The toxicity of social media.

Over the past two decades, online social networking has revolutionized the way we communicate and interact with one another. Friends and relatives separated through vast geographical distances are now able to interconnect with technical ease. Overall, it has been a masterstroke in technological advancement. However, these changes may affect particular aspects of human behaviour, perhaps even contributing to, or entirely causing the development of psychiatric disorders. 

Excessive use of social networking sites such as Facebook and Instagram appear to be associated with the development of low self-esteem, especially in children and younger adolescents. This doesn’t appear to be straight forward though, as evidence is available to support the opposite. As a result, the impact of social media on our mental health has been a controversial topic for many years. Due to this potential link between ‘social’ interactions online and our mental health, I feel it is important to lay out my thoughts. I believe that excessive social media use can likely result in insecurity, feelings of depression and anxiety, and contribute to the development of unrealistic expectations towards other people, and the world we live in.

One of the first studies which indicated that general internet use significantly affects social relationships and community participation was published over 20 years ago, in 1998[1]. The authors highlighted that for participants who spent more time online, a reduction in communication with family members was observed. In addition, the user’s social circle also diminished – a social change which can contribute to loneliness, which in turn is associated with the development of depression[2]. Worryingly, a further study published in 2000 suggested that increased internet use may have negative effects on the social development of children[3]. An obvious point to note here is that when these studies took place, the majority of the social media platforms available today did not exist. For example, Facebook was not founded until February 2004, and thus internet usage was likely infinitesimal compared with today. 

Since the development of social media platforms, the time children and adolescents spend online has exponentially increased. Although they enable us to easily interact with a large number of people, these interactions are often shallow and will unfortunately never replace face-to-face communication effectively. In a study published in 2012, investigators reported a positive correlation in a high school population between social media usage and depressive symptoms[4]. Conversely, in a 2013 study sampling university students, researchers failed to find a similar correlation[5]. These conflicting studies therefore put forward the idea that children and young adolescents may be more susceptible and negatively affected by social media compared to older teenagers. This could be linked to different responses by different age groups to social media content and challenges. Importantly though, those sampled at university in 2013 may have grown up when social media wasn’t really a considerable factor in their lives. For example, when I was between 8-14 years old (2001 to 2007), I did not really care for social media. Instead, my friends and I would see each other face-to-face daily, often playing sports or various other games to pass the time. Thus, my social development and interactions occurred in a natural interpersonal setting. 

Then, Windows Live Messenger happened. Previously known as MSN messenger – which was developed in 1999 – it rebranded in 2005. It eventually took over the brains of the adolescents. Instead of meeting up after school, many kids would go home and spend their entire evening on Windows Live Messenger, talking to people FROM SCHOOL, many of which they would barely speak to in person. This shift resulted in the development of online cliques, and it sucked the life out of strong interpersonal relationships. It wasn’t all bad however, and I think in some situations it provided some positives. For me, I was terribly shy at school. Online messaging allowed me to talk to people I thought were interesting, and it facilitated me to ask questions about their interests without me seizing up with anxiety and fear.

More recent studies, wherein social media has become a central part of the majority of young people’s lives, further strengthens the argument that it could cast a shadow over our mental health. The first, published in the Journal of Social and Clinical Psychology in 2018 asked 140 undergraduate students at the University of Pennsylvania to either continue regular use of Facebook, Instagram and Snapchat, or to limit their use of each to 10 minutes per day – i.e. 30 minutes total. To confirm the conditions were being met, the participants provided data from their phones to show their precise overall app usage throughout the day, rather than relying on memory – an often unreliable feature for scientific investigation. After the three-week study period was completed, the participants filled out a questionnaire to help the researchers understand how they were doing psychologically, with particular interest in depression, anxiety, loneliness and “the fear of missing out”, often abbreviated as FOMO. Perhaps unsurprisingly, the study reported that participants who limited their social media usage to 30 minutes per-day felt significantly better, reporting reductions in both loneliness and depression[6]. This change was particularly pertinent for those who came into the study with higher levels of depression. Interestingly however, both FOMO and anxiety were reduced in both study cohorts, suggesting that the participants might have had the resulting benefit of improved self-monitoring. “Some of the existing literature of social media suggests there’s an enormous amount of social comparison that happens. When you look at other people’s lives, particularly on Instagram, it’s easy to conclude that everyone else’s life is cooler or better than yours,” said study author Melissa G. Hunt.

