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In men, it’s Parkinson’s. In women, it’s hysteria.

In men, it’s Parkinson’s. In women, it’s hysteria.
via Columbia Social Work / Twitter

This article originally appeared on ProPublica. You can read it here.

Once it was called "hysterical" movement disorder, or simply "hysteria." Later it was labeled "psychogenic." Now it's a "functional disorder."

By any name, it's one of the most puzzling afflictions — and problematic diagnoses — in medicine. It often has the same symptoms, like uncontrollable shaking and difficulty walking, that characterize brain diseases like Parkinson's.

But the condition is caused by stress or trauma and often treated by psychotherapy. And, in a disparity that is drawing increased scrutiny, most of those deemed to suffer from it — as high as 80% in some studies — are women.

Whether someone has Parkinson's or a functional disorder can be difficult to determine. But the two labels result not only in different treatments but in different perceptions of the patient. A diagnosis of Parkinson's is likely to create sympathy, but a functional diagnosis can stigmatize patients and cast doubt on the legitimacy of their illness.


Four in 10 patients do not get better or are actually worse off after receiving such a diagnosis and find themselves in a "therapeutic wasteland," according to a 2017 review of the literature by academic experts.

"This is the crisis," said University of Cincinnati neurologist Alberto Espay, the author of guidelines on diagnosing functional movement disorders. "It shouldn't be stigmatized but it is. No. 1, patients are wondering if it is real. 'Does my doctor think I am crazy?' Secondly, doctors can approach it in a way that implies this is a waste of their time."

A study published last year in a leading neurological journal stoked the growing controversy. Of patients diagnosed with functional symptoms, 68% were women. This finding, the authors wrote, "suggests that female sex may be an independent risk factor for the development" of functional symptoms.

The study prompted a furious letter to the journal's editor from Dr. Laura Boylan, a New York City neurologist. She argued that the study's results might demonstrate instead that symptoms thought to be psychogenic were actually the result of Parkinson's, and that doctors were slow to identify the brain disease in women.

"Disparities in healthcare for women are well established," she wrote, adding, "Women commonly encounter dismissal in the medical context."

For Boylan, the issue was more than a professional debate. It was personal. She had been diagnosed with Parkinson's-like symptoms that her doctors, all top caregivers at some of the world's leading medical institutions, largely believed to be psychogenic or side effects of medication.

via PixaBay

Most of her doctors were men, but two were women. Boylan, herself a brilliant neurologist, disagreed vehemently with them. She attributed her problems to a physiological cause, a tiny cyst in her brain, and grew despondent when other neurologists doubted her theory. She gave up her medical practice, became housebound and contemplated suicide. Even today, her case remains a mystery.

The first sign that something was wrong came in 2008.

At the time, Boylan was busy with a successful career that included work as a teacher, researcher and clinician. She was an assistant professor of neurology at the New York University School of Medicine; the director of the behavioral neurology clinic for the VA in New York City; and an attending physician at a hospital in Pennsylvania.

She was married to another neurologist, Daniel Labovitz, who is a professor at the Albert Einstein College of Medicine and practices at Montefiore Medical Center in the Bronx.

It was while driving at night on a Pennsylvania highway that Boylan experienced a vivid hallucination. She saw a cartoonish chipmunk on the steering wheel, smiling and waving at her. Another time, two blue men with red hats appeared on either side of her. She knew the images were not real, but she couldn't make them go away.

Her doctors at the time blamed the hallucinations on side effects of psychiatric medicine Boylan took for her long-diagnosed bipolar disorder. Her bipolar condition would later add another element of uncertainty to the debate over her Parkinson's-like symptoms.

Studies show that people with preexisting psychiatric disorders are more likely to develop Parkinson's — or have a functional disorder with similar symptoms. Boylan said she sees a psychiatrist for the bipolar disorder, but it's "just not a big deal in my life."

Over time, her health continued to worsen. In early 2011, during a tai chi class, she had difficulty balancing on her right leg. Later, she also noticed muscle twitching in her feet and legs.

Boylan was worried that some of her symptoms mirrored those found in patients with amyotrophic lateral sclerosis, or ALS, a rare and degenerative neurologic disease that affects the ability of muscles to function. ALS, also known as Lou Gehrig's disease, was ruled out by a specialist, but an imaging scan performed as part of that exam revealed a small cyst on the front right side of her brain.

The location and type of cyst are considered rare. At the time, Boylan and the neurologist she consulted didn't believe the cyst was causing her movement problems and chalked it up as an "incidental" finding not to be concerned about.

In the fall of 2013, Boylan experienced a three-day bout of double vision that forced her to miss work. The episode was disturbing because it left her, for the first time, unable to perform her duties as a doctor.

About a week later, she went to see Janet Rucker, then a neuro-ophthalmologist at Mount Sinai Medical Center. Rucker diagnosed convergence insufficiency, a condition in which the eyes are unable to work together to focus on close by objects. Rucker thought it unlikely the brain cyst was causing the vision problem and believed it was more likely related to medication Boylan was taking, according to her notes.

via Bryan Jones

Boylan returned home unconvinced by Rucker's opinion. Her vision improved enough to allow her to research the condition herself. She said she found instances where levodopa, a medication used to treat Parkinson's that she had prescribed many times for her own patients, helped alleviate the vision problem.

She decided to take her treatment into her own hands and took levodopa she prescribed for herself. Boylan knew the decision to test her own theory was a direct challenge to Rucker's competence.

While legal, self-prescribing medication is considered an unsound practice by some in the medical establishment. Physicians who treat themselves risk removing the objectivity usually present in a doctor-patient relationship, which can lead to poor decisions.

Within an hour of taking the levodopa, Boylan's eyes converged and the vision problem cleared. That wasn't all. Involuntary tremors and twitches stopped. She later wrote that she "felt years younger" and "moved much better" immediately after taking the drug.

For Boylan, the experience with levodopa confirmed what she had come to suspect; that the cyst in her brain thought to be harmless was in fact causing her Parkinson's-like symptoms. (In Parkinson's, nerve cells in the brain that help control body movements break down or die.)

If she had a functional disorder, the drug should have no effect. She excitedly dashed off an email to Rucker reporting her success and attached a video showing her eyes working properly.

"That is a pretty impressive effect," Rucker replied. She wrote that she rarely recommended the drug for convergence insufficiency, but given Boylan's improvement, "perhaps I'll recommend it more often."

