A Tale of Two Countries: An interview with a Russian young mother on the war in Ukraine At Inspire the Mind, we have previously published on the mental health of displaced populations, in the light of the war in Ukraine. We also published the account of Dennis, a Ukrainian Consultant who drove from London to the Polish-Ukrainian border to deliver medical equipment, and Dr Sasha Dovzhyk’s powerful perspective on the impact on Ukraine through her experience in Lviv. Today, I bring you the account of my Russian friend Polina, a young mother to a beautiful toddler, who moved to another country in Europe in 2003, after spending her childhood and early teenage years in Russia. I met Polina (not her real name) when I was still a teenager and the group of friends that formed in my country of origin, still tight to this day, includes Russian, Romanian, Lithuanian, and Ukrainian. I wanted to ask her about how she has been coping with the news and what was her perspective on the conflict. Thank you for speaking to me, I know how hard this is for you. How have you been since the 24th of February? That is a complicated question. I feel awful, I feel like my heart is being pulled in every direction, so much that eventually, it is going to crack open. When I realised that the Russian government was invading Ukraine, because it was a shock for me, I couldn’t believe it. You know, as a new mother, I started thinking about how other mothers in Ukraine may be feeling. I have been very emotional; I’ve been crying a lot. Even now as we speak…this has been going on for a few weeks and I still cry when I speak about it. It’s horrible, regardless of wherever you’re from, even if you’re not Russian or Ukrainian you must feel so sad and scared like I do. Really, it doesn’t matter where you are from, this war hurts everyone. I feel that my heart is going to break, it’s very hard, this conflict feels so close to me. I was born in Russia, I had my childhood in Russia, this war is impacting my family, my neighbours, my childhood friends…but this is also happening in the whole world, the consequences will be devastating for everyone. Do you remember what you felt when you heard the news? I was at work. Strangely, I heard about it from a work colleague, in the morning when the news came out. I wasn’t aware that this was about to happen. After that, I was stuck in a loop of news, I couldn’t stop watching. In those first few days, I was in denial, I didn’t want to believe it — it felt like a dark nightmare that couldn’t be happening in the 21st century. I felt helpless, this war felt unjustifiable — unjustifiable for the Russian people, the Ukrainian people, to everyone. I can tell you that Russians don’t want this war. It’s not only the country that is being invaded and taken over but Ukrainians’ lives are also being invaded, their lives are being torn. It got to a point where I wasn’t sleeping, I wasn’t functioning. My husband compelled me to stop watching the news and now, for my wellbeing, I try to avoid watching. How are your family and friends back in Russia coping? I have childhood friends and some family back in Russia. My friends are further geographically from the border with Ukraine than my family is. Friends tell me Russians didn’t know this was going to happen — my close friend was going to travel to Ukraine for holidays on the 24th of February, she had no idea, her flights were cancelled 1h before departure and still, she didn’t know why — until the news came out. My family is quite close to the border with Ukraine. In the night they could hear military aircrafts flying above their homes, through the night. They knew something was happening above them, that these military aircraft were going to Ukraine to cause destruction…they would then attack with airstrikes. Can you imagine being woken up with the sound of your country destroying a neighbouring country? What are your views on what is going on in Russia and what people are experiencing there? Things have been better in the media recently, with more accounts from Russians but overall, there aren’t many Russian perspectives. The truth is that the media in Russia is very controlled, actually, right now social media is being shut down — in the last few weeks we’ve heard that Facebook, Instagram and Twitter are being banned. Russia has labelled Meta (the group that owns Facebook, Instagram, WhatsApp, Messenger) as an extremist organisation after the group allowed political expression against the war and in support of Ukraine, which meant that posts against Russian military actions were allowed on the platforms. Hence, people back in Russia are not fully aware of what is happening outside the country and at the same time, people outside of Russia are not aware of what’s happening there. In Russia, anyone who speaks against the war is considered an enemy of the state — so there is no opportunity for these points of view to come out, it’s too dangerous. You can’t go out and demonstrate — so how can people in the West have a clear view of what the Russian people want? People forget that the war is happening in the two countries. The Russian people cannot be blamed for a decision that is not theirs. Everyone that I know is very scared of this war, they have been helping Ukrainian people, both my family back in Russia and the Russians that live in other countries like me. We are fundraising, donating, helping the way we can. I have so many Ukrainian friends, Russians and Ukrainians who live together as a community here where I am based. My friend who is a psychologist in Russia the other day was asking me for support, she can’t cope with all the pain that her clients are going through, and she is exhausted, she running on empty. She thinks she might lose her job too eventually; a lot of sanctions are going to come in soon and she fears for the future. Here, I’ve seen people turning against Russians, even Russian children are being bullied in playgrounds and schools. There is increased animosity, like a “Russian-phobia” at the moment that also scares me, it scares me for my son. Is there anything else that you think the Russian people would like the West to know? We are all, Russians and Ukrainians, grieving for all that is happening. But we feel it all, we are suffering, carrying all this weight on our shoulders. Personally, I feel helpless, I feel guilty of this tragedy that the government of my country created and there isn’t anyone that I know that endorses what is happening. No one can want this to happen. People on both sides of this conflict are stuck, they are powerless. Despite all the help that I have given, in reality, I feel that there isn’t much that I can do at a personal level. Thank you so much for sharing what’s in your heart with me and our readers. I would like to leave you with a quote in Russian: «Мирного неба над головой», which translates as “peaceful sky above“, to wish a sky of peace. Editor’s Note We are deeply saddened by and concerned about the terrible events in Ukraine. Our thoughts and prayers are with the people of Ukraine, and we will continue to raise awareness of this frightening humanitarian crisis. It is heart-warming to see the kindness and solidarity shown in these frightening times with campaigns such as the Emergency Appeal from Dennis Ougrin, a psychiatrist who will be delivering medical supplies to those in desperate need. The personal details in this blog have been changed to protect this individual’s identity. Photo by Ahmed Zalabany on Unsplash

It starts with a casual aside; a set of syllables that should dissolve into the ether like wisps of breath on a mid-winter morning. Yet these words hang heavy in the air like the dense smell of oven gas. ‘Are you going home for Christmas?’ ‘Yes, back to grey Leicester!’ I reply. ‘So, you’ll be seeing your Mum and Dad and stuff?’ ‘Oh, well, I’m an orphan so I’ll be staying with other family.’ (A slight pause in which the other person’s eyes widen and their face is cloaked in shock.) ‘Oh my god, I am so sorry!’ This conversation, around Christmas and all manner of other scenarios  — general family history, where I grew up, even something as stupid as Mother’s and Father’s Day  —  has happened countless times. As I write this on 13th November, it has happened twice in the last three days  —  once literally about going home for Christmas and the other when I was getting to know a new co-worker. My parents both died in the same year when I was 16; my Dad first in February and then my Mum eight months later. Relentless alcoholism did it for my Dad, while my Mum succumbed to that great guardian of mortality: cancer. I’m a journalist and librarian, and in my previous blogs for InSPIre the Mind I wrote about somewhat more conventional mental health topics  — eating disorders and emotional regulation. This piece is more esoteric; I’m not focussing on the grief or trauma of being an orphan, more on how it affects my relationships to other people, how something so unusual creates its own anxiety. The Look It would be a stretch to say that being an orphan clouds every conversation I have with every new person I meet, but once the discussion veers towards something that could potentially mean I have to say it, a strange anxiety grips me. Telling someone I’m an orphan doesn’t bother me; I’m not going to collapse onto the floor in a tidal wave of tears. This is not a clinical indifference on my part, only that it has been 13 years since my parents died, I have told dozens, if not hundreds of people over those years, and it has become a normal part of my reality. Rather, it is the other person’s reaction I most fear, and what fills my stomach with a sickly apprehension. How awkward will it be? Will they get upset? How uncomfortable will it get? I am throwing a grenade of intensity into what may have been the blandest phatic conversation. People’s reactions are so uniform, it actually makes me laugh a little, which doesn’t exactly help the situation. Their eyes go wide in shock, and they start stammering apologies. If they ask a simple follow up question that results in me telling them it happened in the same year, their eyes somehow go wider, an awkward silence forms and it’s clear their mind contains one single thought: ‘****’ A (Very) Brief History of Coming Out The phrase ‘coming out’ is indelibly associated with the LGBTQ+ community, and it’s common understanding refers to somebody revealing their sexual identity to others, with the popular cultural depiction being gay people coming out to their parents. The intrinsic connection between sexual minorities and coming out is a relatively recent socio-cultural phenomenon. It’s original meaning, dating back to the 19th century, referred to the debutante process of introducing young women to their eligible suitors at deliriously posh balls. These balls were adapted in the 1920s and 30s, usually by gay men, and evoled into ‘drag’ balls. These masquerade events were a way for someone to come out to other gay people in the community, and not necessarily to the rest of society. In George Chauncey’s history of modern gay culture, Gay New York, the term was beginning to be adopted in the 1960s to describe revealing your sexual identity to those outside of the gay community. The phrase, and it’s ‘coming out of the closet’ extension, gained wider usage after an organizer at the first Gay Liberation march in 1970 declared; ‘we’ll never have the freedom and civil rights we deserve as human beings unless we stop hiding in closets and in the shelter of anonymity.’ No Fagin, No Danger If we drill down into the idea behind coming out, at its most fundamental level it means that some aspect of your life fails to align with a predetermined, expected set of experiences and/or behaviours, across social, cultural, political or any number of potentialities. You can then, at some level, ‘come out’ as practically anything — from the utterly trivial to the intensely vulnerable. In certain situations, you might have to come out as a non-football fan, a communist or disabled. Perhaps all three at the same time, if you are having a particularly intense session in the pub. In sociologist Abigail C. Saguy’s Come Out, Come Out, Wherever You Are, she describes how ‘coming out’ — as a cultural concept and political tactic — has spread within and well beyond gay rights activism’ and that a ‘search for the terms coming out and closet in the keywords of major papers, indexed by LexisNexis, yields examples of people coming out as asexual, celibate, heterosexual male, Jewish, a Republican, Scotish, a Kiwi male, and even witches (coming out of “broom closets”!). Among many other differences, there is one very clear and obvious distinction between telling someone you are an orphan and telling them that you are not heterosexual or cisgender: the lack of any potential harmful response. Telling someone you are LGBTQ+, to family members or anyone else, can result in all manner of destructive scenarios, up to and including assault and potentially murder. Of course, this is not in anyway a universal experience, and many LGBTQ+ people experience incredibly positive reactions from their loved ones. In contrast though, the chance of something negative happening when I tell someone I’m an orphan is basically 0%, unless I’m talking to a neo-Fagin Victorian psychopath. A Minority of One Being an orphan means I am effectively in the smallest minority group in the country. It is very difficult to find data on how many orphans there are in the UK. I have personally spoken to both the ONS and the Census and neither of them record such data. The crudest estimation I have, based on a bereavement study of the 1970 British Cohort, is that 0.1% of the population are orphans, roughly 68,000 people. This puts me in a very strange place, at once completely removed from the inherent dangers of coming out while simultaneously living an experience so far removed from most people’s lives. According to a 2019 ONS report, there are around 1.4 million people who identify as lesbian, gay, or bisexual, and this doesn’t even account for gender identity with non-binary and trangender individuals, nor other sexualities including asexuality and others under the queer umbrella term. I exist in this weird liminal space where my life has been defined by an experience that most people have not, and by the time they get to my age, cannot ever experience themselves. By 32, I’ll have lived literally half my life without my parents. A family friend got to retirement age with both parents still alive. I’ll never stop telling people I’m an orphan and it will still generate the same response for decades to come, the same anxiety, the same awkwardness as people feel they have stumbled blindly through a door into my most intimate life. Genius screenwriter Russell T. Davies, when talking about himself being gay, said that, “you never stop coming out”. I will always be an orphan, will always have to come out as one, and that’ll always separate me from almost everyone else in society, never in danger but completely alone. Header image: © Eugène Delacroix, Public domain, via Wikimedia Commons

I often think of my Grandma, my dad’s mom. I grew up in the same town as my grandparents in the Okanagan Valley of Western Canada, spent many Sunday dinners at their place, and learned much about my Ukrainian heritage (my grandparents were children of immigrants) from them. Grandma played a significant role in my life, not only for aspects related to my heritage, but also in terms of what it is to be a woman, partner, and mother — in the absence of social norms. Recently I’ve been wondering how I may have impacted her. I’m a neuroscientist, therapist, podcaster, and mom of 2 who often talks about the neuroscience of parenting; shedding light on just how amazing our mom brains are and how much more we need to know about brain changes with parenting in health and illness. I've written for ITM a few times now, which you can read here, here, and here. For a while now I’ve been wondering how the brain changes in Grandparents. Grandparental Brain? In 2017 when I was co-organizing the 6th Parental Brain meeting in Toronto, Canada I remember thinking how amazing it would be to have some work on how grandparenting affects the brain. Are Grandparent’s brains activated by their grandchildren in the same way as they are with their children? If there are brain changes in grandparents do they relate to how much a grandparent cares for their children? Does having grandchildren impact brain health in grandparents? Oh, so many questions and oh, so few answers. In fact, at the time I couldn’t find a single paper looking at grandparenting and the brain — even though there was some work on how parenting affects the brain into ageing. Fast forward to a few months ago, while speaking with Dr. Jim Rilling about his work on fatherhood and the brain for my podcast Mommy Brain Revisited he mentioned recent work that he was doing on brain changes in Grandmothers. As you can imagine I was excited! Grandmas and Grandchildren Dr. Rilling’s study, published in November 2021, was partially based on the idea that grandmas started living longer because they could help to raise their grandchildren — something referred to as the Grandmother Hypothesis. There is science to back this hypothesis up and to me, it makes sense that an extra pair of hands would be beneficial when you’re having kids — someone else helping with childcare or food preparation, laundry, housecleaning, errands, etc. How this Grandmother hypothesis works biologically isn’t quite sorted out but we now know that changes in the brain of grandmas may be important. In his study on the grandmaternal brain, fMRI brain imaging techniques were used to see how a grandmother’s brain was activated in response to viewing pictures of her grandchild and whether this response was unique to the grandchild by comparing it to the activity of the brain when the grandma was viewing an unknown child of the same sex, race, and age. The study showed that when viewing a picture of her grandchild, compared to viewing an unknown child of the same age and sex, grandmothers have increased activation in brain regions that are important in parenting. These ‘parental’ brain areas are important for aspects of motivation, emotional empathy, and understanding of others. The study also reports that this level of brain activation was not related to how much time the grandma spent with her grandchild — suggesting that a basic level of grandparenting impacts the brain. Grandmas as Mothers When looking at a picture of the grandchild’s parent (the grandma’s own child or child’s partner), the grandmother showed even more brain activation in these parental brain areas with the exception of brain regions involved in emotional empathy (the insula and secondary somatosensory cortex). The fact that these brain areas related to empathy are highly activated when grandmas view their grandchildren, and not their children, begs the question of whether “Grandmothers may be more connected to grandchildren than to own offspring”, as the headline from the Guardian pointed out. Maybe Grandmas are more connected, or maybe their relationship with their grandchild is simply different. The Village When I spoke with Jim about this study I still had so many questions. What about grandfathers, maternal versus paternal grandparents, the number of grandchildren, for starters? We joked that perhaps a family neuroscience research field needs to be developed to explore the neural connectivity of the social relationships that make up a family tree. Who knows what the future of neuroscience research will hold. As I told a CNN reporter covering this research, the bottom line for me is that “This work points to the fact that there are important brain changes in members of a ‘village’ that raise a child. It’s not just the brain of birthing parents and partners that change.” Twice My Child I was visiting a friend and collaborator in Athens, Greece a few months ago and we started talking about the importance of Grandparents in Greek society. She told me they have a saying in Greece — “the child of my child is twice my child”. I think there is something to this — especially in the grandmaternal brain.

