Transient Hypofrontality


When one enters a flow state, they experience a condition in which the focused thinking part of the brain turns static for a portion of time. This reduces the dominance of the focused part, allowing the other parts to function greater with more efficiency. Dr. Arne Dietrich, a professor at the American University of Beirut, came up with the term transient hypofrontality, which means that activities like meditation and exercise indulge the brain in a redistribution process known as downregulation. She states that the number of receptors for a neurotransmitter is decreased, typically in response to an increase in neurotransmitter release. She further states that this indulgence in the flow state makes one’s brain focus in the direction of making complex decisions, which brings the prefrontal cortex into a static state, thereafter bringing an alteration in the consciousness.

The Science of Flow

Flow is a mental state which makes one engrossed in a particular activity by diverting their attention towards it. It helps to discover one’s peak abilities in challenging circumstances that engage their fullest capacities. This push to perform at the limits of our ability makes one feel alive and engaged, bringing about enjoyment, pleasure, and happiness. It brings about a pattern of neurochemical changes heightening our senses and increasing our cognitive and motor skills. This initiates one to fight against pressures and thus reach conclusions of those problems. It not only creates pathways for cooling down the mental states but also engages in learning activities. Therefore, it plays an important role in attention focusing, energizing, learning superpowers, creativity, and enjoyment.


The Dorsolateral Prefrontal Cortex is the part of the brain which permits one to self-regulate and is responsible for one’s executive functioning. It helps one to think rationally and plan logically, acting as the parental advisor of the brain. It plays a very important role in decision making and avoiding any wrong long-term mistakes while questioning oneself about their behaviour. However, its con is that it hinders the process of quick reactions and instead focuses on overanalyzing, causes self-criticism, and can lead one to overthink and worry. This overthinking leads to a loss of the pure sense of flow. Here the transient hypofrontality can come into play, inducing the flow state of the brain. It focuses on deactivating the front of one’s brain, so the level of higher functioning in the brain decreases, allowing the brain to flow.

The Dorsolateral Prefrontal Cortex needs to be shut off during this process, diverting the brain to bring other parts into play which one should use without censorship or micromanagement. The result will be quick reactions and uninterrupted productivity. The decrease in the dominance of the Prefrontal Cortex increases the dominance of the other parts, igniting the expanded levels of human potential. One example is losing control in keeping track of time, leading to the past, present, and future melding into one. The brain waves will change, converting from regular beta waves to alpha-theta waves. In this process, the gamma waves occur, binding ideas from all areas of the brain, connecting memories and experiences, and bringing new stimuli into creative action, thus a flow in the making to control the person’s emotional status. The transient hypofrontality has its main focus towards engaging in activities like meditation and exercise. During this process, there is extensive neural activation that runs motor patterns, assimilates the sensory inputs, and coordinates autonomic regulation, resulting in a concomitant transient decrease of neural activity in brain structures, specifically the prefrontal cortex, which are not pertinent to performing the activity. An exercise-induced state of frontal hypofunction can provide a crystal clear account of the influence of the activity on one’s emotion and cognition.


A theoretical basis of transient hypofrontality is yet to be established through constant reviews, supportive evidence, and relevant data. Although different behavioral methods are used to achieve different states, it is observed that all altered states share a common neural mechanism of a transient decrease in prefrontal cortex activity. Furthermore, it is hypothesized that different induction methods target specific prefrontal circuits, removing their computation from the conscious experience. This results in the uniqueness of the altered states. In the mere future, the hypothesis may stimulate research and will encourage researchers from different backgrounds to address testable hypotheses derived from it.

Pratiksha Baliga, Youth Medical Journal 2022


1]F.Hays, K. (2017). The Transient Hypofrontality Edge. Psychology Today.

2]Dietrich, A. (2006, November 1). Transient hypofrontality as a mechanism for the psychological effects of exercise. Psychiatry Research.


The Brains Behind Social Conformity and Change

By Nara Ito

Published 6:05 EST, Mon December 20th, 2021

Conformity: A change in a person’s behaviour or opinions as a result of real or imagined pressure from a person or group of people’ (Elliot Aronson 2011).

We all want to believe that we are in full control of our thoughts, make righteous judgments, and spot when others are trying to manipulate us.  However, psychology and neuroscience has shown that we are all influenced by social factors, and are influenced by peer pressure to adhere to others’ beliefs and behaviours. This article highlights how we as individuals shift our beliefs, mannerisms, and behaviour according to our environment, attachments and the situations we are in.

Conformity, according to an increasing number of neuroscientific studies, attracts brain signals that are comparable to those engaged in reinforcement learning. (Kim et al., 2012)

Reinforcement learning, or operant conditioning, is a core behavioural approach of psychology  that elucidates how we are able to learn behaviours.  Proposed by B.F. Skinner, operant conditioning is based on the idea that a behaviour can be learned of unlearned through constant reinforcement,  either positive or negative..

3  main types of conformity are:

Internalisation: when a person genuinely accepts the group norms, resulting in  private and public change of opinions, becoming part of the way the person thinks and acts.

Identification: conforming to the opinions of a group because there is something about that group we value thus publicly change our opinions to achieve approval.

Compliance :simply ‘going along with others’ in public, but privately not changing personal opinions.

Morton Deutsch and Harold Gerard (1955) developed a two-process theory, in order to explain the basis and reasons for conformity

Informational social influence (ISI) – The concept that one conforms with the opinion of the majority because we believe it is correct.  This may often lead to internalisation

Normative social influence (NSI) – When we agree with the opinion of the majority because we want to be accepted, gain social approval and be liked, possibly leading to compliance

So can social conformity and perception change brain physiology?

Potentially. In a study run by Campbell-Meiklejohn, Frith, and colleagues, found that the lateral orbitofrontal cortex is particularly sensitive to signs of social conflict or disagreement, which may influence changes of opinion.

Adorno et al. (1950) wanted to understand the anti-Semitism of the Holocaust, which their research they came to believe that a high level of obedience was basically a psychological disorder, and tried to locate the causes of it in the personality of the individual, in a study of more than 2000 middle-class, white Americans and their unconscious attitudes towards other racial groups. They developed the fascism scale (F-scale) which is still used to measure authoritarian personality. 

 Findings: Probably the most interesting discovery from this study was that there was a strong positive correlation between authoritarianism and prejudice. Authoritarian characteristics included a tendency to be especially obedient and conferment to authority. They have an extreme respect for authority and submissiveness to it.

For obvious reasons, there are no brain scans or images of the participants’ brains however, in a more recent study by Warner, Tranel and Asp, they concluded that clearly tendencies toward authoritarian attitudes and prejudicial beliefs are the result of environmental and genetic factors, but sufficient damage to the ventromedial prefrontal cortex can contribute to creating authoritarian individuals. Throughout both cognitive and psychometric tests, patients with lesions to this region exhibit consistent conformity and obedience to authoritarian commands as well as, patients with vmPFC damage. 

More modern neuroimaging studies complement these neuropsychological findings and provide evidence that the vmPFC and amygdala are critical structures involved in inhibiting and facilitating authoritarian attitudes.

In conclusion, this argument that we have free will, and control over who ‘we’ are is an extensive debate, but what is currently understood, is that humans conform, and have the potential to change aspects of themselves depending on the situation, whether it be consciously or unconsciously.

Nara Ito, Youth Medical Journal 2021


Warner, K., Tranel, D., & Asp, E. (2016). The henchman’s brain: Neuropsychological implications of authoritarianism and prejudice. In J. R. Absher & J. Cloutier (Eds.), Neuroimaging personality, social cognition, and character (pp. 325–335). Elsevier Academic Press.

Deutsch, M., & Gerard, H. B. (1955). A study of normative and informational social influences upon individual judgment. The journal of abnormal and social psychology, 51(3), 629.

Aronson, E. (2011). The evolution of cognitive dissonance theory: a personal appraisal. In The Science of Social Influence (pp. 115-135). Psychology Press.

Kim, D., & Hommel, B. (2015). An event-based account of conformity. Psychological Science, 26(4), 484-489.

Campbell-Meiklejohn, D. K., Bach, D. R., Roepstorff, A., Dolan, R. J., & Frith, C. D. (2010). How the opinion of others affects our valuation of objects. Current Biology, 20(13), 1165-1170.

Campbell-Meiklejohn, D. K., Kanai, R., Bahrami, B., Bach, D. R., Dolan, R. J., Roepstorff, A., & Frith, C. D. (2012). Structure of orbitofrontal cortex predicts social influence. Current Biology, 22(4), R123-R124.

Snyder, M., & Ickes, W. (1985). Personality and social behavior. Handbook of social psychology, 2(3), 883-947.