This is further supported by a 2019 study conducted at York University in Canada. 120 undergraduate women were asked to use either Facebook or Instagram to find a peer that they perceived to be more attractive than themselves or a family member who they didn’t believe to be, and then leave a comment on their post. Interestingly, the women who interacted with a post of someone whom they perceived as more attractive felt worse about themselves afterwards[7].  “Even if they felt bad about themselves before they came into the study, on average, they still felt worse after completing the task,” said study author Jennifer Mills. It is important to note here however that the women may have felt generally happier engaging with a family member compared to a peer, and this could complicate the data presented in this study. Nevertheless, it is important to note that making any kind of comparison – not just people that we consider more intelligent or attractive, but also people we consider less intelligent, smart or anything else for that matter – is associated with poorer wellbeing. A 2014 study linked this association, reporting that the connection between social media and depression was largely mediated by social comparison[8].

Social networking and self-esteem

As we should all be aware, self-esteem is a crucial factor in developing and maintaining a good quality of life. In a 2006 study, when compared to adolescents with high self-esteem, poor self-esteem in young adolescents resulted in overall poorer mental and physical health, often contributing towards higher levels of criminal behaviour and worsening economic prospects during adulthood[9]. The authors emphasized that the long-term consequences of self-esteem changes could not be explained by adolescent depression, gender or socioeconomic status. Thus, low self-esteem in young adolescents can have negative real-world consequences upon reaching adulthood. Whilst this study underlined that the consequences of poor self-esteem appeared independent of adolescent depression, low self-esteem is associated with the development of various mental illnesses including anxiety, depression and eating disorders[10-12]

Why is social media contributing towards reductions in self-esteem? One possible relationship between these social networking platforms and emotional destructivity appears particularly pertinent: narcissistic behaviour. So, what makes someone a narcissist? Someone who displays narcissistic traits often has a grandiose sense of self-importance, regularly displays a sense of entitlement and also requires constant praise and admiration. On the other side of the coin, a narcissist often intimidates, belittles and bullies others. As you may have already guessed, social media platforms are perfect breeding grounds for this sort of behaviour. Unfortunately, numbers of followers, comments and likes can all contribute to the inflation of one’s ego. As an example, I can say with confidence that many social ‘influencers’ are awfully narcissistic, and they often harbour millions of followers. The problem here is that

many of these followers are often young, impressionable and easily manipulated. 

Is social media a toxin or an escape?

Overall, I think the impact of social media on our self-esteem and mental health is considerably complex. Whether negative or positive, it entirely depends on who we interact with and what we follow. For example, a young teenager only following models on Instagram – who will often have their pictures photoshopped before posting them – will result in the development of a false sense of realism. Following motivational and educational accounts however, may not have the same negative impact. As an example, think about following Kim Kardashian and Michelle Obama on Instagram. Who do you think will be more likely to post things with a positive message? 

Because of this, moderating social media usage of the younger generation may be a valid option. Not to inhibit their freedoms, but just to check on their health and wellbeing, and determine whether any negative changes are directly due to what is seen on the internet. From experience when I was a teenager, I know that seeing ripped and well put together men online really knocked my confidence in my physical appearance. So much so, it still occasionally bothers me today. However, I learned to understand just how irrational I was being, but it took me a long time.

We do need to look at the other side of the coin, however. Something we should immediately consider is correlation versus causation. Social media usage may indeed be directly associated with the development of mental health disorders. Nevertheless, it is crucial to distinguish this from the potential that adolescents increase their social media presence due to poor mental health itself, perhaps as some form of digital escape from the real world – e.g. socioeconomic status or bullying at school. Conducting longitudinal studies – whereby you follow participants over several years – on psychiatric patients and healthy volunteers, comparing those who regularly use social media to those who do not would be a strong experimental study to definitively determine whether social media can be associated with declining mental health.

Another important consideration is that not all social media platforms are created equal. For example, Facebook is focused around updating personal profiles, wherein users can create comments and status updates, alongside uploading pictures and videos. Twitter on the other hand is primed towards the posting of short messages (“tweets”), often expressing thoughts and opinions. This doesn’t mean that Twitter users are less likely to be mentally affected though, it means that study comparisons should be made regarding mental health changes and the utilization of Facebook, Twitter, Instagram and various other social media sites. It is important that these studies also present exclusion and inclusion criteria for participants. In some circumstances, people with personality disorders will spend more time on social media compared to the general population because computer-associated communication can enable them to become more socially successful. This could complicate the data, wherein it may become unrepresentative of the population.

