpouring of kindness from selfless people around us gives a glimmer of hope amid dark clouds. May is mental health awareness month. Let’s increase awareness. Let’s raise voices that reach all the way to the policymakers. Let’s check up on each other and encourage people in need of help to go for professional help. This month and every month. All this while hoping the portal of this pandemic closes soon.

Why we need to talk about black mental health As a young, black researcher at the beginning of a career in mental health research, something that has really struck me on my journey so far is the disparities and inequalities faced by black people with mental health issues and the lack of awareness in black communities. Before working in the SPI Lab, the research group that brings Inspire the Mind to you, I spent some time volunteering at a mental health NHS trust in London. I met lots of lovely people who were going through a really tough time, but it’s not a coincidence that most of the people I met were people of colour. In fact, there is an overrepresentation of Black and Minority Ethnic (BAME) people in crisis care, and Black people are detained in hospital under the Mental Health Act at a rate four times higher than white people. Despite having experienced mental health issues myself, and being a psychology student, I was unaware of just how many people who look like me are affected by mental health problems, and I was shocked to come face to face with the reality of it. It’s something that has made me ever more grateful for the excellent care that I received, and the recovery that I was able to make as a result. Black people in the UK face inequalities in many aspects of their lives; for example, in a previous blog, Dinesh Bhugra outlined some of the health inequalities we face and highlighted the need for an office for minority health. As you can imagine, this is also the case when it comes to mental health. A list of some of the research findings and key statistics can be found on the website of the mental health charity Mind. But, in summary: Black people, especially black women, are more likely than any other group to experience a common mental health issue There is a higher prevalence of psychosis (a less common, but more severe mental health problem) in black men in particular But black people receive less support for their mental health than white people and other ethnic groups If they do access treatment, this is more likely to be in crisis care or through a police, criminal justice or social services route When receiving treatment in hospitals, black people are more likely to be restrained and to be detained in hospital more than once So, it’s clear that a lot of work needs to be done to address these disparities. Indeed, you can also read about the work that is currently being done to reform the Mental Health Act on the Mind website. But why is it that black people are not getting the help they need before it gets to a crisis point? Some studies have sought to investigate this, and a few different factors have been suggested. For example, one study in 2016 examined perceived barriers from the perspective of BAME individuals. It highlights the roles played by stigma and a lack of awareness of symptoms of mental disorders as well as the services available amongst people from BAME backgrounds. Some black people have also reported negative experiences of treatment as well as racism within healthcare services. Though this was not my personal experience when I was receiving treatment, it unfortunately has been for some. It also affects mental health practitioners, with 6 in 10 BAME psychiatrists saying they have experienced racism in the workplace, which in turn affects the care they can provide to patients. And so, two key things are needed so that black people can get help before it gets to a crisis point: 1) More mental health awareness and literacy in black communities; and 2) Improvements in mental health services so that people of all colours feel able and welcome to receive excellent quality mental health care. I believe it is particularly crucial that efforts are made to raise awareness within black communities and give black people who are experiencing mental health difficulties the tools they need to be able to understand, conceptualise and validate what they’re experiencing. Efforts have been made to raise awareness about mental health issues in general over the past few decades and we have come to see that mental illness is like physical illness. But the events of last summer, with the death of George Floyd and subsequent activism, have shone a light on the structural racism within our society, and proved that we need to be actively anti-racist in order to break down these systems and bring black people back up to a level playing field. And the fact that black people are still less able to access treatment goes to show that we need more awareness and education efforts that are targeted specifically towards black communities, or they will only continue to be left behind. The reality is that mental health is still quite stigmatised in black communities, and this is posing a barrier to healthcare. That’s why people like Stormzy opening up about depression is vital in our efforts to get care to those who need it. It can be difficult to come to terms with having a mental illness, and it is often seen as a weakness. At times I have also felt that black people are just expected to be strong and face all the adversity that is thrown at us. To an extent, it’s not like we have much choice in the matter anyway, there is nothing you can do to change the colour of your skin, and so we often have to put on a tough skin just to get through it. But a mental illness is just that, an illness. It’s not a personal weakness, and you don’t have to go through it alone; you can get help. Please don’t suffer in silence. We all want to see black excellence and black people thriving, so here’s how you can take care of your mental health to make sure nothing holds you back: If you would like to improve your general mental health and wellbeing, Every Mind Matters is an excellent NHS tool with lots of information. If you’re concerned about or experiencing any of these symptoms, or any other symptoms of mental illness, please contact your GP. Excessive feelings of sadness or feeling low Excessive worrying or fear Problems concentrating and learning or confused thinking Extreme mood changes, including uncontrollable “highs” or feelings of euphoria If you would prefer to speak to a therapist who looks like you, organisations such as BlackMindsMatterUK and The Black, African and Asian Therapy Network can help to connect you to therapists from BAME backgrounds. A number of mental health services specifically for black people are available locally, such as the Sandwell African Caribbean Mental Health Foundation in Brimingham and the West Midlands. Check which services are available in your local area. If you are feeling suicidal or experiencing any other mental health emergency, call 999 or go to your local A&E. Or you can call the Samaritan’s for free on 116 123.

