Last month, we considered animals at play. And this month, Katie Haylor is joined by a couple of guests to consider the importance of play in human animals - from little kids, right into adulthood...
In this episode
01:23 - Can brain training combat motion sickness?
Can brain training combat motion sickness?
Duncan Astle, Cambridge University; Helen Keyes, Anglia Ruskin University
The paper that cognitive neuroscientist Duncan Astle looked at this month wanted to figure out the relative contributions of REM sleep and non-REM sleep to learning...
Duncan - So they trained people on a visual learning task, and then they let participants have a 90 minute nap. And then when they woke up, they tested them on the task again, to see how much better they'd got from their initial training. Now, whilst they were asleep, they also scanned their brains with a special type of brain scanner called a magnetic resonance spectroscopy scan, or an MRS. And the really neat thing about this scan is it picks up different chemicals in the brain, including neurotransmitters - tiny chemicals that are vital for the communication of electrical signals in everyone's brains. And they looked at two different types of neurotransmitter. So glutamate, which is an excitatory transmitter, it upregulates, or increases, the activity of neurons in the brain. Versus GABA, which is an inhibitory transmitter. It down-regulates or suppresses the activity of different neurons in the brain.
Duncan - So everyone learns a task. Then they go for that nap in the brain scanner and their brains are scanned and, and the relative levels of these different neurotransmitters in the visual areas of their brain that have been responsible for learning the task are measured whilst they sleep. And then they wake up and they're tested on the task again, and they could then establish whether there are any relationships between how good people were at the task when they woke up and what had been happening in their brains as they slept. And what they found was that as people slept, those people who had more non-REM sleep had an excitatory shift in their visual areas. So they got an increase in the glutamate release relative to the GABA. And the bigger that shift, the bigger the improvement on the task that they observed, versus people who had more REM sleep. And they had more of an inhibitory shift in their brain patterns, which seemed to be less well associated with getting better on the task.
Duncan - So there was a twist. So what they then did was they took the same participants and they tried to train them to do a different task, which would interfere with the original task that they had learnt. And so they tried to train them on this different task, and then they test them on the original task to see how much interference they have experienced. And there, they found that the people who did best were those who had had some non-REM sleep, but had also had some of that inhibitory REM sleep. And what they propose is that when you're asleep in that non-REM phase, you get this big increase in excitatory neurotransmitter release that they think might have something to do with brain plasticity. But that what's also important for learning is the stabilisation of those new connections. And so having some REM sleep, the inhibitory shift, they think, has to do with having the stabilisation. And so it's those subjects who have had that bit of stabilisation that showed the best resistance to the interference from the new task.
Katie - I see. So for you to learn something or for your learning to be consolidated when you're asleep, you've got to make those connections. And then you've got to stabilise those connections, and both parts are really important.
Duncan - Yeah, exactly. So people who learnt really well and had loads of non-REM sleep, but had no REM, found that they were highly prone to the interference of the new task, right. So they were able to learn the original task, but as soon as something new comes along, it interferes with their original proficiency on the first task. The best people are those that get a little bit of both.
Katie - So there's quite a lot going on in this study. And I think you said actually earlier, this is just one of four experiments that they did. If you need both REM and non-REM sleep in order to learn something well, what situations would you not get both in a normal night?
Duncan - The timing of the cycles between REM and non-REM sleep are kind of different across different individuals. So for example, in non-REM sleep, there are different stages all the way down to the kind of deepest level of sleep, where the brain is least active. And then gradually the person will rise back up and they'll get to REM sleep, which is like the last step before the person wakes up. Different people cycle through those things at different rates. And so in a night, different people will get different amounts of different levels of sleep. For instance, if I were to wake you up every hour, it might be that you never get to your REM sleep cycle.
Katie - Say if there isn't something specific waking you up, like say, if you've got a young baby or something like that. Say if you have a sleep issue associated with mental ill health, I'm guessing that's going to be pretty important for, as in, a knock on effect for how you learn?
Duncan - Yeah. Actually sleep disturbances is identified in all sorts of different types of disorder, not just adult mental health issues. But for instance, lots of developmental disorders, so kids with ADHD, sleep disturbance is one of the most commonly reported symptoms of having ADHD. And one of the theories going is that one of the reasons why lots of individuals might find it harder to learn, isn't just because of the direct impact of their particular symptoms, like being anxious or being depressed. But it's that combined with having poorer quality sleep, that also contributes to its impact on learning.
