Digitizing Cognitive Enhancement: The Future of Brain Training Software

The Brain Training Software Market was valued at USD 2.97 billion in 2024 and is projected to reach USD 3.32 billion in 2025, with an anticipated growth to USD 9.28 billion by 2034. This reflects a compound annual growth rate (CAGR) of 12.72% during the forecast period from 2025 to 2034.

The Brain Training Software Market is experiencing steady growth as increasing awareness of cognitive health fuels demand for tools that enhance memory, focus, and mental agility. These software applications are designed to stimulate various cognitive functions through exercises, games, and puzzles targeting neuroplasticity. With growing interest in brain fitness among students, working professionals, and aging populations, the market is gaining traction across healthcare, education, and consumer sectors.

The global market is being propelled by an aging demographic, the rising prevalence of mental health issues, and the integration of AI and gamification in digital brain training tools.

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Market Scope
Brain training software encompasses programs developed to improve:

Memory

Attention

Processing speed

Problem-solving

Executive functioning

These are delivered via:

Mobile apps

Web platforms

Therapeutic software for clinical settings

Target users range from children with learning disabilities, working adults aiming for cognitive enhancement, to seniors preventing cognitive decline. Applications span personal wellness, education, neuroscience research, and rehabilitation therapy.

Regional Insight
North America leads the market due to strong tech infrastructure, high awareness of brain health, and presence of major players.

Europe is also a significant contributor, especially in healthcare-based applications, supported by aging demographics and government-funded cognitive wellness initiatives.

Asia-Pacific is the fastest-growing region, driven by a large elderly population in countries like Japan and China, expanding internet access, and rising mental health awareness.

Latin America and MEA show emerging potential as mobile penetration and digital literacy increase.

Growth Drivers and Challenges
Growth Drivers:
Aging Population: Rising concerns about cognitive decline and Alzheimer’s are pushing demand among seniors.

Mental Health Awareness: Increased understanding of brain health’s link to overall well-being.

Gamification & AI Integration: Engagement-boosting features and personalization through machine learning.

Remote Learning & Work: Greater use of brain training tools for students and professionals seeking mental sharpness.

Challenges:
Lack of Clinical Validation: Many apps lack FDA approval or peer-reviewed studies proving effectiveness.

User Retention Issues: Low long-term engagement due to repetitive content or lack of visible results.

Privacy Concerns: Sensitive cognitive and behavioral data requires high security and compliance.

Opportunities
Healthcare Integration: Expanding use in cognitive therapy and preventive care settings.

Corporate Wellness Programs: Employers are investing in employee mental fitness tools.

AI-Driven Personalization: Adaptive training based on user progress and neuroscience-backed data.

Localization: Customizing software for different languages, cultures, and educational systems.

Key Players Analysis
Lumosity (Lumos Labs): One of the most recognized brands with a wide range of brain games.

CogniFit: Offers clinically validated tools for cognitive training and assessments.

Elevate: Focuses on daily brain exercises for productivity and communication.

Peak (by Brainbow): Known for its mobile-first approach and visually engaging interface.

NeuroNation, BrainHQ, Mensa Brain Training, and Fit Brains (by Rosetta Stone) are other notable players. These companies are investing in neuroscience research, AI integration, and UX/UI to stay competitive.

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Conclusion
The Brain Training Software Market is set to expand steadily as consumers increasingly seek cognitive improvement solutions amid a digital-first lifestyle. While challenges such as scientific validation and retention exist, the integration of AI, the rise of health tech, and a focus on mental well-being create substantial growth opportunities. As the market evolves, success will depend on delivering effective, engaging, and personalized experiences grounded in cognitive science.

The Global Sciatica Treatment Market is set to grow from $5.42 billion in 2025 to $11.64 billion by 2035, with a 10.4% CAGR.

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The Neuroscience Market size was valued at USD 31.52 Billion in 2024 and the total Neuroscience revenue is expected to grow at a CAGR of 3.9% from 2025 to 2032, reaching nearly USD 42.81 Billion.

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CHRONIC PAIN-
Mind-Body Approaches to Coping With Pain.
Pain treatment can be optimized by involving mind and body.
Reviewed by Davia Sills

KEY POINTS-
Chronic pain can wear you down emotionally and mentally.
Focusing only on the physical element of pain is one of the factors in many cases of narcotic overuse, with serious consequences.
An anti-inflammatory diet that includes whole grains, healthy fats, lean protein, and berries can reduce inflammation and help decrease pain.
Neuroscience research tells us that becoming mindful for less than an hour during your day can help ease symptoms.

If you’ve ever stubbed your toe or touched a hot stove, you’ve experienced acute pain. An injury or natural process can cause this type of pain, but it goes away relatively quickly.

