The Emerging Neuroscience of Mind-Body Medicine

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For years as a hard-nosed neuroscientist, I’ve been baffled by the success of clinical techniques that my wife, Chris Gilbert M.D. Ph.D., has pioneered to diagnose and cure illnesses such as back pain, chronic fatigue, stomach ailments, and recurring respiratory infections.

The reason for my head-scratching is that many of Dr. Chris’s diagnostic tests and therapies involve no technology at all, and are brain-dead simple. The bench scientist and geek in me (sensory physiology/chrono-neurobiology) instinctively rebels against a no-tech approach to anything, let alone medicine.

In an age of biotech marvels such as MRI, gene therapies, and targeted immunotherapies, my inner scientist is certain that no-tech approaches can’t be nearly as effective as modern medical science.

But the maddening fact is, my wife’s techniques do often work—so well in fact—that the bulk of her patients come to her because visits to other doctors who employ the latest drugs, tests, and procedures have failed to yield lasting results.

A cornerstone of Dr. Chris’s approach is a belief that patients’ bodies know more about what is ailing them and how to achieve lasting cures than do the patients’ conscious minds. So although she will start by asking questions of a patient’s mind, such as “What is going on in your life?” she quickly transitions to a dialogue with a patient’s body.

What’s the difference between talking to the mind and talking to the body?


When she addresses a patient’s mind, Dr. Chris simply asks the patient a question, but when she addresses the patient’s body she will first coach the patient to “become” the body part that is suffering, such the lower back, then to respond in the first person as the lower back.

I once witnessed (with the patient’s permission) a dialogue between Dr. Chris and an ailing back that went like this:

Dr. Chris: Welcome to my office, Back, tell me how you feel.

Back: I am stiff all the time, with shooting pains. After the drive home from work, I get horrible spasms.

Dr. Chris. Thank you, Back. Do your spasms usually come after sitting for a long time?

Back: Yes!! I hate, hate, hate sitting.

Dr. Chris: Is there anything else you hate?

Back: I can’t stand my owner’s mother. When we go over for dinner she picks at him endlessly and I get really tense and tight. I want to stay away from that woman!!! I never want to see her again!!

Dr. Chris: Ok, now that I know what you hate, what do you like?

Back: Swimming! I love it when my owner does laps in the pool. I get warm and loose.

After observing such sessions and having been Dr. Chris’s patient myself (for stomach troubles), I have been shocked by how much patient’s bodies “know” what their minds don’t know, and how quickly a dialogue with the body can relieve symptoms.

For example, the patient in the Back-to-Dr.Chris dialogue professed ignorance about what was triggering his back spasms, only to immediately pinpoint specific triggers for his pain (such as sitting and a nagging mother) when he was queried as his back.

And that same patient, who walked into the office with a lower back so stiff that he couldn’t bend at the waist, loosened up almost immediately after the Back-to-Dr.Chris dialogue, as if venting of the true source of back pain (sitting too long and being with his mother too long) in and of itself was therapeutic.

Once I overcame my skepticism that such simple, direct techniques could actually work a lot of the time (although not always), I started asking myself:

How can neuroscience explain the success of Dr. Chris’s brand of mind-body medicine?

I confess that I didn’t have a good answer until recently when I stumbled upon two unrelated sets of research findings more or less at the same time.

The first body of research described implicit memory. It turns out that we are constantly learning things and storing them away in our unconscious without any conscious awareness that we are learning, or indeed, any overt knowledge of what we have learned.

Ken Paller and Joel Voss of Northwestern University, for example, have shown that unconscious learning occurs when test subjects passively observed kaleidoscope images while paying attention to something else. Moreover, those same subjects were able to make correct “intuitive” guesses based upon what they have learned, without having any conscious awareness that they had learned anything in the first place.

This finding, along with a host of similar results from other labs, implies that much of what we ascribe to gut feelings, hunches, or intuition are actually products of unconscious or implicit learning from past experiences. For example, Dr. Chris’s patient with lower back pain probably learned unconsciously that his back tightened up every time he went over to his mother’s house for dinner.

The second body of research that offered clues to the success of Dr. Chris’s methods, concerned the storage of long-term memories in the sensory cortex. These studies suggest that sensory experiences leave lasting memory traces in the very parts of the cerebral cortex that initially activate when the experiences originally occurred.

Putting the implicit learning and sensory memory research together (admittedly something of an intuitive leap) one could conclude that unconscious memories relating to sensations in a particular body part, might be stored in the region of the sensory cortex that activates when that body part experiences sensations.

Below is a brain map that shows the how areas of the body stimulate different areas of somatosensory cerebral cortex responsible that are responsible for processing touch, vibration, pain, and other sensations from different body parts. The somatosensory cortex occupies a gyrus (i.e., ridge) of the brain just behind the central sulcus (i.e, central fold/groove) called the post-central gyrus. Referring to this map, unconscious sensory memories from the back region (as designated by the blue arrow in the diagram below) would be stored near the top of the post-central gyrus, next to the hemispheric fissure that divides the left and right half of the brain.

So, what might be happening when Dr. Chris addresses a patient’s back (vs. the patient themselves) is that she is focusing the patient’s attention on somatosensory memories and associations stored in a particular region of the cerebral cortex and that the local activation in the somatosensory cortex occurs that when she does this helps release memories stored in the “back cortex” that would otherwise have remained unconscious.

True, I have no experimental data (such as fMRI brain scans showing somatosensory activation during Dr. Chris’s dialogues) to support this theory, so for the moment, it remains just a theory.

But at least the scientist in me is less baffled knowing that a plausible explanation for Dr. Chris’s successes in mind-body medicine is out there.

