Writer’s note: This article has been co-written by Courtney Worrell and Tony Woods It has long been Vincent Van Gogh’s Self-Portrait with Bandaged Ear (1889), courtesy of the Courtauld Gallery Anecdotal Édouard Manet’s Banks of the Seine at Argenteuil (1874), courtesy of the Courtauld Gallery Heart Rate Édouard Manet’s A Bar at the Folies-Bergère (1882), courtesy of the Courtauld Gallery Emotional Intelligence

As explored in this ITM article by Courtney Worrell, perfectionism can turn into a hypercritical relationship

My fellow Inspire the Mind writer Courtney Worrell has already recapped this so eloquently.

of ASPIRE Consortium King's College London, UK: Carmine Pariante, Anthony Woods, Caitlin Pentland, Courtney Worrell, Giulia Lombardo, Lea Schmid, Luca Sforzini, Melisa Kose, Naghmeh Nikkheslat, Nicole Mariani

As Courtney Worrell shares in her 'Transforming the future of Clinical Trials' article, clinical trials The journey towards unlocking the full potential of the human brain has begun, but striking a balance

obsession with appearing morally and socially perfect can be extremely unhealthy and certainly unrealistic; Courtney Worrell talks about this brilliantly in her blog “ The Trials and Tribulations of Moral Perfectionism

You can find more information in this piece, written by my colleague Courtney Worrell at the beginning

An insightful InSPIre the Mind post by Courtney Worrell delves deeper into this relationship between

Loneliness is sometimes sad and uncomfortable, and I think we like to pretend it isn’t happening when it is. We hide the feeling from people we know, like saying it out loud means something is wrong. I now reject this and would like to say: I need social connection, and I’m not afraid to say it anymore! Image source: Selçuk Çalışır on Pexels I’m working as a student research assistant in a psychology research lab that looks at adolescent mental health, more specifically, loneliness. I’m coming to the end of my placement (which I am very sad about by the way), and I’ve realised this hasn’t just been about getting experience or figuring out if I like research and academia. It has actually changed how I think. This sounds dramatic, but it’s true. By the end of this, I hope to offer some insight into how important social connection is and maybe get you to rethink the way you see loneliness, not just as a personal feeling, but as something shaped by the world around us. Before I continue, it is important to make a distinction between being alone and feeling lonely. These are not the same thing. Feeling lonely is a subjective, uncomfortable feeling of disconnect that comes from a gap between the relationships you want and the ones you actually have, while being alone is more of an objective and neutral physical state. We can choose to be alone, but we can’t really choose to be lonely. That means you can be surrounded by people and still feel completely alone, or be physically alone and feel completely fine. I’ve felt lonely living in a house with eight loud, social people, and I’ve also felt completely fine living alone. It’s not about how many people are around you. It’s deeper than that. Also, just to note, loneliness isn’t inherently bad. In small doses, it can actually be quite adaptive; it’s like your brain is telling you that you need social connection. It only really becomes a problem when that feeling sticks around for too long, or when the reasons behind it are out of your control. Loneliness is a social justice issue This was the first paper my supervisor sent me when I started my placement, and I remember thinking, ‘Oh, loneliness is quite political!’ The paper argues that the way society is set up now actually feeds into loneliness. It links this to neoliberalism, which is basically the system that pushes individualism and independence. In simple terms, it promotes the idea that you should be self‑sufficient and manage everything on your own, rather than relying on others or working collectively. You can even see this in workplaces. Research shows that modern industries can push people to think and act as individuals, for example, by weakening unions, or even through teamworking that still measures and separates people. So, even when you’re in a “team”, you’re not always made to feel like part of one. At the same time, neoliberal ideology tends