Regardless of what you think of social media, all platforms – especially Facebook and Instagram – forcefully incite constant self-evaluation on a daily basis, often resulting in unnecessary competition and comparisons of one’s accomplishments with those of others – in some circumstances, people we may not even know. To top it off, social media directly results in the incorrect perception of physical, psychological and social characteristics of others, often resulting in the manifestation of jealously and frustration. If you personally feel like social media contributes towards your own negative feelings, try to take a week away from it, perhaps more. You’ll be surprised by how much better you can feel when you aren’t constantly worrying about what other people are up to. 



Fear of the unknown.

Fear of the unknown.

Many of us are creatures of habit. If everything is going according to plan, we feel in control. Unfortunately, this status-quo often degenerates when a curveball presents itself. In some circumstances, this kickstarts a fear response. In the eyes of many, this is often considered an uncontrollable thought process. Fear has often been described as a self-protecting mechanism, through elicitation of the scientifically characterized ‘flight-or-fight’ response, which prepares the body for action. Whilst this is beneficial in many situations, such as being confronted with a potentially dangerous scenario, it can also become crippling for many of us. In some instances, this crippling fear associates with the uncontrollable. In fact, several anxiety disorders including social anxiety and panic disorder share an underlying trait: increased fear of the unknown. However, the manifestation of fear is becoming an increasingly common trait within society, often associated with what has been coined the ‘victim mentality’. It is an acquired personality trait, wherein a person often considers themselves a victim of the negative actions of others, despite all the evidence to the contrary. For many years, I thought this. I truly believed I was the victim of some cruel universal joke. 

Due to negative and destabilizing life-events that I neither acknowledged nor dealt with, I assumed the worst in many situations. This was especially the case for scenarios I had absolutely no control over. As you may have guessed, I feared the unknown to a disconcerting extent. I feared the future. I was scared of the uncontrollable. I have always been meticulously organized and driven when it comes to work. Because of this, I would often eat myself alive when fear disrupted my flow and motivation. The worst thing? Fear would consume me about scenarios that I either had no control over, or worse… things that may not arise. I feared things that did not yet exist! Future career aspirations, ending of relationships, death of family members. Why was I so consumed by these destructive thoughts and fears?

Fear of the unknown is an acquired trait. It is learned. Because of that, we all have the ability to unlearn it. For many of us, we often allow the past to dictate our opinions on the future. We apply previous worst case scenarios to new situations, often assuming that the past will inevitably repeat itself.  ‘I was in a relationship once… they broke up with me. I had a job interview like this before… they didn’t want to hire me.’ Why should any of us believe that it will not happen again? This thought process can often lead to chronic indifference and lethargy about the potential progression in our lives. We can lose all interest in skill development because of the manifestation of fear. How is that a good life? That isn’t living at all. 

For the best part of a decade I let fear dictate my path. On several occasions I decided to choose security over the prospects of greatness. Why? Was it the fear of embarrassment? The fear of failure? I think it was a combination of the two. I was heavily bullied in school, so when I was in my late teens, if there was any instance whereby I would potentially embarrass myself, I would avoid the situation entirely. The fear of failure had become more prominent during my early twenties. Truly believing failure would extinguish any potential success, I would often avoid new scenarios in which the potential for failure manifested. Because of that, I missed out on some incredible opportunities. 

Things in life which are worth having are never easy. If they were, then we would all have them. I think this is crucial to underline. Does stress contribute to your fear? If aligned, it is important to approach and manage challenges in bitesize chunks. This makes tackling a new situation far more manageable and may consequentially help suppress the development of an exaggerated fear response. Are you worrying about the long-term consequences of failure? In many instances this is an entirely pointless process, often fueling fear, anxiety and unmanageable stress. Focusing on fear linked to things you cannot immediately control is a fruitless endeavor. 

Fear and anxiety many times indicates that we are moving in a positive direction, out of the safe confines of our comfort zone, and in the direction of our true purpose.

