Last year, you and the Alfred Herrhausen Gesellschaft founded the Interdisciplinary Forum on Neuro-Urbanism. What does Neuro-Urbanism mean?

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1 The Alfred Herrhausen Gesellschaft spoke to Dr Mazda Adli, a lecturer and Head of the Fliedner Klinik Berlin who is also the Director of the Mood Disorders Research Group, Department of Psychiatry and Psychotherapy, at the Charité Berlin. Last year, you and the Alfred Herrhausen Gesellschaft founded the Interdisciplinary Forum on Neuro-Urbanism. What does Neuro-Urbanism mean? Neuro-Urbanism is a new term to describe something that didn t used to exist: a collaborative effort by urban researchers, architects and neuroscientists. In a nutshell, Neuro-Urbanism is the scientific study of the interplay between the social environment we have constructed and our psychological state of mind, emotions, behaviours and thoughts. Which scientific fields of study are involved in this forum? The forum brings together architects, urban planners and neuroscientists including psychiatrists and psychologists as well as a futurologist, a sociologist, a smell researcher, a philosopher and a public health expert. You could say that Neuro-Urbanism unites researchers in various urban fields of study with neuroscientists. Why is this topic high on the research agenda today? Not much groundwork has been done on the topic, but there have been some important findings in recent times. First of all, more and more people are living in cities. Second, certain mental disorders occur more frequently in cities, and city dwellers brains react differently to stress than country dwellers brains. There s a connection between the increasing number of certain stress-related disorders, changes in brain function and growing cities. Together with the Alfred Herrhausen Gesellschaft, our group of researchers is trying to get to the bottom of this phenomenon. You are also a psychiatrist and a stress researcher. For years, you have been studying stress-related disorders in cities. What influenced you to explore this particular area? I was influenced by stress research findings indicating that urban life has a great impact on how we react to stress. In this context, I started looking at the impact that urban life has on our psychological well-being and health. How did this interest ultimately develop into the Interdisciplinary Forum on Neuro-Urbanism? The Alfred Herrhausen Gesellschaft s Urban Age project was, for me personally, a pivotal anchor point and source of inspiration. The Urban Age Conference in Hong Kong in 2011 examined health in megacities. It was there that I gave a presentation on the topic for the first time and noticed what a reaction it triggered and how little research had been done on the subject. Together with the Alfred Herrhausen Gesellschaft, we then went on to launch a series of events called Stress and the City and introduced the public in Berlin to the topic. There, too, we noticed that the relationship between cities and stress attracted a massive amount of attention. Many

2 people have questions about this issue or their own ideas. So, in 2015, we founded the Neuro- Urbanism research group. What is urban stress exactly? Could you illustrate it for us? Urban stress is hidden stress. It s not a type of stress that is immediately apparent, but rather a type of stress that creeps up on us without us noticing. It s a chronic type of stress that appears where social density and social isolation occur at the same time. There are people who are completely exposed to urban stress. They have no means of escaping the noise or confinement. They have no access to what we call urban advantage. These can be the elderly, the ill or the poor, or even people with a migrant background. Picture it as living in a neighbourhood where you can hear your neighbours noise through the thin walls of your home. Social stress develops if you don t have any real contact to these neighbours. There s also social stress in our well-ordered everyday lives, too, of course like when you re tightly packed into the underground on your way to work and five people are standing around you, coughing. But this stress doesn t make you ill as long as you know that the situation is temporary, and you will be home soon enough and can shut the door behind you, if that s what you want to do. It does make you ill if you feel completely exposed to social stress. That sounds, above all, like a social problem. We re dealing with the issue of places where people can go to enjoy some peace and quiet, as well as with a lack of opportunities for interaction. Designing public places to encourage people to come in contact with each other isn t all that difficult or expensive. There are lots of examples of this. Think of the bookshelf event on the Bebelplatz or karaoke in the Mauerpark here in Berlin. They attract a huge crowd. Or think of Bryant Park in New York, where they ve set out chairs that aren t bolted down. Anyone can pick one up and put it where they want. You can push them together to form groups or look for a secluded spot in the shade. The space has been very popular since they added these chairs. In everyday life, the way people perceive stress often appears to be a very subjective matter. Is it even possible to generalise it? Stress research is about objectifying stress. That is indeed possible. You can measure stress levels and reactions through stress hormones such as cortisol, or by looking at other vegetative symptoms such as skin conductance or pulse rate. The role a stress factor plays is, indeed, highly subjective. In some people, a tiny change in everyday routines or the environment lead to a pronounced stress reaction, which triggers a massive release of cortisol that lasts for a long time and takes a while to subside. In others, stress barely triggers a change in cortisol levels. This is another thing we want to find out: How can it be that a stressor triggers different reactions? Urban life appears to play a role in this. It essentially modulates the way in which we react to stress. Does this mean we should avoid urban life? No, not at all. This doesn t mean that urban life is fundamentally harmful. Rather, it changes the way we react to stress. On the contrary, you could even say that urban life does most of us good. Cities give people better opportunities to grow and develop their personalities. They also offer better educational opportunities, and education is closely linked to health, as has been demonstrated time