Adorno, T., Frenkel-Brenswik, E., Levinson, D. J., & Sanford, R. N. (2019). The authoritarian personality. Verso Books.

Hollander, E. P. (1958). Conformity, status, and idiosyncrasy credit. Psychological review, 65(2), 117.


Schizophrenia and highly educated guesses: Exploring common practices in treating this psychotic disorder

By Will Onubogu

Published 11:55 EST, Sat December 4th, 2021

The danger of the unknown. The medical world’s ability to not account for the unknown. These concepts are what Michael Focault’s “Madness and Civilization” emphasized; ideas lost in history. It is this very concept that allows us to formulate schizophrenia as a diverse disease under one helm. Schizophrenia is a psychotic disorder classified by positive symptoms: hallucinations and delusions, and an array of negative symptoms such as loss of will and loss of feelings, among many others (Shultz et al., 2007). Schizophrenia occurs most commonly among men in their early 20s and women in their late 20s (Patel et al., 2014). Data on 16,423 Americans from the U.S. National Library of Medicine National Institutes of Health indicate higher rates of diagnosis among Latino Americans (13%) and African Americans (15%) compared to Euro-Americans (9%) and Asians (9%; Schwartz & Blankenship, 2014). From the idea of dementia praecox to modern schizophrenia, we have yet to grasp the disease truly. Thus, in schizophrenia, one must wonder, how should schizophrenia be treated globally? This paper aims to review the history of schizophrenia and the development of past and current treatments, both in the United States and worldwide.

History of Schizophrenia
Benedict Augustine Morel (1809–1873) used the term dementia praecox as an early label of schizophrenia (Lavretsky, 2008). Morel thought of schizophrenia as an early form of dementia. It does make sense as there are intersecting traits such as worsened cognitive functions, which may contribute to his belief that schizophrenia was a form of dementia (Lavretsky, 2008). However, Emil Kraepelin’s description of catatonia, hebephrenia, along with his dementia paranoia, created the foundation for further interest in what schizophrenia was (Lavretsky, 2008). Beur then revolutionized schizophrenia by bringing the disease under one helm. Kraepelin had several different forms of what he called dementia praecox (Lavretsky, 2008). He believed there were fundamental symptoms all people with schizophrenia had accessory symptoms that changed person to person (Lavretsky, 2008). Psychic schisis or split, ambivalence, cognitive features of “loose associations,” avolition, inattention, autism, and incongruent features signified primary deficits for Bleuler (Lavretsky, 2008). In comparison, delusions and hallucinations were treated as accessory features of schizophrenia (Lavretsky, 2008). With the pioneers of schizophrenia allowing the development of ideas into more concrete symptoms and clear definitions, along with this came treatment.

History of Treatment for Schizophrenia
Early treatment was prolonged barbiturate-induced sleep therapy, insulin coma, or psychosurgery. Sleep therapy would induce unnaturally long sleep, sometimes leading to comas and death (Lopez-Munoz et al., 2005). Insulin comas were induced by giving the patients large amounts of insulin, putting the patient into a coma, which often did not help and sometimes led to death (Wright-Mendoza, 2018). With psychosurgery, the idea was to alter the brain, an idea created by António Egas Moniz (Toler, 2021). The most popular form of psychosurgery is a lobotomy, which tries to change the brain’s frontal lobe, which controls personality and behavior. However, some worrying result was brain damage and death (Toler, 2021). Terrier et al. cite that schizophrenia is found in 84% of the 771 lobotomized patients. The postoperative mortality was 7.4% (57 deaths)” (Ögren & Sandlund, 2007) and another saying, “When complications were reported, seizures represented the most common sequelae (1%–23%), followed by chronic headache (15%)…The death rate could have reached 5%.” (Terrier et al., 2019). Furthermore, for those with multiple lobotomies, seizures were more frequent, saying that 25.6% of patients had convulsions in prefrontal lobotomy. In comparison, convulsive seizures stood at 7 % for a simple operation and 47% for several operations (Freeman, 1953).
The first half of the 20th century saw the hospitalization (or jailing) of people with schizophrenia (Lavretsky, 2008). Because the disease was seen as untreatable, patients were essentially checked into the hospital for long periods of time, where they were abused and treated terribly (Lavretsky, 2000). Patients acting in ways deemed socially unacceptable were given what was known as a “chemical cosh” (Lavretsky, 2008). Cosh is derived from British slang, which means to bludgeon. Patients were heavily sedated to calm them, but it served no benefit in reducing symptoms (Lavretsky, 2008). The only effect was a temporary peace (Lavretsky, 2008. Another issue with treating people with schizophrenia in the asylums was that the treatment did not include any preparation for patients to enter the real world (Lavretsky, 2008). Patients’ symptoms would improve but in a context isolated from daily life (Lavretsky, 2008). There was not much improvement. In the 1930s, the Third Reich of Nazi Germany wished to eliminate schizophrenia (Lavretsky, 2008). It was done by euthanasia, which consisted of firstly lethal injection and later gas chambers (Lavretsky, 2008).
The middle of the 20th century brought typical antipsychotics through trying to create antihistamine drugs (Tandon, 2011). Typical antipsychotics are also known as neuroleptics (Tandon, 2011). The neuroleptics cause neurolepsis, a syndrome with the intended effect of psychomotor slowing, emotional quieting, and affective indifference (Tandon, 2011). Paul Charpentier, who experimented with phenothiazine derivatives, hoped to find properties in the compounds that helped with allergies (Ramachandraiah et al., 2009). Then in 1949, Henri-Marie Laborit, a French army surgeon, used promethazine, a phenothiazine derivative, on patients and saw that patients were much calmer and more cooperative (Ramachandraiah et al., 2009). Later on, a chlorinated derivative of phenothiazine was discovered by Laborit called chlorpromazine (Ramachandraiah et al., 2009). He claimed that this substance would be great therapy for patients with mental illnesses (Ramachandraiah et al., 2009). However, his colleagues met him with skepticism, and chlorpromazine was never introduced (Ramachandraiah et al., 2009). Jean Delay and Deniker’s study on 38 patients proved chlorpromazine an effective treatment, after which typical antipsychotics were introduced to the market (Ramachandraiah et al., 2009). Fast forward, and now atypical antipsychotics are dominating the medical world. Starting from the 1980s, they began a further diversification of treatment for people with schizophrenia (Abou-Setta et al., 2012). Second-generation antipsychotics include one of the most effective treatments for schizophrenia which is clozapine (Lieberman, 1996; Nuera, 2020). Clozapine, while being very effective, has a dangerous risk of Agranulocytosis. This disease means the body does not make enough of neutrophils, a type of white blood cell (Clevelandclinic, 2020). These days, even more, great atypical drugs such as risperidone, olanzapine, sertindole, quetiapine, and ziprasidone have shown up-and-coming prospects (Nuera, 2020). The advances made from the late 1800s to the 21st century have been incredible, but one must understand the neurobiology behind schizophrenia when trying to decipher the most globally effective treatment.

Neurobiology of Schizophrenia
Schizophrenia deals with chemical imbalances that influence the functioning of a person who is susceptible to schizophrenia. Imbalances of dopamine, glutamate, GABA, acetylcholine, and serotonin are believed to be essential contributors to schizophrenia (Brisch et al., 2014). These all are neurotransmitters that essentially control our physical nature. Dopamine is a neurotransmitter that regulates movement and emotion and is essential for the normal functioning of a person. If one’s dopamine is hypoactive or hyperactive, it can be detrimental to one’s health. What has been said about dopamine pertaining to schizophrenia is hyperactive dopamine transmission in the mesolimbic areas and hypoactive dopamine transmission in the prefrontal cortex in schizophrenia patients (Brisch et al., 2014). In addition to the mesolimbic brain areas, dopamine dysregulation is also seen in brain regions, including the amygdala and prefrontal cortex, necessary for emotional processing (Brisch et al., 2014). To put this more simply, the mesolimbic areas are our reward pathway activated by things like sugar we ingest (Adinoff, 2004). The region allows the processing of what is real or not as well. Hyperactive dopamine transmission in this region results in positive symptoms, such as hallucinations and delusions (Brisch et al., 2014). The prefrontal cortex (PFC) at this time is said to develop memory, perception, and many cognitive functions such as attention, impulse inhibition, prospective memory, and cognitive flexibility (Pryor & Veselis, 2006). Parts of our PFC help us perform tasks while other parts help us to take in information. The PFC, when it has hypoactive dopamine transmission, leads to negative symptoms, which means it lacks something that should be present (e.g., ability to communicate) (Shultz et al., 2007; Siddiqui & Goyal, 2008 ). We currently know this about schizophrenia from a chemical standpoint and what has been used to prescribe people with schizophrenia best.

