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Italy by bike? E-asy! The Tour de France begins in Emilia-Romagna next month – we road-test the first stage (with some electric assistance)

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The sun is dipping behind the Apennines and I still have 15 miles of tough cycling before reaching the Roman spa town of Bagno di Romagna. My legs are as flat as my bike’s battery but there’s a bar opposite the church where I can sink a couple of beers while man and machine take sustenance.

I am in Emilia-Romagna to ride the first two stages of this year’s Tour de France, which kicks off at the end of June. Most years, the world’s greatest cycling event starts in a country other than France. And this time, it’s Italy’s turn.

I set off on the 260-mile trip from Florence, the start of the first étape, and cycle through the rolling Tuscan countryside before going up, up and away into the mountains of Emilia-Romagna. My e-bike, a Pinarello Nytro racer, offers moderate assistance, but you still have to give it quite a bit of welly on the severe slopes.

Tired and much relieved, I’m at the Thermae Santa Agnese 90 minutes later. It is an ancient spa hotel and soon I sink my tired backside into the warm thermal pool.

Most years, the Tour de France cycling event starts in a country other than France. This time, it's Italy's turn. Mark Porter (not pictured) sets off on the first étape, a 260-mile trip from Florence through the rolling Tuscan countryside (stock image)

Most years, the Tour de France cycling event starts in a country other than France. This time, it's Italy's turn. Mark Porter (not pictured) sets off on the first étape, a 260-mile trip from Florence through the rolling Tuscan countryside (stock image)

Most years, the Tour de France cycling event starts in a country other than France. This time, it’s Italy’s turn. Mark Porter (not pictured) sets off on the first étape, a 260-mile trip from Florence through the rolling Tuscan countryside (stock image)

Mark took his Pinarello Nytro racer e-bike on the ride through towns and villages

Mark took his Pinarello Nytro racer e-bike on the ride through towns and villages

Mark took his Pinarello Nytro racer e-bike on the ride through towns and villages 

Bagno has been a spa town since Roman times and white-robed health tourists waft around the ceramic-tiled corridors like fluffy ghosts. Dinner is a hearty affair and, with the aid of the wine flight, wipes clean the slate of virtue which has been accrued during daylight hours. The first climb the following day is out of Mercato Saraceno up to Barbotto, about three miles and 1,700 feet of lung-busting ascent. Near the summit, a man on a normal bike breezes cheerily past me, not even out of breath.

No matter, I am making good time and stop at the top of another climb to admire the medieval village of San Leo, which crouches on a 2,000ft limestone escarpment, commanding views across the outlying mountains and plains towards Rimini and the Adriatic. I have arranged to meet a group of cyclists in nearby San Marino for a late lunch. Among them is Bernard Hinault, five-time winner of the Tour de France in the late 70s and early 80s, and the greatest cyclist of his generation.

The mountains and buildings of Emilia-Romagna are the setting for the first two stages of this year¿s Tour de France

The mountains and buildings of Emilia-Romagna are the setting for the first two stages of this year¿s Tour de France

The mountains and buildings of Emilia-Romagna are the setting for the first two stages of this year’s Tour de France

San Marino comes at the end of my fourth climb of the morning. My battery has just enough juice to make it to the top, where I fall off the bike in front of a crowd of tourists at the castle gates, having neglected to release my feet from the pedal cleats.

San Marino is an independent state completely surrounded by Italy. Founded around the same time as San Leo, it is the third smallest country in Europe after the Vatican and Monaco.

I take the following day off to visit Rimini and go cycling with the clubbable Monsieur Hinault. Later, we have dinner together with some French cyclists at the Lungomare Bike Hotel in Cesenatico, where we are all staying. The cycle party is here to promote the Italian launch of this year’s Tour. I am here to road test the route on my new Pinarello, but join in the fun and games of the cycle pros.

TRAVEL FACTS 

Hotel Lungomare organises tailor-made four-night/five-day cycling packages with Pinarello e-bikes and airport transfers from Bologna from £735pp (hlungomare.com). Luton-Bologna from £80 return (ryanair.com). Hotel Lungomare has room-only doubles from £75. More information: emiliaromagnaturismo.it.

I ask Mr Hinault what’s the key to being a champ. ‘A mix of physical and mental strength. Once you’ve established that you are actually any good, of course,’ he says. Bernard is a compact man, about my height but made of marble rather than sausage meat. ‘And don’t forget to lubricate the cogs daily with good red wine.’ Which is exactly what we are doing. He is the only one of the deadly earnest cycle party who is not sniffy about my electric racing bike. ‘Do whatever it takes, but just get out there on a bike and have fun.’

Cesenatico is next to Rimini and has a beautiful medieval port designed by Leonardo da Vinci. From here, I head up to Ravenna, where the poet Dante died in exile in 1321.

