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Counting the forms of emotional abuse Is suffering for love inevitable? It is ironic that the person who loves you the most is also the one able to hurt you most deeply. Apparently, romantic relationships entail a great deal of suffering. Everybody seems to think that this is unavoidable, that suffering is just the price of admission for being loved. But it doesn’t have to be this way. If we hurt the person we love, it’s because we must be doing something wrong. It seems that, when we reach a certain degree of intimacy, we start allowing ourselves some behaviors that create conflict and emotional damage. Then, perhaps what we should do is to learn to recognize those behaviors and ways to avoid them. We should learn to love in a better, healthier way. The slippery slope to emotional abuse “Abuse” is a strong word. We tend to neatly divide people between abusers, who deserve our scorn and even jail time, and victims, who must be protected and healed. And then there are the rest of us: nice people who are neither abusers nor victims. This classification may work when it comes to physical abuse, because physical damage is easy to identify. Likewise, social taboos about unwanted sexual contact are normally clearly established within any given society. However, there are no such clear boundaries when it comes to emotional abuse. Whether a particular act is abusive or not depends not so much on the act itself but on context, intention, frequency, and the vulnerability of the other person. Perhaps this explains why we often hurt the person we love, sometimes intentionally, sometimes inadvertently. When it comes to emotional damage, we all can be small-scale abusers and victims. Of course, there are the real psychological abusers, those who cause emotional damage in an intentional or habitual way with the objective of bringing the other person under their control. Emotional abuse is defined as any behavior that causes psychological damage, produces dependence and decreases the self-esteem of the target person. It is based on using three key emotions, fear, guilt and shame, which are used to break the psychological balance of a person. Next, I offer a list of behaviors involved in emotional abuse. 1 - Coercion Coercion is defined as a demand that can’t be refused without bringing about serious negative consequences. One clear example is coerced sex. Imposed, for example, under the threat of a fight. But coercion can be used to obtain other things: going to a party, socializing with some particular people, choosing a vacation spot, how to decorate the house, or when to have children. 2 - Threats Threats are a direct form of coercion. They evoke fear to get what we want. One of the most frequent threats in a couple is breaking up. This usually results from an imbalance of power because one person values the relationship more than the other. It could be that she is more in love or that the relationship brings on advantages that he doesn’t want to lose. In these cases, the impending threat of the breakup can become an unspoken, ongoing and powerful coercion. Or it could be that this threat is just a bluff. Playing chicken because the other person will fold first. 3 - Scaring Threats are just one way of using fear to control a person. Emotional manipulation can prosper in an environment of high anxiety created by actions like screaming, throwing things, breaking things, risking safety or breaking the law. The simple presence of fear creates an environment of oppression. 4 - Blackmail Blackmail is a form of coercion that consists of threatening to do something that the other person doesn’t want us to do if he does not comply with our demands. A common form of blackmail is the threat of telling about something. One example is outing: revealing that somebody is gay, bisexual, into BDSM, polyamorous, or any other form of sexuality not approved by society. 5 - Emotional blackmail Emotional blackmail consists of using fear, obligation or guilt (abbreviated with the acronym FOG) with the goal of pressuring another person to do what we want. There are four types of emotional blackmail. 1.      Threat of punishment. A classic example in couples is the withdrawal of sex or affection. 2.      Self-punishment: the threat of harming oneself. An extreme but all-too-familiar case is the threat of suicide. A milder case is that sulking attitude when we don’t get what we want. 3.      Acts of self-sacrifice with the goal of evoking guilt. These include acts of service that are done, not out of goodwill or love, but to get something in exchange. 4.      Offering a price in exchange for getting what we want. This is the type most difficult to recognize. A classic example is offering candy to a child in exchange for a kiss. In a couple, offering sex as a price may seem like a good idea but, in fact, it is similar to withdrawing sex when we don’t get what we want. The third and fourth types of emotional black mail create a manipulative environment in which we don’t know if favors are given out of love or with a secret agenda. 6 - Breaking boundaries Boundaries are things that we never want to do or don’t want to be done to us. In a healthy relationship, each person defines what their boundaries are and respects the boundaries of the other. Problems arise either when boundaries are not clearly defined, or when they are known but are broken, nevertheless. 7 - Sabotage Sabotage includes instances of not respecting the work, family and social obligations of our lover. A typical case is when a couple’s brawl leaves us so upset that we cannot focus on work. In this case, the sabotage is involuntary and indirect. A step up from that is when somebody has so little respect for their partner that he gives no consideration to her work schedule or the time he needs to devote to family and friends. Time and attention can be misappropriated, for example, by forcing dates or phone conversations at inopportune times. In the more extreme cases, the abuser directly interferes with the work or social environment of the victim with the clear goal of undermining them. For example, I know a case of a husband who called her wife’s boss to tell him that she was quitting the job, which was not her intention at all. 8 - Lack of communication Good communication is vital in any healthy relationship. This is hard even in the best cases, so it becomes nearly impossible when somebody sabotages it as part of a manipulative strategy. One example of this is the “silent treatment”—refusing to talk—or its modern version: ghosting in social media. Another example is doing the opposite: talking continuously to create a Wall of Words that prevents the other person from talking. 9 - Lying Of course, the worst form of lack of communication is not telling the truth. Lying should be considered as a way of taking power away from people, because misinformation prevents them from making the best decisions. Lying is considered the main offense in infidelity cases, but any form of lying or dishonesty is harmful in a relationship because it undermines trust. 10 - Gaslighting Gaslighting is a form of psychological abuse consisting of the systematic manipulation of the information that is provided to a person. The name comes from the play Gas Light and its movie adaptations. The goal is to weave of a web of lies, half-truths, secrets and deceptions that create a distorted view of reality. This is often done with the goal of hiding a situation of generalized abuse. Gaslighting greatly harms the self-esteem and may cause the victim to question her own sanity. 11 - Keeping secrets Whether it’s okay to keep secrets from our partner is a delicate issue. On the one hand, everybody has a right to his own privacy. Some things are so intimate that we want to keep them from anybody. On the other hand, hiding things that our partner has the right to know could be considered lying by omission. The most clear examples are sexually transmitted diseases and adultery. 12 - Invading privacy The other side of that coin is privacy. Even if it is not right to keep some things secret, that doesn’t mean that we may use coercion to force somebody to reveal a secret. Everybody has a right to reveal things about themselves if they want, when they want, and how they want. There is also a right that whatever we tell somebody in confidence is not revealed to third persons without our consent. The most clear example of a violation of privacy, unfortunately common these days, is to search a phone or a computer for information without the permission of the owner. 13 - Complaints and criticisms Complaining is normal. If something is not going well in the relationship, it is essential for good communication to talk about it. But there are many ways to say something. When complaints and criticisms are made with the intention of evoking shame and guilt, we have entered the territory of emotional mistreatment. Problems should be presented at the right occasion, preferably with enough time to discuss them without feeling rushed. There should be no intention of hurting and offending. Like with many other things, quantity matters: a long list of reproaches is offensive. We should also pay attention to two bad habits related to this. 1.      Being easily offended, so that whoever talks to us is kept on edge, having to constantly self-censor. Obviously, this gets in the way of good communication. 2.      To present oneself as a victim, a common strategy of psychological abusers. 14 - Shaming Shame is the emotion that damages self-esteem the most. Consider, for example, all the cases of homosexual teenagers that are driven to suicide by shaming from their parents, their teachers, their classmates or religious authorities. One of the most common instances of emotional abuse is degrading comments and continuous criticism. An extreme case of shaming is cyber-bullying: the harassment and public shaming of individuals in social networks. Another form of shaming is to berate people not for what they do but for who they are, like their gender, ethnicity, sexual orientation or culture. Here we enter on the territory of bigotry and intolerance. 15 - Not apologizing We all make mistakes, so we all should be ready to apologize when we hurt another person. A timely apology could mean the difference between a fight that is satisfactorily resolved and another that leaves scars for a lifetime. It could also mean the difference between a mistake done without malice or an act of deliberate abuse. When a person in a couple apologizes all the time and the other never does, that is a sign of an imbalance of power produced by other forms of emotional abuse. 16 - Not forgiving Not accepting an apology can undermine the dignity of the person offering it and thus can be confrontational and hurtful. Of course, not everything could or should be forgiven. In fact, in many cases of abuse, there is a pathological form or forgiveness based on co-dependency—the victim constantly forgives the abuser, and even makes far-fetched excuses for the abuse. A necessary condition for forgiveness should be that the action to be forgiven has ended. We can’t forgive somebody who persists in the misbehavior. On the other hand, not granting forgiveness that has been earned can become emotional abuse when this is used to perpetuate the guilt of the person asking to be forgiven as a form of control. Maybe the right thing to do when something cannot be forgiven is to terminate the relationship, rather than to continue it in the climate of power imbalance brought by the feeling of guilt. Another problem is when an apology is accepted but used later on, over and over again, to remind the person of his past guilt. That is not true forgiveness. 17 - Passive aggressive behavior Passive aggression is an expression of hostility based on not doing things that we are supposed to do. It includes some of the problems that I mention above, like lack of communication, withdrawing affection, not apologizing and not forgiving. But there are many other ways of being passive aggressive, sometimes hard to identify. Even over-politeness or extreme compliance can be forms of passive-aggression. By the same token, it is easy to accuse a well-meaning person of being passive aggressive. It’s difficult to defend ourselves against such an accusation. 18 - Social isolation In cults, a common technique to create emotional dependence is to separate the new follower from his family and friends. This way, the victim loses the frame of reference that would allow her to escape indoctrination. A similar situation can take place in a couple when a person is separated from her friends and social environment, usually because of jealousy. 19 - Social pressure Similarly, one of the individuals in a couple may become completely surrounded by the friends and family of the other. Then, when problems arise in the couple, these people would have a biased attitude about them. Social pressure can also come from cultural norms that favor one person over the other. One clear example is sexism, when society condones a man’s control over a woman’s behavior. Another case is when one person wants some kind of sexual freedom, like being kinky or polyamorous, and the other prevents it with the help of cultural norms and societal repression. This happens in instances of slut-shaming: harassing women because their sexual behavior infringes cultural norms. Rationalizing emotional abuse I don’t know about you, but I must confess that I have done some of the things on this list. But I also had some of them done to me. Perhaps you think that you don’t do them just because you are a woman, or a feminist, or gay. Well, think again, you may be in denial. After all, even hard-core psychological abusers don’t see themselves as such. Is very easy to rationalize emotional abuse as self-defense, standing up for ourselves, or as being funny. We should stop doing these things because they really hurt that person that we claim to love. They also damage our relationship and gradually wither away the love we seek. On top of that, when we engage in these behaviors we contribute to normalize them, making them harder to identify in cases of serious psychological abuse. We all have been in a couple’s quarrel in which we have tried to scare or hurt the person that we love. We need to stop doing that and raise our ethical standards. If we need to fight, we should at least fight fairly, without being manipulative or cruel. Emotional abuse should not be considered normal, even in its mildest forms. It leaves scars that undermine the relationship, setting the foundation for future fights and even making the relationship toxic. True love doesn’t hurt One of the worse things about psychological abuse is that it’s so hard to identify. There is a gradation between what is socially accepted behavior in a couple (but still wrong) and psychological abuse. Where our behavior falls in that gradient depends not only on what our intentions are, but on how vulnerable is the other person. It’s way too easy to hurt somebody by mistake. Since it’s so easy to engage in emotional mistreatment, it often becomes mutual in a couple. This may lead to a toxic relationship where victim and abuser are not easy to identify. So we should be mindful that, even if we are being mistreated, this does not justify retaliating with emotional abuse of our own. When emotional abuse has made a relationship toxic, the best solution is to break up. We all should examine our behavior towards our loved one and carefully expunge any element of emotional abuse. When somebody opens their heart to us, this makes them extremely vulnerable. We should not betray their trust by using this vulnerability to hurt them or to exploit them. Even if we do it unconsciously, there is no excuse. If we want to be loved, we have to learn to love right. It consists of making the other person happy. True love doesn’t hurt.

