Book Summary & Highlights For Frontal Fatigue: The Impact of Modern Life and Technology on Mental Illness

Book Summary & Highlights For Frontal Fatigue: The Impact of Modern Life and Technology on Mental Illness

Amazon Summary

If technology is making modern life easier, why are we suffering from more stress and mental illness?

In this trailblazing book, Dr. Mark Rego, who has practiced psychiatry in the community and taught at Yale for thirty years, explores why mental illness and stress are skyrocketing alongside technology that was ostensibly created to improve our world.

Using decades of experience and pioneering scientific research, Dr. Rego presents his innovative hypothesis of Frontal Fatigue, the background condition from which many of us now suffer. Frontal Fatigue exists when the unique pressures of modern life overwhelm the prefrontal cortex, the part of our brains that can make us susceptible to mental illness.

Frontal Fatigue examines

  • Why mental illness is increasing in modern times,
  • How the demands of our technology-centric lives place countless people at risk for mental illness and lacking in basic psychological well-being,
  • Solutions for finding stability and peace within the noise of modern life.

This astute perspective in the battle for our collective and individual peace of mind illustrates why mental illness is on the rise in these technologically advanced times and how we can act to adjust our lives in response.

About Author: Mark Rego

  • Has practiced adult, adolescent, and geriatric psychiatry for thirty years.
  • He spent twenty-five years in community practice specializing in treating patients who required medication and addressing the special needs of those in hospitals, nursing homes, and group homes. 
  • Since he began his practice in 1989, he has taught psychiatric trainees at Yale New Haven Hospital.
  • From 2004 until 2010, he spent time in Ayacucho, Peru, working with local groups to build a mental health center and continued years after to help supply them with needed medicines.

Read more on Mark Rego >>

Key Words


This term has traditionally been used in medical reporting to discuss the sum of things other than death that happen to a patient from a disease. The morbidity of a disease could include a rash, an infection, weakness, fatigue, or any other medical condition that could be attributed to the disease in question. In psychiatry, we broaden this definition to include things like poor social functioning and lack of vocational achievement, as these are often direct consequences of mental disorders.

Prefrontal Cortex

The emphasis in mental illness research after twenty-five years of imaging study turned out to be the PFC!1 Hundreds, perhaps thousands of studies have been done, looking at changes in the structure and function of brains in people with psychiatric diseases. These have been done at different ages, different phases of disease, and under different conditions. It is the last factor, varying conditions, that has been so fruitful. Scientists look at patients while they are ill, when they are better from medicines, and when they are performing specific tasks to see which parts of the brain are changing their level of activity. The findings are numerous and difficult to summarize even for one particular disease. That is, with one large exception. In nearly all studies, some part of the PFC is implicated as a primary brain region associated with the illness in question. In the words of the international expert on the PFC, Yale’s Dr. Amy Arnsten, “If we call it mental illness it’s because the prefrontal cortex is involved.” There has been an explosion of study into the workings of the PFC, which gives us our most human proficiencies and experiences and is involved in the most advanced parts of human cognition, sensory experience, emotional processing, and assessing the world and people around us.


Part I: The Mental Illness Epidemic

Everything Is Not OK

"One of the major blind spots of our time is our failure to recognize the pervasiveness and the dangers of mental illness."
"Year by year, decade by decade, mental illness is becoming both more common and more severe in modern societies, a fact documented in several large and well-controlled scientific studies. In recent years, the news media and the medical literature have reported that the number of people receiving care for a mental disorder has risen dramatically. Currently, one in six adult Americans is taking a psychiatric medication. [1] And young people, who in the 1990s were more depressed than a similar-aged group just a generation before, died by suicide in record numbers in the first decade of the twenty-first century.
"There is a rise in the number of suicides, overdoses, and ER visits for attempts at both, and people face long waiting lists for treatment services of any kind, due in part to shortages in our mental health system and lack of health insurance. This data, combined with the experiences of mental health professionals and primary care doctors, all tell the same grim story: we have the makings of a public health disaster on our hands."
"In the late summer of 2017, multiple articles appeared in major news outlets reporting on startling new research revealing a rise in teenage depression associated solely with the use of smartphones. The claim was based not just on one study, but a body of work showing a relationship between teenagers’ use of smartphones and their subsequent feelings of depression. Part of the work even showed that decreasing phone use reduced symptoms of depression." [...] "Although eye-opening, the smartphone story misses the larger context in which this disconcerting news about teenagers and depression is playing out: massive cultural change fueling a worldwide epidemic of mental illness. In a sense, the smartphone study is a microcosm of the broader phenomena affecting our lives: modern life and how we cope, or fail to cope, with the changes to society brought on by technology. These changes create a type of stress that is new to humanity and not manageable by the ways we have handled complex challenges in the past. I believe it is this very struggle to cope that leads to what I’ve named Frontal Fatigue, a modern condition that explains how modern life and the effects of technology have led to a rise in mental illness."