If your pain lasts three months or more, most healthcare providers agree on calling it chronic pain. It’s something you live with for a while and doesn’t go away. This experience can wear you down emotionally and mentally. Many common conditions, such as arthritis, migraine, fibromyalgia, and cancer, involve chronic pain.

Pain’s mental and emotional toll
A sudden injury can be scary. You may experience shock or even post-traumatic stress.1 Living with chronic pain can create anxiety, depression, and overuse problems with medication, alcohol, and other substances.

Experiencing pain affects our thinking and emotions. In turn, these responses can affect your healing. When Dave, a firefighter, strained his back at work, a doctor prescribed pain medications and time off. On leave, Dave filled the hours by catching up with his favorite sports teams and drinking a few microbrews to relax.

Then his mother died suddenly. Dave began drinking more and more. His back pain was intensified by the stress of grief and sorting out his mom’s affairs, and he requested more pain medication.

Fortunately, Dave’s doctor practiced whole-person health. “What’s going on?” he asked. Dave was otherwise healthy, and his physical therapist had reported the injury was healing well.

That simple question was enough. Dave broke down in the office talking about his mom. Then he and his doctor created a mind-body approach to his physical and emotional pain. It included returning to work on light duty and scheduling some sessions with a counselor who was experienced in helping people with loss and grief.

Finally, Dave talked with his younger sister about how sad he was. As the older sibling, he had always filled the role of protector, never admitting to weakness. Talking with his sister allowed her to offer support for a change. Together, Dave and his sister worked on clearing out their mother’s home and preparing it for sale.

We can easily imagine a different path. Focusing only on the physical element of pain—Dave’s back—is one of the factors in many cases of narcotic overuse, with serious consequences.

Optimize pain treatment with mind-body approaches.
If you burn your hand on a hot stove, your first impulse is probably to cool the burn. You may wave your hand through the air to create a cooling draft or stick it under cool water. Then, you may try to distract yourself from the pain by watching a favorite show or talking with a friend. Using these mind-body approaches can calm your mind and relax your body.

The strategies we naturally adopt with acute pain can help with chronic pain as well. If you have been in pain for three months or longer, ask yourself, “How is my treatment working?” Communicate with your healthcare provider about what the options are.

Aaliyah, who has chronic migraine, used this approach. She scheduled a video visit to ask her doctor about her prescribed medication and ask about other options. She also asked about her use of non-prescription medications, which can lead to a condition called rebound headache.

Next, Aaliyah advocated for a mind-body approach. Using a migraine app to track her headaches showed that she tended to get one after being around a particular coworker, in a pattern often called the “let-down” headache.

Talking with coworkers about the problem helped her relieve some of the tension of working with her stressful colleague. She adjusted her workstation so she could stand and move around during meetings with this coworker, releasing stress.

Aaliyah planned to take a short walk after the meetings that typically made her tense up. She also spent a few minutes outdoors to get some sun and relax in nature. Eventually, she took the practical step of transferring to another team.

Aaliyah still has the occasional migraine and keeps her new migraine medication on hand. But the mind-body approach she took works far better for pain than medication alone.

Find the pain management that works for you.
A whole person approach is ideal for managing pain. Here are some evidence-based strategies to try.

Consider your biology.
Biological women have more chronic pain than biological men.2, 3 Research has shown several reasons for this, including hormone shifts over time, being victims of trauma and abuse, and tending to prioritize the needs of others ahead of their own.

Avoid foods that cause inflammation.
Inflammation in the body can worsen pain. On the other hand, an anti-inflammatory diet that includes plenty of whole grains, healthy fats, lean protein and berries—and yes, small amounts of chocolate and red wine—can reduce inflammation and thus help decrease pain.

Try a short meditation.
You may think you don’t have time to meditate. But neuroscience research tells us that becoming mindful for less than an hour during your day can help ease symptoms. In one study, patients who practiced mindfulness-based meditation or had cognitive behavioral therapy had less pain than those who did not add a mind-based practice to their treatment.4

Try a free, relaxing mindfulness meditation. Bonus: it includes a gorgeous nature video to help you reset mentally. You can use it for acute or chronic pain.

Be careful with tech.
The technology that surrounds us can cause pain. Have you ever experienced “text neck” or strained your arms, wrists, or fingers by typing too much? Erik Peper, Ph.D., is the author of Tech Stress: How Technology is Hijacking Our Lives. The book includes strategies for using technology without causing pain, including ergonomics that can help.

Taking control of your pain
No matter what type of pain you have, taking a whole-person approach can help you feel better. As we saw in Dave and Aaliyah’s stories, pain is much more than physical. Having a compassionate provider you can talk with about what else is going on in your life, as Dave did, and advocating for yourself, as Aaliyah did, can make an enormous difference in reducing or eliminating pain and creating the best health possible.