The sadist wants to cause physical and emotional pain, but not suffering What do sadists want? In the context of BDSM (bondage, dominance, submission, sadism and masochism), being a sadist means giving pain to people who enjoy receiving it—masochists—in ways that they enjoy receiving it. And, of course, within the limits of mutual consent. This is the original meaning of sadism, since it derives from the Marquis de Sade, a French nobleman who lived in the 18th and 19th centuries and wrote several novels with extreme BDSM content. The fact that sadism is currently used as a synonym of cruelty derives largely from a misunderstanding of the motivation of sexual sadists like the Marquis de Sade. In addition, sadism and masochism were considered psychological diseases for a long time, along with homosexuality and masturbation. This stopped with the publication of the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). To investigate the motivations of sadists, I did an informal survey in Fetlife.com in which self-identified sadists could choose among 18 possible motivations, as many as they want. That is, the answers were not mutually exclusive. For that reason, the percentages I give below add up to more than 100%. I got 56 people answering the survey. Most self-identified sadists (79%) inflict pain to please the masochists with whom they play. Other common reasons are to establish connection and intimacy (64%), looks like the reactions of masochists and marks on their skin (63%), achieving “top space” (61%), expressing power (59%), getting the masochist into “sub space” (55%), and establishing domination (54%). The rest of the 18 options in the survey fell below the 50% mark. They included “other”, so that people could list reasons I may have neglected. Only 16% of responders checked this. “Cruelty” was near the bottom of the list. Only 18% of the responders—10 people—checked it. I gave the following description of this option: “You like to make people suffer. It’s great that BDSM allows you to express your dark side. You do not try to feel what they are feeling, but rather to dissociate from them.” Some of the sadists who chose cruelty as their motivation expressed surprise that they were so few. They said that, for them, sadism was about making people suffer. They can do this consensually because there are masochists who say that they seek suffering. I thought that the difference between sadism and cruelty was clear to self-identified sadists but, apparently, there are different opinions about the meaning of those words. In this article, I explore it in depth. What is sadism? “Sadism” doesn’t have its own entry on Wikipedia. Instead, you find these three entries: “Sadomasochism, the giving or receiving of pleasure from acts involving the receipt or infliction of pain or humiliation.” “Sadistic personality disorder, an obsolete term proposed for individuals who derive pleasure from the suffering of others.” “Sexual sadism disorder, a medical/psychological condition for sexual arousal from inflicting pain/humiliation on unwilling, non-consenting victims.” The first definition implies that ethical sadism is always associated with masochism. Sadomasochism is consensual and mutually fulfilling: the sadist enjoys delivering pain to a masochist who enjoys receiving it. When the infliction of pain is not consensual, we fall into the third definition, in which sadism is a disorder. Emotional sadism And yet, a scene can be consensual and feel like it involves suffering. That is why some sadomasochists think that sadism involves cruelty. What they are talking about is emotional sadomasochism: scenes that use emotional pain instead of, or in addition to, physical pain. What is emotional pain? Is the distress produced by some negative emotions like fear, sadness, frustration, helplessness, despair, envy, jealousy, disgust and unwanted physical pain. Here are some examples of emotional pain in kink: The sexual frustration of not being allowed to orgasm. The envy and jealousy experienced in cuckolding by seeing your partner pleasuring another person while you are being denied sexual pleasure. Enduring a physical pain that is devoid of erotic value. Being punished when it is obviously unfair. Being unjustly criticized when succeeding in performing a difficult task. Despair by not being able to accomplish an impossible order of the top. The sadness of being denied affection. Fear and despair at the sadist’s cruelty when realizing that they mean to hurt you. Being used as a sexual object with total indifference towards your feelings. Some of this may fall under the category of mind-fucking. However, while in mind-fucking there is often an element of pretending or deceiving, in emotional sadism both the sadist and the masochist want to evoke very real emotions. The sadist wants to hurt the bottom. Here is how an emotional masochist describes how she deals with these feelings. Emotional masochism is usually confined to the time of the scene. Just like the physical pain of flogging or clamps only happens during a BDSM scene, the emotional abuse is limited in time. After that, the relationship goes back to regular affection, fairness and friendship. There should be emotional aftercare to reset the feelings of the masochist. Emotional masochists develop a detachment from their emotions. They see themselves from the outside, with a certain dissociation. They speak of a beautiful melancholy, an enjoyment of these feelings. Emotional pain is enjoyed very much is the same way as physical pain. The sadist does not hate the masochist. Sadists experience a dissociation similar to the one experienced by the masochists, because they want to hurt them and, at the same time, know that the bottoms are enjoying themselves. The scene is based on a consensual agreement. What is suffering? We are confronted with a paradox here. While emotional masochists feel negative emotions that most people would avoid, they welcome them. They desire them. They, in fact, enjoy them. The paradox also works for the sadists. Even though they want to hurt the masochists, they are fully aware that the bottoms are enjoying themselves. And they would not do what they are doing if the masochist were not able to enjoy it. Perhaps there are sadists who desire to hurt people in a way that they would not enjoy it at all—and therefore would not consent to it. Perhaps these sadists act consensually, not because they would feel bad otherwise, but because of a rational decision to act ethically. In any case, you see that there are two levels here. One is the distress produced by negative emotions, which can be enjoyed by an emotional masochist. The other is real suffering. Things that cannot be enjoyed because they damage the very core of a human being or the things that make life worth living. For example: The death of a loved one, like your spouse, your parent or your child. Having your heart broken when you are abandoned by somebody you love. Losing a job that you love or that you need to survive. Losing a limb, your hearing or your sight. A debilitating, incurable disease. Losing your intelligence, your memory or your sanity. Personally, I think that we should reserve the word suffering for these types of experiences. Alternatively, we could call it deep suffering. Pain should mean physical pain, although many people use it to refer to emotional pain. The latter could be called distress, to be more accurate. I explore this issue from the point of view of neuroscience in my article Pain Is Not Suffering. Some sadists enjoy real life suffering Desiring deep suffering on somebody would be unethical, in my opinion. That would cross the line between emotional sadism and cruelty. Yes, many people desire their enemies to suffer this way, but here we are in the territory of hate. And yet, I have heard from some sadists who feel pleasure when they see the suffering in their BDSM partners caused by real life tragedies. In turn, these masochists feel relief from their suffering when they see the sadist enjoying it. There seems to be healing in this interaction, which, of course, is fully consensual. A key issue here is that the sadist eroticizes suffering caused by the random events of life. Unlike what happens with pain in a BDSM scene, the sadist does not inflict this type of suffering on the masochist. That would cross the line into real cruelty. The enjoyment that these sadists take on suffering may seem weird, even revolting. However, it just takes to the extreme something that a lot of people do. Many of us enjoy the suffering of the characters in a novel or a movie. Tragedies have been popular since antiquity. It is undeniable that what attracts us to these stories is precisely witnessing the suffering of their characters. In that way, we are not all that different from the emotional sadists. Why do we desire to witness someone else suffering? Maybe this is the flip side of empathy and compassion. Empathy means that we feel that suffering but, at the same time, we can detach from it because it is not our suffering. That makes us happy that we don’t have to suffer that way. At the same time, the strong emotions involved produce a catharsis in us, a cleansing of our fears and traumas. When the masochists witness the sadist enjoying their suffering, they can partake in the detachment of the sadist. They gain a perspective on it that they would not have otherwise. Maybe this is why emotional sadomasochism is healing for the masochist. What is cruelty? “Cruelty is the pleasure in inflicting suffering or the inaction towards another's suffering when a clear remedy is readily available.” Wikipedia. I think that cruelty can originate from two different motivations: Using people as a mean to achieve our goals, disregarding their suffering. This is the cruelty of the slave owner, the heartless landlord or the exploitative employer. The cruel person blocks any feelings of empathy he may have for his victim. There are mere objects for him. Making people suffer on purpose. Here, suffering is the point. The motivation for doing this may vary. It could be revenge, feeling powerful, enforcing religious beliefs or an enjoyment in the suffering itself. It is possible that people with antisocial personality disorder are naturally prone towards cruelty. The second meaning of cruelty is the one that can be confused with sadism. However, here there is no distinction between emotional distress and deep suffering. While sadist would not inflict deep suffering, cruel people are oblivious to the difference. Empathy One way in which cruelty can be differentiated from sadism is the presence of empathy. Empathy is what makes us feel what others feel. Recently, many neuroscience papers have come out about the social transfer of pain (Smith et al., 2021). The basic observation is that when two mice have been housed together and one experiences an injury, the other mouse becomes more sensitive to pain. Humans have that type of empathy, but we also have another type that is absent in animals: one based on theory-of-mind (Bruneau et al., 2012). This is the ability to model the minds of other people inside our own minds. We know what they are thinking and we know what they are feeling. It is much more detailed than the first type of empathy. It is not abstract thought, but consists of real emotions. Thanks to theory-of-mind, we can experience what characters in a movie or a novel feel. The first type of empathy is automatic, but the second one can be turned on and off. Empathy makes us suffer when other people suffer (Stevens and Taber, 2021). Thanks to it, we cannot be completely happy in a society where other people are unhappy. Cruelty is devoid of empathy. Exploitative people have to make an effort to turn off their empathy to avoid experiencing the suffering of those they exploit. This requires some effort. One way to achieve this is to objectify them, to negate that they are human beings that have feelings. In contrast, the sadist is full of empathy. Feeling the pain of the masochist is the point. If sadists are not aware of the pain that they inflict, they could not be satisfied. Conclusions The distinction between pain and suffering implies a distinction between sadism and cruelty. Sadists like to inflict pain, including emotional pain, but not to make people suffer. Cruel people dehumanize other people to exploit them, to satisfy their hatred, or because of some religious or political motivation. They do not care about the distinction between emotional distress and deep suffering. In sadism, empathy is the point. In cruelty, empathy has to be turned off to keep the cruel person from experiencing the suffering of his victims. These are not mere semantic arguments. They are ideas that need to be kept in mind to define the limits between ethical sadomasochism and abuse. References Bruneau EG, Pluta A, Saxe R (2012) Distinct roles of the 'shared pain' and 'theory of mind' networks in processing others' emotional suffering. Neuropsychologia 50:219-231. Smith ML, Asada N, Malenka RC (2021) Anterior cingulate inputs to nucleus accumbens control the social transfer of pain and analgesia. Science 371:153-159. Stevens F, Taber K (2021) The neuroscience of empathy and compassion in pro-social behavior. Neuropsychologia 159:107925.