Based on lots of implicit learning accumulated watching Dr. Chris work, my gut intuition is that neuroscience has as much to learn from the success of her methods as she does from neuroscience.

Learn more about Dr. Chris’s methods and my neuro-scientific explanations of them in The listening cure: healing secrets of an unconventional doctor


Gandhi, S. (2001). Memory retrieval: Reactivating sensory cortex. Current Biology, 11(1), R32-R34. doi:10.1016/s0960-9822(00)00040-3

Gilbert, C. (2017). Listening Cure : Healing Secrets of an Unconventional Doctor. SelectBooks, Incorporated. ISBN:1590794370

Hasan, M., Hernández-González, S., Dogbevia, G., Treviño, M., Bertocchi, I., Gruart, A., & Delgado-García, J. (2013). Role of motor cortex NMDA receptors in learning-dependent synaptic plasticity of behaving mice. Nature Communications, 4. doi:10.1038/ncomms3258

Voss, J., & Paller, K. (2009). An electrophysiological signature of unconscious recognition memory. Nature Neuroscience, 12(3), 349-355. doi:10.1038/nn.2260

Image via Activedia/Pixabay.

Brain Blogger


Gambling Addiction: Is it as Bad as Cocaine?

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Is gambling an addictive pathology that causes changes in the brain and requires treatment? Or is it merely a compulsive behaviour? This question has long kept the medical world confused.

Traditionally, it was thought that addiction could happen only when a person is dependent on some physically existing substance. However, now this traditional way of thinking is changing. The brain seems to have a weakness of getting trapped by either a substance or experience that brings a reward, be it drugs, sex, eating, or gambling. Like addiction to substances, addiction to gambling can affect a person of any background, education level, and level of income. Many celebrities are known to be overindulging in gambling. The list includes Tiger Woods, Ben Affleck, and Pamela Anderson, to name just a few.

Once researchers agreed that pathological gambling exists, the question as to whether it is more like drug addiction or similar to other obsessive-compulsive disorders remained unanswered. Modern research seems to support the idea of higher similarity with substance addiction than with obsessive-compulsive disorder. However, it is entirely possible that pathological gambling is a heterogeneous disorder and thus shares the components of both conditions. Hence, in some people it may be more like an obsessive-compulsion, while in others it is similar to substance dependence.

Functional MRI studies seem to support the view that gambling addiction is more like a substance-abuse disorder. Therefore, in the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) is has been classified as a behavioral addiction. It does not necessarily mean that other types of this disorder do not exist, as this condition is still not fully understood from a medical point of view.

Why should gambling be considered an addiction?

Perhaps due to the absence of any physical substance, addition to experiences like gambling is more challenging to recognize until considerable harm is done. A large number of people addicted to gambling fail to accept this fact. Yet, it is no secret that gambling addiction can ruin life as effectively as substance addiction.

The person involved in gambling gets ‘high’ and finds it difficult to control or limit gambling, which is also characteristic of drugs addiction. Moreover, there are negative emotions similar to withdrawal syndrome when a person is deprived of the gambling activity. And finally, even the medications used to treat substance addiction have shown to be efficient in the management of gambling disorder.

Neural changes in gambling addiction

Any addiction is caused by the combination of several factors such as genetic causes, environmental issues, and social influences and problems.

Mesolimbic and mesocortical dopaminergic pathways are central to motivation, desire, and perception of pleasure. Dysregulation in the mesolimbic pathway (often referred to as reward pathway) is known to play a vital role in the development of addiction.

Research on pathological gambling is still ongoing; this phenomenon is still not fully understood from a neurobiological point of view. It is clear that in pathological gambling multiple neurotransmitter systems (including dopamine, serotonin, norepinephrine, opioid, and glutamate) and various brain regions are implicated (including the amygdala, nucleus accumbens, prefrontal cortex, and insula).

Addiction to gambling is the result of a pathological importance being attached to the activity. High level gambling and substance addicts give excessive motivational significance to the addictive activity. Glutamatergic projections from the prefrontal cortex to the accumbens is thought to be the neural pathway involved in provoking gambling seeking behavior. This anatomical path is found to play a role in most forms of behavior dysregulation and addiction. The prefrontal accumbens pathway is vital to providing motivational or reward salience and goal-directed behavior.

A few years ago, fMRI was used to compare the brain activity of people occasionally involved in gambling against those known to be suffering from pathological gambling. The scans demonstrated a significant difference in blood-oxygen-level dependent (BOLD) signals between the two groups in the superior temporal regions, inferior frontal, and thalamic region. Those pathologically addicted to gambling showed a distinct frontoparietal activation pattern triggered by gambling-related cues, which is known to play a role in the addiction memory network.

Treatment of pathological gambling

Though the prevalence of pathological gambling is much higher than many psychiatric disorders like schizophrenia, there is a lack of studies and trials aimed at finding the appropriate treatment for this problem. Still, there is a small number of studies that seem to favor the effectiveness of pharmacological treatment.

Drugs that have shown the ability to modulate dopaminergic transmission in the mesolimbic pathways, like opioid-receptor antagonists (e.g., naltrexone) have demonstrated effectiveness in trials. Antidepressants and mood stabilizers are the groups of drugs that may prove to be effective in overcoming gambling addiction.

Various clinical investigations have also examined the effectiveness of non-pharmacological treatments. It has been demonstrated that cognitive-behavioural therapy (CBT) could be one such option. Some studies have also investigated the usefulness of video conferencing for ongoing supervision, and the use of congruence couple therapy and therapies that have a holistic approach to the problem.

To sum up, the latest neurobiology studies confirm that gambling addiction is similar to substance addictions. It may also have serious implications for the person involved, yet little is known regarding how to effectively treat this problem.