ANGER-
Bitterness: What Is Its Function?
We focus on its effects but not its neural basis or its function.
Reviewed by Gary Drevitch

When I enter “bitterness” into Google or PubMed, I receive a long list of articles and research into the taste sensation not the emotional or psychological state. I have to specifically enter the not command for sweet and taste to find a few articles on the destructive state of bitterness. On PubMed, articles refer more to the basic science of aversive states on emotional memory than specifically on bitterness; for example, Likhtik and Johansen’s abstract in Nature Neuroscience:

“While the role of excitatory and inhibitory neural circuits mediating emotional learning and its control have been the focus of much research, we are only now beginning to understand the more diffuse role of neuromodulation in these processes. Recent experimental studies of the acetylcholine, noradrenaline and dopamine systems in fear learning and extinction of fear responding provide surprising answers to key questions in neuromodulation.”

Although researchers have not focused on brain injury anger — that specific type of anger that arises out of neurophysiological injury — they have studied the brain areas involved in anger, yet without differentiating between its many forms. I suspect that each anger type would light up different pathways, one for the sense of outrage at injustice, another from one’s life being threatened, another at seeing a person being assaulted.

Clinicians who work with people who’ve suffered brain injury know that neurostimulation and/or neuromodulation release the person from brain injury anger and eradicate the constant irritation that’s like nails on chalkboard from any kind of sensory stimuli from a passing car to a person’s voice. When rebooting, repairing, and rewiring the brain through neurostimulation eliminates the type of anger that flashes on and flashes off and exists without any ability to control it, then you know it’s neurophysiologically based.

In The Brain's Way of Healing, Norman Doidge defined neuromodulation as an “internal method by which the brain contributes to its own healing. It quickly restores the balance between excitation and inhibition in the neural networks and quiets the noisy brain.”

Neurostimulation can trigger neuromodulation. Since neurostimulation includes using our sensory inputs, our environment and relationships are also a form of neurostimulation. And while Doidge talks about the healing effects, the brain’s same internal neuromodulating mechanism can also harm. Bruce Perry wrote in What Happened to You that, among “those three ‘components’ of trauma, the three E’s — the event, the experience, and the effects — PTSD is about the effects.”

We see trauma effects, including bitterness, even when we’ve missed seeing the precipitating event or the changes in the brain’s wiring. We see bitterness as an emotional state and attribute it to attitude or mental illness. UK-based Harley Therapy echoes other therapists on their blog: “the emotional reaction and mood of bitterness is referred to as ’embitterment’. It is an emotional state of feeling let down and unable to do anything about it.” They cite Michael Linden’s theory of it being a mental disorder, calling it "post-traumatic embitterment disorder," and stating “bitterness can lead to long term psychological distress.”

But isn’t bitterness inherently distressing? As Christopher Lane wrote, “bitterness strikes the person feeling it as a justified response to a social ill or personal wrong.”

Does bitterness emerge after damage to particular neurons or neural networks? Does the damaging event need to be physical, or is emotional or psychological trauma the kind of event that precipitates bitterness? Does it arise more easily in those with learned helplessness than in those whose brains have rewired to act in the face of seeming lack of control? Are there different forms of bitterness like there are of anger?

Most importantly, what is bitterness’s function?
Anger allows us to express ourself when facing injustice or oppression; it initiates action to protect another; it’s a safer way to express our distress than deep sadness or grief as the latter makes us feel vulnerable whereas anger feels protective.

Thinking about the latter, what does bitterness do for us? Perhaps it protects us from feeling the deep psychic pain from betrayal, abandonment, or intentional harm because to feel that pain would render us immobile and unable to eat, sleep, look after ourselves, engage with others.

I've written that “I became bitter when it finally penetrated my brain that doctors…who treat brain injury are simply not interested in thinking outside the box, in learning from non-MDs, in working alongside their patients.” In other words, the medical profession abandoned me to a catastrophic injury and I stopped believing I could escape that shock.

Maier and Seligman have updated their understanding of learned helplessness, as I wrote: “Prolonged exposure to trauma keeps [default neural] pathways, and thus passivity and fear or anxiety, active. For a person with brain injury, already overwhelmed by the injury and fatigue, this could add to or look like no motivation and continual anxiety…discovering one can escape shock creates the learned state.”

What happens, though, if a person has not learned, or has unlearned, that one can escape shock and experiences abandonment, betrayal, or trauma so profound that the psychic pain is unendurable? What if that person’s brain remains in the default passive state, which manifests as not believing one has any control while believing that another has full control over them and has abandoned them? Bitterness may function then as a protective mechanism against the resulting intense lacerating psychic pain.

