Novelist Sarah Perry’s memoir of her late father-in-law, David, chronicles the period from his first signs of illness, when he began to have trouble swallowing, to his diagnosis of oesophageal cancer, to his death at the age of 77 just nine days later.

We first meet David, a retired chemist from Norwich, on a day trip with Perry and her husband in the summer of 2022. The three of them have gone to Great Yarmouth where, seemingly in good health, David gleefully eats four hot doughnuts. She reveals him as an unassuming man who lives in a bungalow, drinks Yorkshire Tea, delights in telling bad jokes, and likes doing sudoku and watching Antiques Roadshow on TV. But right at the start, Perry notes that David’s death was only weeks away. Though his illness was mercifully short, the speed at which it progressed caught his family unawares, leaving precious little time to prepare.

In this moving and sharply observed book, Perry takes the common event that is terminal illness and elevates it to the realms of extraordinary as she recounts the physical and psychological changes in her father-in-law, the ministrations of doctors and carers, and the relentless form-filling. The narrator is the actor Lydia Leonard, whose reading is serious without veering too far into solemnity. David’s death is devastating for those who love him but, in the greater scheme of things, it is by no means unexpected. Perry’s account of his final weeks is required listening to understand an experience that for many feels unfathomable.

Available via Vintage Digital, 5hr 12min

Further listening

Dirty Money
Charlotte Philby, Baskerville, 9hr 59min
A journalist turned private eye and a government investigator join forces in this compelling thriller about power, corruption and exploitation in present-day London. Read by Kirsten Foster and Victoria Fox.

The New Age of Sexism
Laura Bates, Simon & Schuster Audio, 8hr 35min
The activist and author of Everyday Sexism and Men Who Hate Women narrates her investigation into the misogyny coded into AI. Tackling themes including chatbots, deepfake videos and cyber brothels, Bates reveals how AI perpetuates myths and harmful tropes about women.

My psychological research rarely makes good comedy material, but in a standup show in London recently, those two worlds collided. One of the jokes was about how everyone is getting diagnosed with ADHD these days – about the social media videos that encourage viewers to identify common human experiences, like daydreaming or talking a lot, as evidence of the condition. The audience laughed because everyone got it – they’ve all witnessed how common it seems to have become in the last few years. When something becomes this prevalent in society, and this mystifying, it’s no surprise it ends up as a punchline.

Part of my work as an academic involves trying to solve the puzzle of why so many more people, especially young people, are reporting symptoms of mental illness compared to even five or 10 years ago. (ADHD is a form of neurodivergence, rather than a mental illness, but both have seen an increase, so they are related questions.) Whenever I talk about this – to colleagues, school staff, parents – it doesn’t take long until someone brings up that judgment-laden, hot-button word: overdiagnosis.

Overdiagnosis, in its original use, is primarily a critique of medical professionals. In the current public debate about mental illness, though, the focus tends to be on people overdiagnosing themselves. The concern is that individuals are labelling their own mild or transient life problems with the language of disorder.

Is this happening? Yes. There is evidence of “concept creep” – terminology once reserved for mental illness is now being used to cover more mild phenomena. On social media, people are using the language of mental illness more casually and often inaccurately. Clinicians tell us that more patients are now arriving at appointments with existing self-diagnoses. Given the shifting language around mental health and complexity of diagnosis, at least some of these will be false positives. The existing research allows us to conclude that there is some degree of overdiagnosis happening, and that this is indeed one piece of the puzzle of increasing rates of mental illness.

But puzzles have many pieces, and to decide that overdiagnosis is the only cause constitutes a dangerous oversimplification. For starters, some of the increase we are seeing might ironically be the result of a more accurate and compassionate public understanding of mental illness. Stigma has certainly not disappeared, but over the past 15 years, considerable effort has been spent on mental health awareness campaigns, and during this time there has been a measurable decrease in stigma and an increase in willingness to seek help.

We should not be remotely surprised that public health initiatives have had this effect: that was the whole point. But if fewer people are suffering in silence and are instead able to recognise and admit that they are struggling, this will make it look like the numbers are increasing more than they truly are.

Then there is the important possibility that things really might be getting worse, especially for young people. Mental illness is often triggered or exacerbated by stressful lives, and there’s plenty of evidence that life over the last 15 years has been hard. There has been a rise in financial insecurity, major geopolitical and environmental events, and the lingering impact of Covid. Services that might once have been protective against mental health problems, like youth community provision, have been stripped of funding. Smartphones and social media have also become a big part of most people’s lives. That alone cannot explain the change we are seeing and should not be used as a scapegoat, but it is likely part of the picture.