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Image via whekevi/Pixabay.

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How Does Starting School Early Impact Educational Attainment?

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A singular cutoff point for school entry results in age differences between children of the same grade. In many school systems, September-born children, begin compulsory education in September of the year in which they turn five, making them relatively older than summer born children who begin school aged four.

Research on these annually age-grouped cohorts reveal relative age effects (RAEs) that convey the greater achievements accrued by the relatively old (RO) students compared to the relatively young (RY) students. RAEs are pervasive. Across OECD countries, in fourth grade, RY students scored 4–12% lower than RO students, while in eight grade the difference was 2–9% lower. RAEs are most evident in early formal education and can diminish as children mature. In 2016 for instance, Thoren, Heinig, and Brunner published a study on three grades attending public school in Berlin, Germany, and showed that the RAE in disappeared for reading by grade 8 and was reversed for math in favor of RY students.

Investigating the mechanisms involved is important because RAEs can remain evident in high-stakes exams taken at the end of compulsory education. RAEs may impact educational attainment, which is defined as an individual’s highest educational qualification (i.e., compulsory schooling, apprenticeship, or university education). For example, research by Sykes, Bell, and Rodeiro found that 5% less August-born GCSE students than September-born GCSE students chose at least one A level. Likewise, August-born students were 20% less likely to progress to university than September-born students. RO students also outperformed RY students on college admission tests to a university in Brazil, which significantly impacted the probability of being accepted to that university. Moreover, in Japan the percentage of graduates (aged 19–22 and 23–25) was two points greater for those born in April than those born in March. Collectively, these findings indicate that RAEs impact educational attainment because of their direct link to students’ acceptance to higher education. Since much of children’s development occurs within compulsory education, a natural question is whether educators act to alleviate or exacerbate RAE.

RAEs emerge primarily because of within-group maturity differences among RO and RY children (age-at-school-entry effect). RO children, have a one-year developmental advantage over RY children when they sit exams (age-at-test effect). Based on these advantaged test scores and maturation, RO children receive special opportunities from educators to excel in school. Using attainment, program participation, and attendance data from 657 students aged 11–14 from a secondary school in North England, a study by Cobley, McKenna, Baker and Wattie found that RO students were more likely than RY students achieve high scores across various subjects and be admitted to gifted programs. Even if RO students accepted to gifted programs are not actually gifted, the prestige of attending such programs would help them to foster strong positive self-esteem, which can persist over time. In turn, RO students may experience enhanced learning and praise long after small age differences are important in and of themselves.

Conversely, teachers lower their expectations of RY students because RY students appear less developed and intelligent than RO students. Interestingly, having RO classmates can prompt a spillover effect that boosts RY students’ grades, but also increases the probability that RY students will to be pathologized. This research suggests that RAEs emerge as a consequence of maturity differences but are maintained by the magnitude and persistence of social factors, such as educator-student interaction. Another study also reported RAEs in the diagnosis and treatment of ADHD in children aged 6–12 in British Columbia. Incorrect diagnosis can unnecessarily limit RY students’ academic performance by diminishing their self-esteem and task involvement, which are school achievement predictors.

If these inequalities decline over time, the influence of RAE on educational attainment is arguably minimal. However, if relative advantages such as skill accumulation persist in favor of RO students throughout formal education, RAEs translate into academic disadvantages for RY students. For instance, RY students’ negative self-perceptions of academic competence and learning disability can mediate the relationship between depressive symptoms and school dropout in adolescence. In turn, lack of formal education or poor academic performance makes entry to higher education arduous. Research illustrates with 16-year-old RY students scoring 0.13 standard deviations lower than RO students. This test score predicted that RY students would have a 5.8% higher potential dropout rate from high school and a consequently 1.5% lower college admission rate than RO students. Initial gains for RO students partly explain why they have a 10% greater probability of attending top-ranking universities and why they are more likely to graduate from university than RY students.

Research on the impact of RAE on educational attainment is not as straightforward as discussed thus far. Cascio and Schanzenbach used experimental variation by randomly assigning students to classrooms. Results showed improved test scores for RY students up to eight years after kindergarten and an increased probability of taking a college-entry exam. These positive spillover effects are evident when RY students, in a relatively mature peer environment, strive to catch up with higher-achieving RO students and end up surpassing them. Since RO students may strain under the expectations placed on them to be top of the class, RY students have an opportunity to catch up. Alternatively, RO students may not have the same incentive as RY students to work hard for academic success because RAEs already work in their favor. To overcome RAEs and succeed academically, RY students need greater persistence and attention than RO students in their schoolwork, which helps them gain a motivated mindset that benefits lifelong learning. For example, RY students in high school are more likely than RO students to study and compensate for poor academic achievement in middle school.

At a university in Italy, RY students obtained better grades than RO students. This reversal effect was also reported at university in the UK. The researchers postulated that due to RAEs, the RY students developed social skills more slowly. Therefore, RY students had less active social lives and more time to concentrate on educational attainment. The impact of RAEs on educational attainment is, subsequently, probabilistic not deterministic. Although research by Abel, Sokol, Kruger, and Yargeau indicated that RAEs do not affect the success of either RO or RY students’ university applications, they reported that more RO than RY students applied to medical school. In addition, Kniffin and Hank’s study did not find RAEs that influence whether a university student obtains a PhD. These two studies suggest that RAEs do not have such an important influence on college acceptance or educational attainment once in college. Instead, RAEs are a salient influence in so far as students in compulsory education obtain the necessary grades to apply to university in the first place.