These are the questions researchers have yet to delve into. While psychologist, pastors, and self-help experts impose guilt or labels for feeling bitter, researchers are barely studying the neural correlates of bitterness or its function. When we understand these, clinical researchers could develop effective therapies that combine neuromodulation with training the brain to learn it can escape shock and with talk therapy based on the principle of establishing a stable relationship between professional and client that counters abandonment. For ultimately, bitterness arises out of damage to one or many relationships.

5 Ways to Boost Your Brain’s Grieving Process.
A reader asks how to redraw the neural map more quickly after a string of losses.
Reviewed by Abigail Fagan

KEY POINTS-
Experiencing multiple losses in a short time is extremely challenging, so it’s natural and normal to feel overwhelmed.
Your brain requires lived experience and repetition to update the neural map, so you benefit from engaging with life to create your "new normal."
Embrace therapeutic living, such as moving your body, being in nature, and getting support, to boost your brain's grieving and rewiring process.
In response to the post, “As You Grieve, Your Brain Redraws Its Neural Map,” a reader writes:

How can my brain redraw its neural map when losses are piling on top of each other, not allowing ample time to grieve? In the past year, I've lost a sibling, a spouse, a friend, and a parent. Everything has overlapped to the point of crippling my everyday life with a seemingly endless void. How do I redraw and update faster so I can get out of this rut?

First, I’m so sorry you’ve had to endure so many significant losses in such a short period of time. That is an overwhelming amount of grief and adjustment, so it makes sense that you would want your brain to make quick work of redrawing your neural map.

Research on the neuroscience of grieving has yet to specify how the bereaved can more quickly update the brain's neural map. But we do know that your brain requires experience to update, plus there are known ways to nurture your brain's ability to form new neural connections and boost your grieving process, and perhaps these translate into facilitating the redrawing process as well. Here are five suggestions.

1. Have realistic expectations
Rest assured, with three significant losses and another on the horizon, it is natural for you to feel crippled and in a rut. And because your brain is redrawing the neural maps of four close relationships, this process will take time. You can reduce your distress by simply accepting that your grief and mourning will take as long as it takes. Life may seem hopeless as you’ll never recover what was “normal life,” but over time, your brain will update to reflect your “new normal.”

2. Engage with your “new normal”
Your conscious brain knows that your loved ones are gone. But during the formation of those deep bonds, your unconscious brain encoded the implicit knowledge that your loved ones “will always be there for you.” So whenever your brain is confronted with the fact that your loved ones are no longer “there” in the same way, you grieve. That’s why a key part of the grieving process is to redraw the neural map by overwriting it with new routines, new habits, and new predictions. For example, you might completely redo the bedroom you shared with your wife; you can reorder your daily, weekly, or monthly routines; you might seek closer relationships to others in your family or social circles; you could join a group to pursue favorite activities with new people. Leaning into your “new normal” life helps your brain accumulate new experiences, and over time, your brain will update with new neural connections. Eventually you’ll notice that your neural map is more and more reflecting your “new normal,” and those crippling pangs of grief will mellow and then recede.

3. Have faith in your brain
With realistic expectations for a lengthy and arduous grieving/redrawing process and actively engaging in your life, rest assured that your brain is qualified for the job of redrawing its neural map. Every pang of grief indicates that your brain is hard at work, rewiring its neural connections. By having faith in your brain’s expert redrawing capabilities—you can feel more patient, reassured, and compassionate with yourself.

4. Embrace therapeutic living
There are many therapeutic habits, routines, practices, and types of support that cultivate a calm brain and promote its ability to create new neural connections (neuroplasticity).

Daily habits such as getting sufficient sleep, eating nutritious foods, moving your body every day, and spending time outdoors.
Mindfulness practices, such as mindful breathing, meditation, staying in the present moment, and observing your thoughts.
Journaling, which can help you find the words, get clarity, and make sense of it all, rather than just getting lost in a giant blob of pain.
Emotional support also soothes your brain and reduces suffering, whether you lean on family or friends. Given your arduous journey, professional therapy is likely also in order.
Brain-based treatment for trauma, such as EMDR, might be of great benefit to you, as this could help you move forward with your life instead of continuing to feel stuck in reliving the past.

5. Seek growth
Crisis always provides opportunity for growth. Growing pains, indeed. But remember, what matters is not what happens to you, but what you do with it. Growth might include learning more about yourself, leaning into your worth, recognizing your strengths, acquiring new skills, and identifying your values, priorities, and passions so you can live your best life.