My journey ends the following evening in Bologna with dinner at the Caminetto d’Oro, in the heart of the city. This is a favourite of film director Martin Scorsese, and one can see why. Hams, wines and cheeses burst from a jumble of doorways in myriad alleys, while trattorias of obvious excellence beckon like sirens.

Long live the e-bike and the freedom it has heralded, even for an old fatty like me. And long live la bella Emilia-Romagna, far from the Tuscan crowds.

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France lifts state of emergency in New Caledonia, maintains curfew

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France on Tuesday lifted a state of emergency in its Pacific territory of New Caledonia but is maintaining a curfew and sending hundreds of paramilitary reinforcements after two weeks of unrest in which seven people died and hundreds were injured. 

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German police prepare for terrorists, violent hooligans, travelling criminals and deported migrants trying to enter during Euro 2024 by banning all police holiday and beefing up their borders

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  • European Championships get underway in Munich’s Allianz Arena on June 14
  • A total of 2.7m fans are expected in stadiums and up to 12m in across host cities 
  • Have Chelsea offered Manchester United a way out of the Erik ten Hag darkness through Mauricio Pochettino’s exit? – Listen to the It’s All Kicking Off! Podcast 

German police are set to introduce a robust five-point plan to ensure they are equipped to deal with any security threat during the European Championships next month, according to reports.

The much-anticipated tournament gets underway in Munich on June 14 with a clash between the hosts and Scotland at the Allianz Arena. 

The fixture will see the first portion of the expected 2.7million fans expected in stadiums and up to 12m in fanzones and other areas across the ten host cities. 

German police are stepping up their preparations and will particularly target five ‘perpetrator groups’ – terrorists, violent hooligans, travelling criminals, including thieves and serious criminals – according to Bild. 

The outlet claim that a total of 22,000 federal police will be deployed at borders, stadiums, public viewing areas, airports, railway stations and sensitive areas of the critical infrastructure every day.

German police have stepped up their preparations for next month's European Championships

German police have stepped up their preparations for next month's European Championships

German police have stepped up their preparations for next month’s European Championships

Bayern Munich's Allianz Arena will host the opener between Germany and Scotland on June 14

Bayern Munich's Allianz Arena will host the opener between Germany and Scotland on June 14

Bayern Munich’s Allianz Arena will host the opener between Germany and Scotland on June 14

German police took part in an operational drill at the MHP Arena in Stuttgart earlier this month

German police took part in an operational drill at the MHP Arena in Stuttgart earlier this month

German police took part in an operational drill at the MHP Arena in Stuttgart earlier this month

These will reportedly be made up of 25 police units, 50 mobile surveillance units, 45 alarm trains with officials from administrations and offices and 45 trains with young police officers in their second year of training.

Additionally, there is a ban on police holiday during the month-long tournament. 

Bild report that law enforcement are especially concerned about the risk of hooligans during the European Championships. 

In March, Mail Sport reported that thousands of football fans have been banned from following England in Germany under a UK government clampdown.

Over 1,600 fans with football banning orders will be forced to surrender their passports to the police from 4 June until the European Championship final on 14 July to ensure they do not attempt to attend matches.

Anyone failing to hand in their passport or attempting to travel to Germany will face a large fine or prison term, with a maximum sentence of six months.

The new powers to enforce fans to surrender passport were introduced following a surge in football-related violence in recent years, with police making 2,264 arrests at matches last season and issuing 682 new banning orders, the highest figures since 2011.

Meanwhile, Bild report that German hooligans are preparing for riots, with them seeing the event as a ‘home game’ where ‘presence’ must be shown. 

One source is quoted as saying: ‘The hooligan and ultra scene in particular has an increased potential for aggression and an affinity for violence. Particularly away from official venues, disruptive actions must be expected – if the opportunity arises.’

One source told Bild: 'The hooligan and ultra scene in particular has an increased potential for aggression and an affinity for violence'

One source told Bild: 'The hooligan and ultra scene in particular has an increased potential for aggression and an affinity for violence'

One source told Bild: ‘The hooligan and ultra scene in particular has an increased potential for aggression and an affinity for violence’

In March, Mail Sport reported that thousands of England fans have been banned from travelling to Germany for the duration of the Euro 2024 tournament

In March, Mail Sport reported that thousands of England fans have been banned from travelling to Germany for the duration of the Euro 2024 tournament

In March, Mail Sport reported that thousands of England fans have been banned from travelling to Germany for the duration of the Euro 2024 tournament

As a result, fan groups that are particularly hostile will reportedly be assessed internally as a ‘red game’ during the European Championships, with security measures being increased to handle the threat. 

Measures such as threat speeches, reporting requirements, bans on entering areas, expulsions and detention will be utilised. Furthermore, identified violent troublemakers will not be allowed to buy tickets. 

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🔴 Live: Spain, Ireland, Norway set to recognise Palestinian statehood

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Spain, Ireland and Norway will officially recognise a Palestinian state on Tuesday, despite an angry reaction from Israel, which has found itself increasingly isolated after seven months of conflict in Gaza. International condemnations over an Israeli strike that killed dozens in a displaced persons camp in Rafah have increased with the UN Security Council set to convene an emergency meeting on the incident on Tuesday. Follow our live blog for all the latest developments on the Israel-Hamas war. 