– Charles F. Glassman

In some circumstances, fear manifestation can lead us to develop the ‘if it is meant to be, it is meant to be’ mentality. Relying on this internal monologue results in the manifestation of laziness and reluctance. Dedicated and consistent hard work is required for success. The universe will not run that race for us. Because of this, fear in many ways is our mortal enemy.  If unharnessed it has the potential to inhibit our ability to strive forwards. So, what can we do about it? I have listed a few different approaches that may help.

How to tackle our fear.

Limiting exposure to uncontrollable situations. Many of us can get worked up by situations we cannot directly or individually resolve. In terms of global issues, newspapers and news websites are the perfect ingredient to whip up a fear storm. For example, whilst I have been living in the United States, I can say with utmost confidence that Donald Trump has exclusively installed anxiety and fear in the hearts of many Americans. His off-the-wall opinions and abuse of power have many people anxious about their futures. Unfortunately however, the presidential situation can only be resolved on election day. For now, it eludes our control. Excessively worrying about things like this during a period wherein you cannot do anything about it is psychologically and physically draining, and it’s definitely not good for anyone. Focus on the things that you have direct control over. The world is too big to worry about everything.

Seek support. Communicating with others who may feel similar bouts of fear and anxiety can be beneficial. I quickly realized that I was pretty good at giving advice to others about their own anxiety. However more importantly, these conversations helped me understand that I was ignoring my own advice. Eventually this changed, and it has assisted beyond description. 

Reflect on past successes. How many times have we all worried about something only for it to totally work out? Whether that was studying for exams, preparing for a job interview, or organizing travel preparations, we often like to dramatacise and imagine the worst-case scenario. Whilst a realistic approach often helps avoid excessive disappointment if something doesn’t go out way, this thought process is imminently heading towards pessimism. When fear hits you regarding a new opportunity, remember to look back at your previous successes. I hope this reflection will help you realize and understand just how suitable and ready you are for this next experience.

It is important to remember that fear is an entirely natural response, especially when we enter a situation we are not immediately comfortable or familiar with. That doesn’t automatically mean that it should be considered a negative emotion. Many of the best things in life are on the other side of fear. Harness it. Embrace it. The unknown may be terrifying, but it is also totally magnificent. 

The science behind SAD.

Because I am British, it probably comes as no surprise that I unequivocally understand the heartbreak of traditional rainy weather. An indestructible stereotype of the UK, bad weather has never really manifested the ability to catalyse happiness during the morning commute. Whilst the occasionally odd shower is often welcomed, consistent wind and rain provokes noticeable negativity in people – have you ever been in central London during commuting hours? Yikes. Why then, for many of us, does our mood shift in association with the weather? Interestingly, science may have the answer! This discussion is dedicated to what has been coined seasonal affective disorder. Here I will survey some of the evidence surrounding the condition and describe what we may be able to do to fight back against it!

Seasonal affective disorder: what exactly is it?

Seasonal affective disorder is a form of depression otherwise referred to as SAD or seasonal depression. As you may have guessed, people who suffer with SAD tend to experience mood changes and symptoms similar to depression. These symptoms appear to correlate with the changing seasons, primarily beginning in the autumn and winter months, before alleviating during the arrival of spring. With this in mind, it is important to note that SAD is more than just “winter blues”. The symptoms can be distressing, debilitating, and can significantly interfere with daily functioning. Nevertheless, various treatment options are available.


Unfortunately, the biological cause(s) of SAD is still relatively unknown. However, some evidence suggests that it is related to the body’s level of melatonin, a hormone secreted by the pineal gland. Melatonin regulates the sleep-wake cycle, and darkness is known to stimulate its production, preparing the body for sleep. Because more melatonin is therefore produced during the winter months (when sunlight hours are diminished), people tend to feel sleepier and more lethargic. 

In addition, research suggests that some people who develop SAD may produce less Vitamin D. Interestingly, Vitamin D has been suggested to play a role in serotonin activity, a key mood regulating neurotransmitter which is reduced in some depressed patients. 


Interestingly, human clinical trials have identified that both cognitive behavioural (e.g. talk) and light therapy improve the symptoms of SAD, wherein the latter may be more effective for reducing four key signs of the disorder: early insomnia, anxiety, hypersomnia, and social withdrawal. So, if you needed a sensible reason for an expensive winter holiday to the Bahamas… you are most certainly welcome. However, more practical approaches to tackling SAD symptoms include taking care of your general health and wellness, which involves (yep, you guessed it…) regular exercise, good nutrition and getting enough sleep. Spending time outside and rearranging your office space so that you are exposed to a window during the day may also be of benefit.