How A Humble TV Theme Saved My Life Trigger warning: The following blog contains mention of suicidal thoughts and ideation, which some readers may find distressing. When They Might Be Giants rehashed one of their old radio jingles about finding a dead guy in an envelope to a more family-friendly ditty for a new kid’s TV show, I doubt they thought much of it. The duo made up of John Flansburghand and John Linnell, rewrote the song as ‘Boss of Me’ for noughties TV show Malcolm in the Middle. I doubt they kicked back with a beer after finishing the song and discussed how it would become one of the most iconic themes of all time. They probably didn’t dream ahead to the track peaking at number 21 on the UK singles charts and earning them an appearance on Top Of The Tops. But it happened. Their performance was sandwiched between turns from Gerri Halliwell and Sisco on TOTP in July 2001 and came less than an hour after it would have been heard on Malcolm in the Middle. John F didn’t sip a Budweiser and say to John L “I think we’ll win a Grammy for ‘Who’s Gonna Find The Dead Guy 2.0’”, but it happened. The ‘Boss of Me’ even defeated ‘My Furry Friend And Me’, the song written by Sting for Disney’s Emperor’s New Groove which almost definitely came with the request that Mickey would quite like a Grammy. Maybe the two Johns did send off ‘Boss of Me’ and pat each other on the back and dream it would bring worldwide acclaim. What they without question never thought was that it would provide the vital first step to helping a 14-year-old OCD sufferer gain control of his life. But it happened. You would have clicked by now that I was that 14-year-old OCD sufferer. 20 years have passed since They Might Be Giants’ song revolutionised my mindset and triggered me being able to live my life. Thanks to the lesson I learned, I’ve been able to tour the world as a professional magician and work as a freelance journalist for 15 years. Rock Bottom I was at rock bottom and unable to stop washing my hands. I had suffered from OCD for about six years and got by with a handwashing ritual that involved counting for four minutes. But I was losing count. Second-guessing myself. Unable to feel like I had completed my ritual. Constantly feeling unclean. Forever rushing back to the sink. Something had to change. My parents had tried locking the bathroom door to force me to explain why I needed to wash my hands each time. If it seemed logical, I was allowed in. If it sounded crazy, they sent me away. This tough love didn’t help as I simply sat with my hands in front of my face and refused to touch anything. I was so frustrated I contemplated throwing myself off the railway bridge adjacent to my house. When I got to the bridge I didn’t want to get my hands dirty to lift myself over and off it. In the most poetic sense of irony, the one thing making me want to die was the one thing keeping me alive. Then, one Saturday everything changed. I had just gone to the toilet in anticipation of spending the afternoon beating my brother Ed on WWF SmackDown on the Playstation. I was hoping I could wash my hands for four minutes and feel they were clean enough to truly enjoy watching my chosen character, The Rock, ‘Rock Bottom’ my brother’s Kane through a succession of poorly animated tables. But, I had been struggling with my handwashing at this time. The previous day, it took me 73 minutes of constant hand washing until they felt clean. I was wasting my valuable youth indoors washing my hands when I should have been indoors playing video games. Just as I started washing my hands I heard the theme tune of Malcolm in the Middle blaring from the TV. Ed had become bored waiting for me to return to our room to lay the virtual smackdown and popped on a VHS of Malcolm in the Middle. As I began to count the seconds in my head, words came from They Might Be Giants’ mouths and travelled down the hallway: Yes, no, maybe I don’t know Can you repeat the question? You’re not the boss of me now You’re not the boss of me now You’re not the boss of me now, and you’re not so big You’re not the boss of me now You’re not the boss of me now You’re not the boss of me now, and you’re not so big Life is unfair With that, life was a little less unfair. I had counted exactly 30 seconds whilst the theme song had played. I stopped my routine and ran down the hallway to force Ed to replay the theme music and watch the numbers tick by on the stopwatch. 30 seconds exactly. With that, I had unlocked a trick that would prevent me from losing count. To complete a four-minute hand wash, I no longer had to count to 240 without being distracted. All I had to do was sing ‘Boss Of Me’ eight glorious times. So I did. Believe it or not, my routine started to become fun. I’d sway from side-to-side of the sink whispering “you’re not the boss of me now” to myself. Sure, I looked insane but who cared. Not me, this was my first win over OCD. The first time I’d controlled it, managed it, and proven that it was not the boss of me. Me, Me and Blunt As time moved on, I realised that if I knew the length of other songs I could replace one or even seven ‘Boss Of Me’ renditions and only sing it once. I did this. Remy Zero’s uber-angst ‘Save Me’ — the theme from Smallville — fitted in