A boy diagnosed with cancer at seven years old is not thinking about fatherhood. His parents are not thinking about it either, not really, not while they are absorbing a diagnosis and bracing for treatment. And yet, tucked into that first wave of decisions, is one about a future so distant it barely feels real: whether to try to preserve his fertility before treatment takes it away. I recently completed a DPhil in reproductive science, alongside a master's in clinical embryology, focused on developing laboratory techniques to help preserve and restore fertility in prepubertal boys undergoing cancer treatment. Much of that work was spent in a lab, not with patients directly, but the more time I spent on the underlying science, the more I found myself thinking about the boys and their families behind it, and what they must be going through. That is what led me to write this piece. The clinical process for preserving a child's fertility is careful and well established, but what happens emotionally, for the child, and later the adult he becomes, is rarely part of the conversation. I want to bring that gap into view and make the case that the mental impact of this experience deserves as much attention as the science trying to solve it. Image Source: Derek Finch on Unsplash The Clinical Picture When a child is diagnosed with cancer, saving their life is the priority, but for many, the treatment that saves them can also take something else, their fertility. Chemotherapy and radiotherapy work by targeting cells that divide quickly, which is exactly what makes them effective against cancer. Unfortunately, the cells responsible for producing sperm later in life, called spermatogonial stem cells, also divide rapidly, and are often destroyed or damaged as collateral in the process. Depending on the drugs and doses used, this can leave a child with reduced fertility, or none at all. Advances in cancer research mean childhood cancer survival rates have climbed dramatically in recent decades. In high-income countries, around 80% of children diagnosed with cancer are now cured. That is, rightly, one of medicine's great success stories. But it also means that a growing number of people are living long lives after treatment and having to reckon with what that treatment left behind, including their fertility. For teenage boys and adult men, there's a straightforward answer: freeze sperm before treatment starts, the same way it's done for many adult cancer patients. But for a boy who hasn't yet gone through puberty, that option doesn't exist. The body hasn't started making sperm yet, so there's nothing to freeze. Currently, the only options for these patients are still under experimental development: a small biopsy (a medical procedure that removes a small sample of tissue, cells, or fluid from the body) of testicular tissue is removed under anaesthesia and frozen, in the hope that by the time the child grows up, medical science will have found a way to use it to restore fertility. These options include generating patient-derived sperm within a lab or transplanting the biopsies back into the patient once they reach adulthood. The UK's first programme for freezing tissue biopsies began in 2002, and it now happens at a handful of specialist centres, working with a team of paediatric oncologists, reproductive specialists, psychologists, and genetic counsellors all involved in the decision. Families are told clearly: this is experimental. There is no guarantee it will work. It's a biopsy taken on hope, stored for a future that hasn't arrived yet but is on the horizon. This is the gap my own research sits in, trying to build the lab techniques that could one day turn that frozen tissue into something usable. Image Source: maulana ahmad on Unsplash The Psychological Gap What strikes me most, working in this field, isn't the biology. It's the timeline. A five-year-old having testicular tissue frozen has no concept of fertility, parenthood, or what any of this means. The decision is, thus, made entirely by parents and clinicians, guided by careful, compassionate counselling, but the child himself isn't in the room in any meaningful sense. He often can't consent (it is his parents who provide consent) to what's happening to his body, and he won't understand the weight of it for years, sometimes decades. That creates a very particular kind of delayed grief, one of the many late effects of cancer that surface long after the treatment has ended. Unlike an adult diagnosed with cancer, who processes the loss of fertility alongside the diagnosis itself, a boy who has this procedure as a child often doesn't confront what it means until adolescence, or later, when a friend becomes a parent, when a relationship gets serious, when the question "do you want kids one day?" stops being hypothetical. Research on childhood cancer survivors backs this up: many say they want biological children later in life, and infertility has been linked to lower self-esteem, and strain in relationships as adults, not necessarily because of the medical facts, but because of what those facts mean for identity, masculinity, and the future they'd pictured for themselves. The distress associated with infertility is not minor. Studies have linked infertility-related stress to depression and, in some cases, suicidal thoughts, and this burden on men specifically has historically received far less research attention than it deserves. And there's very little structured support for that moment. The clinical process, the biopsy, the counselling, the freezing, is well established. What happens fifteen years later, when a young man learns what was done for him as a child and has to make sense of it, is a conversation the healthcare system isn't always equipped to have. That's the part of this story that doesn't often get told alongside the science. Image Source: Ba11estas Photography on Pexels Closing the Gap The pace of progress in reproductive science gives real reason for hope. Techniques like the ones I work on are edging closer to turning tissue that has sat frozen for years into a genuine path to fertility, and that horizon is closer than it was even five years ago. But the science alone is not enough. Behind every frozen biopsy is a child who did not necessarily choose this, and later, a young man carrying the emotional weight of a decision made before he could understand it. As the medicine improves, we need to improve alongside it, building the emotional support these patients need, and making space for voices that are rarely asked to speak.

Image Source: Taufik Ramadhan on Unsplash+ I have read countless articles on the gut-brain relationship, but very few go into depth about one particular concept. As a Nutrition & Lifestyle Practitioner completing an MSc in Psychology & Neuroscience of the Mind-Body Interface, a few classmates asked me to share my knowledge in this area, so I decided to write about the most important thing I’ve learned in the past several years on the gut-brain axis. Now, for those of you who don't know much about the gut-brain connection, the best way to understand this beautiful mechanism is to see it as a two-way communication network connecting the mind and various organs, including the digestive system. One of the main nerves connecting the two areas is called the vagus nerve, which contains around 100,000 neurons. Because of this connectivity, I often describe the mind and digestive system as one system. Now, here is what I've noticed. Many gut-brain articles discuss a bottom-up approach: how your gut can influence the brain and mind. How eating well can improve gut microbiome diversity, influence mood, and optimise cognitive processes, and how certain species of gut bacteria are protective against cognitive decline. Don't get me wrong, these are great and important findings; but here is what very few authors discuss. The Importance of Top-down Findings of the Gut-brain Connection My own personal health journey taught me just how strong this direction can be. So, allow me to discuss how positive life experiences, emotions, and mindsets can support the gut and the rest of the body. I’d also like to discuss how negative experiences, emotions, and mindsets can disrupt digestion and one’s health. Healthy Function of the Brain & Vagus Nerve We all love serotonin and dopamine, right? After all, healthy levels of serotonin and dopamine are often associated with good mood states, whereas altered levels of these neurotransmitters have been linked with IBS, depression, and PTSD. Relaxing the mind and body can support parasympathetic activity (the ‘rest and digest’ state), promoting healthy function of the body, including the gut. Additionally, relaxed, healthy states of the mind can support activity in the prefrontal cortex, the area of the brain that helps us make decisions, manage emotions and control impulses, often making healthier lifestyle choices easier. A Healthy Microbiome The microbiome is a beautiful ecosystem that, much like our own jungles and forests on this earth, has a variety of species living in various places on our body. The gut microbiome is particularly interesting and has been the most researched. A healthy gut microbiome is often diverse, beaming with all sorts of life. Each species contributes to the growth and maintenance of its environment, i.e. you as the host. Certain bacteria have been shown not only to synthesise serotonin, but also to consume and metabolise the molecule, encouraging serotonin-consuming species to grow. Other neurotransmitters have similar effects. Oxytocin, released when connecting with others, can also alter and improve the overall composition of your gut microbiome, supporting a healthy and diverse ecosystem. Healthy Gut Function Both serotonin and dopamine are important neurotransmitters that regulate gut motility, ensuring the food moves through the digestive tract at a healthy pace so that waste products can be excreted regularly. A more relaxed nervous system helps with the secretion of stomach acid, digestive juices, and enzymes to break down your favourite foods. Serotonin and dopamine allow for that smooth muscle contraction in the gut, known as the migrating motor complex, which moves digested food along the tract so that waste products can leave the body regularly. Additionally, serotonin can help balance the sensitivity of digestive organs and support gut cells to heal and create more gut cells in injured areas. Both serotonin and oxytocin play a vital role in the maintenance of tight cell junctions in the gut wall, helping ensure nutrients enter the bloodstream and unwanted substances stay out. Image Source: muhammad noor ridho on Unsplash Impact of Stress on the Brain Here is where things can go downhill. Although stress can vary from individual to individual, and small amounts are considered beneficial, large amounts of stress can leave us feeling unable to cope with long-term challenges, potentially threatening our wellbeing or survival. This feeling is not always easily identifiable, especially if we were raised in stressful environments, where high levels of stress become the new normal. However, when the stress response is activated, we have less activity in the pre-frontal cortex, which is why willpower and self-control can feel much harder to access. It's much more difficult to make healthy lifestyle choices due to this, as the system prioritises dealing with the threat first. These stress hormones often lead to poorer levels of serotonin and dopamine; both vital neurotransmitters needed for maintenance of body health and function. A Stressed Microbiome Dysbiosis is a term used to describe an unfavourable change in the microbiome ecosystem, often characterised by a loss of diversity, loss of beneficial species, and increases in potentially harmful bacteria. Stress can contribute to the onset of dysbiosis, as well as larger gaps between the cells that line the gut wall. When these gaps increase, the gut barrier can become weaker, making it easier for unwanted bacteria or their by-products to pass through. But here are some interesting ways stress can affect the gut microbiome: Adrenaline & Noradrenaline can elevate certain bacterial levels 10, 000-fold which can crowd out good bacteria. Stress hormones can travel to the gut and increase bad bacteria to grow, e.g E.coli In one study, couples in a troubled marriage had more signs of a weakened gut barrier than couples in a more supportive relationship. Stressed Gut Function Even low amounts of long-term stress hormones can reduce the body’s “rest and digest” signals and have digestion as a lower priority for the body when it comes to energy distribution. So that means less stomach acid can be produced, which may contribute to acid reflux, as the stomach needs certain levels of acid for the stomach’s gate to work properly. It also means fewer digestive enzymes can be produced, so the food is not properly broken down and/or absorbed. Additionally, these stress pathways can directly affect how quickly food moves through the gut by slowing down the intestinal tract, contributing to constipation. That said, adrenaline-mediated stress, which can come from events that make you feel anxious, excited, or fearful, often leads to faster movement through the gut and therefore looser stools. So, hopefully now you have a better understanding of why your appetite might change as exams approach, or why you feel that horrible pit in your stomach before a romantic date. Whilst optimising your nutrition is important, just remember: real-life situations can significantly influence your biology, either for better or for worse. Don’t underestimate the power of the placebo effect, or the strength of changing your environment and the people you spend your time with. Supporting your biology also means managing stress in ways that feel realistic: do activities you really enjoy, find support where you can, and make more plans with trusted friends and loved ones. Avoid taking on too many responsibilities at once. These are all crucial to help your body run as optimally as it can. These small changes can all help your body function at its best.