to increase competition and reduce people’s sense of connection to others. This can make people feel more alone and harm their well-being. We’ve therefore normalised the pressure of figuring out life alone, instead of within communities. When put in a system like that, it becomes much easier for loneliness to persist. It’s not surprising anymore; it’s normal. Privilege Check And once you start thinking that loneliness is the norm, it becomes hard to ignore that access to social connection isn’t equal. Instead, like most good things, access to stable social connections is a privilege. It’s easy to say “just go out and connect” when you actually feel like you belong in the spaces around you. But in reality, not everyone does. Some people don’t feel like they belong; some face exclusion or discrimination; and some just don’t have the time, money, or access to places where connection can happen easily. To list a few, lack of green spaces, travel costs, and family, financial, and academic responsibilities all create real barriers. And those barriers are not evenly distributed. Some people have to work much harder just to access the same opportunities for connection. So “just go meet people” is terrible advice! It ignores the fact that for some people, that option isn’t as easy as it sounds. We need to start thinking about whether the opportunity for connection is actually available to everyone. Image source: Olgaç Lale on Pexels The self-shame is real, but it shouldn’t be Before, I saw loneliness as a personal thing. Something I was responsible for fixing. Like if I felt lonely, it meant I hadn’t tried hard enough to connect, or that I was somehow socially “failing.” But that whole way of thinking is wrong, and it actually makes things worse. It puts all the responsibility on the individual and ignores what’s happening around them. What ends up happening is a cycle. People feel lonely, feel embarrassed about it, don’t talk about it, and then feel even more isolated. So, it’s not just that people are lonely; it’s also that they feel like they’re not supposed to be lonely, like it means something is wrong with them. But the reality is, loneliness is actually really common. A lot of people experience it at different points in their lives, even if no one is talking about it out loud. The need for social and emotional companionship is universal. It doesn’t mean that something is wrong with you. It just means you’re human. Social connection is major Social connection matters in small, everyday ways. Not in a “have loads of friends” way, but in meaningful moments. I have always had a habit of going into spaces and rushing myself to get out. Walking into a shop, avoiding eye contact, paying, and leaving. But there is life in asking the shopkeeper how their day has been, saying hello, talking to people around you instead of pretending they don’t exist. I’ve realised most people are a bit shy too. There’s this unspoken rule where no one wants to be a bother, so we all avoid interaction, even when we might actually want it. But for me, that’s something I’m trying to unlearn. It’s always nice to chat, even briefly. Side note, but relevant: if you ever worked in retail, you may agree with me here. I have, and I promise you, if you want to ask if there is another size in stock, please do. I have gone through whole shifts without a single interaction, just hoping someone would ask me anything. People don’t want to be a bother, so they stay quiet, but honestly, ask. Those small moments are still moments of connection sometimes! And something I’ve really loved about this placement is getting coffee with my colleague after lunch. It’s not just about the coffee; it’s the walk there and back, the quick catch-up, the small break in the day where I get to be out of my own head and in a conversation. That changes everything. I think we underestimate how much these small moments add up. Image source: Author's own image I don’t think I’ve solved loneliness, but I definitely see it differently now. It’s not something to be embarrassed about, it’s just a signal that you need connection. I’ve started noticing it more in myself and in other people. And instead of ignoring it, I’m trying to do something about it. Loneliness isn’t something to hide from. It’s something to respond to, individually, but also as a society.