Information is better than matter or mind as the fundament basic nature of reality What is the ultimate nature of reality? Can everything that exists be reduced to a single entity? Since antiquity, philosophers thought so. There are three main ideas that keep resurfacing in different forms: Materialism: Everything is made of matter. Since Einstein showed that E=m*c^2, we know that matter and energy can be converted into each other, so materialism needs to be restated as everything is made of matter-energy. A more developed version of materialism is naturalism: the idea that the world is solely made of matter, energy and the laws that govern them. Idealism: Matter is just a screen, an illusion. Behind it, the world is made of ideas, or mind, or spirit. One version of idealism is pantheism, which sustains that God is in everything, or that the world is a part of God. Another variation of idealism that has recently come into vogue is panpsychism, that idea that everything is made of consciousness. Dualism: The world is made of both matter and mind. This includes religions like Christianity, that believe that God made the material world but is separate from it. This entails a rejection of pantheism. Here, I propose an alternative: that everything that exists can be reduced to information. Everything is information. Let’s call this idea the Information Paradigm. Advantages of the Information Paradigm With the advent of computers, the internet and the information age, everybody has become familiar with the concept of information. We buy information in the form of downloadable music, movies and books. We also pay for education, another form of information. In fact, money is just information, a bunch of numbers stored in the computers of banks. Cryptocurrency has made this even more real. The Information Paradigm could be considered a form of Idealism. However, unlike mind, spirit or consciousness, information is quantifiable. While believing that mind is separate from matter leads to the problem of explaining how they interact, information is as physical as matter and energy. Physical entities like entropy and genes can be interpreted as information. One of the problems with Materialism is that, if everything is matter/energy, it cannot explain the existence of the laws that govern it. Since these laws are information, Materialism is tacitly admitting that at least some information is part of the basic nature of reality. Dualism has always been in trouble because it cannot explain how two completely different things—mind and matter—can interact with each other. Thus, if my mind is non-material and decides to move my hand, that non-material decision has to be transformed at some point into the energy of the action potentials in my nerves. But energy cannot arise from something non-material, because that would violate the principle of conservation of energy. However, if we understand both mind and matter as information, there is no problem explaining how they interact. In fact, our minds are not the only non-material things. Books, songs, computer programs are also non-material objects. This was pointed out in the book The Self and Its Brain, co-written by the neuroscientist Sir John Eccles and the philosopher Karl Popper, in a last, brave attempt to defend Dualism. However, today we are all familiar with the idea that all these non-material objects are made of information. Indeed, we know how much information is in a song, a book, a movie or a computer program. When applied to different sciences, the Information Paradigm is useful to conceptualize things and explain some notorious problems. The challenge: defining information But first we need to face the challenge of giving a definition of information that can be used as a unifying concept for everything that exists. There are, indeed, many well-defined ideas of information, for example, in computer science and thermodynamics. Would it be possible to show that these different concepts all point to the same thing? In the past, information was understood as something that was exchanged between people. However, modern ideas of information in science conceive it as something independent of humans, just like matter and energy do not need us to exist. Thus, we speak of the amount of information contained in human DNA or the fate of information inside a black hole. In our daily lives, we deal with information the same way we used to deal with energy and matter: as something that can be produced, stored and used. There is an problem with defining information as a basic property of the world. The moment we propose that X is the stuff of which everything is made off, it becomes very difficult to define X because such definition would be in terms of something else. But since we propose that this “something else” is made of X, all such definitions tend to become circular. All other ontologies have the same problem. It is hard to define ideas or spirit in Idealism, God in Pantheism and consciousness in Panpsychism. Materialism seems to elude this problem because we have good definitions of matter and energy in physics. However, Materialism faces the problem of defining the nature of the laws of physics, which exist apart from matter and energy and control them. That’s why some thinkers talk of Naturalism instead of Materialism. According to Naturalism, ultimate reality is matter/energy plus the laws of nature. Ironically, this seems to lead us back to a form of Dualism, since the laws of nature are distinct from matter/energy. But if matter/energy can be reduced to information, and the laws of nature are information, we are back to a single, unifying concept. Properties of information I think that soon physics will give us a rigorous definition of information that can be applied to computer science, thermodynamics, Quantum Mechanics, and all other sciences. For now, instead of trying to define information, I will list some of its properties: It is quantifiable. It defines relationships or interactions between objects. Unlike energy, the amount of information of a closed system can increase. This is not because information can come from nothing, but because information can produce more information. The process by which information produces more information is an algorithm–something similar to a computer program. Nature is full of algorithms, which generate information following well-defined rules. Those rules are also information, and have been previously generated by other algorithms. I give examples below. It takes energy to destroy information. In thermodynamics, information is the same thing as entropy. The laws of nature are information. Many of the laws of nature are emergent: they arose at some point in the history of the Universe. These emergent laws were created by algorithms that used previously existing laws. Physics: measurements as transfer of information The fact that Since information is quantifiable suggests, that there cannot be an infinite amount of information. To state it more formally, a closed system must have a finite amount of information. Since the Universe is a closed system, it probably contains a finite amount of information. This could explain some of the puzzles that we find in Quantum Mechanics. If the amount of information contained by an object is finite, aAs we move down to the sub-atomic level, we will find systems that contain very little amount of information. Heisenberg’s Indetermination Principle could be explained by the fact that a moving particle contains a finite, and small, amount of information. So, iIf we ask it its speed, it cannot tell us its location, and vice versa. The collapse of the wave function when we measure a quantum system could be explained by the fact that the measuring process transfers information from the macroscopic measuring system—which has lots of information—to the microscopic quantum system—which has so little information that it exist in an undefined state. This makes unnecessary explanations involving multiple universes or the involvement of consciousness at the quantum level. The idea that Quantum Mechanics could be understood in terms of information was first proposed by physicist John Archibald Wheeler, with his famous phrase “it from bit”: “It from bit. Otherwise put, every it — every particle, every field of force, even the space-time continuum itself — derives its function, its meaning, its very existence entirely — even if in some contexts indirectly — from the apparatus-elicited answers to yes-or-no questions, binary choices, bits. It from bit symbolizes the idea that every item of the physical world has at bottom — a very deep bottom, in most instances — an immaterial source and explanation; that which we call reality arises in the last analysis from the posing of yes-no questions and the registering of equipment-evoked responses; in short, that all things physical are information-theoretic in origin and that this is a participatory universe.” The location of a single point in space-time cannot be measured with absolute precision, because this would require that space contains infinite information. This means that space-time must be granular, quantified. Indeed, there is a smallest unit of space, the Plank length, and of a smallest unit of time, the Plank time. We cannot define where a point is located with more precision than a Plank length. We cannot establish when something happened with more precision that a Plank time. Plank time is the ultimate present. This granularity of space-time means that information cannot move at infinite speed. Somehow, this would create infinite amounts of information. Information can travel, at most, one Plank length in one Plank time. This is the speed of light, c. Indeed, in the Theory of Relativity, it is not just light or matter which cannot travel at speeds faster than c. It is information itself. Thermodynamics: information is entropy Imagine a box full of black and white balls. If all the black balls are on the right and all the white balls on the left, the system contains little information. We can describe it as I did in the previous sentence. However, if we mixed all the balls, to describe the system we will need to specify the location of every black ball and every white ball. That would require lots of information. In the first state, the system has little information and low entropy. In the second state, it has lots of information and high entropy. In thermodynamics, information and entropy are the same thing. If we want to store information in a system, we need it to have low entropy. In the first state of the black and white balls box that I described above, we could write words by putting some white balls between the black balls on the right, and some black balls among the white balls on the left. However, if all the balls are mixed up, we cannot write anything with them… Unless we expend a lot of energy to move enough balls to create a suitable background for the words. If we tried to write too many words using the balls, we would end up making a mess and all the information we want to convey would get lost. There is a limit to how much information we can put on a system, which is defined by its entropy. It works like this: a system with high entropy contains a lot of its own information, so it would not let us use it to store our own information. The ability of a system to store information depends on its size (total amount of information it can contain) and its entropy (how much of that information is already in use). We are all familiar with that. The amount of information we can put in the hard drive of our computer depends on how big is the drive and how much information is already in it. If we want to make room for more information, we need to erase something. And to do that, we need to spend energy, because erasing something means decreasing the entropy of the system. This is called the Landauer’s principle. When a system is complex enough, it becomes an algorithm that is able to increase its own information. In other words, it starts mixing itself up and increasing its entropy. It is possible that this is what creates the arrow of time: the fact that time is asymmetrical and flows from the past to the future. There is no arrow of time at the quantum level, it only appears in macroscopic systems. This is a crucial issue because, without the arrow of time, it doesn’t make sense to speak of cause and effect. Molecular Biology: life as information-processing As I explain in my article The Secret of Life, the key concept to understand life is homeostasis. Homeostasis means the delicately maintained chemical balance in living beings, in which the concentrations of all the chemicals stay between narrow limits. The chemical composition of non-living systems stays the same, either because there are no chemical reactions at all (as in a rock), or because all reactions are at chemical equilibrium. In contrast, in living organisms all compounds are constantly reacting with each other and these reactions are far from chemical equilibrium. What maintains homeostasis in living beings is a network of signaling systems, mostly involving negative feedback. Any departure from homeostasis is corrected by triggering the opposite chemical reactions. Apart from negative feedback, the information contained in the DNA is extracted to direct the responses of the cell to changes in its environment. In other words, life is an algorithm. An immensely complex one. In 1943, the famous physicist Eric Schrödinger—one of the creators of Quantum Mechanics—had a radical insight about the nature of life, which he explained in a conference at Trinity College in Dublin, Ireland, that was transcribed into his famous book What Is Life? Schrödinger proposed two revolutionary ideas. The first is that living beings store information in the form of an “aperiodic crystal”—meaning a molecule in which some of the atoms are organized in different sequences encoding that information. The second was that life could be understood in terms of entropy: a living organism keeps its low entropy state by absorbing energy from its environment and using it to pump entropy to the outside. Schrödinger’s two insights in What Is Life? were confirmed experimentally. His aperiodic crystal turned out to be DNA, whose structure was discovered 10 years later, in 1953, by Francis Crick, Rosalind Franklin, James Watson and Maurice Wilkins. The idea that living beings are “dissipative structures” that use energy to pump out entropy and maintain a chemical balance far from chemical equilibrium was developed by Ilya Prigogine and published in 1955. He was influenced by Alan Turing, the inventor of information theory and computers. Prigogine was awarded the Nobel Prize in Chemistry in 1977 for this work. Later work unraveled the subtleties of the genetic algorithm. DNA is transcribed into messenger RNA, which is then translated into the chain of amino acids of the proteins following the genetic code. But this is only a small part of the story. Proteins are veritable nanomachines that perform most of the function of metabolism. The complexity of intracellular signaling pathways is still being unraveled in the fields of biochemistry and molecular biology. Evolutionary Biology: evolution as an algorithm Another way in which the concept of information processing can be used to explain life is understanding evolution as an algorithm. This algorithm works like this: Generate mutations in the DNA. Translate these mutations into proteins, physiology and behavior. Test these changes against the environment. If they result in non-survival or decreased reproduction, discard the mutation. If they result in survival and increased reproduction, keep the mutation. Go to step 1. Stuart Kauffman developed computer models of the evolution algorithms. In his view, living beings evolved by searching a state space of all the possible forms that they can adopt that are compatible with survival in a particular environment. Such search algorithm eventually fills all available niches in the environment. The evolution algorithm is an emergent law. When life originated on Earth, primitive life forms only had tentative homeostasis. Living beings with tighter control over their metabolism survived those with more loose control. Reproduction arose as a more effective way to colonize the environment, displacing life forms that were unable to create offspring because they were not able to convey the information of their homeostasis beyond their own death. Another big step was to transition from accidental mutation to directed mutation. Radiation and chemistry randomly alter the information in the DNA. Living beings that protected their DNA too much were eventually out-competed by living beings with more mutations, because they could evolve better adaptations to the environment. An uneasy equilibrium was established between the stasis derived from over-protecting DNA and the chaos produced by too many mutations in the DNA. Eventually, some organisms found a clever solution: have too equal sets of DNA, so a mutation in one set could always be compensated by having the original gene in the other set. That way, they could have their cake and eat it, too. Lots of mutations combined with backup genes. Even better: interchange these two sets of DNA with similar organisms to create offspring that was even better adapted. And, in the process, mix and match genes to increase the rate of mutation (meiosis). Roll the dice more to win more often. Generate more information, but keep previous information safeguarded. Sexual reproduction had been invented. Neuroscience: mind as an algorithm The algorithm of mutation plus natural selection kept life going for millions of years. We could conceptualize this algorithm as a way to extract information from the environment. A mutation is matched with the environment to extract the result: adaptive or non-adaptive. However, this is a very inefficient way to extract information from the environment. Some animals evolved a better way: senses that allow them to rapidly change their metabolism according to changes in their environment. No gene translation was necessary. Changes in enzyme activity and in the membrane potential would suffice. Eventually, sets of organs evolved to produce fast  responses to challenges from the environment. The endocrine system, the immune system and the fastest of them all: the nervous system. Before, information from the environment was stored only in the DNA. Now there was an additional information-storage system: neuronal memory. Evolution kept rolling the dice. The information space of all possible shapes and functions was explored. A new niche was found: increase the memory storage and accelerate the processing speed of the nervous system. Animals with larger and larger brains arose. Culture as an algorithm There was one caveat, however. Unlike the information in the DNA, information in the brain could not be passed to the offspring. It died with the individual. But one animal species with a tremendously large brain found a solution: increase cooperation between members of its species by developing a language that conveys information between brains. That way, the learning of information can be sped up. We are no longer limited to the sensory experience of a single individual. And information can now be conveyed to the offspring, accumulating through generations. Eventually, more efficient ways of storing and processing information were invented. Writing. Books. Mathematics. Science. Computers. And that’s where we are. A nested hierarchy of information systems From the point of view of the Information Paradigm, everything that exists can be understood as a nested hierarchy of information systems. Let me explain this cryptic statement. One information system is the physical world of elementary particle, forces, planets, stars and galaxies. On top of it, there is the chemical world of atoms and molecules. On top of it, there is the biological world of cells, viruses, plants and animals. On top of it, there is the psychological world of minds. On top of it, there is the societal world of cultures, economics, arts and science. It’s a hierarchical system because every step adds a new level of complexity to the previous one. It’s nested because every step is built upon the previous one and cannot exist without the previous one. Each level encloses and supports the others, like the layers of an onion. That’s what I mean by nested. I could add that these information systems are contingent, because the properties of the upper levels cannot be predicted from the properties of the lower levels. You cannot predict the properties of living systems from physics and chemistry. You cannot predict the properties of human cultures from biology. I think that the Information Paradigm provides a perspective from which we can understand everything that exists. It avoids the problems of naturalism of stepping from the material world to the world of mind and cultures. It avoids the problem of dualism in explaining the interaction between matter and mind. It could be considered a form of idealism analogous to panpsychism. However, where panpsychism proposed the existence of an ill-defined consciousness, the Information Paradigm is based on the idea of information, which can be defined and studied scientifically. The Information paradigm has one unresolved problem, however. Does information exist in addition to matter and energy? Or could matter/energy be defined as forms of information? Copyright 2023 Hermes Solenzol

In seven difficult steps 1. Hunt for personal power Personal power is self-knowledge, self-control, self-sufficiency, self-transformation, good health, emotional strength, resilience, inner motivation, wisdom. 2. Act impeccably Generate sustained attention and effort. Choose the right challenge. Face my fears. Develop meta-attention. Plug power drains. Build good habits. Focus on the process and not the destination. Don’t get attached to goals and rewards. Use attention to perform flawlessly. 3. Take responsibility for my actions Follow my own moral code. Learn from experience. Do not complain. Do not blame others. Do not look for excuses. Do not cling to hope. Nip anger in the bud. 4. Abandon self-importance Don’t act based on pride or shame. Don’t be competitive. Don’t be defensive. Encourage my curiosity. Let go of the ego. 5. Erase personal history Do not dwell on the traumas of the past. No regrets. No self-doubt. Forget who I am and lose myself in my task. 6. Use death as an advisor Focus on things that bring meaning to my life. Accept the fact that I am going to die. Do not waste energy on unimportant things. Use my time wisely. Enjoy the present. Cultivate my love of life. Be grateful. 7. Follow a path with a heart My core motivation should be based on joy, curiosity and love. It should not be based on fear, shame or pride. Help others. Live a life worth living. Copyright 2023 Hermes Solenzol.