It is difficult to know fully the relative contribution of each of these factors – overdiagnosis, improved awareness, legitimately increased risk. To confidently answer this question, we would need research that not only showed each factor increasing in parallel with the rate of mental illness but demonstrated a causal relationship too. But that would require well-designed longitudinal or experimental studies where different factors can be controlled or changed, which is often practically or ethically impossible.

Our task then, is to hold all these possibilities in mind. Too often, people observe rising rates of mental illness and debate it as a binary: either “real” or “made up”, with overdiagnosis to blame for the latter. But this is the wrong way to understand the problem. Overdiagnosis could be happening in some individuals or subgroups alongside a genuine rise in others. Underdiagnosis could simultaneously be a problem too, for example, in groups where stigma remains high and access to services is limited. We need to acknowledge that several things might be happening at once.

Crucially, the possibility of overdiagnosis should not be used to dismiss anyone reporting psychological distress or other symptoms of mental illness. There is a longstanding problem of people not being taken seriously when they report such symptoms, particularly among the young. It is easy and convenient to call them snowflakes, to decide that the mental health conversation is mere evidence of their fragility. But to do so misrepresents the problem – in fact, it’s actively unhelpful. Being dismissed when you’re in crisis not only increases distress, it means that, fearful of not being believed, you are likely to use escalating terms to convey your symptoms – compounding an already complicated shift in the use of language around mental health.

When I sat in the audience at that gig, I thought about the people who really do have ADHD, some of them likely sitting around me. ADHD is a condition that can be profoundly disruptive and disabling, even with decent support. Comedians should be free to make jokes about cultural phenomena – that’s the whole point. Anyone should be allowed to question whether, at a population level, overdiagnosis might be contributing to increasing rates of ADHD or mental illness.

But when it comes to individuals, we must be careful. Many people aren’t getting the help they need. It’s impossible to understand the depth of someone’s difficulties by judging them from the outside. If a person tells you they are struggling, you should believe them.

Dr Lucy Foulkes is a psychologist at the University of Oxford

Further reading

The Age of Diagnosis by Suzanne O’Sullivan (Hodder, £10.99)

Bad Influence: How the Internet Hijacked Our Health by Deborah Cohen (Oneworld, £10.99)

Normally Weird and Weirdly Normal: My Adventures in Neurodiversity by Robin Ince (Pan, £10.99)

One of the Nigerian author Chimamanda Ngozi Adichie’s one-year-old twin sons has died after a brief illness.

“We’re deeply saddened to confirm the passing of one of Ms Chimamanda Ngozi Adichie and Dr Ivara Esege’s twin boys, Nkanu Nnamdi, who passed on Wednesday,” read a statement made by Adichie’s communications team.

“The family is devastated by this profound loss, and we request that their privacy be respected during this incredibly difficult time,” continued the statement, signed by Omawumi Ogbe of GLG Communications. “We ask for your grace and prayers as they mourn in private.”

“No further statements will be made, and we thank the public and the media for respecting their need for seclusion during this period of immense grief.”

Adichie and Esege married in 2009. Adichie had her first child, a daughter, in 2016. In 2024, her twin boys were born via surrogate.

Adichie has become one of the most celebrated modern novelists for works exploring love, conflict, identity, feminism and colonialism among other themes. Her debut novel, Purple Hibiscus, was longlisted for the Booker prize in 2004. Her second novel, Half of a Yellow Sun – set during the Biafran war – won the Women’s prize for fiction in 2007, and was named the “winner of winners” from 25 recipients in 2020. Her 2013 novel Americanah won the National Book Critics Circle award. Her most recent novel, Dream Count, was published last year and longlisted for the Women’s prize.

She is also the author of the short story collection The Thing Around Your Neck as well as the nonfiction titles We Should All Be Feminists; Dear Ijeawele, or A Feminist Manifesto in Fifteen Suggestions; and Notes on Grief, which she wrote following the death of her father in 2020. Her mother died months later, in 2021.

Presenter

Jovier Evans, Ph.D.
Division of Translational Research

Goal

The goal of this concept is to support research that addresses the optimization, effectiveness, implementation, coordination, and sustainability of empirically-supported therapeutic and services interventions within and across care settings to better meet the mental health needs of older adults with serious mental illness (SMI).