Does blindness contribute?

From a scientific perspective, there are many interesting questions arising from SAD research. For example, is it more common in people with serious visual impairment? Does the likelihood of developing SAD increase as eyesight progressively degenerates? What about people who are blind and have been since birth; do they develop symptoms of SAD? These are all interesting research avenues which are currently being investigated.

It is important to seek help

Whilst it is thought-provoking topic to discuss, please remember that If you feel like you or a loved one has experienced depressive symptoms for an extended period of time, contact your nearest doctor for support.

Is Grief a Mental Illness?

Image from Pixabay

For the majority of us, grief is an inevitability. 

If you have ever experienced grief, you may be familiar with questioning your own sanity… ‘Did I just fleetingly see my loved one wade through a crowded street?’

In some circumstances it can even result in us questioning our own reason for living. Whilst disturbing, these thoughts usually diminish over time, becoming less consuming and intense. However, sometimes these thoughts can pass the line into pathology, wherein treatment may be required to help alleviate and remove the developing problems. 

Pathological grief disorder (PGD) is a condition which is a fairly new addition to what has been dubbed the ‘bible’ of psychiatric disorders – referred to as the Diagnostic and Statistical Manual of Mental Disorders (DSM). This disorder is commonly known as traumatic or prolonged grief, wherein it typically lasts for longer than six months. However, the addition of the disorder to the DSM has been a fairly controversial one. The reason for this being because it allows for medical treatment of grief related depression within the first few weeks following a bereavement. Diagnosing someone with depression so quickly after a significantly traumatic event is, in my opinion, not the correct decision. 

Grief is a natural response the naturally diminishes over time. This is particularly pertinent to individuals who believe the ‘strong’ and ‘stable’ approach for other family members following a fatality – primarily being men. In 2017, Prince William discussed the destructive nature of the ‘stiff upper lip’ mentality, admitting that it had taken a devastating toll following the death of his mother, Princess Dianna. Thus, relying on medication to potentially numb the emotion of someone in grieving may only exacerbate the issue, especially when the medication is eventually withdrawn. If that was me, I would probably start to believe that prescription drugs were the essential crux for any potential happiness. Whereas in actuality, any recurring negative emotions would have likely reemerged due to not having sufficient time to process the death prior to pharmaceutical intervention.

Whilst immediate medication is not advised, it is crucial to identify signs of chronic psychological distress following a bereavement. Here are a few PGD symptoms to be aware of:

  1. Concentrating on little else apart from the deceased loved one
  2. Extreme focus on reminders of the loved one or excessive avoidance of reminders
  3. Intense believing that life has no meaning
  4. Inability to enjoy life or reminiscence on positive experiences with the loved one. 
  5. Wishing to die to be with the loved one.

Pathological mourning is not a new concept, with publications discussing its commonality and treatment options in the 1980s. The primary problem is that the DSM does not discriminate PGD from intense ‘normal’ grief, thus likely yielding huge false-positive diagnoses from psychiatrists. This is likely to cause additional stress to an already vulnerable individual.

A major reason for this is because the signs between PGD and ‘normal’ grief are practically identical. However, in PGD the symptoms are considerably more prolonged, debilitating and intense. Numbness and detachment can last for over six months, and perhaps extend considerably longer. It is in considerable contrast to feeling sensitive after being exposed to emotional triggers of that loved one – for example, videos and photos or anniversaries.

Nevertheless, ignoring any type of grief is potentially an extremely hazardous choice. The severe consequences of losing a loved one can, without intervention, manifest in post-traumatic stress disorder (PTSD). Whilst primarily associated with individuals who have worked within the military, PTSD is common amongst various groups, including the bereaved. A recent study looked into the rates of PTSD in 132 people who had lost a close relative due to cancer. Strikingly, at one month 30% of the volunteers were rated as having PTSD, with another 26% displaying pre-clinical signs of the disorder.