perfectly and with a running time of 50 seconds took the place of two ‘Boss Of Me’ recitals. Plus, it helped me cut 10 seconds from my routine. But it hasn’t always been smooth sailing. Sometimes I still doubt myself and worry I’ve sung a song too quickly. This forces me to sing all the songs again. The biggest mistake I made was starting my routine at the same time my mum played her new James Blunt CD. As a result, since 2004, I have compulsively scrubbed my hands in pub toilets while singing ‘goodbye my lover’ to myself. But I’d take a lifetime of singing James Blunt and the feeling that I’m controlling my mental illness over the dark despair of standing on a railway bridge. I hope you can use this to see that we are all different in our battle with OCD and that there’s a way we can all control it better. You may not know your way yet but that could just be because someone hasn’t put the TV on excessively loud when you’re trying to carry out your ritual.

Is the pressure of competitive sport flattening athletes’ passion and hindering their mental health? Foolish, Wise, Fearful, or Brave? Everyone will have their own opinion about four-time Olympic Champion Simone Biles’ decision to drop out of the Tokyo Olympics due to her mental health concerns. The recent opinions of Piers Morgan are a prime example of the backlash Simone received for putting her mental health before the Olympics. Piers criticised Simone saying, “you let down your team-mates, your fans, and your country”. Contrastingly, Simone received ample support for her decision to put her mental health before the Olympics, commending her as a brave role model for this decision. If you cannot tell, I am one to think this was a wise and very brave decision. From loss of passion to disregarding for a balanced lifestyle, Simone sheds light on some of the important issues in competitive sport and how the effects on mental health can be a risk to physical health. And that’s what we’re going to discuss briefly today. Loss of passion: “What I love has been kind of taken away from me” Quoted in a recent Guardian article, Simone conveyed a very important message about the impact of pressurised competitive sport on athletes’ passion: This Olympic games I wanted it to be for myself, but I came in and I felt like I was still doing it for other people. It hurts my heart that doing what I love has been kind of taken away from me to please other people. I just want you to pause for a moment. Think about that one thing you are most passionate about; how it excites you; how it clears your mind of every worry; how at that moment you can feel so content and free. Now imagine this feeling being taken away from you. That excitement turned to nerves; that clear-mindedness turned to worry and fear; that freedom turned to confine pressures. I cannot speak in expansion for Simone or any other athlete on what they truly feel, but I can share statistics and anecdotes to give a sense of their experience. From a personal perspective, I have seen the effects competitive bodybuilding can have on athletes’ mental health; development of eating disorders, muscle dysmorphic disorder, and exercise addiction as a result of the pressure. Loss of interest in activities that we usually love is a common symptom of anxiety and depression, known as anhedonia. Given high rates of anxiety and depression (up to 45%) in elite athletes, it is unsurprising that the pressure of Olympic sport can lead athletes down a path of dwindling passion and continued performance just to please other people. Though loss of passion may not occur in all athletes with anxiety or depression, and vice versa, it is important we take seriously these potential warning signs. While it’s hard to grasp the true issue of these mental health difficulties with simple statistics and reported quotes, I just want you to take a moment to think about these athletes below: Naomi Osaka- Olympic tennis player “suffered long bouts of depression since her first major tournament victory in 2018 when she defeated Serena Williams at the US Open.” Michael Phelps — Olympic Swimmer “Contemplated suicide after the 2012 Olympics while wracked with depression.” Liz Cambage — WNBA player “Relying on daily medication to control my anxiety is not the place I want to be right now. Especially walking into competition on the world’s biggest sporting stage.” Simone Manuel — Olympic Swimmer “had been experiencing depression, anxiety, and insomnia as a result of overtraining syndrome." These are just four examples of Olympic athletes whose mental health have suffered at the hands of a pressurised sport. Disregard for a balanced lifestyle: “We’re not just athletes… There is more to life” Something that really struck me about Simone’s decision was her statement that: “we’re not just athletes… There is more to life than just gymnastics.” It’s concerning that under the pressure of public expectation athletes feel that we only appreciate them as athletes; that other components in their life do not matter. Jenny Rissveds, the youngest women’s cross-country mountain biking champion, deeply instilled this point when she said: Not just the race. But all these years, to not have to carry that title anymore. I have a name and I hope that I