Author Archives: Jake Medoff

When I was a little kid, my favorite book was Philippe in Monet’s Garden, a picture book about a frog who escapes a Parisian frog catcher and finds a home on the famous painter’s estate. When I was a few years older, I marveled at the beautiful paintings of the waterlilies in Monet’s pond. Needless to say, I was thrilled to take a day trip to Giverny and see for myself the iconic place that has enthralled me for years. The grounds of Monet’s home did not disappoint; I consider this outing to be one of my favorite things I have done in France.

The cover of my favorite children’s book, Philippe in Monet’s Garden by Lisa Jobe Carmack and Lisa Canney Chesaux.

Despite my love for all of the art that originating from that special place, while walking through the gardens I wasn’t thinking about paintings or talking frogs; I was swept up in the beauty of it all. It’s not everyday you find yourself in a place so dense in natural beauty, but even the parks around Emory seem to have this soothing effect on me.

A number of scientific studies have set out to explore this phenomenon that I have observed. Large scale studies of different populations have concluded that people who live close to nature, whether it be Monet’s gardens or Piedmont park, tend to be happier and experience less mental distress than those who live in more urbanized areas (White et al., 2013; Shanahan et al., 2015). Another experiment in 2012 found that patients with various mental health disorders reported higher mood and self-esteem when they participated in nature walks compared to indoor exercise (Barton et al., 2012). Since access to nature can serve as both a preventative measure and a component of treatment, it seems to be an excellent candidate for further public health research.

Me in Monet’s garden, and just as happy as Philippe to be there! Giverny, France

But what is it about nature that has such a profound effect on us? The primary shortcoming in proposals to incorporate nature into public health initiatives is a poor understanding of what kind of natural experience is helpful (Hartig et al., 2014; Shanahan et al., 2015). Since the rise of urbanization, human beings have lost much of the connection with nature we once had; in order to optimize an effort to bring the health effects of nature to cities, we need to better understand the mechanisms of these effects (White et al., 2013; Shanahan et al., 2015). Current research tends to focus on the visual system, but my walk in Giverny was about more than the sights; the smell of the flowers, the sound of the wind in the vines, and the warmth of the sun on my back all contributed to my experience. A recent attempt to translate nature into a mental health treatment failed for this very reason; participants viewing a simulated natural environment reported less stress reduction than controls who were in the actual outside environment and complained of a disconnect from “real nature” (Kjellgren & Buhrkall, 2010). A multi-sensory system study on the effects of nature could help bridge the gap between the clear benefits to be had and the best method to adapt them to an increasingly urban world (Franco et al., 2017).

The sounds of nature are considered to be especially pleasing; people prefer the sounds of nature to those of a city and many buy recordings of natural sounds to help them relax or sleep (Yang & Kang, 2007; Alvarsson et al., 2010). A group of researchers wanted to test the effect of natural sounds on stress levels after a challenging task by measuring skin conductance levels (a well known measure of stress) in a group that was played bird song and a group that was played other noises (Alvarsson et al., 2010; Cummings et al., 2007). They found that participants who were played nature sounds recovered faster from the stress of the task than groups who were played generic noise. This is only one experiment of many documenting the positive effects of nature sounds, but it demonstrates that there is a potential for auditory stimulation to become a part of alternative mental health treatment regimens.

The olfactory system is also plays an important role in a holistic experience of nature. The smells of nature can help to immerse us in an outdoor experience, and it has been demonstrated that certain odors evoke emotional responses (Glass et al., 2014; Franco et al., 2017). The popularity of essential oils as a natural remedy attests to this fact.