Schizophrenia Treatment Globally
Treatment that is just as diverse worldwide as our understanding of the disease itself. Different medicinal regulations and different practices formed different treatments across regions. Nigeria’s residents have been more inclined to use more traditional medication to treat schizophrenia (Ayonrinde et al., 2004). Herbalists, traditional healers, and spiritual healings are all commonly sought out to treat schizophrenia (Adewuya, 2015). In contrast to Canada, Bermuda and the United States prefer antipsychotics (Crockford & Addington, 2017). A research paper notes on a study that included Nigeria that a systematic review of the effectiveness of traditional healers in treating mental disorders concluded that people with acute relapses improve. In contrast, in the care of traditional healers, improvements could not be established, however, as any different than the regular illness route (Endale, 2020). They are illustrating the effective properties herbs may have while also highlighting their ineffectiveness as a mainline treatment. Through my background on schizophrenia, one can see the advancement of antipsychotics and how it has helped people with schizophrenia the most out of all treatments. Looking into herbs for treating schizophrenia, the US National Library of Medicine National Institutes of Health has said herbs to be beneficial with regular antipsychotics, and this belief is not synonymous with this organization (Chengappa, 2018). K.N. Roy Chengappa, M.D. A professor of psychiatry remarks similar thoughts stating herbs can reduce worsening symptoms but should be taken along with antipsychotics (Chengappa, 2018).

This paper aimed to review the literature on the history of schizophrenia and the development of the most effective treatment. Schizophrenia is classified by positive and negative symptoms and is affected by the lack of or overabundance of dopamine transmission. It took many years and will take more to discover a more effective treatment for schizophrenia. Schizophrenia is a complicated disease that has stumped a generation and left us in mystery. We entertain the fruits of life in hopes of striking a discovery and coming one step closer to curing schizophrenia. Although more definitive answers would have been preferable, we are left with a scramble of highly educated guesses in science’s beginning and forward-moving end.

Will Onubogu, Youth Medical Journal 2021


Abou-Setta, A. M., Mousavi, S. S., Spooner, C., Schouten, J. R., Pasichnyk, D., Armijo-Olivo, S., & Hartling, L. (2012). First-generation versus second-generation antipsychotics in adults: comparative effectiveness. University of Alberta Evidence-based Practice Center: Rockville, MD, USA.

 Adinoff B. (2004). Neurobiologic processes in drug reward and addiction. Harvard Review of Psychiatry, 12(6), 305–320.

Ayonrinde, O., Gureje, O., & Lawal, R. (2004). Psychiatric research in Nigeria: bridging tradition and modernisation. The British Journal of Psychiatry, 184(6), 536-538.

Brisch, R., Saniotis, A., Wolf, R., Bielau, H., Bernstein, H. G., Steiner, J., Bogerts, B., Braun, K., Jankowski, Z., Kumaratilake, J., Henneberg, M., & Gos, T. (2014). The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: old fashioned, but still in vogue. Frontiers in Psychiatry, 5, 47.

Crockford, D., & Addington, D. (2017). Canadian schizophrenia guidelines: schizophrenia and other psychotic disorders with coexisting substance use disorders. The Canadian Journal of Psychiatry, 62(9), 624-634.

Ernest, D., Vuksic, O., Shepard-Smith, A., & Webb, E. (2017). Schizophrenia: An information guide. Centre for Addiction and Mental Health.

Freeman, W. (1953). Hazards of lobotomy: Study of two thousand operations. Journal of the American Medical Association, 152(6), 487-491.

Lavretsky, H. (2008). History of Schizophrenia as a Psychiatric Disorder. Clinical Handbook of Schizophrenia. 25-29. DOI

Lieberman J. A. (1996). Atypical antipsychotic drugs as a first-line treatment of schizophrenia: a rationale and hypothesis. The Journal of Clinical Psychiatry, 57 Suppl 11, 68–71.

López-Muñoz, F., Ucha-Udabe, R., & Alamo, C. (2005). The history of barbiturates a century after their clinical introduction. Neuropsychiatric Disease and Treatment, 1(4), 329–343.

Ögren, K., & Sandlund, M. (2007). Lobotomy at a state mental hospital in Sweden. A survey of patients operated on during the period 1947–1958. Nordic Journal of Psychiatry, 61(5), 355-362.

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P &  : A peer-reviewed Journal for Formulary Management, 39(9), 638–645.

Pryor, K.O. & Veselis, R. A. (2006). Chapter 29 – Consciousness and cognition. Foundations of Anesthesia (Second Edition), 349-359.

Ramachandraiah, C. T., Subramaniam, N., & Tancer, M. (2009). The story of antipsychotics: Past and present. Indian Journal of Psychiatry, 51(4), 324–326.

Schwartz, R. C., & Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry, 4(4), 133–140.

Sedhai, Y. R., Lamichhane, A., & Gupta, V. (2021). Agranulocytosis. StatPearls [Internet].

Shultz, S. H., North, S. W., & Shields, C. G. (2007). Schizophrenia: A Review. American Family Physician.75(12), 1. DOI 

Siddiqui, A., & Goyal, N. (2008). Neuropsychology of prefrontal cortex. Indian Journal of Psychiatry, 50(3), 202–208.

(Siddiqui, 2008)

Tandon, R. (2011). Antipsychotics in the treatment of schizophrenia: an overview. The Journal of Clinical Psychiatry, 72(suppl 1), 0-0.

Terrier, L. M., Lévêque, M., & Amelot, A. (2019). Brain Lobotomy: A Historical and Moral Dilemma with No Alternative?. World Neurosurgery, 132, 211-218.


Complex Regional Pain Syndrome : effects and reality.

By Isobel Radford

Published 11:14 EST, Sat September 4, 2021

Complex Regional Pain Syndrome is a rare neurological disorder that causes chronic/acute pain that can affect all areas of the body, but most commonly occurs in the extremities. For the majority of patients CRPS is usually started by an injury such as a sprain, broken bone or surgery and is characterised by intense pain.


A broken bone. Whether the radius or femur for the vast majority of the population the treatment plan is a straight path towards recovery and regaining normal function and life quality. However, 7 % who experience orthopaedic trauma gain CRPS (Complex Regional Pain Syndrome) [1] – a chronic condition potentially caused by improper function of the peripheral nerve fibres that carry messages to the brain. The condition is poorly understood by medical professionals across the world with limited knowledge surrounding the cause and treatment leaving patients with uncontrollable debilitating pain and a potentially severe disability resulting in a negative impact upon their quality of life. The poor comprehension of the disease means that an injury as simple as a broken bone or minor surgery can result in a condition that extends over months and years with no visible endpoint and with few global treatment centres it leaves patients to face allodynia, impaired muscle strength and dystonia indefinitely as well as  unbearable pain and inflammation.


Complex regional pain syndrome occurs in two different types, each of which have similar causes and symptoms, but different causes characterised by nerve damage. CRPS type 1 previously known as RSD typically occurs after an injury that did not directly cause damage to the peripheral nervous system within the limb. Type 1 occurs in around 90 % of patients with CRPS [8] . Many people diagnosed with CRPS type 2 have similar symptoms to type 1 but often occurs after a distinct nerve injury and was previously known as causalgia.


Due to the complex nature of the condition, misunderstanding and lack of knowledge from medical professionals, the cause remains unknown, but the disease has many potential causes. Most commonly it is believed to be a widespread abnormal response to an injury that damages the musculoskeletal system or central nervous system causing the bodily systems to malfunction resulting in a pain response beyond the scope of normality. The systems believed to be affected include : the immune system, the vascular system, the peripheral nervous system , the central nervous system and the musculoskeletal system. These systems are responsible for many of the body’s functions that are often impacted in people with CRPS, such as detecting pain and transmitting pain signals, triggering swelling and controlling temperature and movement.

immune system- responsible for defending the body against infection, vascular system for delivering oxygen


  • hyperalgesia – hypersensitive pain reception
  • allodynia – experiencing pain from light sensation on the affected skin area .
  • joint stiffness.
  • muscle spasms ( dystonia )
  •  insomnia
  • osteoporosis 
This image shows the dystonia , swelling and changes in skin colour that CRPS can cause. [9]

Controlling Biological Effects 

Chronic medical conditions invariably have multiple, interlinked causes which continually affect one another exacerbating a person’s overall condition. CRPS has to be looked at with this vewipoint due to the lack of knowledge of the original cause and widespread damage to multiple bodily systems to maximise recovery chance and end the persisting trauma. With insufficient awareness the biological impacts cannot be treated with a myriad of medications and procedures. Subsequently many have to resort to clinical trials for a slight glance of hope towards recovery such as the trial into the efficacy and safety of intravenous neridronic acid beginning in 2018 [3]. Fortunately, anticonvulsants such as gabapentin and TCA’s such as amitriptyline have been proven to help control the neuropathic pain following the development of the condition resulting from the original injury. Other treatments include intensive physiotherapy, nerve blocks, Botox injections and spinal cord simulation. [4. The Botox injections help to relax certain muscle groups that are causing dystonia and contributing to a patient’s condition. The nerve block is a form of therapy that targets the sympathetic nervous system and helps the body to control several involuntary bodily functions such as blood flow. However, this only manages the problem; it usually doesn’t solve it. This condition is time sensitive in cases where the patient develops dystonia increasing the physiological effects and risking muscle atrophy creating irreversible issues. 