Yours is not an easy row to hoe, but with realistic expectations, engaging in life, having faith in your brain, therapeutic support, and seeking growth, you can redraw your neural map in ways that help you to heal and serve you well going forward.

When Self-Pleasure Habits Get in the Way of Partnered Sex.
The neuroscience behind our sexual patterns.
Reviewed by Michelle Quirk

KEY POINTS-
The more ways you can experience sexual pleasure, and the more pleasure you can generate, the more likely you are to reach orgasm.
When you bring yourself to orgasm in a specific way, you’re strengthening a neural pathway in your brain.
It takes time to build a new neural pathway.

If I could give one piece of sex advice to everyone, it would be this: “Switch it up on a regular basis!”

The more ways you can develop for experiencing sexual pleasure, and the more pleasure you can generate, the more likely you are to reach orgasm, whether alone or with a partner. The more different routes you have to orgasm on your own, the more likely you will find a way to reach orgasm with a partner. And the more different routes you have to orgasm with a partner, the more likely you are to experience pleasure even when life throws a wrench into things and certain activities aren’t possible for one reason or another.

Most people who reliably reach orgasm have one primary way of doing so. It is perfectly understandable that people go with what works; why argue with success? Our cultural expectation seems to be that sex isn’t “real sex” unless there is an orgasm, and not only that, an orgasm that someone else “gave” us. So once we figure out how to “give our partner an orgasm”, we tend to stick with that strategy rather than continue to explore and risk not “getting it right”, “being a bad lover” or just missing the orgasm entirely some of the time.

Here’s the problem: the more you focus on just one way of reaching orgasm or experiencing pleasure, the more likely you are to get stuck in a rut. When you bring yourself to orgasm in a specific way, you’re strengthening a neural pathway in your brain. Every time you do the same thing, that pathway gets stronger. Unless you switch it up and cultivate other ways of reaching orgasm, it becomes harder and harder to do so in any other way.

There are lots of ways this might look:
I self-pleasure by rubbing myself against something, and I can’t get that same feeling and reach orgasm with a partner
I self-pleasure while watching porn, and find it hard to reach orgasm with a partner
I can’t reach orgasm without a particular fantasy, and that makes me uncomfortable; I’d rather be able to do it without that particular fantasy
I self-pleasure dry (or with a tight hand), and then when I have penis-in-vagina sex with my partner, the sensation just isn’t strong enough to get over the edge

All of these examples point to a particular pathway to orgasm, involving a combination of thoughts, images, novel stimuli, types of touch, amount of slipperiness, amount of pressure, broad versus specific stimulation, etc.

The key to shifting a habitual neural pathway to orgasm is to start to change it up. Let me be clear; this is not always easy, nor is it something most people can accomplish quickly. That’s why an ounce of prevention is worth a pound of cure! If you already have multiple ways you can experience high levels of sexual pleasure, make sure to use all of them to get to orgasm, not just the easiest one.

And if you are in a rut, consider what is different between the way you most easily reach orgasm and the way you and your partner have sex. Think about all the components of the interaction. Then begin experimenting with shifting one or two things more toward a sensation or visual stimulation that partnered sex can match. Here are some specific suggestions:

If you watch porn, watch just one video all the way through rather than clicking between many. Get used to arousal ebbing and flowing, and returning, even when the “action” is a little slower and less novel
If you touch yourself without lube, try using lube. Partner sex is often slicker than solo sex, although not always. If the opposite is true, try using less lube.
If you rub against something, try placing your hand between the object and your body. Gradually shift how much of the sensation is coming from diffuse pressure versus your hand moving, or specific touch.
If you have a favorite fantasy, see if you can develop a second-runner-up fantasy. See if you can come up with one that has some things in common with sexy aspects of your partner, or the way you and your partner have sex.
The strategy is to, very gradually, use the new way more and more during any given sexual interaction. Most people like to start this experiment solo, but there is no reason you can’t do it with a partner too if you’re both comfortable with some experimentation.

Start getting turned on the “old” way. But once arousal is building, switch it up. If arousal begins to fall and it is hard to get it to build again, shift back to the tried-and-true, but when possible, shift back again to the new way. Most people starting this experiment need to use the old way to tip over into orgasm at first, but the goal is to become able to get over the orgasmic threshold with the “new way”, which ideally is in some way significantly more similar to partnered sex.

This is necessarily a gradual process, because it takes time to build a new neural pathway. And it generally feels frustrating; neurons have to literally find one another and connect in new ways.

Having a therapist who can support this process can be very helpful. It is important to strike a balance between building the new neural pathway, and experiencing sexual pleasure without too much frustration. You can’t rush this process. Finding ways to stay steady, find patience, make it fun, and keep clear on why you’re doing this in the first place will be crucial.