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Eamonn Holmes breaks silence on his divorce from wife Ruth Langsford as he thanks viewers for their support

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Eamonn Holmes has used his presenting slot on GB News’s breakfast programme to break his silence over his divorce from wife Ruth Langsford.

Accompanied by co-host Isabel Webster, who smiled supportively as he spoke, the TV veteran said: ‘Just before we move on we’d just like to thank people for your support for Ruth and I over the last few days as to the news of our separation.

‘Your support for both of us is very much appreciated.’

This is a breaking story – more to follow. 

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Papua New Guinea orders thousands to evacuate amid second landslide fears

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Thousands of residents were ordered to evacuate from the path of a still-active landslide in Papua New Guinea by the government on Tuesday, after parts of a mountain collapsed, burying an initial estimate of more than 2,000 people.

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Pennsylvania is sitting on major untapped lithium ‘white gold mine’ that could generate new billion-dollar industry, government study finds

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Pennsylvania could be at the center of America’s new ‘white gold rush’ with the discovery of a major untapped source of lithium in the state.

Government scientists have shown that they can filter the precious metal from the state’s shale gas wastewater: pulling tons of lithium per day, with little left behind.

They concluded that Pennsylvania alone could produce nearly half of the total US demand for lithium — starting in the first year — supplying this key compound that’s needed to power everything from smartphones to electric vehicles to solar panels.

A project on this scale could make Pennsylvania a rust-belt Saudi Arabia, ending US dependence on lithium from China, which now controls 90 percent of the market.

And unlike many new lithium-mining proposals, which have threatened scarce water resources from Arkansas to Colorado, this process would make a virtue of the high-pressure water already used by the hydraulic fracturing, or fracking, of natural gas.

With 72 proposed lithium mines across the US, the discovery could help reduce local ecological fallout as America shifts away from ‘greenhouse gas’-emitting fossil fuels. 

Over 1,200 tons of lithium could be recovered per year from Pennsylvania's natural gas 'fracking' wastewater alone, according to the new research, produced in collaboration by the US National Energy Technology Laboratory (NETL) and the University of Pittsburgh

Over 1,200 tons of lithium could be recovered per year from Pennsylvania's natural gas 'fracking' wastewater alone, according to the new research, produced in collaboration by the US National Energy Technology Laboratory (NETL) and the University of Pittsburgh

Over 1,200 tons of lithium could be recovered per year from Pennsylvania’s natural gas ‘fracking’ wastewater alone, according to the new research, produced in collaboration by the US National Energy Technology Laboratory (NETL) and the University of Pittsburgh

‘Wastewater from oil and gas is a burgeoning issue,’ as one government geochemist behind the new study put it. ‘We’re looking at a beneficial use of that waste.’

Fracking is a process used to extract natural gas from deep underground shale rock, via the injection of more than a million gallons of water, sand and chemicals at high pressure into drilled wells.

The pressurized mix cracks open the shale rock, creating new fissures that are held open by the sand, allowing natural gas from the rock to flow up into the well.

However, despite having reduced US dependence on foreign oil, fracking has proven to be highly controversial due to its use of chemicals, groundwater contamination, noise, air pollution and even its ability to create earthquake-like tremors.

And these risks have become a fiercely debated issue in Pennsylvania, where fracking has been linked to cancer other health issues.

Over 1,200 tons of lithium could be recovered per year from Pennsylvania’s fracking wastewater alone, according to the new research, produced in collaboration by the US National Energy Technology Laboratory (NETL) and the University of Pittsburgh.

Although the price of lithium has fluctuated in this volatile new market, the annual return to the state from this wastewater lithium could range from $1.6 to $18 million dollars at current prices

Although the price of lithium has fluctuated in this volatile new market, the annual return to the state from this wastewater lithium could range from $1.6 to $18 million dollars at current prices

Although the price of lithium has fluctuated in this volatile new market, the annual return to the state from this wastewater lithium could range from $1.6 to $18 million dollars at current prices

Fracking is the process of drilling down into the earth before inserting a high-pressure water mixture to release natural gas. Water, sand and chemicals are injected at high pressure into underground boreholes to open up cracks in the rock, freeing trapped natural gas

Fracking is the process of drilling down into the earth before inserting a high-pressure water mixture to release natural gas. Water, sand and chemicals are injected at high pressure into underground boreholes to open up cracks in the rock, freeing trapped natural gas

Fracking is the process of drilling down into the earth before inserting a high-pressure water mixture to release natural gas. Water, sand and chemicals are injected at high pressure into underground boreholes to open up cracks in the rock, freeing trapped natural gas

Although the price of lithium has fluctuated in this volatile new market, the annual return to the state could range from $1.6 to $18 million dollars at current prices.