can be Jenny now and not the Olympic champion because that is a heavy burden. I hope that I will be left alone now. Though we may think we give these athletes the praise they deserve, it’s apparent we need to change the way we address their achievements. The way Jenny mentions she has “a name” and hopes to be “Jenny now” really saddens me; for her to think her entire identity is centred around her Olympic career and that we only care for her achievements we are truly doing Jenny — and other athletes – a disservice. But how can athletes feel like ordinary people when they’re expected to live a life with such high expectations? Naomi Osaka raised an important point that Olympic athletes do not have the same possibility to take a step back when their mental health is suffering. Recently Naomi said: Perhaps we should give athletes the right to take a mental break from media scrutiny on a rare occasion without being subject to strict sanctions…In any other line of work, you would be forgiven for taking a personal day here and there, so long as it’s not habitual. These statements only reiterate the point that we have been failing to support the mental health of Olympic athletes and have been ignorant to the fact they are more than the medals they were. The risk of continuing when struggling with mental health To finish, I would like to leave you with a really important point that Simone Bile made when standing down from the Tokyo Olympics: But at the end of the day, we want to walk out of here, not be dragged out of here on a stretcher… I didn’t want to go out there and do something dumb and get hurt and be negligent. Waivered concentration is well-knowingly associated with many mental health disorders and poor lifestyle changes, many of which are highly prevalent in Olympic athletes. Common examples include poor sleep quality, excess stress, anxiety, and depression. If we continue to push athletes to perform under such conditions, we will inevitably push them to their breaking point…. Quite literally.

How social pressure distorted my body image and impacted my mental health One in 8 adults have experienced suicidal thoughts because of concerns about their body image. And just over 1/3 of teenagers reported feeling upset about their body image. For roughly 5 years, this was my experience. If you missed my recent blog on the two-sided nature of the gym environment, you may not know that I began using the gym at just 15 years old. In the hopes of looking like ‘other girls’, my goal was to lose weight. I didn’t need to lose weight but being surrounded by ‘smaller’ girls completely distorted my perception of my own body. With popular girls usually being the thinner girls, it was evident that ‘thinner’ was ‘prettier’ and more socially acceptable… or so I thought. This social pressure to look a certain way wasn’t just at school or university. It was on the TV, on social media, on billboard advertisements, and even in the judgemental stares between others in restaurants and clothes shops. Conscious and unconscious, directly and indirectly, we are exposed to social pressures every single day. And, as is the case for so many others, these pressures completely changed the way I viewed myself. I wanted to be thin. I wanted to be a size 6. And eventually, I was. But I couldn’t see it. As I stood at the mirror day-in-day-out I saw nothing but fat. I saw nothing but imperfections. And, as if I was stood at a funfair, looking in a carnival mirror, my reflection was completely different from reality. This only led to a continued worsening of unhealthy behaviours; obsessive exercising, disordered eating, and use of fat burners. I want to clarify that disordered eating is not the same as an eating disorder. We do have some incredibly insightful blogs by Hattie Gladwell and Emily Bashforth on their experiences with eating disorders if you would like to learn more. We also have a blog by Catherine Shuttleworth, which I’d highly recommend reading, on improving her body image after over 2 years of battling Body Dysmorphic Disorder. What began as a start-stop of healthy eating and exercising soon became obsessive behaviour patterns of specifically weighed meals, exercising 3 times a day, and only eating a salad at restaurants, while my friends and family ate full meals. Most days, I hated going to school and would feel anxious about eating in front of other people. Coupled with the indirect social pressure that thinner was prettier (or so I thought at the time), I later found myself in a relationship where my partner constantly made me feel I wasn’t good enough. Occasionally, he even told me I was ‘fat’, ‘not even attractive’ and that ‘no one else would want me.’ How could I possibly see the reality of my tiny size 6 frame if the person closest to me sided with the inner voice that told me I wasn’t thin or pretty enough? It wasn’t until I left this relationship and began surrounding myself with better people, that I noticed a shift in these societal pressures… or at least a change in the effect that these pressures had on me. My experience is definitely not one in isolation. Research highlights the impact of social pressure and peer interaction on body image and mental health. One study found that body image status was positively correlated with peer acceptance; those with positive body image reported greater perceived peer acceptance. Coupled with this, a recent study found peer teasing and bullying to be a recurrent source of negative body image in 68% of males and 73% of females during adolescence. This was experienced by an equal number of participants across the two sexes. This, therefore, shows peer relations can influence body satisfaction and vice versa. Such effects also extend to the online world. The detrimental impact of photoshopped bodies, and subsequent unrealistic expectations, on mental and physical health are not new discoveries. A recent systematic review found social networking to be associated with body image concerns and disordered eating across several studies, showing that behavioural alterations can indeed occur as a result of social pressures to look a certain way. Further research extends these findings; those with greater internalised appearance ideals, in turn, engage more in emotional eating behaviours related to subsequent depression, anger, and frustration. This all further highlights the need for change in the way we approach body image and a need to re-write the narrative on the ‘beauty standard.’ Words of wisdom To finish, if I could share any words of wisdom to those struggling with body image right now, they would be those from two amazing women — Beyoncé and Colbie Caillat — whose songs made me realise my self-hate was actually a reflection of other people’s opinions. When you’re alone all by yourself. When you’re lying in your bed. Reflection stares right into you, are you happy with yourself? — Beyoncé Why should you care, what they think of you? When you’re all alone, by yourself, do you like you? Do you like you? — Colbie Caillat

Let’s talk about your brain on motherhood for a minute or two. I’m a neuroscientist who studies the maternal brain. When I mention the brain and motherhood to people often the first thing that comes to mind for many, and maybe you too, is the forgetfulness or brain fog that comes with pregnancy and motherhood that so many women talk about - aka Mom Brain, Mommy Brain, Pregnancy Brain or Baby Brain. It’s a topic that comes up a lot on social media (#mombrain / #mumbrain) and I thought we could dig a little deeper here into what our Mom Brain really is. Stay with me, it’s pretty amazing! Baby Brain is defined in the Cambridge Dictionary online as “the condition of forgetting things and not being able to think clearly that pregnant women are often said to experience”. Mom Brain is a more common term for essentially the same thing but extending to the postpartum period. “I used to have functioning brain cells but traded them in for children” is a phrase I’ve seen going around social media. It has stuck with me for a few reasons. First of all, I’m a mom and I can relate to the brain fog that comes with having kids (and a million things to do). Research has shown that the majority of pregnant people and new moms, when asked, will say that they experience short term memory loss, lack of concentration, or brain fog. For me it was forgetting words for things on a regular basis or mixing words up. What’s interesting to note is that although many women report experiencing memory changes with motherhood, the research to date has shown that these memory changes are not large, are specific to certain types of memory and generally would not significantly impact important day-to-day functioning. This may be due to the fact that many of these memory tests are done in quiet laboratory settings and not in a normal home environment — something research I was involved in started to show. This means that our environment is impacting our memory as moms. How many things we put on our to-do lists can impact how much our brain will remember. This happens to all of us regardless of having children, but perhaps more so when we have kids because of the extra ‘stuff’ that we are doing when we have a baby — not to mention lack of sleep and the physical, social and psychological changes that can take place with parenting. Not all memory is affected negatively by motherhood. In fact, recent research has shown that visual memory is improved in both moms and dads. Crazy right? One of my favourite studies shows that after only a few hours of being with their newborn both moms and dads can recognize their infant by touching the back of the infant’s hand when given a choice between three infants. Think about how amazing that is. Wow! [Go ahead and try this the next time you’re with your parent friends and let me know how it goes. ] Apart from these amazing mom brain memory moments, let’s actually talk about what happens to our brains across pregnancy. Do we really trade in brain cells for children? This question directly relates to my doctoral research where I reported that in the brains of moms (mother rats, to be exact) there is a decrease in the production of new neurons of the hippocampus. I know, you’re thinking “I knew it!”, my brain has gone to mush. Truth be told it hasn’t. I actually found that these mom rats did better on memory tests, particularly at the time of weaning. How does this relate to human mothers? Well, a study came out a few years ago