Psychological Effects 

As with many pain conditions it is almost inevitable to have major psychological impacts on those who suffer ultimately impacting their daily life. People with severe CRPS often develop secondary psychological problems including depression, anxiety, and post-traumatic stress disorder (PTSD). All of which heighten pain perception, further reduce activity and brain function making it hard for patients to seek treatment and begin the path to recovery and rehabilitation [5]. A study into the psychological impacts by H. Hooshmand, M.D., and Eric M. Phillips Neurological Associates Pain Management Centre Vero Beach, FL  showed that out of 824  (CRPS) patients, one or more of the listed issues were present in every case except three : insomnia (92%), irritability, agitation, anxiety (78%), (depression (73%), poor memory and concentration (48%), poor judgment (36%), and panic attacks (32%) [6]. Without further research patients will continue to suffer with the impacts of this rare neurological disorder that causes endless suffering for around 1-3 million globally [7]. The psychological impacts could be reduced through the acknowledgement of patient’s symptoms from Doctors as well as support from family and the multidisciplinary team to help control this condition .


CRPS (complex regional pain syndrome) , is an incredibly detrimental disease to an individual’s quality of life due to limited knowledge and treatment options .For many years the cause was believed to be solely psychological meaning that treatment options were never explored until recently. However due to the unknown nature of this disease the development of treatment is difficult as researchers are unsure about which bodily system requires targeting. Not only are the biological effects extensive and debilitating but the psychological effects are equally as prevalent. Regardless of its rarity it is hoped that in the future medical researchers are able to find the cause and generate a cure. It is also to be hoped that awareness is created to ensure patients receive an accurate diagnosis to give them the best chance at rehabilitation. Currently in the United Kingdom there is only one adult treatment centre and two paediatric centres leaving many patients without access to treatment and specialist medical professionals. 

Isobel Radford, Youth Medical Journal, 2021












The Neurological Effect of Illegal Substances and Alcohol on the Brain

By Ipshita Rishi

Published 1:07 PM EST, Tues Aug 10, 2021


The brain is unarguably the most complex organ in the human body, as it is still an organ yet to be fully understood. The brains’s complex structure & composition continues to be the topic of academic research & composition. 

Surrounding the world of alcohol and drugs lies a huge psychological illness, addiction. Seen as a taboo in many societies, addiction causes more than 750,000 deaths globally each year. Addiction is an individual’s compulsive behavior towards a substance or activity that includes pleasure and enjoyment, later suffering from withdrawal and tolerance issues, it is classed as a medical disorder – rather than a habit – and requires treatment just like other diseases and illnesses. The most common type of addictions include: drugs, gambling, alcohol, smoking, sex and food. According to the charity Action on Addiction, 1 in 3 people struggle with addiction. 

But what has addiction got to do with the brain? When someone develops an addiction, the brain craves the reward of the substance or activity. This is due to the intense stimulation of the brain’s reward system, known as the mesolimbic dopamine pathway. It is located in the cerebrum in the brain and is a set of structures that deals with emotions, memory and basic instincts. The brain is responsible for regulating temperature, emotions, decision-making, breathing and coordination. This major organ also impacts physical sensations in the body, emotions, cravings, compulsions and habits. Under the influence of powerful substances such drugs and alcohol can cause alterations in the brain. The substances react with the mesolimbic system in order to release strong feel-good emotions which affect the body and mind. Our brains reward us when we do something that brings pleasure, to illustrate for a drug addict the pleasure would be substance use thus creating a cycle of drug use and intense highs. This eventually leads to them taking drugs for the release of hormones that make us feel happy, such as dopamine, oxytocin, serotonin and endorphins (these are known as D.O.S.E chemicals).

It is important to classify the different types of drugs and understand them on a molecular level in order to understand its neurological effects. In order to classify drugs, we must first  understand what drugs are. The dictionary definition of drugs are: “a medicine or other substance which has physiological and psychological effects when ingested or introduced to the body.” Although not commonly seen as one, alcohol is also classified as a drug, except it is not an illegal substance under UK laws. However, commonly known substances Such as as heroin, opium and cannabis are illegal substances. Illegal substances refer to drugs forbidden for consumption, possession and exchange by the law. There are 8 main categories that drugs can be classified into: depressants, stimulants, hallucinogens, dissociative anaesthetics, narcotic analgesics, inhalants, agonists, antagonists and reuptake inhibitors. It is important to also remember that a single drug can overlap, meaning that a drug could be a stimulant, hallucinogen, inhalant and agonist!

So how does the NHS manage people with addiction? The first steps to tackling and seeking help for addiction usually starts either with your GP or local addiction treatment services. In most circumstances the patient will be assigned to a key worker who helps work with the patient to plan the right treatment. Treatments include: therapy (such as CBT), medication, detoxification and self-help. Rehabilitation is not an easy process on the NHS, and it is only granted in severe and critical cases of addiction. Funding is difficult to obtain and the process involves applying to the government for a lump sum of an individual patient’s treatment. With funding and budgets getting tighter, only chronic and the most deserving cases are encouraged to apply. So should the NHS increase the funding for addiction patients?

Drug Misuse and the Neurological Effects

So what do the different classifications mean? Depressants slow down the CNS and decrease the speed of synapses to transmit responses. Examples of depressants include alcohol, opioids and heroin. Stimulants are the opposite of depressants, they stimulate the CNS and increase the speed of synapses to transmit responses, examples are: caffeine, nicotine and ecstasy. Hallucinogens alter the perception of reality and change sense of smell, taste and sight, examples are: ketamine, magic mushrooms and LSD. Dissociative anesthetics include drugs that inhibit pain by cutting off or dissociating the brain’s perception of the pain. PCP, its analogs, and dextromethorphan are examples of dissociative anesthetics. Narcotic analgesics relieve pain, induce euphoria, and create mood changes in the user. Examples of narcotic analgesics include codeine, morphine and oxycontin. Inhalants include a wide variety of breathable substances that produce mind-altering results and effects. Examples of inhalants include Toluene, paint, gasoline, hair sprays, and various anesthetic gases. Agonists causes a brain chemical that stimulates the receptor associated with a particular neurotransmitter, elevating its effects. Antagonists are molecules which do the opposite of agonists, they inhibit the action of receptors associated with a neurotransmitter. Reputable inhibitors are chemicals which stop a neurotransmitter being reabsorbed by sending neurons, thus causing antagonistic responses. To put it in context, let’s take the example of dopamine antagonists. Dopamine antagonists block the action of dopamine. They have profound importance in several antipsychotic diseases such as schizophrenia, bipolar disorder, and psychosis. They are also used in non-psychotic illnesses such as orthostatic hypotension, vomiting, and nausea.

Common, well-known “street drugs” contain heavy amounts of carbon, hydrogen and nitrogen, they are referred to as alkaloids. Alkaloids are any class of nitrogenous organic compounds of plant origin which have pronounced physiological actions on humans, such as drugs and poison. 

The brain is made up of more than 100 billion nerves that communicate in trillions of connections called synapses. The brain’s reward system evolved because it helped us seek out things that are important for our survival, but if this system is hacked, it leads to addiction. The reward pathway can be divided into 6 steps: stimulus, urge, desire, action, reward and learning. These are how the 6 steps work:

Stimulus: the initial stimulus can originate outside the body, such as the sight of drugs, or from within, such as falling dopamine levels. 

Urge: dopamine released from the VTA to the nucleus accumbens drives us to seek out and work for the reward that is linked to the stimulus. 

Desire: the urge may be registered as a conscious desire in the cortex, but sometimes it goes undetected, or even opposes our conscious desires. 

Action: a region of the frontal cortex weighs the inputs and decides whether to seek the reward, the body then acts to reach it. 

Reward: the reward triggers parts of the brain known as “hedonic hotspots” to release opioid-like neurotransmitters, giving a sense of pleasure. 

Learning: if the reward is better than expected, the brain relaxes more dopamine, strengthening the connection between the stimulus and reward.

