I woke up to texts from my friends. “Happy Publication Day!” And, from friends who’ve published books themselves, messages like: “How’s pub week going?” “Just checking in to see how you’re feeling?” “Let me know if you need to vent.”

Perhaps publication week is like this for everyone, or perhaps my friends recognize that I’m particularly neurotic, but my predominant feeling is not excitement, or happiness, or pride. It’s anxiety, tinged with derealization. I know, intellectually, that so much horrible sh*t is going down in the world, but what I’m thinking about is that I have a book coming out today.

I feel like milk being scalded—all my ego, and narcissistic fantasies of acclaim, and equally narcissistic fantasies of public humiliation, are rising to the top. How does one skim oneself?

Georgia O’Keeffe said that she staged shows for herself before she displayed her art to the public: “I make up my own mind about it—how good or bad or indifferent it is. After that, the critics can write what they please. I have already settled it for myself, so flattery and criticism go down the same drain, and I am quite free.” How I long for that sort of freedom! I am not there yet, certainly. I am a reasonably successful academic, which means I have never been in the habit of settling things for myself. Criticism does not go down the drain.

My three-year-old, though, embodies the O’Keeffe spirit. She can be quite critical of her art as she makes it, frequently starting over, or exclaiming in frustration if she doesn’t like how it’s going. But if she is happy with a drawing, then nobody can tell her nothing. She gets herself a piece of tape from the dispenser and tacks the drawing up on the wall so she—and others, if they want—can look at it.

Lately, she has been longing to write. She can’t read; she can’t really sound out words. But she knows her letter shapes, so if I spell things for her, she will write and write and write. I previously wrote about how I want to be more like my 13-year-old. In this respect, I want to be more like my 3-year-old: Engrossed in making, quite free. She signs her name to everything, letters backwards, out of order, upside down. “Look, look, look, what I made!”

Look what I made: I wrote a book! It’s about sin and forgiveness, genes and environment, chance and choice, motherhood and daughterhood, punishment and accountability. I will sign it for you, and even write the letters in my name in order, if you purchase it from this local independent bookshop.

If you read my book, I would be very grateful if you took a picture of any passage you find interesting and posted it to any social media platform (“look!”), or wrote a review on Goodreads or the hegemonic retail site. As much as I would like to cultivate my soul’s freedom from flattery or criticism, feeding the engagement beast does make a genuine difference to whether the book can find its audience.

With gratitude for your support,

Paige

Upcoming Events

• Virtual salon on “Rethinking Accountability in a Genetic Age” with Interintellect, tomorrow night, March 4 at 7 PM CT. A few public tickets are left!

• In-person book talk at Harvard Book Store (Cambridge, MA) on March 19. Free!

Round-Up of Recorded Conversations

• With Olga Khazan for the Me, But Better podcast

• With Josh Szeps for the Uncomfortable Conversations podcast

• With Andrew Huberman for the Huberman Lab podcast

• With Chris Williamson for the Modern Wisdom podcast

• With Dr. Aliza Pressman for the Raising Good Humans podcast

• With Xavier Bonilla for the Converging Dialogues podcast

• With Paul Eastwick and Eli Finkel for the Love Factually podcast

A few years ago, I received a long letter in my university mailbox. It was written by a man who is in prison for a sexually violent crime that he committed when he was a young teenager. He has been in prison since he was 16 years old. He had read about me and my lab in an article in Texas Monthly magazine. He wrote to say that he agreed with the premise of our research that genes help shape how a person behaves. “As we say here in Texas, the apple doesn’t fall far from the tree.” He had a few questions for me, including one that haunted me for months: “What makes a child go bad—nature or nurture?”

When I got the letter, I had already started planning a new book about how genes and early childhood environments influence “bad” behaviors—behaviors that break rules, laws, norms. Hurting animals and other people and not feeling guilty about it. Lying, stealing, cheating. Getting into fights, threatening other people with weapons. Having risky sex with lots of partners, driving drunk, abusing drugs. These behaviors are moralized; these behaviors incite outrage, resentment, and, often, punishment. The behaviors are seen as vices. And, these behaviors run together in families, even when people are not being raised by their biological parents.

The idea that a person’s genes could influence their likelihood of behaving in ways we ordinarily treat as moral was the topic that seduced me into science in the first place. In the early 2000s, I took my first job in science as an undergraduate research assistant. My professor was studying how a particular receptor in the mouse brain affected how the animals responded to opiate drugs, like morphine. My job in the lab was to put little shunts in the mice's skulls, so that we could easily insert viral vectors that would affect gene expression into particular brain regions. I was 18 years old and a committed Evangelical Christian. I would have, at that point in my life, described opiate addiction in purely spiritual terms, a problem to be solved with prayer, baptism, and the redemptive power of belief in Jesus as your personal Lord and Savior. Yet here we were, modeling what I had thought was a moral failing in a little white mouse, and hoping to intervene by tinkering with the receptors in its brain. I was hooked.

Since then, my research has shifted from rodents to people, but my core scientific interest has endured: How do genes affect behaviors that are commonly treated as morally blameworthy in everyday life? My master’s thesis was on conduct problems in children. My dissertation was on antisocial behavior in adolescents. And in the nearly two decades since then, I’ve published papers on genetic influences on ADHD symptoms and conduct problems, on early sex and marital conflict, on drunk driving and problematic alcohol use and illicit drug use, on psychopathic personality traits, on rule-breaking and aggression and violence. (To be clear, I’m not saying that all of these should be considered bad behaviors; I’m saying that schools, parents, religious communities, and the state do consider these behaviors to be violations of their rules. Thou ought not.)

Given the volume of research that I and others have conducted on the genetics of these “externalizing” behaviors, I could have given the man who wrote me a clear scientific answer: It’s never nature or nurture. It’s always both. Your parents (usually) give you both your genes and your early environment; the environment affects the expression of your genes; your genes affect how your parents, peers, teachers, and strangers treat you. There is no firm boundary separating your insides from your outsides. Nature structures nurture; nurture gets under the skin. Genes and environments are a Möbius strip.

But, is that what he was really asking me? For a science lesson on gene-environment interplay? This person’s life has been full of horror. He kidnapped and sexually assaulted a girl when he was still a boy himself, and he was writing to me from a prison cell where he will spend most, if not all, of his life. Why would it matter to him whether aggression is statistically more strongly associated with genetic variants or environmental risks? What does someone want to know when they ask a scientist, “Why?”

I can’t know for sure why he wrote me, or what he was hoping to learn. But I’ve taught Intro Psych for more than a decade now, and my students are rarely motivated to ask me questions by their purely intellectual interest in abstruse scientific debates. They are drawn to psychology because they are longing to tell themselves a new story about their lives. They ask about nature and nurture, about brain chemistry and hormones, about appetite and sleep cycles; they ask, “Why?” And, very often, what they’re really asking me is: “Is it all my fault? Am I totally to blame? Can I change? How do I change?”

Receiving that letter was one of two incidents that radically altered the type of book that I wanted to write. (I won’t describe the other incident that radically altered my book project here. You’ll have to buy the book if you want to read about me doing acid in the desert with my then-boyfriend—an experience that ripped apart our ordinary sense of being in control of our choices.) Struggling to write him back, I realized that I didn’t want to write a book that just described the nature and nurture of addiction, of aggression, of antisocial behavior, without grappling with why people are interested in the question of “nature or nurture.”

Take a look at the science headlines, and you’ll see: People hope that genetics will give them a new story about their lives. Scientists like me study the genetics of behaviors that are called vices, and those scientific results are immediately put to work in the stories that people tell to absolve themselves from blame.

“Can’t lose weight? You may have obesity genes to blame.” “Six ways to beat your bad genes.” “Experts give cunning tips for overcoming the influence of pesky DNA.” “Can’t quit smoking? Blame your genes.” “Yes, you can overcome a genetic predisposition to Type 2 diabetes.” “Don’t blame kids if they do not enjoy school, study of twins suggests.” “Addicted to Facebook? Your genes may be to blame.” “Don’t blame bad dancers—it’s in their genes.” “Can we blame procrastination on our genes?” “Healthy lifestyle choices can help women overcome genetic breast cancer risk.” “Want to take a nap? Don’t feel guilty, it might be in your genes.”

Are these stories about genetics true? Does science let us off the hook—or, at least, some of us off the hook some of the time? Or is science, in the end, as accusatory as a bad acid trip, as a fire-and-brimstone preacher? What do nature and nurture have to do with blame? These are the questions the man who wrote me from prison confronted me with. These are the questions that have obsessed me for the past few years, writing my book.

Some of my fellow scientists are absolutely convinced that knowledge about the causes of human behavior, including its genetic causes, renders blame and punishment obsolete. Others are absolutely convinced of the opposite conclusion: Science has nothing to tell us about how to treat one another, or it just confirms the rightness of our current practices.

I confess that I am suspicious of men who confidently declare they have definitive answers to complicated questions about what it means to have a body. Knowing that I have an inherited biology that has profoundly shaped my life sometimes feels like a curse, and sometimes feels like a relief. I love things that are bad for me. I punish myself, and other people, for things we didn’t know how to change. I am no longer an Evangelical Christian, but I do believe we inherit predispositions toward sin. Sometimes I am outraged, and convinced that someone deserves punishment, only to find my convictions shimmering, fading, as I inspect them more closely. I have spent much of my adult life studying how our genes, and our early environments, cause us to behave in ways that are punished. What does this work mean for how we should treat one another?

Next month, my book addressing this question will finally be released into the world. It’s called Original Sin: On The Genetics of Vice, The Problem of Blame, and The Future of Forgiveness. The book talks about MAOA and GWAS, about Augustine and Pelagius, about cloned bulls and Skinner’s pigeons, about genetic determinism and essentialism, about eugenics and polygenic embryo selection, about Nietzsche and Aeschylus, about spanking and mass incarceration, about being a mother and a daughter. It ends with an answer to the man’s letter—an answer that is also a meditation on how there is no solution to the puzzle of being human. I’m apprehensive about publication day, because it is the most intimate thing I’ve ever written, and I am unnerved to remember that I’m about to reveal so much of myself to strangers. But, mostly, I’m very excited to be in conversation with people about it.

If you want to hear some early discussions about the book, I’ve already had interesting conversations with a few podcasters, including Olga Khazan and Josh Szeps—with several more conversations set to drop soon. (If you are looking for someone to appear on your podcast or make a guest appearance in your class, this is an excellent time to ask me!) Finally, if you want to get a different sense of the book’s themes and topics, I’ve also put together a (highly genre-inclusive) playlist of songs that are, in one way or another, about our terrific, terrible human fallibility.

When you write an academic paper, usually the nicest thing anyone ever says about it is, “I have no further suggestions for revision.” So, it was a wonderful surprise when my publishers started sending me advance praise from early readers. The blurbs are stunningly generous; especially if you’re an academic, please go read them and marvel at how nice they are. My favorite is from Sue Black, a forensic anthropologist who wrote All That Remains: A Life in Death (and other books). She called Original Sin “a powerful read that stops you dead in your tracks and forces you to think very deeply.” I can think of no higher compliment.

I hope you buy my book or borrow it; I hope you read it and underline it; I hope it causes you to think very deeply. If you are considering buying the book, I would be especially honored if you ordered it from my local South Austin bookshop, Reverie Books. This one-room bookstore is my family’s favorite place to spend a Saturday afternoon, especially when the shop cat is curled in his basket and the owner’s daughter is painting children’s faces out front. Nearly every good thing I’ve ever had in my life is connected, in some way, to reading books, and I’m honored to be making another small contribution to our collective library.

With excitement,

Paige

Nucleus is just one of several companies now offering pre-implantation genetic testing of IVF-created embryos. Pre-implantation genetic testing for chromosomal abnormalities, like the trisomy that causes Down syndrome, is already a standard part of reproductive medicine. What distinguishes Nucleus and other companies, such as Orchid and Herasight, is that they will also test embryos for genetic variants associated with polygenic characteristics, like height and performance on standardized intelligence tests.

The founder of Nucleus, Kian Sadeghi, wrote that the “Have your best baby” ad campaign was intended to make people pause and wonder. Science, he wrote, has “sprinted ahead” of public awareness of technological possibility. “Have your best baby” is meant to shock and awe—and to suggest that what’s shocking today might be tomorrow’s ho-hum usual. He told Antonio Regalado of MIT Technology Review that the campaign aimed to normalize a technology that was previously only whispered about: “The entire subway is genetic optimization. We’re bringing it mainstream.”

The feeling that the Nucleus ads are aiming to evoke—"Wait, can I do that!? Are people doing that? Is this not taboo anymore? When did we start living in this future?”—reminded me of another time I was confronted by medical technology that has sprinted way ahead, faster than anyone but experts realized: When Kris Jenner revealed her new face. She even used similar language to the Nucleus ads. The now 70-year-old reality TV star and “momager” to her many famous Kardashian/Jenner offspring told Vogue Arabia that she had a new facelift because she wanted to be “the best version” of herself.

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And the parallels between polygenic embryo selection and cosmetic surgery don’t stop there.

(1) Both cosmetic surgeons and polygenic embryo selection companies advertise beautiful results—and elide the pain, expense, and risk required to achieve them.