Rucker, however, didn't appear to think the cyst was responsible for Boylan's double vision, calling it the "least likely" of options, according to her notes of the case. More likely, she wrote, it was related to other medications Boylan was taking.

Boylan didn't learn about the contents of the medical notes from her visit until later. Boylan, who believed her recovery proved that the cyst was the origin of her double vision, was insulted.

"That I solved this problem with levodopa, documented it, and returned to work the next day might be taken as evidence of my skill rather than having a screw loose," she later wrote to Rucker, who declined comment for this story.

Levodopa is a potent drug used to control tremors and stiffness in Parkinson's patients. The development of the drug, and what it revealed about how the brain works, was an important breakthrough that won one of the researchers involved the Nobel Prize in medicine in 2000. But levodopa can also produce side effects that include involuntary movements, from tics to sudden, jerky body motions, different from those that it had alleviated in Boylan.

Boylan decided to continue taking the drug, but wanted another neurologist to help manage her situation. She chose Elan Louis, a neurologist who had been just ahead of her in the Columbia residency program. Boylan told him she was serving as her own neurologist and that her situation was "getting acutely worse."

via pixabay

The two doctors saw each other at the occasional reunion, but they were not close. Boylan largely knew of Louis by reputation. He is considered one of the leading experts on movement disorders and is the editor of Merritt's Textbook of Neurology, a standard clinical guide in the field.

He practiced at Columbia when Boylan first began seeing him in late 2013 but was recruited to Yale University in 2015 to serve as chief of the movement disorders division in the neurology department.

Louis had not treated a specialist in his own field before. The relationship proved challenging. Boylan has a combination of intelligence and passion that attracts devoted friends. Louis described Boylan as "super smart" and someone who was constantly digging into the medical literature to learn as much as she could about her symptoms and the cyst in her brain.

She could also be blunt and confrontational. Boylan was one of several people arrested a decade ago for refusing to leave a U.S. senator's office as part of a sit-in advocating for single-payer health care.

She was also an early proponent of limiting the perks that pharmaceutical companies give doctors to encourage them to prescribe their drugs, a stance that irked some colleagues but also won her admirers. Boylan was not hesitant to challenge her own doctors' assessments, as she had done with Rucker. With a mix of pride and contrition, she describes herself as a difficult patient.

In one email exchange in 2015, Boylan appeared miffed that Louis did not believe that a bout of heart palpitations and dizziness was related to her brain cyst. "I wish you'd responded earlier when you found my questions odd/unreasonable," Boylan chided Louis. "At present I know more about this area than you and yet seem crazier because of it."

At least 10% of the patients who seek help for movement disorders at the Yale clinic are determined to have a psychogenic, or functional condition, Louis said. At other neurology clinics, the number is as high as 20% and second only to headaches as the reason for seeking help.

To determine if a condition is functional, neurologists identify symptoms that don't match with physiological movement disorders. In Boylan's case, the cyst was on the right side of her brain, which meant it should only cause symptoms on the left side of her body. The right leg weakness she experienced at tai chi, for instance, didn't fit with this.

Then there are a series of tests that can help determine if movements are genuinely involuntary. One group of tests is designed to distract a patient. A patient with a left arm tremor, as was the case with Boylan, might be asked to extend that arm out and then use the hand on the other arm to tap out a sequence of numbers.

As the neurologist calls out for one tap, four taps, two taps and so on, he or she is watching to see if the tremor on the left side stops as the patient focuses on the tapping.

When Louis performed these tests on Boylan, she knew exactly what he was assessing. She administered the same tests to her own patients. To Boylan, the fact Louis was even doing the tests meant he had already concluded some of her symptoms were psychogenic. "I knew I was going to fail," she said later, adding that the tests are not always a valid indicator.

"I tried so hard to do things properly that it can look extreme." Louis observed that Boylan's tremor stopped when she was distracted. "If something is truly involuntary, it should persist whether someone is paying attention or not," Louis told me. He agreed with Boylan that the tests are not foolproof, but said that they are useful in evaluating a case.

In his initial assessment of Boylan, Louis referenced the brain cyst and possible medication-induced effects as well as the possibility that "something else is going on here." The difficulty, he noted, was "piecing it all together."

To help solve this puzzle, with Louis' encouragement, Boylan consulted two neurosurgeons.

The first, at Columbia Presbyterian, wrote the cyst might be playing a role in her tremors but warned surgery should only be considered as a "last resort." The second, at Mount Sinai, was skeptical the cyst was playing a role, writing, "It is difficult for me to pin the presence of this cystic lesion on her worsening symptoms."

After the appointments with the surgeons, Boylan returned to see Louis on Nov. 14, 2013. Louis told her he saw some "psychiatric overlay" in her symptoms and said there may be something "organic beneath a lot of overlay," according to his notes.

He estimated that perhaps 70% of her symptoms were psychiatric in nature. He doubted the brain cyst was causing her rapidly worsening symptoms. It "doesn't fit," he wrote. He noted Boylan "was not happy about this but seems to have accepted it during subsequent emails/phone calls."

Louis told me that Boylan's case was "very complicated" because some of her symptoms and the cyst in her brain were rare. "Her syndrome is difficult to neatly put in one box," he said. "That is why she has defied diagnosis and had a difficult time."

A psychogenic diagnosis, he said, is hard for patients because "there is a feeling with people that it is not real, it is all in our head and imaginary and undervalues and devalues what they are going through. No one wants that."

While Parkinson's is treated with medications such as levodopa, patients determined to have a functional or psychogenic condition are often prescribed psychological regimens such as cognitive behavioral therapy. Louis said he has worked successfully with a Columbia psychiatrist to treat functional patients.

"We have had patients unable to walk who were walking out two weeks later," he said. Louis said he discussed Boylan's case with her psychiatrist to share his evaluation of her situation and to coordinate medications. Her psychiatrist referred her to behavior therapy, Boylan said. "I did a round," she said. "It helped me tolerate problems but did not change them."

The more Boylan tried to convince others that the cyst was causing her problems, the more she felt she was viewed with suspicion. It became an obsession. Louis once remarked to Boylan that no one in the world knew as much about the square inch of brain where the cyst was located as she did.

Despite their clashes, Boylan respected Louis. When he delivered his diagnosis, it caused her to second-guess her theory about the cyst. She also believed that some of her doctors used her bipolar disorder to cast doubt on her complaints.