Whether you are thinking about this from the viewpoint of a therapist helping others, or a person wanting to increase your experience and ease with orgasm, ask yourself what neural pathway issues may be at play, and how you can start building diverse pathways towards more connected, satisfying, and flexible encounters.

DEPRESSION-
How My Depression Revealed My New North Star.
A Personal Perspective: Failing to identify my own severe depression.
Reviewed by Lybi Ma

It was a humbling experience, but one I feel is important to share: Although I am a 20-year veteran of psychiatry and the chair of a major department in the field, for months I failed to identify my own severe depression and resisted getting treatment, causing myself pain and harm.

How could this happen? Well, doctors are clearly not immune from the proverbial saying that the shoemaker goes barefoot. But I have concluded that there is more: our society must shut down the stigmatization of mental illness.

I feel I'm called to tell my story, in hopes of helping others muster the strength and courage to seek the help they need. So here it is.

A few years ago, I became the chair of Behavioral Medicine and Psychiatry at West Virginia University’s Rockefeller Neuroscience Institute. We have over 200 employees, a psychiatric hospital, and a residency training program. I was new at this, and nobody put me through a ”chair school” to learn it. But it’s not uncommon that people who demonstrate some degree of confidence, trustworthiness, and perhaps competence receive authority. So far, so good.

I began to experience insecurity about the new job. I compared myself to others – the “compare and despair” phenomenon. That leads to what’s known as imposter syndrome – the feeling that any day somebody might realize you’re the wrong person, just pretending to be what others wanted you to be. I think this is more common than often realized, and it affects people in different ways. Some can become horrible bosses. I became more vulnerable.

Then Covid hit in March of 2020, and we didn’t know what this would do. Would we harm patients by bringing them in? Would staff be harmed by coming into work? Would we bring this virus back to our families? There was so much fear and uncertainty, and as the department head, I felt responsible for people's lives.

I threw myself into my job, working 12-hour days, while my community support shut down. My church had been an especially important community for me, for connection and spirituality. Looking back, being cut off from it was a big hit against my wholeness, and even who I was as a human being.

When I talk about this now with other doctors, we realize that we can be horrible about recognizing illness in ourselves. I did recognize that I was stressed, waking up in the middle of the night with panic attacks, but felt it was just stress from job anxiety. For all my training, despite all the teaching I’d done, I couldn’t recognize that I was in a state of clinical depression.

I think what saved me was some caring friends and colleagues who began to note that I wasn’t looking so good and to tell me that I don’t seem like myself. I reached out to my mentor, who is a psychiatrist at the University of Hawaii, and he walked me through some questions:

Are you losing weight? Yeah, I’ve lost about 15 pounds in the last two months.

Are you sleeping? I sleep about two hours a night.

Are you enjoying anything anymore? No, I can't stand anything and don't enjoy the things that I used to. I feel like every day is drudgery and that it’s a chore to get out of bed.

Are you feeling like you don’t want to live anymore? Yeah, I think about suicide every day, and I wish I were dead.

And then he said it: “Jim, you're depressed.”

I imagine readers will ask themselves how it can be that experts cannot diagnose themselves. My explanation is that like everyone else we put up defense mechanisms to just get through the day. All people have strong egos and we don't want to admit that we are weak – that something powerful could interfere with who we are. We are slaves to a mystique that we are masters of our domain. In short, emotions are stronger than intellect at times.

Even after I acknowledged I was in a depression, it took me weeks to finally get treatment for it, because of pride. I thought should be able to handle this myself. And while I had prescribed thousands of antidepressants over the years, I was unwilling to take one myself or to see a therapist.

Finally, I broke down and agreed to treatment directed by my mentor. He started meeting with me weekly to check in. I started exercising, which I had not done in a long time. I started an antidepressant. I saw a counselor who helped me understand what was happening within my body and my brain.

It was all stuff I knew, but I needed to hear it from another professional – where I could be the patient as opposed to the educator. It is akin to a medical doctor who comes in for a physical – you need to leave your own stethoscope at the door.

Over about a month I began to feel more energetic. I started feeling better, standing up straight, regaining weight, sleeping better, and thinking less about dying. The whole ordeal lasted about five months. It could have been shorter.

My experience is probably typical. What can we do better?
I think part of the issue is that our culture enforces competition and if we show signs of weakness and vulnerability that puts us at a disadvantage versus others in what is seen as a zero-sum game. As a society at large, we can do better in that area. This is not good for society, or individual wellness.

We could also use a renewed emphasis on human connection. The fact that I had friends who cared about me enough to warn me was invaluable. I knew they had my back and could go into a position of safety, to confront what I didn't want to confront.