More promising still, their projection that this wastewater recycling could meet nearly half of US lithium demand does not factor in any nearby activity other states.

The so-called Marcellus shale region, where an estimated 144 trillion cubic-feet of natural gas lays pocketed between two massive layers of limestone, covers much of Pennsylvania — but also extends into New York, Ohio, and West Virginia. 

‘Pennsylvania has the most robust data source for Marcellus shale,’ NETL geochemist Justin Mackey said in a statement. ‘But there’s lots of activity in West Virginia, too.’

Mackey and his colleagues were able to calculate the likely amount of lithium floating in solution in this fracking wastewater through contaminant reports that each oil and gas company in Pennsylvania is required to file with regulators.

‘Lithium is one of the substances they have to report,’ Mackie said. ‘That’s how we were able to conduct this regional analysis.’

Based on their estimates, published this April in the journal Scientific Reports, fracking wells in the southwestern portion of Pennsylvania appear to contain nearly twice as much lithium as wells elsewhere in the ‘Keystone state.’ 

Geochemist Justin Mackey and his colleagues were able to calculate the likely amount of lithium floating in solution in this fracking wastewater through contaminant reports that each oil and gas company in Pennsylvania is required to file with regulators

Geochemist Justin Mackey and his colleagues were able to calculate the likely amount of lithium floating in solution in this fracking wastewater through contaminant reports that each oil and gas company in Pennsylvania is required to file with regulators

Geochemist Justin Mackey and his colleagues were able to calculate the likely amount of lithium floating in solution in this fracking wastewater through contaminant reports that each oil and gas company in Pennsylvania is required to file with regulators

While geologists had long known that lithium was present in the mineral content around these shale gas deposits, an accurate estimation only became feasible as years of these mandated reports came in.  

‘There hadn’t been enough measurements to quantify the resource,’ Mackey explained. ‘We just didn’t know how much was in there.’

But an accidental benefit had occurred, because lithium-based mineral compounds like lithium chloride and lithium carbonate are water soluble. 

The simple act of injecting fracking wells with high-pressured water has acted to pull much of that lithium metal out of the rock and into the fracking wastewater.

Water in underground aquifers, as Mackey put it, have been ‘dissolving rocks for hundreds of millions of years.’

‘Essentially, the water has been mining the subsurface,’ he said.

America has about eight million metric tons of lithium in its land, which means the US industry is worth about $232 billion.

However, the nation only makes up about one percent of the global lithium production — while China has dominated the market for decades because 90 percent of the metal mined is refined in their nation.

But reckless exploitation of America’s lithium wealth could come at a grave cost, experts warn.

Approximately 40 of the 72 proposed lithium mines in the US are set for Nevada, America’s driest state, and 80 percent of them would sit on water supplies deemed at risk of low water levels, according to an analysis by the Howard Center for investigative journalism. 

Central Nevada Regional Water Authority Executive Director Jeff Fontaine told Howard Center researchers that overuse of water in the basin can cause ‘permanent’ damage underground and ‘a combination of things that happens that would prevent that aquifer from ever really restoring itself.’ 

Poor planning of such mines, the Howard Center noted, could hurt local communities and wildlife that need access to these aquifers’ fresh water.

Patrick Donnelly, a conservation biologist for the nonprofit Center for Biological Diversity, told the Howard Center that if all of the 72 proposed mines are constructed under the current rules, ‘it would be a fundamental transformation of the American West.’

‘People compare it to the Gold Rush, but the Gold Rush was pretty small scale, compared to what all this lithium’s looking like,’ Donnelly said.

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Boohoo facing shareholder revolt on bosses’ bonuses after tumbling to a £160m loss

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Bad look: Boohoo is facing a shareholder revolt over bosses' bonuses

Bad look: Boohoo is facing a shareholder revolt over bosses' bonuses

Bad look: Boohoo is facing a shareholder revolt over bosses’ bonuses

Boohoo is facing a shareholder revolt over plans to pay bosses bonuses despite losses. 

The fast fashion giant has been blasted after the £1million payouts were outlined in its yearly report despite missed financial targets. 

Several shareholders are planning to vote against proposals to hand co-founders Mahmud Kamani and Carol Kane and CEO John Lyttle bonuses at Boohoo’s annual general meeting next month, 

The Sunday Times reported. It comes after Boohoo revenue tumbled 17 per cent in its latest financial year, and it reported a loss of nearly £160million. 

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Pictured: The desert in China with so many tourist camel trains that TRAFFIC LIGHTS have been installed to allow pedestrians to pass between them

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As an unexpected location for congestion, a desert takes some beating.

Especially when it’s camels that are gridlocked.

But camel traffic jams are exactly what take place amid the dunes of Mingsha Mountain and Crescent Spring Scenic Spot in China.

The problem became so acute that local authorities dreamt up a unique, world-first solution to stop delayed tourists from getting the hump (as Brits sometimes describe becoming annoyed) – camel traffic lights. 