Exploring how the simple, ancient act of singing can help mothers navigate their changing identities, build community, and hear themselves again Before a baby can understand a single word, before they can even clearly focus on a face, they already know one sound better than any other: their mother’s voice, with research suggesting that infants learn to recognise this specific sound even before they are born. The maternal voice has a profound impact on the baby, playing a crucial role in their cognitive and emotional development, fostering secure attachment, and providing a sense of safety and comfort. Image by Israel Torres on Pexels But this beautiful reality raises a vital question: if a mother’s voice is so important for her baby, who is looking after the mother’s voice? I am not referring only to the sound she makes, but to the woman behind it, her identity, well-being, confidence, and sense of self. I am a professional singer, a performer, and a voice educator. I am also a researcher specialising in Singing for Health, and I have spent years observing how people use their voices to express themselves. My work combines artistic practice with scientific research because I believe empirical evidence and lived experience should inform one another. Recently, I led a qualitative research project called Melodies of Motherhood, exploring how singing might support maternal well-being and the mother-infant relationship. Mothers participated in a series of inclusive online group singing workshops. Before the workshops, mothers completed an open-ended questionnaire about their beliefs in their ability to be successful in their role as mothers. After the workshops, I also conducted interviews to understand shifts in mothers' emotional well-being, self-confidence, and perceived connection with their infants. This project and my work in community settings became a lens for exploring broader questions about what it means to find, lose, and reclaim one’s voice during one of life’s most profound transitions. Finding the "Me" in Motherhood Becoming a mother is a life-changing experience, full of joy and love, but also marked by uncertainty and self-doubt. Many mothers feel isolated, face stigma, and lose a sense of control. One mother in my study said that after having a baby: "you can feel like you lose your identity and just become Mum". People ask about the baby, but often forget to ask about the mother. Caring for another being is an enormous responsibility that may reduce a woman's daily routine to feeding, changing, and sleeping, leaving little space for herself. In this challenging period, it is not surprising that mothers’ emotional well-being may be affected. As one mother expressed, "If I am not me, how can I make him him?" Her mental health is absolutely crucial; without it, she cannot pour from an empty cup to nourish another human. So, what do we do? More Than Just a Lullaby To understand how we might better support women during this time, I designed singing workshops specifically tailored for mothers. Throughout history and across cultures, singing has been part of our lives, bringing people together, facilitating communication, and helping relieve stress. Singing has also been suggested to support maternal mental health and wellbeing; in fact, research has shown that group singing can reduce symptoms of postnatal depression. Yet, the aim of Melodies of Motherhood was not to create a clinical intervention, but to offer a safe, inclusive space where mothers could sing together, express themselves, and support one another. We did not utilise traditional nursery rhymes; we sang pop, soul, gospel, and folk songs. One mother mentioned that nursery rhymes can sometimes feel a bit "whiny," and that having the opportunity to sing songs she truly loved added a whole new dimension to her routine. The workshops provided a dedicated space for mothers to focus on breathing, warm up their bodies, and simply enjoy music. Nurturing the Mother’s Voice Nurtures Her Identity One of the most notable outcomes of the project was how singing served as a bridge back to the mothers' own identities. Singing helped these women carve out a space just for themselves. Image by Gustavo Fring on Pexels One mother realised during the project that she missed her music deeply. Before having her baby, music was a huge part of her life, but the silence of early motherhood had taken over. After the workshops, she began putting on her own music in the kitchen while her baby ate, realising she was allowed to have her music too. Another mother spoke of dusting off her ukulele, an instrument that might have sat in a cupboard for another year if she hadn't been motivated to share her love of music with her child. These moments are meaningful. By prioritising their own joy and self-expression, mothers are empowered to take charge of their emotional health. They stop treating singing as a tool to soothe the baby and start using it as a shared activity. Finding Harmony Together Singing also affects the relationship with the baby. The mother-infant bond heavily relies on the mother's emotional availability and confidence in her ability to care for her infant. In fact, if a mother is distressed, she may struggle to recognise and respond to her baby's needs. On the contrary, when a mother is relaxed, the connection improves. Reflecting on this shift, one participant shared: “I mean, definitely my confidence has improved with him… I feel like I understand him more and his needs and how to help him.” During our project, mothers noticed that when they sang for pleasure rather than just trying to soothe a crying infant, and the baby was in a good mood, the child responded beautifully. One mother noted: "Choosing my moments when I'm singing to him, perhaps not to soothe him, I don't think it works, but when he's in a good spot, as part of our enjoyment, our playtime together, yeah, it's clearly something that he likes." Image by Kiera Burton on Pexels Singing for pleasure and making up songs together became a communication vehicle. Mothers reported that their babies began to babble more, make eye contact, and smile as they watched their mothers' mouths move to familiar tunes, creating a one-on-one interaction that supported emotional synchrony. The Power of the Collective Engaging in these online workshops also helped reduce feelings of isolation during the postpartum period. Even from their own living rooms, mothers were touching base with others navigating this beautifully chaotic season of life. When they sang together, it became a shared experience, a collective exhale. As one mother reflected on the physical relief of these sessions: "You're so consumed with sort of surviving this person... but actually, it does make you feel better to do some quite small things that just make you feel more connected to your own body". You do not need to be a "good" singer. Sometimes, the baby is not in the mood, or a mother feels she cannot "perform". These moments served as a reminder that motherhood is not a performance to be judged, but a continuous journey of learning and adapting. Hearing Themselves Again Throughout my research process, I found a quote that truly inspired me and my project: “You only get to be one mother in this world.” We only have one chance to be a mother and care for our children, and we deserve to live motherhood as healthily and happily as possible. Perhaps singing will not erase the fatigue of sleepless nights, nor is it a substitute for professional mental health support, but it is a powerful and accessible tool that can effectively support the transition to motherhood. Having a baby does not mean a woman must lose herself; rather, motherhood should be considered an enrichment of her identity. By giving mothers space to sing and freely express themselves, we support their need for creativity, joy, and community. We remind them that they are still the protagonists of their own lives and that they have the right to put themselves first. Perhaps singing does not simply help mothers care for their babies. Perhaps it helps mothers hear their inner voice again.