Katie - I dunno if this is more of a semantics question, but does it depend on what you're learning? I know this was a visual task, is that right? What if you are doing some sort of, I don't know, just growing up in life, emotional learning or something like that?
Duncan - Yeah. I think that's different. So it may be that sleep's crucial for that in the same way, but we don't know that from these data, but there are other studies. For example, if I teach you new words, like if I taught you the new word cathedruc, to start with you find that people do remember it quite well, but it doesn't interfere with your other known words like cathedral. And so we know that it's not properly represented like a word, but after a good night's sleep, you find that people start to represent it like a real word. And so we know that it will interfere with a real word like cathedral. And so we know that it works for more complex tasks, not just kind of really basic visual learning tasks, even kind of complex vocabulary tasks where you're learning a new word with a new meaning, seem to have sleep dependent learning effects.
Katie - Is it a bit of a perennial issue with sleep science to try and really accurately replicate the sleep that people would have at night at home, normally, in a lab in a 90 minute nap?
Duncan - There are universities that have labs that are specially designed to try and recreate. But I think the reality is that you're never going to perfectly recreate someone's sleep. Because for instance, we are going to have to put some electrodes on their head, to know what sleep stage they're in.
Katie - What would you say the significance of this finding is? Because it certainly makes sense that in order to learn something, you need to have what I would call a good night's sleep, which I guess encompasses multiple sleep cycles and REM and non-REM. Is that novel?
Duncan - I think people have hitherto assumed that the reason that a good night's sleep is important is so that the next day, you're alert and bright-eyed, and that's true probably. But what these data show is that there's another reason, which is actually actually, whilst you're having a good night's sleep, the learning is continuing. As in your brain is continuing in a process of laying down durable representations and durable patterns of activity that will assist you the following day. The more we understand about the neurochemical relationships between what happens when we sleep and how we learn, the better, because there are so many people who have disturbed sleep for various different reasons, like having ADHD. And understanding more about what's going on in the brain when we get good sleep, might in the long run, actually help us intervene and support those people who could do with a better night's sleep.
Perceptual psychologist Helen Keyes mused over motion sickness this month...
Helen - One in three of us suffer quite significantly from motion sickness when we're travelling. And aside from medications, there are actually very few ways to alleviate this. But there is some research that shows that habituation or repeated exposure to travel sickness inducing situations can help to alleviate the problem. Now, as you can imagine, repeatedly exposing yourself to being travel sick is not a pleasant solution to the problem.
Katie - Urgh, no. Repeatedly exposing myself to motion sickness does not sound like my cup of tea! Helen explained that motion sickness arises out of a disconnect between what you're seeing and what your body is feeling.
Helen - Some research had previously noted an interesting link between visuo-spatial abilities and travel sickness. They noted that people who have greater visuo-spatial control abilities are less susceptible to travel sickness. Visuo-spatial abilities, essentially just how you are at moving through the world. So mentally rotating scenes in your head, how you are at hand-eye coordination, all of these things are tied in together. So just your spatial awareness and your control of that. And so that had been what previous research had shown us, but there's very little done on this. But it did lead the researchers to ask whether people could be trained to have better visuo-spatial skills. And if so, whether this in turn would lead to reduced travel sickness.
Helen - So they tested just that, they had 42 participants, which is very few, and that was further divided down so that 20 of those participants did their testing in a driving simulator. Driving simulators are really famous for their travel sickness effects. So they're a pretty good tool to use for this study. Then the other 22 participants were in a real car being driven around on the road. Now those other 22 participants, only 15 of them were in the real experimental condition. And the other seven were in a control condition.
Helen - So what did they do? Well before anybody began any of their testing, a measure of visuo-spatial skills were taken, and this was done using the classic mental rotation task. You may have come across this, you're shown an image of some blocks in a particular configuration, and you are asked to rotate that mentally in your head, and then you have to choose which one it would match up with if it were rotated. So it's a good measure of your visuo-spatial skills.
Katie - Oh dear. I find that sort of thing really hard. I have to turn the Ikea flat pack instruction guide to the way that the stuff is sitting in my living room.
Helen - And do you also suffer from travel sickness?
Katie - Yes!