My dog Ruby knows a little something about the positive effects of floral odors on mood. Emory University, GA

A 1998 study used an EEG to measure the effects of relaxing and alerting (lavender and rosemary respectively) essential oils on the brains of participants. The EEGs showed that participants who smelled the lavender exhibited more alpha and beta bands, a measure of relaxation, than they did before exposure. Participants who smelled the rosemary exhibited fewer alpha and beta bands than they did before exposure, indicating alertness. These results were supported by self-reporting from the participants and an anxiety questionnaire (Diego et al., 1998). The exact underlying mechanisms of these effects remain unclear, but suggest that olfaction is a key piece to the positive mood effects created by spending time in nature.

In isolation, each of these sensory systems has been demonstrated to contribute in some manner to the mental health of the test subject. In nature, we are experiencing sensory input to all of these systems and more, all at once. It would certainly be difficult to encapsulate all of these factors into an artificial natural environment in a setting like a hospital, but the research certainly makes a compelling case for the inclusion of parks or other natural environments in cities. In the meantime, my walk through Monet’s gardens was the refreshing stress relief I needed to finish up this study abroad program on a high note, and I’ll be making a concerted effort to find an equally inspiring spot back in Atlanta.

Works Cited

Alvarsson JJ, Wiens S, Nilsson ME (2010) Stress Recovery during Exposure to Nature Sound and Environmental Noise. International Journal of Environmental Research and Public Health 7(3): 1036–1046

Barton J, Griffin M, Pretty J (2012) Exercise-, nature- and socially interactive-based initiatives improve mood and self-esteem in the clinical population. Perspect Public Health 132(2): 89-96

Cummings ME, El-Sheikh M, Kouros CD, Keller PS (2007) Children’s skin conductance reactivity as a mechanism of risk in the context of parental depressive symptoms. Journal of Child Psychology & Psychiatry 48(5): 436-445

Diego MA, Jones NA, Field T, Hernandez-reif M, Schanberg S, Kuhn C, Galamaga M, McAdam V, Galamaga R (1998) Aromatherapy Positively Affects Mood, EEG Patterns of Alertness and Math Computations. International Journal of Neuroscience 96(3-4): 217-224

*Franco LS, Shanahan DF, Fuller RA (2017) A Review of the Benefits of Nature Experiences: More Than Meets the Eye. International Journal of Environmental Research and Public Health 14(864): doi:10.3390/ijerph14080864

*Glass ST, Lingg E, Heuberger E (2014) Do ambient urban odors evoke basic emotions? Frontiers in Psychology 5(340): https://doi.org/10.3389/fpsyg.2014.00340

Hartig T, Mitchell R, de Vries S, Frumkin H (2014) Nature and health. Annual Review of Public Health 35: 207-228

Kjellgren A & Buhrkall H (2010) A comparison of the restorative effect of a natural environment with that of a simulated natural environment. Journal of Environmental Psychology 30(4): 464-472

Shanahan DF, Fuller RA, Bush R, Lin BB, Gaston KJ (2015) The Health Benefits of Urban Nature: How Much Do We Need? BioScience 65(5): 476-485

White MP, Alcock I, Wheeler BW, Depledge MH (2013) Would You Be Happier Living in a Greener Urban Area? A Fixed-Effects Analysis of Panel Data. Psychological Science 24(6): 920-928

Yang W & Kang J (2007) Soundscape and Sound Preferences in Urban Squares: A Case Study in Sheffield. Journal of Urban Design 10(1): 61-80

* Indicates that an article was published online, and DOI is given in place of page numbers

Wander down any street in Paris, and you will be struck by a number of differences from an American city. People speaking dozens of different languages, crowding tables on the sidewalk drinking wine and smoking cigarettes have become a familiar sight to me; but one aspect of Parisian life always manages to grab my attention: the bakeries. Hundreds of them, on every street corner, all bustling with activity and displaying their delicious wares behind wide glass windows. I was not prepared for the sheer amount of bakeries, and by the time I go home I might have gained a pound from croissants alone. What I really need is an intervention, but first I’m going to find out what it is makes those bakeries so difficult to walk away from. 

These frosted biscuits caught my eye from a block down the street (Boulevard Saint-Germain, Paris).