Research and experiments have shown that substance and alcohol abuse can cause severe symptoms both neurologically and physiologically. Common physical symptoms include  changes in appetite appearance changes sleeplessness, injury or disease caused by substance abuse and increased tolerance to the source of addiction. Excessive and prolonged usage has also shown disruption of nutrients reaching the brain needed by brain tissue, direct damage and apoptosis of brain cells, including neurotransmitter receptors,  alterations to brain chemicals and concentrations and deprivation of oxygen to brain tissues.


A study done in 2013 showed that alcohol shrinks the hippocampus and the use of methamphetamine shrinks the amount of great matter in the brain’s frontal cortex, among other areas leading to a decline in mental function. Such long term effects can cause permanent brain alterations and future health problems such as slurred speech, physical imbalance caused by an inefficiency cerebellum cortex, brain atrophy, memory loss, cognitive decline and as discussed before, addiction. Although the effect of substance abuse on people is different, it can still lead to a very bad lifestyle and harmful effects. Your body will react differently to substances based on the type of drugs, strength of drugs, how it is being taken, what is present in your bloodstream during absorption, existing health condition and how many different types of drugs are taken at once. 

Although a treatable illness, addiction took hold of the UK and cost the NHS millions of pounds. In 2016, the National Treatment Agency (NTA) estimated the cost of the NHS of treating drug misuse at around £500m a year and alcohol misuse as much as £3.5bn a year. Substance abuse and alcohol abuse are seriously harmful, and it is vital that the government increase the funding for education and awareness of sensitive topics such as addiction. If you know anyone who needs help with substance abuse or addiction, please contact a health care worker as soon as possible. 

Ipshita Rishi, Youth Medical Journal 2021


Addiction Helper. (2018a). 10 Most Common Addictions. [online] Available at: [Accessed 3 Feb. 2021].

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Ritchie, H. and Roser, M. (2018). Opioids, cocaine, cannabis and illicit drugs. [online] Our World in Data. Available at: [Accessed 3 Feb. 2021]. (2019). [online] Available at:

Wikipedia Contributors (2018). Drug. [online] Wikipedia. Available at:

Ipshita Rishi, Youth Medical Journal 2021


Psychoanalysis of the total personality

By Suhani Khandelwal

Published 4:45 PM EST, Sun July 11, 2021


Psychoanalytic theories explain human behavior in terms of the interaction of various components of personality. Sigmund Freud was the founder of this theory. While Freud’s ideas have often been critiqued and labeled unscientific, his work continues to be highly influential in the field of psychology even today.


The ID develops at birth and forms the primary and unconscious component of the personality. It controls the most primitive and instinctive behaviour of a person; thereby, requiring instant gratification. The id is essential early in life because it ensures that an infant’s needs are met. If the infant is hungry or uncomfortable, they will cry until the demands of the id are satisfied. Young infants are ruled entirely by the id, there is no reasoning with them when these needs demand satisfaction.

The Id, therefore, is also the source of bodily needs and wants, unconscious instincts, emotional impulses and desires, especially aggression and the libido (sex drive).

The Id also works on something called the pleasure principle. The pleasure principle is a term originally used by Sigmund Freud to define the tendency of people to seek pleasure and avoid pain.

In his book, Beyond the Pleasure Principle in 1920, Freud concluded that all instincts fall into one of two major classes: life instincts or death instincts. While we tend to think of life instincts in terms of sexual reproduction, these drives also include such things as thirst, hunger, and pain avoidance. The energy created by the life instincts is known as libido. Death instinct is generally channelled by people outwards in the form of aggression or violence. However, sometimes these instincts towards destruction can be directed inwards, however, which can result in self-harm or suicide.

Although people eventually learn to control the id, this part of personality remains the same infantile, primal force throughout life. It is only due to the development of the ego and the superego that people are able to control the id’s basic instincts and act in ways that are both realistic and socially acceptable.


The ego develops around the age of 3. Although it is majorly conscious, it has preconscious and unconscious life to it as well. The ego is an adjustment of the id that develops as a result of the direct influence of the external world. It is the “executive” of the personality as it is responsible for regulating libidinal drive energies so that satisfaction aligns with the demands of reality. It is the epitome of reason, reality-testing, and common sense, and has at its command a range of defensive devices that can repel, repress, or transform the expression of unrealistic or forbidden drive energies. 

The Id and the superego, which is explained later in the article are two very extreme parts of our personality seeking either pleasure or morality, both very contradictory fulfilments that must be met in the middle. In this way, the ego acts as a referee. 

The ego operates based on the reality principle, which strives to satisfy the id’s desires in realistic and socially appropriate ways. The reality principle weighs the ‘pros and cons’ of an action before deciding to act upon or reject impulses. The ego may do this by delaying gratification, compromising, or anything else that will avoid the undesirable consequences of going against society’s norms and rules.

However, like the id, the ego too is interested in seeking pleasure, it just wants to do so in a realistic way. It’s not entirely interested in right and wrong, but in how to maximize pleasure and minimize pain without getting into trouble.

While the ego has a tough job to do, it does not have to act alone. Anxiety also plays a role in helping the ego mediate between the demands of the basic urges, moral values, and the real world. When you experience different types of anxiety, defense mechanisms may kick in to help defend the ego and reduce the anxiety.


The superego is present in the conscious, preconscious, and unconscious state and develops at around 5 years of age.

It originates in the process of overcoming the Oedipus complex which is, in psychoanalytic theory, a desire for sexual involvement with the parent of the opposite sex and a consequent sense of rivalry with the parent of the same sex; a crucial stage in the normal developmental process. Sigmund Freud introduced this concept in his book, Interpretation of Dreams (1899).

Like the Id with the pleasure principle and the ego with the reality principle, the superego works on the morality principle. It holds the adopted moral standards and ideals that we acquire from our parents and society; our sense of right and wrong.

The superego is the ethical component of the personality and provides the moral standards by which the ego operates.

Superego has two parts

a) Ego Ideal (idealised self image)- Positive obligations. Like volunteer work or smiling or being polite. It includes the rules and standards of good behavior one should adhere to. If one is successful in doing so, it leads to a mental state of pride. However, if the standards of the ego ideal are too high, the person will feel like a failure and experience guilt.

b) Conscience- The consciousness is that part of the superego that prohibits unacceptable behaviors and punishes through feelings of guilt when a person does something they shouldn’t.


As Freud proposed in The Ego and the Id, three agencies of the mind fight for supremacy: the ego strives for dominance over both id and superego, an ongoing and often worthless task in the face of the id’s wild passions and demands for satisfaction, on the one hand, and the superego’s crushing demands for submission to its dictates, on the other. The work of psychoanalysis was “to strengthen the ego”; as Freud famously put it 10 years later, “where id was, there ego shall be.”

Freud’s text also supports a conceptualization of the ego as an experienced sense of self. In it, Freud had fascinatingly referred to the ego as “first and foremost a body-ego,” explaining that it “is ultimately derived from bodily sensations.”

In conclusion, the id, ego and superego are not three separate entities with clearly defined boundaries. These aspects are dynamic and continuously interacting in order to influence an individual’s whole personality and behavior.

Suhani Khandelwal, Youth Medical Journal 2021



The Intimate Gut-Brain Connection


In the last decade, research in the field of the gut-brain connection has tremendously increased, providing advanced neurobiological insights to the treatment of mental illnesses like clinical depression and anxiety. When scientists worldwide recognized the medical implications of the bidirectional gut-brain axis, the biochemical signaling between the cognitive centres of the brain and the intestinal tract, several psychological and neurodegenerative diseases such as Alzheimer’s and Parkinson’s were re-evaluated to a large extent. Moreover, new therapeutic approaches for type 2 diabetes, obesity, and others were deduced. Although this field of research is still in its infancy, through the exploration of various studies conducted, this article will explain how the gut-brain connection influences intuitive decision-making, emotional states, and the mere functionality of the human brain. 

What is the ENS?

The brain is often mistaken as the most diverse organ when the gut clearly supersedes it by possessing 5 times the number of neurons present in the brain. Surprisingly, the gut has a brain of its own which medical practitioners call the Enteric Nervous System (ENS). Comprising 2 fine layers of 100 million neurons and more, the ENS can be traced through the gastrointestinal tract, beginning in the esophagus and ending in the rectum. Fundamentally, the ENS orchestrates the process of digestion, from the mastication of food in the mouth to the elimination of waste. Throughout this process, the ENS has been found to communicate back and forth with the brain. One example of the intricate gut-brain bidirectional system is the involuntary flight or fight response. The Central Nervous System is triggered and the Enteric Nervous System responds by completely halting digestion or reducing its speed so that energy spent on it can be redirected to muscles elsewhere to act upon the danger which initiated the fight or flight response. 