Our Brains on Bad Headlines: How “doomscrolling” affects our mental health I find myself there again before I realize it: compulsively scrolling through bad news, feeling anxious and cynical about the world. My current newsfeed is one big and scary mosaic made up of climate change, the ongoing global pandemic, and the frightening invasion of Ukraine. It’s hardly an environment that reassures and relaxes. If you spend too long on them — like I do — chances are that you feel tempted to believe that the planet is heading towards some kind of doom. The habit of getting stuck scrolling through one bad news story after another is fittingly called “doomscrolling,” and has become so relevant to our times that it was named a Word of the Year by the Oxford English Dictionary in 2020. As more of us are feeling its negative effects, doomscrolling is increasingly emerging as another force for us to reckon with in the challenge to protect our mental health. My name is Livia and I have an interest in mental health. I have previously written for Inspire the Mind on what cultural heritage can do to support better mental health. Today, I would like to explore the curious phenomenon of doomscrolling and answer the questions that have been on my own doomscrolling mind: What does repeated exposure to bad news do to our brains? How can we dial back our doomscrolling? And is the world really as bad as our news feeds make it out to be? Scrolling, scrolling, scrolling… towards doom. Keeping an interest in the goings-on of the world is a good thing — it means that you are curious and care about people and the planet. Moderate and healthy news consumption, however, turns into doomscrolling when you get stuck scrolling through endless negative content and become absorbed enough to stop feeling grounded and present. Though scary headlines do not put us in physical danger, they are likely to trigger our stress response all the same. Persistent doomscrolling over longer periods of time may eventually lead to unpleasant feelings similar to those associated with Generalised Anxiety Disorder, including muscle tension, fatigue, and depression. Studies are increasingly suggesting that we need to find ways of dealing with our digital overload — especially as screen time has risen dramatically in response to the Covid-19 pandemic. For example, researchers in Germany found that substantial exposure to alarming Covid-19 media during the beginning of the pandemic likely led to increased symptoms of anxiety and depression whilst the challenge of climate change — reported with particular existential doom — is leading to surges in climate depression and anxiety in youth. It seems strange that we keep scrolling when it scares us, but from an evolutionary point of view, doomscrolling makes plenty of sense. We have evolved with an unwavering instinct to survive and therefore naturally pay much closer attention to perceived threats than good news, which explains why mainstream journalism would rather deliver punchy and alarming headlines. For the doomscroller, keeping up with the terrible things happening in the world gives the illusion of preparedness and control — making information gobbling feel weirdly comforting. Doomscrolling does not, however, end up reassuring us but only feeds on itself, causing more anxiety in the long term. It may soothe in the moment but ends up disconnecting us from our inner thoughts and feelings, making it harder to focus on other tasks or go to sleep. Not all doom and gloom Scrolling away boundlessly can therefore put our mental health out of balance — but could our attempts to stay perfectly informed also make us misinformed about the world? The fact that we are seriously starved of good news does not mean that humanity never makes any progress. Yet many — I included — are inclined to think that way. Swedish physician and public speaker Dr Hans Rosling, one of the world’s most prolific researchers and educators in global health and development, argued that most of us tend to get even basic facts about human progress wrong. Surveys undertaken by Dr Rosling’s organisation Gapminder and compiled in the book Factfulness show that most of us tend to wrongly assume the worst regarding global challenges ranging from poverty to life expectancy. More than 8 in 10 people falsely think that there are many more refugees and hungry mouths to feed, for example, than there really are — suggesting that lots “suffer from systematic misconceptions about the world” that may be at least partially formed by impressions obtained from the media. In the bigger picture — the one spanning thousands of years — humanity is making astonishing progress in tackling problems that were once thought unsolvable. Knowing these facts matters because they show us that we have reason to be hopeful that we can solve our biggest remaining crises. It was not for nothing that environmentalist David Attenborough called humanity the biggest “problem-solvers to ever have existed on Earth” at the COP26 climate conference last year. Feeling sceptical? Take the survey yourself and see if you can be pleasantly surprised about something! Looking for silver linings The domination of bad headlines in mainstream news will not change anytime soon. Instead, we need to protect our brains by teaching ourselves better digital habits. Reconnecting with myself and others helps me step back from doomscrolling, including reading books with real pages, seeing friends and family in person, and walking in nature. I believe we need to get better at finding and acknowledging good news, too — I can really recommend looking further into thinkers like Hans Rosling and Yuval Noah Harari for more facts on seriously real human progress. Regulating your news intake does not mean that you stop caring or feel less compassion for suffering in the world. You are simply respecting your human boundaries so that you can protect your own mental health. Doomscrolling only shows us the downside of the world — so now I try to scroll less and look more at the perfectly real silver linings out there. Header image by Malachi Brooks on Unsplash

As I sat on the grass soaking all the dewy fresh green around me in the early morning, I thought to myself, is green the colour of nourishment? Can we assign colours like that? Is there a colour of happiness and a colour of depression? I am a writer with Inspire the Mind and other wellness & spirituality magazines. I wonder about seemingly little things and wander into their realms of connections with us and the universe. Born with anxiety and ‘introvert genes’, I donned the cap of Human Resources. Perhaps, I liked the hue of irony. The world of colours has been an intriguing topic for centuries not only for healers of ancient civilization, but for scientists of the modern world too. Whether it’s the physics behind this philosophical quote by the poet Aleister Crowley, “A red rose absorbs all colours but red; red is therefore the one colour that it is not”, or neurologist Beau Lotto's philosophy that, “Every colour that people see is actually inside their head and it’s a useful perception of our world, but not an accurate one”; it has always fascinated my pinkish brain with all its grey matter. Tippy, Tippy, Tap; what colour do you want? It is interesting to note that the most popular favourite colour across the world is some shade of blue, perhaps reminding us of water and a clear sky. On the contrary, it is noted that we mostly feel repulsed by colours like brown, perhaps reminding us of dirt, rotting, and decay. A drab dark brown hue was informally chosen as the ‘world’s ugliest colour’ in 2012 when the Australian government hired a British research agency, GFK Bluemoon, to discover the colour to discourage people from smoking. It’s Pantone 448C, and is being used by more than 14 countries for plain cigarette packaging to curtail smoking. Well, did it work? Or did poor Pantone 448C just become a victim of colour-shaming! I was the kid who loved everything in purple once. In my late twenties, purple became mundane, and soon entered a new colour into my world: turquoise. The calm that this colour gives me is inexplicable. Maybe my mind connects it with the mighty yet serene sea. We might dismiss this as insignificant, but colours influence us in much larger ways than we expect. Grey is the colour of depression. In a 2010 study, when asked to reflect on feelings of depression using the Manchester Colour Wheel, a tool used to study people’s preferred pigment concerning their state of mind, people pointed to grey. A 2016 study found those scoring highest on depressive scales selected grey as their colour of choice. The scientists found that depressed people have great difficulty in detecting the contrast between black and white. I might not be able to see grey in the same light ever! (Would it still be grey then?) Yellow was considered the colour of happiness but when more factors were taken into analysis, like hours of sunshine, amount of rainfall, and proximity to the equator, yellow-joy association levels varied a lot. As low as 5.7% in hot Egypt and as high as 87.7% in chilly Finland. Healing with Colours Several ancient cultures, including the Egyptians and Chinese, practised chromotherapy, or the use of colours to heal, which is still practised today as a holistic or alternative treatment. Egyptians used sun-filled rooms with coloured glasses for therapeutic purposes. They believed when the sun rays penetrated the specific parts of the body through coloured crystals, it would heal ailments. Indian ayurvedic medicine also believes that using certain colours that correspond to seven chakras in the body can bring balance and heal us on a physical as well as mental level. One possible explanation behind these ancient systems of healing is that the unique wavelength and frequency of each colour are believed to bring a specific effect on our minds and body. Do colours really hold the power to affect our mental and physical health? What do hue think? Let’s explore the most popular colour, blue. Blue can be the problem; blue can be the answer! Blue light improves alertness, attention and moods according to a study published in 2016. Blue light in electronic screens affect circadian rhythm and in turn, our sleep quality, and setting them to warmer yellow tones or using blue light filtering glasses may help to some extent. For instance, these glasses have been introduced as a possible new treatment option to treat sleep disturbances even in patients with medical conditions, such as in patients with Parkinson’s Disease. Moreover, narrow-band blue light therapy has emerged as an effective option to treat Seasonal Affective Disorders (SAD) — a form of depression related to seasonal changes, when daylight hours are reduced. Moreover, this type of therapy is used not only to treat adults, but all different age ranges. In fact, blue light phototherapy (light therapy) is also used when newborn babies contract jaundice, quite a common condition, which causes yellowing of the skin. Here, phototherapy works by treating the high level of bilirubin in their systems. Colours aren’t magic and the impact that they can have on an individual depends on the cultural connotations, experiences, and memories. Even the language matters! A Russian can tell the different hues of blues faster than an English speaker because the Russian language has a clearer distinction of varied shades of blue. This was observed in a colour discrimination study done in 2007. End Note While colour psychology is interesting, there is still a lot of research needed in this area to reach definite answers. Yet, undoubtedly, colours make this life a wonderful place to be. Butterflies and rainbows, green forests and aqua oceans, iridescent hummingbirds and peacocks — the kaleidoscope of the world around us is unparalleled. May we find ways to see the sunny side up in between the greys!