Why my favourite animals are great white sharks and what they mean to me A fun fact about me (and often my go-to icebreaker): Great White Sharks are my favourite animals. Not cats, not dogs, nothing fuzzy or cuddly or cute. And this has been the case since I was 6 or 7 years old. Weird, isn’t it? I’ve made it a habit of weaving my personal interests and hobbies into my Inspire the Mind articles, beyond the work I do as a Trial Manager in Perinatal Psychiatric Research. I’ve previously written about baking sourdough bread, the importance of children’s movies, and my favourite music artists. Today, I’m going to write about my love for great white sharks, and why, despite the instinctive fear they instil in so many people, they have a strangely calming effect on me. Image source: Getty Images for Unsplash+ Why Sharks Calm Me Down I remember my dad bringing back from a trip abroad the National Geographic CD of a Great White Shark documentary. I grew up in India, where at the time we didn’t have too much variety in available CDs. So, CDs like this were such a novelty. Each time he went for a trip, he’d bring back a new Nat Geo documentary. Stories of the Serengeti, blue whales, cheetahs. But something about the shark documentary stuck with me. And now when I reflect, I wonder why. Perhaps it was something calming about the ocean, seeing a large, animal gracefully, slowly moving, making its way, all the way from Australia to South Africa (12,400 miles), and back again in nine months. And this theory makes sense, if you think about the Blue Mind, which is the state characterised by calmness and peace from being in or near water, coined by marine biologist Wallace Nichols in his book by the same name. And perhaps it’s also why I enjoyed Avatar: The Way of Water so much that I wrote about how the underwater sequences made me feel serene, just as the ocean always has. I guess, at the bottom of it all, it’s the thought that this is an animal I’ll maybe see only once in my life (if I’m lucky), in an environment in which I don’t belong (if only I had fins). I’d be completely at its mercy. There’s something about the sheer size of it (did you know, Deep Blue, the largest recorded great white shark, is approximately 20 feet long), and the grace with which it moves, that I find strangely calming. Maybe that’s what I love about the documentaries, too: those long, quiet sequences where the shark simply glides through the water, so effortless. There’s no noise, no urgency, just this enormous, ancient animal moving through a world that feels completely removed from my own. And somehow, watching it makes everything else feel a little quieter. Perhaps also, is the fact that sharks, as a species, are hundreds of millions of years old, having survived all five major extinction events that the Earth has seen. Now, when I’m stressed out, I find myself either revisiting a beloved Disney movie, or diving into another shark documentary. Either because it takes me back to my childhood, watching shark documentaries in a simpler time, or because it’s the ocean and has my favourite animal in it. Image source: Michael on Unsplash The Slight Fear That Accompanies My Love and the Reason Why I have to admit. I don’t only watch shark documentaries. I also watch fictional shark movies. Some of my favourites include Open Water, The Reef, and The Shallows. What this genre has done, however, is reduce these incredible animals to human-hunting villains. Bloodthirsty predators who mindlessly kill, popularised by the Jaws film series. In reality, it’s not great white sharks that are to be feared. Statistics show that there are far more survivors of great white shark bites than fatalities, and fewer than 17% of unprovoked attacks have been fatal, since records began in 1580. They do not actively hunt humans. If I were swimming in the ocean, I’d be more scared of bull sharks or tiger sharks (but that’s just a nerd fact from me). And what’s more important, humans pose a bigger threat to sharks than the other way around. Despite knowing this information however, I have a slight fear of the ocean, and what’s in it. Although great white shark attacks are often a case of ‘mistaken identity’, I understand that I’m swimming in an ocean, and therefore, there may be sharks. And these fictional shark horror films do not help my case. Take for instance, the time I watched a shark movie the night before I went off on a two-week holiday to Mauritius. I know full well there are no great whites in Mauritius, but you best believe I was still scared. I know my dream holiday is South Africa, because of one reason. Neptune Island, where you can go cage diving to see great white sharks. But, since the shark horror film 47 Meters Down came out, I’m a bit scared. Sharks as a Metaphor for Misunderstood Mental Health Image source: Mikhail Nilov on Pexels While writing this piece, I got to thinking, sharks are so misunderstood, much like mental health. Through these movies (Jaws was the first and most culturally impactful one), sharks have been painted as monsters and bloodthirsty, human-hunting predators, lurking beneath the surface, waiting for the opportunity to attack. But a shark is simply an animal, behaving according to nature, in ways we don’t fully understand. They aren’t out to get us humans. And mental health can be quite similar. Poor mental health, be it intrusive thoughts, trauma, anxiety, and low mood, can exist beneath the surface, invisible to those around us. An individual with a calm demeanour might be fighting numerous, invisible battles beneath the surface. When it comes to diagnoses, there is so much stigma surrounding a mental health diagnosis. Just as great white sharks are too often reduced to human-hunting predators, people with mental illness are reduced to their symptoms, their diagnosis, or their most vulnerable moments. They are so much more than just their diagnosis. They’re labelled as ‘dangerous’, and often subject to prejudice, discrimination, and social isolation. My intention isn’t at all to reduce people’s experience of mental illness to ocean animals, but my love for sharks, coupled with my career in mental health, did get me thinking about the parallels in biased perceptions. Just as sharks are not inherently terrifying, mental illness does not make someone inherently dangerous or undeserving of compassion. While the ocean has taught us to fear what moves beneath the surface, mental health shows us that just because we may not see outward evidence of struggle, that doesn’t mean it doesn’t exist. Image source: Getty Images for Unsplash+

“Until then, there was always someone to rely on if things went wrong. This was the first time I knew everything would depend on me.” When we imagine our lives through the years, it might be easier to imagine a linear, gradual transformation. We were children, now we're adults, and the story continues across a medium of existence, too flux and too holistic for singularities. But when we tell our stories, we often refer to these singularities: moments that became dividing lines between older and newer versions of ourselves. In fact, research shows that people often define their lives around turning points and build their narrative identities on how these turning points reshape them. *The interviewed individuals' names have been changed for anonymity. Image Source: Paweł L. on Pexels My name is Tezor Dedam, a journalist and communications specialist with a focus on people, culture, and the social contexts in which they interact. Many people can identify one life-changing moment — a decision, a loss, an acceptance, a letter, a diagnosis, a surprise opportunity, or a phone call — that permanently changed their lives. I would like to explore these moments for how they have shaped mental health, identity, and emotional well-being. This article is important now because of the uncertainty of today's human experience; people are navigating marriages, work, politics, relationships, and so much more. In the blur of these volatile experiences, it is important to discuss how people steer through events by reflecting on key moments that have defined one's life's journey. So, with the main message of exploring pivotal events, this article invokes a universal aspect of psychological well-being: how we interpret important moments in the feeling process that is life. To capture these interpretations, I interviewed three unique individuals share excerpts from our conversations below, to highlight the experience and effect of these events. The quote at the start of the article is from Bruna Soares*, a Brazilian MA student pursuing an Applied Data Science degree at the University of L'Aquila, in Central Italy. She is the first from her family's lineage to attain a formal education beyond the basic level, and her story is told below: Bruna Soares and Her Admission Call-up Image Source: HONG SON on Pexels “[My moment was] getting the email that I had been accepted into a master’s program abroad with a scholarship. It was the first big opportunity that was entirely mine. I had lived abroad before with my family, but this time I was leaving on my own, because of something I had worked for. I was always someone who liked to challenge myself, but I had never been fully on my own. Until then, there was always someone to rely on if things went wrong. This was the first time I knew everything would depend on me. I remember feeling excited, proud, hopeful, and definitely nervous. It was a huge change, but I never thought about turning it down because I was scared. The weeks before moving were a mix of excitement and "what am I doing?" moments." One of the biggest takeaways from speaking with Bruna was her perceived degree of change. One day she was resigned to a mundane life, with no dreams or ambitions; then the next, she was looking at an email with a full admission and scholarship that has led her to the fulfilled woman she is today. To broaden this concept of ‘before and after’ versions of ourselves, I next spoke to Philip Abney-Hastings, a 30-year-old prison social worker in Australia. Philip Abney-Hastings and His Life-Changing Diagnosis Image Source: Ron Lach on Pexels “I got diagnosed with HIV in December, 2025. Whether it is good or bad, I cannot say just yet. But it has surely had some negative consequences… the major shock to my system that has really made me think about myself on a deeper level. My whole life is centred around this medication, and if I do not take it, I would die [laughs]. Prior to my diagnosis, I was already in a constant state of self-loathing, because I had always felt lonely and craved "belonging". Since I discovered my status, there has been an overwhelming sense of panic — to fix up my life, career, etc. I realise I am not as strong as I thought; I entertain a lot more suicidal ideation, even now I often ask what the point of anything is. What can people learn from my story? Well, my story isn't over, but the key lesson is to wrestle self-love into your life. You are worthy of dignity. But it's easier said than done, and I am struggling with it every day and getting through it by playing badminton and watching RuPaul's Drag Race.” Philip’s story shows his newfound perception of how his life suddenly felt finite to him. Every plan he made had to be vetted and reconsidered; every part of the rest of his life had to be viewed through the lens of his diagnosis. It showed me how a single event can make people reassess what really matters, and how these events stay with us long after they have happened. But in a good way, the biggest change for him was internal, not medical — he learnt to reconcile his newfound reality with a better and more compassionate version of himself. But beyond a change in individual circumstances, bereavement is critical enough to change world-views and even