The unique system was installed in 2021 at the popular spot on the outskirts of Dunhuang City in northwest China’s Gansu province.

Camel traffic lights have been installed at Mingsha Mountain and Crescent Spring Scenic Spot

Camel traffic lights have been installed at Mingsha Mountain and Crescent Spring Scenic Spot

Camel traffic lights have been installed at Mingsha Mountain and Crescent Spring Scenic Spot 

The unique system was installed in 2021 at the popular spot on the outskirts of Dunhuang City in northwest China's Gansu province

The unique system was installed in 2021 at the popular spot on the outskirts of Dunhuang City in northwest China's Gansu province

The unique system was installed in 2021 at the popular spot on the outskirts of Dunhuang City in northwest China’s Gansu province 

The signals serve the same purpose as regular traffic lights and display the same traditional green pedestrian symbols on one side.

But on the other side, they show a distinctive image of a two-humped camel. 

Dozens of traffic lights were installed along the scenic route to allow pedestrians to cross in between long lines of camels. 

The signals serve the same purpose as regular traffic lights. They display the traditional green pedestrian symbols on one side, but an image of a two-humped camel on the other

The signals serve the same purpose as regular traffic lights. They display the traditional green pedestrian symbols on one side, but an image of a two-humped camel on the other

The signals serve the same purpose as regular traffic lights. They display the traditional green pedestrian symbols on one side, but an image of a two-humped camel on the other

The unique system at Mingsha Mountain (above) has itself become a tourist attraction

The unique system at Mingsha Mountain (above) has itself become a tourist attraction

The unique system at Mingsha Mountain (above) has itself become a tourist attraction

When the green camel light is on, camels can pass, and when the red camel light is on, camels stop to let pedestrians through. 

While the traffic lights have worked to speed up camel rides through the desert, it hasn’t made the area any less busy – the traffic lights have become a popular tourist attraction in themselves.

According to China Daily, Wang Youxia, deputy general manager of the company responsible for the scenic spot’s operations said that more than 3.7million tourists visited last year, with 42 per cent of those opting for camel rides. 

The scenic area is home to around 2,000 camels, each transporting multiple tourists a day, according to the website. 

The camel rides are operated by local villagers, who charge around 100 yuan (£12/$14) per tourist for an hour-long camel trek. 

The scenic area is home to around 2,000 camels, each transporting multiple tourists a day

The scenic area is home to around 2,000 camels, each transporting multiple tourists a day

The scenic area is home to around 2,000 camels, each transporting multiple tourists a day

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I thought my anxiety was genetic, says MISTY PRATT. Then I discovered why so many women are diagnosed with depression and given pills they don’t need

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Aged just 17, I got sick. The kind of sick doctors can’t diagnose using a blood test or a scan; the kind of illness that’s talked about in whispers, behind closed doors, if it were even talked about at all.

It started on my first morning back to school after a blissful summer. I clearly remember walking through the school hall and everything suddenly seeming grey and bleak.

Today, I know this was my first experience of the terrible weight of depression.

At the time, though, I didn’t recognise the darkness for what it truly was, which wasn’t helped by the rapid onslaught of ailments seemingly contained in my body, not my mind.

Headaches, stomach aches, irritable bowel syndrome, insomnia and panic attacks: all these physical symptoms crept into my life one at a time. I couldn’t get on buses or trains or go into any other place where I felt confined, because my panic revolved around my intense nausea and a fear of vomiting.

'Headaches, stomach aches, irritable bowel syndrome, insomnia and panic attacks: all these physical symptoms crept into my life one at a time,' says Misty Pratt

'Headaches, stomach aches, irritable bowel syndrome, insomnia and panic attacks: all these physical symptoms crept into my life one at a time,' says Misty Pratt

‘Headaches, stomach aches, irritable bowel syndrome, insomnia and panic attacks: all these physical symptoms crept into my life one at a time,’ says Misty Pratt

I visited specialists who pressed on my abdomen and stuck a scope down my oesophagus, on the hunt for a physical cause of my tummy troubles. All tests came back negative for serious illness.

‘You need to reduce stress,’ one doctor said, and I nodded in agreement, unsure how to do that. My body’s internal smoke alarm was beeping, but I couldn’t find the source of the fire.

I took to popping Zantac, a medication used to reduce stomach acid, every time I felt the familiar stab in my abdomen.

Soon it was a daily habit. My weight dropped rapidly and I began to isolate myself. Schoolwork was the only thing tying me to some sense of normality.

My depression lasted for years. Eventually I ended up taking antidepressants.

At first, the drugs helped — but the positive effects soon wore off, leaving me with side-effects like an involuntary twitch and a diminished libido, which thankfully resolved after I painstakingly weaned myself off the medication.

By the age of 35, I had received five different diagnoses from five different doctors.