The acquisition of higher mental functions and schooling over time helps normalize the student population by minimizing the attainment gap between RO and RY students, which helps explain why RAEs lessen in university. In addition, universities are often learning environments with great diversity in age (i.e., mature and repeat students), culture (i.e., international students), and academic achievement (i.e., doctorate/master’s students). Perceived developmental parities are inherently less important in university because classroom composition becomes heterogeneous, mitigating and masking the remaining relative age differences. Given this knowledge, greater classroom heterogeneity could be applied to compulsory education to minimize RAEs. Students in mixed-grade classrooms in Norwegian junior high schools, for example, outperformed students in single-grade classrooms on high-stakes school finishing exams. With this classroom composition, it is not disproportionately skewed in favor of younger/older students, the losses for RO students following class mixing would not outweigh the gains of the RO students. With more heterogenous classes, educational attainment could subsequently become less influenced by RAEs and a more equalized pursuit.

Since mitigating the impact of RAE on educational attainment depends partly on the strength of compensating investments such as classroom environments, streaming remains controversial. Academic streaming involves separating students according to innate ability. In reality, streaming is based on students’ prior academic performance, which is an imperfect measure of ability that can lead to misallocations. Streaming in early education can be particularly unfair because RY students do not get the opportunity to more closely approximate older classmates’ mental and physical development when sitting exams. In Germany for instance, being relatively old increased test scores by 0.40 standard deviations, increasing the probability of attending the highest secondary school track (gymnasium) by 12%. RY students are also at risk of being unfairly streamed into lower-ability classes because they are more likely than RO students to be diagnosed with behavioral problems and learning disabilities. Streaming thereby provides students with unequally differentiated educational experiences of teaching, competition, and opportunity that limit their academic exposure. Therefore, postponing streaming can reduce the impact of RAEs on educational attainment by ensuring that any developmental gaps have time to narrow.

Unequal educational experiences can limit RY students’ educational attainment. In 2015, the average number of 25–64-year-olds with tertiary education was greater for countries who exhibit almost no streaming, such as Ireland (42.8%), compared to the OECD average (35%). Is it the case that streaming at multiple stages can rectify initial misallocations while still enhancing academic achievement? In Austria, children are streamed in grade five (aged ten) and in grade nine (aged fourteen). In one study, RY students in grade five were 40% less likely to be streamed into higher classes, but the second streaming, in grade nine, helped mitigate RAEs by giving students the opportunity to upgrade to a higher stream. In a complex interplay, streaming and RAEs can reinforce and be reinforced by existing socioeconomic inequalities. In this vein, the researchers concluded that RAEs only disappeared for students with favorable parental backgrounds in the second streaming. In contrast, RY students with unfavorable parental backgrounds were 21% less likely than RO students to move to a high-ranking school. As previously mentioned, learning at the wrong academic level can strain academic achievement and reduce the chances of continuing to higher education.

Socioeconomic status is the extent to which learning opportunities are disadvantaged as a result of low-income. Socioeconomic status can exacerbate the impact of RAEs on educational attainment. Huang and Invernizzi’s research examined a cohort of 405 students in a high poverty, low performing school from the beginning of kindergarten until the end of grade two. Results concluded that early-age literacy achievement gaps between RO and RY students narrowed over time but did not fully close by the end of grade two. Similarly, a Madagascar-based study by Galasso, Weber, and Fernald indicated that differences in home stimulation are dependent on the wealth gradient and accounted for 12–18% of the predicted gap in early outcomes between advantaged and disadvantaged children. At least in early education, these findings suggest that diminished academic performance and exacerbated RAEs are in direct proportion to socioeconomic status. Thus, greater flexibility regarding age at entry in compulsory schooling could help lessen the impact of RAE on academic performance.

Suziedelyte and Zhu published a “Longitudinal Study of Australian Children” and reported that starting school early benefits children from low-income families who, compared to children from high-income families, have limited access to learning resources at home and formal pre-school services. However, a three-month postponement of the cutoff enrollment date (increasing grade age) can increase both academic success and the likelihood of repeating a grade. Similarly, a one year delay in school enrollment (redshirting) can produce a 0.303 standard deviation decrease in test scores and lead to significantly lower math scores for students identified with a disability when compared to nonredshirted students with disability. These mixed findings suggest that equalizing educational attainment opportunities among RO and RY students, by implementing a flexible entry cutoff point, varies as a function of individual difference. Therefore, managing and mitigating RAEs requires greater sensitivity to confounds such as socioeconomic status.

The impact of starting school early on educational attainment is mediated by social factors, school policy, and socioeconomic factors, resulting in individual differences in learning outcomes. RAEs fade throughout formal schooling and can even reverse in higher education. The relative age phenomenon, nevertheless, caveats that ascribing merit to students based on relative age can lead to the provision of unequal learning opportunities and harmful pathologies. Unfortunately, the mechanisms that underpin the impact of RAEs on educational attainment are currently quite speculative and inconclusive. In this sense, existing findings warrant further empirical research and reveal the need for more comprehensive methods for determining an appropriate school entry cutoff point.


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Thoren, K., Heinig, E., & Brunner, M. (2016). Relative Age Effects in Mathematics and Reading: Investigating the Generalizability across Students, Time and Classes. Frontiers In Psychology, 7 (n/a).

Zhang, S., Zhong, R., & Zhang, J. (2017). School Starting Age and Academic Achievement: Evidence from China’s Junior High Schools. China Economic Review. doi:10.1016/j.chieco.2017.03.004

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The Dangers of American Sexual Prudishness

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Is the US the world’s most uptight nation regarding sex? Maybe not the most, but certainly among them. For example, the US has more laws regulating sexual behavior than all European countries combined. US prudishness is so severe as to be deadly. To end sexual violence and harassment against women, something has to change.