Flow is a mental state of focused attention in which we become productive and creative without apparent effort What is flow? You may have heard of flow, a seemingly magical state that some people enter when they write that lets them be tremendously productive and creative with little effort. Flow happens in many arts, like painting, performing music and dancing. We also hear of flow in sports. The archetypical one is rock climbing, but it can also occur in skiing, hiking, running, sailing and any other sport. It may be a bit more difficult to enter flow in competition sports, because ego gets in the way. How can flow be the same mental state in writing and rock climbing? These are very different activities. Writing is almost purely mental, while rock climbing is physical and scary. In what activities can we enter flow? Can it be just any activity? Is flow the same thing as mindfulness? Is flow real or an illusion? Does brain activity really change when we enter flow? In this article, I will answer these questions by examining the neuronal circuits in the brain that mediate flow. The six characteristics of flow Flow is a mental state of focused attention on a task—which can be an art, a mental activity or a sport—without apparent effort (“effortless effort”). It was defined in the 1970 by Mihaly Csikszentmihalyi as: “An optimal state of consciousness where we feel our best and perform our best” (Kotler et al., 2022). Csikszentmihalyi gave flow these six characteristics: Focused attention on a task. Merging of action and awareness. Decreased self-awareness. Altered perception of time, which either speeds up or slows down. Feeling of complete control. Positive emotions like joy, pleasure, euphoria, meaning and purpose. Triggers of flow According to a recent review paper (Kotler et al., 2022), the state of flow is driven by: Having clear goals. Knowing what you want to do and how you want to do it. Quick feedback. Getting clear signals about the effectiveness of your effort. Balance between challenges and skills. Flow cannot be achieved if your skills are not sufficiently developed to accomplish the task. But you don’t enter flow, either, if the task is so easy that it can be accomplished by routine or memory. Novelty and unpredictability. You enter flow when the activity that you are doing engages your curiosity and challenges your attention. Complexity. During flow, you must be learning something from your activity. Insight. Flow involves creativity, so you discover new things about your task as you do it. Risk. Some activities that induce to flow, like rock-climbing, skiing or martial arts, involve physical risk. There is an element of fear that maintains the focus of the attention. Others, like writing, performing music or painting, do not entail physical danger, but the emotional risk of failure. Awareness across multiple senses. Many of our senses are involved during flow, including interoception and muscle feedback. Curiosity. Experimentation and learning new skills are important during flow. There is basic curiosity about the outcome of the new things we try. Autonomy. Flow requires being self-sufficient and self-confident. Passion. You care deeply about what you are doing. Purpose. Flow requires an unbending will to stay engaged in your task. Mastery. Flow can only be accomplished after mastering a particular art, sport or activity. You don’t enter flow when you start learning a new sport or art because there is too much self-consciousness involved. Are there different flow states? It seems that, as long as these requisites are fulfilled, any activity can put you in a state of flow. However, it doesn’t seem logical that we have the same mental state when doing tasks as vastly different as writing and rock climbing. Surely, they engage different parts of our brain, no? Could it be that there are different states of flow with some common characteristics? In fact, in the scientific literature, there is a discrepancy about whether flow activates or deactivates the amygdala, an important part of the brain that mediates fear, aggression and other emotions. The paper by Kotler et al. proposes a thought experiment in which somebody is driving a motorcycle when a car suddenly moves into his lane, forcing him to swerve. This may not be a good example of flow because it normally does not involve a surprising, scary event, but a decision to start an activity that requires effort and concentration. Regardless, the authors describe the sequence of activation of brain areas leading to flow instead of panic. Activation of the amygdala is key in this sequence of events. The opposite case is illustrated by the studies of Ulrich et al. (Ulrich et al., 2014; Ulrich et al., 2016a, b), consisting of fMRI brain imaging in volunteers who achieved flow by doing arithmetic tasks. Of course, these did not involve surprise or fear. In this case, the amygdala became deactivated. This discrepancy suggests the existence of two types of flow. The first occurs in activities like driving a motorcycle, rock-climbing or martial arts, which involve risk and fear. In these cases, the amygdala gets activated. The second occurs in activities like performing arithmetical tasks, writing or playing music, which do not involve fear, but a calm state of mind. In these states of flow, the amygdala gets deactivated. In his book about flow (Csikszentmihalyi, 2008), Csikszentmihalyi implies that it is uniquely human. However, I think that predatory animals enter flow when they hunt. You can see it, for example, in the focused attitude of a cat stalking its prey. This suggests that there is a third modality of flow: predatory aggression (Haller, 2018). In humans, we find it in the focused attention of hunters and fishermen. While it usually does not involve fear, predatory aggression also activates the amygdala. Deactivation of the default mode network Since it was first described Mihaly Csikszentmihalyi in 1970, the brain activity that accompanies flow has been described in details by neuroscience studies like the ones cited above. When it is not in flow, the brain state consists of the default mode network. This network is are a series of interconnected brain regions that are active when we are not doing anything in particular. It is engaged we are daydreaming, thinking about ourselves, remembering the past, or planning for the future. The default mode network it is composed of the medial prefrontal cortex, the posterior cingulate cortex, the precuneus and the angular gyrus. The medial prefrontal cortex is involved in thoughts about ourselves. The posterior cingulate cortex is located deep inside the fissure that separates the brain hemispheres, behind the anterior cingulate cortex. It is involved in awareness and memory retrieval, particularly spatial and autobiographical memory. The precuneus is part of the superior parietal lobule, located halfway to the back of the brain. It is involved in the processing of visual and spatial information, episodic memory, self-awareness and consciousness. The angular gyrus is also part of the parietal lobe, located at the bottom back of it. It is involved in reading, language, processing numbers, memory and attention. It also participates in theory-of-mind: our ability to create mental models of what goes on in other people’s minds. During flow, the default mode network becomes deactivated. Activation of the saliency network Kotler et al. propose that flow is initiated by a shift from the default mode network to the saliency network. Although they propose that this shift is triggered by a surprising event, it could also be produced by the struggle to perform a difficult task, or by the decision to focus the attention on a task. The saliency network is in charge of increasing the importance of certain stimuli by presenting them to consciousness (salience), while other stimuli are relegated to the background and remain unconscious. Salient feelings are those that are important for survival—like pain, pleasure, disgust and fear. Other salient stimuli are important for reproduction—like sexual desire, seeing a loved one or caring for children. However, if we have decided that a task—like writing or playing music—is important for us, anything related to that task becomes salient. The saliency network is primarily formed by the dorsal anterior cingulate cortex and the anterior insula. It also includes the inferior parietal cortex, the right temporoparietal junction, the pre-supplementary motor area and the lateral prefrontal cortex. The primary function of the anterior cingulate cortex is to select plans for action. It does that by identifying conflicts and errors in executing actions, and discovering new action plans. In the flow state, this leads to creativity. The anterior insula also mediates the monitoring of performance and error processing, using its capacity to anticipate the state of the body as a result of a certain action. Involvement of the dopamine pathways The activity of the saliency network is dependent on the striatal dopaminergic pathway (Wise and Robble, 2020). Dopamine neurons are located in a region of the midbrain called the ventral tegmental area (VTA), and also in the substantia nigra. Axons going from the VTA to the nucleus accumbens form the reward pathway, where addictive drugs induce craving. Dopamine neurons from the VTA also project to the dorsal anterior cingulate cortex and the prefrontal cortex, playing a key role in maintaining focus in whatever we are doing. The VTA is activated when the salience network receives sensations that are novel, rewarding, or that conflict with ongoing expectations. There are two types of dopamine neurons in the VTA: Value-coding neurons are activated by unexpected rewards and inhibited by unexpected distressing events. They project to the shell of the nucleus accumbens and to the ventromedial prefrontal cortex. Saliency-coding neurons are activated by the incentive value of new information, motivating us to act. They project to the core of the nucleus accumbens and to the dorsolateral prefrontal cortex. During flow, the struggle to start a hard task initially decreases dopamine release from the value-coding neurons. Once we have overcome this struggle period, the saliency network drives dopamine release from the saliency-coding neurons that connect the VTA with the anterior cingulate cortex and the dorsolateral prefrontal cortex. In these brain regions, dopamine helps sustain effort-based decision-making, leading to tenacity, grit and resilience. This creates the feeling of effortless effort during flow. However, another part of the prefrontal cortex, the medial prefrontal cortex, gets inhibited during flow. The medial prefrontal cortex is part of the default mode network and mediates thoughts about our self, our past and our future. Its inhibition is what produces the selfless feeling characteristic of flow. Engagement of the executive attention network As the state of flow gets established, the salience network induces the activation of the executive attention network. While the salience network is activated by stimuli that are important for survival, the executive attention network is engaged when the brain takes charge and directs the attention. The executive attention network is involved in cognitive control, working memory, sustained attention and the solving of complex problems. It is also called the frontoparietal network, and is formed by the rostral lateral and dorsolateral prefrontal cortex and the posterior parietal cortex. One key function of the executive attention network is sensory-gating: filtering out sensations that are not relevant to the task at hand. This happens when the prefrontal cortex inhibits the reticular nucleus of the thalamus. The thalamus is located in the center of the brain, and is a hub where different sensory stimuli are processed, filtered and directed to different areas of the cortex. Therefore, the prefrontal cortex directs the thalamus to select sensations that are related to the task that we are doing, and to inhibit the rest. The amygdala and the locus coeruleus As I said above, there are two different types of flow, depending on whether the amygdala gets activated or inhibited. While the type of flow involved in writing inhibits the amygdala, the type of flow involved in rock climbing activates it. The amygdala is the area of the brain that mediates fear, anxiety, aggression and other emotions. It is connected to the dopamine reward pathway of the striatum. It has two main parts: Basolateral amygdala, involved in the three responses to stress: fight, flight and freezing. Central amygdala, involved in the formation and storage of fear memories. The central amygdala sends axons to two areas in the brain that initiate pain inhibition: the periaqueductal gray (PAG), which is the origin of the endorphin analgesic pathway, and the locus coeruleus, which is the origin of the norepinephrine analgesic pathway. The locus coeruleus is critical for flow. It not only sends norepinephrine-releasing axons to the spinal cord to inhibit pain, but also to different areas of the cortex, where they maintain attention. These include: Dorsomedial prefrontal cortex, where norepinephrine increases focus and performance. Ventrolateral orbitofrontal cortex, where it reduces impulsivity (the urge to take careless action), which is essential for purposeful control. Temporal parietal junction, where it increases empathy. Dorsal anterior cingulate cortex, which is involved in action planning. Its feedback to the amygdala serves to sustain flow. Noradrenergic projections from the amygdala to the hypothalamus activate the hypothalamus-pituitary-adrenal (HPA) axis, leading to increases in cortisol and adrenaline in the blood. This hormonal stress response increases the heartbeat to sustain muscular activity. However, it seems that activation of the amygdala, locus coeruleus and HPA axis is important in the rock climbing type of flow, but not is the writing type of flow. The former, but not the latter, is triggered by the perception of danger. The fear caused by a risk activity can lead to three different stress responses: fight, flight or freeze. Only the first takes us into flow. Here, fight doesn’t mean aggression, but engaging with the source of fear. In contrast, flight means avoiding the challenge, maybe by procrastinating or daydreaming instead of performing the activity. Freeze means becoming passive. There is a switch in the brain that puts it into fight mode instead of flight or freezing. It is located in the thalamus, the area in the center of the brain that serves to sort out sensory information on its way to the cortex. The freeze response is mediated by the xiphoid nucleus (Salay et al., 2018), located in the ventral midline of the thalamus. Fight responses are mediated by projections from the nucleus reuniens, which surrounds the xiphoid nucleus, to the medial prefrontal cortex. Flow and mindfulness Flow is not the same as mindfulness, although both states support each other when we practice them. In mindfulness, our conscience is passive, taking in incoming feelings without judging them. It activates the salience network. In flow, our consciousness is in an active state. In it, the executive attention network takes over the salience network. Unlike mindfulness, in flow our consciousness selects the sensations necessary to perform a task instead of giving equal weight to all stimuli. Although both mindfulness and flow turn off judging, they do it in different ways. In flow, the inhibition of the medial prefrontal cortex makes us forget about our self. The activity that we are doing completely fills our consciousness. One type of judging remains: the feedback from our activity. But it doesn’t involve self-criticism. In mindfulness, judging is turned off purposely by looking at all stimuli with equanimity. Final remarks I have shown here that the brain circuits that mediate flow are quite well understood. One consequence of this is that neuroscience is beginning to understand consciousness quite well. Unlike being something ethereal and separated from the mind, as proposed by some mystics and philosophers, consciousness exists in different states, each controlled by its own neuronal network in the brain. These states include the default state, mindfulness and flow. Learning to enter flow can help us work at our jobs with a feeling of fulfillment and effortlessness. If we engage in artistic activities, it will increase our creativity and take us to the edge of our capabilities. Other states of flow can be entered while doing sports. When danger is present, as in rock climbing or skiing, flow let us use our fear to increase our focus, thereby decreasing the risk by maximizing our performance. However, we don’t need to practice a difficult art or a dangerous sport to enter flow. Any activity can lead us to this mental state if we find a way to challenge ourselves while doing it. The key is to avoid mechanical action and daydreaming, which keep our brain in the default network. During Zen retreats (sesshins), I was taught how to stay mindful while doing menial tasks like cutting vegetables, washing dishes or sweeping the floor. The determination of staying completely focused on the task created a challenge that put me in a state of flow. Flow feels great! When we learn how to enter it, there are no more boring tasks, no more unpleasant work. Every task can be joyful because what matters is not what we do, but the mental state in which we do it. Like any other mental activity, flow is habit-making. This means that, once your brain learns to go into flow, it becomes easier and easier to enter that state. As we do more and more activities in a state of flow, it becomes a way of life. One that leads us to a life worth living. References Csikszentmihalyi M (2008) Flow: The Psychology of Optimal Experience: HarperCollins eBook. Haller J (2018) The role of central and medial amygdala in normal and abnormal aggression: A review of classical approaches. Neurosci Biobehav Rev 85:34-43. Kotler S, Mannino M, Kelso S, Huskey R (2022) First few seconds for flow: A comprehensive proposal of the neurobiology and neurodynamics of state onset. Neuroscience & Biobehavioral Reviews 143:104956. Salay LD, Ishiko N, Huberman AD (2018) A midline thalamic circuit determines reactions to visual threat. Nature 557:183-189. Ulrich M, Keller J, Grön G (2016a) Neural signatures of experimentally induced flow experiences identified in a typical fMRI block design with BOLD imaging. Soc Cogn Affect Neurosci 11:496-507. Ulrich M, Keller J, Grön G (2016b) Dorsal Raphe Nucleus Down-Regulates Medial Prefrontal Cortex during Experience of Flow. Frontiers in behavioral neuroscience 10:169. Ulrich M, Keller J, Hoenig K, Waller C, Grön G (2014) Neural correlates of experimentally induced flow experiences. NeuroImage 86:194-202. Wise RA, Robble MA (2020) Dopamine and Addiction. Annu Rev Psychol 71:79-106. Copyright 2023 Hermes Solenzol.