Definition Of Frontal Fatigue

The pervasive effects of technology on all aspects of modern life have produced a type of stress that is new to humanity. This stress is most evident in the particular and pervasive mental demands modern life puts on us. These demands are handled by a large part of our brains called the prefrontal cortex (PFC). The PFC has an amazing range of abilities, but also has two major liabilities. One is that it does not work well, if at all, under stress. Second is that, once stressed, any vulnerabilities to mental illness may then become active.

Those who are genetically predisposed to such illness or have enough previous stress and trauma in their lives (or commonly, both) may then be added to the expanding ranks of those with mental illness. The more technology-centric modern life, the more Frontal Fatigue, and the more mental illness.

Rego MD, Mark D. Frontal Fatigue: The Impact of Modern Life and Technology on Mental Illness (p. 9). River Grove Books. Kindle Edition.


  • Medication
  • Suicide
  • Overdoses
  • ER visits

Explanations For Why It's Happening

  • Medicating issues that would be considered normal in the past. (better medication, doctors over-prescribing, pharmaceutical ads are working, medication being normalized, more awareness of the issues, etc)
  • More people seeking therapeudic treatment (awareness, normalization)
  • More granular and common diagnostic instruments

Mental Illness—The Cost We All Pay

A conservative estimate is that the combined incidence of these two disorders [schizophrenia and bipolar disorder] is at least 1 percent for any given population.
Loss of work, underachievement, absenteeism, poor parenting, increased health-care costs, and other results of mental illness add up to astounding financial costs, almost $1 trillion in the US alone.
We’ve seen an increase in the last seventy-five years in the incidence and severity of mental disorders in industrialized societies. It appears that as societies modernize, mental illness grows like a weed. There is clearly something about modernity that acts as fertilizer for mental disorders. And while few in the general public fully understand mental disorders, I am certain that if most people knew about the rising incidence of mental illness around the world, they would not be surprised. Most people view our era as one of stress. In fact, ours is often called the age of anxiety.

Which Mental Illnesses Are Not Impacted By Modern Life?

  • Autism
  • Intellectual disabilities
  • Dementia
  • Personality disorders (narcissistic, antisocial, and obsessive personality)
  • PTSD
Many researchers believe that this increase reflects a true rise in incidence, rather than greater awareness of the illness by parents and medical professionals leading to more frequent diagnoses. However, autism-related disorders are developmental disorders that are tied to the growth and development of the brain, not environmental factors like family or society at large, at least as far as we know. As modern society itself is the focus of this book, we will leave out autism spectrum disorders.

Mental Illnesses Increasing In Severity Or Prevalence

  • Depression
  • Bipolar Disorder
  • ADHD
  • Schizophrenia
  • Anxiety and Mood Disorders beyond Depression
  • Substance Abuse
  • Psychological Distress
  • Burnout

Part II: Modern Life

Our Technological Modern Life—How We Got Here

The Character Of Modern Life

Part III: Why Are We Sicker?

Types Of Theories

Biological Theories—WE've Strayed From Our Evolutionary Niche

Psychological Theories—How We Interact With Our World

The Loss Of Social Connectedness

Stress-Vulnerability: The Key To Understanding Causes Of Mental Illness

Part IV: The Prefrontal Cortex—The Jewel In The Crown

Part V: Frontal Fatigue—Our Weary PFCs And Mental Illness

From our discussion on the nature of modern life, we’ve discovered that complexity, abstraction, and reformatting are the three demands that modern life places on all of us. In doing so, this triad creates a kind of stress that is new to humanity. As we’ve learned, this stress can only be handled by the powerful human prefrontal cortex.
When stressed, PFC function will begin to deteriorate.
The Most important findings of modern neuroscience: the PFC is centrally involved in almost every form of known mental illness, and it is now known that stress to the human PFC does produce mental illness. The result is that whatever vulnerability to mental illness was already present in an individual’s PFC will manifest itself. This connection has been proven repeatedly by Amy Arnsten and many other scientists. This puts us at the foothills of the modern epidemic of mental illness.
The positive side of this is using the PFC wisely to put off gratification while we pursue other goals. The ability to resist action is one of our greatest strengths as humans. This is a valuable strength of the PFC. It is certainly part of the modern equation as we constantly put off emotional desires for more practical ones and long-term goals.

Straw That Breaks The Camel's Back: College, Covid?

The developing picture is like that of a young person going away to college or leaving school and entering the workforce. Suddenly, they are surrounded by students or coworkers who are mere strangers, and their way forward is open ended, not mapped out for them like it had been before. Those with a blossoming biological predisposition to mental illness, as well as those whose predisposition is already established, will have a difficult road ahead. This scenario is when new cases of psychosis usually appear and young people with already established psychiatric problems—ADHD, depression, OCD, and anxiety disorders, for example—will start to fall backward in their life paths. The demand placed upon the PFC is not the sole cause of these problems, but it adds a significant strain. It can easily be the straw that breaks the camel’s back. I believe this assault on the PFC is largely responsible for the increased severity and incidence of problems we are now seeing at this age and during adolescence. The COVID-19 epidemic, which took place during the writing of this book, is a case in point. Young people were isolated and made dependent on technology at a time when they should have been broadening their social circles and skills. The result has been that many young people suffered a decline in their mental health.1