History of Research

Historically, advances in findings of the ENS were minimal; scientific trade was limited because it was seen as a collective endeavor of only a few communities. Furthermore, the economic model for bioengineering didn’t provide enough financial incentive to motivate scientists to carry out research back then. However, our triumphantly digitized contemporaneity has enabled us to improve our understanding through sophisticated scientific apparatus. Gut microbiomes are unique to each individual like DNA, and it appears to colonize at birth itself. Aiding in digestion, metabolizing medications and so much more, our gut microbiomes hold enormous significance to our body. Until 2004, it was highly doubted that the gut microbiota could affect mental health. However, Nobuyuki Sudo disproved this theory when he declared the observations of the study he conducted at Kyushu University, Japan. He confirmed that the mice which were so-called germ-free exhibited a fiercer reaction when exposed to stressors compared with the normal mice. Germ-free mice are organisms grown in a controlled and quarantined environment so that they have no microorganism exposure at all This experiment garnered international attention after which researchers began exploring this department in depth. 

The Vagus Nerve and the Forced-Swimming Experiment:

Prior to this, the concept of alteration of behavioral appearances of mice by making changes to their gut was unprecedented. In the year 2010, the European Union authorized the simulation of the vagus nerve in medical treatment for patients suffering from depressive disorders. The vagus nerve is distinguished for the extensive range of organs it connects to the medulla oblongata, a grape-sized tissue at the base of the brain. Being complex and long, it serves as a platform of communication between the brain and the gut. Essentially, the modulation of this nerve affects the psychological and physiological states and alters any bodily processes dependent on information exchange between the two. A pioneer in this field, Jay Pasricha, M.D., director of the Johns Hopkins Centre for Neurogastroenterology, whose research has been recognized globally, explains that these findings better demonstrate why patients suffering from irritable bowel syndrome, constipation, and diarrhea have been found to develop depression on a more-than-normal scale. This emphasizes how important this is because up to 30 to 40 percent of us go through irritable bowels at least once in a lifetime. Following the approval of modulation of the vagus nerve, an innovative experiment was engineered by a team commanded by an Irish scientist, John Cyran, whose forced-swimming test  revolutionized medicine permanently.

The forced-swimming study was primarily designed to test out antidepressants on mice. Mice are placed in identical containers of deep water, coercing them to try to remain afloat by swimming. The principle of this experiment epitomizes the significance of life and how determined the mice were to strive towards something abstract and intangible like happiness. Mice with depressive tendencies gave up quickly; in fact, they did not even make an effort and apathetically anticipated death. This displays that inhibitory signals were distributed around more productively than motivational signals resulting in stronger reactions to stress in their brains. Antidepressants were then tested on these mice and, if they made an effort to swim or outdid their recorded time compared to their previous attempt, it indicates that the drug has worked. What was a simple experiment was redesigned by Cyran by giving half of these mice Lactobacillus rhamnosus JB-1, a strain of bacteria typically found in yogurt, resulting in the mice fed with the bacteria strain exhibited improved behavioral, physiological, and cognitive functions proving that the wellbeing of the gut influences the functionality of the brain. Remarkably, the mice fed with this strain were more driven and to swim longer. Additionally, fewer stress hormones were detected when compared to the previous blood samples, and this set of mice achieved better than the other set in both learning and memory tests.

Stimulation of the Brain to Establish a Connection Between the Gut and the Brain

Following Cyran’s research, in 2013, the first study on the effect of gut health on human brains was published. The scientists who pioneered this research at UCLA were astonished by the results. What they had expected were no visible changes in the brain. However, after 4 weeks of observations with 3 groups of women -one group being fed with a culture of probiotics, another with a placebo (a product that looked and tasted like yogurt, in this case), and another with nothing at all – the results were extraordinary. 

All the 3 groups were scanned in 2 different states, one resting and when performing an emotion-recognition test. This test measures the ability of the subjects to identify six basic emotions by recognizing facial expressions when viewing a picture. This test was picked due to the exposure of visual stimuli which will help in determining the differences in the cognitive area of the brain. The scientists reviewed the Functional Magnetic Resonance Imaging (fMRI) scans before and after the experiment and then established that some areas of the subject’s brains were undoubtedly modified, particularly in the areas responsible for managing emotions and physiological  states. 


After 30 years of correlating intestinal health with the brain, it can be unequivocally said that the gut microbiome does influence certain parts of the brain controlling behavior and brain function. What followed was using this information to alter treatments by regulating the gut microbiota of an individual. The over-intake of high energy foods combined with inadequate exercise is blamed to be the primary cause of obesity. Since the 1980s, 13% of adults started battling obesity which was a very concerning case. 

This led pharmaceutical companies to spend billions on manufacturing “diet pills” and formulating drugs in vain. Medical representatives globally speculated an escalation of cases of cardiovascular diseases, osteoarthritis, sleep apnoea, immune weakening, endocrine complications, and low degree inflammation, but the most distressing one was type 2 diabetes. 

When the gut microbiota was explored in obese patients, it was found that there were excessive microorganisms that obtained more energy from the diet. However, the increase in fat mass is not only due to a more efficient harvest of energy, but also the microbiota participating in changes in systemic inflammation, bowel permeability, insulin resistance, and other protein synthesis processes like lipogenesis. Therapeutic approaches for obesity including the modulation of the gut microbiota include: the usage of prebiotics and probiotics, impressive antibiotic therapies, gut microbiome transplants, and other upcoming cures for mitigating metabolic disorders like pre-diabetes and resistance to insulin. This was very contributive to the diabetic community because even though insulin was discovered in the early 1920s, it was not procurable until a lot later. 

To conclude, this connection is revolutionizing medicine’s perspective of mental and psychological disorders, changing the course of prognosis for a multitude of illnesses and providing a ray of hope for finding cures for chronic diseases. 

Parineeta Karumanchi, Youth Medical Journal 2021


Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems. Annals of gastroenterology.


An Evolutionary Explanation of Loneliness

By Melle Hsing

Published 1:38 PM EST, Wed June 16, 2021


There is the saying that loneliness has the same impact as smoking 15 cigarettes a day, which may not be an exaggeration in reality. Loneliness is the feeling of isolation, more specifically the unpleasant awareness that one is isolated. Although there is no formal diagnosis for chronic loneliness, it can pose serious threats to mental and physical health: including hypertension, depression, Alzheimer’s disease, and more. During the pandemic where large social gatherings are not encouraged, it is arguably unsurprising that there would be higher risk of chronic loneliness in individuals around the world. The negative health effects of loneliness are more dire in the elderly population, who may already suffer from loneliness due to being far away from family members in modern times. This article explores the evolution of loneliness and how it manifests in individuals, as well as what can be done to alleviate loneliness and its associated health risks.

Cacciopo’s Evolutionary Theory of Loneliness

A key difference between being alone and lonely is that the former is objective while the latter is not. Even when alone, a person may not feel lonely and when surrounded by people, one can feel lonely. Surprisingly, loneliness has evolved as a feeling to benefit human survival. According to Cacciopo’s Evolutionary Theory of Loneliness (ETL), loneliness not only induces depressed feelings, but it also acts as a warning that one’s social connections to other human beings may be prone to breaking. Humans are social animals by nature, and that renders us more favourable of forming groups to increase our chances of survival. To overcome feelings of loneliness, one is encouraged to reach out to others. Hence, from an evolutionary perspective loneliness is actually a beneficial signal which motivates individuals to reform social connections in order to stop the detrimental feelings of loneliness from physically harming one’s own body.

In a study done by Cacciopo and other researchers in 2009, lonely participants and non-lonely participants were asked to observe unpleasant pictures of people and objects. Meanwhile, researchers recorded the activation of the temporo-parietal junction (TPJ), a part of the brain which — according to scientists — handles mind tasks involving putting oneself in someone else’s shoes. The researchers hypothesized that the cause of loneliness is due to a self-protecting mechanism, which tells an individual that they need to take care of themselves before interacting with others under unfavourable or risky circumstances, resulting in social isolation. The study showed that non-lonely participants had higher activation of the TPJ and thus more inclination to put themselves in the perspective of others. On the other hand, lonely participants had lower activation of TPJ which links to the idea that lonely participants prioritise their own needs over those of others.

The temporoparietal junction (TPJ) – Brian's Bewildering Brain Blog

Figure 1: Temporo Parietal Junction (red) in the Brain, sourced from Brian’s Bewildering Brain Blog

Hence, the cause of loneliness supposedly ensures survival under certain circumstances where one’s own risk outweighs the need to prioritise the group, while loneliness itself is also a way of ensuring survival under socially favourable circumstances. 

Loneliness is also a heritable trait. A large twin study published in 2005 found that genetics contributed to 48% of the causes of loneliness, which confirms the results from a previous one-year study which investigated how loneliness was passed down as a trait. Nonetheless, it is important to keep in mind that environmental factors also influence the susceptibility to chronic loneliness and that genetics is not a defining factor of whether a person will feel chronic loneliness or not.