Is America the World’s Most Uptight Nation When It Comes to Sex?

Less than half of girls and boys in the US have received the HPV vaccinations that can protect them from deadly cancers. Why? Because HPV is a sexually transmitted infection (STI), and discussing teen sexual activity is taboo. Many doctors refuse to recommend the vaccine because they are uncomfortable discussing STIs.

Related to this prudishness is the view that women’s bodies are purely sexual and therefore all female nudity is provocative and shameful. Even public breastfeeding makes most Americans uncomfortable because a woman’s breast is exposed.

This prudishness about women’s bodies claims to be “protecting” women. At its heart, however, it is about power rather than sex. The “protection” it provides is both seductive and insidious. Seductive, because many women find it comforting to imagine that men are protecting them from danger, even strangers such as legislators—insidious in its implications.

Whom do we protect? Children and adults who are too young, inexperienced, weak, or incompetent to protect themselves. Putting a normal adult woman into this category disempowers her, ensuring that someone else can dictate the most intimate conditions of her life: how she dresses, where she can go alone, whether she has final authority over her own body.

Prudishness also justifies a perceived division between “good” and “bad” women. The former are  modest, compliant and “covered up.” The latter, bold, proud, and independent. That separation buttresses men’s sense that they can treat “bad” women badly. Because the women are “out there,” they can be objectified, attacked, harassed, groped. The result is evident, as the tidal wave of sexual violence and harassment reports continues to grow.

Despite broad recognition of this public health epidemic and dedicated efforts to end sexual violence and harassment, few programs have been successful. The problem is that they are fighting an uphill battle against the prevailing social mores described above. If men are inherently more powerful than women and can define “good” and “bad” women, the only way to end sexual assault and harassment is to convince men they should not assault women. Otherwise, the only option is to mitigate the impact by convincing bystanders to intervene, or training women to defend themselves.

We need a completely new approach. Let’s consider societies with two striking cultural differences from the US. These cultures hold that women are equal to men and that women, from teenhood, should have complete control over their own bodies.

Consider the Kreung society of the lovely Ratanakiri (“Mountain of Jewels”) Province in Cambodia. The Kreung believe that healthy, loving marriages require women who are strong, self-assured, and have self-confidence about their sexuality. Parents help each teen daughter achieve this state by giving her a room of her own. She can invite a boy she likes to spend the night in her room. There, she makes all the rules and reigns supreme. Will they talk the night away? Sleep? Cuddle? Have sex? She alone decides. In this completely secure space, she is free to explore her own sexuality, to discover what pleases her. When she says, “No,” he obeys instantly, without argument or bad feelings. A boy who flouts this rule faces severe penalties from the entire community, as do his parents.

Take another interesting group, the Vanatinai, a small island society off New Guinea. There, women and men are equal in all major aspects of life: decision-making, ritual practices, spiritual power, property holdings, and sexual activity. By working hard to gain goods and giving them away through ritual generosity, anyone of any sex can become one of the authoritative and influential leaders known as “gia”. Everyone is free to engage in sex before marriage, to end a marriage, and to marry as often as, and with whomever, he or she wishes.

The result? Divorce is rare in these societies; sexual violence virtually unknown.

The Takeaway

Sexual violence and harassment are rooted in the very foundations of culture. It is not enough to tell men they should not indulge, or bystanders that they should intervene, or women that they should protect themselves. Ending sexual violence and harassment requires a fundamental shift in cultural attitudes and values, beginning with equality between women and men, and women’s complete control over their own bodies. This change includes ending the putative “protection” of women—including laws to restrict abortion, to regulate women’s attire in ways that are different from those for men, or other social and legal constraints that claim to “protect” but actually disempower and diminish women. Only such basic cultural and legal changes will make it possible to end sexual violence and harassment against women.

References (2017). Sexual Violence: Prevention Strategies. [online] Available here.

Lepowsky, M. (1993). Fruit of the motherland. New York: Columbia University Press.

Mullin, E. The Cancer Vaccine That Too Many People Ignore. (2017). MIT Technology Review, 120 (6), pp.16-17.

Muong, V. (2014). ‘Love huts’ of Ratanakiri minorities: Is a tradition quietly slipping away?. The Phnom Penh Post.

Procida, R. and Simon, R. (2007). Global perspectives on social issues. Lanham, Md.: Lexington Books.

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The Neuroscience Behind the Placebo Effect

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As a child, did you ever feel better after your mother kissed your bumped knee? How do you think that worked? The power of suggestion—or the placebo effect—is a powerful psychological phenomenon that affects every aspect of our lives, dictating our preferences for food, drink, medication, social activities, and more.

Pioneering experiments describing the use of sham drugs date back to the late 18th century. A version of John Quincy’s Lexicon Medicum published in 1811 defines the placebo as ‘an epithet given to any medicine adapted more to please than to benefit the patient’. However, physicians of the past tended to use forms of treatment that they assumed were ineffective, as opposed to the modern day usage of inert substances.

A wide variety of conditions have been proven to be amenable to placebos, including depression, sleep disorders, Parkinson’s disease, and pain2. The placebo effect has been shown to impart tangible changes on the immune system similar to those who received real medication, where patients given syrup had increased white blood cell counts. Remarkably, patients with Parkinson’s disease stopped experiencing tremors and muscle stiffness after taking inert sugar pills. The success of mirror therapy in relieving phantom pain in amputees can be thought of as another example of the power of suggestion.

How our minds are fooled is not fully understood. The placebo effect may be an evolutionary adaptation that allows the brain to make quick decisions and assumptions about the environment. Consider this: if we had to analyse every single stimulus that our environment threws at us, we’d go mad in no time.