Nucleus Genomics’ ad campaign features pictures of adorable babies, and indeed, IVF might result in a very adorable baby. But you will never see Nucleus run an ad campaign that shows the gritty reality of IVF, which requires many daily needles, injecting hormones in one’s belly or thighs, followed by a doctor inserting a needle through one’s vagina. Side effects can range from mild (mood swings, bloating, fatigue) to severe conditions requiring hospitalization (ovaries leaking fluid, rapid weight gain, kidney failure).

Similarly, advertisements for “deep plane” facelifts, the procedure reportedly undergone by Kris Jenner, feature stunning “before and after” pictures showing patients looking remarkably younger. It’s a lot more difficult to find photographs of the procedure itself, because it involves, you know, taking someone’s face off. Specifically, it requires cutting ligaments that ordinarily keep the face in place and then reanchoring both facial muscles and skin. (Here is a nongraphic description of the procedure using drapes of fabric on a dummy face.) Risks range from infection to temporary numbness to irreversible nerve damage, necrotic skin, and disfigurement

Both IVF and facelifts, in other words, are medical procedures, and all medical procedures involve some level of pain, intrusion, and danger. I bring this up nearly every time I write about polygenic embryo selection, because I’m constantly surprised how few conversations about embryo selection, even critical ones, mention it at all. Many women consider the pain, expense, and risks of egg retrieval to be worth enduring for their reproductive goals; however, “costly but worth it” is not the same thing as “free.” I’m suspicious of anyone who is cavalier about how costly—physically, psychologically, financially—it is for a woman to bring a child into the world, no matter how that child is conceived. Tech execs crowing about how easy egg extraction was for them (or failing to mention that there’s a medical procedure involved at all, as if embryos rain down like manna from heaven) are, in my mind, about as trustworthy as reality TV stars.

(2) Both industries appeal to our desire for health, but there’s a big gap between indicators of health and health itself.

The “after” photos of an expertly executed facelift are discombobulating, because the face is, ordinarily, a pretty good indicator of one’s biological age. People who are biologically aging more quickly than others who are the same chronological age do, indeed, look older. Even when comparing twins, the twin who appears older tends to die sooner. Humans, unlike immortal jellyfish, age in one direction; there is no restart button. Yet Jenner looks younger than she did last year. It’s arresting to see such a radical change.

And it’s hard to remember that, while she has changed what is ordinarily a decent marker of health and ageing, her facelift has not actually changed her underlying health. Taughtening one’s face will not improve one’s liver, heart, kidneys, or brain. The ticking clock ushering her toward death is unchanged.

Polygenic embryo selection also intervenes on a biomarker of health, selecting the embryo with the lowest or the highest “polygenic risk score,” a single number that sums up an embryo’s genetic variants, weighted by how strongly the variants are correlated with an outcome (like height) in a reference sample. But, just as intervening to make one’s face look younger does not guarantee health, neither does selecting an embryo with a particular polygenic risk score guarantee anything about the child’s life.

Unlike facial firmness, polygenic risk scores (PGSs) are not merely correlated with health outcomes; rather, PGSs are, to some extent, indexing the genes that cause better health. (They are also indexing, to variable degrees, environments that cause better health, which happen to be correlated with genetic differences.) Selecting the embryo with the lowest polygenic risk score can reduce the probability that the resulting child will suffer from certain diseases or increase the probability that the resulting child will be taller or perform better in school. But the genes we know how to measure account for only a small part of the total variation in these outcomes; these genetic effects might depend on environmental factors in ways that are poorly understood; and there might even be unanticipated “off-target” effects. Some of the genes associated with going further in school, for example, are also associated with a higher risk for schizophrenia. (My first book, The Genetic Lottery, provides a more in-depth introduction to the construction, interpretation, limits, and potential uses of polygenic scores.)

An IVF-created embryo is not a baby, and polygenic risk scores are not a crystal ball showing the future physical health, or mental health, or intelligence, or personality of any embryo. What a prospective parent can “pick” is not a baby, but an embryo that has a particular combination of polygenic risk scores, each with a complicated, probabilistic, and environmentally-dependent association with a desired or undesired outcome. “Have the baby that results from the embryo that has a 12% lower risk of dropping out of college, but a 4% greater risk of a serious psychotic disorder, compared to the embryo selected at random” doesn’t make for very good ad copy, though.

(3) Both cosmetic surgery and polygenic embryo selection have been embraced by wealthy elites, and their public adoption of these new technologies has the potential to change how everyone relates to their body.

I started going grey in my 20s; now, at 43, I am nearly fully silver in the top layers of my hair. I stopped dyeing my hair during the pandemic and never restarted. People ask me about my hair all the time now, way more often than when it was artificially brown, and they commonly use the word “brave.” (“You’re so brave!” “I wish I were that brave.” Also: “But what does your husband think!?”) It’s odd to be told by strangers that I’m brave for simply letting my hair grow out of my head. But I understand what they are trying to say. In a world where most women dye their grey hair, one’s relationship with one’s grey hair is changed, even if—especially if—one doesn’t dye it. My hair is no longer a fact about me; it’s a choice I’ve made. After all, I could always spend $400 at the salon and not be grey, at least for a few weeks. So, if there are any negative consequences to looking older—well, I’ve made my choice. I’m so brave to choose to look like I'm past my last f**kable day. (Even the actresses in that skit color their grey hair.)

The facts about me that are now seen as choices keep multiplying. I have brown spots that testify to sunscreen-free childhood summers spent with my chain-smoking grandparents. I’ve had four pregnancies, three C-sections, three nursing infants, and I have the stomach and boobs to match. I have spent a shamefully large amount of time perusing the website of a local cosmetic surgery practice, reading about procedures to tighten stomach skin, lift boobs back up to their pre-breastfeeding positions, fill in wrinkles, laser off age spots, and slice away crepey upper eyelids. I will not do any of these things, but merely being aware that these procedures exist has changed my relationship to my aging body, and not for the better. Haven’t I chosen to have these brown spots, these wrinkles, these breasts?

Embryo testing companies envision a future in which parents who conceive their children without medical intervention will feel about their child the way I sometimes feel about my aging body: regret at being saddled with an inferior product, self-blame at not having “fixed” it. A child’s differences, fragilities, flaws, and challenges will no longer be facts about a person, which you might grieve, accept, accommodate, ameliorate, treat, care for, or even celebrate. They will be choices, and the parent will be culpable for not choosing to avoid them.

This vision of the future is most clear in the statements of Noor Siddiqui, the founder of Orchid Health. One characteristic post reads, “If you wouldn’t screen, fine. Just be honest: you’re okay with your kid potentially suffering for life so you can feel morally superior….or because you can’t be inconvenienced for 2 weeks to extract eggs and check for genetic issues before they develop.” Another reposts the claim that “In time it will be viewed as irresponsible to have kids naturally.”

The chanciness of reproduction, like the inevitability of aging, has always been a universal fact of being human. Indeed, the biological challenge of developmentally programming a child might be part of why we evolved to age as we do. We are bodies, composed of cells, which replicate and divide imperfectly. These imperfections are the very mechanism of our evolution. But now the facts of being human—that we age, that we die, that we get sick, that we need care—are being rebranded as choices. Instead of solidarity based on our shared fragility, we are being sold the opportunity to avert some of the ways that bodies fall apart, but also to blame ourselves, and each other, for any outcomes we didn’t choose to avoid. Having children, we are told, is an endeavor to be treated with the same optimizing energy and the same potential for recrimination as one’s diet and skincare regimen.

(4) Both cosmetic surgery and polygenic embryo selection reveal a tension between valuing individual bodily autonomy and valuing social solidarity.

In this essay, I wrote about deep plane facelifts and polygenic embryo selection, but what if I had been tasked with writing about facial feminization surgery or second-trimester abortions? These are also intrusive medical procedures; these are also interventions that transmute biological facts into individual choices. Who am I to say that you shouldn’t stretch your face to resemble a sexy baby tiger? Who am I to say that you shouldn’t create as many IVF-embryos as you want, and select only the ones most likely to be six feet tall? After all, I would not say that a transgender person should be barred from getting facial feminization surgery, and I would not say that a pregnant person should be barred from getting an abortion.

Which is to say—I think being in charge of your own body is, on the whole, a good thing, even if you might choose to do things with your body that I personally would find gross, painful, risky, or even harmful. As the philosopher puts it, Your body is for you.

But, I also think that people have far less real choice about how their bodies and lives turn out than is commonly imagined, and that invoking “choice” works, all too often, as a get-out-of-jail-free card for caring about other people. For example, some people object to universal health care, because why should they contribute to a system that pays for treatment for people who “chose” to smoke, or “chose” to get pregnant, or “chose” to be overweight? Do we face a future where, if you choose not to select your embryo to minimize your future child’s risk of a genetically-caused disease, your child will be denied access to medical care?

I want people to be able to have children, if they want them, and to have them on their own terms. I value bodily autonomy. At the same time, I want to live in a society where everyone is recognized as deserving of and entitled to care, regardless of whether they “optimized” their career, diet, skin care, facial tautness—or their child’s genome. I don’t live in that society, and I fear that the possibility of polygenic embryo selection, even if most people don’t avail themselves of it, will further undermine the sense of solidarity necessary to work towards it.

Sociologists Arno Van Hootegem and Gaia Ghirardi articulated this concern in their recent article, “Embryo selection based on polygenic prediction risks reinforcing social inequality”:

“[O]ffering these techniques increasingly reinforces human reproduction and health as a private commodity, where individuals rely on private markets and pay high premiums to procreate and try to maximize health outcomes. The development of welfare states has been strongly oriented towards decommodification, which implies making citizens independent of market systems and has significantly benefited public health by offering social protection to all citizens. Offering genetic predictions for embryos to improve health outcomes latches onto a privatization logic that does exactly the opposite and hence erodes a system based on social equality and solidarity. . . . [S]elling embryo selection based on genetic testing is a form of privatization and commodification on steroids that takes preventive and private medicine to an extreme.”

“Commodification on steroids” has arrived. Kris Jenner has an entirely new face, as do half the members of the Trump administration, and Jenner’s BFF Jeff Bezos is pouring money into figuring out how to live forever, and Kardashian family friend Elon Musk has who-knows-how-many genetically-selected children, at least one of which is “an Orchid baby.” The most intimate parts of our corporeal forms, parts that are central to how we relate to each other and central to our sense of self, are now products. The actions of these unfathomably rich people embody the danger that I’m trying to describe: They are changing public perception of what aging and reproduction should look like, using their own bodies to lead the way, even as they actively work to destroy systems of solidarity that improve the lives of ordinary people, from unions to USAID. In fact, their very public embrace of cosmetic surgery and embryo selection could be seen as a bit of embodied rhetoric in support of their political and economic project. How else to justify, to others or even to yourself, such parasitic hoarding of wealth without advertising yourself as exempt from the shared human condition?

As is probably clear by now, I feel deep antipathy at the depredations of the billionaire class, the ones who are trying to sell us on the necessity of embryo selection and cosmetic surgery. Whereas, I feel much more ambivalent, even sympathetic towards their would-be customers. Reproduction is scary, and risky, and so is aging, and if you feel like you don’t want to reproduce, or age, in the old-fashioned way, I understand that! Your body, again, is for you. The difference in how I judge the purveyors versus the potential consumers of these medical innovations reminds me of a criticism that , an evolutionary psychologist who is also interested in ethics and genetics, once leveled at how I defined “eugenics” in The Genetic Lottery. According to Fleischman, I "redefine eugenics in a way that makes capitalism eugenics and subsidized embryo selection not eugenics.”

My conceptualization of “eugenics” in The Genetic Lottery was heavily influenced by the political philosopher Elizabeth Anderson, and in particular her 1999 article, “What is The Point of Equality?”. Here is the most relevant passage (my emphases added):

Inegalitarianism asserted the justice or necessity of basing social order on a hierarchy of human beings, ranked according to intrinsic worth. Inequality referred not so much to distributions of goods as to relations between superior and inferior persons. Those of superior rank were thought entitled to inflict violence on inferiors, to exclude or segregate them from social life, to treat them with contempt, to force them to obey, work without reciprocation, and abandon their own cultures. These are what Iris Young has identified as the faces of oppression: marginalization, status hierarchy, domination, exploitation, and cultural imperialism. Such unequal social relations generate, and were thought to justify, inequalities in the distribution of freedoms, resources, and welfare. This is the core of inegalitarian ideologies of racism, sexism, nationalism, caste, class, and eugenics.

Egalitarian political movements oppose such hierarchies. They assert the equal moral worth of persons. This assertion does not mean that all have equal virtue or talent. Negatively, the claim repudiates distinctions of moral worth based on birth or social identity—on family mebership, inherited social status, race, ethnicity, gender, or genes. There are no natural slaves, plebeians, or aristocrats. Positively, the claim asserts that all competent adults are equally moral agents: everyone equally has the power to develop and exercise moral responsibility, to cooperate with others according to principles of justice, to shape and fulfill a conception of their good.

I stand by my definition: “Eugenics” (derogatory) is an ideology that asserts the justice and necessity of basing social order on a hierarchy of human beings, ranked according to genetic worth, where the allegedly genetically superior people feel entitled to inflict violence on alleged genetic inferiors, to exclude or segregate them from social life, to treat them with contempt, to force them to obey, work without reciprocation, and abandon their own cultures. Whereas an anti-eugenic, egalitarian ideology asserts the equal moral worth of persons, who can and should have the power to shape and fulfill a conception of their good.