What started as ‘panic’, became ‘generalised anxiety’, then morphed into an eating disorder, was revised as ‘cyclothymia’ — a condition that shares many similarities with bipolar disorder — and culminated in a bout of ‘postpartum mood disorder’.

Indeed, my mental illness lasted through my two pregnancies — my first at 29, my second three years later — and beyond, as my children grew into beautiful young girls.

And the cause of all this?

At first I presumed it was, as the phrase puts it, ‘all in my head’, some kind of genetic legacy gifted to me by my paternal grandmother, who suffered from manic episodes.

I had witnessed them from the age of five. She would have grandiose ideas, like falling in love with someone she barely knew, or make epic shopping sprees that tallied in the thousands. On other occasions, she experienced complete breakdowns and lost the ability to speak.

Later, I learned the curse of mental illness had touched the lives of at least two other women in my family tree, both following childbirth. My paternal great-grandmother stayed in a so-called ‘nursing home’ after the birth of her third child.

Even more tragic was the story of my grandmother’s sister, who died by suicide shortly after the birth of twins.

I suppose I also thought it was a ‘woman thing’, or some sort of chemical imbalance in my brain that just needed ‘righting’.

But today I know, thanks to years of research — both in my job as a health researcher and also by speaking to mental health experts and other sufferers — that women’s mental illness is far more complex than these two often-cited explanations would make you think.

Indeed, many scientists believe the minute intricacies of our female bodies, the complex ebb and flow of our hormones — not to mention the pressurised, multi-tasking world in which women live and work — are absolutely vital to unpick if we are ever truly to tackle female ‘problems of the mind’.

Yet as one professor of psychiatry — Jayashri Kulkarni, a specialist in women’s mental health at Monash University, Australia — told me wearily, ‘psychiatry remains primitive’ in how it diagnoses and treats problems like mine.

You might wonder why I am writing so specifically just about women here. It’s because I’m far from alone. As one of the first doctors I saw as a teenager said, while sighing and shaking his head: ‘Why are so many girls dealing with things like this?’

The reality is that women make up the bulk of mental health patients. Today, women are three times more likely than men to experience common mental health problems.

In England in 2014, one in six adults had a common mental health problem; about one in five women and one in eight men.

While rates of severe mental illness have remained steady over time, and don’t differ much by gender, more common disorders, including depression and anxiety, certainly reflect a gender difference.

Women are approximately twice as likely as men to be diagnosed with depression, according to data published in 2011.

Adapted from All In Her Head: How Gender Bias Harms Women's Mental Health, by Misty Pratt, to be published by Greystone on June 6

Adapted from All In Her Head: How Gender Bias Harms Women's Mental Health, by Misty Pratt, to be published by Greystone on June 6

Adapted from All In Her Head: How Gender Bias Harms Women’s Mental Health, by Misty Pratt, to be published by Greystone on June 6

It’s also notable that half of all serious mental illness begins in adolescence — and girls far outweigh boys among the diagnosed.

Between the ages of 12 and 17, more than 36 per cent of girls develop depression, compared with less than 14 per cent of boys. And once mental illness begins in adolescence, it often persists throughout a person’s adult life.

Add to this the fact that statistics show when a woman presents at her doctor’s office with complaints of anxiety or a depressive mood, she is also almost twice as likely, compared with men, to be prescribed psychotropic medication, such as antidepressants — and you can see we have a problem.

Finally, once a woman is on medication, research seems to indicate that it’s hard to stop taking them. In a study in 2017, researchers in Sweden found it was twice as common for women as for men to use antidepressants when they were not currently depressed.

These findings suggest women are being overtreated with these drugs.

Surely, given all the amazing medical advances that are possible in our technologically proficient age, we can do better than our current method of treatment — doling out antidepressants, and crossing our fingers that they do the trick?

Part of the problem, sadly, is that we often still treat women, medically, on the same basis as we do men, ignoring glaringly important differences between us.

One 2016 report in The Lancet Psychiatry cited some of these differences as including: women’s diminished stress response (we are more likely to release less cortisol during stressful events, which is associated with a higher risk of subsequent depression even after the event has passed); the fact that women are more likely to have lower self-esteem and higher risk for rumination (meaning being stuck in a cycle of negative thoughts) and body-related shame — and also that women suffer higher rates of traumatic childhood experiences, such as physical and sexual abuse.

Yet the thresholds and treatment of mental health issues are not gender specific.

And aside from diagnosis, clinical research to study the effectiveness of antidepressants and their potential harms has, historically, mostly been in male animals and adult male humans — which means that much of what we know about their side-effects relates to the male body.

Little wonder, perhaps, that one 2020 report in the journal Biology of Sex Differences found worrying implications for how women process standard prescribed doses of antidepressants.

‘Among patients administered a standard drug dose,’ the report said, ‘females are exposed to higher blood drug concentrations and longer drug elimination times than males.

‘This likely contributes to the near doubling of adverse drug reactions in female patients, raising the possibility that women are routinely overmedicated.’