showing that after pregnancy many brain areas decrease in volume in new mothers  — another decrease in your mom brain. But the thing is, this research didn’t find any relationship between these decreases in brain areas after pregnancy and forgetfulness. They did find that the changes in a mother’s brain were associated with how she felt about her infant. The more decreased the brain areas, the more attached she felt towards her baby. I like to think that less is more when it comes to our brains and motherhood. Perhaps our mom brain is fine tuning across pregnancy to become efficiently functioning organs devoted to caring for a newborn. I also want to point out the obvious — that you don’t need to give birth to be a parent. You also don’t need to give birth to see changes in your parental brain. A lot of these changes have to do with experience caring for a child. Our mom brains, and parental brains in general, are learning so many things when we parent. Things that we don’t even think about or notice. So why then is there all this talk of Mom Brain as a negative thing? Why aren’t we focusing on the amazing things that our Mom Brains do? This discussion is perhaps more fitting for a whole other post, but I can tell you that I can relate to having classic ‘mom brain moments’, even now years after being a mom of 2 under 2, but I’ve started to think of them as mental load moments and not related to my Mom Brain. Mom Brain should symbolize all the amazing things that our brain is doing to ensure our little one survives. Things that I’ve only touched on briefly here. Mom Brain is also a driving force in our ability to take care of ourselves as parents. If we start to think of it as something to support and nourish, because of all the work it is doing, maybe we will make friends with the brain fog and realize that it is a way for our brain to tell us to slow things down, take a break or get some support. Mom Brain is a superpower and I hope we start rebranding it as such. It is a force making us into the parents that we are.

There seems to be something special about places and things from the past — something that could even help us with our mental health. Have you ever, for example, experienced feelings of wonder and calmness when wandering about in a historic environment? Perhaps through an old part of town or amongst some imposing prehistoric mounds that you have found in a field? Or maybe you have momentarily forgotten the stressors of modern life when enjoying museum objects made by humans, like yourself, who lived long ago? As a newly graduated archaeologist, I have experienced this mysterious but hugely inspiring effect often — and I am convinced that heritage and wellbeing are closely linked. In this blog, I want to introduce you to the mental magic of heritage. Engaging with the unfathomably rich and diverse cultural heritage across our planet has helped me face personal challenges and continuously keeps me in appreciation of the changing nature of our world. For example, arriving from abroad as an international student, learning the history of my new city helped me befriend it and set me on track to make it my home. My experiences with archaeology and history have me swearing up and down that engaging with heritage can be a soulfully nourishing experience that profoundly inspires and, rather ironically, can ground the mind in the present. Spending time with heritage has stereotypically been considered an intellectual pursuit for enthusiasts with white beards and monocles, but this may be about to change as the role of heritage as being something important to the wellbeing of all is increasingly being explored by researchers and heritage organisations. The studies I will go on to discuss give strong indications that the past can do much more than simply teach us about people from very long ago — it can also help us live better lives in the present. Like being in nature, tapping into the past can help us heal, protect ourselves against mental ill-health in the future, and feel that we are part of something bigger. So, is it time to receive heritage on prescription? It certainly looks like it! Here is how heritage can help us cultivate better mental health. What is cultural heritage? Cultural heritage is defined by UNESCO as physical and abstract legacies left behind by past generations. Across the globe, heritage is incredibly diverse and comprises things like monuments, statues, archaeological sites, oral traditions, rituals, and so on. Though the public generally agrees that cultural heritage should be protected, fewer appear to think of it as important because it actively enhances our psychological and emotional wellbeing and helps us manage stress. Heritage as healing One of the most encouraging rewards of heritage engagement appears to be how it can support recovery in groups facing mental health challenges. Operation Nightingale is one of the first initiatives in the world to provide military veterans suffering from debilitating trauma with the opportunity to try “rehabilitation archaeology.” Since 2011, veterans have arrived on Salisbury Plain — one of the richest historical landscapes in Britain — to participate in several weeks’ worth of archaeological fieldwork whilst being