Part VI: Coping In A PFC-Centered World

The Turn Inward—A Challenge And A Choice

We no longer follow the paths of adults in our communities as a way to develop our own identities. We must find our future selves by looking within. This turn inward will continue to rise throughout adulthood. It will become another source of the demands of modern life. Examples of the inward turn include the well-known neuroticism manifest in self-consciousness, guilt, and anxiety. And we cannot forget the narcissism of our age in our quests for self-satisfaction and self-realization. But all is not negative. We must add to this list various forms of insight that deepen our relationships and commitments, as well as the place of ethics in our lives. I do not believe these would have happened without the turn inward.
Blank Slate Bias: These people had a form of the blank slate theory of mind.3 This term refers to a theory of mental development that claims that a child is born with no preformed mental faculties. Everything the child learns and acquires is from the environment. This theory has been disproven many times by developmental psychologists, but it has continued to resist its own demise. What we now know is that children develop from a combination of inherent abilities and what they are exposed to.
The ability to see you are in a vulnerable state that will change your experience and understanding of everyday life represents a profound shift in thinking within modern society. The more the turn inward, the more a person seems to understand this vital distinction.

How To Help Your PFC

Symptoms you are pushing your PFC too hard

  1. Loss of focus in conversation or reading, for example, losing your place.
  2. Trouble finding words. This is the “tip of the tongue” phenomenon. It does not mean you have forgotten the word. Rather, your PFC normally retrieves the word but now is having trouble. It is more common with people’s names or with words we do not use frequently.
  3. A feeling that you must mentally strain to stay engaged in whatever you are doing, especially high-focus things like reading something technical.
  4. Difficulty doing multiple things at once that you normally do. For example, quickly shifting to keep several things going, like cooking.
  5. Becoming irritable when you have to shift focus, especially because of interruption.
  6. Feeling that you are brittle and have surges of emotion, such as getting angry quickly and calming down just as fast. The same would go for becoming tearful or feeling sentimental all of a sudden.

Here are three ways to approach the world without relying solely on thinking:

  1. Your hands. Build, make, cook, create, touch, play. Find activities that lead with the hands so that you physically interact with the world and use areas of the brain other than your PFC to get something done.
  2. Your senses. Feed your senses. Let me be clear: senses, not your desires and appetites (this is not a free pass to hedonism). I think we are starved for common beauty and curious things that present their beauty or uniqueness in the way they simply exist. A more direct description is to expose yourself to things that draw you in, not only because they are interesting, but also because they just look, sound, feel, smell, or taste good, unusual, or in whatever way intrigues you.
  3. Other people. Engage with others in person and perform activities together. Square dancing, political activism, dating, doing hobbies, it doesn’t really matter what you do, just that you do it with other people. And in doing so, indulge your curiosity about others. Many of us experience a lack of things to say in social situations (and some have the opposite problem). Just as some feel anxious about saying things in social settings, others now feel it is intrusive. We are all inherently interested in others on some level. I say indulge that interest, with appropriate boundaries. People are fascinating and they usually love saying so. It is a compliment to show interest and will open your eyes, as well as your heart. Be curious and of course polite, and ask about particular things, not generalities.

I am going to emphasize three specific skills I think everyone should take up as part of a fitness program for their minds. They do not directly focus on PFC functions; we get enough of that. But they engage the PFC in certain ways. By doing so we expand the mental space for these functions to operate. With this in mind, they are—

  1. Find a way to quiet your mind. Vegging out is not what I have in mind. These things, like watching TV, do settle us down and even allow rest. But they quiet the mind by blunting it. Here I am thinking of a sense that your mind is truly quiet but is still alert, not passively sitting back and allowing whatever comes along to fill it.
  2. Read deeply. This means finding something you are interested in reading that is longer than one or two sittings—with each sitting being at least thirty minutes. This is only an approximation, but it gives you the idea of staying with reading material over longer periods of time than text messages or email. When you do this, you engage with an author and their work and learn things you simply cannot learn any other way. It can be fun or serious; it can be about the folks down the block or in the Arctic Circle. There is no specific time or length requirement. It is a matter of sticking with an article or book that takes more than a minute or two.
  3. Consider shifting -eds to -ables. This last suggestion is very different from quieting the mind or reading deeply. It differs in the sense that it is highly personal. Nonetheless, I believe this is important in developing a level of comfort with how your own mind works.

Rego MD, Mark D. Frontal Fatigue: The Impact of Modern Life and Technology on Mental Illness (p. 195). River Grove Books. Kindle Edition.

Key People Mentioned

With regard to this book, there are two scientists, without whom there would be nothing about the brain to write. Professor Amy Arnsten, PhD, of Yale University and Professor Donald T. Stuss, PhD, of the University of Toronto (who passed away in 2019) were both instrumental in the establishment of their respective fields in the study of the prefrontal cortex.

Amy Arnsten

Donald Stuss

Resources Mention

Related Resources