identity. Research has shown how loss changes people’s sense of meaning, affection, and identity. From this perspective, I learnt a lot from Amaka Onyeanwuna, a 53-year-old Nigerian woman who has spent the last two decades raising three children and supporting her husband’s business. Amaka Onyeanwuna and Her New-Found Challenge Image Source: cottonbro studio on Pexels On August 15th, 2025, she received a call from her husband’s apprentice stating that he had collapsed from a heart attack and passed away before receiving medical care. She said she remembers very little about the hours that followed: friends and relatives poured in with condolences, and important funeral decisions had to be made at once. "I moved through those days like someone acting in a film." But for her, another moment came about three months later when she found herself sitting at the dining table, all alone with an unpaid bill in front of her and discovered that she did not know how much money was in their family's bank account or how the rent was being paid. In all these years of marriage, her husband took all financial decisions. Amaka’s thorough resolve and responsibility show that crisis reveals capacity. I can see how the loss forced her into roles she didn’t think she would be in. But even more, I learnt how grief and growth can be intertwined into these singular moments of crisis. All three individuals are doing well and have grown from their singular experiences. Bruna graduates later this year. Amaka is financially on top of things, and she counts dispensed money at ATMs and explains Compound Interest to anyone who cares to listen. Philip swears he's the best badminton player in the whole of Australia (I've seen him play; he's not). Across these three experiences, we can learn that good mental health is not simply the absence of distress but the process of experiencing, adapting, and learning from defining moments. These defining moments don't only divide the before and after; they also shape our identity, resilience, and how we understand and love ourselves. This article has been sponsored by the Psychiatry Research Trust, who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Image source: Kampus via Magnific.com In an era of increasing need for understanding mental health and neurodegenerative conditions, identifying links between the two could revolutionise our approach towards clinical care. My name is Lili, and I am a stem cell biologist working at King’s College London in the Institute of Psychiatry, Psychology & Neuroscience. I am part of a research group that uses cellular and molecular biology, as well as bioinformatics, to further our understanding of psychiatric conditions such as autism and schizophrenia. I am – funnily enough – also neurodivergent myself, with an immense fixation on asking the questions “why?” and “how?”, which is what brought me to science in the first place. Here, I would like to share our newest research project, which aims to explore a potential link between schizophrenia and Amyotrophic Lateral Sclerosis (ALS) – two conditions which impact millions of people and their loved ones worldwide. By investigating this, we hope to not only gain understanding but also identify new ways they could be treated; and by writing this, I hope to answer all of your questions, starting with “How” and “Why”. Image source: syarifahbrit via Magnific.com What is Schizophrenia? Schizophrenia is a psychiatric condition impacting over 24 million people worldwide, which often presents with symptoms such as hallucinations, confusion, delusions, depressive tendencies, and feeling disconnected. It often manifests in young adults and children, and symptoms gradually become more intense. While the causes of schizophrenia are not fully understood, risk factors include genetic predisposition, environmental factors, and substance abuse. While with treatment, such as medication and therapy, marked improvement is seen in about half of patients, the other half continue to face lifelong struggles. Image source: vectorjuice via Magnific.com What is ALS? Amyotrophic lateral sclerosis (ALS), often referred to as motor neuron disease or Lou Gehrig's disease, is a neurodegenerative disease which manifests in the progressive degeneration of upper and lower motor neurons. Symptoms of ALS include weakness and stiffness of the extremities, as well as muscle spasms, cramps, and twitches. ALS is terminal, with treatments focusing on management of symptoms. While it most often manifests in patients over 45, it progresses rapidly, with most patients succumbing to the disease within 30 months from diagnosis. Causes of ALS are also not fully understood, but we know that about 10-15% of cases are familial. These cases can be identified via genetic testing; however, a variety of genes have been linked to the disease. The other 85-90% of cases are caused by a variety of environmental factors, viruses, and autoimmune processes. The Connecting Key Player While the two diseases differ in almost every aspect, including age of onset and presentation, epidemiological studies – studies focusing on the patterns and distribution of disease – have found that schizophrenia is reported at a higher rate within the families of ALS patients, suggesting the presence of a potential biological factor. Furthermore, previous genetic studies support a shared biological basis between ALS and neuropsychiatric disorders. One of the genes linking the two conditions identified in prior studies is called Neurexin-1 (NRXN1). It is one of the biggest genes in the human genome, and it is responsible for the expression of a protein of the same name. The NRXN1 protein plays an important role in forming synapses, the connections between neurons that allow them to communicate with each other using electrical and chemical signals. The NRXN1 gene can exist in multiple different forms, known as “isoforms.” These are different versions of the same gene that can affect how it is used by cells and how the resulting protein functions. Mutations in NRXN1 can change the balance between these isoforms, which may affect how neurons communicate with one another. In mice, it has been found that such mutations lead to symptoms which resemble neurodegenerative conditions. In humans, people carrying these mutations often develop movement-related abnormalities resembling the symptoms of ALS. Our Mission Recent findings have identified changes within a region of NRXN1 that are strongly associated with ALS. Our group’s previous research has also established a link between this region and psychiatric conditions, including schizophrenia. We have also shown that it regulates both the physical structure (the morphology, a.k.a. physical appearance) and function of neurons. Building on these findings, our brand-new research project, led by me and supported by my wonderful mentors Ahmad and Deepak as well as my colleagues, will investigate how mutations in this region of NRXN1 affect the behaviour of neurons. Our experiments will range from growing neurons on chips and measuring their electrical activity to analysing valuable genetic data collected from patients and donors. By looking at this data, we hope to identify patterns in gene activity that may be linked to ALS and schizophrenia. This project is particularly exciting because, for the first time, it will allow us to investigate how mutations in this important region of NRXN1 change the way neurons function. In doing so, we hope to gain new insights into the biological processes underlying both schizophrenia and ALS. As much as I look forward to this research bringing us some answers and hopefully serving as a stepping stone towards better treatment options for patients and their families, what I look forward to most is the questions that will arise on the way. Because, at the end of it all, that’s what science is all about: asking the questions “why?” and “how?”.

Trigger Warning: This piece discusses themes relating to pregnancy termination and suicidal ideation which some readers may find distressing. After years of suffering with my mental health, in particular depression and OCD, I finally thought I had got what I had always dreamt of. I had met someone I was about to marry, and I was pregnant with my first child. I had never thought I would even be in the position to imagine a future like this. Then I experienced prenatal depression, and my world collapsed. Image Source: Illustration by Jerry Padfield Prenatal depression is not as widely discussed as postnatal depression, yet when I experienced it, together with hyperemesis gravidarum (a very severe form of morning sickness), it led me to make the devastating decision to terminate my pregnancy. Although this is one of the most difficult things I have had to write, I know that I need to shine a light on this issue because if there had been more information available to me, I potentially may have felt less tormented about a decision that ultimately saved my life. What Is Prenatal Depression, and How Did It Affect Me? Prenatal or antenatal depression is depression that occurs during pregnancy. Symptoms include extreme or ongoing sadness, anxiety, and in severe cases, it can cause women to harm themselves or the developing fetus. The National Institute for Health and Care Excellence (NICE) states that depression and anxiety are the most common mental health disorders experienced by women during pregnancy, affecting about 12% and 13% of them respectively. Although I had struggled with my mental health for many years, when my husband and I decided to have a baby, I had never felt so positive about my future. Certainly, I didn’t imagine that mental health struggles would once again shatter the happiness that I had worked so hard to achieve. Initially, things seemed to be going well. I was excited, and I felt like I finally had a purpose in life. I was determined to be the best mother I could be. I have hazy memories of how the depression started. At one point, I was looking at baby clothes in shops, and then it seemed that all excitement and life had been sucked out of me. In the coming days and weeks, I felt numb and detached from everything, like I was existing behind a pane of glass. I wasn’t looking forward to the baby anymore, despite me forcing myself to. Having once been so excited at the prospect of appointments and scans, I now felt nothing. Image Source: Volkan Olmez on Unsplash There are really no words to describe how I felt during this time, but ‘desperate’ comes pretty close. My mood had plummeted so much that I was suicidal, and I felt like I had made a terrible mistake getting pregnant. As my depression deepened, I became consumed with existential fears around long-term responsibility and sheer panic about the permanence of my situation, which overshadowed my waking moments. I spiralled so badly with intrusive thoughts that I was questioning why people even have children, and fantasising about my life before this. Every single moment of the pregnancy was making my mental health worse. If I did manage to sleep, I would wake up thinking that this was all a bad dream. When I remembered my reality, my world would come crashing down, and I would be wracked with distress and feelings of doom. I thought that ending my life was the only option I had to escape my situation. It was like a black blanket had dropped over me, and I could see no way out. All the plans I had imagined about how I would share my exciting news had disintegrated, and I felt like I was losing myself. Nonetheless, throughout this whole time I was trying to convince myself to keep going with the pregnancy. On my first appointment with the midwife, she must have sensed that I was struggling, as she referred me to the Perinatal Mental Health Team, a team that supports pregnant women with mental health problems, as well