Biology has tied the evolution of human vision to food behavior; it is thought that we developed the ability to see in color in response to demands of the foraging our ancestors had to do to survive (Bompas et al., 2013). But today, visual-cues related to food are everywhere, whether it be Parisian bakeries or billboards with burgers on them. There have been numerous studies investigating the role of food in brain function, and how specific nutrients affect various brain systems. For example, omega-3 fatty acids have been shown to support plasticity and help the brain recover from traumatic brain injury (Wu et al., 2007). Furthermore eating food, especially food rich in sugar, has been shown to activate the same dopamine-reward pathways activated by drugs (Hernandez & Hoebel, 1988). More recently, neuroscientists have been trying to determine a link between the consumption of food and visual cues in our environment. This research is of the utmost importance in our modern world, where advertising for food is everywhere and childhood obesity rates are at catastrophic proportions (Han et al., 2010). Studies have found that images of food can affect the human body in a variety of ways, including increased salivation, neural activity, and reward anticipation; food advertising is simply more powerful than most other forms (Spence et al., 2016).

Just a closer look at what I’ve been trying to resist (Boulangerie Chambelland, Paris).

The effects of food advertising can be more pronounced in individuals who have any sort of food related behavioral issue. A 2019 study used neuroimaging on the brains of adolescents who displayed “loss of control” eating behaviors and found that in these individuals there was increased brain activity when food related images were presented compared to control (Biehl et al., 2019). The researchers also found that obese patients performed poorly compared to controls on a goal oriented task when images of food were presented as distractors (Biehl et al., 2019). In an interesting parallel, another study performed a similar task with anorexic patients and found that they too are more likely to have task performance impeded by visual food cues (Neimeijer et al., 2017). These findings support the popular theory that food can be an addiction; actual changes in neural circuitry occur in patients with abnormal eating behaviors, resulting in a different response to food-related stimuli in the environment (Biehl et a 2019; Neimeijer et al., 2017). The two studies also underscore the effect that visual food stimuli can have; even the control group experienced greater brain activity to food cues compared to neutral cues, with an even greater difference when they were hungry.

Finally, science backs up my mother’s longstanding rule “never go to the grocery store on an empty stomach”. Parisian bakers have stumbled upon principles of neuroscience to draw pedestrians into their shops; seeing delicious pastries in a window captures one’s attention and sets off a series of neurological functions evolved to drive one to eat. It’s really no wonder I grab a coffee and a croissant every time I see a rack of them in a window; you can’t fight science!

Works Cited

Biehl SC, Ansorge U, Naumann E, Svaldi J (2019) Altered Processing of Visual Food Stimuli in Adolescents with Loss of Control Eating. Nutrients 11(2): 210

Bompas A, Kendall G, Sumner P (2013) Spotting Fruit versus Picking Fruit as the Selective Advantage of Human Colour Vision. i-Perception 4: 84-94

Han JC, Lawlor DA, Kimm SY (2010) Childhood obesity. Lancet 375: 1738-1748

Hernandez L & Hoebel BG (1988) Food reward and cocaine increase extracellular dopamine in the nucleus accumbens as measured by microdialysis. Life Sciences 42(18): 1705-1712

Neimeijer RAM, Roefs A, de Jong PJ (2017) Heightened attentional capture by visual food stimuli in anorexia nervosa. Journal of Abnormal Psychology 126(6):805-811

Spence C, Okajima K, Cheok AD, Petit O, Michel C (2016) Eating with our eyes: From visual hunger to digital satiation. Brain and Cognition 110: 53-63

Wu A, Ying Z, Gomez-Pinilla F (2007) Omega-3 fatty acids supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. Journal of Neurotrauma 24(10): 1587-1595