And according to the definition, what would be more anti-eugenic, more supportive of people’s equal power to shape and fulfill their conception of the good? What would be more affirming of both individual bodily autonomy and social solidarity?

Option #1: We could remain a society in which individuals must rely on private markets to try and maximize their, and their children’s, health outcomes, a society in which the awesome scientific progress of the last century is channeled toward enriching the already obscenely rich—but we restrict consumers’ options a bit. They can screen embryos for only monogenic diseases, perhaps, instead of for polygenic ones, or they can select embryos using polygenic scores only for “diseases” but not “traits.” Or Option #2: We have genuinely public health care, which guarantees access to egg freezing and IVF and abortion and embryo selection (monogenic, polygenic, diseases, traits, the whole shebang) to everyone who feels they or their child would benefit from it—and also guarantees health care to all people, period.

Diana, you were right: I do think Option #2 is less eugenic. More embryo selection, maybe, but less capitalism.

Let me return to the ad campaign that started this essay: “Have your best baby.” The ad is clearly targeted at people who do not yet have children, because having a child, in my experience, renders the idea of “best” nonsensical. Which of my babies is my best baby? Did I have the best babies out of all my potential babies? My children aren’t skincare products or home entertainment systems; there is no Wirecutter for babies. They are people—people I’m getting to know, people to whom I owe a particular duty of care.

I describe some of my own reproductive journey—four pregnancies, three children—in my new book, Original Sin, which has a chapter on the science and ethics of polygenic embryo selection, specifically selection using polygenic scores developed for disorders such as ADHD, alcoholism, and antisocial behavior. I won’t give away the whole story here, but I will close with an excerpt from that chapter, a rejoinder to the shallow, hubristic notion that children are chiefly an engineering problem to be solved:

“I was not put into a position to choose between embryos; nature chose for me. If I could have chosen my children, selected them from a menu of physical traits and temperamental quirks and psychological abilities and inclinations, would I have chosen these particular children, with their specific characteristics? Probably not. They are not “easy” children. But I am grateful for qualities I would never have known to wish for. In their variedness and difficulty, they are infinitely more interesting than what I imagined before I was a mother.

In their room, I put a framed print by the artist Hallie Bateman that reads, “It’s a miracle we ever met,” and it does feel that way to me: Each of them is an astonishment. Out of all the possible people that I could have mothered! And now that we have met, I have the rest of my life to get to know them. Would my wonder and delight at their sheer improbability be diminished if I had deliberately picked each child from a stockpile of embryos, rather than surrendering to the horrifying lack of control that reproduction ordinarily entails? Maybe. But I think it’s more likely that any attempt at control on my part would, in the end, only highlight how ultimately laughable the idea of control over creation is. Not even God himself was able to create a child who went according to plan.”

-Paige

I’m thinking of a psychiatric disorder.

(You can click on the links below, but hold off for a bit, until you get to the end, and see if you can guess it.)

It’s one of the most common disorders of childhood and adolescence, with an estimated prevalence rate of 3-9%.

It’s one of the most common reasons—some reviews say the most common reason—why adolescents are referred for psychological evaluation.

It’s expensive to parents and communities: A child with this diagnosis costs an average of $70,000 more in extra services and adverse outcomes per 7-year-period.

It has a relatively poor prognosis, with over 50% of children receiving this diagnosis meeting diagnostic criteria for at least one psychiatric disorder in adulthood.

It’s as heritable, or more so, as other psychiatric disorders (as estimated from twin data).

It’s impairing: A study of global causes of disability ranked it the #30 cause of nonfatal disease burden, above autism, ADHD, and malaria.

It’s highly comorbid with ADHD.

It does not have any FDA-approved medications to treat it.

It has not been the exclusive focus of a single-disorder GWAS since 2010 (105 years ago in dog-years and about that long in genetics-years, too), and that study included only about 4,000 people.

It is not included in the most recent cross-disorder genetics paper, published yesterday in Nature, because there are no large-scale single-disorder GWAS data on it to include.

Can you name the disorder?

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Answer: Conduct Disorder.

Conduct Disorder is classified as a “Disruptive Behavior Disorder” in DSM-5. CD is characterized by “a persistent pattern of violating the rights of others and disregarding social norms.” A young person is diagnosed with CD if they persistently hurt other people or animals, break rules, and don’t show guilt or remorse (“limited prosocial emotions”). Children who meet diagnostic criteria for CD are ten times more likely to meet criteria for ADHD, and more than 50% will meet diagnostic criteria for a substance use disorder in adulthood. CD is heritable, particularly CD accompanied by high levels of callous-unemotional traits. And, twin and adoption studies have repeatedly demonstrated that a substantial portion of the genetic risk for both ADHD and substance use disorders is shared with CD.

Consequently, we can make strong predictions about where CD would land in the psychiatric genetics landscape, if it were included in transdiagnostic analyses.

Here is the path diagram from the new cross-disorder Nature paper, which analyzes data from 14 psychiatric diagnoses across more than 1,000,000 cases. This figure might be largely unintepretable to anyone who doesn’t already speak path diagram, but you don’t have to parse the whole thing. I just want you to look at the circle labeled “ADHD” (seventh from the left on the bottom row) and the two arrows pointing to it. One arrow is coming from the circle labeled “F3g”, which also has an arrow to Autism Spectrum Disorders; the other arrow is coming from the circle labeled “F5g”, which also has an arrow going to the various substance use disorders (cannabis, alcohol, nicotine, and opioids). Even though ADHD is grouped with ASD under “F3g”, which the authors labeled the “neurodevelopmental disorders,” the strength of the connection between ADHD and substance use disorders is not much weaker (0.49 versus 0.59).

In other words, some of the genetic risk for ADHD overlaps with autism, but nearly just as much of it overlaps with substance use disorders. And both the “neurodevelopmental disorders” factor and the substance use disorder factor were genetically correlated with childhood aggression—one symptom of CD—at ~0.9 and ~0.7, respectively. These findings are entirely consistent with the conclusion that people have drawn from twin studies: genetic studies of both ADHD and substance use disorders are largely picking up on genes associated with disinhibition more generally—and another common, impairing, and poorly understood clinical manifestation of disinhibition is CD.

So, why isn’t it there? This is not a question for the authors of this particular paper, who are working with the GWAS data that exist. This is a question for the field: Why doesn’t that GWAS data exist? CD is more impairing than ADHD, more common than schizophrenia, more heritable than depression. What does it tell us about the field that this disorder has been so neglected by the psychiatric genetics community? The data included in the new cross-disorders paper represent a staggering investment of money, time, and effort into genetic investigations—hardly any of which has been devoted to the most common reason why adolescents are referred to psychological services.

I have been wondering about this my entire career. My very first grant application, submitted way back in 2006, was for a pre-doctoral fellowship to support my dissertation research. I proposed to use twin data in Add Health to study the effects of religious involvement on conduct problems. It scored well, but then NIMH declined to fund it, because conduct problems were “not mental health.” I agreed to add measures of illicit drug use, and it eventually got picked up by NIDA. Two decades later, you can see evidence for the same weird reasoning—drug use merits genetically-informed study, but repeatedly hurting other people doesn’t—in what genetic data is now available, and in what isn’t.

I now have a working hypothesis about why conduct disorder, out of all the disorders, has been left out of the psychiatric genetics enterprise. I don’t think the omission is an accident, and in fact, I wonder if it had to be left out, in order to legitimize the whole field. In the same way that the life insurance industry had to exclude some people as uninsurable to be accepted as morally legitimate by a skeptical public, the psychiatric genetics field, perhaps, had to exclude some diagnoses from its theater of operations as it fought for scientific resources.

But before I get into my working hypothesis about why conduct disorder has been mostly left out of the GWAS revolution, I am curious what others make of this lacuna. Why do you think CD has been left behind? What’s going on here?

Curiously yours,

Paige

When I was on the academic job market in the winter of 2008/2009 (a truly terrible time to be on the academic job market), a professor at the University of Michigan asked me, over a mediocre lunch at a bland university cafe: “Don’t you think you’ll be the last behavior geneticist?”

He went on to explain: Now we could measure the genome! And there was so much interesting research coming out, documenting interactions between specific genetic variants and specific environments. The serotonin transporter polymorphism interacted with life events to predict depression. The warrior gene interacted with childhood stress to predict aggression. By comparison, what I was proposing to do as a new baby assistant professor—start a twin study and continue to publish research on twins—was so 20th-century. So passé. So not worth investing in. I was, in his mind, the tail end of a nearly dead lineage: The last Mohican, the last Samurai, the last Twin Researcher.

Reader, I am not employed at the University of Michigan.

But I did get a job1, a great tenure-track job. And I did co-found a twin study (an absolutely ridiculous undertaking for an assistant professor) and succeeded in publishing a lot of research about twins. Sixteen years later, the serotonin transporter and warrior gene research that my University of Michigan interviewer was so excited about has long been discredited as “whole imaginary edifices, whole castles in the air.” The twin study, though, remains as stubbornly, perennially controversial as it was then.

Recently the debate about twin studies has focused, yet again, on whether they produce inflated heritability estimates. (See here, here, here, here, here, here, and here for some of this discussion, and here is the most recent empirical paper on this topic.) The twin study estimates heritability by comparing the similarity of identical twins (who are genetically identical) and fraternal twins (who are as genetically related as ordinary siblings). Newer molecular methods estimate heritability by comparing the similarity of people who are more genetically related to people who are less genetically related, where genetic relatedness is directly measured from DNA, rather than inferred based on twin zygosity. The gap between those two estimates—the twin and the molecular—is commonly referred to as “missing heritability.”

Missing heritability is sometimes large and sometimes small, but it is almost never zero, even for what might seem like straightforward biomedical things, like blood lipids and telomere length. Identical twins are always more alike than can be satisfactorily explained by quantifying the effects of any genes that we have measured.

While methods for estimating heritability from molecular genetic data are rapidly developing, the conclusion that “there is something unignorably weird going on with identical twins that we can’t really explain” is decades old. Look, for example, at Irv Gottesman’s classic data on familial resemblance for psychotic disorders, data that was foundational to reconceptualizing schizophrenia as a neurodevelopmental disorder, rather than as a response to bad mothering and double binds.2 If your full sibling develops schizophrenia, then you have a 9% chance of developing it, too. If your half-sibling develops schizophrenia, then that risk drops to 6%. But if your identical twin develops schizophrenia, then your risk is 48%!

The persistent strangeness of twin data fuels a persistent question: Why study twins, if the answer you get from twin studies about the heritability of human behavior—or even the heritability of blood lipids— consistently fails to match the answer you get from molecular methods, or from comparing other sorts of relatives? The geneticist Sasha Gusev put it this way: “Twin studies can’t even get it right for simple biomedical traits.”

This comment seemed a bit backward to me, which might be a matter of disciplinary background. Unlike Gusev, I’m not a geneticist. I’m a psychologist. Which means that the fundamental unit of interest, for me, is not the allele, not the gene, not the genome, not the neuron, not the brain, but the person. The individual. I am interested in how people’s lives turn out—what they think, and feel, and do, and how this thinking, and feeling, and doing changes, and just as importantly doesn’t change, resists change, as they mature and age. My favorite genre of nonfiction is memoir; with all due respect for Paul Meehl, I loved case conferences when I was a trainee. I want flesh on the numbers.

And you know what is the absolute #1 best predictor of how people think, feel, behave, change, stay the same? How their identical twin thinks, feels, behaves, changes, stays the same. People who begin life as the exact same life are uncannily similar, years and decades later, in nearly every way we can think to measure. The identical twin correlation is one result that no one can make go away, that always replicates, perhaps the most reliable banger that psychology has ever produced. I am not interested in twins because they are an imperfect method to estimate heritability; I am interested in the concept of heritability because it might imperfectly help explain why twins are so similar.

The biologist Conrad Waddington introduced the concept of the “epigenetic landscape” for understanding the development of a single cell as it differentiates. An embryonic pluripotent stem cell could be anything, but an adult liver cell has arrived at a fixed cell fate. The cell is imagined as a ball about to roll down a hill, and you can see how, as it picks up momentum, it will be channeled into progressively deeper valleys, such that tiny initial differences can have large and irreversible (or, at least, very difficult to reverse) final consequences.

As a scientist, as a person, I am obsessed with Waddington’s landscape, but for people instead of cells. I have rolled down the hill of development; I find myself in one valley and not another. Change is possible, but it is also constrained. I love my life, and it is not the one I imagined for myself as a child. How did I get here?

Don’t you wonder: “How did I get here?” Doesn’t everyone?

I don’t have an identical twin, but because of twin studies, I know that where one ends up in the Waddington landscape of life is highly dependent on one’s starting point at the top of the hill. Even relatively tiny perturbations to the starting point—being half-siblings versus full-siblings—can result in very different outcomes. But people who begin life in the exact same place, because they begin life as the exact same person, end up with lives that are canalized in very similar ways. How can one be interested in people, in development, and not be interested in that observation?

The “starting point” of the Waddington landscape of life is made up of innumerable variables—rare genetic variants and common genetic variants, and intra-uterine conditions and shared epigenetic marks, and labor and delivery complications, and early life nutrition and lead exposure and maternal cognitive stimulation and interparental conflict and neighborhood green space and and and and. Some of these variables we have historically put in the bucket of “genes” and some in the bucket of “environment”, but none of them stay contained in their buckets, because there is no impermeable boundary between the insides and outsides of people’s bodies. Nature and nurture is a Möbius strip.

To further complicate things, twins can actively participate in building their similarity. Take the Byers twins, who were students at my university about a decade ago. They owned two of every single thing, down to earrings and shoes, and each morning one of them would choose what they both would wear. They scheduled all their classes together and worked the same internship. They split all their meals, including coffee. And, most intriguingly, they described their shared life as feeling like the most authentic expression of their identit(y/ies). “It’s our identity, together, and we enjoy it. . . . When we tried individualization, we didn’t feel like we were being ourselves. When we are together, when we dress alike and we take the same classes, we just enjoy the closeness. . . .We’re kind of one brain.” Nature/nurture is a Mobius strip, and so is agency/constraint.

What the new molecular data show us is that the incredible similarity of twins, the dependence of one’s life outcomes on one’s exact starting point, is very difficult to explain with reference to specific genetic variants, or even to specific stretches of the genome.

But people rarely note that the exact same thing is true for specific environmental variables, too. Heritability is missing, but so is environmentality. Let’s say we halve every heritability estimate from a classical twin study, presuming that the estimate is inflated, and attribute that variance to the “shared environment.” Where are the causal effects of specific environmental influences that add up to anything remotely close to that shared environmental variance component? They don’t exist. Even when you change literally everything about a child’s life by adopting them into an entirely new family, or adopting them out of hellacious institutional care, you still don’t get effect sizes big enough to explain the incredible similarity of identical twins. The “missing heritability problem” is just another manifestation of a much more general problem—the granularity problem, the reductionism problem. Human lives are both undeniably structured by naturenurtureluck and very poorly predicted by individual variables, at least the ones we currently know how to measure.

How then do we proceed? One option is to surrender to feelings of futility. We could wallow in the belief that there are no systematic causes of human behavior, or that it is wholesale impossible to study them, or perhaps that just the genetic ones or just the environmental ones are uniquely impossible to study. Another is to proclaim premature victory for one’s preferred explanation of human behavior, be it“hereditarian” or “nurturist,” a fragile victory that requires tucking the twin results or the molecular genetic ones or the sociological ones out of conscious awareness.

Or, we could, you know, act like scientists, which is to identify a phenomenon that’s interesting in the world and go about trying to understand it, with the humble recognition that we are not likely to succeed but that we’ll learn things along the way we couldn’t have anticipated. Identical twins are uncannily similar and being able to measure people’s DNA, even the rare variants, didn’t explain that similarity as much as some scientists predicted. To quote one of my favorite children’s books: “A mystery, a puzzle, a riddle, a quest! This was the moment that we loved best!”

And we can read poets, who remind us that psychology is about people—people who are having a subjective experience of rolling down the Waddington landscape of life. Robyn Sarah, in her poem “Riveted”, captures it perfectly:

It is possible that things will not get better
than they are now, or have been known to be.
It is possible that we are past the middle now.
It is possible that we have crossed the great water
without knowing it, and stand now on the other side.
Yes: I think that we have crossed it. Now
we are being given tickets, and they are not
tickets to the show we had been thinking of,
but to a different show, clearly inferior.

Check again: it is our own name on the envelope.
The tickets are to that other show.

It is possible that we will walk out of the darkened hall
without waiting for the last act: people do.
Some people do. But it is probable
that we will stay seated in our narrow seats
all through the tedious denouement
to the unsurprising end—riveted, as it were;
spellbound by our own imperfect lives
because they are lives,
and because they are ours.

From my imperfectly canalized life to yours,

Paige

I write to you from the land of the sick, a metaphor that I appreciate only when sick or injured, because the memory of what it’s like to be sick or injured smooths itself over as soon as I am well again, returned to the land of the healthy. Being seriously injured changes one’s diet, routines, vistas just as dramatically as traveling to a foreign land where one doesn’t speak the language. I am at the mercy of other people to help me navigate the “activities of daily living” that are now regular crucibles of frustration and dependency.

I’m being dramatic. But only a little.

At the end of September, I slipped and fell on wet tile in my bathroom. I have hated that tile since the moment we bought the house, an unrenovated 1960s ranch. We bought it, despite its rotting foundation and hideous tile, because it’s set on a very pretty acre of land, in a walkable neighborhood full of—and I don’t say this casually—good people. For the first time in my adult life, I know most of my neighbors, and their children come over to my house to forage for snacks and feed the koi, even if my children aren’t there. Our original plan was to live in this piece of shit house for only a few months before renovating it (my husband is an architect), but interest rates, a new baby, writing block—months turned into years. All that time, I raged to the kids about the dangers of the bathroom tile, about their habit of not closing the shower curtain all the way and not drying off completely, leaving wet tracks through the bathroom. “You’re going to slip and fall and crack open your skull!”

Haha, joke’s on me. I slipped and fell and, thankfully, didn’t crack open my skull. I was taking a bath, but the baby— she’s not a baby, she’s three, but she’s the baby— wouldn’t stop kvetching in her bed, so I got out of the bath to try to settle her and in my haste knocked over a glass of water, which I promptly forgot about. Twenty minutes later, still wrapped in my towel, I walked back into the bathroom and slipped. Cartoonishly, catastrophically slipped.

My tibia, carried away by foot, went cattywampus to my femur, dislocating my kneecap, ripping the ligament that connects my kneecap to my femur, slightly cracking my femur where that ligament connects, and tearing the cartilage at the top of my tibia. I went down like a felled moose, crying out, “Oh! Oh! Oh!”

Oliver Sacks, in his memoir A Leg to Stand On, described the moment he suffered a similar injury. Sacks was hiking on a remote Norwegian mountain when he encountered a bull and, frightened, lost his footing running away down the steep, muddy path. He wrote of the shock of such an injury:

“To be full of strength and vigor one moment and virtually helpless the next, in the pink and pride of health one moment and a cripple the next, with all one’s powers and faculties one moment and without them the next—such a change, such suddenness, is difficult to comprehend, and the mind casts about for explanation.”

The first explanation my mind fished out of the sea of possible explanations was divine punishment. Didn’t all my life choices lead me to living in this very particular house with its very old tile? Didn’t my slipping mean that I had lost God’s favor with those choices? I fell, and then I thought, “Of course, of course, of course—this is my punishment for daring to think I could pull it off, this balancing act that is my life. Of course, I can’t keep balancing.”

My kneejerk self-condemnation echoes the prosperity gospel of my childhood, the Americanized version of Calvinist doom. According to this version of Christianity, which preaches good news only to the already blessed, there are the Elect, whom God has selected before the beginning of his time to receive his grace and salvation, and then there is everyone else, the unfortunate damned. There is no way to know for sure whether you are one of the Elect, since not even faith can be freely chosen by a will corrupted by original sin, but there will be signs of God’s favor in terms of material wealth and physical health. Calvinism takes bad luck as a reflection of one’s badness. I will never be free of that preacher’s voice in my head, the one that says I fell because I’m fallen.

My husband heard me cry out. He ran into the bathroom, yelling, “What the hell happened?”

Reese Witherspoon once gave a speech where she said the most unrealistic thing movie writers do is have the female lead ask the male lead, “What do we do now?” What woman says, “What do we do now?”, in a crisis? Reese’s observation proved correct. I’m so anxious about small things—having people over for dinner, for instance, can absolutely undo me for days, worrying about whether they will have a bad time. But while I was lying on the bathroom floor like a lame horse, I felt I knew exactly what to do. I was very calm, and I gave Travis instructions. Bring me my phone so I can call my ex-husband. He will come get the baby and put her to sleep at his house with her older siblings. Bring me a tampon from this drawer and these clothes. Call an ambulance to take me to the ER.

The EMTs who arrived to put me in an ambulance positively radiated competence. They later told me that they specialize in high-risk situations— people who have hurt themselves at the top of skyscraper construction sites, people who have fallen down mountains running from bulls. Slow night, then, to get the middle-aged lady who fell in her bathroom. They put in an IV and said that they are going to give me fentanyl and Tylenol. “Don’t worry, you’re too old for it to make you autistic,” they joked, and I laughed at the absurdity, and with relief that I could still find things absurd. The fentanyl came on nearly immediately; I went white, and nearly fainted, and then I puked. They brought out a large, handled tarp called the Mega Mover, slid it under me, hoisted me on the gurney.

The weeks after the ER visit were spent mostly waiting. Waiting, and cursing the giant immobilization brace that entombed my leg from thigh to calf. Waiting for the orthopedist visit, waiting for an MRI, waiting for the MRI to be read, waiting for the follow-up orthopedist visit, waiting for the visit to the new orthopedist who specializes in complex ligament injuries, waiting for surgery.

When I wasn’t waiting, I was filling out paperwork. Yes, I have insurance. Yes, I understand I am responsible for paying for shit that my insurance might not pay for. Yes, I understand I’ve already met my deductible, that I will pay 20% “coinsurance”, that my surgeon is in network, but his physician assistant is not. Yes, I understand that the anesthesiologist bills separately from the surgeon, which bills separately from the surgery center, and both from the orthopedic practice that provided me with the dreaded immobilization brace, and then a different brace, and then a third brace, and also crutches, and a polar cube that continuously pumps cold water around my deformed knee, all of which, they were careful to tell me, might be covered by my insurance or might not. Let’s fuck around and find out! Oh, and don’t forget to return the pump that will be attached to a catheter threaded down a nerve in your thigh— if you don’t return it post haste after surgery, yet another entity will send you yet another bill. Everybody gotta get that bag.

I am, by American standards, very “fortunate,” because I have “good” insurance, employer-provided insurance, for which I pay “only” $714.48 a month. (Scare quotes, because American standards are absurd.) My monthly premiums have flowed into the coffers of Blue Cross Blue Shield of Texas for the past 16 years, and in all that time, I have, other than giving birth, “consumed” very little medical care. Which is exactly how it’s allegedly all supposed to work—that many of us pool our resources for the many weeks of our lives when we are healthy, so that there are resources to be used by the few of us when we are ill. Except my insurer seemed shocked that I wanted to use insurance to pay to fix my injured leg. It took multiple rounds of denials and appeals for my surgeon to convince the insurer that repairing my completely torn ligament so I can hope to walk normally again is “medically necessary.” As if people are clamoring to have holes driven in their bones, to have their cartilage shaved, just for the fun of it.

A few days after my injury, the U.S. government shut down. The “heart of the impasse” was the fight about subsidies for health insurance premiums purchased on the Affordable Care Act (aka, Obamacare) marketplace. Without the subsidies, many Americans will pay hundreds or even thousands of dollars per month for health insurance, or will lose coverage entirely. A Republican Senator from Kansas, in his description of why he opposes the subsidies, claimed that 40% of Obamacare enrollees don’t file any medical claims— “billions of taxpayer dollars flowing to insurance companies for people who don’t even use the system.” That is, obviously, the whole fucking point of insurance! Lots of people pay for something they probably, if they are lucky, won’t have to use very often, because they can’t know in advance if—when—they will become one of the unlucky ones that has to use it.

Watching the debate unfold so soon after my own injury made me realize how much America’s deranged health care system is haunted by the very same zombie Calvinism that haunts my own psyche. The good fortune of health, which can be taken away from you at any time by an impersonal universe, is mistaken for goodness, while bad fortune is seen as evidence of inherent undeservingness.

The highlight of the waiting period was physical therapy, which felt like a respite from my otherwise constant sense of helplessness and rage—at my new physical limitations, at our country’s political decline. Getting off screens, being around people, is the only balm. And the physical therapist’s office offers the most diverse cross-section of people of any place in town. Young, old; fit, frail; wealthy, scrappy; Latino, Anglo. The most universal thing about people is that we have bodies that break. One day, my therapy cot was next to an older woman with a thick Texas accent, dramatic fake eyelashes, and a neat silver bob. Demographically, she almost definitely voted MAGA. She is recovering from a knee replacement. We did our heel slides together and discussed the relative merits of crutches versus walkers. It felt a little like being in church: We were performing embodied rituals that both reflect and heal our brokenness, and we were doing them together. I remembered what we repeat at the Eucharist mass to affirm that Christ was both fully God and fully Man: “This is my body, which is broken for you.”

My physical therapist was an undergraduate psychology major at UT, where I teach. I asked if she felt like she was using her degree, and she said, “Oh yes, healing is just as much the mind as the body.” Hearing this delighted me. Physical therapy does, it turns out, resemble psychotherapy. There is the damage from the initial injury, and then there is the dysfunction that results from your brain’s attempts to protect you from further injury. Avoidance, numbness, hypersensitivity— these are great, healthy, adaptive responses in the immediate aftermath of trauma. But, sadly, if you keep doing them, if you avoid discomfort, you will just fuck yourself up worse. Physical therapy involves a lot of exposure to one’s bodily sensations, behavioral activation, reframing catastrophic thinking, empathy for the patient’s pain and distress, without endorsing all they are doing to avoid pain and distress. And a lot of quad sets.

The other highlight of the long waiting period was experiencing my husband’s care. I couldn’t bear much weight in my right leg for weeks, and I couldn’t maneuver into our shower on crutches. My beloved husband set up a chair in the backyard, with a stool to prop my deformed leg up. He filled up buckets of warm water. He helped me undress and then he poured warm water over me, making sure my hair was clean, making sure he washed my foot that I couldn’t reach. For better and for worse, in sickness and in health, as long as we both shall live.

Last week, I finally had surgery, which involved drilling holes in my kneecap and femur, affixing a donor ligament in the holes, plucking out bits of bone and cartilage that were floating about the joint, and shaving off the ragged cartilage flapping off my tibia and behind my kneecap. The older kids were curious about the procedure, so before surgery, we watched an animated YouTube video produced by the company that sells biocomposite screws for ligament reconstruction surgery. We read all about biocomposite screws and their advantages. I found the video both revolting and strangely reassuring. Seeing my injury as a physics problem, or a materials science one, dialed down my body horror. Intellectualization has always been my most beloved defense.

The outpatient surgical center is an assembly line for broken toys. The nurse who took my clothes from me and put in my IV said they got especially busy in November and December, because people wanted to get anything elective done before their deductible started with the new year.

I have few memories of the hours after the surgery, or the hour before. My surgeon is, it must be said, an extremely handsome man; he looks more like a character in a TV medical drama than a real physician. McDreamy, McSteamy, McOrtho. But I don’t remember his face before the surgery. I must have talked to him, because I do remember falling asleep to Rachmaninoff’s Piano Concerto No. 2, the first movement, which is not the loveliest movement but the one with the appropriate amount of verve for surgery. I must have told him to play it.

The day after the surgery was gnarly. They sent me home with a nerve catheter snaked into my thigh, an ice machine to pump cold water around my knee, plus ibuprofen, Tylenol, and oxycodone. I still felt the pain.

By the third day, I felt much better, so much so that I began to fantasize I would be one of those patients who has an astonishingly easy recovery, the knee surgery version of the celebrities wearing bikinis a week after giving birth. I even wrote a commentary on the life of James Watson, who died that week, for The Atlantic. Then my nerve catheter came out, and I realized what everyone who has suffered a trauma, physical or spiritual, eventually realizes—that their seemingly quick initial “recovery” was just adrenaline and numbness. Now, I am not in agonizing pain, but neither do I feel anything approximating wellness. I am uncomfortable and am faced with slowly learning how to walk again.

People keep recommending TV shows to watch while I’m housebound, but mostly what I’ve been doing for the past week is reading and listening to the same pieces of music again and again. The Rachmaninoff. Schubert’s String Quintet in C major. And, a new entry to my convalescent canon, Mendelssohn’s Violin Concerto in E minor, a piece suggested by Oliver Sacks’s book, which described how music—its rhythm, its unity—was indispensable to him relearning to walk:

“Music, as I had dreamed at the weekend, was a divine message and messenger of life. It was quintessentially quick—‘the quickening art’, as Kant had called it—quickening my soul, and with this my body, so that suddenly, spontaneously, I was quickened into motion, my own perceptual and kinetic melody, quickened into life by the inner life of music. And in that moment, when the body became action, the leg, the flesh became alive and quick, the flesh became music, incarnate solid music. All of me, body and soul, became music in the moment … [The] stream of music, of action, of life, was essentially, and entirely, and indivisibly, as a stream, an organic whole, without any separations or seams, but articulate, articulated, articulate with life.”

My flesh has not yet become alive and quick, incarnate music; my articulated joint still has quite visible seam lines where they sutured me up. But I replay the Mendelssohn all the same, hopefully, in anticipation of being capable of spontaneous movement again.

My brother-in-law texted me to ask after my recovery. He predicted, “You’ll get better so quickly and forget this ever happened.” I want the former, but not the latter. I don’t want to forget any of it. I don’t want to forget the lessons of this brutal season. Sacks put it this way, “I found the abyss [of injury] a horror, and recovery a wonder; and I have since had a deeper sense of the horror and wonder which lurk behind life and which are concealed, as it were, behind the usual surface of health.” It is horrible to realize: We are all potentially five minutes away from needing other people very much, from being utterly dependent on care. There will be, in the end, no victory over our flesh falling apart. And it is a wonder: the hope, healing, and consolation we can find in each other, and the solidarity to be found in our common fragility, our most universal characteristic.

From my breakable body to yours,

Paige

James Dobson, the founder of the Focus on the Family media empire, recently died. The New York Times described him as an “influential leader of the religious right” who “advised parents how to communicate better with each other and how to educate and discipline their children.” Many on social media put it more bluntly. “May he rot in hell for the child abuse he perpetuated” is a representative post.

James Dobson first ascended to cultural prominence in 1970, when he published Dare to Discipline. The book argued that parents should spank their children, as young as 15 months old, aiming to inflict pain of “sufficient magnitude to cause the child to cry genuinely.” But if the child cries for more than 5 minutes, then he should be required to stop, “usually by offering a little more of what caused the original tears.” (The beatings will continue until morale improves!)

Dobson followed up Dare to Discipline with The Strong-Willed Child, which opened with a story about him beating the family dog—a daschund named, I kid you not, Sigmund Freud—with a belt. These books sold millions of copies and launched Dobson’s career as an author, radio personality, and political organizer.

Dobson’s “Focus on the Family” products were omnipresent in my 90s Evangelical household. In addition to the radio program and newsletters for adults, my brother and I received the teen magazines: Breakaway for boys, Brio for girls. Sometimes I wonder if I hallucinated this content, but no, other ex-Evangelicals confirm it was real. One Reddit poster has been tracking down old issues of Brio and uploaded this photo of an article about how to make yourself ready for marriage (to a man, of course).

The focus of this photo is on the section admonishing the teenage girl to avoid becoming an oily, smelly, slovenly, disgusting pig (“Does your hair look like you’ve been conditioning it with Oreo centers?”). The sections above and to the side are just as representative of the Focus on the Family worldview, and just as horrifying to re-read:

“Understanding guys can be tough, … because so many of them are … even unable to put their [feelings into] words. Learning now to be a good [listener] (or a good detective) will pay…”

“Respecting your husband is part of loving him. Besides that, God commands it. The husband has ultimate responsibility for his family, much like the president of a company. Wives, although equal partners, are second in command.”

“Even if your husband helps, you’ll probably have primary responsibility for [the children].”

My parents considered this type of advice about marriage, family, gender, and child-rearing to be the Gospel truth. They eagerly consumed Dobson’s advice on “how to communicate better with each other and how to educate and discipline their children.”

They are now divorced, and I haven’t spoken to one of my parents in seven years.

As Jesus said, you shall know them by their fruit.

In graduate school, one of the first studies for which I was the lead statistical analyst was a study of punishment and mental health in children-of-twins. Children-of-twins is a classic study design for teasing apart environmental influences from genetic transmission in families.

The basic logic of the design goes like this: if your mother is an identical twin, you are as genetically related to her co-twin, your aunt, as you are to your mom. If something that your mom is doing environmentally is hurting your mental health, but her sister (your aunt) isn’t doing that thing, then you’re going to have more mental illness than your cousins. But if that thing your mom is doing is correlated with mental health problems because it’s a proxy for the genetic risks that she and her sister share, by virtue of being identical twins, then your cousins are just as likely to have mental health problems as you are.

In our paper on punishment, we applied the children-of-twins logic to data from 887 twin pairs and 2,554 children of twins from Australia. The children-of-twins were no longer children when they were interviewed. Their average age was 25 years old—older than I was at the time I was working on this paper.

They were asked: “What was the usual way in which your [mother/father] punished or disciplined you?” The response choices were: “(a) nonphysical mild (scold, isolate, fine, remove privileges), (b) nonphysical harsh (lock in closet, deprive of food), (c) physical mild (slap, spank), (d) physical harsh (use weapon, punch, kick), and (e) did not punish.”

We specifically analyzed whether harsh punishment and corporal punishment (physical mild punishment) were associated with internalizing psychopathology (depression, anxiety), externalizing psychopathology (impulsivity, conduct problems), and drug and alcohol use problems, when comparing within families. Did the children who remembered being punished more harshly than their siblings have more mental health problems than their brothers and sisters? Did the children whose parents punished harshly have more mental health problems than their cousins, who were as genetically related to them as siblings?

The children who reported that their parents used mild, nonphysical forms of punishment had the lowest rates of mental health problems, overall. The differences between the groups, as is typical for psychology, were small. When comparing within families, most of the effects of corporal punishment went away—being spanked or slapped was not associated with markedly worse mental health, on average, at least not in the ways measured by psychiatric checklists. But neither did it do what Dobson promised his followers it would do to their children—perfect them.

Harsh punishment, on the other hand, was associated with worse mental health even when comparing within families. We concluded, “The observed association between harsh physical punishment and negative outcomes in children survived a relatively rigorous test of its causal status, thereby increasing the authors’ conviction that harsh physical punishment is a serious risk factor for children.”

What did my 23-year-old self make of these results? Did I recognize myself in the “physical mild” and “nonphysical harsh” groups? Did I have any inkling of my own personal interest in the topic? I remember no such self-awareness. If anything, I probably found the small associations with physical mild punishment, and the fact that those associations were no longer significant in a (probably under-powered) within-family comparison, reassuring. It couldn’t have been bad, not really, how my parents punished me, if the statistics from an analysis of data from a group of people on the other side of the world had p-values greater than 0.05.

Now, I think that slapping or spanking your child is bad, not because, or not only because, it might cause mental health problems, but because your child is a person—a small, vulnerable, dependent person—and physical aggression in the context of an intimate relationship with another person is simply not okay. It has taken me a long time to say that so plainly. It was not okay.

“Did you and your brother fight?,” my therapist recently asked me, when I was talking about how frustrated I was at my older two children’s bickering and squabbling.

“Not very much. We hid it, too. Or else my mom would spank us. Or lock us in the bathroom.”

“She would … lock you … in the bathroom?”

“Yes, if she got frustrated at us arguing she would lock us in the bathroom until we could get along. We were fine. There’s water in the bathroom. I don’t know for how long. It felt like hours, but who knows? I remember we made puppet shows with our socks…. Except for this one time, she set a timer and made us hit each other until the timer went off.”

“She made you … hit each other … until the timer went off.”

“Yes, I remember us crying and begging her to let us stop. We didn’t hit each other after that. So I guess in one way it worked.”

“It … worked?”

How many other children were hit with a belt, a hand, wooden spoon, a shoe, a tree switch? How many were locked in a bathroom, a closet, a room? Or worse. So much worse. Social media is filled with accounts by people whose parents read or listened to Dobson and took his advice as license to hurt.

Children, he said, the Church said, are sinners. And sin is not only something you do. It is something you are. It is a condition of brokenness that is inherent and that begins at conception. And the only appropriate response to inherent sin is punishment.

Dobson did not invent the Christian argument for hitting your children. He only updated it using the psychotherapeutic language of the late 20th century. In For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots of Violence, the psychoanalyst Alice Miller describes the “poisonous pedagogy” espoused by Christian pastors and physicians in Germany in the late 19th and early 20th centuries. Before Hitler came to power, when the Nazis were still children, what were their parents reading? Content that sounds like it could have been written by James Dobson.

For instance, one Dr. Schreber, whose books went through forty printings in Germany, wrote:

“The little ones’ displays of temper as indicated by screaming or crying without cause should be regarded as the first test of your spiritual and pedagogical principles . . . Once you have established that nothing is really wrong, that the child is not ill, distressed, or in pain, then you can rest assured that the screaming is nothing more than an outburst of temper, a whim, the first appearance of willfulness. Now you should no longer simply wait for it to pass as you did in the beginning but should proceed in a somewhat more positive way: by quickly diverting its attention, by stern words, threatening gestures, rapping on the bed . . . or if none of this helps, by appropriately mild corporal admonitions repeated persistently at brief intervals until the child quiets down or falls asleep . . .

This procedure will be necessary only once or at most twice, and then you will be master of the child forever.”

Corporal admonitions … repeated persistently … until the child … falls asleep?

What happens when a child is hit, and then instructed to quiet down and fall asleep—or maybe, as Dobson instructed, to smile and hug the person who hit them? Miller argued that, “If there is absolutely no possibility of reacting appropriately to hurt, humiliation, and coercion, then these experiences cannot be integrated into the personality; the feelings they evoke are repressed, and the need to articulate them remains unsatisfied, without any hope of being fulfilled.”

In other words: If someone hurts me (“I am making you hit your brother until you weep”), while telling me I am not being hurt (“I love you and this is good for you”), and if allowing myself to know that I am being hurt is too dangerous, I must come up with some way to make that knowing go away.

To the young child, the parent is necessarily a sort of god. The parent’s caprices must be rationalized as just and good, because what is the alternative? That they are dependent for their very survival on a fallible being, capable of cruelty? Such a conclusion is intolerable for a child. It’s intolerable for many adults, even: Avoiding coming to such a conclusion about the Christian God is exactly what motivated the doctrine of inherited, inherent sin in the first place. I must be bad, so my parent can be good, and my parent must be good, if I have any hope of survival.