Dr Liisa Galea, a world-renowned neuroscientist, now at the Centre for Addiction and Mental Health in Toronto, Canada, found that only five per cent of studies from neuroscience and psychiatry journals in 2019 used an appropriate analysis for the discovery of possible sex differences in the outcomes.

When women are included in trials, variables such as hormonal contraceptives, menstrual cycles (which means differing responses to medication at different points in our cycles), pregnancy, childbirth and menopause have been found to affect treatment outcomes.

But these variables sometimes lead researchers to exclude women from participating in research altogether, in the belief that it’s just too difficult to incorporate them in their findings.

This is despite the fact that, as Dr Galea tells me: ‘Pregnancy and postpartum do create a perfect storm for mental health disorders, because we see the same kind of biomarkers occurring during those stages that we see in mental health problems.’

In depression, there is a reduction in volume of the hippocampus, a part of the brain that’s involved in memory, for instance.

As Dr Galea points out, the same reduction occurs in pregnancy and postpartum.

Other major changes in this same timeframe affect our immune system, stress hormones and metabolism — all in ways similar to what we see during an episode of major depression.

This gender bias in the diagnosis and treatment of women’s mental illness just further medicalises natural processes in our bodies and pathologises our emotions.

Those pesky wombs and changing hormones affect our moods — of course they do! — but that shouldn’t automatically lead doctors to focus on women’s emotions and dole out antidepressants and ignore other serious health issues that may be going on.

Part of the answer, surely, must be in precision medicine, rather like that we are seeing in cancer care and cardiology.

‘We need the ECG for the mind,’ says Kulkarni, referring to the test that checks heart function by measuring its electrical activity. Indeed, it seems there are in fact ways emerging to define what type of mental health disorder women have.

Professor Kulkarni identifies different types of depression based on factors such as hormonal changes or a history of trauma, which would impact the stress response system and thereby change brain chemistry over the long-term.

Other researchers have studied blood tests that could identify whether a person was experiencing a depression associated with inflammation in the body. Meanwhile, research suggests that more than 50 per cent of the variance of antidepressant response and tolerability is genetically controlled.

New genetic tests — embryonic though they are — show some early promise in predicting antidepressant treatment response and remission rates.

Taken together, these advancements provide hope for those women who have found antidepressants have not been the ‘happy pills’ we were promised.

But the missing piece of the puzzle, as I can testify, is that women desperately require holistic care, as well as sound biologically based medical care — particularly at moments of hormonal change, such as adolescence, pregnancy and menopause.

It’s at times like these that overburdened women can feel TATT — ‘tired all the time’. But this feeling of being worn out is all-too-often diagnosed as anxiety or depression.

When this happens, treatment solutions may prove ineffective, leading to worsening symp- toms or an abandonment of treatment altogether.

That’s because treatment for mental illness generally centres on therapy and medication, while treatment for burnout needs more practical solutions — such as time off work to rest; negotiating different working hours with an employer or encouraging basic self-care, such as getting a good night’s sleep and taking exercise.

There is even evidence that women should try to see that some bumps in the road could, in the end, be positive for our mental health.

According to Dr Galea, the structural changes we see in the brain during puberty, pregnancy and menopause ‘might even be better for you’, she says.

For instance, research on brain changes that occur during adolescence shows that grey matter in the prefrontal cortex begins to thin.

This is an important process of pruning unwanted neural connections in the brain, while the connections that remain are strengthened.

In pregnancy, brain volume changes may help us to feel more bonded to our babies.

And images of our brains during menopause have shown changes in its structure, neural connectivity and energy metabolism which have the potential to make women more vulnerable to mental health issues — or, instead, make us more resilient to change and better able to adapt.

All these changes are likely serving a functional purpose, helping us transition into the next stage of life.

For me, making peace with my moods and coming to the realisation that there’s nothing I need to ‘fix’ about myself helped me to recover.

But long term, it’s only with more research dedicated specifically to women’s bodies and minds — in all their complex glory — that we may ever fully tackle the idea that our mental health woes really are just ‘all in our heads’.

Adapted from All In Her Head: How Gender Bias Harms Women’s Mental Health, by Misty Pratt, to be published by Greystone on June 6, £18.99. © Misty Pratt 2024. To order a copy for £17.09 (offer valid to June 8, 2024; UK P&P free on orders over £25), go to mailshop.co.uk/books or call 020 3176 2937.

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Indiana Pacers honor Bill Walton ahead of Celtics playoff game after ex-Boston center’s death at 71

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The Indiana Pacers paid tribute to Bill Walton before their playoff game against the Celtics on Monday night after the former Boston center’s death at 71.

Walton, who won the NBA Championship with the Celtics in 1986, died while surrounded by his family on Monday following a battle with cancer.

He was a two-time NBA champion, winning his first title with the Portland Trail Blazers before adding another in Boston.

The ex-UCLA star was also one of the greatest college basketball players of all time, winning three consecutive national college player of the year awards between 1972 and 1974 and two NCAA titles with the Bruins. 