In the English classes that I take at Emory, there often comes a discussion about what influence, if any, the life of the artist should have on our interpretation of the source material. In most instances, it is important to allow the work to speak for itself. JK Rowling has made headlines recently for angering fans by making proclamations about the Harry Potter universe which are not evident in the books. But sometimes the life and the art are intertwined; Sylvia Plath’s poetry for example is deeply personal, and it is difficult to avoid factoring in her suicide when discussing it. Of all the cases in which the life of an artist and their art are connected, the story of Vincent Van Gogh is probably the most famous. A brilliant painter, unappreciated in his time, struggles with his sanity, cuts his own ear off, and dies under mysterious and violent circumstances. This past week I have gotten the chance to see some of Van Gogh’s paintings first hand and to wander the town of Arles where he worked, but unfortunately following in his footsteps has not yielded much clarity. Van Gogh’s art speaks for itself, but a deep appreciation — and, I admit, some morbid curiosity — drove me to take a closer look.

Garten des Hospitals en Arles by Van Gogh.

Yours truly in the above garden, trying to figure out how it got so yellow.

Over the decades, a number of scientists have applied modern medical knowledge and a fair deal of detective work to try to better understand Van Gogh the man and his paintings. One study suggests that the increased amount of yellow in Van Gogh’s later work was the result of digitalis intoxication, a side effect of the foxglove plant he was prescribed to treat his epilepsy. Digitalis intoxication can cause yellow spots in an individual’s field of vision (Lee, 1981).

Van Gogh’s painting of Dr. Gachet, seen with the foxglove plant he likely treated the artist with. I was going to buy it, but I’m about $82 million dollars short.

It is not sound medical practice to posthumously diagnose a patient, and so much of what we know about Van Gogh’s mental health is based on records from his prolonged hospitalization in Arles. Van Gogh was diagnosed and treated for epilepsy, a disease that was likely made worse by his substance abuse (Lee, 1981). It is believed that Van Gogh may have suffered from an additional mental illness, as his bouts of mania and depression bear striking similarity to bipolar disorder (The Van Gogh Gallery: Vincent Van Gogh’s Mental Health; Lee, 1981). However, a diagnosis of epilepsy does account for many of the curious features in the artist’s work.

Temporal lobe epilepsy is a form of refractory focal epilepsy (Allone et al., 2017). In this version of epilepsy, neuronal misfiring in temporal lobe structures start seizures which may or may not spread throughout the brain (Engel, 1996; Engel 2001). This is likely the form of epilepsy which Van Gogh had, as it is the most common form of epilepsy and temporal lobe structures deal with auditory processing (Van Gogh suffered from auditory hallucinations) and object recognition (Engel, 2001). Interestingly, hallucinations or dream-like cognitive states are not uncommon in patients with the disease (Allone et al., 2017). One of the defining features of Van Gogh’s art is the dream-like blurring of objects; in the above painting of Dr. Gachet, the background and the doctor himself are distorted into surreal representations of the subject matter. This effect is common in impressionist paintings, but it is more pronounced in Van Gogh’s work than in most other’s. This artistic style may have been more potent for Van Gogh if he painted while in a state of delirium or if he had sustained damage to an area of the temporal lobe implicated in object recognition. The cognitive impairments arising from severe temporal lobe epilepsy can manifest in different ways. Patients commonly report memory deficits, but one feature may be a negative effect on “praxis”, defined as one’s ability to perform skilled actions like painting (Allone et al., 2017). Between hallucinations and delirium, seizures, brain damage, and loss of praxis one can begin to see why Van Gogh’s perception of the world differs so much from that of the average person.

Taken together, Van Gogh’s epilepsy and treatment regimen can begin to account for some of the features of his art. The longer temporal lobe epilepsy persists, the more severe the cognitive impairments associated with the disease become, which explains why Van Gogh’s symptoms seem to have worsened over time (Allone et al., 2017). Epileptic activity may also explain Van Gogh’s hallucinations and his unorthodox depiction of objects in his paintings. Ironically, the treatment it is thought Van Gogh was prescribed can also negatively impact vision and cognition, even causing delirium in certain cases (Lee, 1981).