In my early twenties, I suffered with agoraphobia. Agoraphobia is a fear of crowded places, open spaces, or being in places where it is not easy to escape. A person who suffers from severe agoraphobia may be afraid to leave their own home. I am a writer and project manager who has lived with anxiety for over ten years. You could look at me nowadays and think that I was completely cured. You could see photos of me travelling the world and think that I had found the cure to anxiety. Unfortunately for me, and an astounding number of other people in the world, I haven’t found the cure. What I have found, through talking therapy used for treating agoraphobia like cognitive behavioural therapy (CBT) and years of trial, error, and persistence, is how to stop lapses from turning into relapses. By writing this article I hope to share some of my experience so that it can help others. A lapse is a temporary setback, a brief revisit of old habits that encourages the anxiety to grow. It can make you feel like all your hard work was for nothing. A lapse is not a relapse. A relapse is a return to how you behaved at the height of your anxiety when you let it rule your life. For me, a relapse would mean not leaving my house, quitting my job, developing a fear of the outside world, and abandoning all the CBT techniques I have used over the past eight years to manage my anxiety, and instead giving in to the negative thoughts. As of right now, I have never experienced a relapse. I have, however, experienced lapses. In fact, I experience lapses all the time. There are so many factors that can influence our anxiety levels, and subsequently influence our behaviour. Some are in our control, and some aren’t. I am especially anxious in hot and crowded spaces, like the tube at rush hour. The sensation of being hot therefore reminds me not only of that hot flush that washes over me during a panic attack, but also of the hot and crowded places I hate so much. Whenever the weather is especially hot, I feel anxious. I associate the heat with anxiety, and so during the summer, my anxiety skyrockets. I can’t control the weather, of course, but I can control how I react to it. A recent lapse Recently, while on holiday, my partner and I were driving to a restaurant. At the height of my agoraphobia, I was terrified of restaurants. The idea of being stuck at a table where it would be socially unacceptable to run away used to drive my anxiety wild. I would get so nervous that I would feel sick and lose my appetite, making eating in restaurants impossible. Throughout my course of CBT, I exposed myself to restaurants repeatedly until I became comfortable with them, but suddenly I was afraid of them again. Why? Europe was at the beginning of an intense heatwave, and the hot weather was making me anxious. I did what you should never do: I gave in to the anxiety. We didn’t go to the restaurant. I avoided the situation, and so I taught my brain that avoidance gets rid of anxiety. It then became harder to go to a restaurant the next time, and I avoided them again. By the time we were back home, the thought of going to a restaurant made me feel sick, as if I had made no progress at all in the last eight years. At this point, I had the choice between letting this be a lapse, or letting it turn into a relapse. How to stop lapses from becoming relapses The only way to stop a lapse from becoming a relapse is to retrain your brain to know that there is nothing to fear in the situation. It is within the core principles of CBT — you teach yourself that a situation is not harmful so that your negative thoughts do not cause anxiety, and then the anxiety won’t make you leave the situation. I did exactly what my mind was telling me not to do, but what I had to do: I went to restaurants. I sat at the table, feeling sick and frightened, and ordered food even though I truly believed that I couldn’t stomach it. I let myself be anxious. I didn’t leave. I waited for the anxiety to pass, and then I ate. It’s been a few months since that lapse, and I’m happy to say I can enjoy restaurants again. Using CBT to keep relapses at bay I first referred myself for CBT with my local Improving Access to Psychological Therapies (IAPT) service in 2014. I was assigned a course of twelve sessions with a High-Intensity CBT therapist. The course worked wonders for me and by the end of it, I was able to do many things I couldn’t do before. This includes buses, trains, restaurants, cinemas, and even a long-haul flight to my brother’s wedding in America. It’s important to understand that I was not cured at the end of the course, despite the successes I achieved. I was taught the coping skills and tools that I needed to start my journey of recovery. CBT teaches you skills that you can use every day, and I use them all the time to prevent relapses. When you suffer from a lapse Firstly, go easy on yourself. If you’re experiencing high levels of stress or something has triggered your anxiety, it’s not your fault. Practice self-care and be kind to yourself. Then, write down what is giving you anxiety, and what you are avoiding. You can then plan to start exposing yourself to it again, using CBT coping skills to help. When I first experience a lapse, I am terrified. I’m convinced that my anxiety is coming back in full swing, ready to ruin my life again. That fear is what gives me the persistence to keep practising CBT and to keep exposing myself to the things that scare me, and I always manage to stop the lapse in its tracks.

It is no secret that texting has become an integral form of communication in our everyday lives, yet nothing has quite taken the world by storm like the emoji phenomenon. It has almost become unnatural to not have a couple of emojis in most, if not all of the text messages we send and receive from friends and family, and dare I say, colleagues? This new-age phenomenon has managed to wriggle its way slowly, yet surely, into the workplace, causing an uproar and sparking debates regarding the appropriateness of using emojis in the workplace or in a professional setting. I am studying Cognitive and Clinical Neuroscience at the University of Westminster and undertook a year-long placement with the eBRAIN Study at the Institute of Psychiatry, Psychology & Neuroscience as part of my degree. During my placement, working in an office, it was intriguing to see how emojis are used in a professional setting. I’m now entering my final year and as a young person about to embark on their career, I found it really interesting to explore current research and become more aware of workplace etiquette regarding communication involving the use of emojis. I think this is a topic that individuals of all ages can benefit from, as it helps bridge the gap between the younger and older generation, and how we communicate with one another. This blog will delve into why there seems to be mixed responses on this topic, as well as provide an exclusive emoji guide for the workplace, outlining the most acceptable and common emojis used and most importantly, ones that should be avoided! So, what exactly are emojis and why do we use them? The word emoji actually derives from a Japanese portmanteau of two words: “e’’ meaning picture and “moji’’ meaning character. Emojis help express our emotions clearly during online communication and they make a great addition to emphasise and clarify exactly what we are trying to say. Research generally shows users tend to use emojis in positive messages and use them less in sad or angry messages. Either way, the use of emojis has become the norm with regard to online communication. In fact, their popularity and ability to appeal to diverse audiences have led to many businesses incorporating these as part of their branding to relate to mass consumers. It’s no surprise then that emojis have sneaked their way into workplace communication as well. Whether it’s to reassure a colleague they did great on a presentation 👍 or showing gratitude for their help on a project 🙏, there is an emoji for almost everything and the list keeps getting bigger, with new emojis being added relatively frequently. How has remote work changed the way we view emojis in the workplace? One positive thing that has come from the pandemic is the flexibility to be able to work from home, and according to Microsoft Design VP Jon Friedman, remote work has helped us move past the old-fashioned “professionalism” that perpetuated the idea that emojis were unacceptable in a work setting. In fact, there is research that shows how emojis increase likeability and make colleagues appear friendlier. For instance, According to Adobe’s 2021 Global Emoji Trend Report, two-thirds of global emoji users (66%) like it when their colleagues use emojis in work communication. In fact, 71% of respondents agree workplace emojis enhance colleagues’ likeability, whilst 62% agreed it boosted their credibility. These statistics show that emojis are definitely making a positive impact in the workplace and are actually improving communication between colleagues, as well as our perceptions of our colleagues. How do different age groups view the use of emojis in the workplace? A major factor contributing to mixed responses in whether emojis are appropriate at work or not tends to be age. For instance, according to SurveyMonkey, out of 560 participants, 29% of individuals 45 years and older found emojis to make colleagues appear more unprofessional, whilst 46% of 18–29-year-olds found emojis to be appropriate for work and improve communication between colleagues. This suggests a clear generational gap with the younger generation viewing emoji use at work to be fun and emanate approachability, compared with the older generation viewing emoji use at work as ingenuine and unprofessional. However, it’s worth addressing the reluctance of older employees to use emojis as part of their online communication boiling down to them not understanding what some emojis mean. For example, according to Adobe’s 2021 Global Emoji Trend Report, 22% of survey respondents aged 45 and over admitted to receiving an emoji at work they didn’t understand. On the other hand, only 12% of 18–34-year-old respondents encountered an emoji they didn’t understand at work. This suggests that perhaps a lack of understanding and information on emoji use, in general, may hinder older employees from engaging with emoji use, particularly at work. Perhaps a quick and easy guide, which I will cover in this blog, would encourage this demographic to hop on the bandwagon of using emojis at work, helping bridge the generational gap and improve communication between older and younger employees. Why the use of emojis should be encouraged in the workplace: 1) Helps convey emotions better — According to an Adobe survey, 74% of respondents feel that emojis make positive news more sincere and 78% feel emojis have a positive impact in the workplace 2) Create closer bonds with colleagues — 50% of respondents find a colleague to be more fun, 43% see them as more approachable, and 35% deem the colleague to be kinder if they use emojis 3) Helps colleagues feel supported — According to 2019 Emoji Trend, 91% of respondents said they used emojis to express support to others 4) Research shows that our brains react similarly when we receive an emoji to when we see a person’s facial expression face-to-face — This may explain why we smile when we see a smiley emoji on text! Emoji Guide for the workplace Four emojis to use: Four emojis to avoid: Emoji misconceptions and why context matters As mentioned before, emoji misconceptions are understandably more apparent amongst the older generation than the younger generation. With regards to the emoji guide, it is important to note that emojis in the avoid column may be acceptable to use in some cases. This all comes down to context as well as knowing your recipient and if it’ll be received well. Additionally, when it comes to emojis, the phrase “less is more” is a perfect way to remind ourselves that overuse of emojis is not an ideal way to go during work communication and even communication in general. Overuse of emojis can take away the impact of what we are actually trying to communicate. Remember emojis are an addition to communicating effectively, not a replacement! Emojis in work emails It is also worth mentioning that it is better to use emojis sparingly in work emails or not use them at all, until you have identified the conversation style of your recipient. For instance, if your recipient uses emojis in their email, you can also assume it’s appropriate for you to use an emoji in emails too. More broadly speaking however, emojis are more appropriate to use in text communication in comparison to emails. Most accepted emojis vs. least accepted According to a study carried out by Fast Company, when analysing responses of 1,011 employees, they found that the most accepted emoji was the “Thumbs up emoji” with 71% of respondents agreeing. The least accepted emoji in the workplace at 22.1% was “face blowing a kiss”, most likely due to misconceptions and confusion over romantic implications. 4 quick takeaways from this article: ● The stats show that emojis help workplace communication, however important to bear in mind context and your recipient ● Make sure to familiarise yourself with which emojis are acceptable and which ones are not, to avoid any misunderstandings or confusion ● Older generations are more sceptical with the use of emojis compared to younger generations, so again, bear in mind who you are communicating with and whether emojis are necessary in an email or text ● Don’t overthink it! Although there is much debate around the appropriateness of emojis in the workplace, emojis are mostly harmless and light-hearted; they help humanise our conversations and bring emotion to what we are trying to express so the majority of the time enhance our communication with colleagues.