Helen - Well, there you go. You've just demonstrated what these researchers were looking for! They wanted to have a kind of baseline measure of people's motion sickness. So initially, participants would either be in the driving simulator or be driven around in the car for 30 minutes, and then they would have a measure of their driving or motion sickness taken. Then for 14 days, once a day, participants would use a visuo-spatial training pack, pen and paper tasks, like looking at an unfolded cube and trying to manipulate that in their heads to think what it would look like as a folded cube, those types of tasks. And then after the 14 days, they would repeat the driving task. So they would either go back into the driving simulator, or they would again be driven around in a car. And again, their motion sickness measures would be taken. And they would also do the mental rotation task again to see if their abilities had improved.
Helen - So the first finding was that people who took part in the training did show a significant improvement in the mental rotation task. Following this training, motion sickness scores reduced hugely - by 51% in the simulator group and by 58% in the on-road group. Whereas for the controls, the people who didn't do any training at all, motion sickness scores didn't change. So the visuo-spatial training did seem to reduce levels of travel sickness quite significantly.
Helen - The authors are really keen to point out the benefits of this type of brain for travel in automated vehicles. So we are predicting that as driving becomes more and more automated, even drivers may eventually be able to engage in reading or watching screens or even producing work while they're driving. And in this way, they're saying, well, perhaps this training could reduce the ill effects of motion sickness. I would say though, that it is a very small sample size and to make these claims on, but there were huge effects. So that does give us some hope.
Helen - Essentially, what the authors think is happening is that the visuo-spatial training is leading to an enhanced ability to resolve visuo-spatial conflicts. And that's essentially what travel sickness is. It's a conflict between your visual information and the spatial and bodily information that you're feeling. So they think just practicing, manipulating those and controlling those visual spatial tasks is helping you to resolve those conflicts when you're in the car.
Katie - Does this particular study help establish that kind of crux, that mechanism, of what's actually changing in someone who has that problem compared to people who don't?
Helen - I think it does. Because we know from previous research that, you know, you can essentially get into a habit of, if you put yourself in the situation of being traveled sick a lot of times, it can help to reduce that effect. We're thinking it's tapping into the same thing, your body is getting practice at resolving those conflicts, those visup-spatial conflicts. And that seems to be just essentially getting you used to it, and you don't feel so ill with it.
Katie - And why is it that if I'm actually driving in a car, I'm in control of the vehicle, I don't get travel sick. But if I'm a passenger, every time I get travel sick! What's going on there?
Helen - I think that's a really interesting question, and it's a really universal effect. Drivers have less motion sickness than passengers. Obviously you're not in control of the motion. So if you're ever doing any virtual reality headsets or you're ever really immersed, like in the driving simulator, where movement is happening, even if your body and eyes are moving, movement is happening, but you're not in control of it, or you don't feel like it's part of what your body is doing, that's more of a conflict for you. It's less predictable for you. But secondly, when you're a passenger, you're also less likely to have your eyes directly on the horizon, on the moving outside of the car. You're more likely, again, to be focusing on other parts, perhaps looking at your phone, things like that. So there's two reasons, but the main reason is your body isn't in control of that motion that's happening to it.
Katie - Helen, as you said, this is quite a small number of people involved in this study. How convinced are you of the strength of this association?
Helen - Not that convinced Katie because the sample is so small, you know, it would be a really magnificent and strong effect if it was this simple to resolve motion sickness. This is wonderful. On the basis of this study, I am going to give it a try myself, I have to say, if I'm going to be doing something where I'm going to be a passenger on a long journey. But it is such a small sample size to make these claims on. The size of the effects, reducing motion sickness by 51 or 58%, that's huge. So that does suggest there's something there, that it's not just some sort of minor fluke, but really there's no other literature on this and people haven't done work on this. It's kind of a lone ranger, a bit of a Wild West here with this new exciting study, and I think it's going to need a lot more work before we can be confident that it's a real effect.
Katie - Duncan?
Duncan - I just wanted to ask about the control condition?
Helen - The control condition was not very well run. So there were only seven people in the control condition and they were only in the car driving condition. They didn't do a control for the driving simulator. And the control condition didn't involve any sort of real control. It involves the people doing nothing for the 14 days and then coming back and being tested again. Whereas obviously a better control would have involved them engaging in some sort of other pen and paper task everyday for 15 minutes. It could well be a placebo effect. We need to bear in mind that these motion sickness measures were self-reported motion sickness. It's very possible you would want to be pleasing the researcher and give lower scores there in the direction you thought the researcher wanted. This is not the most methodologically sound study I've ever come across, but the effects were just so large that this really lept out at me as something that was quite interesting and perhaps worthy of further investigation.