as those who are planning a pregnancy or who have a baby up to a year old. I was clearly in crisis, but the perinatal team only offered to see me every two weeks. I didn’t think I could get through the next minute, let alone the next two weeks. My husband was as supportive as he could be and extremely worried about me, but he isn’t an expert, and I needed professional, specific help, which wasn’t readily available. I recognise that this is just my experience, and other people are offered valuable support from the perinatal team, which is a hugely needed service. In fact, record numbers of women accessed perinatal mental health support in 2024. The response I got was probably in part due to staff pressure, underfunding, and what is referred to as “fragmented care” – a lack of integration between services, which clearly needs to change. A Double Blow Not long after this, I started experiencing hyperemesis gravidarum. When I thought I had already reached rock bottom, I went through one of the darkest times of my life. I was constantly sick. I couldn’t stand, walk, or eat without triggering vomiting so forcefully that I would wet myself. I couldn’t keep anything down, not even water, to the point that I was eventually hospitalised with severe dehydration. Image Source: Stephen Andrews on Unsplash I have often wondered whether things might have been easier, and I could have managed better, if I only had to cope with depression or hyperemesis. But I honestly don’t know — each was its own unique hell. The Hardest Decision I just knew in my heart that I couldn’t survive this. This wasn’t how I wanted to start married life. The relentless toll on my body and mind had beaten me, and I couldn’t fathom how I had been so blissfully happy a few weeks earlier. Despite everything that was happening to me and how horrendous it was, I was tortured over the decision to terminate this wanted pregnancy. But eventually it came down to the brutal truth that it was too risky for me to keep going. I want to emphasise that everyone’s experience is different; some people may have milder symptoms or find the right support that allows them to carry their pregnancies safely. For me, however, this was the right decision given my circumstances. Image Source: Art Institute of Chicago on Unsplash The sad thing is, I still lost a baby, but often I feel like I can’t be openly sad because it was ultimately my decision, and that isn’t socially palatable. My husband and I always say that we make the best decision we can at the time, and although it is difficult to accept, I am getting there. Of course, I think about what could have been. I still find it painful to see other people’s children, and I avoid the baby aisles of supermarkets. Embracing Life Although logically I know that I don’t need a baby to feel fulfilled or purposeful, society puts huge value on conventional roles. However, I am working through all of this, and in a strange way, this experience has helped me to live more authentically and to trust my mind and body more. Families do come in all shapes and sizes, and me, my husband, and our little black and white cat make a great one that is a force against the world. Image Source: Joe Yates on Unsplash I am slowly coming to terms with the fact that I made the best decision for me, and for my mental and physical health. While I am learning to accept that we never fully know the outcome of our journey, I am trying to embrace the path that I am now on and looking less to the path that could have been. Resources: If you have read this article and feel you would benefit from some support, groups below may be helpful: Pregnancy Sickness Support Phone: 0800 055 4361 HER Foundation Phone: 1-971-HELP-4-HG This article has been sponsored by the Psychiatry Research Trust, who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Every person with Parkinson’s has a different story, AI may help us understand each one a little better Like many researchers, my journey into Parkinson’s disease began with a personal connection. Growing up with a father with Parkinson’s, I learned early that a diagnosis is only the beginning of the story. Parkinson’s disease is a progressive neurodegenerative condition best known for its effects on movement, but it can also affect mental health through changes in mood, thinking, sleep and perception. Perhaps most importantly, no two people experience it in exactly the same way. Symptoms, disease progression, and response to treatment can vary remarkably from one individual to another. My father’s Parkinson’s was one version of the disease, but there was no personalised blueprint. Neither is there for anyone else. Today, I am a PhD candidate at King’s College London, where I use artificial intelligence (AI) to investigate Parkinson’s risk, psychiatric symptoms, disease progression, and treatment response. At its core, my research asks a simple question: how can we move beyond a one-size-fits-all approach and towards understanding Parkinson’s at the level of the individual? When A Personal Question Became Scientific For my father, Parkinson’s did not unfold in a straight line. It felt more like climbing terrain that kept changing: one section marked by movement symptoms, another by changes in mood, thinking or perception. The terrain differs for every person, but every route is shaped by the same difficult truth: there is currently no cure, so treatment focuses on managing symptoms, and preserving quality of life. For our family, navigating that terrain became a shared mission. Treatment often felt like an exercise in trial and error, with every decision involving trade-offs. For example, levodopa, the main medication used to improve movement symptoms, can also contribute to psychiatric side effects, including hallucinations and delusions. It could sometimes feel like solving one problem only to create another. Just when we thought we had found our footing, the terrain shifted again. Long before I had the scientific language for it, I was already living with the question that would later shape my research: could those decisions be made with more foresight and less trial and error? Turning Experience Into A Research Programme My father lost his battle with Parkinson’s in June 2023, one month before I moved to London to begin my Master’s at King’s College London. Exactly one year later, in June 2024, I was accepted into the DRIVE-Health PhD programme with a proposal I had developed on using AI to transform Parkinson’s research and care. What began as a need to understand one person’s experience became a research programme focused on making Parkinson’s care more precise, predictive, and personalised. I am now a PhD candidate in the Artificial Intelligence in Mental Health Lab at King’s, where I use machine learning, a form of AI that learns patterns from data, to investigate psychiatric outcomes, disease progression and treatment response in Parkinson’s. Alongside my PhD at King’s, I am also a Research Fellow at the Martinos Center for Biomedical Imaging in Boston where I use AI and neuroimaging to study Parkinson’s disease and treatment outcomes. Across my research, the aim is the same: to move beyond what happens on average and towards understanding risk, progression and treatment response at the level of the individual. Illustration produced by the author. How AI Can Move Us Beyond Trial and Error Parkinson’s is not a one-size-fits-all diagnosis. Clinicians already adapt care to each person, but much of the evidence available to them still tells us what works on average. AI can help by looking at many pieces of information at once. A machine-learning model can combine clinical assessments, cognitive tests, genetic information and brain imaging, then identify patterns that may be difficult to see when each measure is considered alone. The goal is not for an algorithm to dictate care, but to provide evidence that supports better-informed, more personalised decisions. Can we identify who is at greater risk of psychiatric symptoms? Can we recognise patterns linked to faster progression? Can we better estimate who may benefit from a treatment and who may experience side effects? Prediction is only useful if it improves what happens next. Used well, AI could support earlier and more accurate diagnosis, identify emerging complications sooner, estimate which treatments are most likely to help a particular person, and anticipate who may be more vulnerable to side effects. That could mean earlier, better-targeted treatment with fewer cycles of adjustment. The promise of personalisation is not perfect certainty, but a more informed starting point than trial and error. How I Use AI to Personalise Parkinson’s At King’s, my research focuses on prediction at two different stages of Parkinson’s. The first one is recognition and diagnosis. The changes associated with Parkinson’s can begin more than a decade before diagnosis, and even after movement symptoms emerge, around a year can pass before someone receives a diagnosis in the UK. Using routinely available clinical information, I am developing an AI model to estimate an individual’s risk of developing Parkinson’s earlier. The aim is to make early prediction as feasible as possible, opening the door to closer monitoring, earlier access to clinical trials and, as disease-modifying treatments emerge, interventions designed to delay onset or progression. I also focus on Parkinson’s psychosis. Mental health difficulties are common in Parkinson’s, and more than half of people may experience psychosis during the course of the condition. It is one of its most serious complications, associated with care-home placement and poorer survival, yet there is currently no routine way to predict who will develop it. In my work on predicting Parkinson’s psychosis, I combine machine learning with brain imaging to identify patterns linked to psychosis and, ultimately, improve individual risk prediction. At the Martinos Center for Biomedical Imaging in Boston, I apply the same principle to treatment decisions. Deep brain stimulation is a surgical treatment that can improve movement symptoms when medication no longer controls them well, but its effects are not identical for everyone. Using clinical and brain-imaging data, I investigate whether AI can help predict who may benefit and what outcomes might realistically be expected after surgery. The goal is to make a major treatment decision more individual: not simply asking whether deep brain stimulation works, but what it is likely to mean for the person considering it. Illustration produced by the author. What Lived Experience Brings to Science Watching my father’s Parkinson’s change over the years showed me how many forms one diagnosis can take. The symptoms that dominated at one stage could give way to different challenges at another, including changes in movement, cognition or mental health. People with Parkinson’s may share a diagnosis, but the course of the condition, the difficulties they face, and the way they respond to treatment can look very different. That perspective keeps me focused on building tools that preserve the individual within the data. Personalisation means asking not only what happens on average, but what may happen for this person, at this stage, and which information could support a better-informed decision. I know there are people with Parkinson’s, caregivers, and family members navigating their own changing terrain now, searching for answers about symptoms, treatment and what comes next. I can only hope that my research gives them answers I once searched for, or that this story gives someone the confidence to become the researcher who finds the next one. Sometimes a scientific career begins long before a laboratory, with a question that matters too much to leave unanswered. Illustration produced by the author.

