Reading Dr. Mark Rego's provocative, intense "Frontal Fatigue: The Impact of Modern Life and Technology on Mental Illness," I found myself thinking of David Foster Wallace's "This Is Water." In it, the late author observes the need to be aware of "what is so real and essential, so hidden in plain sight all around us."
Today, we live in a culture that is often corrosive to our mental and physical health, but it's water in which we swim. The water of an incessant blare of notifications and breaking news; the water of, as Rego explains, that "something about modernity that acts as fertilizer for mental disorders."
There's already plenty of literature about our contemporary mental health crisis. But Rego, who has practiced psychiatry for three decades, takes the unique approach of examining with specificity the impact of 21st century life on our magnificent, misunderstood prefrontal cortexes. He offers no sweeping generalizations, or finger pointing. Instead he takes the reader deep into the science of how the region of our brains that controls executive function evolved, how it operates — and what the unbelievable demands we put on it every day are doing to it. It's a fascinating window into what makes us human, and an urgent call to "build our lives as best we can."
Salon spoke to Rego recently via Zoom about why we're all feeling the effects of frontal fatigue, and what we can do to shake it off.
This conversation has been edited and condensed for clarity.
Thank you for writing this fascinating, unsettling book. What inspired you to take on this immense topic?
This has been an interest of mine for a long time. It's always been my habit to read a lot of journals and try to compare my experience to what research is saying. I found that when I looked in bibliographies, I was running across words like "phenomenology" and "hermeneutics" and things I didn't quite understand why they were there. So I got interested in philosophy. I was always looking for another way to pry open mental illness. In 2004, I went to a meeting of philosophers and psychiatrists. The theme of the meeting was technology and psychiatry, which sounds odd but technology has a fairly long provenance in philosophy, starting with Heidegger at least. There's been the idea: are we controlling technology or is it ordering us in our lives?
I thought I could use technology as a proxy for modernity, because that was my real interest. When I researched, it became clearer that I didn't need to use it as only a proxy. It seemed to me that the very nature of modern life was in a sense technologic. It has infiltrated our lives that much so where tradition and culture once ordered our lives, I think technology now does. That was the paper that I presented and got accepted. I've always thought that I could do more with that paper, so I wrote the book.
Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter The Vulgar Scientist.
You start it with this very provocative statement that is also hard to dispute — that we have "the failure to recognize" the pervasiveness of mental illness. We don't know what life was like for our grandparents. We don't know what "normal" was for them. We certainly couldn't say necessarily their lives were better, but what are we not recognizing now — and what is really going on?
With this book, I first had a go round with a large agency in New York. We parted ways, but I had an editor and she kept saying "You really shouldn't say that, Mark." But after reading some of the content, she said "I thought I knew about mental illness but well, I guess I don't." She was very educated and knew as much as any non-professional person might know, but I really think that much more than stigma, the problem is ignorance. The way we know what a tumor is versus an infection versus a broken bone, the categories that people know and the signs that you recognize which category a problem is in, I don't think people have any idea how that works for mental illness.
Even a lot of practitioners I think don't understand psychopathology. As the book talks about and most epidemiologists agree, whatever this situation with our ancestors was, things seem to be getting worse. At least that's what the data says. I think we're in a culture where physically things are getting better. We're obviously living longer or not as ill, physically. But I do think mental illness is becoming much more common. It's just there. It's something that happens to almost everybody at some point in their lives and if you talk to any educated person, I don't think they would feel that's the way things are.
If you're living in this world right now, you may have depression. You have anxiety, you have PTSD, you have OCD, you have ADHD, all the things that you talk about and identify in this book. Generationally, it is so scary because it does seem to be accelerating. We can identify the causes or the contributing factors, but you can tell me more about what makes this moment in our time so different?
I didn't want to talk about childhood illnesses too much because I'm not a child psychiatrist. But I had to talk about ADHD, because that's just becoming so much more prevalent even after you try to correct for the problems with the data. I think there are two major things. I don't, by the way, think it's because our world is particularly dangerous or stressful. Most people would say, "Look at the world today. Of course everyone's depressed." If you looked at the world of our grandparents, great grandparents, probably for you and I, the world was burning at any particular time. There was no food. Women died in childbirth routinely. It was a pretty dangerous place.
I think the thing now is the way we are stressed by putting these excessive demands on our very powerful prefrontal cortexes, which I think is more of what makes us human than language. Most people in humanities and in science would say language is what makes us human. I think it's the prefrontal cortex. It's even a big discussion about what could have been the evolutionary pressure for language. It appears so fast in evolution, and socially, I think the prefrontal cortex is the pressure. We suddenly had something to say — "You go that way and I'll go this way and we'll catch that woolly mammoth."
So the problem I'm describing in the book creates a background condition of vulnerability. A new level of stress creates a new problem neurologically for us and neuro psychologically, such that our level of vulnerability is increased across the board. Secondly, our social disengagement does fit into the frontal fatigue problem. You can put it under the same tent, although it needs to be mentioned as a separate thing. We're not just rational beings. We're rational, emotional, social beings.