20:26 - Play in kids' social development
Play in kids' social development
Jenny Gibson, Cambridge University
To find out about the importance of play in young humans' development, Katie Haylor spoke to Cambridge University's Jenny Gibson from the PEDAL (Play in Development, Education and Learning) research centre...
Jenny - There are some quite interesting links between the emergence of early language and the emergence of pretend play, in particular. So some of those early skills around being able to represent one object as something else. So, I dunno, pretending that a stone as a toy car or something like that, is a kind of symbolic representation of the same kind that we need to use when we're thinking about language as well. So there's some quite strong links between pretend play and language development and early childhood. And then those seem to propagate over early childhood and into middle childhood, to become more sophisticated links. So we see things like elaborate pretending, conversational turn-taking, all manifest in playful contexts. So it's quite an interesting link.
Katie - I was thinking back on how I used to play as a kid. And I remember having quite an important distinction in my head between playing a made up game and then a real game, like badminton or football or something. Is that what you see in other kids?
Jenny - Yeah, I think so. And I think children seem to have quite a good awareness of what they're playing and how and what the parameters of that are. So I think with games like badminton, you've got a quite wide societal acceptance of the rules of the game and what you have to do to join in and play. But when it's more fantasy and make believe, it tends to be a bit more intimate and it happens between close friends. And those close friends negotiate the rules and the boundaries of that universe between them. And then they play within it.
Katie - When I was trying to figure out what play means to me as a concept, I realised that it's probably quite an individual thing and some people find, you know, one thing fun and it might not be fun to somebody else. So from a psychology point of view, is there a scientific definition of what play is?
Jenny - Well, it's a very controversial area and I think you're right. I think it's because it is so tied up with that individual perspective or that kind of small group perspective on what's enjoyable and what you choose to do freely. So I don't think there's a universally accepted definition. Lots of people talk about the importance of intrinsic motivation for play. So it's something that you're doing for its own sake, that it's not with a particular goal in mind, but it's something that's enjoyable and pleasurable and in the moment and something that you do voluntarily. And that can vary from person to person, of course, and across different groups as well.
Katie - How do researchers like you study play?
Jenny - There are lots of different approaches. So the research that we've been doing in my lab, which is the play in communication lab, we've been looking at play from different perspectives. So we've been looking at pretend in particular and doing video based observations of children, where we pair up children, pop them in a room together with some toys. And then the researcher sort of makes an excuse and leaves the room where we just film the unfolding interaction. And then we watch the video, annotate it for important behaviours relating to play and sort of manifestation of pretense, like getting into character, for example. So that's a sort of research-defined approach. And of course, because we've got that video record, we can verify that with independent researchers, for example, to make sure that two people are taking the same thing away from the same video independently. And it's not as subjective as just one person watching it and drawing their conclusions.
Jenny - The other thing that we've been doing is getting children's own perspectives on play. So that's been really good fun! We'll go into a classroom and ask children to sort of tell us about who makes up the good stories, who makes people laugh, who tells jokes, who's playful in your classroom? And try to understand whether the children conceive of playfulness as a personality trait that you might vary along. And then related to that, we've also been asking children for their own views and experiences of play too.
Katie - So there's a lot of communication involved in what you were describing. Does play necessarily have to be a kid playing with another kid, or can children play by themselves?
Jenny - The solitary aspect is important too, and that's kind of linked to behaviours around exploration and curiosity and sensation-seeking. A lot of early play for infants might be exploring an object, putting it in their mouth, seeing how it feels, what sort of noises does it make? And I guess similarly, you see solitary interests emerging in a more sort of formal way in adolescents and adults, when you might be playing solo video games or something like that, or getting into origami that really keeps you occupied and intrinsically motivated, but it doesn't necessarily have to have that social component.
Katie - What about if communication is difficult for you as a little kid? Because it seems quite fundamental to playing with other kids.
Jenny - This is one of my main interests in the research. So children who have got communication struggles can really have challenges with that social aspect of play, and sometimes they can be neglected by their peers or they might actively be rebuffed or even victimised and bullied in some cases. It can turn into quite a problematic time of the day, I'm thinking about school play time in particular now. So I think for children with communication challenges, we're just starting to understand their play needs and how we might make accommodations for different ways in which they might prefer to play, which are perhaps not quite as dependent on those advanced language and communication skills. And a really interesting project that we're just starting is looking at autistic play. Play-based therapies and interventions to support communication skills are common in early childhood interventions for autism or developmental language disorders, but they quite often take a very deficit-based approach. And we're interested in thinking about it in a more positive way. And looking at ways in which autistic people or people with developmental language difficulties might choose to play differently, and how we could use that to scaffold their strengths rather than trying to always address deficits.
Katie - How much has this got to do with the environment in which kids are playing? I guess at home that could be, I don't know, bedroom, garden, maybe at school it's the playground or the classroom. Does where you're playing and what you're playing with, make a big impact?
Jenny - Yeah, it does. I mean, I think one of the biggest things that makes an impact is not being surveilled all the time. So I think having freedom and independence and autonomy are really, really important for play. So it's not saying that we need to abdicate entirely from the idea of safety, but having this idea that taking some risks and being able to be secret is okay for children and we need to make spaces for that to happen.
Katie - Do you think kids are playing enough? Because it's such a challenging time for so many people at the moment.
Jenny - It's particularly concerning that children have had this period where they haven't been able to get outside and play. I think a lot of the - sometimes called - adventurous elements of play happen outside when children have got space to do so. And, so I think there's real deprivation there, as a result of the lockdown. And I think particularly for children who are maybe in poorer families where they don't have access to outside space in the garden, for example, or there might be a lot of overcrowding in the home, there are serious challenges around getting those kinds of play opportunities.
Jenny - But on the other hand, I think the play instinct is really strong and children play and they find creative ways to play sort of no matter where they are, you know. Even in quite extreme adverse circumstances, you can still see evidence of play coming through. It's not an ideal situation, but I'm sure that children are creatively compensating for this.
Katie - What do you think is really not very well understood about play, with regards to kids, that needs further work? Where do you think the priorities are?
Jenny - It depends on who you're talking to! So in general, I think people see play as somewhat trivial, just for kids, it's not that important, nothing to do with education and development. And I think we need to challenge that view and understand more about the role that play has in promoting communication and those collaborative and social skills. I think there's another extreme view that just says play is this kind of panacea for everything. And it's so wonderful. We should all be doing it all the time throughout the whole school day. And I don't think we've got the research evidence to back that up yet. So I think somewhere between the two, there's a space where play research needs to happen, acknowledging that it's an important right for all children. And it's part of a healthy and happy childhood, but also sort of taking a more rigorous approach to understanding how play is a developmental mechanism and what its role might be in educational settings.
30:27 - Do adults really need to play?
Do adults really need to play?
Stuart Brown, National Institute for Play
Do adults really need to play? Or is it just a kids' game? Stuart Brown is a psychiatrist, play researcher and founder of the National Insitute for Play in California. And he spoke to Katie Haylor about the importance of lifelong play for health and wellbeing...
Stuart - Though we are capable of imagination and imaginary play as adults, the drive to play and the percentage of time one, in adulthood, plays is less than obviously than when we were children. But the wiring of the brain to respond to play signaling occurs throughout life. It's different in various ages and cultures and genders and so on, but it's there. So that the ability to respond to playful stimuli is a part of being human through our life cycle.
Katie - So what constitutes play as an adult? Is it having a giggle, relaxing, doing a hobby?
Stuart - I like to think of the best way to define play for adults and really for children too, is as a state of being in which what you are doing and what you are experiencing is voluntary. It's fun. It gives you a sense of freedom from anxiety about the time pressure or the outcome. It's something you want to engage in again, it can be highly varied. The individual response to playful stimuli can be gardening, reading a novel, climbing a mountain, going to a pub and having fun with your buddies. You know, there are all kinds of phenomena that constitute true and or real play, but it is essentially a state of being that is different from all others. And that's not a common way of thinking of play. We think of it as a little nonsensical, it's purposeless or appears purposeless. It's not as important as real responsibility. And yet, when I look at the phenomenon of severe play deprivation, it has a profile amongst adults and children that indicates it's a necessity for being fully human.
Katie - What do you mean by that? What kind of work have you done?