Interventions for pathological grief disorder

Because the diagnostic criteria for PGD is lacking, many suffers are instead diagnosed with major depressive disorder and are ‘treated’ with antidepressants. Whilst this is sometimes beneficial for the patient, evidence is lacking as to whether this is successful for PGD sufferers. 

On the other hand, grief counselling is available. Therapists for this type of support are widely knowledgeable and understand that each experience of grief is entirely unique, complex and emotional. Your culture, personality and individual experience will all affect the grieving process. A ‘one size fits all’ approach in terms of medication is unlikely to help the majoring of us. Grief counsellors on the other hand will intricately tailor treatment to meet your specific needs. 

I would strongly recommending reading about grief counselling if you believe there is a loved one who requires it. Communication with health professionals (alongside loved ones) is absolutely crucial for healing and recovery. Unfortunately, grief is a normal and upsetting part of life. Instead of immediately jumping towards medication as a potentially damaging crutch, take the right initial steps following a bereavement: Emote and communicate with friends and family. But remember, never be ashamed to seek guidance and support if you think you need to. 

Social anxiety and loneliness.


Fearnounan unpleasant emotion caused by the threat of danger, pain, or harm. 

Does that sound familiar to you and your experiences? Perhaps it may. Anxiety is often coined to be a particular type of persisting fear, wherein we worry about potential future outcomes associated with specific events. In fact, the way we feel when either frightened or anxious are extraordinarily similar, because the basic emotion for both remains the same. So, despite not being in any immediate danger, anxiousness can result in similar symptoms to that of fear: increased heart rate, feelings of sickness and/or dizziness, and a loss of appetite. For many, new social situations can be a common trigger of these symptoms, often termed as social anxiety. 

Social anxiety: what is it?

Also labelled as social phobia, social anxiety presents itself as a long-lasting fear of being humiliated or scrutinised by others. It is sometimes (and incorrectly) compared to general shyness. However, whilst shyness often manifests for many prior to an unfamiliar situation, this usually dissipates following exposure to the new social situation. This is not the case for social anxiety. The latter often manifests during adolescence, when the opinions of friends and peers become increasingly important. This impairment can continue into adulthood, wreaking havoc on a wide variety of important life events. Separating social anxiety symptoms from those of general shyness is thus essential before discussing management and treatment options. 

The symptoms

Symptoms of social anxiety (as with any form of anxious behaviour) can be wide ranging, and it is unlikely that any one individual would experience them all. All anxiety disorders can be associated with the symptoms mentioned previously. However, common identifiers for social anxiety usually include the feeling of dreading everyday activities, such as starting up conversations with strangers, speaking on the phone to unfamiliar people, or even going into work. As a consequence, social anxiety can result in the avoidance of many social activities such as eating out or going to parties.

Can social anxiety effect my health? 

Because of the primal need for social interaction between humans, the consequences of social isolation on both physical and emotional health can be catastrophic. A recent meta-analysis – a statistical approach which combines data from multiple studies – identified that a lack of social connections can heighten health risks as much as smoking fifteen cigarettes a day or having an alcohol consumption disorder. The analysis suggested that social isolation can significantly increase the risk of premature mortality, with the magnitude of risk exceeding that of other common leading health threats. A recent study in 2019 analysed the data from more than 580,000 adults, finding that social isolation increases premature death risk for every race.

The negative impact on both mental and cognitive health is also apparent. Evidence supports a link between social isolation and adverse health effects including poor sleep quality, depression and accelerated cognitive decline, the latter of which is associated with problems in memory, language and judgement. A 2018 study also discovered a clear association between loneliness and dementia, increasing a person’s risk of developing the latter by up to forty percent. Examining data from more than 12,000 U.S. adults aged fifty or older, participants rated their loneliness and social isolation alongside completing a battery of cognitive tests every two years for up to ten years. 

Do you think this applies to you?

As reported by a 2018 survey, loneliness levels have reached an all-time high. Of the 20,000 U.S. adults approached, nearly half reported feeling alone, with the youngest generation being the loneliest of all. However, isolation is also well characterised in the elderly. According to Age UK, over two million people in England over the age of 75 live alone, with over one million stating that they go for over a month without conversing with a friend, neighbour or family member10

It is essential to determine whether social anxiety and/or loneliness applies to either yourself or a loved one, and then take appropriate action. It is important to try and communicate with friends and family where possible. However if this is hindered, it is imperative to seek out advice from a qualified medical professional.