Trigger warning: this blog discusses mental health struggles and suicidal thoughts. Even though I’m a journalist by trade, until now, I haven’t publicly shared my struggles with mental health medication. I read many, many magazines, and though all champion open discussion of mental health, I’ve never found the words I needed to read. So here they are. Google borderline personality disorder (BPD) and you’ll soon realize how much stigma surrounds it. Also known as emotionally unstable personality disorder, the condition’s characteristics include emotional dysregulation, intense but unstable relationships and impulsive behaviour. The world feels like a big, scary place when you’re that sensitive, and it’s incredibly isolating. For several years I refused antidepressants because I didn’t believe in altering my mood artificially. Even if they did work, I told myself, I wouldn’t deserve this new and improved me. I’d be a fraud. Photo by Matteo Badini on Unsplash Then I hit a dark spot and, desperate, I gave them a shot. Antidepressants made me like life in a way I never had before. My future wasn’t a black hole. A hallmark of BPD is feeling inherently “bad”. I see the world in black and white — I might idolize you one minute and despise you the next. One wrong move can fill me with red hot rage. This black and white thinking applies to my own sense of self, too; unlike everybody else, who are fundamentally good but make mistakes, I am B-A-D. When I do make mistakes — oftentimes, I’ll lash out when my despair is overwhelming — the shame is all-consuming. At this point, I’ll start depriving myself of medication. Usually, I’ll go cold turkey, knowing deep down my mental health will deteriorate while also convincing myself the pills don’t work anyway. Surely, I’ll decide, they must be a placebo, ashamed that these tiny pills help me function. Travelling in Georgia, Asia For a while, I won’t notice a drastic change in mood. Ha! See? Placebos! Then a week or two will pass. My world suddenly becomes very small. Days go by without brushing my teeth, changing my clothes, or having a shower. My body aches like I have the flu. While in Bulgaria, I make plans to buy a rope as soon as I arrive home in Wales. Marsha Linehan likens people with BPD to third-degree burn victims: ‘Lacking emotional skin, they feel agony at the slightest touch or movement.’ To experience this without antidepressants is like death. More recently, rather than going cold turkey, I’ve made excuses not to take the pills. While privately I know depriving myself will make life worse — based on 100% of the times this experiment has failed before — I’ll still find reasons. Maybe I’ll roll in drunk from a night out, telling myself I’ll take them in the morning before immediately passing out. I might “forget’’ to renew my prescription. I love to travel; out there in the world, I feel indestructible and decide I must be cured, or am just so busy — I swear I’ll take a double dose tomorrow. Sometimes I hold the pills between my fingers, willing myself to place them on my tongue. Travelling in Venice, Italy I feel terrible shame for my behaviour and even more for not having the guts to end this perceived misery I put everyone through. At my worst, I believe I am a Bad Egg who doesn’t deserve inner peace — in fact, I deserve to feel as bad as possible. I sleep with a razor under my pillow and convince myself I’m repenting. If I go a week, two weeks without meds, God will forgive me. I’ll finally be good. But the goalposts keep shifting. I ruminate over the many occasions I’ve allowed my moods to ruin. As a child I loved a show called Bernard’s Watch, about a boy with a timepiece which could be paused at any time, leaving Bernard free to make mischief as the world stood still. I fantasise about owning that watch, about having just a few moments to pause and process before the situation hurtles out of control like a train into a brick wall. Compounding this shame is awareness of how privileged I am to live in a country where medication is free, while friends abroad smoke weed in an effort to keep their mental health afloat. The waiting list for DBT therapy in my area is obscene so I was offered a mental health nurse to talk to, which helped me become more aware of this black and white thinking. I hadn’t realized just how deeply ingrained my self-loathing was — I genuinely believed I was evil. Every week they would point out how I reverted to this default mindset and it took many months for me to start being kinder to myself. I didn’t think it was possible, but our talks opened my mind to the spectrum of colours that exist in between black and white; I can be impulsive and hot-tempered but I’m also kind, fun and generous. Now, I’m at least willing to consider the possibility I may not be An Entirely Bad Egg. I’m flawed, just like everybody else. We recently parted ways after a year of chatting and every day, I catch myself falling into the same old thought patterns and have to give myself pep talks. Because of the pandemic we never actually met — we spoke on the phone — so I find it funny that I might walk right past this person who cared about me without even recognising them. Over the past few months, I’ve tried hard to hold myself accountable. I anticipate how many days’ worth of pills I have left and ensure I have a fresh supply, and even when I’m sleepy, I force them into my mouth before passing out. There’s a note on my phone which reads ‘Keep taking meds!!! Even when I’m feeling low. Don’t sabotage myself.’ I consider what advice I’d give to a friend in my position and remind myself that, despite what my mind has to say about it, I really do deserve to feel better. 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 CALM (Campaign Against Living Miserably) offers a chat and hotlines service from 5pm to midnight Papyrus (Suicide Prevention Charity) offers similar service for adolescents and young adults under the age of 35 Mind — 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 Talk to your GP

The Hype on “Beyond the Hype”: an Interview with Fiona Fox, the Head of the Science Media Centre We are celebrating the 20 year anniversary of the Science Media Centre (SMC) — the organisation that Fiona Fox funded in 2002 in London, with the ambition of bringing scientists and researchers into the “nation’s airwaves”. And we are just now starting to reflect on lessons learned (or not) on the effects of the COVID pandemic on the communication between scientists, politicians, and the public. Thus, Fiona’s recently-published book Beyond the Hype: The Inside Story of Science’s Biggest Media Controversies seems to be one of those perfectly-scheduled writing outputs that makes wannabe-writers like me profoundly envious. No surprise therefore that, as we are laughing about the reversal of roles for this blog (“the interviewee is interviewing the interviewer”), I asked her how she managed to write the book right in time for these two events. But of course, she didn’t. “The book was mostly written in a sabbatical I took in 2019, in a lovely cottage in Donegal”, she explains. The aim at that time was to put together the stories that had framed the SMC’s activities of the last few years — from illegal drugs to climate change, from animal research to GM food, from human-animal embryos to Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis. Of course, the plan to have the book finished and published by February 2020 was thrown in disarray by the pandemic, and the book was kept on hold till the end of 2021. Just in time to write a new chapter on the pandemic at the beginning of 2022. And the new book was born. “Part-memoir, part-manifesto for change”, in Fiona’s own words. So, what does this “charismatic and sometimes combative” woman (as Nature described her almost 10 years ago) want to change? “The ability of the public to hear from the scientists is paramount”, she continues, yet “at risk of being undermined in a variety of ways, whether by government communication officers, press offices’ corporate strategic priorities, harassment of researchers on social media, and the general polarisation of the scientific debate.” Hence the book, now, and the opportunity to have her voice heard in the printed media and in podcasts. The problem with the current science communication ecosystem Fiona has many concerns. Lots of scientific research now comes into the orbit of the government communications machine, because the scientists are government-funded, or the studies are commissioned by government departments like the Department of Health or Department for Environment, Food and Rural Affairs. Government communication officers are focussed more on publicising the government’s ideas than about providing nuanced scientific information. They are worried about mixed messages that senior scientists may put across when speaking openly about the uncertainties and gaps in knowledge — as it happened during the pandemic. The creation of the UK Research and Innovation body (UKRI) has also brought the research community closer to government, with the effect of a loss of independence. Research communications is also under pressure, as many university press officers are increasingly called on to support wider communications activities required by universities, including marketing, student recruitment, fundraising and reputation management. “We worry about who will support scientists who would like to have their work presented to the media, if research press officers are under-staffed or busy with other things to do. Who will mediate with the media in case of misunderstanding, for example, by pushing newspapers to rectify a mistake in the way a science news has been (mis)interpreted or (mis)represented?” There is also the enormous problem of social media trolling, abuse and threats that scientists receive when they communicate findings to the public. Nature recently published a survey of scientists who have communicated about COVID, and found that 60% have experienced attacks on