3 and again. You ll also find greater prosperity in cities, which is another factor that has a positive impact on health. Cities also offer better access to healthcare. Usually, the nearest doctor, hospital or psychotherapist isn t far away. But just 50 kilometres outside of Berlin, for example, it can be virtually impossible to find a psychotherapist. If access to healthcare isn t as optimal in the country as it is in the city, then isn t it possible that stress symptoms simply receive less attention or aren t as easily identified in the country? That s one possible assumption. But the epidemiological studies on the subject point to a different conclusion. Good population-based studies attempt to place a check on such sources of errors, such as by sending researchers from door to door to interview and examine residents so as to avoid leaving anything to chance. Of course, you might also assume that mentally unstable people prefer to move to cities because they attract less attention here. Still, given everything we know today, that too does not appear to explain the tremendous differences we see between city and country. Instead, there appears to be a genuine causal link between urban life and stress-related disorders. Another potential overall connection is the relationship between urban planning and city dwellers a complex, interdisciplinary field. What is the Forum on Neuro-Urbanism s approach in this respect? First, we took a look to see whether we had common research interests. Then we defined the questions we wanted to answer together by joining forces as architects, urban planners and neuroscientists, and drafted a work programme. Based on that, we formulated the goal of wanting to better understand and decipher the interaction between the social environment we have constructed and our psychological state of mind and emotions. We are now transforming this into a first specific research project that we are currently developing together to examine where stress arises in cities and how it impacts individuals state of mind. Could you be more specific? We are developing an app that registers where people are in the city and their psychological state of mind. Test subjects rate how they feel where, in a manner of speaking, resulting in an emotional map of the city. We want to find out where and when people s tension levels rise or fall. Of course, it s clear that this depends on several factors, not just the environment. It may have something to do with whether you got up on the right side of the bed or what else is on your mind. It s essential to differentiate between these factors when crunching the numbers. How many test subjects will you need? A lot! The app we are currently developing needs to be so easy and inviting to use that as many test subjects as possible sign up. We hope to get about 1,000 test subjects in Berlin. Then we are going to focus on specific places where we want to measure stress. When test subjects arrive at such a spot, they receive a signal and rate how they are feeling. This will let us measure them in certain regions of interest. What is the timeline for this first study?

4 We hope to be able to start measuring data in early To what extent do you hope to gain insights in Berlin that can be transposed to other cities that may be very different? Berlin isn t Mumbai, and it isn t Sao Paolo. The major megacities in the global south are a whole other story. They re probably far richer in terms of stressors. Nevertheless, the studies examining stress-related disorders currently tend to be performed in major cities in the global north, such as London, Copenhagen and Amsterdam. Even in these relatively moderate cities of the global north, researchers have found a clear cluster of stress-related disorders compared to rural areas. It s safe to assume that the differences will be even greater in the south. But we can even transpose our findings in a city like Berlin to larger cities or cities with a challenging social fabric. At the very least, it allows us to draw conclusions. Berlin is the largest city in Germany, and that s reason enough for us to perform the study here and to try to understand how we can transpose the findings. Right now, the integration of refugees is a major issue in urban life. Do current problems play a role in Neuro-Urbanism? Refugees and their state of mind is an urban issue, as is the state of mind of the populace that has to take in refugees and integrate them into society. The movement of refugees usually ends in cities, resulting in a particular challenge that extends to urban healthcare systems. In a separate research project, some of us are investigating how to organise the provision of psychotherapeutic care to traumatised refugees despite linguistic and cultural barriers.it is up to cities to act here. This is one kind of urban issue that is relevant to Neuro-Urbanism. Do you see this as having a long-term or short-term impact on the way people perceive stress in cities? These are developments that we need to keep a close eye on from a socio-medical perspective. It s going to be particularly important to prevent the segregation of refugee groups. Social fragmentation and the formation of parallel societies, up to and including the formation of ghettos, are problematic for society and for the mental health of the urban population. The integration of refugees is also a healthcare issue. We already know a lot about the social determinants of mental health, including poverty, growing up in uncertain conditions and poor hygienic standards. Growing up in conditions that appear hopeless and a lack of prospects are also factors that have a significant negative impact on health and life expectancy. This is the responsibility of urban policy and is an excellent example of an area where we will be able to leverage the shared findings of Neuro-Urbanism in the future. What are your medium-term hopes for the findings of the Neuro-Urbanism Forum? My hope is that we will have systematic research on the wide range of topics behind Neuro- Urbanism and a common research programme, and that the research we are currently doing on a very small scale will be pursued on a larger scale. Right now, our work is mainly being fuelled by the idealism of a few protagonists. Going forward, I also hope to add the political spectrum to our circle.

5 Over time, our research will grow into a political call for action. Our findings are tremendously relevant for the development of public spaces. Will the field of medicine, along with the political sphere and urban planning, also be able to benefit from the forum s insights? Absolutely; continuing to investigate the interplay between the environment and the individual is very important for medicine. Major common medical disorders in particular, such as high blood pressure, are the result of the body s inadequate ability to adapt to the current environment. From an evolutionary perspective, humans are still better adapted to the stone age than to the city. What impact does that have on us city dwellers today? There have been 120,000 generations of hunters and gatherers on this planet. By contrast, modern man has only been around since the birth of agriculture some 500 generations ago. The way our body reacts to stress stems from the time when we were still hunters and gatherers. The time that we have spent in modern civilisation has not yet had a chance to sufficiently influence our biology. Our world of electric power, big cities, mobility and digital work is an incredibly brief phase in our evolution. Ultimately, this is also a cause of diseases of civilisation. Interviewer: Dr. Barbara Olfe-Kräutlein