A person being choked may have a cardiac arrest or become unconscious. This is what you should do. I strongly recommend not to practice choking. This article is part of a series intended to show that choking is unsafe, may cause brain damage, and is potentially lethal. The advice I give here is intended to mitigate the damage caused by choking. It does not make choking safe. There are no warrantees that any of this will work. You may find that a partner that you just choke is unconscious and unresponsive. Don’t panic. Never, ever, leave your partner and run away! He or she will probably die, and you will probably end up spending many years in jail. Is there a cardiac arrest? Cardiac arrest - when the heart stops beating - is a rare occurrence during breath play, but a definite possibility. It is very hard to predict. Even a healthy person who has been choked many times can go into cardiac arrest. The first thing you should do is to check for a heartbeat. If there is none, you have a life-threatening problem. As I explained in previous articles in this series, a blood choke can induce cardiac arrest by messing with the sensing of blood pressure in the carotid sinuses. If the heart stops beating, every second counts to save your partner’s life. If there are people around who can reach you, call out for help. No matter who they are. No matter if you and your partner are naked. You need as many people as you can, so that somebody can make an emergency call, while somebody does cardiopulmonary resuscitation (CPR) and somebody else goes searching for an automated external defibrillator (AED). If you are alone, call immediately 911 (in the USA) or a similar emergency number in your country. If you put your cell phone in speaker mode, you should be able to make that call while you start CPR. CPR may bring back a person with cardiac arrest, but chances are that it may not. Regardless, you should continue CPR until a rescue team arrives. CPR can maintain enough blood circulation and oxygenation to keep the brain alive. You can learn CPR online here. Using an automated external defibrillator (AED) If you have access to an AED, you should use it. But don’t leave your partner alone to go looking for one. AEDs are those electric pads that we see in the movies being used in hospitals. You place them diagonally across the chest, shout “clear!” and press a button to deliver a shock to the heart to start it beating again. Most CPR classes will teach you how to use an AED. These days, many public places like shopping malls, public transportation and movie theaters have AEDs. If you are in a public dungeon of a BDSM club, they will probably have one. The Staying Alive app, by Le Bon Samaritain, can be installed for free on your cell phone and can show you where the nearest AED is located. It also shows you how to use one. You can buy or rent an AED, to have it handy if you practice choking. Unconsciousness but no cardiac arrest Much more common than cardiac arrest would be a situation in which the person who has been choked has a pulse but remains unconscious. You should be able to restore consciousness with assisted breathing, either mouth-to-mouth or with chest compressions. While you do that, keep checking the pulse and watch out for vomiting. A person who needs rescue breathing to regain consciousness should be taken to an emergency room or urgent care facility for examination. This is particularly important if the person experiences problems with balance, vision abnormalities, slurred speech or persistent dizziness. Keep in mind that a person in this condition may not be fully capable of making decisions and may misjudge their state. Even if they don’t seek medical attention right away, they need to be closely watched. Don’t leave them alone. Ideally, a person who has been unconscious for lack of oxygen for more than a few seconds should be examined by a doctor for signs of brain damage a few days after the incident. Brain imaging and other test can detect if some areas of the brain have been injured. There are medication and treatments to help the brain recover. If a person has been unconscious and has dizzy spells, headaches, nausea, blurred vision or difficulty speaking, they need to see a doctor right away. Knowing CPR doesn’t make choking safer What I wrote above is meant to increase the chances of survival in case of an accident during sexual choking. It should not be taken as an endorsement of this practice or as a reassurance that knowing CPR makes choking any less dangerous. In the words of Jay Wiseman, the author of SM 101: A Realistic Introduction: “It's good for people to learn CPR. […] That said, should breath play result in a cardiac arrest, it cannot be reasonably said that doing CPR is reliably likely to revive the victim. Cardiac arrest is a completely out of control disaster. Resuscitation is certainly not guaranteed even for a very experienced and highly trained medical team with all advanced life support equipment immediately available. An inexperienced and minimally trained civilian, likely working alone, faces a much more uphill battle. In the unlikely event that an automatic external defibrillator (AED) was available it should certainly be used, but the battle nonetheless remains very much an uphill one. While CPR training can reasonably be said to mitigate some of the "lesser" risks of breath play, such as respiratory arrest or airway obstruction by the victim's own tongue, it cannot reasonably be said that CPR training significantly mitigates the "greater" risk of a fatal outcome due to cardiac arrest.” Jay Wiseman's "Closing Argument" On Breath Play. If don’t want to be in a situation in which you have to fight to bring your partner back to life or, even worse, watch them die, don’t do sexual choking. Copyright 2023 Hermes Solenzol.

Is the euphoria produced by exercise mediated by opioid receptors or cannabinoid receptors? The endorphin rush The endorphin rush is an expression widely used in popular culture that refers to feelings of euphoria, elation, endurance, and decreased anxiety and pain supposedly caused by the release of endorphins in the brain. The endorphin rush has sunk deep roots in the popular culture. There are drinks and rock bands named after it. It is considered responsible for increasing the performance of athletes, the pleasure of sex and even “sub space”—an altered state of consciousness produced by pain in masochists. The runner’s high But the most well-known example of an endorphin rush is the runner’s high. A marathon runner is about to hit the wall. His energy is depleted, he is exhausted, and his legs are about to give up. But, all of a sudden, something magical happens. He feels full of energy and can complete the race, running even faster. All the anxiety is gone and, in fact, he feels totally happy. What happened? Well, his brain resorted to a last-resort trick. It released a bunch of endorphins that relieved his fatigue and made him high. That was the story that we have been told for a long time. But now it turns out that it may not be the endorphins after all, but some marihuana-like compounds called endocannabinoids. This article looks at the evidence for both explanations. In the process, it will explain some interesting facts about the brain and the methods that scientists use to explore it. Endorphins and opioid receptors “Endorphins” is the name popularly given to endogenous opioids, a large family of peptides found in the brain and the blood that are able to activate the opioid receptors used by drugs like morphine, heroin, fentanyl and codeine. There are three classic opioid receptors, designated by the Greek letters mu, delta and kappa. A fourth receptor and its corresponding peptide were discovered simultaneously by two groups, so it was given the two names that they used: the nociceptin/orphanin receptor. However, this receptor does not produce euphoria or analgesia, so I will leave it out of this discussion. Endorphins are peptides encoded by three genes: proopiomelanocortin (POMC), proenkephalin and prodynorphin. If Nature was well-organized and rational, each of these genes would encode a peptide that would activate each of the three classic opioid receptors, and that would be that. Alas! Nature is neither simple nor rational. In fact, it displays a perverse penchant to make things convoluted. And so each gene encode for a complex mixture of peptides: enkephalins, dynorphins and beta-endorphin. To make things even more fun, the POMC gene also encodes for two peptides that have nothing to do with opioids and their receptors. One is alpha-melanocyte-stimulating hormone (alpha-MSH), which regulates appetite and sexual behavior. The other is adrenocorticotropic hormone (ACTH), which is part of the stress response of the hypothalamus-pituitary-adrenal (HPA) axis. See? I told you Nature was devious. So, let’s try to keep things simple for this discussion. Enkephalins and beta-endorphin bind to mu and delta opioid receptors, that produce analgesia and euphoria. Dynorphin binds to kappa receptors that produce analgesia and dysphoria—the opposite of euphoria. Measuring endorphins in the blood or the saliva is meaningless Initial studies on the runner’s high measured endorphin in the blood or the saliva of runners, and found that running and other types of exercise increased them. However, this is meaningless. Endorphins do not cross the blood-brain barrier, a wall in the capillaries of the brain that makes its chemical environment totally different from that of the blood. So endorphins in the blood cannot induce euphoria or analgesia, because these effects are produced by neurons in the brain. On top of that, endorphins (mainly the beta-endorphin encoded by the POMC gene) are released into the blood from the pituitary gland at the same time as ACTH, which is also encoded by the POMC gene. Since ACTH release is part of the stress response, endorphin in the blood does not produce euphoria. In fact, when endorphins are released in some parts of the brain (the locus coeruleus), they turn off the stress response. Hence, to determine if the runner’s high is mediated by endorphins, we need to measure them in the brain of the runners. A study of endorphin release in the brain of runners Measuring endorphins in the brain of humans while they are awake—in fact, shortly after they performed a strenuous exercise—may seem like an impossible task. However, it can be done by using a fancy technique called positron emission tomography (PET). PET uses drugs that incorporate unstable isotopes like fluor-18 (18F) or carbon-11 (11C). These drugs are called radiotracers. When the isotopes decay, they release a positron. It interacts with an electron, producing a gamma ray, which is detected by the PET machine. When the radiotracer drug is bound to a receptor, like the mu-opioid receptor, it stays longer in that brain region, which gives a brighter PET signal. However, if endorphins are released in that brain region, they displace the radiotracer from the receptor, so the PET signal decreases. This allows scientists to create images of the brain where endorphin release is color-coded and quantified. The first study that investigated the runner’s high with PET (Boecker et al., 2008) used as radiotracer [18F]FDPN, an opioid drug that binds to all the classical opioid receptors. The subjects were 10 male runners who had experienced the runner’s high before and trained for a minimum of 4 hours weekly for the last 2 years. These inclusion criteria were important because they ensured that the effects studied were really a runner’s high and not mere responses to exercise or fatigue. Thirty minutes after a two-hour run, the subjects received an injection of the radiotracer and had their brains scanned with PET. As control, they had a PET scan after 24 hours without exercise. These two PET scans were separated by 4 weeks and their order was randomized. The results were shown as endorphin release after running compared with rest for each subject. An increase in endorphins was found in the following brain regions: orbitofrontal cortex—a region of the prefrontal cortex that assigns value to actions, evaluates contingencies and appraises emotions; dorsolateral prefrontal cortex—involved in decision making, cognitive flexibility, working memory and planning; insula—an area of the cortex buried inside the brain hemispheres that is involved in pain, pleasure, euphoria and other emotions; anterior cingulate cortex—a region of the cortex between the hemispheres that controls motivation, detects errors and conflicts, and plans actions; posterior cingulate cortex—involved in spatial memory, emotional saliency and learning; sensory and motor cortex—involved in detecting sensations and directing muscle contraction, respectively. The runners were also given a psychological test to evaluate their emotions after running. Two emotions increased after running: happiness and euphoria. This indicated the presence of the runner’s high. Other emotions didn’t change after the run, including confusion, anger, sadness, fatigue, fear, energy and tension. Finally, the scientists analyzed both sets of data together to determine if there was a correlation between the feelings of euphoria and endorphin release in each brain area. A positive correlation between endorphin release and euphoria was found in the orbitofrontal cortex, dorsolateral prefrontal cortex, anterior and posterior cingulate cortex, insula, sensory cortex and motor cortex. These results strongly support the idea that the runner’s high is a feeling of euphoria caused by endorphin release in brain areas that process emotions and direct actions. Endorphin release in the brain during moderate and intense exercise Ten years later, another study (Saanijoki et al., 2018) used PET scanning to find out if moderate and intense exercise are equally able to induce endorphin release. Another difference with the previous PET study is that they used a radiotracer, [11C]carfentanil, that is a selective agonist of mu-opioid receptors. The previous study used [18F]FDPN, which could also bind to the kappa opioid receptors and therefore detect the release of dynorphins in