We need to better educate the public that depression is something that certainly can be managed, and it can go away. Even chronic mental illnesses like schizophrenia may not go away but we have the tools to help people thrive. For all of us, the three hardest words to say are “I need help.” That’s especially so with mental illness. We need to arrive at the point where it's as natural and supported to reach out to get help for your mental illness as it is for your hypertension, diabetes, or cancer.

Mainly, though, we need to genuinely fight the stigmatization of mental illness and of everybody who suffers from it. No one is spared from such issues – including those in powerful positions, like CEOs or principals or judges, or politicians. As it is, there will be barriers that will keep them from getting help. The stigma of mental illness should not be one of those barriers.

In my case, part of my fear had been whether my career would suffer. In West Virginia, as in many states, the medical license renewal form asks whether you’ve been treated for a mental illness. I wanted to be ethical, so I wrote yes – but really, why is that question there? It's discriminatory against people who suffer from mental illness. Better, as some states do, to ask whether the doctor is undergoing anything that would impair the ability to practice medicine.

I'm sorry I went through this. I never want to go through it again. But in a way, I’m grateful that I did. It has given me a new dimension of understanding what people go through when they're in the depths of despair. Once you get out of it you've got space to reflect on the bigger picture. But when you're in the middle of it, it's just darkness.

I want people to know that there’s no reason to wallow in that darkness and that they need not be alone. That is the North Star for me now.

PREGNANCY-
Born to Bond: Vaginal Birth Boosts Physical, Mental Health.
And why C-sections can disadvantage mothers and infants.
Reviewed by Tyler Woods

KEY POINTS-
Vaginal birth biologically primes parenting behavior and bonding, and physically alters the newborn to ready it for life outside the womb.
These changes trigger a virtuous cycle of behavior and response that supports the parent-child relationship and healthy infant development.
Unfortunately, these processes are disrupted by C-section birth, which can save lives, but sometimes has negative long-term repercussions.

In the shadow of America’s shameful maternal death rate lies another pervasive health crisis: nearly one-third of U.S. births are by Cesarean section. This means that over a million new Americans start life facing risks to their development every year, often unbeknownst to their parents.

Vaginal birth is not just a means of moving an infant from the uterus to the outside world. Rather, it is a complex interaction between the fetus and the mother’s body that profoundly alters the neurobiology and physiology of each, preparing them for the new stage of life ahead. Vaginal birth impacts everything from the mother’s instinctive reaction to her baby’s cries to the newborn’s organ maturation.

Parenting a newborn is incredibly difficult and demanding, so nature has given mothers a helping hand, beginning with hormonal changes during pregnancy that rewire the brain in preparation for parenthood. Then, vaginal birth builds on that foundation by releasing a flood of hormones which transform new mothers’ brains, altering their cognitive, salience, and reward systems. This makes bonding and new parental behaviors easier and exceptionally rewarding, and radically alters their sense of themselves and their well-being. A virtually unbreakable lifelong bond is rapidly formed between mother and infant, so strong that while romantic love frequently ends in a breakup, women seldom “divorce” their children.

The Impact of Vaginal Birth on Newborns
For the newborn, the impact of vaginal birth is at least as profound. Birth does not naturally take place when a fetus is ready to breathe air, nurse, and digest milk, but instead when it is ready for the vaginal birth process itself to add the finishing touches that prepare it for those new tasks.

In infants, the physical stress of the journey through the birth canal alters the immune cells in blood plasma and releases hormones which promote the maturation of the lungs and intestines. It also deactivates fetal genes and triggers postnatal epigenetic changes, including those that support antibody production, stress responses and glucose regulation. Vaginal birth washes the newborn in the microbiome of the mother’s birth canal, seeding its body with beneficial microorganisms which will aid its digestion, immune response, and much more.

Additionally, the vaginal birth process initiates new, unlearned behaviors in newborns, including breathing air, suckling for nutrition, seeking physical closeness and warmth, and crying when distant from their mothers.

The Impact of C-Section Births
After C-section birth, infants may display these same behaviors, but often less vigorously, because C-sections eliminate or reduce (depending upon timing) these vital processes and the profound neuro-physiological reorganization they trigger. This increases such newborns’ risk for conditions ranging from post-birth hypothermia to lifelong disorders including asthma, obesity, diabetes, celiac disease, juvenile arthritis, autism, cognitive difficulties, and mental illness.

Mother-child bonding can also become more difficult, increasing the mother’s risk for postpartum depression and potentially impacting the child’s long-term development.

Fortunately, many children born by C-section go on to have normal lives, and primary caretakers who don’t experience vaginal birth can develop alternate pathways for developing parental bonds by means of conscientious, focused efforts. However, it isn’t automatic or easy. The unfortunate consequences of our excessive C-section rate may be hidden in plain sight, ranging from news of rising perinatal and postpartum depression and reduced infant-maternal bonds, to a teen mental health crisis.