Wandering around Arles, I was struck by the notion that I didn’t see the town in the same way Van Gogh did. There is a gap between the landmarks I saw and his paintings of them that I found difficult to reconcile. I now know that only part of that gap should be attributed to artistic representation; Van Gogh’s world may have been one of blurred images, vibrant colors, and distorted objects. I believe that part of the function of art is to help the viewer see the world’s beauty in a different way, and Van Gogh certainly accomplishes that in all of his paintings. At the end of the day, it doesn’t matter if the artist’s masterpieces were fueled by imagination or misfiring neurons. The world is lucky that one man’s tragic suffering resulted in such incredible works of art, and I’m lucky to have been able to take a step closer to understanding that man’s incredible mind.

Works Cited

Allone C, Buono VL, Corallo F, Pisani LR, Pollicino P, Bramanti P, and Marino S (2017) Neuroimaging and cognitive functions in temporal lobe epilepsy: A review of the literature. Journal of the Neurological Sciences 381:7-15

Engel J (1996) Introduction to temporal lobe epilepsy. Epilepsy Research 26: 141-150

Engel J (2001) A Proposed Diagnostic Scheme for People with Epileptic Seizures and with Epilepsy: Report of the ILAE Task Force on Classification and Terminology. Epilepsia 42(6): 796-803

Lee TC (1981) Van Gogh’s Vision: Digitalis Intoxication? The Journal of the American Medical Association (JAMA) 245(7):727-729

The Van Gogh Gallery: Vincent Van Gogh Biography. https://www.vangoghgallery.com/misc/biography.html

Our first week in Paris coincided with two championship soccer games. Like many Americans I am unfamiliar with soccer, but our group gathered at a English bar called The Mazet on Wednesday night to watch the Europa League Final: Chelsea vs. Arsenal.   

The Mazet bar in Paris, where our group gathered to watch the Europa League Final

Most of you will be familiar with the ongoing controversy about traumatic brain injury (TBI) in sports. Our national conversation tends to focus on American football, but TBI is also a huge problem in boxing, hockey, and lacrosse (my sport of choice). In the field of medicine, a distinction is made between sports based on the level of risk of injury. The sports listed above are all deemed collision sports, in which “athletes purposely hit or collide with each other or with inanimate objects (including the ground) with great force” (Rice, 2008). Soccer is a contact sport, meaning that “athletes routinely make contact with each other or with inanimate objects but usually with less force than in collision sports” (Rice, 2008).

While watching the game, I noticed that Arsenal’s goalkeeper Petr Cech was wearing a sort of helmet which I later identified as rugby headgear (Rugby is a collision sport). Chelsea’s goalkeeper wore no headgear; neither did either keeper playing in the Champion’s League Final I watched on Saturday night. A fellow patron informed me that Cech had suffered a serious head injury earlier in his career, and had continued to wear the helmet ever since as a preventative measure.    

Two images of Petr Cech at the 2019 Europa League Final, taken at the Mazet in Paris

As an American sports fan, I was intrigued. Most players in the sports that I watch are required to wear some form of personal protective equipment (PPE), but very few wear items which are not required. During my years as an athlete, I would often forgo recommended PPE which I found to be unnecessary; most of my lacrosse teammates chose not to wear athletic cups and opted for the elbow pads which were the least restrictive (and therefor the least protective). While the decisions Peter Cech and other athletes make about their PPE mostly come down to personal preference, I became curious about what is being done to tackle (pun intended) the problem of TBI in sports.