The third thing I was going to talk about in the book but it's too speculative is related to frontal fatigue. I think it's the sense that we no longer live in a world that's guided by culture and tradition. The prefrontal cortex has more extensions into the rest of the brain than any other area and also receives more extensions than any other area. I would speculate that tradition and culture provide a lot of things like sensory input. Being in very sensory rich environments provides a lot of input to the prefrontal cortex to do what it does, which is give us the picture of reality that we experience as consciousness.
Without that input I think the prefrontal cortex then is cut off, disinhibited, and does just some things that it knows how to do like get depressed. It goes into these default settings that it has without guidance. It's not supposed to create the world for us out of nothing, but it's being asked to do that.
In the book, you start with the mind and then you move into the body before you get us to the prefrontal cortex. You take this time to say that there's a physical aspect to the way we feel mentally. There's a physical aspect to the reasons we are seeing these particular manifestations our mental state that has to do with getting outside, moving our bodies, preparing food. We're not meant to sit and stare at screens.
There are obviously other explanations that people have offered and they all have, like most things, a seed of truth. I just thought the book would be incomplete without saying look, there are all these other aspects of our lives people have pointed out. There's issues with sunlight, with sleep, with nutrition. There's very interesting work of two psychologists where they looked at kinds of pictures that calm people down. It was more with greenery and with places you could go to explore. It just seemed people felt better looking at those pictures. So I wanted to complete the picture of the problem. I really wanted the book to not just talk about frontal fatigue, but talk about the problem of increasing mental illness and what is going on in modern life that we find ourselves in these situations.
This is not a self-help book. It's a case for why we have reached the point that we have reached. But you do say there are things that we can do. Talk to me a little bit about what some of those things are, because we still have to live in the 21st century. We're being interrupted and flooded with images constantly. What realistically can we do to take back a little bit of that space in our brains, and then what happens when we practice that?
I see these things all the time like, "Here's a five minute thing you can do to increase mindfulness during your day," or "Here's a two minute exercise you could do." We're not going to change our lives with those things. I'm interested in meditation and I've always been a meditator, but my question has always been, how do I increase the mindfulness in my life? Not just sitting down for half an hour a day. How do we change our lives as opposed to just trimming around the edges?
I love Jenny Odell's "How to Do Nothing," because she talks about how our culture has now created this idea of mindfulness as a means towards higher productivity. That you are going to be mindful so that you can be a better worker, as opposed to no, I need to figure out how to reclaim this space in my brain. I need to reclaim this time for my mental health and my physical health and for the wellbeing of those around me.
The whole point of mindfulness comes out of the Vipassana tradition and Buddhism. It is to increase insight. It's not to increase productivity. I give a two pronged approach in the book. On the one prong, I think you need to have a little toolbox or find things that appeal to you. One thing is to lead with your hands not with your mind. Whatever you do, let your hands do it. Have greater sensory richness in your life. I do think we're starved for common beauty.
And social connections.
Yes. Those things are all about getting out of your PFC (prefrontal cortex). Part of it is knowing when your PFC is getting strained but getting out of it. That has to be part of your life. They're not quick, they're not hacks. They are tests to be part of your life. And then the other part, which seems opposite, is getting into your head but in a way that you are more mindful about the level of stress you're carrying. I talk about mindfulness as the way that in the middle of the 20th century, suddenly we had to watch our weight and exercise when no one in the history of humanity ever had to do that. I think now we have to all learn a way to watch our minds.
I want to know how the pandemic changed things. We went into a time unprecedented in modern history of deprivation, of high anxiety, of a lot of us experiencing profound loss and fear and illness while balancing everything else, and also doing it in often relative isolation.
I wrote a blog post in Psychology Today about why I thought young people were doing worse with just about everything, whether it's suicidality, depression, et cetera. All are worse in teens and children and I think the reason, at least a big part of the reason, is that their lives have become intensified versions of modern life. They are more isolated, they are more chained to technology. I talked about Facebook. They are using virtual substitutes of real life for now everything, school, social things.
So they have an intensified version of frontal fatigue because they have an intensified version of modern life. They don't even have — this is a paradoxical — the problems of worrying about a job and family, some things that keep adults out there somewhere working on something. They're here, in this [virtual] space, whether to socialize or go to school. Now it's a world without a world, in that it's not just a meaningless world, it's a nothing world.
Just to give you a pessimistic example, a woman who I talked to at Columbia who's a very well known psychiatric epidemiologist just to say, "Am I really correct in saying that you guys all think that mental illness is getting more common or worse?" And she said, "Yes, that's what we think." She noted that a cohort of young people that she identified in the nineties as being more depressed as teenagers are now killing themselves in record numbers as people in their forties. So she said, here's what happens to them.
I have to keep hope as a parent. I have to believe in better outcomes, and I hope that this younger generation is seeing some of the pain of the people who are just a little bit ahead of them and saying, we need to figure out alternatives. We need to reclaim some of our life and our space.
I feel the same way. I am hopeful that they will think of something.
More Salon brain science stories: