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Check out our key concepts here, which will help you to apply a critical thinking lens to this topic, and articulate your ideas about it. These concepts are highlighted.

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A mini-lesson based on a Conversation article, tracing the etymology of the word ‘cancer.’

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WHAT’S IN A WORD? | ACT mini-lessons (Middle)

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A Smithsonian article, looking at the legacy of Dr Lulu Hunt Peters, who invented the term ‘calorie’, leading to a paradigm shift in the way we viewed diet and nutrition. 

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A Smithsonian article, looking at the legacy of Dr Lulu Hunt Peters, who invented the term ‘calorie’, leading to a paradigm shift in the way we viewed diet and nutrition. 

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This Doctor Pioneered Counting Calories a Century Ago, and We’re Still Dealing With the Consequences

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When Lulu Hunt Peters brought Americans a new method for weighing their dinner options, she launched a century of diet fads that left us hungry for a better way to keep our bodies strong and healthy

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A Big Think article, which tries to ascertain whether certain health issues are caused by, or correlated with, the consumption of artificial sweeteners.  

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A Big Think article, which tries to ascertain whether certain health issues are caused by, or correlated with, the consumption of artificial sweeteners.  

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UNPACKING THE SOURCE How important is it to know the methodology behind scientific conclusions and guidelines? What steps can we take to discover these?

KEY TERMS Associatedwith, Lazy nutrition science, Observational, RCTs, Correlation vs. causation, Hyped health stories, Alarm fatigue

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Don’t buy the lazy nutrition science on artificial sweeteners

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You might have heard that non-sugar sweeteners are bad for you, maybe even worse than sugar, itself. You’ve been misled by lazy research.

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A Guardian article, asking the question ‘what makes people annoying?’ to prompt a discussion about this little known and studied aspect of psychology.

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A Guardian article, asking the question ‘what makes people annoying?’ to prompt a discussion about this little known and studied aspect of psychology.

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I couldn't stand her.

I didn't actually know her. My friends had been sharing her videos about politics and current events. Her opinions weren't that different from my own. But something about her felt insincere. Smug. Less interested in politics and current events and more in presenting herself. Her shtick felt both irritating and uncomfortably familiar.

I scrolled back through her videos, to ones that had been posted years ago. There was that familiar feeling again: they were all of her singing.

Of course. She was a theater kid.

A performer, a self-promoter, talented - but painfully aware of it. Everybody finds theater kids annoying: their self-seriousness, their loudness, their incessant recitals of Rent. Somewhere, right now, a group of them are systematically ruining someone's night at Denny's.

Yet, I felt guilty for being annoyed. Because I'm a theater kid, too. I always have been. I was performing made-up songs and monologues for my friends in preschool. I have a BFA in drama. I've considered getting an Our Town-inspired tattoo.

When I saw that girl's videos, I thought of my most embarrassing self. The constant "too loud/excessive talking" marks on my report cards; the exasperated faces when I finally got the karaoke mic; the constant grandstanding on Twitter in my 20s. Theater kids live at the nexus of painfully sincere and desperately performative.

"You don't like in other people what you don't like in yourself," someone once told me. I wondered if it's as simple as that.

What is annoyance?

"Annoyance is probably the most widely experienced and least studied of all human emotions," wrote Joe Palca and Flora Lichtman in their 2010 book, Annoying: The Science of What Bugs Us. "There is no Department of Annoying Studies or annoyingologists." Many psychologists consider it a subset of anger, rather than a pure emotion in itself, and thus harder to study.

Many psychologists consider annoyance a subset of anger, rather than a pure emotion in itself, and thus harder to study

"Emotions are sometimes plotted on a chart," Palca and Lichtman write, "with positive/negative on one axis and arousal/calm on the other." This method of charting emotions is often called the valence-arousal model. While the extremes are easy to see - such as excitement, a positive feeling with high arousal, or depression, a negative state often with low arousal - where does something less dramatic like annoyance fit in?

MC Flux, a psychologist, neuroscientist and science communicator from the University of Colorado, Boulder, describes annoyance as "moderately negative, and moderate arousal". Ultimately, he believes, humans want to "maintain homeostasis", to feel as if they are safe, stable and in control. Emotions, particularly high-arousal ones, often lead to actions that we hope will get us there.

Similarly, annoyance serves a purpose, says Flux: "It's basically a flag, saying: 'Something is wrong, and I should probably do something about it.'"

Graphic with three lines of text that say, in bold, 'Well Actually', then 'Read more on living a good life in a complex world,' then a pinkish-lavender pill-shaped button with white letters that say 'More from this section'

Many annoying things are designed that way. A baby cries because it needs attention. Ambulance sirens need to be loud and obnoxious so people will get out of the way. "The job of an EMS driver ... is to overcome everyone's ability to ignore things," Palca and Lichtman write.

"A lot of our emotions evolved to push us in the direction of social cohesion," says Flux.