So, the knowing must go away. Repression can manifest as neurosis, as anxiety, depression, anger turned against the self. But, as Miller argues, having to repress one’s normal reactions to being hurt can also manifest as scorn for that part of oneself that feels hurt or humiliated, as contempt for anyone else who reminds us of that vulnerable, dependent part of ourselves, and as a “naïve submissiveness and uncritical attitude [toward authority] that completely belie his brilliance in other situations.” Resistance to authority, she argues, depends on our ability to trust ourselves—the one capacity most eroded by violence in the parent-child relationship, especially when the parent not only hurts the child but insists they cannot act like they are hurt. “Our capacity to resist has nothing to do with our intelligence but with the degree of access to our true self.”

Miller was writing in 1980 about early 1900s Germany, but her words read as prophetic for our time. What more perfectly describes MAGA than scorn for weakness, a psychological identification with the aggressor, and a naïve submissiveness to authority? Empathy for others’ suffering is now “toxic.” Trump’s followers see him as the angry father who has returned home to give his wayward child—America—a “vigorous spanking.” And they love him for it. Whenever I see a man in a red hat, a woman posing in front of a cage, I imagine them as a child, wanting to say, without being able to say, without being able to know:

“I don’t want to be the bad child anymore. I want to be the good parent, and the good parent hurts people, weak people, dependent people. The weak and the dependent deserve it! It is for their own good. It was for my own good. But I’m not weak anymore. See? I’m just like Daddy. I’m the strong, good parent. I will be the Punisher now, not the punished. Right? Right??? Tell me I’m right. Tell me I’m not the bad child anymore.”

Sometimes our strange political moment is explained in terms of the horseshoe theory, where the far-right becomes indistinguishable from the far-left, but I think one of the defining horseshoes of today is how Christianity can become Nietzschean.

One irony of Dobson’s “Christian” approach to disciplining children is that the first words that the character of Jesus ever speaks are him sassing his parents. In the second chapter of the Gospel of Luke, the 12-year-old Jesus sneaks away. His parents spend three days looking for him, and when they find him in the temple, they are “astonished” and ask, “Why have you treated us like this?” Jesus responds: “Why were you searching for me?” It’s not until the next verse that the writer describes Jesus as finally being “obedient” to his parents.

In her poem “R.I.P”, Meagan Ruby Wagner imagines James Dobson meeting this Jesus—the strong-willed child—in the afterlife:

“I hope James Dobson meets Jesus as a 7-year-old—wild and a little mouthy
Maybe with a swing in his step
And realizes that being a child is not a sin."

What a brilliant repudiation of Dobson’s worldview and legacy! I understand the impulse of those who reacted to his death with gleeful fantasies of him rotting in hell—but you know what would piss him off even more? Rejecting the whole idea of hell; resisting all the ways we enact hell on earth. Seeing every single last person as deserving of goodness, and embracing our wild, mouthy children.

I am off to do just that with my three—

Sincerely yours,

Paige

I am writing to you from an uncomfortable chair in my grandmother’s hospital room. She fell and broke her hip. They operated this morning. She is, mercifully, finally, sleeping. Her dementia has gotten worse this year, and this afternoon she was cycling between pain, agitation, and confusion. “Baby?!”, she would cry out, calling for my grandfather. He would touch her face, say, “There’s my girl,” calming her. They’ve been married for 71 years, and he still calls her “my girl.”

My grandfather and aunt and uncle and other aunt and other uncle and cousin went home to rest. My father is arriving soon, and then I will go home to sleep. Like all families, ours has drama, which is often expressed in the vernacular of holy roller religion. Un-Christ-like behavior. A demonic spirit. Yet (nearly) everyone, across all the various factions, was put on the same group chat, and responded. Nanny has fallen. She can’t be alone. When can you come?

My default response to my family—its complications and its politics—is avoidance. I’m perhaps the unlikeliest of Nanny’s many progeny to be sitting with her tonight. I’m the one who fails to show up for Easter lunches and birthday dinners. But here I am, holding her hand when she moans in her sleep.

Maybe it’s morbid to be writing from the hospital bedside, but what else am I going to do, as I sit here in this uncomfortable chair?

Damn, the nurse is here, and she woke Nanny up.

It’s late now. My dad’s plane is stuck in Dallas. The past hour has been tiring. Nanny needs IV drugs, but her IV isn’t working. Her nurse can’t get a new one in. An ER nurse who is known for being good at sticking elderly patients comes up to replace her IV but can’t find a vein. They give her meds by mouth instead, crushed up in apple sauce. She refuses to open her mouth for the unfamiliar nurse, so I spoon feed her instead. She licks her lips. “Mmm, is that good?,” I ask. She smiles.

Two orderlies arrive to take her to another hospital room. They explain why, but I have already forgotten the explanation by the time they finish talking. “You’re so cute,” my Nanny tells them. It’s the most coherent statement she’s made recently. She thinks everyone under 40 is beautiful. She asks them how old they are. 29. 24. Hospitals are run by young bodies.

We get her settled in the new room on a new floor. The slight change in layout and the complete change in nursing staff disorients her even more. They get yet another nurse to try to put in yet another IV, this time under ultrasound guidance. Ira. “You’re so cute,” Nanny tells Ira. He is pretty cute. But then he sticks her and she hollers—hollers in a way that reminds me of a toddler, or an angry cat, but also of my Nanny in happier times, praising the Lord.

“Shhhh. Why are you hollering? Hold my hand.”

“Are you one of mine?”

“Yes, I’m one of yours. I’m Paige. Stephen’s daughter.”

“I’m scared.”

“You’re safe. You’re uncomfortable, but you’re safe.”

“I love you.”

“I love you, too, Nanny.”

Then she starts moaning and hollering again. “I’m scared; I’m scared; I’m scared.” They give her risperidone and gabapentin. I hold her hand while she moans and asks me, again, again, again, again, about who I am and what my sweatshirt says and where she is and what’s behind the cabinet door. Together, we wait for the dopamine signal to go down and the GABA signal to go up in her brain. When she’s calmer, I turn the rest of the lights off, pull the recliner next to her bed, as close as I get it, and tuck her in. “It’s night-night time. We’re going to sleep now.” She closes her eyes but is still clenching my hand for a long time, before we both finally doze off.

The book in my backpack tonight is Morals and Markets: The Development of Life Insurance in the United States, by Viviana Zelizer. (Ten years ago, Viviana and I were in the same cohort of a sabbatical program, and I enjoyed her company very much.)

Morals and Markets is a sociological history that considers the curious, decades-long pause in the development of the life insurance industry in the U.S. and other countries. Urbanization and the rise of industrial capitalism in the 18th and 19th centuries meant that many women and children became increasingly dependent on the wages of a male worker, and increasingly vulnerable to destitution in the event of his death. For decades, though, while people insured houses against fire and ships against shipwrecks, they resisted insuring lives against death. People found the idea that a man’s life could be valued in purely economic terms repugnant. It was only when insurance could be understood in terms of other cherished values—providing for one’s family, leaving a legacy for one’s children—was life insurance re-branded as something wholesome, responsible, dutiful, rather than dirty or subversive to the will of Providence.

Once they finally gained momentum, life insurance companies became wellness influencers. They encouraged a proactive stance against disease, recommending annual medical visits. Longer lives, after all, meant bigger profits.

Longer economic lives. Someone who was no longer able to work for a wage had already experienced “economic death.” According to the new actuarial tables, my Nanny has already died. In fact, she never lived. She had her first child, my father, at 18, and was only very occasionally a waged laborer. She has 4 children. She has 7 grandchildren and 12 (going on 13) great-grandchildren and 1 great-great-grandchild. No wonder she can’t keep us straight. Are you one of mine? My many mines?

We know the estimated economic value of a wage earner, but what is the value of a great-great-grandmother?

A broken hip killed my other grandmother. Kathryn. She taught me to play piano. She lived in rural Mississippi in a tiny house, and her Baldwin grand piano took up most of the living area. How she managed to own it is a mystery. She is the reason I still use my first name in writing, despite being called by my middle name for most of my life. She sat down wrong, broke her hip, went into surgery, and never woke up.

Last week I got a bone scan. I told my endocrinologist that, no, cancer didn’t kill my grandmother, a fall did, and she said, a little too bluntly for my taste, yes, that kills a lot of women. She recommended that I get a bone scan to establish a baseline measurement before I descend even further into perimenopause. She recommended more calcium, more Vitamin D, more and heavier weightlifting, which are recommendations I already follow. I, too, seek to maximize my healthy lifespan. I would like to avoid death for as long as possible, both the economic kind and the corporeal kind.

Actually, no, I don’t think it’s death that I want to forestall. It’s frailty. It’s dependence.

Last year, my friends and I did mushrooms together and went on a little hike on a trail behind my friend’s house in Park City. As my trip came on, stronger than I was expecting, I became repulsed by the sight of houses, the whine of cars. I wanted quiet. I lay down on the ground and watched the moss furling and unfurling. I hope dying is like that. That you feel like you just want to lie down by yourself for a while, while your friends are talking in the background, and meld with the moss. Hashtag girlmoss.

Thinking about it that way, dying doesn’t seem that bad. It’s the part before dying I’m scared of.

An article from The New Yorker has been making the rounds of my professional circle. It describes the Don’t Die adherents, the longevity biohackers, the men who want to never age, never weaken, never fall, never die. Even as I see up close the suffering of infirmity, and try to prevent it for myself, I find the ambition of Don’t Die repugnant. What, after all, refuses to die? Vampires, zombies, horror movie villains, cancer cells. I feel about Don’t Die the way women in 1810 felt about life insurance.

I think my repugnance, like many hatreds, comes from a place of recognition. I, too, am afraid of old age. What if I suffer enormously? What if I can’t recognize other people? What if I am rendered unrecognizable?

What if, in the end, no one will hold my hand in the middle of the night and tell me they love me?

I also recognize the impulse to try and high-function my way out of being weak, being needy. Yes, this part of life is painful and difficult for everyone else, but I will be the exception. (Ha!) But in trying to be the exception, my scope of concern narrows, and narrows again. Trying not to die means spending a lot of time caring only for yourself. We are going the wrong way, I think, when we spend all our time optimizing ourselves, and no time building and nourishing the communities of mutual care that we all need.

I will suffer, and fail to recognize people, and feel unrecognizable from my younger self. And so will you. But I hope we will have other people to hold our hands.

I’m home now. My dad finally arrived at the hospital, so I got a few hours of sleep before waking up to get Lavinia ready for her first day of preschool. I helped her pee and helped her dress and brushed her hair and coaxed her to finish her oatmeal. Dependence is the modal human condition.

Once Liv got out the door, I took a shower. While I was in the shower, Rowan surprised me by making up my bed and making me a cup of Earl Grey tea. She cleaned the kitchen table and set out the sugar bowl. She watched me take the first sip of tea. “Is it good?”

It is good to have your 10-year-old daughter make you a cup of tea when you’re tired. It is good to care, and be cared about in return.

Yours sincerely,

Paige

Dear Reader,

Last week, Lavinia kicked me in the face.

She didn’t mean to. Or, at least, I’m choosing to believe that she didn’t mean to. She’s only three, after all. The problem, I think, is that she’s bored and lonely this summer, and we are bored and lonely taking care of her.

She has been home for most of the summer. I didn’t sign her up for any camps, because we are already spending a small fortune on camps for our older two children. And social interactions with other kids her age have been rare, for many reasons. Because all the other kids in our neighborhood are school-age. Because Travis is the stay-at-home parent, and the other preschool moms do not think to include a dad in their group texts about play dates. Because we live far away from my siblings and their children. Because, as I have titled the Google spreadsheet that my ex-husband and I use to coordinate summer plans, AMERICA IS A CHILDCARE HELLSCAPE.

So, like I said, she’s bored. Every time we leave the house, she protests returning. “I don’t want to go home. I want to see friends. I want to go to the ocean. I want to pet animals. I DOOOON’T WAAAAANT TO GOOOO HOOOOOME.”

On the morning of the kicking incident, I made the mistake of taking her with me to drop off her older siblings at rock-climbing camp. When Lavinia realized that she wasn’t going to be allowed to stay, she had an epic meltdown. I peeled her, screaming, off the climbing gym floor, carried her flailing body to the car, tried to wrestle her into her car seat—and then she kicked me, hard, in the face. Her sparkly silver shoes, a gift from the “pacifier fairy”, have rubber soles and scratchy sequin uppers. They fucking hurt.

Later that day, a reporter emailed me to ask if I would be willing to talk to her about two new companies that are calculating polygenic scores (PGS) in IVF-created embryos. My first thought when I read the reporter’s email was: Do they have a PGS for not kicking your mother in the face?

After I dropped Lavinia off at home, I was supposed to go to the office to work, but my nervous system was still too jacked up to concentrate. I ended up, instead, at my beloved local bookstore, where I bought a novel I’ve been considering reading for a while: Sheila Heti’s Motherhood, a rumination on the decision not to have a child.

The narrator of Motherhood, a writer who seems modeled after Heti herself, has moments where she intensely wants to have a baby. She calls that desire the sound. A friend of hers hears the sound and tells her new boyfriend to come inside her. The relationship doesn’t last, but it doesn’t matter. The sound was about the baby, not the man.

This was my experience. I have a short video of my 29th birthday, filmed by my now ex-husband. I am opening his gift, an expensive jacket that I still wear. He jokes that he should have saved it for my 30th birthday. “What am I going to get you next year?,” he asks. “A baby,” I reply, and he laughs, thinking I’m joking. On my 30th birthday, I was 6 months pregnant with my first child. I have heard the sound three times, and I have three children.