Warning: This piece contains spoilers. Disney+ has just released FURIOUS, a gripping new crime drama following FBI agent Alice Black as she becomes consumed by the hunt for Catherine Grace, a female serial killer. But FURIOUS is far from a simple game of cat and mouse. Alice and Catherine are both driven by their own ideas of justice, operating on opposite sides of the law while pursuing a similar purpose. As their lives become increasingly intertwined, the boundaries between justice and revenge, victim and villain, and right and wrong begin to blur. As a mental health research assistant, I naturally found myself looking deeper into each character. There is plenty that could be said about FURIOUS through a psychological lens. But that wasn’t what stayed with me. Instead, I kept questioning who I was actually rooting for. Every character seemed flawed in one way or another. It was a far cry from the television shows I usually watch, where I can almost instantly find someone to cheer on. But who do you root for when, technically, they could all be considered villains? And somewhere amongst the murder and fury, I noticed something unexpected. Why did FURIOUS make me feel sort of… exhilarated? Image Source: Furious (2024) promotional poster. © Hulu / Disney. Accessed via IMDB I Am Supposed to Hate Her… Right? The show begins with a man crawling across an apartment floor. A woman wearing a Halloween cat mask watches him as she casually gathers sweets for a child waiting at the door. When she returns, she injects the man with something and watches him die. We later learn that the woman is Catherine, a serial killer with a long list of victims. Soon after, the case lands on the desk of Alice, a former police officer turned FBI agent who left the force after her childhood sweetheart, also a police officer, assaulted her. I instantly thought: perfect. The lines are clear. Cop and killer. Good and bad. Someone to root for and someone to hate. Right? Wrong. FURIOUS makes it almost impossible to keep either woman neatly on the “good” or “bad” side of the line. Let’s start with Catherine. Her victims are not random; they are predatory and powerful men connected to the abuse she endured after being trafficked into sex work as a teenager. With each man she kills, she also hopes to move closer to discovering the truth about what happened to Isabel, her best friend, who was trafficked alongside her and died in suspicious circumstances that Catherine seems to have blocked out. But it isn’t only Catherine’s motivation that complicates how I see her. Just as she begins to frighten me, she dances furiously when nobody is watching, plays with stickers and carries Isabel’s sequined bag as a relic of their friendship. Then there is Aldan, Catherine’s romantic interest, who draws out an unexpectedly loving side of her. Then there is Alice. If Catherine complicates what a villain can look like, Alice complicates what we expect a “hero” to be. She represents the law, investigating Catherine’s murders. But as the series progresses, Alice’s pursuit of justice becomes tangled up with her own fury, trauma and desire for control. One scene that particularly stood out to me was when Alice invites her former abusive boyfriend over to “talk.” Perhaps naively, I expected this to be the moment when she finally confronted him, said everything she needed to say, and walked away with some sense of closure. Instead, she traps him and pours alcohol over his face, knowing he is a recovering alcoholic. When he eventually leaves, in his underwear and covered in liquor, she asks her neighbour to report a suspicious-looking drunk man to the police. It is calculated, vindictive and cruel. And I thought this was Alice. She was supposed to be the “good” one. But she wasn’t. And this is where FURIOUS really got me. With Catherine, I began with someone I thought I was supposed to hate and slowly found reasons to care about her. With Alice, I began with someone I thought I was supposed to trust and slowly found reasons to question her. I wanted Alice to stop Catherine, but I didn’t necessarily want Catherine to be caught. Neither woman would stay in the box I had put her in. Image Source: Furious (2024). © Hulu / Disney. Accessed via New York Times Why Do I Need Them to Be Likeable Anyway? The more I thought about Alice and Catherine, the more I realised there was another assumption hiding underneath my response: I kept trying to justify why I was allowed to like them. We have spent decades being fascinated by complicated male protagonists who behave terribly. Think Tony Soprano, Walter White, Don Draper or Dexter Morgan: men who lie, manipulate, cheat, exploit and, in some cases, kill. Their moral failures don’t make them less compelling. Quite often, their flaws are exactly what keep us watching. Yet I noticed myself doing something different with Alice and Catherine. With Catherine, it was: yes, her victims are predatory men connected to the abuse she suffered, but she still kills them. Yes, terrible things happened to her, but she can also be frightening and ruthless. With Alice, I found myself doing almost the reverse. Yes, she is trying to stop Catherine, but she can be vindictive and cruel. Yes, she is on the side of the law, but her choices can be morally questionable. Why did I need the “but”? Maybe neither woman needs me to defend her. Maybe I don’t need to prove that Catherine is secretly good, or that Alice remains morally right, before I am allowed to find them compelling. What If Suffering Doesn’t Make You Better? Part of what interested me about these characters was how they disrupted the kind of story I have come to expect about suffering. There is an idea sometimes described as the “perfect victim”: someone whose suffering is easiest to recognise when they behave in ways that preserve our sympathy for them. On television, that can mean a woman who is understandably damaged by what happened to her, but never becomes so angry, bitter or difficult that her behaviour threatens our sympathy. There is nothing wrong with stories about survivors who heal. But I realised how much they have shaped my expectations of what surviving something terrible should look like. I want to see someone go to therapy, rebuild their relationships, forgive, grow, perhaps even use what happened to them to help others. I want their suffering to produce wisdom, resilience or purpose. It’s an idea we have explored before at Inspire the Mind in our series on victimisation, including in “Why Survivors Don’t Need to Be Inspirational.” The piece challenges the expectation that survivors should turn what happened to them into something positive or inspiring, an expectation I realised I had brought with me while watching FURIOUS. Pain is easier for me to sit with when I know it eventually becomes something meaningful. But neither Alice nor Catherine gives me that comfort. Obviously, these are fictional examples, and experiencing trauma does not inevitably lead someone to violence. But Alice and Catherine made me confront an uncomfortable question: why did I expect them to respond to suffering in ways that preserved my sympathy for them? That doesn’t mean their suffering excuses their actions. FURIOUS asks me to hold two truths at once: I can have compassion for what happened to someone while still holding them accountable for what they do to somebody else. Perhaps this is where my interest in mental health inevitably crept back in. Understanding why someone behaves the way they do doesn’t require placing them neatly into the category of innocent victim or irredeemable villain. People rarely fit into either box. Someone can be harmed and harmful, vulnerable and cruel, sometimes all at once. And I found watching women occupy that morally uncomfortable territory surprisingly refreshing. Image Source: Furious (2024). © Hulu / Disney. Accessed via IMDB The Joy of an Unlikeable Woman By the end of FURIOUS, I realised that the question I had been asking from the beginning, “Who am I supposed to root for?” was probably the wrong one. Maybe I wasn’t supposed to choose between Alice and Catherine or decide which woman was secretly good, and which was secretly bad. Maybe I was simply being asked to care about characters whose choices I couldn’t always defend. And perhaps that is what I found so exhilarating. The women in FURIOUS don’t make themselves easy to like. They are angry, selfish and vulnerable. They hurt people. They make choices that are difficult to defend. Yet the story still treats them as people worth understanding rather than problems that need to be made more palatable. Maybe the joy of the “unlikeable woman” isn’t that she’s unlikeable at all. It’s that nobody is asking her to earn the right to be interesting by behaving well. She doesn’t have to turn her suffering into wisdom. She doesn’t even have to make it easy for us to root for her. Sometimes, she can simply be furious.