Her symptoms worsened and the stress overwhelmed her. On Dec. 9, she was admitted to the emergency room at St. Luke's Hospital with severely elevated blood pressure and stress-induced cardiomyopathy, a heart muscle disease that makes it harder to pump blood. When a cardiologist inquired if she was under stress, Boylan tearfully told her, "My doctors think I am hysterical."

As 2014 wore on, Boylan needed increased doses of levodopa to get the relief she first experienced when self-treating her double vision. It was a vicious circle. She needed the medicine to help with her with her lack of balance, which was causing her to fall, as well as her vision and left arm tremor. But the side effects from the medicine were severe.

On a Sunday afternoon in September 2014, Boylan stumbled out of a taxicab onto the sidewalk in front of the emergency room at NewYork-Presbyterian/Columbia University Medical Center. A couple of ambulance workers noticed she was having difficulty and helped her into a wheelchair.

Boylan was gaunt. She had lost more than 30 pounds since the beginning of the year. In the preceding days she slept little. Her body was twisting up in uncomfortable and unusual positions, making it hard to walk.

Her head jerked and her knees pushed together as she bent forward. She was unable to control the movements. In a brief video taken after she was admitted to the hospital, Boylan leaned against a wall with her head slumped awkwardly to the side as she waited to use a bathroom.

To the doctors who attended to Boylan, her condition was disturbing. They knew her as an accomplished neurologist who trained and mentored a new generation of doctors. She was a familiar face at Columbia, having done her medical residency there in the late 1990s. On this day, Boylan appeared paranoid and agitated. She argued with doctors about medication and their assessment of her condition. She complained that her husband thought she was crazy.

Her case defied an easy diagnosis. "She is a quite complicated movement disorders patient," one of the treating physicians at Columbia noted.The attending neurologist at the hospital that weekend thought Boylan was suffering from "mild psychosis" with contributing factors that included fatigue and the side effects of medication.

The doctors noted Boylan recently received a distressing email about a former patient who was dying; the implication was that this was a possible source of a psychogenic effect. Louisa Gilbert, a friend of Boylan's, said that when she arrived at the hospital she found doctors treating Boylan as a "psych case."

Boylan left the hospital after one night. In the following weeks, her condition worsened. She stopped working and was largely homebound. Her diet was poor, consisting primarily of ice cream and grapefruit juice, and she continued to lose weight. She was again having trouble reading and developed severe writer's cramp that she attributed to the brain cyst.

Boylan grew dependent on others to take care of her, including Gilbert, whom she first met at boarding school. A professor of social work at Columbia University, Gilbert always admired Boylan for her resiliency. Boylan went through her last two years of medical school while a single parent. She never missed work. Now there were days when Gilbert would show up at Boylan's apartment and find her friend writhing on the floor, unable to get up.

"It was so bewildering," Gilbert said. "What the hell is going on?"

By December, Boylan was spending hours lying on the floor of her apartment while sipping orange juice to speed up the absorption of the levodopa she was taking to stave off muscle spasms. She was now separated from her husband; they would later divorce. Alone and unable to work, Boylan despaired and made plans for suicide. "I had and am still having emotional meltdown over this loss of profession/vocation/self-definition," she wrote in an email to her brother, Ross, in California.

Ross and Laura Boylan were the only children of a corporate lawyer and a homemaker. For most of their youth they lived in an apartment near the Metropolitan Museum of Art on Manhattan's Upper East Side. Their mother suffered from severe mental illness and was hospitalized a number of times. Their father was an alcoholic. The couple often argued. Laura was happiest when she was out of the apartment, and she often spent summers away from the city.

The Boylan siblings both attended boarding school at Phillips Academy in Andover, Massachusetts, but rarely interacted there. Ross was two years older and each of them moved in their own circles. Laura returned to New York City to attend Barnard College. Ross went on to Harvard University and then moved permanently to the west coast.

In her December 2014 email to her brother, Boylan wrote "bad news" in the subject line. She said the brain cyst was causing "more and more problems." She shared that she gave up clinical practice because of "fatigue, stamina, vision and other problems." She said there was a "small possibility of neurosurgery" but she wasn't sure it was worth the risk, and she doubted any surgeon would take the chance anyway. She said her symptoms were getting progressively worse and there was no cure.

Ross Boylan responded with a short note that ended with a touch of optimism. "The future is not written," he wrote.

The email from his sister caught Ross Boylan off guard. "I thought she was doing OK," he said in an interview. "Then she sends me this email, oh by the way every single sphere of my life is collapsing." The doctors she consulted seemed to be uniform in their view that her brain cyst was irrelevant and that removing it would be pointless and probably dangerous, Ross Boylan said. "It's impossible to operate, and nothing could be done about it," he said. Most concerning, it seemed to him that the "fight had gone out" of his sister.

Ross Boylan is a research statistician at the University of California, San Francisco, and his department frequently works with doctors at the medical school there. Among all the specialists at the university, he figured there must be one who could help his sister. He didn't tell Laura that he was going to try to help. He was afraid she would tell him not to bother, and he didn't want to get her hopes up in the event his efforts failed.

On a webpage for the university neurology department, Boylan came across a group photo that included his boss. It turned out his boss had done some statistical work for the research team of neurosurgeon Michael Lawton. An introduction was made. Ross Boylan gave Lawton what information he had about his sister's condition, and within days Laura Boylan was in contact with the surgeon by phone and email.

"My hunch is that operating on the cyst will help and I am ready to proceed," Lawton wrote her. "You can appreciate that we surgeons like to be certain that our efforts are going to be curative, and in your case I can't be sure. Nonetheless, I think this operation will be safe and I am ready to move forward whenever you are."

Boylan decided to go ahead with the surgery and booked a flight to San Francisco.

Lawton told me that the cyst was located in an area of brain circuitry that is disturbed in Parkinson's patients and could be the cause of her movement disorders and double vision. "It fits," he said. "It's right where that kind of lesion would produce those symptoms." Nonetheless, he said he cautioned Boylan the procedure could be done perfectly with no complications yet have no therapeutic effect.

Louis said he wasn't certain if the surgery was a good idea. "I deferred to the surgeon," he said. "There was little margin of error, and that made it a very complex decision." Others close to Boylan were concerned about the speed in which the decision to operate was made and that Boylan decided to go ahead before even meeting with Lawton in person.

Boylan herself confessed in an email to a colleague days before the operation that she felt "in over my head" in arranging the surgery and was "beginning to think this is not a good idea."

via PixaBay

On Jan. 9, 2015, Lawton and his team performed a nearly five-hour craniotomy on Boylan in which part of the bone in her skull was removed to expose her brain. The cyst was drained and a piece cut out to prevent it from accumulating fluid in the future.

Boylan was worse off in the weeks after the surgery. The awkward, twisting movements persisted. She couldn't use her right arm. She didn't know if she would recuperate to a life worth living.

About a month after the surgery, Boylan saw neurologist Rebecca Gilbert at NYU Langone Medical Center. Boylan arrived for the appointment wearing an eye patch and an arm sling.

Gilbert's notes of the encounter make it clear she thought Boylan's symptoms, even after the surgery, might be psychogenic. A right side tremor was "inconsistent" and abnormal movements were "variable and erratic" and only "present during the formal exam."

In contrast, when "patient is telling her story, there are no abnormal involuntary movements." Gilbert wrote that she was "very concerned that at least part of this neurologic picture is psychogenic in nature."

By mid-March, just a month later, Boylan's condition improved significantly. On March 21, she sent an email to Lawton with the subject line "have turned a corner." She said her symptoms were improving and she was "back out and about in the world."

She told him he had "given me my life back." She also criticized those who questioned the wisdom of her decision to undergo the operation. "I confess that, in accord with my own pre-existing bias, some neurology pals have thought I must have found a cowboy who took a lucky long shot," Boylan wrote. "I correct them carefully in detail."

Ten days later, Boylan saw Gilbert for a follow up appointment. Gilbert wrote that Boylan "returns looking very well. She feels well neurologically and psychiatrically. She attributes her improvement to the surgery." Gilbert declined comment on Boylan's case.

By June, Boylan was back to work.

On a Sunday morning this spring, Boylan sits at a conference table in the neurology department at Bellevue Hospital in Manhattan, the country's oldest public hospital. The room is sparse save for a large, formal portrait of the former head of neurosurgery. The painting does not escape Boylan's notice. Like many of the leading figures in neurology, the former official is a white male.

Boylan, 57, is dressed casually in black pants and a flower-print blouse. A lanyard with a Bellevue identification tag hangs from her neck. On this morning, she is the attending neurologist, overseeing medical residents. In addition to Bellevue, Boylan does part-time stints at a hospital in Duluth, Minnesota, and a VA facility in Albany. She has regained the weight she lost when her illness was at its worst, as well as the mental sharpness that dulled during that time.

Across the table, a resident briefs her about a woman who arrived in the emergency room the day before. The exchange is thick with medical terms, but there is a clear point to the back and forth: They are trying to determine if the woman's symptoms are functional. The patient complained of a generalized burning sensation.

That's the type of vague complaint that could point to a psychogenic diagnosis. On the other hand, the resident said the patient reported having problems with her coordination, but not with her strength. People with functional disorders might also indicate they were weak, because they tend to have a wide array of complaints.

When the resident pulls up a scan of the woman's brain on a screen mounted on the wall, Boylan points to an area that she describes as a "little bent" with a "kink in it." This is potential evidence, she says, of a cerebral fluid leak. The woman recently underwent an epidural injection and fluid leaks are a known complication of the procedure. Boylan talks to the patient and comes away confident a leak is the problem. The remedy is intense rehydration. The patient improves, and is released the next day.

Afterward, Boylan said her own experience has prompted her to evaluate cases more carefully. She said she also has to guard against failing to recognize cases that may, in fact, be psychogenic. "I have to be careful not to lead the patient," she said.

After her surgery, Boylan requested copies of her medical records from most of the doctors who treated her over the prior five years. She was angered to find that several of them highlighted her history of bipolar disorder — in some cases it was the first item entered — and discounted the role of the brain cyst in her symptoms.

Boylan believes that many of her doctors discounted the brain cyst because of a predisposition toward diagnosing psychogenic conditions in women, and that her case is symptomatic of gender bias in the field of neurology.

"I don't believe I would be treated this way if I was a man," she said. By sharing her experience publicly, Boylan is determined to counter what she views as an ingrained suspicion of symptoms reported by women that dates back to the use of the word "hysterical" to demean them as emotionally and physically weak and prone to exaggeration.

She calls it a "pervasive and potentially lethal bias" in neurology.Gender inequality is rife in neurology. Female neurologists were last in pay and had the biggest salary gap between men and women, in a 2016 survey of salaries by specialty and gender at medical schools.

The American Academy of Neurology has had only one female president in its 71-year history even though women now constitute 40% of the professional society's membership. Female neurologists are also disproportionately underrepresented in awards handed out by the academy, according to a study last year. In 24 of the 28 years studied, the recipients of the academy's lifetime achievement awards did not include a single woman.

The more difficult question is whether this inequality spills over to clinical practice. Boylan received care from both male and female specialists, and her medical records are devoid of outright indications of gender bias. Boylan said female neurologists are trained "in a paradigm of thinking generated by men for men" in which the same symptoms are viewed differently in men and women.

Louis said there was no gender bias in his evaluation of Boylan. He said functional disorders are "far more common" in women and "if a person is that gender I am more comfortable with that diagnosis." Still, gender is "only one of many, many pieces of information" used to make a diagnosis, he said.

Dr. Sarah Lidstone, a specialist in functional movement disorders at Toronto Western Hospital, said it is "impossible to say" that gender bias doesn't exist in diagnoses of this condition. "That does factor into that." Still, she said, there appear to be real gender differences. "We don't know why. It's complicated."

Researchers are working to figure out whether women are disproportionately diagnosed with functional disorders.

"We don't know what is right or the whole truth necessarily," said Dr. Mark Hallett, a senior investigator at the National Institute of Neurological Disorders and Stroke. He said one study underway is looking at whether women suffer more childhood trauma, particularly sexual abuse, than men and if that is a cause of functional disorders.

He said he didn't believe that gender bias played a significant role in the fact that women receive the diagnosis more often than men, and he said other explanations may include hormonal differences between the sexes or that women may be more likely to seek treatment.

It's impossible to know for certain how Boylan got better. The workings of the mind are complex and our understanding of diseases of the brain and of psychology is constantly evolving. It may be that, as Louis suspected, a combination of factors was at work that include both a psychogenic component and the brain cyst.

"To me, where she is now is nothing short of a miracle," said Boylan's friend, Gilbert.