credibility, 40% emotional or psychological distress, 20% threats of physical or sexual violence, and 15% death threats. Fiona replies: “When we ran an event on harassment recently we discovered that many universities and research institutes do not yet have anything in place to support scientists suffering online abuse”. I asked her about “open research” or “open science”, the movement advocating that all research outputs, like publications, data, software and biological materials, should be openly shared within the scientific community. This movement has led to new publication practices such as publication in open access scientific journals (that is, available to all readers, for no fees) or pre-print publications (a publication of a “first-draft” of scientific papers before they undergo the “peer review” process by other scientists that characterise publication in scientific journals). I asked her if this emphasis on open research is cascading down to the promotion of public science communication? “The two movements are still separate”, she comments. “We are very supportive and enthusiastic about open access publishing, but that’s about the scientific process and openness. The process for communicating science to the public through the news media is a separate issue and there are dangers of the public reading about very early research findings in the news before they have been peer reviewed and published”. For many scientists, their duty stops when their data is made openly available to all the other scientists of the world; it does not include effective communication to the press and the public. In fact, miscommunication may arise when a scientist is seeking journalists’ comments for a pre-print, and then hope to get a second “bite at the cherry” when the paper comes out into a scientific journal. “Journalists don’t tend to do the same story twice, and a pre-print is by its nature not the very best most accurate version of a set of findings”, Fiona argues. I have had similar thoughts. The COVID emergency, where the publication waiting times could costs lives, is hopefully over. Let’s go back to the slower but more effective pace of contacting journalists when the paper is published in a peer-reviewed journal. Fiona agrees with me. What does the future hold? Fiona is unsure of the best way forward. “Do we lobby for universities to invest in and value their science press officers more, so that SMC can stay small? Or do we need a larger SMC because universities now need to invest more in broader communications?” Internationally, the SMC model has been repeated in many countries. SMCs in Australia, New Zealand, Canada and Japan had already opened when Nature talked about the SMC in 2013. Germany followed suit. And in the past year, new SMCs have opened in Spain, Taiwan and East Africa. “Italy should also be in the list”, I say, volunteering to help. “The SMC model is quite a unique concept in media relations. Unlike other PR offices, we are not interested in promoting our brand name or institutional message. We are really just about helping journalists to access the best scientists”. This is the model that Fiona hopes to inspire internationally. All the existing SMCs are independent associations, loosely associated by a common charter of guiding principles. It’s only one page long, and it is worth reading. I love the stated mission: The mission of an SMC is to inform public debate and discussion on the major issues of the day by injecting evidence-based science into headline news. Where can I sign? My last question is about all this exposure she has received for her book, and how this has been for her. Isn’t she worried that she had become, in Alastair Campbell’s famous words that Fiona reports in her book, the press officer [who] becomes the story? “I had thought about this”, she firmly replies. “I did not want to be the story. I considered waiting until after retirement to publish the book.” But she was worried that openness in science communication was under threat. “Things had changed so dramatically in the last two years. Waiting was not an option.” And I am glad she did not wait. Header image is the cover of Fiona Fox’s recent book

...and that Challenges Me a lot Most Days The good news is challenges are meant to be overcome Writing is my lifeline. Ever since I was a young girl, I’ve always been writing in one way or another. My first experience with writing regularly came from journaling on a daily, sometimes hourly basis. This underrated act of self-care got me through many difficult times in my life. But that was all it was. Words for me to spill onto the page to help make sense of living life with anxiety and depression. Since the beginning of the pandemic, I took to writing fiction to process past trauma, and to rewrite the narratives in my life. Fast-forward a decade, or so later, I decided to try and help others by sharing my experiences publicly. Never could I have imagined how challenging it would be to be a professional writer living with mental illness. It’s emotionally draining to write on the topic of mental illness and everything that goes with it. Trauma, triggers, and flashback, I’m looking at you. And, while yes, I write about mental health often, I’m talking about all the other times too. It doesn’t matter if I’m writing about society, or fashion, or education. My anxiety, depression, and PTSD couldn’t care less about what the topic at hand is. Honestly, the most consistent experience I’ve had, as a writer with mental health concerns, is that the symptoms tend to always show up are the worst possible time. You know, like when a deadline is looming, or I have an interview scheduled for an article. Because, of course, what better time for an anxiety attack than mid-conversation with someone you’re trying to impress. Yes, The Struggle Is Real As a writer, you have several responsibilities, just like any other job. Let me just get this out of the way before we dive any deeper. A freelance writer, content creator, pen for hire, or whatever you want to call us, people who leave words on a page don’t have the stress-free lifestyle Sex and the City portrays. We have deadlines, pressures, and stress. Do I have the freedom to make my own hours? Sometimes. But usually, those hours fall outside your typical 9-to-5. Another situation that pop-culture fails to represent is the ability to have a proper work-life balance. Depending on whether you are self-employed or employed by a company, your time off looks different too. When you’re self-employed, there are no holidays or sick days. It’s not that I can’t take a day off. But if I do, it will hurt my bottom line. My brain is too foggy with depression, or my anxiety has been massively triggered by the way an email response was worded. I read in between each and every single line, fixating on all the wrong things. Or sometimes, when I wake up in the morning, I feel so overwhelmed about everything I have to do that it keeps me from doing much of anything at all. When you have those really hard depressive episodes, and everything is moving in slow motion, you have to push really hard to just get through each moment. Occasionally, I just can’t, and for someone who is high functioning, that is even harder to admit. Sorry, dear editor. I know it might sound ridiculous, but is it possible to extend the deadline? I’ve had some difficult PTSD flare-ups and haven’t been able to get this article quite finished. Having to send that email is my worst fear. I don’t want them to think I’m a flake who is incapable of doing my job. Sincerely, I’ve never been more grateful for opportunities to advocate, educate, and empower using my words. But, sometimes, my mental illnesses feel like they hold me back. Have you ever felt like this? Desperately trying to find the balance between practicing enough self-care to allow yourself to flourish and doing what you love the most? Never fear. There is hope, and there are ways to have a career you love and take care of your mental health at the same time. Real Talk? It Isn’t Easy, But It’s Totally Worth It When you plan accordingly and communicate honestly, you can be productive and serve those who need to read these words. You might even help someone who is going through the exact same thing. I know, I know. I’ve painted a less than wonderful picture of being a creative with mental health concerns. But I’m writing this for you today, not to tell you I’ve got it all figured out (because I most certainly do not), but instead, to share with you that it is possible to pursue this kind of career even when you live with mental illness. Being self-aware is one of the most important things to wrangle early on. When you are self-aware, you can identify the nagging feeling that begins to stir right before everything turns upside down. Even when you have the best-laid plans, triggers can muck it all up, and that’s okay. That’s where making sure you have open and honest communication comes in. Having honest communication is hard. Like really, really hard, especially when it involves disclosing a personal struggle. Now I’m not saying you have to delve into your trauma and everything behind your mental illness, but there is nothing wrong with giving your editors (clients) a heads up. On the other hand, reflect within yourself because you know yourself best. Am I taking on too much work? I know what my limitations are, does the proposed deadline work? No matter how badly you want to be super (wo)man, at the end of the day, we are all human, challenges, quirks, and all. As a writer who lives with mental illness, it can be a helluva challenge, but it’s not impossible. I do my best to plan and be self-aware about how I am feeling. I keep an honest and open line of communication with the people who I work with. Because here’s the thing, if we want to break the stigma around mental illness and health conversations, we have to start having them. Don’t be afraid of judgment or raising anyone’s eyebrows just because you’re being true to yourself. Because honestly, are those the kind of people you really want to be working with in the first place? Header Image source: Kat Stokes on Unsplash