Ahead of their Game 4 battle with Boston at Gainbridge Fieldhouse, Indiana held a moment of silence to remember Walton following his death on Monday.

The Indiana Pacers paid tribute to Bill Walton before their playoff game against the Celtics

The Indiana Pacers paid tribute to Bill Walton before their playoff game against the Celtics

The Indiana Pacers paid tribute to Bill Walton before their playoff game against the Celtics

Walton won the NBA Championship with Boston

Walton won the NBA Championship with Boston
The 71-year-old passed away on Monday

The 71-year-old passed away on Monday

Ex-Celtics center Walton (left, playing for Boston in 1985) died while surrounded his family on Monday following a battle with cancer

Walton’s NBA career – disrupted by chronic foot injuries – lasted only 468 games with Portland, the San Diego and eventually the Los Angeles Clippers and Boston. He averaged 13.3 points and 10.5 rebounds in those games.

His most famous game was the 1973 NCAA title game, UCLA against Memphis, in which he shot an incredible 21 for 22 from the field and led the Bruins to another national championship. 

Walton was selected with the No. 1 pic in the 1974 NBA draft, and won his first NBA Championship with the Trail Blazers three years later. He was the NBA’s MVP in the 1977-78 season.

After struggling with those foot problems, Walton’s career took off again when he was traded to the Celtics for Cedric Maxwell in 1985 for two seasons. Alongside Larry Bird, Walton collected his second NBA Championship in 1986.

After retiring, he overcame a stutter to thrive on the microphone, winning a Sports Emmy in 1991 and being named one of the top 50 sports broadcasters of all-time in 2009. 

Walton originally joined ESPN and ABC in 2002 as a lead analyst for NBA games before moving to college basketball in 2012. 

Pacers coach Rick Carlisle took part in a moment of silence for Walton before Monday's game

Pacers coach Rick Carlisle took part in a moment of silence for Walton before Monday's game

Pacers coach Rick Carlisle took part in a moment of silence for Walton before Monday’s game

Walton (right) was part of the Boston Celtics team that won the NBA Championship in 1986

Walton (right) was part of the Boston Celtics team that won the NBA Championship in 1986

Walton (right) was part of the Boston Celtics team that won the NBA Championship in 1986

After his playing career, he moved into the commentary box and won a Sports Emmy in 1991

After his playing career, he moved into the commentary box and won a Sports Emmy in 1991

After his playing career, he moved into the commentary box and won a Sports Emmy in 1991

Larry Bird (center) was one of many who paid tribute to his former Celtics teammate (left)

Larry Bird (center) was one of many who paid tribute to his former Celtics teammate (left)

Larry Bird (center) was one of many who paid tribute to his former Celtics teammate (left)

During a lengthy broadcasting career, he also worked for CBS and NBC.

Tributes poured in for Walton following the news of his death on Monday, including from former Celtics teammate Bird. 

‘I am very sorry about my good friend, Bill Walton,’ Bird said. ‘I love him as a friend and teammate. It was a thrill for me to play with my childhood idol and together we earned an NBA Championship in 1986. He is one of the greatest ever to play the game.

‘I am sure that all of my teammates are as grateful as I am that we were able to know Bill, he was such a joy to know and he will be sorely missed. My family and I extend our sincere condolences to the Walton family.’

Former US President Barack Obama took to social media to pay his respects to Walton, branding him ‘one of the greatest basketball players of all time’.

‘Bill Walton was one of the greatest basketball players of all time – a champion at every level and the embodiment of unselfish team play,’ Obama wrote. 

Former US President Barack Obama took to social media to pay his respects to Walton

Former US President Barack Obama took to social media to pay his respects to Walton

Former US President Barack Obama took to social media to pay his respects to Walton

Walton and former teammates Kevin McHale (left) and Danny Ainge (right) being honored by the Celtics in 2016

Walton and former teammates Kevin McHale (left) and Danny Ainge (right) being honored by the Celtics in 2016

Walton and former teammates Kevin McHale (left) and Danny Ainge (right) being honored by the Celtics in 2016

The NBA Hall of Famer is survived by his wife Lori and sons Adam, Nate, Luke and Chris

The NBA Hall of Famer is survived by his wife Lori and sons Adam, Nate, Luke and Chris

The NBA Hall of Famer is survived by his wife Lori and sons Adam, Nate, Luke and Chris

‘He was also a wonderful spirit full of curiosity, humor and kindness. We are poorer for his passing, and Michelle and I send our deepest condolences to his family.’

Fellow NBA legend, Julius Erving, also shared a snap of himself with Walton.

‘I am sad today hearing that my comrade & one of the sports worlds most beloved champions & characters has passed,’ he wrote on X.  

‘Bill Walton enjoyed life in every way. To compete against him & to work with him was a blessing in my life. Sorry for your loss Walton family. We’ll miss him too. Doc.’ 

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