Chronic Loneliness in
Modern Times

There are many symptoms of loneliness ranging from loss of concentration to increased desires for engaging in certain activities such as eating, binge-watching videos, or shopping excessively. Although the proposed evolutionary explanation for loneliness may no longer apply as effectively in modern times as in the past, the same survival mechanism can still be seen throughout the modern lifestyle. For example, working from home has become more common ever since the COVID-19 social restrictions, and as a result more people are becoming isolated in their homes. Loneliness therefore warns oneself about the lack of social interaction in light of the pandemic, encouraging individuals to reach out to each other despite this being counterproductive in terms of pandemic control.

As stated earlier, there is no official clinical diagnosis for chronic illness. However, there are still many preventive measures and lifestyle changes that can be implemented to alleviate the negative impacts of chronic loneliness. Making use of social media apps such as Whatsapp, Facebook, and Skype could be beneficial for connecting with others without having to physically meet them under unprecedented times. Additionally, learning to do something new such as painting or dancing, volunteering in a community event, or simply taking a walk outside in nature can help relieve one’s own mental state. Changing one’s mindset to be more open to others and also polishing up on social skills are two methods which have shown to be effective in improving symptoms of loneliness.

Melle Hsing, Youth Medical Journal 2021


Cacioppo, John T et al. “Evolutionary Mechanisms For Loneliness.” Cognition & Emotion vol. 28,1 (2014): 3-21. doi:10.1080/02699931.2013.837379.

“How Loneliness Can Make You Sick.” American Psychological Association,

“Loneliness during Coronavirus.” Mental Health UK,

Raypole, Crystal. “Is Chronic Loneliness Real?” Healthline,

“Social Isolation, Loneliness in Older People Pose Health Risks.” National Institute on Aging, 23 Apr. 2019,,Alzheimer’s%20disease%2C%20and%20even%20death.

“The Temporoparietal Junction.”

Biomedical Research Neuroscience

‘Patient H.M’ – An unsung hero: The forgotten man who forgot everything

By Asmita Anand

Published 4:40 PM EST, Sun May 23, 2021


In recent decades, scientists have made huge progress discovering how our identities, and memories are made and stored. A patient that transformed our understanding of the way  memory functions are organised in the human brain, is  referred to as ‘the man who couldn’t make memories’; Henry Molaison possessed one of the most famous brains worldwide and bestowed unique insights into the inner-workings of human brains.

Who Was He?

Figure 1: HM in 1953 before his surgery (

Henry Gustav Molaison, also known in medical literature as patient H.M. to protect his identity, was born on February 26, 1926 in Manchester, Connecticut.

As a child, he had a relatively normal childhood. Although it wasn’t long after a minor head injury and a family history of seizures (although the exact aetiology behind his seizures remains uncertain), that Molaison began suffering from severe epilepsy. At the age of 10, he started having absence seizures and 6 years later he developed generalised tonic-clonic seizures. His seizures greatly impacted his daily life and led him to drop out of high school. Later he was also unable to maintain his job and function independently. Molaison’s case was so severe that it couldn’t be treated pharmacologically with high doses of anticonvulsant medication.

After nearly 10 years he turned to Dr William Scoville, a renowned daredevil neurosurgeon of his time, with hope to lead a normal life once again. At the age of 27, his hippocampus was removed in an experimental procedure in an attempt to alleviate the impact his seizure had on the quality of his life. He underwent a ‘bilateral medial temporal lobectomy’, which surgically removed the medial temporal lobe on both sides of his brain. This included the hippocampal complex, parahippocampal gyrus, the uncus, the anterior temporal cortex, and the amygdala, according to Scoville’s own illustrations of his surgical technique. However in around 1992-199, MRI scans revealed that the surgery was less extensive than he thought, but enough to cause the damage it did. [1]

Figure 2: Diagram depicting HM’s brain after surgery compared to a normal human brain (

Although Dr Scoville hoped it would cure the epilepsy, he still wasn’t completely sure whether it would be successful or if there might be any long lasting side effects of this procedure. As a result, both of his thoughts were correct. Molaison’s seizures had stopped but unfortunately he was also left with long term memory loss, leaving him constantly living in the present tense. Later Scoville admitted that the operation was a tragic mistake and has spoken strenuously about the dangerous implications of bilateral mesial temporal lobe surgery.

Different types of Amnesia

There are multiple types of amnesia, such as Retrograde, Anterograde, Transient global and Infantile amnesia. Retrograde amnesia is when someone is unable to recall events that occurred before the development of the amnesia and is commonly used in films and media. [2] Whereas anterograde amnesia refers to a decreased ability to retain new information and is typically caused by brain trauma. [3]

Molaison developed a peculiar form of amnesia and suffered from both partial retrograde amnesia and anterograde amnesia. The latter meant he lost the ability to form new memories, such as the inability to remember what he had eaten for lunch that day, tests that he just done minutes before and names he had just been introduced to. Scoville wrote: “After operation this young man could no longer recognise the hospital staff nor find his way to the bathroom, and he seemed to recall nothing of the day to day events of his hospital life. There was also a partial retrograde amnesia.” [4] This meant that while he could recall memories from his childhood, he was unable to remember almost 11 years of events prior to the operation. 

However, both his personality, intellectual abilities and perception remained unaffected and his IQ increased from 104 to 117. [5] Molaison still had the ability to form non-declarative memories, allowing him to still acquire and develop motor skills, which led to Brenda Milner’s discovery of the distinction between procedural and declarative memories. While his mind became like a sieve, through other testing performed by Milner she discovered that he still possessed short term memory. This led to the notion that this too existed in a separate brain structure to the one he lacked.

Short Term and Long Term Memory

Molaison’s misfortune ended up as a milestone in our understanding of the brain as up until it occurred memory wasn’t thought to be localised in one area of the brain. Dr Scoville and Brenda Milner were the first to make observations and report his case in 1957 in the “Loss of recent memory after bilateral hippocampal lesions”. Since he had difficulty remembering doing the tests in the day, Molaison never grew tired of the numerous experiments he partook in.

It is thanks to Molaison, that today we know that intricate functions are directly connected to distinct regions of the brain. The hippocampus, which is embedded deep into the temporal lobe, plays an important role in forming, retaining, and recalling declarative memories and spatial relationships. It’s also where short-term memories are turned into long-term memories.

Five decades later, referred to as Patient H.M., Molaison’s case grew in popularity due to the publication, which has thoroughly been cited numerous times. Researchers arrived at the conclusion that short term memory was not connected in any way to the medial temporal lobe structures. A particular researcher out of the 100 who studied him, Suzanne Corkin, spent the most time with Molaison interviewing him and working with him for 46 years. In her book “Permanent Present Tense: The man with no memory, and what he taught the world”, Dr Corkin covers how Molaison’s mind was used to understand how our minds and memory work. It also covers his early life and key childhood memories from their personal conversations or careful reporting and research. She wrote about how she went from viewing him as a “subject” to seeing him as a human being. Molaison’s life was not easy as he often struggled at times. After a while he came to understand that while others could retrieve and store memories, he could not. Nevertheless, he remained positive, coping well with his difficult situation and he acts as a true inspiration for his extreme resilience. H.M. once poignantly remarked that “every day is alone in itself. Whatever enjoyment I’ve had, and whatever sorrow I’ve had”. [6] 

His Legacy

Figure 3: Photography by Spencer Lowell (

Sadly Henry Molaison passed away at the age of 82 due to respiratory failure. Despite his death in 2008, his brain still continues to excite and offer further investigation into memory as there is still much to uncover. Mr Molaison was much, much more than a research specimen but a person who despite facing grave misfortune, still managed to show ‘the world you could be saddled with a tremendous handicap and still make an enormous contribution to life.’ [7] Columbia pictures and Scott Rudin have even acquired rights to develop a film based on his life.

As Dr Corkin described as “a beautiful finale to his enduring contributions”, his frozen brain was cut into 2,401 slices postmortem, which have been photographed and digitised into a high-resolution, 3D model for further anatomical analysis, in which we can even view individual neurons!

Molaison once commented: “It’s a funny thing – you just live and learn. I’m living and you’re learning.” Henry Molaison leaves behind a legacy (quite literally through the preservation of his brain!) which shall be remembered by us all and stay within our own memories. His forgetfulness has revolutionized our understanding of the brain, which we can still learn so much from till this date.

To end, as Dr Corkin said “Henry’s disability, a tremendous cost to him and his family, became science’s gain”.

Asmita Anand, Youth Medical Journal 2021 


[1] Annese, J. (2014, January 28). Postmortem examination of patient H.M.’s brain based on histological sectioning and digital 3D reconstruction. Nature Communications.