I asked Lawton if Boylan might have experienced a placebo effect from the surgery. While that can happen, he said, Boylan's relief and turnaround "was pretty significant to the point that it outlasted the typical duration of most placebo effects which I think run their course."

Louis said he believes the surgery "did do some good" and at a minimum removed a cyst that was in a dangerous position. But he is not persuaded it is the main reason for Boylan's turnaround. He suspects many of her symptoms were functional, and sometimes patients with that diagnosis get better over time.

Boylan is convinced her cyst and reactions to medicine to treat the symptoms caused by it were the primary sources of her illness. She views her story as a cautionary tale: She was a woman with means, a degree in medicine and a cyst in her brain. Still, she said, "that did not spare me from being cast as hysterical."

True


Life can be bleak, so we’re going to be celebrating the small joys while we can—whether that’s asweet snack that boosts your mood (courtesy of our friends atAll In), or a spontaneous moment between strangers that's so joyful it restores your faith in the algorithm (even if only for a second). These momentary mood boosters are everywhere you look—you just have to be able to find them underneath all the noise. And that’s where we come in.

Consider this weekly web series your cheat sheet to the best of the Internet—not just random memes to make you laugh, but examples of people truly finding something extraordinary in the mundane. Each Friday we'll be delivering five pieces of media that allow you to stop for a second, take a breath, and feel just a little bit brighter among the daily stress. (Think of us as your chronically online bestie who knows exactly how to make you smile, exactly when you need it the most.)

Ready to smile? Here we go.

1. The best travel buddy surprise 

@tarareynolds03

Surprising Grandson with going on vacation with him.

♬ original sound - Tara Leanne Reynolds
This sweet grandson thought he was just heading out on vacation—until he spotted a very familiar face at the airport. The moment he sees Grandma standing there, his jaw literally drops. He sets his backpack down and then runs straight into her arms for the biggest hug. "Oh my God! You're coming with us to Jamaica, right?!" he asks her, already smiling from ear to ear. It's the kind of unscripted joy that makes you want to call your own grandma to say hi—and other TikTokers are having all the feels in the comments section: "This brought me to tears," says user KE. "I would kill to go on another vacation with my grandma again. She passed in February. Take so many pictures!"

2. Saying 'thank you' to a very special teacher 

Last week, we shared a question on Upworthy’s Instagram that sparked an outpouring of heartfelt responses:
“If you could say thank you to one person right now, who would it be, and why?”

For Kate Delisle, a teacher in North Andover, Massachusetts, the answer came instantly: her longtime colleague and teaching assistant, Jeanne Donovan.

“Jeanne has been by my side for seventeen years,” Kate shared. “Next year, we’ll have to split our program — and we won’t be working together anymore.” In her message, Kate described Jeanne as more than just a coworker. She’s supportive, empathetic, and “my right arm — someone who lights up every room she enters. I’m privileged to know her and consider her family.”

To celebrate that incredible bond, our friends at All In recently paid a surprise visit to Kate and Jeanne at their school — letting Jeanne know just how deeply appreciated she is by her colleagues and students alike. And get this: Jeanne is *so* beloved that Kate's parents, kids, sister, and husband all came to the surprise to honor her alongside everyone else. A true tear-jerker and a must-watch.

3. The proudest big brother

@caylaleighbrown This is the original video, He also said it looks like Mike Wazowski after we got done crying LOL #fyp #infertility #infertilityjourney #twins #twinpregnancy #ultrasound #pregnancyafterinfertility #pregnancyannouncement #twinannouncement #twinsies #twinmom ♬ original sound - Cayla Brown ✨ WDW

Grab your tissues for this one. After eight long years of hoping for another baby, TikTok user Cayla Lee Brown surprises her stepson Caleb with a sonogram photo—and his reaction is nothing short of beautiful. When Caleb realizes not only that he's going to be a big brother but that twin siblings are on the way, his eyes well up and he whispers "We're having twins?!" Cue the heart explosion. In a follow-up video, Cayla shares something that makes this news extra special: Caleb isn't actually her biological child, and although she considers Caleb her son she wasn't sure she'd be able to have biological children at all. "[Caleb] was my gift and I was blessed with two more," she explains. This video is the best reminder that love makes a family, and sometimes the best surprises take a little time.

4. Overly excited dogs 

@puppylovestoplay6 Part23: When they hear a word they like#dog#funny#funnyanimals#funnypets#animals #dogsofttiktok #pet #foryou #longervideos#foryou#fyp #funnyvideo ♬ original sound - Puppylovestoplay

This feel-good compilation is basically a highlight reel of dogs at their happiest: realizing they’re about to go on a walk. From excited tail wags to full-body zoomies, every pup in this video gives a masterclass in unfiltered enthusiasm. One especially clever owner even uses sign language to say “walk,” just to see if their dog picks up on it—and spoiler: the reaction is still pure chaos (the joyful kind). These dogs just know, and they are ready (read: unhinged.) Truly a reminder that the simplest things—in this case, some fresh air and a little adventure—are what spark the most joy.

5.Bunny ASMR

@megancottone The way she munched down the carrot ribbon #bunnies ♬ Married Life (From "Up") - Gina Luciani

If you've had a stressful day, allow this floofy little friend to press the reset button on your brain. TikTok creator @megancottone gives us a full 60 seconds of bunny bliss: one ridiculously adorable rabbit, some deliciously crunchy snacks, and the kind of soft background music that makes your heart rate drop in the best way. The gentle munching noises? Therapeutic. The fuzzy face and floppy ears? Instant joy. It’s like nature’s version of white noise—but cuter. Honestly, someone get this bunny a wellness podcast deal.

For even more “extra”-ordinary moments, come find us on social media (@upworthy) or on upworthy.com!

For scrumptious snacks that add an extra boost of joy to your day, be sure to check out All In.

Canva Photos

A viral TikTok argues that women don't want to give up the joy of their own personal peace and freedom for anyone.

There's been a lot of discourse on the state of modern dating and a lot of theories on why it seems harder than ever for people to find connection with romantic partners. Could it be that the achievement and education gaps between men and women are altering the dynamics? Have social media and dating apps broken our brains and hearts? Do we all have unrealistic expectations and unlimited options, leading to never feeling satisfied with anything or anyone?

Those are all intriguing options, but an alternate theory has recently arisen that's quickly gaining steam: Maybe being single isn't as lonely as we think. Maybe being single is actually freaking awesome.