Scientists have identified that the psychological mechanisms of the placebo effect lie in both conscious expectations and learning. Although learning and expectations are not mutually exclusive, they are heavily dependent on each other.

To explain, when we expect a drug to reduce pain levels, our brains release endogenous endorphins that in turn are responsible for alleviating pain. On the other hand, the learning process involves integrating environmental and social cues in order to generate an internal expectation and subsequent placebo response. Experiencing repeated patterns of learning conditions (as in classical conditioning – think Pavlov’s dogs), causes a person to respond in a way that has spill-over-effects effects that influence unconscious physiological processes.

Multiple studies have singled out the ventromedial prefrontal cortex (vmPFC) as a main player in mediating the placebo effect. Other areas of significant importance are the dorsolateral PFC, lateral orbitofrontal cortex, periaqueductal grey area, rostroventral medulla, and nucleus accumbens-ventral striatum.

In short, the complex underlying neuronal circuits involve the higher functioning areas of the brain (frontal cortices) and the seat of unconscious processes such as breathing, the brainstem. Interestingly, rsearch reports that the placebo effect is absent in those with Alzheimer’s disease (due to degeneration of the frontal cortex) and in patients subjected to external suppression of frontal cortex function via transcranial magnetic stimulation.

The endogenous opioid system and its role in placebo-induced analgesia is perhaps the best studied neurotransmitter system involved in the placebo effect. Naloxone, an opioid receptor antagonist, has been found to nullify the effects of placebo pain-killers. Other systems that have been implicated include the cannabinoid system.

These neuroanatomical and neurobiological findings likely have much room for growth and refinement considering that different placebo responses have been found to invoke different parts of the placebo circuit.

Given the complicated psychological mechanisms behind the placebo, it comes as no surprise that various factors are able to modulate its strength. Social context has a real impact on the placebo effect, as it fosters preconceived notions regarding treatment. For example, several trials showed that similar benefits were experienced by both groups of patients who underwent either traditional or sham Chinese acupuncture (the latter involving superficial needling at non-acupuncture points). The physician attitude and appearance of competency, as well as the cost, branding, shape, size, color, and taste of the pills were able to affect the perceived treatment efficacy.

It is common beleif that one must be unaware of the placebo in order for the placebo effect to work. Not so, argue a group of researchers from the University of Basel (Switzerland) and Harvard Medical School. They demonstrated that participants who were told that they were getting placebos and who received detailed explanations of the placebo effect experienced significant relief from heat-induced pain compared to those that were not told that they were given bogus drugs.

These surprising results underscore the formidable effects of the placebo effect and how much more there is still left to learn. Furthermore, this study opens doors to more ethically designed placebo-controlled studies. Withholding potentially beneficial treatment from patients in placebo-controlled trials is considered inherently unethical. However, with this study, it appears that full disclosure may not be that different to the traditional practices of keeping placebo patient groups in the dark.

In order to manipulate the placebo effect for clinical benefit, the notion of placebo responders and non-placebo responders was investigated. Are some people more amenable to the power of suggestion than others? If so, is it due to unchangeable genetic makeup or individual personality? Other questions that come to mind regard the persistency of the placebo effect. For how long does it last and does it transfer to other types of placebos? To illustrate, will a person responding to placebo painkillers for pain relief also respond to placebo antidepressants for improved moods?

In conclusion, we know that the placebo is a strong weapon in the clinician’s armamentarium. Despite that, the unpredictable variability of its effects obligates future research that enables us to get a better understanding of exactly when and for how long the placebo effect will work.


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Price DD, Finniss DG, Benedetti F. A comprehensive review of the placebo effect: recent advances and current thought. Annu. Rev. Psychol. 2008. 59:565–90. doi:10.1146/annurev.psych.59.113006.095941

Colloca L, Miller FG. How placebo responses are formed: a learning perspective. Philosophical Transactions of the Royal Society B: Biological Sciences. 2011;366(1572):1859-1869. doi:10.1098/rstb.2010.0398.

Geuter S, Koban L, Wager TD. The cognitive neuroscience of placebo effects: concepts, predictions and physiology. Annu. Rev. Neurosci. 2017. 40:167–88. doi:10.1146/annurev-neuro-072116-031132.

Wager TD, Atlas LY. The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci. 2015 Jul;16(7):403-18. doi:10.1038/nrn3976.

Miller FG, Colloca L, Kaptchuk TJ. The placebo effect: illness and interpersonal healing. Perspectives in biology and medicine. 2009;52(4):518. doi:10.1353/pbm.0.0115.

Buckalew LW, Coffield KE. An investigation of drug expectancy as a function of capsule color and size and preparation form. J Clin Psychopharmacol. 1982 Aug;2(4):245-8. PMID: 7119132

Howe LC, Goyer, J. P., & Crum, A. J. Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response. Health Psychology. 2017;36(11):1074-82. doi:10.1037/hea0000499.

Locher C, Frey Nascimento A, Kirsch I et al. Is the rationale more important than deception? A randomized controlled trial of open-label placebo analgesia. Pain. 2017 Dec;158(12):2320-2328. doi:10.1097/j.pain.0000000000001012.

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Marijuana And Sexual Dysfunction — Could Your Marijuana Usage Be Hindering Your Performance in Bed?

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What is marijuana? Marijuana, also called pot, cannabis, weed, reefer, Mary Jane, dope, broccoli, chronic, reefer, and 420, among countless others, consists of a mixture of dried plant leaves, flowers, and/or stems of the Cannabis Sativa plant. In addition, there is a resin-based version of marijuana that is called hash. Most people either smoke marijuana or vape it (warming it, but not cooking it), but it can also be ingested in oil form. The most common way to ingest marijuana is to roll it up and smoke it like you would a cigarette or cigar, or use a smoking tool like a pipe. Some users, however, consume weed by infusing foods (i.e., butter and cooking oil) or teas.