Rationale

Given the rapidly aging population, there is an urgent public health need for therapeutic and services research addressing practice-relevant questions and conducted within and across settings where older adults with SMI are likely to be identified as needing or receiving care. Despite the heightened risk of medical comorbidity, poor functioning, institutionalization, early mortality, and socioeconomic costs associated with SMI in later life, older adults with SMI remain under-identified and undertreated. While effective therapeutic and services interventions exist for younger and middle-aged adults with SMI, few have been adapted and implemented to address the needs of older adults. For example, age-related cognitive and physiological changes, co-occurring health conditions, and other individual and interpersonal factors (e.g., social supports and isolation, physical mobility, and residential status) are often not sufficiently considered or addressed in spite of evidence supporting their association with intervention outcomes and the extent to which older adults seek, receive, and adhere to mental health care. Factors associated with the health care system also serve as barriers to caring for older adults with SMI, such as inadequate access to specialty mental health care; poor coordination of psychiatric, medical, and social services; limited number of geriatricians, mental health and other providers (e.g., assisted living and nursing home staff, emergency department and hospital staff) with the knowledge to identify and provide care to older adults with SMI; and challenges associated with the transition from general adult health care and housing to geriatric services.

Some progress has been made in establishing an evidence base for effective therapeutic and services interventions in later life, however these efforts tend to be specific to late-life depression or anxiety disorders, and few studies focus on the development and implementation of comprehensive, evidence-based practices specifically for older adults presenting with other types of SMI. Moreover, access to and implementation and coordination of evidence-based interventions for SMI for older adults in community practice or service settings (e.g., primary care and geriatric specialty clinics, home health care, assisted living and long-term care facilities, and community-based programs) remains limited.

The proposed concept would foster research that supports the optimization of empirically-supported treatment and services interventions as well as testing of innovative implementation strategies for the delivery, organization, adoption, and sustainability of evidence-based mental health care for older adults with SMI. Research related to adapting and implementing efficacious treatment of SMI and strategies to improve clinical outcomes that include the reduction of co-occurring chronic health conditions among aging populations, is encouraged. Collaborative research combining multidisciplinary expertise to address SMI and improve access to evidence-based interventions in later life, such as research to evaluate the administration of the health system, interventions that facilitate care transitions and continuity across settings, and research on strategies to improve care linkages and coordination across systems, is also encouraged.

Presenter

Laurie Nadler, Ph.D. 
Division of Neuroscience and Basic Behavioral Science

Goal

The goal of this concept is to determine changes in protein expression, post-translational modifications, protein-protein interactions, and/or metabolite abundance in human postmortem brain and human-derived cells across development and as a function of mental illness and/or neurodevelopmental disorders.

Rationale

From 2014-2024, the NIMH PsychENCODE Consortium  (PEC) generated a comprehensive resource of gene expression (transcriptomics) and gene regulation (chromatin activity) in the human brain across disease states, brain regions, cell types, and developmental epochs. While the PEC had a major impact on the field of psychiatric genetics, leading to two sets of landmark papers in 2018 and 2024, our understanding of the signaling pathways underlying mental illness and neurodevelopmental disorders remains limited as such pathways must be inferred from genomic and transcriptomic data. Due to regulation at the levels of mRNA degradation and protein synthesis, mRNA expression does not correlate strongly with protein expression, nor does it reliably predict dynamic signaling pathways involved in biological function or disease.

Proteins, encoded by genes, as well as small molecule metabolites, carry out crucial cellular functions. Full understanding of the biological pathways altered by psychopathology will require investigation of protein expression, post-translational modifications (e.g., phosphorylation, glycosylation, ubiquitination), protein-protein interactions, and metabolite abundance. To date, few proteomic studies of mental illness and neurodevelopmental disorders in human postmortem brain or human-derived cells have been conducted, highlighting the gap in our understanding of how genetic variation leads to altered molecular cascades underlying psychopathology.

The proposed concept would target the gap in our understanding of biological pathways altered in mental illness and neurodevelopmental disorders by determining changes in protein expression, post-translational modifications, protein-protein interactions, and/or metabolite abundance in human postmortem brain and human-derived cells across development and as a function of disease. Research related to this concept may include, but is not limited to, mass spectrometry-based analyses of well-characterized human postmortem brain tissue or human-derived cells from individuals with mental illness and/or neurodevelopmental disorders versus healthy controls. Bioinformatic approaches would integrate the proteomic and metabolomic data with existing functional genomic data to generate a foundational public resource of multi-omic knowledge about networks and pathways in specific regions and cell types of the human brain that correlate with development, mental illness, and neurodevelopmental disorders. Data would also be harmonized within and across projects. This comprehensive dataset would lead to the generation of well-informed, testable hypotheses about dynamic cellular and molecular mechanisms of mental illness and neurodevelopmental disorders, and may lead to the identification of new therapeutic targets. The proposed concept complements efforts supported by the BRAIN Initiative Cell Atlas Network (BICAN ) and the Scalable and Systematic Neurobiology of Psychiatric and Neurodevelopmental Disorder Risk Genes (SSPsyGene ) Consortium, in which few proteomic projects and no metabolomic projects currently exist.