addition to enkephalins and endorphins. Remember that dynorphins binding to kappa opioid receptors produce dysphoria, the opposite of what the endorphin high is supposed to be. But perhaps the most relevant differences were the subjects and the type of exercise. The 22 subjects were also men, but there was no requirement of them to have previously experienced the runner’s high or to exercise regularly. The exercise used in the experiments was not running, but indoor cycling. Moderate intensity exercise was defined as cycling for 1 hour “at workload in the middle between aerobic and anaerobic thresholds,” which were determined previously. High-intensity interval training (HIIT) consisted of five cycling sprints of 30 seconds at maximal load, separated by 4 minutes rests. They found that HIIT, but not moderate intensity exercise, induced endorphin release in many brain areas. Some were the same areas identified in the previous study: dorsolateral prefrontal cortex, orbitofrontal cortex, anterior and posterior cingulate cortex, thalamus and insula. In addition, they found endorphin release in the ventral striatum, hippocampus, cerebellum, amygdala and periaqueductal gray (PAG). The ventral striatum contains the ventral tegmental area (VTA) and the nucleus accumbens, which form the dopamine reward pathway that mediates motivation and drug addiction. The amygdala mediates fear and controls the stress response. The PAG is the beginning of a neuronal pathway that goes from the brainstem to the spinal cord and inhibits pain. Again, psychological tests were used to determine if the subjects had a runner’s high. They were taken by 12 subjects that did both types of exercise. Surprisingly, euphoria, motivation and satisfaction were higher during moderate-intensity exercise than during HIIT. Conversely, negative feelings like exhaustion, tension and irritation were higher during HIIT than during moderate exercise. Pain increased with exercise and it was not different between HIIT and moderate exercise. Even more unexpected was the finding that the negative feelings during HIIT correlated with endorphin release, particularly in the dorsal prefrontal cortex. Moreover, the euphoria produced by moderate exercise also correlated with endorphin release in the dorsal prefrontal cortex. So, there is no endorphin rush? This second study brought into question the idea of the endorphin rush. On the one hand, yes, exercise releases endorphins in the brain. And intense exercise releases more endorphins than moderate exercise. But, instead of being associated with euphoria and feelings of energy, which is the classic description of the runner’s high, endorphin release during intense exercise correlated with negative emotions like exhaustion and irritation. On top of that, moderate exercise produced euphoria and other positive feelings. All of these contrasts with the common description of the runner’s high, which is only achieved after hitting a wall of exhaustion during extreme exercise. So, endorphin release during intense exercise does not produce euphoria? There is no endorphin rush? The answer may be a bit more complicated. Maybe what happens is that endorphins are released during exercise as a compensatory response to negative feelings like pain, anxiety, irritation and exhaustion. With moderate exercise, they are able to eliminate these feelings and even produce euphoria. But with intense exercise, the negative feelings are so strong that endorphins cannot drown them. These negative feelings may be mediated by neuropeptides like dynorphins, corticotropin-releasing factor (CRF) and cholecystokinin (CCK). CRF drives the stress response of the HPA axis and the locus coeruleus. CCK induces anxiety and opposes the effects of endorphins. Mice do not have an endorphin rush Meanwhile, some scientists raised the possibility that the runner’s high was mediated by endocannabinoids instead of endorphins. Endocannabinoids are to cannabinoid receptors what endorphins are to opioid receptors. They are substances produced in the body that activate the same receptors as the psychoactive compounds in cannabis. The two main endocannabinoids are anandamide and 2-arachydonoyl-glycerol (2-AG). The high produced by marihuana is mediated by CB1 receptors, which are abundant in the brain. There are at least two other cannabinoid receptors, CB2 and GPR55, which do not mediate the psychotropic effects of cannabis but some of its other effects on the body. A study in mice (Fuss et al., 2015) showed that, when mice exercise on a running wheel, they have less anxiety and pain. They also had elevated levels of endocannabinoids in their blood. The analgesia produced by exercise was eliminated by blocking CB1 and CB2 receptors with their antagonists, but not by blocking opioid receptors with naloxone. This indicated that the pain reduction was mediated by endocannabinoids and not by endorphins. Similarly, the decrease in anxiety produced by exercise was blocked by antagonists of CB1 receptors, but not by antagonists of CB2 receptors or by naloxone. In a sophisticated experiment, the scientists selectively eliminated CB1 receptors in GABA-releasing neurons in the forebrain of mice using transgenic techniques. These mice ran less on the wheel than normal mice and lose the anxiolytic effect of running. This showed that the decrease in anxiety produced by wheel running in mice is mediated by CB1 receptors in forebrain neurons. However, this study does not tell us much about the runner’s high because its main characteristic is euphoria, and euphoria cannot be studied in mice. What it shows is that exercise decreases pain and anxiety in mice, and that these effects are mediated by the action of endocannabinoids in the forebrain. However, the analgesic and anxiolytic effects of cannabinoids have been known for a while. So, it’s not endorphins but the endocannabinoids? To see if endocannabinoids are responsible for the euphoria of the runner’s high, the same group performed their next experiments in humans (Siebers et al., 2021). The obvious experiment would be to repeat the first two studies with PET scanning, but with a radiotracer that binds to cannabinoid receptors instead of opioid receptors. Indeed, there are several radiotracers for CB1 receptors (Horti et al., 2006; Varlow et al., 2020; Hou et al., 2021). However, this study did not use them. Instead, they did three experiments. The first consisted of measuring endocannabinoids in the blood before and after exercise, which consisted of walking or running on a treadmill for 50 minutes. The second experiment consisted of a battery of psychological test to measure euphoria before and after the exercise. The subjects were injected with naltrexone, a mu-opioid receptor antagonist. If naltrexone decreased the euphoria, then it was mediated by endorphins. A more complete design would have used also CB1 receptors antagonists, like in the experiments with mice. Unfortunately, CB1 antagonists have not been authorized to be used in humans. Rimonabant, an antagonist of CB1 and CB2 receptors, was used in humans for a while, but withdrawn (Sam et al., 2011). The third experiment was a sophisticated way to measure anxiety, called the human elevated plus-maze. The subjects were made to walk on wooden planks forming a plus sign while wearing a virtual reality (VR) headset. In one direction (closed arm), the headset showed the planks surrounded by protective rock walls. In the other direction (open arm), the VR headset showed a 55 meter (180 feet) fall to either a river of icy water or a parking lot with cars. The time the subjects spent in the open arm was a measure of their anxiety levels. Both walking and running increased endocannabinoids in the blood, but running produced a larger increase than waking. Running, but not walking, produced euphoria. Naltrexone produced a small decrease in euphoria that was not statistically significant. As for the fancy experiment with the VR headset to measure anxiety, the results were rather meager. After running, the subjects experienced marginally less anxiety than after walking (p = 0.024). Naltrexone did not change the anxiety levels in either condition. This study was touted by the press as showing that the runner’s high is mediated by endocannabinoid and not by endorphins. Sensational news! People had been fooled into believing in the endorphin rush all along. My conclusion: it’s the endorphins, after all However, I have my doubts. The paper by Siebers et al. did not invalidate the two original studies using PET imaging to measure endorphin release in the brain. In fact, those two studies were of much higher quality than the one by Siebers et al. The two PET studies demonstrated the endorphins are released by exercise in brains areas relevant for controlling pain, mediating emotions and inducing euphoria. They were done by different groups and, in these measures, they were consistent which each other. The main thing in question is whether the endorphins released by exercise produce euphoria. In this, the two PET studies reached conflicting conclusions. The one by Boecker et al. showed that strenuous running produced euphoria. The one by Saanijoki et al. showed that only moderate exercise produced euphoria, which correlated with endorphin release. Intense exercise produced negative emotions, which also correlated with endorphin release. As I pointed out before, these results can be reconciled if we assume that endorphin release is a compensatory response that can reverse the negative emotions produced by moderate exercise, but not by intense exercise. But, what about the third study arguing that the euphoria is mediated by endocannabinoids? Its results are far from compelling. It showed only that the reduction is euphoria produced by naltrexone was not statistically significant—which is not the same as proving that naltrexone had no effect on euphoria. That would require a different statistical test, one that shows that euphoria with and without naltrexone is statistically the same. Hence, it is possible that naltrexone decreased euphoria, but this effect was not statistically significant due to the experimental design of this study. And it did not show that euphoria was caused by endocannabinoids, or that there was cannabinoid receptor activation in areas of the brain that mediate euphoria. The results of the anxiety tests by Siebers et al. were even less conclusive. The effect of running on anxiety was too small when compared to walking. A key control is missing: anxiety measures at rest. This should be compared with anxiety after walking. If we don’t have a clear decrease in anxiety produced by exercise, testing the effect of naltrexone on this small effect is meaningless. Endocannabinoids are released in the blood by exercise, for sure. But, although they cross the blood-brain barrier, this is not the same as endocannabinoids being released in brain areas that mediate euphoria, which is what the two PET imaging studies showed for endorphins. If we don’t know in which brain areas the endocannabinoids are released, we cannot propose a mechanism by which they induce euphoria. Besides, cannabinoids decrease anxiety, but they do not produce the high levels or euphoria induced by the opioid drugs and the endorphins. I think that the main source of confusion is the assumption that any strenuous exercise is going to automatically induce a runner’s high. This is not the experience of runners. The runner’s high is an altered state of consciousness that is encountered only by a selected group of runners after extremely long runs. It is probably a learned response. Only the first study (Boecker et al., 2008) selected runners who had already experienced the runner’s high and that said that they achieved that state during the experiment. The second study (Saanijoki et al., 2018) did not even select athletes who trained regularly. The third (Siebers et al., 2021) selected subjects who performed “endurance exercise more than twice a week,” but did not check if they experienced a runner’s high. My conclusion is that exercise releases endorphins and endocannabinoids. It induces a variety of positive and negative emotional states, mediated by euphoric (endorphins, endocannabinoids) and dysphoric (dynorphins, CRF, CCK) neurotransmitters. However, only in some special situations endorphin release raises to the level to produce the high euphoria seen in the runner’s high. The endorphin rush is not automatic. It seems to require entering some sort of trance state, or breaking through a neurophysiological barrier. References Boecker H, Sprenger T, Spilker ME, Henriksen G, Koppenhoefer M, Wagner KJ, Valet M, Berthele A, Tolle TR (2008) The Runner's High: Opioidergic Mechanisms in the Human Brain. Cerebral cortex (New York, NY : 1991). Fuss J, Steinle J, Bindila L, Auer MK, Kirchherr H, Lutz B, Gass P (2015) A runner's high depends on cannabinoid receptors in mice. Proceedings of the National Academy of Sciences 112:13105-13108. Horti AG, Fan H, Kuwabara H, Hilton J, Ravert HT, Holt DP, Alexander M, Kumar A, Rahmim A, Scheffel U, Wong DF, Dannals RF (2006) 11C-JHU75528: A Radiotracer for PET Imaging of CB1 Cannabinoid Receptors. Journal of Nuclear Medicine 47:1689-1696. Hou L, Rong J, Haider A, Ogasawara D, Varlow C, Schafroth MA, Mu L, Gan J, Xu H, Fowler CJ, Zhang MR, Vasdev N, Ametamey S, Cravatt BF, Wang L, Liang SH (2021) Positron Emission Tomography Imaging of the Endocannabinoid System: Opportunities and Challenges in Radiotracer Development. J Med Chem 64:123-149. Saanijoki T, Tuominen L, Tuulari JJ, Nummenmaa L, Arponen E, Kalliokoski K, Hirvonen J (2018) Opioid Release after High-Intensity Interval Training in Healthy Human Subjects. Neuropsychopharmacology 43:246-254. Sam AH, Salem V, Ghatei MA (2011) Rimonabant: From RIO to Ban. Journal of Obesity 2011:432607. Siebers M, Biedermann SV, Bindila L, Lutz B, Fuss J (2021) Exercise-induced euphoria and anxiolysis do not depend on endogenous opioids in humans. Psychoneuroendocrinology 126:105173. Varlow C, Boileau I, Wey HY, Liang SH, Vasdev N (2020) Classics in Neuroimaging: Imaging the Endocannabinoid Pathway with PET. ACS Chem Neurosci 11:1855-1862.