What happens to your body when you ingest marijuana? THC (tetrahydrocannabinol) is the most active ingredient in marijuana. When you smoke this herb, it travels to your lungs before entering your bloodstream. Once in your blood, it travels to your brain and other organs (i.e., heart, tissues, etc.). FYI: Drinking or eating marijuana can delay the effects of THC. But, once it bonds with your brain’s neural receptors you become “high.”

THC can also affect the sections of your brain that control memory, thinking, concentration and focus, and coordination. When this occurs, it can trigger unpleasant side effects like distorted thinking, delayed learning, lethargy, increased appetite, low inhibitions, hallucinations, distorted perception, clumsiness, and memory loss. These side effects are normally temporary; however, they can still lead to dangerous consequences, especially if you drive while under the influence.

Is marijuana legal in the U.S.? Yes and no. The state legalization process (for medical marijuana) first began during the seventies. But, unfortunately, even though the process started 40-plus years ago, there has been very little progress on this front, in many states. Why not? Because each state is tasked with developing and enforcing its own laws, rules, and regulations.

Ironically, marijuana possession (in small amounts) has been legalized in other parts of the world (i.e., Czech Republic, Canada, and Israel), yet only 29 states (Oregon, Montana,  Alaska, Ohio, New Mexico, Arkansas, California, Illinois, New York, Colorado, Delaware, Washington, DC, Connecticut, Florida, Hawaii, Illinois, Maryland, Michigan, Vermont, Minnesota, Nevada, New Hampshire, New Jersey, Arizona, Maine, North Dakota, Pennsylvania, Massachusetts, Rhode Island, Washington, and West Virginia) have moved to decriminalize the herb for medicinal purposes.

It is important to point out that medical marijuana has not been thoroughly tested due to government regulations and production limitations. However, research suggests that it may ease nausea and vomiting during chemo treatments, alleviate chronic pain, boost appetite in those with HIV/AIDS, and relieve muscle spasms. In November 2016, Nevada, Massachusetts, California, and Maine also passed measures to legalize recreational marijuana.

Common Sexual Dysfunctions and the Effects of Marijuana

What are sexual dysfunctions? Sexual dysfunctions, also known as erectile dysfunction (ED), sexual disorders, premature ejaculation (PE), sexual malfunctions, and sexual arousal disorders, are issues that can occur during any stage of the sexual response cycle (i.e., anticipation, plateau, orgasm, and decline). This issue can prevent couples from experiencing sexual fulfillment during sexual intercourse.

What are the different types of sexual dysfunctions? They usually involve four categories: (1) desire disorders (a lack of sexual desire or a loss of interest in sex); (2) arousal disorders (an inability to become or stay aroused during sex or sexual activities; (3) orgasm disorders (unable to climax (orgasm) or a delay in climaxing); and (4) pain disorders (pain that occurs during sexual intercourse).

Should I use marijuana for my issue? Regarding marijuana and sexual dysfunction, THC can negatively affect penile function, possibly leading to premature ejaculation. How? Well, there are receptors in a man’s penile tissue that when confronted with THC, increases the risk of erection and orgasm issues. Why does this happen? Marijuana boosts dopamine levels in the body. Dopamine regulates moods and emotions. If you get accustomed to really high levels of dopamine, you may subsequently find that your natural level of this hormone may not be high enough to sexually stimulate you, thus, making it harder for you to maintain an erection.

Is it Even Safe?

Is it safe to use pot for sexual dysfunctions? Unfortunately, the answer is complicated. Study results have been both inadequate and variable. For instance, a recent La Trobe University study interviewed over 8000 Australian men and women, between 16–64 years old, to determine how marijuana usage could affect sexual function. Researchers focused on condom use, sexual partners, sexual dysfunctions, and sexual-transmitted diseases (STDs).

Results indicated that men, who use marijuana daily, are four times more likely to have orgasm problems and three times more likely to experience premature ejaculation, than men who do not use it or don’t use it regularly. In addition, researchers also found that daily male marijuana users are at-risk for delayed orgasms. So, why do men use it if it has serious side effects? Well, the researchers of the La Trobe University study believe that some men with premature ejaculation use marijuana because they believe that the herb will help them “last longer” – the reality is, however, that for many men, it actually worsens their conditions, causing them to ejaculate even faster. The common practice methods used to fix premature ejaculation don’t involve the use of marijuana.

Similarly, another study on sexual dysfunctions and marijuana found that marijuana usage is linked to lower testosterone levels, which is a contributor to erectile dysfunction. Like the previous study, the results also suggested that cannabis (marijuana) is associated with orgasm problems like premature ejaculation and an inability to achieve orgasm. Likewise, a 2010 study found that marijuana can affect sexual functions by disrupting the part of the nervous system that regulates erections, thereby, possibly leading to sexual dysfunctions like erectile dysfunction and premature ejaculation.

What are the Signs of Overuse?

To better understand the possible signs of overusing marijuana, it is important to answer the following questions. Have you gained or lost any weight, since using marijuana for sexual dysfunction? Do you need a higher amount of pot to get the same results, i.e., “last longer?” Are you spending exorbitant amounts of money on this herb hoping it will improve your sexual performance? Do you suffer from terrible withdrawal symptoms (i.e., cravings, insomnia, increased hunger, mood swings, irritability, depression, and/or anxiety) when you ease up on it or quit taking it all together? And lastly, is it creating a disturbance at work and/or issues in your relationship?