Content warning: This article contains mentions of violence and hyperlinks to true-crime accounts which some readers may find distressing. Image Source: Thiago Dorsch on Behance Like many who heard the news on the evening of Wednesday 26th August about the passing of actor Tim Curry, grief presented itself in me as reminiscing about his iconic roles throughout my childhood. Across a career spanning film, television, stage, and voice acting, his ability to be magnetic yet menacing, charismatic yet unnerving was undeniable. Transforming himself again and again, each character as fascinating as the last, Tim Curry was able to portray a diverse plethora of personas. Certainly, his most culturally recognisable role Dr Frank-N-Furter in Rocky Horror is what first comes to minds at the mention of his name – though his penchant for the glorious and camp goes far beyond this one character. That evening, looking over his filmography, I was suddenly struck with a memory – in fact, one of my earliest ones: being no older than two, in my mum's arms, in the living room, my dad beside us, and our tv in the corner where a flash of a clown face fills the screen. I immediately burst into tears and my parents ‘awww’, amused while they console me. It’s a memory that I’ve always found funny. My mum insists this absolutely couldn't be true, which only makes it funnier. Though I wouldn’t say that I’m scared of clowns now, I do remember feeling uneasy about their whole deal and persona as a child. Although Curry’s Pennywise the Dancing Clown in the 1990s adaptation of Stephen King’s IT may have helped cement the sinister killer-clown trope in the mainstream since, the fear of clowns long precedes his performance. If there’s one thing I always try to work into my articles for Inspire the Mind, it’s talking about movies and stories that I love. As a PhD student, researcher, and generally too-curious-for-her-own-good person, I all too often find myself going down an extra-circular research rabbit hole, prompted by the simple question of “but why?”. This and the reminder of my childhood fear led me down a path of exploring more about the fear of clowns and the neuropsychology behind the phobia. When Laughter Becomes Fear An intense fear of clowns is commonly called coulrophobia. Though not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), coulrophobia is recognised and used globally, according to research across the last three decades, and can be classed as a ‘specific phobia’. Research on the prevalence of coulrophobia varies drastically, with some studies suggesting figures as high as 53% of adults in an international sample while others closer to 5% of young adults. Not everyone who dislikes clowns has a phobia, though. A person may find them creepy without experiencing deep panic or the need to avoid places where one might appear. However, for someone with a specific phobia, even a memory, photograph, film scene, a specific laugh, or the thought of a clown may trigger sweating, panic, nausea, a racing heart, or an urgent desire to escape (Anyone remember Phil from Modern Family and his fear of clowns?). So, why does the children’s entertainer associated with parties and laughter inspire such a powerful, dreadful response? Image source: Francois Bredenkamp on Behance A Face We Cannot Read A recent study by Tyson and colleagues investigated possible explanations for the origins of clown fear. Their findings revealed that theories primarily centred around three key aspects: physical appearance, behaviour, and lived experience. One explanation lies in the clown's painted face. From our very first months of life, we use facial expressions to project our emotions and, more importantly, judge other people's emotions and intentions. When we meet someone, we are reflexively and instantaneously observing eyes, mouth, and facial muscle movements, making our deductions: is this person friendly? Angry? Frightened? Playful? Dangerous? Clown makeup disrupts this deduction process. Wide hollow eyes, unnaturally pale skin, and a fixed smile paint an unnerving picture where we cannot rely on the signals that we are typically used to. A big smile should signal happiness and trustworthiness, and the wide eyes should signal attention. But instead, we’re recognising it all as deception and suspicious mimicry. This uncanny-valley ambiguity we’re faced with, where we see something that looks slightly-to-the-left-of human, leaves us feeling uneasy. This isn’t just about looks though. Clowns are unmistakably human, yet their distorted appearance alongside their strange expressions and movements create an experience that conflicts with how we expect a person to look, emote, and behave. A Move We Cannot Predict With clowns, there is also the key component of unpredictability. In fact, perceived unpredictability appears to be a factor to which individuals frequently attributed their fears in other specific phobias too, like spiders – a deep discomfort and tension brought on by not being able to predict the next move. Behaviour prediction, like our judgement of faces, is key in how we navigate our daily lives. It allows us to make decisions by assessing potential outcomes, anticipate danger, and makes social interaction possible. Due to the nature of their performance, clowns disregard ordinary social rules: they invade personal space, move in strange and abrupt ways, laugh at random intervals, play tricks, and make unexpected noises. Though most of us would simply be off put by these behaviours, individuals with coulrophobia may read these behaviours, combined with their appearance, as malicious deception and immediate threat. When we can rely on our predictions, it’s also significantly less mental load; rather than having to consciously think through if a situation might be dangerous every single time, we reflect on previous experiences to respond quickly. This may also offer an explanation as to why individuals with coulrophobia and similar fears feel overwhelmed very suddenly – exposure leading to an overstimulated nervous system working in overdrive. A Story We Cannot Escape Stories such as IT have undoubtedly strengthened the association between clowns and danger. Pennywise belongs to a much wider tradition of fictitious criminals, serial killers, and jokers. Repeated exposure to these portrayals in media can teach us that clown imagery signals violence, loss of security, and menace, even when we know consciously that these are only characters in stories. Negative media portrayals are a powerful thing. I would fairly confidently bet that most of us have not been chased down by a vicious clown in real life – though 2016’s “killer clown craze” certainly increased chances of an encounter. But we all have learned a cultural fear built by decades of horror franchises, Halloween costumes, and true-crime stories wherein the clown character is a façade for something far more sinister. This culturally inherited knowledge of clowns through media is something that I find particularly fascinating. Specifically, because there is no shortage of clown-related horror media out there. Despite the fear being as well-known as it is, there remains a clear appetite for this subgenre of horror – and horror in general. Our Editor-in-Chief, Professor Carmine Pariante spoke about exactly this phenomenon recently, in an article for The Guardian where he explained that “A horror film builds a safe enclosure where we can rehearse terror, chaos and helplessness with no adverse consequences.”. The difficult to decipher looks, jarring movements, and ambiguous (though probably malicious) intent are as unnerving as they are captivating, keeping audiences hooked while in the safety of their own homes. Image source: Kelly Romanaldi on Behance My extracurricular research into clown fear has revealed one key thing: phobias do not always have a single, dramatic origin. Instead, it is a culmination of perceived threat, uncanny valley unease, the media we consume, vicarious learning, and direct personal experience. Research consistently suggests that several explanations can overlap; our minds develop fear, like anything else, through a mixture of temperament, learning, culture, and experience. So, if an infant-me's nervous system really did flag something unreadable yet alarming in that clown’s grin and piercing laugh, then it wasn't being irrational – it was doing exactly what phobia research says it's built to do.

Depression can look very different from one person to another. Our study asks whether a particular pattern of symptoms may point to inflammatory depression, and whether current depression scales are equipped to capture it. Image Source: ASPIRE When we think about depression, we often think first about sadness, hopelessness, or losing interest in things we once enjoyed. But depression is much more diverse than that. Two people can receive the same diagnosis and experience very different combinations of depressive symptoms. For example, even the same symptomatologic areas can be affected in opposite ways: some people may sleep much more than usual, while others struggle with insomnia and have difficulty sleeping. Some people may experience increased appetite and weight gain, while others may eat less and lose weight. For some people, depression can also have a particularly physical manifestation, with persistent fatigue, difficulties concentrating, or simply feeling as though the body has run out of energy. As a researcher and adjunct professor at IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, my work focuses on the biological and clinical factors involved in mood disorders for precision psychiatry. I am also a work-package leader in the ASPIRE study, which has been described before in Inspire the Mind. In our recent study as part of the project, we asked whether some of these symptoms could help us better characterise an emerging concept in mental health research: the inflammatory subtype of major depressive disorder. What Does Inflammation Have to Do With Depression? Inflammation is part of the body’s natural defence system. When we have an infection or injury, our immune system produces an inflammatory response to help us recover. But inflammation can also become persistent or dysregulated. Over the past few decades, researchers have found evidence of low-grade increased inflammatory activity in a subgroup of people with depression. Studies have linked inflammatory markers with symptoms including fatigue, changes in appetite and sleep, and anhedonia, the reduced ability to experience pleasure. Higher levels of inflammation have also been associated with poorer responses to some conventional antidepressant treatments. This is particularly important considering that around one in three people with depression do not respond adequately to standard antidepressant treatment. This does not mean that all depression is caused by inflammation, or that everyone experiencing these symptoms has increased inflammation. Depression is complex and can arise through many interacting biological, psychological, and social pathways. Instead, the idea is that inflammation may play a particularly important role for some people with depression. And identifying those people is where things get complicated. The Problem: What does “inflammatory depression” actually look like? Although research into inflammation and depression has grown rapidly, researchers have not yet agreed on exactly which symptoms should characterise an inflammatory subtype of major depressive disorder. That matters. If different studies define and measure this type of depression differently, their findings become harder to compare. We may even miss treatment effects simply because the questionnaires used in a clinical trial do not ask about the symptoms most relevant to inflammation. So, rather than starting with another laboratory experiment, we started with a deceptively simple question: Which symptoms should we actually be looking for? Asking experts to reach a consensus We used a method called the Delphi method, in which experts answer a series of structured questionnaires designed to gradually identify areas of agreement. Our international panel brought together researchers, mental health professionals, including psychiatrists and psychologists, and people with lived experience of depression. Members of the international ASPIRE consortium evaluated symptoms that previous research had linked to inflammation. They could also suggest additional symptoms that they believed were relevant. This process identified ten candidate symptom domains: fatigue or low energy sleeping too much, aka hypersomnia increased weight or appetite cognitive difficulties, such as problems concentrating lack of motivation anhedonia, or reduced pleasure loss of interest a sensation of physical heaviness sometimes called leaden paralysis slowed movement or thinking insomnia We then asked an independent group of experts from the European College of Neuropsychopharmacology’s Immuno-Neuropsychiatry Network to evaluate them. Five symptoms received support from both expert groups: fatigue or low energy, hypersomnia, increased weight or appetite, cognitive difficulties, and lack of motivation. Five symptoms supported by both ASPIRE and INPN-ECNP groups. Created by Tommaso Cazzella, from Vai et al. (2026), Brain, Behavior, and Immunity. Importantly, this is a first framework rather than a diagnostic checklist. Some domains received weaker agreement than others, and further studies will need to test whether these symptoms actually correspond to biological markers of inflammation. Are We Asking Patients the Right Questions? Once we identified these symptoms, another problem became apparent. Many of the questionnaires traditionally used to measure depression do not assess them very well. For example, commonly used scales can focus more heavily on what are sometimes considered “typical” or melancholic symptoms of depression, such as the aforementioned anhedonia, lack of emotional reactivity to positive events, and depressive symptoms being much worse in the morning. In contrast, less attention is given to symptoms that are not melancholic, such as sleeping too much, increased appetite, lack of motivation, or bodily heaviness. Among the questionnaires we evaluated, the Inventory of Depressive Symptomatology (IDS) and its shorter version, the Quick Inventory of Depressive Symptomatology (QIDS), provided the most comprehensive coverage of the symptom profile identified in our study. This may sound like a technical detail about questionnaires. It isn’t. If we do not ask about symptoms, we are much less likely to understand their importance. Figure 2. How well commonly used depression rating scales capture symptoms associated with the inflammatory subtype of major depressive disorder (ISMDD). Created by Tommaso Cazzella from Vai et al. (2026), Brain, Behavior, and Immunity. What People Living With Depression Told Us This was particularly clear when we asked people with lived experience of depression to contribute to the study. Eleven members of the ASPIRE Patient Advisory Board evaluated how these symptoms affect different aspects of their lives. The identified symptoms were perceived as negatively affecting important areas, including relationships, leisure activities, work or education, and independence. They also highlighted something perhaps even more important: the severity of these symptoms was not perceived as being extensively assessed or discussed during mental healthcare. Only fatigue/low energy and insomnia reached consensus as symptoms whose severity was extensively addressed by mental-health professionals. A person may therefore be struggling with exhaustion, motivation or cognitive difficulties that profoundly affect everyday life, while these experiences remain relatively peripheral in a clinical conversation. Where Do We Go From Here? Our findings do not establish a new diagnosis, nor do they mean that symptoms can be used on their own to determine whether someone has inflammation. Instead, they provide a framework that researchers can now test prospectively alongside biological measures of inflammation. If the associations are confirmed, better symptom assessment could help researchers identify patients for clinical trials and understand who might benefit from treatments targeting immune-inflammatory pathways. The study therefore points towards a broader goal in psychiatry: moving away from assuming that one diagnosis represents one biological process and towards understanding the different pathways that may lead to apparently similar symptoms. For clinicians, there is also a much simpler message: Ask about the symptoms that matter to people. Fatigue, motivation, sleep, appetite and cognitive difficulties can easily be considered as secondary features of depression. For the person experiencing them, however, they may be among the most disabling parts of the illness. Understanding depression better may therefore begin not only with new biomarkers or new treatments, but with something surprisingly basic: making sure we are asking the right questions.