Heti’s narrator sometimes hears the sound, but for her, hearing it is not enough. She hears the sound of other things, too—things that babies make more difficult, if not impossible. Sex, sleep, art. She considers:

On the one hand, the joy of children. On the other hand, the misery of them. On the one hand, the freedom of not having children. On the other hand, the loss of never having had them—but what is there to lose? The love, the child, and all those motherly feelings that the mothers speak about in such an enticing way, as though a child is something to have, not something to do. The doing is what seems hard. The having seems marvellous.

Yes, exactly, the doing is what is hard. The doing is guaranteed to be hard. Sometimes it seems like women who have deliberately chosen not to have children are the ones who see most clearly, or at least are willing to say most clearly, the challenges of motherhood. If the downsides weren’t obvious to them, they wouldn’t have managed to avoid the social pressure to conceive.

Even as she entertains the possibility that she might have a child, Heti’s narrator is sometimes repulsed by other people’s reproduction: “How assaulted I feel when I hear that a person has had three children, four, five … It feels greedy, overbearing and rude—an arrogant spreading of those selves.”

I can see how it would look that way from the outside. Three children! What an extravagance! But my children do not feel like a spreading of my self. Quite the opposite. Caring for them requires constant contractions. I am always disciplining my greediness for quiet, for space, for rest, for ease—sometimes even for food, when we’ve underestimated how much they’ll want to eat for dinner. I’m always making my wants smaller.

The narrator’s partner has a child from a previous relationship, and he provides little encouragement. He warns her: “It’s a risk… his daughter is lovely, but you never know what you’re going to get.”

Why did I take the risk? Why did I listen to the sound? And more than once. I knew the doing was going to be hard, very hard, but I still wanted the having.

Introspection has its limits, and the reasons why people do and do not have children are, to some extent, inscrutable. But I feel like I was able to embrace the riskiness of childbearing because I enjoy unusual security in two other domains. One, work—I am a tenured academic, and so have financial stability and much ownership over my time. And two, partnership. Both of my children’s fathers do as much as I do, if not more, to raise our children. Security allows for risk-taking.

Also, listening to the sound meant uniquely good sex. Avoiding getting pregnant is, at best, inconvenient. At worst, it is horrible. In my decades of trying not to get pregnant, I tried condoms, the pill, the mini-pill, the pull-out method, the ring, the patch, the shot, and an IUD, which perforated my uterus and had to be surgically fished out of my abdomen. Embracing my fertility—having non-hormonally-disrupted, non-interruptus, condomless sex with someone I loved and wanted to have a baby with—was marvellous.

The making of a baby was also marvellous because the doing of motherhood was guaranteed to be hard. Because you never know what you’re going to get. Procreative sex felt like one of the few moments in my life when I had literal skin in the game. The risks weren’t abstract, and my participation wasn’t mediated by a screen. This must be why people play Russian roulette—the particular feeling of aliveness you experience when you put your body on the line.

The theme of riskiness, of chance, is carried throughout Motherhood. In every chapter, the narrator poses a series of questions and flips three coins to receive yes or no answers. An author note tells the reader that this is a variant on the ancient Chinese technique of I Ching, and that in the novel, “all results from the flipping of coins result from the flipping of actual coins.”

Are the fantasies that visit us, of living other lives—like living with children if we don’t have them, or living without it if we do—taboos?

yes

Are we supposed to build a conscious relationship with these taboos, so we might feel at home in the world, on a macrocosmic level?

yes

Heti is a novelist; she did not have to constrain herself to the results of actual coin flips. She could have exerted a God-like power over the events of her novel, even down to which coins came up heads. Instead, the author/the narrator uses the unpredictability and uncontrollability of the coin-flipping as a tool for deeper self-reflection. What result are we hoping, perhaps subconsciously, that the universe will give, and what can we learn when the universe does not deliver that to us? Motherhood is more textured, more interesting because some of the creator’s power was ceded to pure chance.

Motherhood, then, has been on my mind as I think about the new conversation about calculating embryos’ polygenic scores. The reporter who emailed me wanted to talk particularly about two new companies that are deploying polygenic scores designed to be predictive of intelligence. Another reporter followed suit a few days later. “What do you think?,” they wanted to know.

I think: On the one hand, the joy of children. On the other hand, the misery of them.

That is, I feel a great deal of ambivalence about “preimplantation genetic testing for polygenic conditions”, or PGT-P, as it’s known. The topic seems to deserve ambivalence. We are talking, after all, about deciding to bring a child into the world, and then deciding which of several potential children to bring into the world, an enigma wrapped in a dilemma, new to humankind. Yet much of the discussion about PGT-P is characterized not by ambivalence, but by self-righteousness, and strident proclamations of certainty.

There are the right-wing religious conservatives, who condemn PGT-P, and condemn IVF, and condemn the queer and trans couples who must use IVF to conceive a child. To them, IVF embryos are children, are persons, and procreation should be limited to marital sex. Discarding embryos is murder. “To be clear, this technology does not help you extend your baby’s life; it provides information — and dubious information, at that — to help you kill your weakest children,” says one man quoted by The Federalist.

Then there are the left-wing opponents of PGT-P, who sometimes condemn it in strikingly similar terms as the Southern Baptists and conservative Catholics. Choosing one embryo over another on the basis of a polygenic score—or at least one the basis of some types of polygenic scores—is likened to Hera throwing “her disabled child” off Mount Olympus. The embryo is again elevated to personhood.

Reading some of these criticisms, I wonder: How many of the academics rushing to condemn PGT-P as morally abhorrent tested their own fetuses for conditions known to cause intellectual disability? (Published statistics suggest that the use of prenatal diagnosis, and the likelihood of terminating a fetus predicted to have Down Syndrome, increases with maternal education.) How many support the right to terminate a pregnancy for any reason, including on the basis of predicted disability? This is a 100% serious question. I want to know more about the reasoning that results in the conclusion that it is morally acceptable to abort a fetus on the basis of predicted disability, or to abort a fetus for any reason, or to create IVF embryos and choose among them at random, or to create IVF embryos and choose among them based on a definitive genetic test, but not to choose among them on the basis of a probabilistic polygenic score.

Sometimes the moral condemnation of PGT-P is combined with another criticism, which is that polygenic predictions are not very good, and that customers are being misled. This criticism is, I think, justified: Polygenic predictions really aren’t that good when you’re trying to predict an outcome for a single individual, especially when the individual’s genomic background is not very similar to the people included in most genetic studies (aka, white British people). There is just so much that we do not know about these genetic risk scores and how they work. But when the uncertainty criticism is combined with a more general moral condemnation of PGT-P, the resulting complaint reads like “The food was bad, and the portions were too small.”

The latest round of conversation about PGT-P was started because two new companies have begun offering polygenic testing for “traits”—including, most controversially, intelligence—instead of just “diseases.” Traits, the argument goes, are social constructs, whereas diseases are medical realities. Most discussions of polygenic embryo selection—and genetic research more generally—proceed as if there is a crisp distinction between traits and diseases, and that everyone agrees which is which. But this is simply not the case. The distinction between “traits” and “diseases” is, as I have written before, “as contentious, fluid, and historically and culturally contingent as the distinction between art and obscenity.”

The genome doesn’t care about our categorizations. To give a concrete example, my colleagues and I are finishing up a paper, following up on our previous work, describing results from a genome-wide association study in which we identified genetic variants that are associated with all seven of these things: ADHD, age at first sex, number of sexual partners, smoking initiation, cannabis use disorder, alcohol abuse, and self-reported risk tolerance. The genes we discover also significantly predict these things: suicide attempt, viral hepatitis infection, and lung cancer.

Some of these things you might categorize as “diseases” and some as “traits”. But the same polygenic score is associated with all of them.

If you screen your embryo to have the lowest chance of lung cancer, are you screening for a disease? What if those genes are associated with lung cancer because they affect people’s likelihood of smoking? What if those genes are associated with lung cancer because they affect people’s likelihood of smoking, because they affect people’s personality,? Genetic studies of “diseases” don’t magically subtract out the “trait”-relevant genetic variants, and genetic variation in “traits” is relevant to many, many diseases.

The distinction between “traits” and “diseases” is blurry even if we limit ourselves to cognitive phenotypes. IQ? Trait. Alzheimer’s Disease? Disease. But one of the best predictors of not getting Alzheimer’s or other aging-related dementia is having a high IQ in midlife, before aging begins, and one of the genetic predictors of Alzheimer’s, after the APOE gene, is a polygenic score for educational attainment.

When people make a sharp distinction between “diseases” and “traits” in their attitudes toward polygenic embryo selection, when no such sharp distinction exists in our genome, I often wonder if they are, subconsciously, trying to draw distinctions about prospective parents’ intentions and motivations. Selecting your embryo so that the resulting child is less likely to suffer from a medical disease? Good, unselfish, caring, responsible. Or, at least, justifiable, necessary. Selecting your embryo so that the resulting child is more likely to score highly on an intelligence test or go to a selective college? “Greedy, overbearing, and rude—an arrogant spreading.”

Historically, the singling out of some reasons as Bad reasons for people to use a method for controlling their reproduction has been a forerunner to a complete ban on that method, regardless of motivation. Condemnation of unmarried people who were using contraception to fornicate justified banning everyone’s access to contraception. Abortions based on the sex or predicted disability of their fetus justified banning abortion, full stop. It shouldn’t be surprising that the same argument is now playing out for IVF. Some people might use IVF to select embryos—they might even select embryos for traits!—so no one, some argue, should be able to use IVF.

Meanwhile, the companies offering PGT-P seem to be competing over who can be the most morally unserious. Elon Musk evidently thinks one of the new companies is “cool.” One of the scientists involved in that new company, whose work I have long respected for its methodological rigor, thinks that Musk’s endorsement is “cool.” The exchange reads like a text messaging thread I would have with my 13-year-old son. It’s so adolescent. Lol, nothing matters, brb.

Another one of the new companies advertises the opportunity to “Build Generational Health”— a play on the phrase “generational wealth.” Talk about a greedy and arrogant spreading. Generational wealth is like cancer—dependent on the larger cooperative but parasitically rerouting resources to sustain its limitless consumption, growing with no logic other than to grow, trashing the environment, and ultimately threatening the survival of the very system that allowed it to freeride and flourish. The subtext of America’s fucked up healthcare system—a system so dysfunctional that people cheered for the murder of a health insurance executive—is explicitly made text by this new company. Health is, in this framing, not public. It’s not a matter of social solidarity in the face of our shared fragility. Instead, health is something to be sold as a positional good. It’s yet another thing to be hoarded.

And then there is the slogan repeated by another company’s founder: “Sex is for fun, and embryo screening is for babies.” The slogan trivializes sex, and trivializes women’s pain. Here is how one medical site summarizes the IVF process. I’m reproducing the details here because they are almost always elided in any discussion of embryo selection:

“Daily gonadotropin injections are used to stimulate the ovaries to produce multiple follicles. Ultrasound imaging and bloodwork are performed regularly to monitor follicular growth and hormone levels. When the lead follicles reach the appropriate size, a trigger injection—typically using hCG or a GnRH agonist—is given to complete final egg maturation. Egg retrieval is scheduled 34 to 36 hours after the trigger injection. Egg retrieval is performed under intravenous sedation in a procedure room. Using transvaginal ultrasound guidance, a needle is inserted through the vaginal wall into the ovaries to aspirate the fluid from each follicle.”

If men had to go through any of that, I’m convinced we would not be having this conversation about PGT-P, because there is no way in hell that men—raised to be entitled to physical comfort and pleasure in a way that women are simply not—would be going through daily hormal injections followed by one big hormonal injection followed by a needle inserted through their genitals. All the calculations about how selection on different polygenic scores with different R-squared values might increase months of healthy life if used at scale—where in these calculations are the months of comfort and health sacrificed by the women doing IVF?

Lost in all of this clamour—“cool”, “you are killing your weakest children”, “sex is for fun!”, “build generational health”—is the person doing the (painful, invasive, expensive) reproductive labor of creating embryos, the person doing the reproductive deciding. The person who will care for the resulting child, care that will often be painful and boring and lonely, even in the best possible circumstances. The person whose uncertainty, questions, hopes, and fears are wonderfully centered—are taken seriously—by Motherhood.

The would-be parent who is a potential customer for PGT-P: what do they want? What do they long for in a child, and in their relationship with that child? What do they fear? Why does genetic testing seem like a hedge against those fears? And, crucially, if there were greater solidarity and security in our culture, would the risks of reproduction seem more tolerable, such that some attempts at genetic selection no longer seemed necessary?

What, ultimately, makes a person feel safe enough to take the risk of having a child?

At one point in her deliberations, the narrator of Motherhood meets her friend’s new baby, two months old, and describes him as “a glimmering fish in a silvery net, a shining and throbbing soul.” To conceive a child is to do a “hopeful thing—pull a glittering fish out of the deepest sea, to trap it in this beautiful life.” What I think about PGT-P is that its existence exposes a felt need, and I am not in the position to judge what other people think they need when they are trying to do a hopeful thing, when they are trying to pull a glittering fish out of the deepest sea—even as I distrust the slick techno-optimism of purveyors selling poorly understood algorithms as solutions for deeply human fears.