Bipolar disorder is a serious mental health condition that severely affects a person’s mood. It is a relapsing-remitting condition. It might more accurately be called ‘bipolar spectrum disorder’. At one end of the spectrum is profound depression. At the other end of the spectrum is mania. In between these two poles are the less severe forms of depression and mania: moderate depression and hypomania. At the very centre of the spectrum is normal mood. People with bipolar depression might feel hopeless, desperate and suicidal. They may have little energy or interest in doing things and be unable to enjoy things that they would normally find pleasurable. When I have experienced severe depression, I have been almost completely paralysed by it and felt constantly suicidal. Antidepressant treatment never helped me, nor did electroconvulsive therapy (ECT). People with mania can often feel euphoric, energetic, excitable and invincible. It can be a time of great creativity. However, this can quickly spiral out of control into overspending and other excessive behaviours. At the extreme, people with mania can also experience psychosis, including hallucinations and delusions. When I had psychotic mania, I did a lot of thinking and writing. I had a heightened sense of awareness where every little thing seemed to carry great significance and importance. I had insights into life that I am unable to access whilst in a normal mood state. It was when I started hearing voices that I agreed with my psychiatric care team that I needed to be admitted into hospital. They had been threatening to section me for several weeks. In some people with bipolar, the two poles of depression and mania coexist in tension with each other. The result can be a tangled web of unpredictable thoughts, feelings and behaviours. It’s not nice and it’s not comfortable. This is called a mixed affective state. Approximately 40% of patients with bipolar disorder will experience mixed episodes, defined as a manic state with depressive features, or manic symptoms in a patient with bipolar depression. It is thought that people with bipolar disorder who have a history of mixed states are overall at a higher risk of suicide than those who do not experience mixed states. Moreover, research suggests that young adults with bipolar disorder in a mixed state are at a higher risk of suicide compared with those in a depressive episode. This is an account of my very personal experience of a mixed affective state. However, all mixed states are different. No two people with bipolar disorder will have the same experience. I knew that something was wrong on that June day back in 2016 when I walked through M&S Home and felt compelled to buy everything in sight. Not just things that I actually needed, but also things I liked the look of. I managed to restrain myself, but it was a very clear warning sign. The next time I walked through the same shop a couple of days later, I gave in and I shopped! I knew that this was hypomania. I was going high. I am now 61 years old. I have had bipolar disorder since I was 21. I experienced the manic psychotic episode when I was 25, and had since then suffered numerous profound depressive episodes, but I had experienced no further episodes of pure mania or hypomania. However, I knew all the signs. Why should I have gone high again at the age of 56? At the time I was receiving a powerful drug called Rituximab, which is used to treat some cancers and autoimmune conditions. I had a type of blood cancer. Rituximab is often given by intravenous infusion. I had six infusions, each given three weeks apart. It was in the days leading up to the final infusion that I noticed that my mood was slipping. The hypomania in itself was not particularly uncomfortable. It was a lot easier for me to manage than full mania or depression. I was spending too much money and I was aware that I was talking more quickly than usual. I accessed an appointment with a psychiatrist, who confirmed the hypomania. I was prescribed a higher dose of my mood stabiliser, and I believed that my mood would stabilise quickly over a couple of weeks. It didn’t. Things became a lot darker for me. I became very agitated. I went out for long walks to try to walk through the agitation, but it didn’t go away. I am a keen gardener but there were times when I couldn’t even go into my garden because the colours were too bright for my brain. I felt paranoid, confused and overwhelmed. My mind was a chaotic mess. I knew something was very wrong. I went to see the Crisis Team. About half an hour into the meeting, I had to leave when I felt compelled to throw my metal thermos flask through the window, which I really didn’t want to do. I was on edge, agitated, highly emotionally reactive, my mind was racing and I was frequently so distraught that I cried uncontrollably. The depth of my distress was very scary. It was as though I was feeling all the losses I had ever experienced throughout my whole life all at once. These overwhelming feelings would come over me suddenly with no warning. I couldn’t deal with this so I regularly started taking high doses of my mood stabiliser, which was very sedating, to try to get through the distress and the agitation. I was inadvertently overdosing. I was in a dangerous place. My brain was overactive. I pursued lines of thought compulsively. I did a lot of thinking when I was out walking. I was like a dog with a bone; tossing ideas around in my mind constantly, pursuing one line of thought and then another. It was very wearing. Some lines of thinking were productive, others not. When I had met with the Crisis Team, they decided that I was exhibiting the symptoms of Emotionally Unstable Personality Disorder, and that I required no further assessment. I am not quite sure how this happened as my medical records very clearly showed that I had a bipolar diagnosis. Only eight days before meeting with them, I had been diagnosed with hypomania by a Consultant Psychiatrist, which was also clearly documented in my records. I managed to get taken on by the local mental health service. However, as the months went by, I wasn’t getting any better. I went to A&E departments to try to get help. Some of my behaviours were extreme and erratic. I was becoming increasingly desperate. At one A&E visit, I was lying on the floor and later screaming at the top of my voice. I felt out of control. I repeatedly went to see my GP, who on one occasion tried to persuade me that I was depressed. I told him that I wasn’t depressed. I told all the mental health professionals who I met with that I didn’t know what was wrong with me, but I knew that it wasn’t depression or hypomania because I knew these mental states well. Looking back, I presume that the doctors treating me were interpreting my symptoms and behaviours within the framework of a personality disorder. I had the feeling that my ‘care team’ were trying to control my erratic behaviours rather than trying to understand the underlying cause of them. Finally, after all the months of trying to get help, the breakthrough came. I happened to be in email contact with a psychiatrist. I told him that I wasn’t getting any meaningful help locally. He suggested that I ask my GP to refer me to the Affective Disorders Service at the Maudsley Hospital in London for an assessment. Prior to the assessment, I was sent a lot of questionnaires to complete and return. I was eventually seen at the Maudsley. The assessment was very thorough. At the end of it, the Consultant Psychiatrist who saw me said: “You are in a mixed state”. He advised me to stop taking the antidepressant that I was being prescribed, and he recommended a different mood stabiliser for me to take. Finally, he said, “This will pass”. It took about eight weeks after this before I could honestly say that I was fully out of it. The mixed state had lasted for nine months. I was diagnosed with Hypomania with Mixed Features (of depression). This described my mental state perfectly; with the compulsive trains of thought, agitation and emotional reactivity, alongside the all-consuming distress. It explained the overdosing and other risky behaviours. The relief I felt from receiving the diagnosis was overwhelming. It was all completely explainable. The madness had a name. It was going to end. I had hope that I could become sane again. I could rejoin humanity. Slowly but surely I came out of the mixed state. I became calmer and the compulsive thinking slowed down and eventually stopped. The distress subsided. I started to feel as though my feet were getting back on firm ground. Why didn’t I myself realise that I had been in a mixed state? This was mainly because I had never knowingly experienced one before so had no personal knowledge of it. Also, I knew very little about mixed states. I barely even knew they existed. If I had realised what was happening to me, then I could have accessed expert help far sooner. The psychiatrist who assessed me at the Maudsley concluded that it was most probably the Rituximab that had destabilised my mood all those months earlier. Indeed, unwanted side effects of Rituximab include “confusion”, “nervousness”, and “feeling sad or empty”. He also considered that the antidepressant medication which I was being prescribed at quite a high dose may have contributed to the mixed state. My main motivation for writing this piece is to try to raise awareness of mixed affective states, most especially for health professionals and for people with bipolar. It is potentially a very dangerous state to be in. I suspect that other people with bipolar disorder are having their mixed states missed or misdiagnosed just as mine was. It effectively trashed nine months of my life, which I will never get back. I survived it but others may not. My concern is for those people who do not come out of the other side to tell their stories.