The truth is, most people believe that marijuana, in general, is harmless, but this is certainly not the case when it is being overused for sexual dysfunctions. Dr. Juan Paredes, a South Beach Clinic board-certified psychiatrist, specializing in male sexual dysfunctions, asserted that one of the major consequences of marijuana overuse, when treating sexual dysfunctions, is that it can lead to extremely weak orgasms, premature orgasms, or no orgasms at all.

In summary, marijuana usage and allowances have started to relax in some states and countries. And, legal restrictions and people’s perceptions of the herb have also eased over the last ten years. Because there is an increased acceptance of marijuana usage for a variety of reasons (i.e., from recreational to medicinal), it is important to learn the possible consequences of regularly ingesting it. Why? Well, because more and more studies are finding that there is a relationship between marijuana and male sexual dysfunctions. And, although smoking, eating, or even drinking marijuana may relieve some symptoms for some men, for others, it could end up being a disaster waiting to happen—in the bedroom.


Pro Con. (2017). 29 Legal medical marijuana states and DC. Retrieved from here.

Wu, B. (2017). Marijuana and erectile dysfunction: What is the connection? Medical News Today. Retrieved from

Harclerode J. (1984). Endocrine effects of marijuana in the male: preclinical studies. National Institute on Drug Abuse Research Monograph Series, 44, 46-65. Access here.

Smith, A. M.A., Ferris, J. A., Simpson, J. M., Shelley, J., Pitts, M. K. and Richters, J. (2010). Cannabis use and sexual health. The Journal of Sexual Medicine, 7, 787–793. DOI: 10.1111/j.1743-6109.2009.01453.x

Localization and Function of Cannabinoid Receptors in the Corpus Cavernosum: Basis for Modulation of Nitric Oxide Synthase Nerve Activity

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Re-Learning the Joy of Living with Journaling and Meditation

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Moving along the treadmill of life, many of us succumb to the ever-present pressures to be faster, stronger, more efficient, and smarter. Perspective on what is happening in our lives is lost. We focus on failure and lacking within ourselves, rather than the abundance and opportunities for growth that surround us.

We stop taking the time to appreciate the simple pleasures of our lives as we spiral our way into a depleted existence—physically, emotionally, and mentally. Now more than ever, there is a global need to circumvent this pattern of being. We need to learn to unconditionally love and appreciate ourselves just as we are, how we are.

Growing Epidemic

Traditionally, it was believed the cause of stress, anxiety, and depression was attributable to genetic disposition, personality traits, the existence of stressful events, physical health problems, and substance abuse, as well as serotonin, dopamine, and epinephrine imbalances within the brain. Whilst this is largely still the case, this perception has altered over the last decade or so.

In our fast-paced world, we judge ourselves as harshly as we judge others. We are encouraged and manipulated to compete with others with whom we continually compare ourselves. We try so hard to emulate or exceed expectations placed upon us that we forget our personal needs in the process (no time for that!). Stress and anxiety often manifest as a result as we try and prove our worth to the world, and depression looms when we judge ourselves as falling short of the benchmark that is set for us to achieve.

Prolonged periods of stress wreak havoc on the human mind and body. Chronic muscle tension leads to tension headaches and migraines. The cardiovascular, respiratory, and endocrine systems become over-taxed and the risk increases for the development of diseases like asthma, type 2 diabetes, and heart disease (just to name a few).

In recent times the media has reported stress, anxiety, and depression as reaching epidemic proportions, reportedly attributable to numerous causes including an increase in hours in front of computer screens, national and cultural competitiveness, the exposure to a broadening range of choices due to advances in technology, and the belief that worthiness is related to monetary success.  Additionally, there is a sense of “collective stress” in regards to issues such as climate change and terrorism.

Mindfulness & Self-Reflection

Whilst living a faster pace, society has forgotten the art of living in the present moment, and yet there is much evidence to support that engaging in mindfulness and self-reflection enables sufferers to break the cycle of anxiety, stress, and depression as it promotes a greater sense of well-being and perspective.

Those who engage in the art of mindfulness and self-reflection can improve their ability relate to the world around them in a more compassionate and empathetic manner.  A feeling of gratitude, joy, and abundance is also often a pleasant side effect.

The Value of Meditation & Journaling

Studies have shown that journaling can positively impact a person’s mental health as it allows one to “capture” a thought for long enough to acquire a 360-degree perspective on what that thought is about, where it came from, and how acting on that thought might impact those around us.

Many forms of meditation, like mindfulness meditation, work particularly well with journaling as it takes the mind out of a conscious, judgmental state and into a reflective, sub-conscious state. Such meditative practices smooth the path for writing down thoughts and feelings by prompting less judgment of the thoughts being written down.

Meditative practice can be merely taking five minutes to go for a walk in the park or to focus on breathing patterns—anything that promotes being in the present moment. Likewise, there are many effective journaling techniques that may help people with self-reflection and mindfulness that work well with meditation, and they are not restricted just to writing.

For many, mindfulness can be achieved through writing, art, photography – any means that allows a person to step into a reflective zone. It is for an individual to explore what takes them to that special place where they can set down their emotional and mental baggage to touch base with their soul, and nurturing a sense of gratitude and appreciation for all the simple attainable pleasures within day to day life.


University of Michigan Depression Center, Depression Journaling

Tams, L, Journalling To Reduce Stress (1 May, 2013) Michigan State University Extensiona,

Hidaka BH, Depression as a disease of modernity: explanations for increasing prevalence, 2013,

McCormack, A, “Lovitude: Trying To Calm The Monkey Mind”, 2016, Peacock Dreaming Publications, Nelson (NZ)

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