Image Source: Pool Photo by CJ Gunther, via the New York Times Trigger Warning: This article discusses killing and suicide. Some readers may find this distressing. I have been watching the Lindsay Clancy trial unfold over the past few weeks, with growing unease. Now, after weeks of testimony and intense public scrutiny, the proceedings have ended in a mistrial. Before I started my PhD, I knew very little about postpartum psychosis (PPP). I had briefly studied it during my Neuroscience and Psychiatric research bachelor’s and master’s degrees. But it wasn’t until I co-led the PRAM-P cohort study (which followed women at risk of PPP from pregnancy up until their children were between 6-12 years old) that I truly started to understand the complexity and severity of this psychiatric disorder. And yet, I still have so much to learn. I am not a psychiatrist or legal expert, nor have I watched every moment of Clancy’s trial. I am not here to judge what its outcome should have been. What I can comment on is how PPP has been discussed around the case. The trial may have ended without a verdict, but the conversation around it has revealed something important: PPP remains profoundly misunderstood. The Complexity of Postpartum Psychosis If you take one thing from this piece, let it be this: PPP is an extraordinarily complicated and variable disorder. It can develop rapidly and its presentation can fluctuate dramatically. Also, it is not postnatal depression. PPP remains relatively under-researched. It is rare, and people are often extremely unwell when researchers would need to recruit or assess them. I saw these challenges first-hand during PRAM-P: some participants became too unwell to continue, while for others, their illness made reconstructing aspects of their clinical history difficult. Our evidence base is therefore still developing. I know that my colleagues who first assessed these women when pregnant and postnatal also found it challenging. A colleague, Dr Katie Hazelgrove (Postdoctoral Research Associate), noted, "Although many women were highly motivated and willing to participate, participating in the research often meant sharing deeply personal experiences during an already complex and vulnerable time." Even its classification reflects this complexity. During the Clancy trial, psychiatrist Dr Avram Mack testified that PPP has not been approved as a distinct diagnosis by the American Psychiatric Association (APA). This requires some context. PPP is not a standalone diagnosis in the DSM-5-TR, widely used in American psychiatry; instead, postpartum psychotic presentations are classified within existing mood or psychotic disorders. The UK predominantly uses the World Health Organization’s ICD-11, which explicitly recognises mental or behavioural disorders associated with pregnancy, childbirth or the puerperium, including those with psychotic symptoms. Neither system, however, recognises PPP as a distinct category, something perinatal researchers and clinicians are campaigning to change. This illustrates a broader challenge in psychiatry: we need diagnostic categories and “typical” presentations to recognise, study and treat illness, but these categories are imperfect. The absence of a distinct diagnostic label does not mean a disorder is not real. Image Source: Ben Blennerhassett on Unsplash A Description of Postpartum Psychosis PPP is rare, affecting 1-2 out of every 1000 births. As mentioned above, PPP is part of the bipolar spectrum, and indeed women with bipolar or schizoaffective disorder and/or previous history of PPP are at a much higher risk of experiencing it, close to 1 in 2 such women. But crucially, PPP can occur in people without a previous diagnosis of severe mental illness, usually (but not always) as a first episode of a bipolar or schizoaffective disorder. Despite its rarity, PPP is considered a psychiatric emergency because of the potential for serious harm to both mother and baby, including, in extreme cases, suicide or infanticide. PPP can emerge extremely suddenly, sometimes within hours of giving birth, with most cases beginning within the first two weeks. For others, the illness evolves more gradually. Symptoms can include mania, hyperactivity, irritability, severe depression, anxiety, paranoia, and psychotic symptoms like delusions (false, bizarre ideas, usually with persecutory content) and auditory or visual hallucinations (hearing voices or seeing things that are not there), which may centre on the baby. Severe insomnia, disorganised thinking and behaviour markedly different from the person’s usual character are also common. The clinical picture can also fluctuate considerably from day to day, or even hour to hour. Someone may appear calm and lucid at one point and later experience profound confusion and the aforementioned psychotic symptoms. This does not mean that a woman has PPP one moment and not the next, rather, the ongoing illness changes its presentation rapidly. Also, these fluctuations do not make these symptoms less real when they occur. As Professor Carmine Pariante (ITM Editor-in-Chief and a researcher and clinician in perinatal mental health) told me: “Once you see a woman with PPP, you never fail to recognise it again, and when the husband or the family see their loved one experiencing PPP, they always know something is not right.” Importantly, the features described above detail what can occur, they are not a checklist of what must occur. A person does not need to display every symptom, or display them continuously, for their illness to be severe. The Clancy Case Clancy does not deny killing her children. Her defence argues instead that she was not criminally responsible for the deaths of five-year-old Cora, three-year-old Dawson and eight-month-old Callan, because she was experiencing hallucinations and delusions at the time of the killings, because of PPP. Expert witnesses for the defence, such as forensic psychiatrist Dr Phillip Resnick, testified that Clancy heard a voice telling her “This is your last chance. Kill the children so you can kill yourself,” acting as a direct command, a typical psychotic symptom. After the killings, Clancy jumped from a second-floor window to kill herself, leaving her paralysed from the waist down. Prior to the killings, Clancy had experienced anxiety, insomnia and depression, received inpatient psychiatric treatment, been prescribed several psychiatric medications, and searched online for terms like “psychosis”. Clancy’s defence’s central argument is that this “fragmented care” and systemic medical failures were to blame for her catastrophic psychiatric decline. Clancy’s former mother-in-law testified that Clancy was “begging for help” when describing how Clancy’s mental health deteriorated following the birth of her youngest son. Prosecutors, on the other hand, have argued Clancy deliberately killed her children, sending her husband out for errands so that she could kill them. The prosecution has pointed to evidence they argued demonstrated planning, awareness and purposeful behaviour. It is tempting to interpret apparently organised or purposeful behaviour as incompatible with psychosis. But, as described above, severe psychiatric illness does not always look the way we expect it to. So, someone can behave coherently while experiencing psychosis. Someone can perform organised actions while experiencing psychosis. Neither observation tells us, on its own, what Clancy's mental state was when she killed her children. Professor Paola Dazzan, an expert in PPP involved in the campaign for the recognition of this as a distinct category, explains: “The crucial issue is whether she killed her children because her false, delusional beliefs, and the voice she heard, led her to do this, rather than how organised or premeditated she was in her actions. While I only know the clinical details that I have seen in the news, the picture I saw described is certainly compatible with PPP”. What I Hope We Take From This Case There is no way to write about this case without acknowledging the enormity of what happened. Three young children lost their lives. My heart breaks for them, for their family, and for Lindsay Clancy, who by all accounts was a devoted mother. Whatever conclusions are ultimately reached about her mental state and criminal responsibility, this is an unimaginable tragedy for everyone involved. But PPP is not synonymous with violence. Most women experiencing severe perinatal mental illness will never harm their children. Yet PPP is a psychiatric emergency, and without timely and adequate care, its consequences can be devastating. And our words matter. Somewhere, a new mother may be experiencing terrifying thoughts, hearing voices or feeling profoundly confused. If she sees women with psychosis described as monsters or inherently dangerous, she may become more afraid to disclose what she is experiencing. We can discuss difficult cases while recognising the limits of internet sleuthing. I do not know what Lindsay Clancy’s mental state was when she killed her children. But the plethora of non-expert opinions surrounding this case has exposed how profoundly misunderstood PPP remains. The lesson should not be that women experiencing PPP are dangerous, but that severe mental illness must be recognised, understood and met with timely and compassionate care. To access more information and support, Action Against Postpartum Psychosis (APP) offers dedicated resources for women and families.