How common are suicidal ideation and attempts in Kenya, and what influences them? Trigger warning: The following blog describes research about suicidal ideation, suicidal attempts, and suicide. Some readers may find this distressing. It used to be commonly said, both in the West and in Africa, that suicide was a western phenomenon and that it rarely occurred in Africa. This presumption was at least partly based on figures submitted by governments to the World Health Organisation (WHO). However, richer nations generally have had and still have much more exhaustive methods of data collection about causes of mortality based on formal death certifications of all deaths by qualified doctors, which were then reported to a national database. In low and middle income countries where doctors were and still are often few and far between, where burials are swift (generally within 24 hours) and where suicide may still be illegal, suicide reporting has generally been much less systematic. Therefore, these factors contribute to an underestimation of the numbers of death by suicide in these countries. I am a psychiatrist and epidemiologist who has worked for some decades with governments and their ministries of health, especially in low and middle income countries, on policy development, research and training of health staff. This article describes some research into the prevalence of suicidal thoughts and attempts, and their risk factors, in a district of western Kenya. When I first started working with ministries of health in Africa in 1997, I was puzzled by the presumption that suicide is rare, especially as I frequently heard anecdotes of what sounded like probable suicides, such as people jumping from high buildings or ferries. But then I came across a careful study of female mortality in one region of Tanzania, which found a suicide rate in women aged between 15 and 59 years old that was similar to rates in England. Researching the Population Pathway to Suicide When seeking to study the antecedents of actual suicide, it is useful to look at suicidal ideation and suicide attempts, partly because they are much more common than actual suicides, and partly as these are part of the pathway to suicide. These range from depressive thoughts, feeling that life is not worth living (tedium vitae), feeling one would rather be dead (death wish) to suicidal thoughts, suicidal plans and hence to suicide attempts. So, my Kenyan colleagues and I carried out the first household population study in Kenya to look at suicidal thoughts (ideas ranging from feeling that life is not worth living and that one would rather be dead, to thoughts of wanting to kill oneself, and even to considering possible methods) and suicide attempts as part of a mental health epidemiological survey of a household population in Maseno district, near Lake Victoria in Nyanza Province in Kenya. How Do Rates in Kenya Compare with Those in Other Countries? We found that, at some point in their lives, over a quarter of the study participants had thought that life was not worth living (tiredness of life or tedium vitae), while over a fifth had experienced death wishes at some stage. When we compared these figures with similar albeit much larger surveys in Britain, Australia, and the United States (US), we found that suicidal ideation in this Kenyan population is a little more common than suicidal ideation in the United Kingdom (UK) and Australia, and nearly twice as common as that found in the US, meanwhile suicidal attempts in Kenya were rather more common than that found in the US but a little less common than found in the UK. This is the first household population study in Kenya to look at suicidal ideation and suicide attempts. Previous studies have only looked at patient samples and at college students. Interestingly the studies of the Kenya college students also found higher prevalence of suicidal ideation compared to US college students. What are the Factors Associated with Suicidal Thoughts and Attempts in Kenya? When we looked at factors associated with suicidal thoughts in our Kenyan survey, we found that female sex, having Common Mental Disorder (CMD), having a number of recent stressful life events (such as serious illness, injury or assault to oneself or a close relative, death of an immediate family member, death of a close family friend or other relative, separation due to marital difficulties, or steady relationship breakdown, serious problem with a close friend, neighbour or relative), and having a large social group size were all associated with increased rates of lifetime suicidal thoughts. Furthermore, when we looked at factors associated with suicidal attempts, the presence of psychotic symptoms (such as feeling happy without a break for days on end, feeling that thoughts were interfered with or controlled by someone else, feeling that people were against you, and plotting to cause serious harm, feeling that something strange was going on, and hearing voices) was found to be significantly associated, once factors such as age, sex, employment status, and life events had been taken into account. How Does This Compare with Other Countries? Risk factors associated with suicidal thoughts and attempts show some consistency across studies and countries. The World Mental Health Survey Initiative which studied 17 countries (including Nigeria and South Africa, but not Kenya) found that risk factors for suicidal ideation which were consistent across the selected countries included female sex, younger age, less well educated, unmarried (i.e., single, separated, divorced or widowed) and having received a diagnosis of a mental disorder. The US National Comorbidity Survey also found that higher rates were associated with being female, young age, less well educated, unmarried and unemployed. We were therefore surprised that an association between age and either suicidal ideation or attempts was not found in this Kenyan study. Why We Might Not Have Found a Decline in Suicdal Ideation and Attempts in Older People in Kenya A detailed cohort study in the UK found that the decrease in reported previous-year suicidal thoughts with increasing age was partly explained by lower rates of reported abuse in childhood (in those older than 75), depression, and anxiety symptoms (in those older than 55), all factors which are all strongly associated with suicidal thoughts. Moreover, higher rates of homeownership and cohabitation are protective factors in people older than 35. Interestingly, rates of phobias, irritability, and compulsions (an irresistible urge to behave in a certain way) also decreased with age, and the association of these symptoms with suicidal thoughts was particularly strong in the youngest age group (between 16 and 34 years of age). Additionally, childhood abuse looks to be a common risk factor in all age groups as people who reported experiencing childhood abuse in all age groups reported higher rates of suicidal thoughts. This suggests that childhood sexual abuse (i.e., non-consensual sexual intercourse, unwanted sexual touching, and uncomfortable sexual talk) has lifelong negative effects on suicidal ideation. So, it is possible that in our Kenyan sample, the older age groups have accumulated fewer protective factors than would be found in a Western sample. What About the Effects of Life Events and Social Network Size? The relationships we found between life events and suicidal ideation and attempts respectively were to be expected and are found elsewhere. However, the inverse relationship of suicidal ideation and suicide attempts with social network size in Kenya is counter-intuitive. Nevertheless, in the same survey we found a similar inverse relationship (when one variable increases, the other variable decreases and vice versa) of CMD and psychosis with social network size and perceived social support. Similarly, a previous study in Tanzania found a relationship of CMD with three or more recent life events but no relationship with social network size or perceived social support; and a relationship of psychosis with two or more recent life events, but again no relationship with social network size or perceived social support. It may be that extended family groupings, common in Africa, and hence network size, confer obligations as well as supports, and this may account for the lack of protective effect of social network size or perceived social support found both in this study and in the earlier study in Tanzania. This study indicates that suicidal ideation and attempts pose a significant public health burden in this poor rural area of Kenya, characterised by political unrest, high unemployment and environmental problems of drought, and water hyacinth in the Lake hampering the fishing industry. This is a local rather than a national survey and there is a need for a nationally representative mental health survey in Kenya which includes an appraisal of suicidal ideation and attempts. The findings are relevant for mental health promotion and prevention programmes, public education and professional training programmes in relevant sectors, especially in front line health workers and social workers who need regular systematic training in biopsychosocial assessment and management of suicidal risk. Organisations which provide both resources and direct help: distrACT — Appwhich provides information and advice about self-harm. nhs.uk/apps-library/distract Samaritans — 116 123 (freephone); jo@samaritans.org; Freepost SAMARITANS LETTERS; samaritans.org If you would like to learn more about this topic, here are a few articles that I’d recommend as helpful reading: Prevalence, types and comorbidity of mental disorders in a Kenyan primary health centre. Social psychiatry and psychiatric epidemiology Suicidal ideation and suicide attempts among Hispanic subgroups in the United States Suicidal thoughts and behaviours among Australian adults: findings from the 2007 National Survey of Mental Health and Wellbeing Suicidal behaviour among youths associated with psychopathology in both parents and youths attending outpatient psychiatric clinic in Kenya Suicidality and depression among adult patients admitted in general medical facilities in Kenya A cross-sectional study of co-occurring suicidal and psychotic symptoms in inpatients at mathari psychiatric hospital, Nairobi, Kenya Cross-national prevalence and risk factors for suicidal ideation, plans and attempts The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in Ghana Prevalence and Correlates of Suicidal Ideation Among Students in sub-Saharan Africa Correlates of suicide ideation and attempt among youth living in the slums of Kampala Header Image by James Wiseman on Unsplash