What is your research about?

“My initial research question was: can we use the brain to better understand psychiatric problems or psychiatric symptoms, and even define them differently? I studied the relationship between the development of the brain and psychiatric symptoms from childhood into adolescence. The symptoms I looked at in youth can be precursors to diagnoses later in life like depression, anxiety and ADHD.”

How did you go about that?

“I used the Generation R study from Rotterdam, and a similar study from the US called the Adolescent Brain Cognitive Development study. Both collected biomedical data from the general population over a long period of time. Generation R started in 2002 with about ten thousand children from before birth. Every four years people come in to have data collected, including brain images from MRI scans. Most children in this population are healthy, though already in childhood and adolescence around 7 to 10 per cent have symptoms of psychiatric disorders.”

What did you find?

“I found some associations between the brain and psychiatric symptoms, but these are very small and spread out. So, at least for now, it seems unlikely that we will be able to define psychiatric problems based on the brain in youth for large populations.

“Also, these brain differences that we found were present either in childhood or in adolescence. I didn’t find that psychiatric symptoms in childhood are associated with changes in the brain that develop into adolescence; or the other way around. It’s not clear why I didn’t see that. For instance, it might be that the brain catches up during the development into adolescence. Or that these associations disappear during adolescence but will eventually manifest when they’re adults.”

That sounds surprising. Was that unexpected?

“Yes, I set up my thesis with the expectation to find a lot of signals in the brain for psychiatric symptoms. In neurology this works very well. For instance, if you put a person with epilepsy through a brain scan, you are likely to find certain differences, often in specific parts of the brain. So, these are used for diagnosis. But when it comes to psychiatry, we see that the situation is so much more complex.”

What motivated you to work on this topic?

“I wanted to work on this topic because psychiatric problems affect so many people and it is important to learn more about them. While my findings were unexpected, and they don’t have a direct clinical use yet, I think they helped push our knowledge of psychiatric problems.”

What would these clinical implications have looked like, if you had found different results?

“For now psychiatry is still based on symptoms. There are no clear biological indicators that we can see in brain images that tell us whether someone has a disorder or what kind. Learning more about that, we could help with diagnosis. It could also inform us to find better treatment options, and it could help with prognosis or even prediction of when and who will develop a psychiatric problem.

“But all of that is not happening yet. Perhaps we could find it with advanced technology in the future.”

Is it helpful for patients, and for society at large, to think of a psychiatric disorder as something that is wrong in the brain?

“Yes and no. Historically practitioners mostly used a family and social context model to explain the disorders. Parents and individuals were implicitly blamed that they were sick, and it led to a lot of stigma. However, there are biological components to the illness, like genetics. Linking mental health problems to something biological like the brain, might help mitigate stigma. The other side of the coin is that patients might feel a lack of control. People might think: ‘this is just how I’m wired’. That thought makes them less likely to seek care. But the brain can change, and this room for change might encourage people to seek therapy.”

The cover of your dissertation depicts a castle and three little girls holding their brains like balloons. What is the story behind this?

“The castle symbolises the main landmark of Imola, the city in Italy where I’m from. Imola was Italy’s centre for psychiatric care for over a hundred years. In Italy they call it the ‘city of the crazy’. Back in the day, psychiatric patients were put in asylums. People in the city were afraid to go near the asylums and there was a lot of stigma around psychiatric problems. So I grew up talking a lot about mental health, but it was in a negative way. I wanted to understand it better and learn more about it.

“The little girls holding their brains like balloons symbolise the transition from childhood to adolescence. But they also represent me and my two sisters, and also me and my little nieces, to whom I dedicate the thesis. They are the new generation. I wish for them to grow up with a new understanding of mental illness with less stigma.”

What was the most difficult part of the PhD process?

“When I didn’t find the results I expected, it was difficult to see how to move forward. Also there was a bit of grieving and trying to be okay with things being different than what I hoped for.”

And were there any highlights?

“The event of the defence is basically like preparing a wedding. It was one of the most beautiful days of my life. I like how in the Netherlands there is so much ceremony and tradition involved. It is a really good way to close this journey.”

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