Yet, while we can pick up a crying baby or pull over when we hear a siren, we can't do much about other people's behavior, at least not without causing some social discomfort. Perhaps this is why it stings when we see our annoying qualities in others.

"When you see a little bit of yourself in something," Flux says, "you recognize it more and you feel like you have more ability to intervene."

I wish I could tell social media theater kids that not everyone needs to hear their opinions all the time, but I can't. All I can do is try to remember that myself.

What makes something annoying?

Of course, not all annoying people act like us. Sometimes a behavior is annoying because we don't understand it.

Sometimes a behavior is annoying because we don't understand it

In Annoying, Palca and Lichtman quote Michael Cunningham, then a communications professor and researcher at the University of Louisville, who describes annoying acts as "social allergens". These don't bother us so much at first, but build up over time. He says most fall into one of four categories: uncouth habits, inconsiderate acts, intrusive behaviors and "norm violations".

The first three categories are all about roughly the same thing: crossed boundaries. Someone's actions are intruding on our time, personal space or sense of propriety. Yet his final category may be the most important.

"These are intentional behaviors that are not aimed at you personally, but violate some standard that you have," Cunningham is quoted as saying.

Norms and values dictate our lives, and show us what to expect. These can vary widely, though. In a recent conversation with a friend, I discussed someone I thought was a bit conceited.

"Don't you hate when people go on and on about all the things they've done?" I asked her.

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She disagreed. She figured people like that were just being honest, and taking pride in their accomplishments. I was stunned. Didn't everyone believe that modesty was the ultimate virtue, like my Irish-Catholic father and raised-in-Minnesota mother had taught me? Apparently not.

There are a million different cultures and viewpoints. Obviously, some will conflict. I could go on any social media app and see something completely against my beliefs: "Women should always be subservient to men," say, or "The Phantom of the Opera is a great musical."

"We are a culture that takes annoyance seriously," says Flux. In the US, we pride ourselves upon rebelling and speaking out. It's led to some great advances, but fundamentally, we may not be great at picking our battles.

It's easier to be annoyed about a minor irritant (someone's showy videos about politics) than it is to be upset about a major issue (the limits of what I can do politically).

"'If you see something, say something' - that is the epitome of our culture! We say something about everything," says Flux. "Annoyance robs us of our energy and our ability to really make a difference ... We have to figure out how to re-balance our responses."

Is it possible to be less annoying - or annoyed?

I know I can be annoying. Sometimes I've wondered if it's possible to have secondhand embarrassment for myself. I also know that I can be easily annoyed.

Pam Shaffer, a licensed marriage and family therapist in Los Angeles, suggests getting "curious about the other person's experience". If someone is doing something that violates our norms or boundaries, there's almost always a reason for it. Trying to imagine what is driving their behavior can make us feel less annoyed.

Trying to imagine what is driving someone's behavior can make us feel less annoyed

While it's not necessarily a positive emotion, curiosity "can defray a negative emotion", Shaffer says.

So we shift the question from "Ugh, why would anyone do that?" to "Huh, why would anyone do that?"

"Often the behavior I find most annoying is attached to some deep-seated insecurity," says Rachel Vorona-Cote, author of Too Much: How Victorian Constraints Still Bind Women Today.What annoys her is people who lack awareness of their own actions. "It's uncomfortable to bear witness to people who don't have any idea of the effect they have on others."

Monitoring our own behavior, then, and being conscious of what we are insecure about, might make us less likely to irritate others. This can be tricky, though, especially for the many people who struggle to interpret social cues, or for those who live in a culture different from the one they were raised in.

And how much looking inward is too much? The cruel irony is that being obsessed with how one is coming across can make one more annoying. I spent my teens and 20s as the friend who apologized constantly. It was exhausting, both for me and for others.

The cruel irony is that being obsessed with how one is coming across can make one more annoying

Flux suggests that it's not helpful to think about how to be less annoying. "Everyone's going to find you annoying in some way," he says. A more important question might be: "How do we learn to better manage things that annoy us?"

"I think sometimes we can take too much of a confrontation-heavy approach to how we interact," says Flux. Instead, we could try what he calls "prosocial behaviors" - actions that are designed to build connections with others, like teamwork, positive reinforcement or making ourselves useful.

Funnily enough, my old theater kid days provide a good example of how to do that.

At my arts high school, eligible theater students auditioned for every play. If we weren't cast, we would help build sets, make costumes, run lights and assist the stage manager.

It gave us perspective. We worked with different people, learned why they were the way they were. If we found someone annoying, too bad - we still had to work together. When someone is showing you how to use a miter saw, you have to stop singing Defying Gravity and actually listen, lest you lose a finger.

Rather than focusing on oneself, working together and getting curious are good ways to be less annoying, and less annoyed. Because, as a theater kid might say: "Together, we're unlimited."