This morning, I finally gave my glittering fish back her glittering shoes. (“I can’t kick Mommy,” she said, unprompted, when I handed them to her.) We walked to the neighborhood playground so she could, at her request, go down the slide. My preferred playground posture is 80s mom, if an 80s mom were even at the playground in the first place. I want to sit in one place, read my book, and mostly ignore my children. Lavinia, though, wanted me to stand right next to the slide, so that she could hold my hand until the very last moment before her course became irreversible.

I initially balked at her request. “You said you wanted to go on the slide, so slide down already! You don’t need me.”

But then I stopped protesting and did what she wanted me to do. She was telling me what she wanted to feel safe, and she wanted me to listen to her. I held out my hand, and she took the plunge. May we all feel so secure, so held, in our risks.

Sincerely yours,

Paige

This week, I devoured Ann Patchett’s newest novel, Tom Lake, which you should read! Recommending the newest Ann Patchett is like recommending the newest Taylor Swift album; Tom Lake was a Reese’s Book Club pick and it’s probably already sold a bazillion copies. But don’t be suspicious of its popularity (as I was); the novel is both lovely to read and worth thinking about after.

I picked it up because the Kirkus review said it captures “the evolving dynamics of a family, and the complex interaction between destiny and choice,” topics I will forever be interested in. But, in addition to those topics, the book was a particularly beautiful and psychologically astute depiction of some of the dynamics of lifespan development: “the dynamic and continuous interplay between growth (gain) and decline (loss)”, the importance of “historical embeddedness and other structural contextual factors,” and “the range of plasticity in development.” The question of range and plasticity, on multiple different timescales, is especially central: How do you change, from week to week, from season to season, from setting to setting, from decade to decade; how do you remain the same? How do you construct a coherent sense of self across abrupt transitions?

The book flashes back and forth between two timelines. The first is set in circa-2020 Michigan. A woman’s three daughters have been driven home to the family cherry farm because of the Covid pandemic. One daughter would be there anywhere; she is going to take over the family farm and marry the boy next door. One is an aspiring vet and rapidly finds herself useful. And one is an aspiring actress, chafing at the lost months spent away from the city, away from the stage, away from all the things she thinks she wants. The four women spend their days picking cherries, as the mother, Lara, recounts how she spent her 20s: her own brief career as an actress, her summer romance with a man who became a movie star, and the events leading up to her long and contented marriage. How I Met Your Father.

By flashing back and forth between Lara’s current life and her youth, the book layers multiple timescales. “I am fifty-seven. I am twenty-four.” She is both radically different than her younger self and recognizably the same, and we are asked to consider: How do the multiplicity of changes in our lives somehow add up to a life story? How do the daily monotonies somehow add up to growth? Sometimes, the changes in Lara’s life happen in an instant: she injures herself; she runs into a man she hasn’t seen in years. But how much do those dramatic “turning points” really matter, or would she have ended up in the same, or a highly similar, place nonetheless? Other times, change seems impossible: Lara is in one place, doing one job, and no exit ramps are visible. But how much do the periods of seeming stability, even stasis, make subsequent changes possible, and potentially more enduring? Adam Phillips made this point in On Wanting to Change: we don’t think a person has really changed unless the change sticks, that is, unless they then stop changing. Plasticity requires stability.

The personality psychologist Ted Schwaba and his colleagues did a study where they tracked people’s personalities over 12 years and compared their actual trajectories of personality change to their subjective sense of whether their personalities changed in response to a life event. What they found is that people who perceived themselves as changing did change their personality, but often they had already started changing before the life event happened. They were already getting more emotionally stable, even before they had a kid, got married, or moved. They were already getting less conscientious and more neurotic, months or even years before that breakup, relapse, or injury. And, their initial personality traits were related to whether their personalities changed and whether they perceived them to have changed. The long-term patterns of our lives are difficult, if not impossible, to see from close up; the things that actually made a difference are hard to pinpoint in retrospect; and change can result in more of the same.

The juxtaposition of timescales in Tom Lake reminded me of a very different, much darker book: How to Be Depressed by George Scialabba, which I have been recommending to all my graduate students. I think it should be required reading in every Clinical Psychology Ph.D. program. How to be Depressed is a strange sort of memoir, in that it features very little of Scialabba’s own voice. He wrote the introductory chapter and conclusion, but the meat of the book is an edited selection of therapy notes written by his psychiatrists and psychologists. The notes span decades, from his first serious depressive episode as a young man graduating college, all the way up to his retirement. The reader sees psychoanalysis pass out of fashion and the rise of cognitive-behavioral therapy. Tricylics give way to SSRIs. Electroconvulsive therapy protocols become easier to bear.

Therapies change, but they also stay the same. Scialabba’s treatment options are always constrained by economics. (Will his insurance cover more sessions? What is the co-pay? Can he take time off of work?) And, despite the innovations in treatment, it is painfully clear to the reader how much depression remains a mystery, how much guesswork goes into clinical care, and how often the treatments hurt instead of help.

And, Scialabba changes, and stays the same, with dramatic short-term changes obscuring the longer-term continuities and patterns that unfold over years and decades. By the end, when he has gotten into yet another new relationship with another new girlfriend, and suggests to his treater that he try stopping his latest antidepressant medication, I found myself silently screaming at the page, “No! Don’t do it!” But you can’t see the bigger picture when you’re living the day-to-day. He stops taking his medication. Becomes disenchanted with the girlfriend. Relapses. Again.

How to Be Depressed is a memoir of suffering through what David Foster Wallace called “the Great White Shark of pain,” but I found the ending to be surprisingly tender. Among the advice that Scialabba gives in his closing chapter is a list of foods to keep in the fridge, like good yogurt: tiny pleasures might sustain you, even for just a few moments, when your capacity to perceive a different future has been obliterated. The fictional narrator of Tom Lake recounts a much happier life, but there is a similar tender domesticity in its conclusion:

“The painful things you were certain you’d never be able to let go? Now you’re not entirely sure when they happened, while the thrilling parts, the heart-stopping joys, splintered and scattered and became something else. Memories are then replaced by different joys and larger sorrows, and unbelievably, those things get knocked aside as well, until one morning you’re picking cherries with your three grown daughters and your husband goes by on the Gator and you are positive that this is all you’ve ever wanted in the world.”

Wishing you whatever your version of good yogurt and a Gator is,

Paige

Chickens are known for their pecking order, and American economists are known for their ranking obsessions, but it’s male mice who have perhaps the most brutally enforced linear dominance hierarchies. Alpha Mouse bites Beta Mouse; Alpha Mouse and Beta Mouse bite Gamma Mouse, and so it goes, all the way down the line. Revolutions are rare and swiftly resolved.

In addition to biting his subordinates, Alpha Mouse also pisses everywhere, marking his territory. Mice burrow underground, but they must come up for sustenance, and the areas around the tunnel openings are prized territories, access to which is regulated by status. Alpha Mice also dominate access to mates. As with humans boarding an aircraft, position in the social hierarchy determines who gets to go first through a portal.

All this biting and pissing and fucking is time-consuming and metabolically costly. Alpha Mouse doesn’t sleep much, and he has to keep eating and drinking. Pissing, after all, requires drinking, and drinking requires thirst. When a mouse ascends to Alpha, he shows rapid changes in patterns of gene expression in his hypothalamus, a part of his brain that regulates hormones and basic physiological drives. More thirst, more appetite, less sleep, more testosterone, more sperm, more urinary proteins, better spatial cognition. Faster biological aging, a compromised immune system.

One of the genes differentially expressed in dominant mice codes for “cocaine- and amphetamine-regulated transcript (CART) protein.” I don’t know what CART protein does, but just the name is evocative — descriptions of what happens to a mouse when he ascends to Alpha do, indeed, remind me of being 26 in a Cambridge dive bar with male friends who have snorted Ritalin. They don’t care if I’m ready to go home and go to bed; sleep is not on the menu. They are going to have another drink and then another and then another; they are going to grind on women on the dance floor and respond explosively when a stranger passes by too close, jostling their arm. The night will teeter on the sharp edge between fun and disaster.

I know a little bit about “social status mediated variation in hypothalamic transcriptional profiles of male mice”, because James Curley, a behavioral neuroscientist who studies social dominance and social behaviors, is my colleague in the Psychology department at the University of Texas. He recently went up for tenure, which requires giving a talk to the whole department on what you’ve done with the past decade of your life. Curley described a series of experiments where male mice are put together in a giant vivarium and allowed to establish their usual dominance hierarchy — and then, like a rapturing demiurge, he removes the Alpha and watches what happens next. Who ascends? (Usually, but not always, the Beta.) When? (Astonishingly quickly.) And (here is the behavioral neuroscience part) what happens to the ascendent Alpha’s body and brain? How do these changes affect Alpha Mouse’s subsequent behavior, such as whether his dominance collapses, or how despotic he is? It’s fascinating work.

The fact that I, a clinical and developmental psychologist who studies human children and adolescents, am in the same department as a behavioral neuroscientist who studies mice is not unusual. Psychology is a discipline that transcends species boundaries. In addition to studying mice, faculty in my department also study quail and voles and monkeys and rats. My first job in science was in a research lab that studied neurobiological mechanisms for opioid tolerance and withdrawal … in mice. I co-teach an undergraduate Introduction to Psychology course with a personality psychologist who wrote his dissertation on personality … in spotted hyenas. Our course, like most Intro Psych courses, has a lecture on classical and instrumental conditioning, which begins with salivating dogs and ends with exposure therapy for war veterans with PTSD, with stops along the way for cats in puzzle boxes and pigeons pecking for food and a baby taught to fear white fuzzy things. We always begin our course with a definition of psychology (“the science of mind and behavior”) and a description of our goal (“teaching you to think like a psychologist”) — but we’ve never articulated one core aspect of thinking like a psychologist, probably because we’ve been so close to it, we can’t see it, it is water to our fish: Human behavior is a type of animal behavior, because humans are animals.

Humans are animals. This was the thought that flashed through my mind last November when a young woman approached me after a talk I gave at the American Society of Human Genetics. Human. Genetics. You might think that a working scientist at a conference devoted to the study of human genetics would also have fully incorporated the idea that there are important continuities between the study of humans and of non-human animals, but you would be wrong!

My talk at the ASHG conference was part of a panel summarizing the work of a three-year, multidisciplinary Hastings Center working group on “Wrestling with social and behavioral genomics: Risks, potential benefits, and ethical responsibilities.” The panel went well, I think, except that one of my Internet trolls, a man I blocked on Twitter/X years ago but who continues to post vitriol undeterred, showed up in person to yell admonishments at us. I find it creepy when people obsessively hate things on the Internet; I find it creepier when the need to communicate those obsessive hates jumps from the screen to real life. But the interaction I’ve continued to think about in the weeks and months afterward is not with the sad older man who traveled gosh-knows how far and spent hundreds, maybe thousands, of dollars just to yell for a few minutes. It’s the one with the young woman, who was so confident when she asked: “Doesn’t it stand to reason that only social factors, not biological factors, explain social behavior?”

I didn’t give her a particularly articulate or compelling response, in part because I was so flabbergasted by her premise, and by how casually it was advanced. “Social laws are to be discovered only through the study of society; natural laws only through the study of nature.” So said the Russian Marxists, and so said this academic geneticist. For the record, I don’t think social behavior — in mice or people — is determined by biological factors or entirely explained by biological factors or reducible to biological factors. Even for mice, the way to know who is dominant and who is subdominant and who is subordinate is not to measure anything about their biology but to observe the operation of power: who aggresses against whom, who monopolizes resources? But only social factors explain social behavior?! The way I see it, the study of social behavior is part of the study of nature and the study of nature is part of the study of social behavior because humans live in societies and humans are part of nature. Because humans are animals.

Poets remember this. Here, for instance, are lines from Mary Oliver’s enormously popular poem, “Wild Geese”:

You only have to let the soft animal of your body
love what it loves. ... 

Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting -
over and over announcing your place
in the family of things.

And here are lines from Claudia Rankine:

To live through the days sometimes you moan like deer. Sometimes you sigh. The world says stop that. Another sigh. Another stop that. Moaning elicits laughter, sighing upsets. Perhaps each sigh is drawn into existence to pull in, pull under, who knows; truth be told, you could no more control those sighs than that which brings the sighs about.

//

The sigh is the pathway to breath; it allows breathing. That's just self-preservation. No one fabricates that. You sit down, you sigh. You stand up, you sigh. The sighing is a worrying exhale of an ache. You wouldn't call it an illness; still it is not the iteration of a free being. What else to liken yourself to but an animal, the ruminant kind?

What else to liken yourself to but an animal? I’ve been thinking recently about how many of my scientific interests, literary interests, and political commitments fall under that theme, which can be both horrible and liberating to contemplate. Near the end of Janet Malcolm’s Psychoanalysis: The Impossible Profession, she quotes one of the analysts she’s been interviewing:

To say “Man is not an animal” is to say nothing that banal people haven’t always said. To say that our essential humanity resides in precisely that part of our nature which is most instinctual, primitive, and infantile — animal — is to say something radical.

My plans for this Substack are still unclear, in part because I’m ambivalent about thinking out loud in public again (a topic for another post!). But this is what I want to think more deeply about — about the science and poems and memoirs and novels and political movements and personal experiences that remind me how my essential humanity resides in the soft animal of my body. I hope you will think along with me.

With excitement and trepidation,

Paige

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