Several surveys found that nearly a majority of college students use choking during sex I strongly recommend not to practice choking. This article is part of a series intended to show that choking is unsafe, may cause brain damage, and is potentially lethal. Sexual choking is not exclusive of BDSM, and has become prevalent among the young. In a survey of 4,989 US college students, 58% of women had been choked during sex at least once (Herbenick et al., 2021). Another survey of undergraduate students (Herbenick et al., 2022a) found that 37% of the women and 7% of the men had been choked more than five times. Strangulation is also increasingly a feature of sexual assault. It is also used non-consensually during sex that was consensual up to that point. However, I will limit this discussion to consensual choking. Yet another survey of undergraduate and graduate students (Herbenick et al., 2022b) studied closely sexual choking in terms of prevalence, characteristics and physical responses. The survey was given to 13,449 students, of which 4,254 completed it. Men were 49.6% of the responders, women 48.1% and transgender/non-binary 2.2%. Age differences The survey found that 30% to 40% of the responders have practiced choking during sex. By comparing the responses of the older graduate students with the younger undergraduates, it found that choking is more prevalent among the young. The percentage of people doing the choking was 37.1% among the undergraduates and 27.6% among the graduate. The percentage of those being choked was 42.1% of the undergraduates and 32.1% of the graduates. Therefore, choking is more frequent in the younger generations, a sign that is increasing over time. Choking was less prevalent among people over 40 (Herbenick et al., 2023). Gender differences There were also substantial gender differences. Men did more choking (47.4% undergraduates, 37.7% graduates) than women (26.7% undergraduates, 16.2% graduates). Conversely, men were choked (25.4% undergraduates, 23.5% graduates) less frequently than women (57.6% undergraduates, 41.3% graduates). In transgender/non-binary people, choking (45.0%) and being choked (51.5%) were even more prevalent. In summary, men prefer to do the choking while women prefer to be choked. A majority of the women and transgender people in this sample have experienced choking. References Herbenick D, Fu TC, Patterson C (2023) Sexual Repertoire, Duration of Partnered Sex, Sexual Pleasure, and Orgasm: Findings from a US Nationally Representative Survey of Adults. J Sex Marital Ther 49:369-390. Herbenick D, Guerra-Reyes L, Patterson C, Rosenstock Gonzalez YR, Wagner C, Zounlome N (2022a) "It Was Scary, But Then It Was Kind of Exciting": Young Women's Experiences with Choking During Sex. Arch Sex Behav 51:1103-1123. Herbenick D, Patterson C, Beckmeyer J, Gonzalez YRR, Luetke M, Guerra-Reyes L, Eastman-Mueller H, Valdivia DS, Rosenberg M (2021) Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. The journal of sexual medicine 18:1024-1041. Herbenick D, Fu TC, Eastman-Mueller H, Thomas S, Svetina Valdivia D, Rosenberg M, Guerra-Reyes L, Wright PJ, Kawata K, Feiner JR (2022b) Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students. Arch Sex Behav. Copyright 2023 Hermes Solenzol.

Is it just to please a partner, for pleasure, or something else? I strongly recommend not to practice choking. This article is part of a series intended to show that choking is unsafe, may cause brain damage, and is potentially lethal. Many people finds been choked pleasurable In their survey of undergraduate and graduate students, the group of Herbenick (Herbenick et al., 2022b) found that 41.1% of the people who had been choked reported that choking was very pleasurable, 33.8% responded that it was somewhat pleasurable and 14.2% said that it was a little pleasurable. Only 3.1% said that choking was not pleasurable at all and didn’t want to repeat the experience, while 5.9% said it was not pleasurable but they would do it if their partners liked it. Please note that saying that a sexual act is done to please a partner does not make it non-consensual. It is not just that women accept being choked to please their partner; some men choke women only because they are asked to do it. More women than men found choking pleasurable, with 50.0% of undergraduate women and 26.8% of undergraduate men saying that it was very pleasurable. The number of graduate students that found it very pleasurable was 36.1% for women and 16.3% for men. Hence, a large majority of the students found breath play pleasurable. This can explain the growing popularity of choking, despite its reputation for being dangerous. However, this paper did not inquire into what made choking pleasurable. Consent Regarding consent, people who had been choked said that choking was consensual 92.1% of the time (Herbenick et al., 2022b). This number did not change much across genders or from undergraduates to graduate students. Among those who had been choked, choking was found to be consensual in all of their sexual encounters by 76.5% of women, 85.6% of men and 63.6% of non-binary people. In a more general survey about sex amongst college students (Herbenick et al., 2021), 21% of the students who had been choked said that they had never been asked for consent before being choked. An additional 32% of them said that they were asked for consent only sometimes. A qualitative survey (Herbenick et al., 2022a) found that the initial choking experience of many women occurred without discussing it beforehand or giving explicit consent. Often, consent was assumed or was sought while it happened. The authors remarked that consent to choking often fell in a gray area. For example, when verbal consent was given during sex or after sex. Sometimes consent was non-verbal, usually during sex. Other times, consent was assumed based on prior conversations, because they has done it before, the person’s interest in choking, or because it was assumed to be part of regular sex. Keep in mind that this happened among college students and not in the BDSM community, which has a strong consent culture. The students also considered choking to be safer than other forms of kinky sexy, an attitude that has been encouraged by the media (Herbenick et al., 2023). My survey in Fetlife I did my own inquiry into this by posting an article in Fetlife titled What Do You Like About Being Choked? It said: I heard some people say that being choked puts them in an altered state of consciousness that is different from sub space or from the effect of any drug. Is it true? In your experience, does choking make orgasms more intense? Or do you like choking for the psychological feeling that it brings you? Like, for example, surrender? Or perhaps you like the feeling of losing consciousness? Or is it a feeling of euphoria? Or is it something else? I think Fetlife was a good choice because I wanted to query specifically people who are into BDSM, and not those who practice choking as part of sex. However, the answers need to be interpreted in that context. I got 12 responses, 10 from women, 2 from non-binary persons and none from men. Four responders defined themselves as submissive, one as a slave, three as a masochist, one as a little, and the other three as exploring or curious. The following reasons were given to enjoy choking: Surrender (9 responders): loss of control, feeling helpless and vulnerable, feeling the power of the dominant, giving power to the dominant. Fear (5 responders), including feeling challenged and overcoming panic. Trust (4 responders): feeling that they could trust their safety to the choker. Euphoria (4 responders), including feeling high, lightheaded and physical pleasure. Orgasm and sensations are more intense (4 responders). Feeling safe, centered, calm (3 responders) despite the risk. Unconsciousness (3 responders). Edging to orgasm (2 responders). The most common responses align with the feelings usually sought in other BDSM activities: surrender to the power of the dominant, and the interplay between fear and feeling safe by trusting the top. But choking was also a source of pleasure. It produced euphoria and a high consisting of lightheadedness and physical pleasure. It also intensified physical sensations, including orgasm. Last, three people reported a paradoxical feeling of safety and calm, despite the obvious risk of the activity. My findings are consistent with one of the papers by the group of Debbie Herbenick (Herbenick et al., 2022a), a qualitative survey about the reasons why women like to be choked. In it, no participants reported actually losing consciousness. But many mentioned being excited about surrendering, empowering their partner, enhanced sexual arousal and longer orgasms. Fear and danger made the sex more exciting and pleasurable. Are the effects of choking similar to those of nitrous oxide? I was surprised not to find any mention to drug-like altered states of consciousness, which I heard about in some comments to my articles in Fetlife. When I asked if the feeling of being choked resembled the effect of any drug, one person responded that it did not feel like the effect of cannabis or psychedelics, but it could be similar to that of nitrous oxide, also known as laughing gas and whippets. Whippets are obtained as canisters to make whipped cream (Srichawla, 2022). They produce a severe deficiency in vitamin B12 (Maheshwari and Athiraman, 2022) and serious neurological effects. They are consumed because they produce euphoria, analgesia and a brief high. The mechanism of action of nitrous oxide is still unclear. It acts on many neurotransmitter receptors, blocking excitatory NMDA receptors and nicotinic acetylcholine receptors and potentiating inhibitory GABA and glycine receptors. Perhaps the brain hypoxia produced by choking has similar effects. Indeed, inhaling nitrous oxide as whippets produces hypoxia. References Herbenick D, Guerra-Reyes L, Patterson C, Rosenstock Gonzalez YR, Wagner C, Zounlome N (2022a) "It Was Scary, But Then It Was Kind of Exciting": Young Women's Experiences with Choking During Sex. Arch Sex Behav 51:1103-1123. Herbenick D, Patterson C, Khan S, Voorheis E, Sullivan A, Wright P, Keene S (2023) "Don't Just Randomly Grab Someone's Neck during Intercourse!" An Analysis of Internet Articles about Choking/Strangulation during Sex. J Sex Marital Ther 49:41-55. Herbenick D, Patterson C, Beckmeyer J, Gonzalez YRR, Luetke M, Guerra-Reyes L, Eastman-Mueller H, Valdivia DS, Rosenberg M (2021) Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. The journal of sexual medicine 18:1024-1041. Herbenick D, Fu TC, Eastman-Mueller H, Thomas S, Svetina Valdivia D, Rosenberg M, Guerra-Reyes L, Wright PJ, Kawata K, Feiner JR (2022b) Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students. Arch Sex Behav. Maheshwari M, Athiraman H (2022) Whippets Causing Vitamin B12 Deficiency. Cureus 14:e23148. Srichawla BS (2022) Nitrous Oxide/Whippits-Induced Thoracic Spinal Cord Myelopathy and Cognitive Decline With Normal Serum Vitamin B₁₂. Cureus 14:e24581. Copyright 2023 Hermes Solenzol.

Choking is the main cause of death in BDSM, but less common than it is thought I strongly recommend not to practice choking. This article is part of a series intended to show that choking is unsafe, may cause brain damage, and is potentially lethal. Deaths by autoerotic asphyxiation Choking appears in the popular imagination as a deathly activity, largely because of the many celebrities that have died of autoerotic asphyxiation. However, it is important to distinguish between breath play practiced in solitary and that practiced in couples. In the former, loss of consciousness or control over the body can lead to dead because the person cannot escape the asphyxia, while in the latter the person doing the choking has some control over the process. But even the number of deaths produced by autoerotic (i.e. solitary) asphyxiation has been exaggerated. It is often mentioned that it causes “500 to 1000 deaths per year in the United States and Canada” (Sauvageau, 2012), but that number is an estimation based on unpublished data. An epidemiological study based on 38 autoerotic deaths in Alberta, Canada, gave a lower number: 0.56 deaths per million inhabitants per year (Sauvageau, 2012). Multiplying this number by the population of the United States, 333 million, gives us an estimate of 186 deaths per year caused by autoerotic asphyxiation. The number of autoerotic deaths per million inhabitants per year is similar in other developed countries: 0.3 in Australia, 0.14 in Sweden and 0.5 in Germany. Choking deaths in BDSM Another paper (Schori et al., 2022) inquired specifically about deaths involved in BDSM play. Doing a literature search, they identified 17 deaths produced by BDSM activities. Of those, all were caused by asphyxia except one case, in which death was caused by hemorrhage due to inserting an inflatable balloon and other objects in the vagina. One death by asphyxia was caused by blocking the mouth and the nose with tape and fingers. The remaining 15 deaths were by strangulation, 5 with the hand or the forearm and 10 with ligatures (rope, belt, collar or chain). One of the cases of strangulation was a shibari scene in which two women were hanged with the same rope suspended from the ceiling (Roma et al., 2013). When one of them lost consciousness, her weight hanged the other. The first ended up death and the second, in a coma. The rate of death was similar across genders: 9 men and 8 women. In 9 of the cases, both partners were experienced in BDSM. In 2 cases, the top was a professional dominatrix. In 3 cases, the participants had discussed breath play techniques and cardiopulmonary resuscitation (CPR). Therefore, experience and education were not enough to prevent the deaths. Conclusions The conclusions are a mixed bag. On the one hand, fatalities caused by BDSM are rare: 15 occurred in the United States from 1986 to 2020, and 3 in Germany from 1993 to 2017. On the other hand, breath play caused a disproportionate number of the deaths in BDSM. It is fair to say that, by far, choking is the most deathly BDSM activity. But dying is only the worst thing that can happen during breath play. There may be other health consequences, including brain damage. These are much harder to assess. I will discuss that in future articles. References Roma P, Pazzelli F, Pompili M, Girardi P, Ferracuti S (2013) Shibari: double hanging during consensual sexual asphyxia. Arch Sex Behav 42:895-900. Sauvageau A (2012) Autoerotic deaths: a 25-year retrospective epidemiological study. Am J Forensic Med Pathol 33:143-146. Schori A, Jackowski C, Schön CA (2022) How safe is BDSM? A literature review on fatal outcome in BDSM play. International Journal of Legal Medicine 136:287-295. Copyright 2023 Hermes Solenzol.