supported psychologically. This involves surveying for buried structures and artefacts and potentially digging on locations that hint at hidden remains. Though you may occasionally find yourself trowelling through the mud in the rain when you dig for archaeological remains, archaeological fieldwork is somewhat of an unrecognised goldmine for improving wellbeing as several key mood boosters are part and parcel of the experience — gentle physical exercise, learning new skills, and building community. Collaborating with others is essential on-site and provides ground for new and supportive relationships to be formed. In addition, excavation is not unlike gardening in that you are mindfully engaging with soil and breathing in the fresh air; most archaeological sites are located in the midst of nature spaces from which you automatically receive the calming effects of forest bathing, too — so you get two in one! A study conducted with support from partner organisation Breaking Ground Heritage concluded that veterans joining their fieldwork projects reported reduced symptoms of anxiety, depression, and PTSD at the end of their participation. They also stated that they were feeling less isolated and more valued, reflecting the supportive aspect of communities coming together to work towards shared goals. The experience, one veteran said, helped them to “switch off from [their] own head,” hinting at the transformative effect several good days on-site can have upon individuals coping with trauma. Getting muddy is not for everyone, though, and luckily the benefits of heritage extend to the indoors. Spending the night in historic buildings has been proven to lower feelings of anxiety and offer respite from stressors associated with the modern world. Studies have also shown that merely observing and handling old museum objects can offer mental respite for hospital and care home patients who are unable to visit museum spaces themselves. The Heritage in Hospitals project found that participants were often stimulated upon being introduced to museum objects, with some engaged to levels of wonder — being absorbed into the specialness of objects, some around 9,500 years old, that they encounter. Another study focused on mental health patients specifically observed that intriguing pieces like Roman tile and Neolithic axe heads distracted participants from their immediate personal troubles and supported them in developing new perspectives, with participants stating that “dealing with something that’s [very] old […] puts your life into perspective […]” and that it was difficult to be “depressed by looking at a piece of Egyptian pottery.” Heritage does seem to heal — but the general public can also make significant wellbeing gains from engaging with local pasts. A local German museum reconstructed a 7000-year-old Neolithic longhouse to scale and offered visitors the chance of handling stone tool replicas and engage in Neolithic baking activities, offering tantalising glimpses into the prehistoric past of the area. When visitors were surveyed about their experiences, most reported enhanced moods, and feelings of good health. This could become valuable preventative healthcare in the long term: it has been estimated that promoting heritage as another recreational activity to boost wellbeing could save the NHS almost £300 million by reducing medical appointments. Shaping your present — with the past. If this sounds intriguing to you but you are not sure whether there is anything interesting nearby, I would like to put your mind at ease. There is no need to be neighbours with Stonehenge to engage with the past — 99.3 % of people in England live within one mere mile of a heritage site. Remember that strange pile of stones you played by when you were little? Or walked past on your last country walk? That could be your buried local past! No matter how Podunk you believe your town to be, there may well be buried stories that can surprise you and help you connect with your home and fellow residents. Only last summer, I discovered that there were more than forty Viking graves located less than five minutes’ away from where I grew up — and I thought I knew that place like the back of my hand. The link between heritage and wellbeing shows that heritage is much more than dead weight of the past. It matters to us in the present, and the trend is catching on. Encouraging results from heritage wellbeing projects like Operation Nightingale have inspired somewhat of a movement as new projects are appearing across Britain and the world. However, before you venture out into the wildly diverse world that is heritage, it is worth mentioning that confronting certain parts of the past may not always be easy — especially for ethnic minority groups who live in societies with imperial legacies, like Britain. As with anything you implement for your wellbeing, be mindful. If you would like to learn more, have a look at the wellbeing report by the Heritage Alliance or get in contact with your local heritage organisation for opportunities to become involved. Whether you are looking to cope in times of stress or want something different to shake up your wellness routine, this could be the time to don your sports equipment for a trowel.