A guy on TikTok who goes by Get To the Point Bro shared a hilarious monologue on why women who have been single for a long time "don't want to date anymore." Women say he absolutely nailed it.

the office, andy bernard, dating, relationships, dating advice, single, romance, loveThe Frenchman's monologue was absolutely spot onGiphy

At first, it might seem like he's poking fun, either at single women or at the men who can't seem to win them over. But not so! What he's done is perfectly captured the joy many people find in being single and, frankly, able to do whatever the hell they want.

"Some women have been single for so long they don't date anymore, they grant you access to their peaceful little empire like a reluctant queen handing you a visitor's badge," he says. "You text her good morning and she's already annoyed, like 'Why are you disturbing the sacred silence of my personal growth journey?'"

He goes on, "Bro she's been sleeping diagonally in her bed for three years, she's not giving up that territory because you opened the door and paid for coffee."

"You plan a cute date, she's thinking 'That sounds nice but also I could stay home, deep clean my apartment, do a 12 steps skincare routine, order sushi and not have to listen to a man breathe.'"

"You try to check in emotionally, 'How are you feeling?' She's feeling fantastic because you're not here."

"You're not competing with other guys. There are no other guys. You're competing with her weighted blanket, her peace, her cat named Chairman Meow, and the simple joy of not having to share her fries."

These are just a few of the best lines from the nearly 2-minute rant, all delivered in the most amazing French accent you can imagine. Please, enjoy:


@gettothepointbro

DATING A GIRL WHO IS USED TO BE ALONE CAN BE VERY HARD .

The best thing about the video is the discussion in the comments. Women want to know how this man got access to this top-secret information. The rant is so eerily, frighteningly accurate that women are convinced this French guy is living in their heads. That, or someone's secretly leaking intel.

"dammit. somebody call a meeting of the council. he knows too much."

"I dont often offer this compliment to the male species but you explained it better than I ever could."

"Alright, who’s told him this info??? So exposed right now"

"The joy of sleeping diagonally across my bed cannot be fully explained."

"This is the most accurate profiling I’ve ever heard. You absolutely ailed it."

Clearly, we've tapped into a real phenomenon here.

@gettothepointbro

CAN YOU RELATE LADIES ? THAT’S WHY WE LOVE YOU ❤️

The truth is that many people—both men and women—are disillusioned with the sad state of the dating scene these days. App burnout is a real thing, and meeting new people in real life is a ton of work. So, it's no surprise that more and more people are just choosing to stay single and enjoy all the perks that come along with it. This is a stark change, especially for women.

According to FiveThirtyEight, "Women were also more likely than men to say that they weren’t dating because they have other priorities right now." Priorities like travel, career, friendship, and even just self-care—all things that wind up taking a backseat when people get involved in relationships. It wasn't too long ago that women of a certain age that were still single were called "spinsters," but that word has lost a significant amount of power. This new generation of women aren't embarrassed or ashamed to be single; they're loving it for exactly all the reasons this video describes.

This article originally appeared in April.

Innovation

Innovative farm in Virginia can grow 4 million pounds of strawberries on less than one acre

This method uses 97 percent less land and up to 90 percent less water than conventional farming.

A new way to grow strawberries with less land, less water, and more berries.

Strawberry farm harvests aren't something most of us calculate on a regular basis (or ever at all), but the numbers from a strawberry farm in Richmond, Virginia are staggering enough to make it worth an old-school word problem. If the average American eats 8 pounds of strawberries a year, and an average strawberry farm yields approximately 20,000 pounds of berries per acre, how many people could a 200-acre strawberry field feed?

I won't make you do the math. The answer is 500,000 people. But what if a crop that size, providing enough strawberries for half a million people, could be grown on just one acre instead of 200? It's possible. You just have to go—or rather grow—up, up, up.

Indoor vertical farm company Plenty Unlimited knows a lot about growing up. In fact, it's their entire business model. Instead of the sprawling fields that traditional farming methods require, vertical farms have a much smaller land footprint, utilizing proprietary towers for growing. Plenty has used vertical farming methods to grow greens such as lettuce, kale, spinach, and more for years, but now it boasts a vertical berry farm that can yield a whopping four million pounds of strawberries on a little less than an acre.

Growing indoors means not being at the mercy of weather or climate unpredictability (barring a storm taking out your building), which is wise in the era of climate change. Unlike a traditional greenhouse which still uses the sun for light, Plenty's indoor vertical farms make use of the latest technology and research on light, pinpointing the wavelengths plants need from the sun to thrive and recreating them with LED lights. Plenty farms also don't use soil, as what plants really need is water and nutrients, which can be provided without soil (and with a lot less water than soil requires). Being able to carefully control water and nutrients means you can more easily control the size, taste and uniformity of the berries you’re growing.

If that sounds like a lot of control, it is—and that idea might freak people out. But when a highly controlled environment means not having to use pesticides and using up to 90% less water than traditional farming, it starts to sound like a solid, sustainable farming innovation.

Plenty even uses AI in its strawberry farm, according to its website:

“Every element of the Plenty Richmond Farm–including temperature, light and humidity–is precisely controlled through proprietary software to create the perfect environment for the strawberry plants to thrive. The farm uses AI to analyze more than 10 million data points each day across its 12 grow rooms, adapting each grow room’s environment to the evolving needs of the plants – creating the perfect environment for Driscoll’s proprietary plants to thrive and optimizing the strawberries’ flavor, texture and size.”

Plenty even has its own patent-pending method of pollinating the strawberry flowers that doesn’t require bees. Even just the fact that this enormous crop of strawberries will be coming from Virginia is notable, since the vast majority of strawberries in the U.S. are grown in California.

strawberries, strawberry fields, fields, farming, traditional Traditional strawberry farming takes up a lot of land.Photo credit: Canva

Plenty's Richmond farm is currently growing strawberries exclusively for Driscoll’s.

“Partnering with Plenty for the launch of the Richmond Farm allows us to bring our premium strawberries closer to consumers in the Northeast, the largest berry consumption region in the U.S.,” Driscoll’s CEO Soren Bjorn said in a press release. “By combining our 100 years of farming expertise and proprietary varieties along with Plenty’s cutting-edge technology, we can deliver the same consistent flavor and quality our customers love—now grown locally. This new innovative farm is a powerful step forward in continuing to drive category growth in new ways for our customers and consumers.”