Stuart - If you start with objective animal play. The rats, for example, that are bred to play, engage in very intense, rough and tumble play when they are four to 15 weeks old. And if you allow that and then evaluate the brain changes as the rats play, you find that they have much enrichment of their entire cerebral cortex, but particularly their executive function. And there is some sense that, though you can't do that ethically for humans, that human play also produces a whole array of benefits - faster learning, more resiliency, a sense of belonging to your social group, etc, that is required kind of learning for our human species. And when that is missed intensively in humans, there is a problem in empathy and in belonging to your social group. So that the experience of childhood and play throughout the lifetime is from my standpoint, very significant.
Stuart - That makes sense to me from a developmental childhood point of view, but the resilience and stuff you were talking about then, does that apply to say, if somebody doesn't play enough as an adult?
Stuart - If you take a life history of many, many people, as I have done over the years, and you look at how they view themselves and the world, if they are severely play deprived over a period of time, they lack optimism. There is a kind of a smoldering depression that is a part of the play deprivation profile. There is a rigid kind of ideology that often is a part of the world view and their values. So to me, the way of thinking about this - it's a little different cause most people don't think of play this way - is to think about something as pervasive in the human and animal phenomenon is sleeping and dreaming. And we all know that if you miss sleep and you miss dreams, there are objective phenomena. If you miss play, which is a universal human capability, over time in a very major way, there are mood and other changes that tend to occur. It's not as measurable or as simple as sleep deprivation, but there is an analogy that I think is worthwhile.
Katie - And when explaining to me what's going on in the brain at play, Stuart mentioned the work of play pioneer Jaak Panksepp, who animal behaviour expert Sarah Heath mentioned last episode when talking about cats and dogs. Stuart mentioned Jaak alongside Sergio Pellis. And Stuart explained that when studying objective animal play, these researchers removed the cerebral cortex from playful infant rats. As they grew and developed, they played just as intensively as those rats with a cerebral cortex, Stuart told me. This, he said, suggests that the neurocircuitry of play is hardwired into the survival centers of the brain.
Stuart - One of the graduate students, now a professor at Northwestern, Jeff Burgdorf, has arranged for, in experiments, for rat rough and tumble play to occur while the cerebral cortex, which is intact in his studied rats, is primed to fluoresce when genes in the cerebral cortex are activated. Jeff has found that when the rat rough and tumble play occurs, it activates 1200 prefrontal cortical genes in the rat cortex, so that there is a selective interaction between the priming centers for play and the learning portion of the cortex, which is waiting to get stimuli from the environment. So I hope that's clear. It's kind of complicated, but some very good research.
Katie - Does that suggest something pretty significant about how we've evolved to play?
Stuart - Absolutely. If you look at the long developmental evolutionary history of play itself and look at, you know, reptiles who don't play as frequently, or as vigorously as mammalian and bird species, you find a mosaic of play that is highly varied. Just like there's a mosaic of sleep that's highly varied. But you still see play occurring in the more complicated, more intelligent species. And it occurs and can be defined as a separate form of behaviour from all others.
Katie - I appreciate we live in a complex world, made up of complex societies, but do you think there's enough play around?
Stuart - It depends on the circumstances. You know, I think right now with the COVID-19 shelter at home, I think it's tough. No youth sports, no adult gatherings that are festive, you know. I think it's tough to play enough. And I think that we're gonna see some consequences from that.
Katie - Do you have any suggestions as to how people can build play into their lives? Because as you were talking, I was just wondering if it would be appropriate to kind of build play somehow into the work environment?
Stuart - No, I think it's very possible to build play into the work environment. I think it's very possible for an individual to recognise that they need it, and for them to find something in their day, that gives them a sense of freedom and a sense of fun and a sense of not relying on outcome. So that people realise that just like hand washing and good nutrition are important, so too is finding for yourself moments, even when you're stressed, that are playful. Whether it's music or dance or, you know, imaginary fantasies, it is an important element of personal health.
Katie - It seems to me that as with a lot of components of health, some people might be more privileged than others in terms of who has the time, capacity, to access this kind of headspace. Do we know very much about how things, like personal finances, do they interact with the idea of play?
Stuart - Oh, of course. I think poverty, stress, disease, economic intense worries. Those, you know, when you're not safe and you're not well fed, it's very difficult to play. But even in circumstances that are very adverse, I think it is possible to have these moments where there is some personal sense of private freedom from all of the heaviness of the day, where we recognise that experiencing that kind of safe space, even if it is temporary, is an important element of personal health.
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