Beyond Daddy Blues I’m a neuroscientist and therapist. Generally, my work focuses on maternal mental health for a number of reasons — but primarily because I think that maternal mental illness effects on the mother has only recently been getting the attention that it deserves. Thus, I would like the focus to remain on mothers. But, am I being fair? No. Anyone who struggles with a mental illness, especially a parent, deserves support and to feel well. Recently we’ve seen many more fathers talking about their struggles with mental illness and breaking the stigma of being “strong and silent” and becoming “brave and open” (a phrase I’ve stolen from author Elizabeth Lesser in Cassandra Speaks). This is impressive and I have faith this trend will continue — where we focus on the perinatal mental health of all parents. Sad dads. In July of 2021, a NYTimes article was published titled: “I Gave Birth, but My Husband Developed Postpartum Depression” bringing much-needed awareness to this ongoing and often overlooked mental illness in fathers. The author writes, “While maternal postpartum depression is widely discussed and recognized as a serious health issue, it’s often hard for people to take seriously the idea of a man having similar problems. My husband, for one, found it “ridiculous.” ” Ironically, her husband ended up being the one diagnosed with postpartum depression. A recent meta-analysis, a review of the literature that combines data from many studies to get a more complete picture of effects, on the prevalence of depression in fathers, reports that nearly 1 in every 10 fathers struggles with depression. That’s significant. Not surprisingly a couple’s relationship suffers from perinatal depression, and research reports that if one parent has depression there is a high chance that the other parent will have depression as well. Let that sink in for a minute. That means there is a pretty good chance that both parents are depressed if one gets a diagnosis of perinatal depression. Imagine the difficulty of trying to care for a newborn when neither parent is feeling well. I also want to note here that I’m talking about fathers as they are the most studied partner in a parenting relationship, but that is changing. It takes two. Often the mother bares the ‘blame’ for how a child will develop. There is no denying that there is an impact of early life stressors on child development but these are not always related to the mother. Mothers are often the key to healthy development. Fortunately, recent research shows that a father’s mental illness and stress can impact child development too. When depression is involved, treatment is needed. Much of my research over the past 15 years is based on how antidepressant medication use during the perinatal period affects the mother and developing offspring. I want to mention here that my research, and the clinical research available on this topic, points to the importance and safety of treating maternal mental illnesses with antidepressant medications. Effective treatment, when clinically indicated, is the best option for both the mother and child — so stay on your meds if they are helping you feel well. Impacting offspring. Apart from moms’ mood and medication use during pregnancy, I’ve also been curious about how dads’ mood and antidepressant medication use affects the developing child — something we don’t study much because there often lacks a direct link between the medication and the child. This year a scientific study was published that got me thinking a bit more about this issue of perinatal mental health and antidepressant medication use in both parents. The study investigated the long-term effect of moms’ and dads’ prenatal antidepressant medication use, as an indicator of their underlying mental illness, on the risk of mental health struggles in their offspring during the teen years. This was done in order to better understand the enduring effects of perinatal mental illness and antidepressant medications on development. To do this research population-based health linked data was used. This means that the researchers accessed basic medical information from thousands of people in the medical system of the country they were doing their research (in Denmark). This data is limited as it provides very basic information. For example, the researchers didn’t have details of specific mood or anxiety symptoms or levels of stress — so more research would be needed in this area. What the researchers found was that antidepressant medication use during pregnancy, in both mothers and fathers, impacted the mental health of their offspring as teenagers. Before you think that perinatal exposure to medications are not a good thing hear me out. First of all, if dad’s medication use during pregnancy is related to offspring mental health then that means it’s not the direct effect of the medication from the mom crossing the placenta to the developing child that is a problem — that is, moms shouldn’t feel guilty about taking their meds during pregnancy. Second, the authors point out that, although they investigated antidepressant medication effects, what this indicates is that the severity of the underlying mental illness of each parent is having an impact on child development. The authors go on to speculate that it is likely genetic and/or environmental factors that are important key components playing a role here. Things such as biological make-up or stress in the home may be playing a role on the mental health of offspring. I’ll admit this isn’t great news because it does show that perinatal mental illness in parents can contribute to poor mental health in offspring. But, what it means to me is that the mental health of each parent is important — not just for the parent but for their child as well. It’s not all about the mom. Dad’s mental health is important too