The Link Between Vaginal Birth and Parenting
The importance of the vaginal birth process and the consequences of missing out on it have to do with our nature as mammals. Ruth Feldman, the Simms/Mann professor of social neuroscience and director of the Center for Developmental Social Neuroscience at Reichman University, with a joint appointment at Yale Child Study Center, is a leading researcher of the human capacities for love, empathy, and resilience.

“Being born a mammal implies that the brain is immature at birth and develops in the context of the mother's body and caregiving behavior,” she wrote. “Infants rely on the provisions embedded in the mother's body, such as smell, touch, heat, or movements, and the expression of caregiving behavior for maturation of neurobiological systems that sustain participation in the social world.”

From blind, mewling kittens to monkey infants clamped onto to their mothers’ backs, mammalian young require intensive parenting as soon as they are born. Human babies are especially dependent because they are born without fully developed brains or endocrine, temperature regulation, sleep, hormonal, digestive and cardio-pulmonary systems, and require near-constant physical contact with a caregiver to regulate them. Even an hour of separation from their mothers causes two-day-old infants physiological stress and interferes with their sleep. Human infants are closer in some ways to kangaroo joeys, which mature in their mothers’ pouches, than to alert, clinging baby monkeys—indeed, we would have to gestate for another nine to 12 months to catch up with other primate newborns.

Although mammals rely on mothering for species survival, no one teaches a lioness or a horse how to parent. Instead, vaginal birth itself unleashes tides of hormones and neurotransmitters that activate specific neural pathways, triggering automatic responses so powerful that even first-time mothers will display brand new behaviors upon giving birth, from licking their babies, to assuming the right position for nursing, to responding to infant cries.

These changes also transform the normal adult aversion to crying infants into an attraction to them and a desire to care for them. Vaginal birth even triggers both mothers’ and infants’ ability to recognize and bond with each other based on scent.

How does vaginal birth accomplish all this? Through the most intense and rapid brain alternations in adult life—and the intense feelings they create. Many human mothers experience the greatest high of their lives when their infants are born. They are often floating on cloud nine, and fall in love with their infants the moment the newborn is placed, skin to skin, on their chests. That euphoria, an extreme surge of oxytocin, dopamine, and other neurotransmitters caused by labor and delivery, is necessary for mammals like us to overcome the strain, pain, and exhaustion of childbearing to immediately nurse and care for our infants. Nursing produces a milder form of the same high.

In this way, vaginal birth triggers a virtuous cycle, where the mother and infant are drawn to each other and instinctively engage in mutually rewarding behaviors. This close, affectionate physical contact facilitates the infant’s neurophysiological maturation and supports normal social, cognitive, and emotional development, as well as the mother-child bond.

Implications for C-Section Parents
C-section birth suppresses both the neuro-remodeling that promotes new parenting behaviors and the hormonal surge that makes them so rewarding. Of course, parents who don’t give birth vaginally (including fathers and adoptive parents) can still provide lots of close physical contact and bond with their babies—they just don’t have the same hormonally-enhanced motivations and behavioral prompts that vaginal birth provides, so they must sometimes make deliberate efforts to compensate.

Summarizing some of his vast body of research, Larry Young, Director of the Center for Translational Social Neuroscience at the Silvio O. Conte Center for Oxytocin and Social Cognition, and the William P. Timmie Professor of Psychiatry and Behavioral Sciences at the School of Medicine at Emory University, says “…this does not mean mothers with C-section cannot bond, they can nurse to release oxytocin, and skin-to-skin contact and eye-gazing can also stimulate oxytocin release, it just might not be the flood that happens with vaginal birth, which animals need to drive their behavior.” In other words, with consistent interventions (discussed further in Part 2), it is possible for parents to overcome the deficits caused by C-section birth.

Though C-sections are sometimes essential and life-saving for both mother and child, their potential mental and physical health repercussions are often not fully understood by either parents or physicians, who may take decisions about birth method too lightly. Caesarian sections remain far more prevalent than medical necessity demands, with the result that millions of American families may struggle to overcome unrecognized deficits.

Every child deserves a start in life that enables their full flourishing and psychological health, and every mother deserves to understand how her body’s capacity to give birth was evolutionarily designed to jumpstart her parenting brain and prepare her emotionally and neurologically for successful mothering. In part 2, we will explain how the biological processes set in motion by vaginal birth lead to the positive early experiences essential for healthy child development—as well as what happens when it goes wrong, and how parents of C-section or premature babies can improve their outcomes.