The two main practices to induce asphyxia for pleasure I strongly recommend not to practice choking. This article is part of a series intended to show that choking is unsafe, may cause brain damage, and is potentially lethal. Choking, as it is used during sex or in BDSM, aims to deprive the brain of oxygen to induce mental changes that are pleasurable, either by themselves or because they intensify sexual sensations. This can be done in two ways: by interrupting the air flow into the lungs (“air choke”) or by interrupting the blood supply to the brain (“blood choke”). This terminology comes from martial arts. There is some debate in the BDSM community about which one is better. The air choke Still, most of the choking during sex is done by squeezing the throat with one hand (Herbenick et al., 2022). It is hard to say if this is an air choke or a blood choke. If pressure is applied to the front of the neck, this can close the trachea, producing an air choke. However, applying pressure to the trachea is unpleasant and dangerous, because it can damage the vocal cords, impairing speech. It can also damage the thyroid gland or the trachea itself, which can have serious health effects. The trachea is a very delicate structure made of cartilage, a tissue similar to bone that also makes our joints. This makes the trachea semi-rigid, so applying pressure on it can deform it permanently. Therefore, this form of choking can produce long-term damage affecting breathing, talking and swallowing. A crushed trachea is life-threatening. You can kill somebody this way. Another straightforward way to produce an air choke is to block the nose and the mouth with the hand. A person can easily get out of this choke by struggling, which can be both a problem - involuntary struggling can stop the choke - and an advantage - a built-in safety feature. Deep throating - inserting the penis into the mouth deep enough to block air passage into the larynx - can be a form of choking. However, the gagging reflex would be induced much sooner than air deprivation is felt. Besides, a panicking bottom can bite the cock that is gagging him or her. Using a pillow or a mask to block breathing is dangerous because the top cannot see the face of the bottom, and therefore cannot judge the level of asphyxiation. This could be prevented by using a transparent bag, but removing it takes too long. Still too dangerous. Some people use a sharp object to quickly puncture the bag, but this risks cutting the face of the person being choked. The blood choke (carotid occlusion) The blood choke consists of stopping the blood supply to the brain by blocking the carotid arteries. They run superficially on both sides of the neck and can be blocked by applying a small amount of pressure on the right spots. On purpose or by accident, this is probably what it is done in some of the one-hand chokes that are more prevalent, according to the surveys. A common chokehold in martial arts consists in wrapping the neck of the adversary with one arm from behind, in a position resembling the number 4. This compresses the carotid arteries and jugular veins, but not the trachea, cutting the blood flow to the brain and thus inducing unconsciousness in 10-20 seconds. However, using this chokehold during sex of BDSM play has the problem that the person applying the choke cannot see the face of the person being choked, and therefore cannot regulate the pressure and the timing to avoid going too far. Unlike in martial arts and self-defense, most people that use choking during sex do not want to induce unconsciousness. Neither should they, since loss of consciousness by anoxia often leads to brain damage. Hence, the most common way to induce a blood choke during sex is to apply pressure to the sides of the neck with one hand, while looking into the face of the person being choked to evaluate their response. Which one is safer? Some people in the BDSM community argue that the blood choke is safer than the air choke for the following reasons: It affects only the brain and not the rest of the body. The blood flow can be manipulated quickly and subtly by changing the pressure of the hand. Changes in consciousness can be induced and restore quickly. It avoids damaging the trachea and other delicate structures in the neck. It does not increase the CO2 levels of the blood and hence blood acidity, like the air choke does. However, the blood choke has dangers that are not obvious at first sight. But understanding these dangers requires some complicated explanations about the functioning of the brain and cardiovascular physiology, which I will give in the next articles. For now, let me just say that the blood choke is, in fact, more dangerous than the air choke. Previous articles in this series https://www.hermessolenzol.com/en/post/how-common-is-sexual-choking https://www.hermessolenzol.com/en/post/why-do-people-enjoy-being-choked https://www.hermessolenzol.com/en/post/how-deathly-is-choking

Dying is not the only danger of choking I strongly recommend not to practice choking. This article is part of a series intended to show that choking is unsafe, may cause brain damage, and is potentially lethal. What happens when the brain lacks oxygen? To stay conscious and alive, our brain needs a continuous supply of oxygen and glucose from the blood. Neurons are the most finicky cells of the body. If they don’t get their oxygen, they throw a tantrum and die. Tantrum is quite an appropriate metaphor, because a neuron that is starving for oxygen begins firing a lot of action potentials and releasing its neurotransmitters. The main excitatory neurotransmitter in the brain is the amino acid glutamate, which is also an abundant metabolite. When a neuron dies, all of its glutamate is released into its surrounding medium, activating glutamate receptors in its nearby neurons. Too much activation of glutamate receptors kills those neurons, too, setting off a chain reaction that produces a wave of cell death spreading through the brain. This glutamate release is what produces brain damage during a stroke. A stroke happens when a capillary inside the brain is blocked by a blood clot. Neurons that were supplied with oxygen by that capillary die, releasing glutamate and starting this wave of death. So, why doesn’t it end up killing the whole brain? Because there are cells in the brain, the glia, that are in charge of preventing damage by absorbing glutamate and other neurotoxic substances. Still, considerable harm can be done before these cells manage to bring the situation under control. Once neurons die, the body cannot replace them. The carotid arteries detect blood pressure Oxygenated blood is supplied to the brain through the carotid arteries, situated on the sides of the neck, towards the front. Just above the thyroid cartilage, or Adam’s apple, the carotid arteries split into the external carotid, which supplies blood to the face, and the internal carotid, which supplies blood to the brain. This bifurcation of the carotid artery is very important because it forms the carotid sinus, a swelling of the internal carotid artery. The carotid sinus is one of the two places in the circulatory system where there are baroreceptors. The other place is the aortic arch, situated in the aorta artery just above the heart. Baroreceptors are sensory neurons is charge of detecting blood pressure. They send this information to the brain so it can adjust the beating of the heart and the dilation of the capillaries. The carotid sinus sends blood pressure information to the brain through the glossopharyngeal nerve, while the aortic arch sends it through the vagus nerve. Both nerves end in the same place: the nucleus of the solitary tract or solitary nucleus, in the medulla oblongata. The solitary nucleus modulates the activity of the sympathetic and parasympathetic systems through the hypothalamus. Among other things, this modulates the heartbeat and the dilation of the capillaries, forming a feedback loop that controls blood pressure. Problems with the blood choke In a previous article, I explained that an air choke is blocking the entrance of air into the lungs, while a blood choke is blocking the carotid arteries and the jugular veins to interrupt the blood supply of the brain. The information above is crucial to understand the problems with the blood choke. In an air choke, a person can survive for several minutes without breathing. The air that remains in the lungs and the oxygen stored in the blood's hemoglobin and the muscles’ myoglobin can supply the organs, including the brain, for some time. Free-divers can hold their breath and remain conscious for several minutes, even while swimming vigorously in cold water (Scott et al., 2021). Interrupting the oxygen supply to the brain is an entirely different matter. Unconsciousness takes place in 10 to 20 seconds, irreversible neurological damage before one minute, and death soon afterwards. Therefore, a blood choke has to be timed precisely to avoid brain damage and death. But even if a blood choke is done for a time short enough for survival, there are other problems involved. It compresses or blocks the carotid arteries, which supply blood to the brain, and the jugular veins, which are the exit route of blood from the brain. This decreases blood flow (cerebral ischemia) and therefore the supply of glucose and oxygen (cerebral hypoxia). This represents a big problem for the brain, as shown by the damage caused by stroke. Except that, with a blood choke, we are altering the blood supply to the entire brain and not just a small part of it. Some neurons may be more sensitive to hypoxia than others, resulting in localized trauma that is hard to detect. Reperfusion injury Another problem is reperfusion injury, the harm produced when blood suddenly enters a tissue that has been deprived of it. Reperfusion increases the production of reactive oxygen molecules from the sudden increase in oxygen, as well as cytokines and chemokines, which are pro-inflammatory molecules produced by immune cells and microglia (Kalogeris et al., 2012). All this is extremely damaging to nervous tissue. The vasovagal response Yet another problem arises from the fact that the carotid sinus contains the baroreceptors that control blood pressure in the entire body. A blood choke changes the pressure detected by these baroreceptors. Pressure on the neck above the trachea would be exerted directly on the carotid sinuses, stimulating the baroreceptors. Pressure lower on the neck would decrease the blood reaching the carotid sinus, making it detect a lower blood pressure. The error signal thus produced in the carotid sinus would affect the beating of the heart, usually decreasing it. A highly controversial issue among pathologists is whether this could stop the heart altogether. This could explain why some deaths by strangulation occurred even though the choke did not last long enough to produce brain damage. The vasovagal response or reflex syncope “is a brief loss of consciousness due to a neurologically induced drop in blood pressure. Before the person passes out there may be sweating, a decreased ability to see, or ringing in the ears. […] Carotid sinus syncope is due to pressure on the carotid sinus in the neck. The underlying mechanism involves the nervous system slowing the heart rate and dilating blood vessels resulting in low blood pressure and therefore not enough blood flow to the brain.” Wikipedia. Other problems with the blood choke Messing with the blood pressure sensing by the baroreceptors in the carotid sinuses also affects the sympathetic and parasympathetic nervous systems, explaining why choking can produce reactions like nausea and vomiting. The whole body is thrown out of balance. There may be other complications of carotid occlusion, like cholesterol plaques being released from inside the carotids to cause strokes in the brain. Carotid occlusion is much more dangerous than other forms of asphyxiation. The key fact is that when you hold your breath, or when somebody blocks your breathing, there is a big reservoir of oxygen that your body can use to stay alive. However, your brain cannot store oxygen. When you block the carotids, your brain starts to run out of oxygen right away. Is there a risk of cumulative brain damage? Even if it does not cause death, repeated choking to the point of unconsciousness may have cumulative effects, leading to brain damage. Neuronal death may happen without any symptoms because the brain is very good at compensating for loss of function. You don’t know what is going on in your brain when you drive it close to unconsciousness, just because it’s so much fun! Your neurons could be dying while you party. This is what happened with traumatic brain injury (TBI), which is now called a “silent epidemic” (Alkhaibary et al., 2021). Sports like boxing and football cause repeated concussions that have an additive effect. When TBI finally manifests itself, it is too late to do anything about it. TBI is different from one person to another because different brain regions are affected. It produces sensory hypersensitivity, chronic pain, motor problems, memory loss and cognitive decline. While TBI and brain anoxia may seem different, they both involve neuronal death, so they may produce similar symptoms. Recreational choking may lead to another silent epidemic that would remain unknown for many years because the symptoms take a long time to appear and their cause may not be apparent at first. But, is there any evidence of this? Or is it just speculation and fearmongering? In the next article of this series, I will present evidence that repetitive choking leads to cognitive deficits and psychological problems. References Alkhaibary A, Alshalawi A, Althaqafi RMM, Alghuraybi AA, Basalamah A, Shammaa AM, Altalhy AA, Abdelrahman TM (2021) Traumatic Brain Injury: A Perspective on the Silent Epidemic. Cureus 13:e15318. Kalogeris T, Baines CP, Krenz M, Korthuis RJ (2012) Cell biology of ischemia/reperfusion injury. Int Rev Cell Mol Biol 298:229-317. Scott T, van Waart H, Vrijdag XCE, Mullins D, Mesley P, Mitchell SJ (2021) Arterial blood gas measurements during deep open-water breath-hold dives. J Appl Physiol (1985) 130:1490-1495. Copyright 2023 Hermes Solenzol.