Emergency room visits for TBI predominantly involve children, and a significant portion of these injuries are sports related (Sarmiento et al, 2019). This fact seems especially troubling considering the long term effects of TBI and the effects it may have on development are still being investigated. A 2019 study by Russel and Selci administered the Pediatric Quality of Life Inventory (PedsQL) to 134 adolescents who had sustained concussions playing sports. Compared to a control group with non-concussion sports injuries, the experimental group demonstrated severe detriments to their quality of life, especially cognitive functioning and school performance. Patients who had recovered from multiple concussions were significantly more likely to also suffer from depression and headaches (Russel et al, 2019). In this study, after the patients had recovered fully (according to the Post-Concussion Symptom Scale) no longterm neurological symptoms were detected.

The ongoing media narrative surrounding concussions in sports paints a very different picture from this research. An article published just last month in the New York Times (Branch, 2019) lambasts the National Hockey League for its refusal to acknowledge a link between the sport and neurodegenerative symptoms in its players. Specifically, the article discusses chronic traumatic encephalothopy (CTE), the poorly-understood disease which makes headlines nearly every time a pro-athlete dies. CTE is only diagnosable postmortem and is thought to be linked to repeated TBI (Stern et al, 2019). The disease is characterized by a build up of “tau-aggregates” in neurons, similar to the amyloid-beta plaque build up that occurs in Alzheimer’s disease. In fact, brains in the late stages of CTE also show amyloid-beta plaque deposits (Stern et al, 2019). In a 2019 study analyzing the build up of tau aggregates in the brains of former NFL linebackers, Stern and Adler found significantly more tau aggregate build up in several brain regions thought to be affected by CTE than in non-athletes. However, the increased levels of tau aggregate did not correspond to amyloid-plaque deposit increases or to neurodegenerative symptoms (Stern et al, 2019). To be clear, TBI does have negative effects on one’s health and wellbeing — wear your helmets, kids — its just uncertain how these effects manifest over a lifetime.

Several similar studies seem to debunk the popular narrative that repeated TBI results in severe neurodegenerative symptoms. A 2019 paper by Brett and Wilmoth designed to review the symptoms of CTE and the way that it is diagnosed concluded that the diagnostic criteria are unclear, causing the disease to be over reported (Brett et el, 2019).The high-profile of athletes who suffer from the disease combined with the troubling amount of TBI in children explain why the media, educators, and legislators are all fascinated with combatting a disease that scientists remain uncertain about. Regardless of the effects, TBI is a real risk to athletes the world over. Professional athletes like Peter Cech who are proactive about their safety set a good example for adolescents like me who are making the choice between comfort and protection every time they suit up.

Works Cited

Branch, J (2019) The NFL Has Been Consumed by the Concussion Issue. Why Hasn’t the NHL? New York Times 5/31/2019

Brett BL, Wilmoth K, Cummings P, Solomon GS, McCrea MA, Zuckerman SL (2019) The Neuropathological and Clinical Diagnostic Criteria of Chronic Traumatic Encephalothopathy: A Critical Examination in Relation to Other Neurodegenerative Diseases. Journal of Alzheimer’s Disease 68: 591-608

Rice SG, Council on Sports Medicine and Fitness (2008) Medical Conditions Affecting Sports Participation. Pediatrics 121:841-848.

Russel K, Selci E, Black B, Ellis MJ (2019) Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study. Journal of Neurosurgery Pediatrics 23:455-464.

Sarmiento K, Thomas KE, Daugherty J, Waltzman D, Haarbauer-Krupa JK, Peterson AB, Haileyesus T, Breidling MJ (2019) Emergency Department Visits for Sports – and Recreation – Related Traumatic Brain Injuries Among Children — United States, 2010-2016. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 68:237-242.

Stern RA, Adler CH, Chen K, Navitsky M, Luo J, Dodick DW, Alosco ML, Tripodis Y, Goradia DD, Martin B, Mastroeni D, Fritts NG, Jarnagin J, Devous MD, Mintun MA, Pontecorvo MJ, Shenton ME, Reiman Em (2019) Tau Positron-Emission Tomography in Former National Football League Players. New England Journal of Medicine 380:1716-1725