Is Plenty’s model the farm of the future? Perhaps it’s one option, at least. The more we grapple with the impact of climate change and outdated, unsustainable farming practices, the more innovative ideas we’ll need to feed the masses. If they can get four million pounds of strawberries out of an acre of land, what else is possible?

This article originally appeared in February.

"Horse horse, tiger tiger." What does that mean?

You probably know what it means to hit the hay, tie the knot or buy a lemon. Maybe you’ve already killed two birds with one stone today, so effortlessly that it was a piece of cake. But to a non-English speaker, using these phrases would probably make you sound crazy … or should I say gone crackers?

That’s the fun thing about idioms. They change depending on the time, place and culture creating them. In other words, they usually sound ridiculous to anyone except those who normally use them. Looking at turns of phrase in different languages helps us see the world through different eyes. And man does it seem impressive at a party.

Just think, instead of saying “it’s raining cats and dogs,” next time you could incorporate a more Lithuanian take, and say “it’s raining axes.” How metal is that?

It can also be raining old women, barrels, buckets, pipe stems, frogs, female trolls, fire and brimstone … depending on where you’re from.

Some of these idioms from around the world make a lot of sense. Others get so lost in translation, you can’t help but get tickled pink.

Swedish idiom, fish being cooked"Now your fishes will be warmed."Photo credit: Canva

Swedish

”Nu ska du få dina fiskar värmda.”

Literal translation: Now your fishes will be warmed.

It's another way of saying someone’s in trouble, or their “goose is cooked.”

The Swedish language is definitely not lacking in the threats department. They also have a saying, “nu har du satt din sista potatis,” which translates to “now you have planted your last potato.”

Imagine hearing Batman say “You’ve planted your last potato, Joker.” Doesn't have quite the intended effect.

ham, italian idiom"To have one’s eyes lined with ham."Photo credit: Canva

Italian

“Avere gli occhi foderati di prosciutto.”

Literal translation: To have one’s eyes lined with ham.

Leave it to the Italians to have food-related phrases. You can use this when someone can’t see what’s right in front of them. It can also be used when someone is blinded by love. Sadly, there is no “ham-colored glasses” idiom.

Icelandic idiom, laying your head in the water, man in the water"To lay your head in water."Photo credit: Canva

Icelandic

Að leggja höfuðið í bleyti.”

Literal translation: To lay your head in water.

You say this when you “need to sleep on something,” or “put your thinking cap on.” This one is hilarious because I cannot fathom getting any mental clarity from holding my head in the water.

two donkeys, arabic idiom, repetition "Repetition teaches the donkey."Photo credit: Canva

Arabic

"At-Tikraar yu’allem al-Himaar.”

Literal translation: Repetition teaches the donkey.

Practice makes perfect, but it especially does for donkeys. Animal-themed wisdom at its finest.

German idiom, train station"I only understand train station."Photo credit: Canva

German

"Ich verstehe nur Bahnhof."

Literal translation: I only understand train station.

It's another way of saying “it’s all Greek to me.”

The history of this one is a bit mysterious. One theory is that it originated from WWI soldiers who had only one thing on their mind after getting discharged: returning home. Meaning, they could only comprehend the train station that would lead them there. Others say it refers to tourists new to Germany who have really only learned the German word for “train station.” Which would indicate that everything else is foreign to them.

And let’s not forget “nicht mein bier, nicht meine sorgen,” translating to “not my beer, not my worries.”

(Fun fact: The term “not my circus, not my monkeys” actually stems from a Polish proverb, not an English saying at all.)

norwegian idiom, liver, model of a human liver"To speak directly from the liver."Photo credit: Canva

Norwegian

Å snakke rett fra leveren.”

Literal translation: To speak directly from the liver.

When you say something without sugar-coating it, you are speaking directly from the liver. This dates back to a time when the liver was thought to be the magical organ that produced courage. So speaking from the liver is just like speaking from the heart, only down and to the right a little.

two horses, two tigers, chinese idiom"Horse horse, tiger tiger."Photo credit: Canva

Chinese

“Mama huhu.”

Literal translation: Horse horse, tiger tiger.

You can use it to say something is just okay. Not good, not bad, just … meh.

As the story goes, a Chinese painter who, not very good at his craft, created a drawing of an animal that looked sort of like a tiger, and sort of like, you guessed it, a horse. That story actually has a tragic ending that serves as a cautionary tale against carelessness. But nowadays it takes on a lighter connotation.

And like “comme ci, comme ca” in French, “horse horse, tiger tiger” isn’t quite as commonly spoken as non-native speakers would assume.

Language continues to be an ever-evolving and always entertaining way to not only appreciate other cultures, but also note the similarities. Words might change slightly, but ultimately we're all expressing the same things.

This article originally appeared three years ago.

@mannybuckley/TikTok, Photo credit: Canva

Someone finally said what we're all thinking.

Listen, baby name trends come and go. What was once a hip and cool name will eventually be seen as passé (this coming from someone with a name that is now obsolete, apparently), and names once thought of as old-fashioned will absolutely become cool again. It’s part of the circle of life, like the tides, the seasons, the rising and setting of the sun…accept it.

In fact, this comeback is already happening. According to the Social Security Administration, vintage names like Theodore, Henry, Willam, Charlotte, Evelyn, and Emma are among the top ten most popular baby names of the moment. Jimmy Fallon’s daughters are named Winnie and Frances, for crying out loud.

However, just because there’s been an uptick in names that harken you back to a time when “good show, old sport” was a common phrase, not everyone is on board. Recently, content creator Manny Buckley hilariously put into words what many of us think of these WWII-era names.

In a clip posted to his TikTok, Buckley first savagely said, “Y’all went from naming all y’all’s kids Jayden, Cayden, and Aiden, Madison, Addison, and Addylyn to giving them all old people names.” He then recounted being on a train and hearing another call after her toddler, whose name was George.

“Ma’am. George is a mechanic in his 60s and he can’t work on your car this week because his sugars is running high.” Where’s the lie?

@mannybuckley

What is this cycle of naming kids!? #names #naming #name

He didn’t stop there, going on a lighthearted rant about the types of images certain now-popular names actually evoke, like Agnes (a “Florida retiree in her 70s who cannot leave the retirement home”), Ira (an “80 year old Jewish man”), Belinda (a “registered nurse who has been working in the field for 50 years”), and Clifford (a 85-year-old navy vet who needs “all y'all to be quiet”). Nary a kid sounding name in sight, if you ask him.

babies, baby names, funny baby names, kids on rug, blocklsA group of toddlers in preschool.via Canva/Photos

Although the video was clearly just a lighthearted jab, a few adults commented to defend the use of vintage names.