The journey to understand the light and the dark is ongoing, but I know that I am not defined by cyclothymia

Check out Courtney’s piece on perfectionism and mental health here. Look After Your Mind Other blogs mentioned o Why Perfectionism May Be Damaging for our Mental Health — Courtney Worrell o Should Psychiatry be working to prevent Mental Illness in the first place? 

Image Source: Gustavo Fring on Pexels It was November 2004 when I received my comorbid (that is, two disorders together) psychiatric diagnosis: Panic Disorder with Agoraphobia and Major Depressive Disorder. At age 14, this had been a huge relief and also the first time I encountered what the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) were. For the first time, I had a valid explanation for my feelings of impending doom, my breathlessness and dizziness, and my rapid heart rate any time I mustered the motivation to venture more than 10 meters away from my home. I finally had an explanation for why all I wanted to do was stay in bed all day and why I had problems sleeping during the night. Unfortunately, this diagnosis had come 8 years too late. My memories of my symptoms as a child are less crystallised, but I remember that going to friends’ birthday parties was always a source of anxiety. The loud music, the crowded rooms, and the intense lights were all too much for me. At age 6, I wasn’t able to articulate my symptoms of panic attacks very well, so I described them as dizziness. I still tried to attend parties every year, but they would always result in the same outcome. I would call my parents telling them I felt dizzy, and they would come and take me home after 30 minutes or so. The same “dizziness” would also occur in the classroom a few times, as well as during long trips. When my parents took me to the doctor, the first course of action was a blood test and a physical examination. Nothing wrong was found so the doctor suggested that I might have a lack of vitamins contributing to my “dizzy spells”, and therefore I should take some supplements. And so, I did. The “dizzy spells” would come and go, and for the next 8 years I would just accept them. It was not until age 14, when my symptoms became severe enough that I had to quit school for a year, that I was able to describe my symptoms more accurately: and a visit to a psychiatrist, rather than a physical health clinician, seemed like the right place to turn. And so, in November 2004, when I received my diagnosis, my symptoms were severe enough to warrant medication – benzodiazepines for my panic attacks for a couple of months and antidepressants for my depression, which could also act as a longer-term solution for my panic attacks, alongside CBT. It took a few attempts to find the right dose of medication. After years of highs and lows, remissions and relapses, I was able to get back into education and regain good social functioning. Image Source: Polina Tankilevitch on Pexels These experiences have formed a lot of my motivation for the research I carry out today. When I think back to those years, I have a few questions: What if I could have been diagnosed at age 6 rather than at age 14? Would I have had a less strenuous path to recovery? What if, at age 14, I could have had a test that determined the right dose of medications, at the right time? Would I have been able to get back to being myself faster? Why did I have those experiences? I hadn't experienced trauma; I had a stable and loving upbringing, so why did I have a comorbid psychiatric diagnosis? From patient to researcher, I now try to answer these questions myself. In my work, I try to use Artificial Intelligence (AI) approaches to improve pathways for personalised medicine in mental health. My area of work is broadly structured around three foundational themes: Can we predict the onset of symptoms/a disorder before they occur? Can we better understand the mechanisms of disorders across the diagnostic spectrum? Can we provide patients with personalised options that increase patient choice? A good example of the work that I do was published in Biological Psychiatry in 2022. I have always been fascinated by the comorbidity in the same individuals of both depression and psychosis, because much of modern psychiatry is based on the (mis)understanding of how these disorders differ, starting in the late 19 th century. Emil Kraepelin, a German psychiatrist working under the leadership of Alois Alzheimer, dichotomised psychoses into manic-depressive illness and dementia praecox (the precursor of schizophrenia). Much of modern psychiatry is based on that original dichotomy. However, such clear-cut dichotomies rarely exist in mental illness. Comorbidity rates in psychiatry are very high and follow a rule of 50%: half of people who meet diagnostic criteria for one mental health disorder also meet diagnostic criteria for a separate disorder at the same time; half of people who meet diagnostic criteria for two disorders at the same time also meet diagnostic criteria for a third disorder; and so on. Moreover, there is a lack of accepted biological or genetic markers for diagnostic categories. It is therefore very important to understand whether the current diagnoses we have reflect clinical reality and whether they have a strong biological basis. Image Source: Google DeepMind on Pexels In my 2022 Biological Psychiatry article , I used AI to try to identify whether the diagnostic categories of depression and psychosis are rooted in biology and whether a biology-first approach could be better. I used brain scans detailing the brain structure of patients with depression and psychosis and fed those into an AI algorithm. I tasked the algorithm with finding groups of similarity based on brain structure without telling the algorithm which patients had psychosis, and which had depression. If the algorithm placed most of the people with psychosis in one group and most of the people with depression in another group, then that would show us that our current frameworks are biologically based. If the algorithm identified groups consisting of a mix of patients (so-called transdiagnostic groups), then our current frameworks would be failing to capture meaningful biological pathways. Our results showed exactly that. The algorithm identified two transdiagnostic groups. Moreover, these groups showed specific symptoms that are not usually associated with patients who belong to either group. These findings showcase a simple truth that exists in current clinical practice: while two people might have the same diagnosis, their neurobiology might be very different – yet they will be treated with the same medication; and while two people might have a different diagnosis, their neurobiology might be very similar – yet they will be treated with different medications. Taking things a step further, I wanted to see whether predicting symptoms with AI in these new, more biologically grounded groups could offer better insights. Since we had data from these patients nine months after admission, I tried to predict their symptoms using only their data at presentation. I found that I was able to predict their 9-month symptoms more accurately in this new biologically based separation compared to the traditional depression-psychosis separation. Astonishingly, we could do that using only data from a blood test and a few questions.   Mental health research still has some way to go before we are able to get patients in the clinic, ask them a few questions and/or run a few tests, feed those into an AI algorithm, and provide accurate diagnoses, prognoses, and medication doses. However, what we are seeing in this line of work is promising and makes me hopeful. My hope is that, in a few years, a 6-year-old Paris presenting with “dizziness” symptoms can have a blood test and get an accurate diagnosis and course of action. Or that a 14-year-old Paris receives a biologically based diagnosis rather than a comorbid diagnosis, ensuring he can receive the right treatment at the right time.