[2] I. (2020, November 25). Retrograde Amnesia | Symptoms, Causes, Illness & Condition. The Human Memory. amnesia is a form,that occur after the onset

[3] Cherney, K. (2018, September 18). Anterograde Amnesia. Healthline. amnesia refers to a,is a subset of amnesia.

[4] Lichterman, B. (2009, March 17). Henry Molaison. The BMJ.

[5] Scoville, W. B., & Milner, B. (1957, February). Loss of recent memory after bilateral hippocampal lesions. NCBI.

[6] Loring, D. W., & Hermann, B. (2017, June). Remembering H.M.: Review of “PATIENT H.M.: A Story of Memory, Madness, and Family Secrets”. Archives of Clinical Neuropsychology.

[7] Adams, T. (2018, March 22). Henry Molaison: the amnesiac we’ll never forget. The Guardian.

Halber, D. (n.d.). The Curious Case of Patient H.M. Brainfacts.

Gholipour, B. (2014, January 28). Famous Amnesia Patient’s Brain Cut into 2,401 Slices. Livescience.Com.

Shah, B. (2014b, July 1). The study of patient henry Molaison and what it taught us over past 50 years: Contributions to neuroscience Shah B, Pattanayak RD, Sagar R – J Mental Health Hum Behav. Journal of Mental Health and Human Behaviour.;year=2014;volume=19;issue=2;spage=91;epage=93;aulast=Shah

Hodges, J. R. (2013, November 23). Memories are made of this. Oxford Academic.

Shapin, S. (2017, June 19). The Man Who Forgot Everything. The New Yorker.

Billington, A. (n.d.). Scott Rudin Developing Feature Film About Henry Molaison. FirstShowing.Net. a cue from The,in medical circles as H.M.


Subliminal Stimuli and its Neurological Affects

By Neha Menon

Published 6:12 PM EST, Fri April 16, 2021


Subliminal messages have been used since time immemorial, but researchers are yet to give a very concise explanation of, both, whether it works and if it does, how? In simple words, “any sensory stimuli below an individual’s threshold for conscious perception is called a subliminal message.” (Wikipedia)

Consciousness, put very plainly, is the state of being aware – aware of one’s surroundings, thoughts, emotions and the external & internal environment. On the contrary, the unconscious state of mind is one wherein there lies “a reservoir of feelings, thoughts, urges, and memories that are outside of one’s conscious awareness.”[1] This consciousness is enabled by the part of our brain called the cerebrum, whereas the unconscious actions are performed by the basal ganglia and cerebellum. This concept may be  attributed to Sigmund Freud – Austrian neurologist and the founder of psychoanalysis. The discussion of the conscious and unconscious state of our mind highlights the core topic of this article: subliminal primings or subliminal messages, which were brought to the mainstream media as early as 1957.[2]   However, extensive research and scientific opinions on this subject have only emerged in the recent years. This is discussed in further topics.

Primarily, subliminal messages work by nudging your unconscious. This would imply that by listening or looking at a subliminal message, we are gathering information or getting affected unconsciously. This is why, before we look at the ‘what, why and how’ of subliminal priming, we must understand the theories of the unconscious state of mind, which will give a great deal of insight regarding the direct workings of a subliminal message on the brain.

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“The mind is like an iceberg, it floats with one-seventh of its bulk above water.” — Sigmund Freud.

The Unconscious State of Mind

It would be beneficial to understand first that the conscious state of mind is finite. If we were to notice and process (consciously) everything that we see, hear or feel in a day, our brain would be far too overwhelmed and the retention of this information may be compromised. The unconscious, on the other hand, is vast – limitless – to say the least. Everything we see, hear or feel goes into our unconscious but doesn’t necessarily get processed. This means that the way we perceive something may not be the actual reality of it.

Secondly, it is important to note that the brain can only perceive something in the way and form that it first enters our mind. Meaning, imagine a picture, for instance, that could be perceived in two different ways based on how you look at it. Perhaps (as shown in the image below) : an old woman who, if and when the perspective is changed – looks like a young girl. Your brain may be able to identify these two ‘forms’ of the same picture but it will not be able to see both forms at the same time.

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Image credits: public domain

The “How” Of Subliminal Messages

Once we know how the unconscious mind works, we can move on to explore why and how subliminal messages affect our brain neurologically.

In subliminal messages, there are multiple items (audio/video/picture) that require relational processing. This may  be compared to the picture discussed above, which can be seen as two separate images. Relational binding hence calls upon the hippocampus – a complex brain structure embedded deep into the temporal lobe. It has a major role in learning and memory. Hence in this case, it can rapidly store novel relations for a longer term. Usually, it is known that the hippocampus is involved in the encoding and retrieval of consciously perceived information.

“However, growing evidence suggests that hippocampus operates independently of consciousness and that nonconscious relational learning is humanly feasible”[6]

While talking about the direct effects of subliminal stimuli on the brain, they robustly activate certain parts:

Amygdala – It is recognised for its role to process emotions. It is the part of the human brain best known for its ability to drive the ‘fight-or-flight’ response and also plays a vital role in memory. 

Insula – The insular cortex links sensory experience and emotional stimuli. It is also linked with conscious emotional feelings

Hippocampus – It plays a part in memory consolidation: the process of transferring new learning into long-term memory

Anterior cingulate – has been implicated in several complex cognitive functions, such as empathy, impulse control, emotion, and decision-making.

We see that most of the affected parts have a role to play in emotional valence or memory. It is these parts that are activated when your brain is exposed to subliminal messages.

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Subliminal Messages In The 1900’s

When the history of subliminal messages is regarded, we see that most of them were used in marketing, or advertisements. The following timeline shows some of the important milestones in the history of use and discovery of subliminal messages:

1943 – Subliminal messages were occasionally used on the radio and television programs. [3]   

1990 – Many researches showed little or no link in the subliminal messages and the psychology of the brain, while others started uncovering subtle effects. [3]   

2006 – Studies showed and proved that subliminal messages did work in several advertising scenarios.  [3]   

2007 – Subliminal messages for academic performance were uncovered and studied. [3]  

2010-2015 – Imaging proved that subliminal messages did affect several parts of our brain, including but not limited to the visual cortex and hippocampus[3].   

Other common forms of subliminal messages in recent years are:

  • Images being inserted into the frames of movies, trailers, commercials etc., for an extremely short amount of time in such a way that the brain cannot consciously comprehend it.
  • Audio messages inserted under louder audio messages in order to mask it.

The “Why” Of Subliminal Messages

Subliminal messages and stimuli have been used in several places for several different reasons. 

  • The most common of all, is advertising and marketing. Companies like Coca-Cola show a good example of subliminal messaging for marketing in the late 1900s. Here the words “Buy Coca-Cola” and/or “Buy Popcorn” were flashed into movie reels.
  • For political agendas, like the one in the George Bush campaign in 2000. The opponent, Al Gore, accused Republican campaign managers of including a subliminal message in an attack ad focusing on Gore’s proposed healthcare policies. The word ‘RATS’ was flashed quickly right before the presentation of the word ‘bureaucrats’. 
  • In Disney movies like Aladdin, The Little Mermaid and The Lion King. It is unclear what the agenda for these were, and whether they were intentional at all.
  • In more recent times, subliminal messages have been famously used as auditory sources – melodic rhythms in particular. These claim to be able to change several things in your physical and mental realms; from removing mental head-block to changing eye color or weight. It’s efficiency or lack thereof, is not proved yet.


Exposure to subliminal stimuli have been proved to have certain effects on the human brain through research and experimentation. The efficiency, however, is not ensured. According to a UCL research, subliminal messaging is most effective when the message conveyed is negative in comparison to when it is positive. [7] Certain subliminal stimuli (especially now that the concept has taken pace) may have harmful impacts on the brain. They cannot damage the brain per-se, but can have negative impacts on your subconscious mind.

Neha Menon, Youth Medical Journal 2021


Cherry, K. (2020, December 09). The Structure and Levels of the Mind According to Freud. Retrieved from[1]

6 Examples of Subliminal Advertising, from Spooky to NSFW. (n.d.). Retrieved from [2]

Stern, V. (2015, September 01). A Short History of the Rise, Fall and Rise of Subliminal Messaging. Retrieved from [3]    

Sigmund Freud. (n.d.). Retrieved from [4]  

Subliminal stimuli. (2021, February 16). Retrieved from [5]

Ruch, S., Züst, M. A., & Henke, K. (2016, August 20). Subliminal messages exert long-term effects on decision-making. Retrieved from[6]Ucl. (2018, November 15). UCL study: Subliminal messaging ‘more effective when negative’. Retrieved from [7]