“We aren’t naming babies. We’re naming people,” one top comment wrote, while another seconded, “Exactly! Some people don’t realize this. They are kids for a very short period of time, then they are adults.”

Still, another quipped, “yeah, but they aren’t senior citizens forever either!” Another wrote “I’m Martha…I’ve been 80 since the first grade.”

A few others, particularly teachers, chimed in with their own equally funny experience of kids having old fashioned names.

I am a kindergarten teacher. I have Marjorie and Brenda. It’s like a 1950’s secretarial pool.

I have kindergarteners named Edyth, Arthur, and Iris. They’re going to form a knitting club at recess.”

“My nephew is Charles lmao and he may only be 2.5, but he is the school maintenance and everyone call uncle.”

“We have Matilda and Cordelia, 4 and 2, shelling beans on the porch. Their nicknames are just as old as Tilly and Della. I love them, though.”

babies, baby names, newbors, diapers, old-fashioned namesTwo babies in diapers.via Canva/Photos

Some of the names that Manny called out may sound humorous, but the trend of using old-fashioned names is real. The Social Security Administration recently announced a list of old-fashioned names that have been making a comeback in the last year. Some of the biggest climbers were Rocky, Marjorie, Heath, Aabner, Lettie, Benny, Micah, Salome, and Carlo.

And there you have it, folks. We have indeed come full circle. But is it any weirder than the thought of someone calling their Grandma Brittany? I think not.

This article originally appeared in February.

via Ketut Subiyanto/Pexels and Dinielle De Veyra/Pexels

How long can you hang out? The answer may say a lot about your potential lifespan.

Would you really want to know how long you have to live? On one hand, it’d probably inspire you to go out and complete your bucket list. On the other, it may be depressing to know just how many days you have left. Well, science has yet to discover a way to determine the average person's life expectancy, but some indicators can show whether someone is in danger of having their life cut short by deteriorating health.

You could, if you were so inspired, shell out a bunch of money for fancy genetic and biological testing. Chasing immortality is all the rage with billionaires, so if you've got the money, you can find out an awful lot about how long you're likely to live.

Or you could just hit the gym or local playground and find out for free.

A study published by Clinical Interventions in Aging in 2019 determined that handgrip strength can be a reliable proxy for how long one has to live, or longevity.

One of the best ways to judge handgrip strength is to time how long you can hang from a bar. To test your grip strength, find yourself a pull-up bar, whether at a gym or local park, take a deep breath, and start hanging. Don't worry, you don't need to be able to do a pull up!

Ironically, the move is called a "dead hang." So-called, because you literally just hang there for as long as possible.

The literature revealed that 30 seconds is a good target for women and 60 is an excellent goal for men.

Therefore, if you go longer than the goal, you’re looking at a long life. But if you can’t quite get there, your life may be shorter than you’d like.

longevity, aging, living long, getting older, seniors, dying, mortality, health, fitness, longevity testCats are undefeated in grip strength.Giphy

Dr. Peter Attia, founder of Early Medical and author of Outlive: The Science and Art of Longevity (2023), believes that grip strength is a great way to determine one’s overall health.

“It's just a great proxy for overall body strength and muscle mass, but I think it's also a very functional form of strength,” he said on The Drive podcast. “Basically, everything in your upper body is mediated through your hands. And if your grip is weak, everything downstream of that is weak. When you watch someone who's got a weak grip deadlifting it's very difficult for them to deadlift correctly because they don't create a proper wedge."

There are may ways to measure grip strength, but the dead hang is likely the simplest. When you think about it, it requires an incredible combination of shoulder mobility, spinal stability, core strength, and overall fitness. Not only are these all positive biological health markers, they're also all key to preventing falls as we get older.

Regularly practicing the dead hang, on the other hand, has incredible benefits including stretching your muscles and deloading your joints and spine, giving them a much needed rest.

- YouTubewww.youtube.com

Doctors Eve M. Glazier and Elizabeth Ko at UCLA Health say poor grip strength is connected to numerous diseases. “Research continues to link a decline in grip strength to a range of adverse health issues, including heart disease, arthritis, osteoporosis, Type 2 diabetes and certain cancers. It has also been found to be a predictor of the likelihood of post-surgical complications, post-surgical recovery time and mortality,” they wrote on the UCLA Health blog.

Weight can also significantly affect how long a person can hang from a bar. So, do lighter people have an unfair advantage over those on the heavier side? Well, weight is also an important indicator of longevity. A study published in Aging Cellfound a direct correlation between increased body mass and decreased longevity.

Other studies have elaborated on the findings: More important than your absolute grip strength and dead hang ability may be how it changes over time. Losing grip strength is a negative sign for your overall health, but maintaining or even building it is associated with better outcomes.

Another good reason to hit the gym regularly, at any age. No matter where you're starting, you want to do everything you can to maintain that level of strength as long as possible.

The good news for people who didn’t quite make their hang time goal is that you can improve it by practicing dead hangs.


longevity, aging, living long, getting older, seniors, dying, mortality, health, fitness, longevity testPracticing dead hangs will help you maintain grip strength no matter what your starting point. Photo by Charlotte Karlsen on Unsplash

How to perform a dead hang (according to Healthline):

  • Use a secure overhead bar. Use a step or bench to reach the bar with your arms easily. You don’t want to jump straight into a dead hang.
  • Grip the bar with an overhand grip (palms facing away from you). Aim to keep your arms shoulder-width apart.
  • Move your feet off the step or bench so you’re hanging on to the bar.
  • Keep your arms straight and stay relaxed.
  • If you’re new to the exercise, hang for 10 seconds. Then, work your way up to 45 seconds to 1 minute at a time.
  • Slowly step back onto the step or bench before releasing your arms. Repeat up to 3 times if you wish.
Grip strength is so strongly correlated with longevity that many medical professionals advocate for it being considered a true biomarker. A biomarkers is a regularly measured state of the body that's used as a key health indicator, like blood pressure or cholesterol. Grip strength, some say, should be regularly evaluated at medical check ups as an indicator of healthy aging.

This article originally appeared last year. It has been updated.