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'Annoyance is probably the most widely experienced and least studied of all human emotions,' say the experts - here's what we know, and how to deal

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A Conversation article, looking at Dua Lipa’s ‘radical optimism’ philosophy to life, and concluding that ‘radical openness’ represents a more effective approach. 

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A Conversation article, looking at Dua Lipa’s ‘radical optimism’ philosophy to life, and concluding that ‘radical openness’ represents a more effective approach. 

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UNPACKING THE SOURCE How can we navigate a path between toxic positivity and fearful pessimism?

KEY TERMS Choose optimism, Pragmatist, Philosophical school of thought, Agency and responsibility, Toxic positivity vs. fearful pessimism, Self-delusion, Meliorism

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In a teaser video for her third album, Radical Optimism, Dua Lipa explained that every track has that "through-the-struggle-you-are-going-to-make-it" optimistic feeling.

She has also said that the album "taps into the pure joy and happiness of having clarity in situations that once seemed impossible to face". She added: "The hard goodbyes and vulnerable beginnings that previously threatened to crush your soul, become milestones as you choose optimism and start to move with grace through the chaos."

This "chaos" is a feeling all too familiar for many young adults today. The philosophy of radical optimism sounds like an answer to the confusion that often accompanies our 20s and 30s. So, should we all seek to harness "radical optimism" to gain the kind of clarity and fortitude Lipa speaks of in our own lives?

I'm a pragmatist philosopher researching how we can constructively and honestly face personal and collective catastrophe. While I like the idea of fostering a hopeful and empowering outlook when facing life's many challenges, I worry that radical optimism can have some damaging consequences.
This article is part of Quarter Life, a series about issues affecting those of us in our 20s and 30s. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life. You may be interested in: Lucky girl syndrome: the potential dark side of TikTok's extreme positive thinking trend What millennials and gen Z professionals need to know about developing a meaningful career Big Mood is a gloriously exuberant comedy about navigating mental health in your 30s
Radical optimism isn't a singular recognisable philosophical school of thought, so it can be hard to pin down exactly what it means.

If pessimism is the expectation that mostly bad things will happen, then optimism is the expectation that mostly good things will happen. Radical optimism stresses the importance of agency and responsibility in understanding our negative experiences, prescribing a mindset that things will ultimately work out for the better.

This might sound a lot like the deeply unscientific "law of attraction", which suggests that positive thoughts can somehow cosmically "attract" positive outcomes, such as wealth and success. But radical optimists, much like people who follow stoicism, generally place a greater emphasis on equanimity (calmness and composure in difficult situations) than fans of the "law of attraction". They believe that confidence and trust are better ways of dealing with problems than fear and worry.

The perceived importance of happiness and positivity is so embedded in our culture that phrases like "stay positive" or "be kind to yourself" seem to have become the common sense adages of our age.

In most cases, they serve as simple reminders not to be too hard on ourselves. This is appropriate because humans tend to suffer from a negativity bias - we notice and dwell more readily on negative experiences than positive ones. Taken too literally, however, these adages can result in "toxic positivity" - a compulsion to present an upbeat attitude, regardless of how you authentically feel.

This can be damaging as it can lead to desensitisation and even dissociation by hindering your capacity to discern your true feelings and values. It can also disconnect you from valuable experiences of sadness, frustration, anger and grief.

Radical optimism ultimately aims for a middle way between toxic positivity and fearful pessimism. But when coming from a megastar like Lipa, the message of radical optimism can feel a bit rich.

On the whole, with a positive attitude and appropriate efforts, things probably will work for out for privileged people like her. But is the same thing true for those living within the normal range of talents, gifts and wealth? If not, then embracing radical optimism could actually be a mild self-delusion, heightening expectations that simply can't be met and so causing greater despair down the line.

I suspect that Lipa is not blind to this, as she has shared her own experiences of suffering and is the daughter of refugees. The album title comes from her 2021 Grammy acceptance speech, when she said:

One thing that I've really come to realise is how much happiness is so important. I felt really jaded at the end of my last album where I felt like I only had to make sad music to feel like it mattered ... happiness is something that we all deserve and something that we all need in our lives.

These words were heartfelt and poignant, personal but also collective since they arrived on the screens of millions of people during the pandemic - probably feeling a good deal of fear and despair. In times of duress, allowing yourself to hope for future happiness is both healthy and helpful.

However, directly trying to boost our happiness has a tendency to make it recede ever further on the horizon.

Psychologists have amassed a trove of data about happiness, and it turns out that happy people rarely think about their own subjective happiness. Instead, they direct their attention towards things that they find intrinsically valuable (like personal passions or their sense of purpose) and towards their relationships with others. They also tend to be physically active and regularly feel grateful.

Meliorism and being 'radically open'

I think a better approach than radical optimism is to understand that the future is radically open. The American philosopher and psychologist John Dewey described " meliorism " as "the belief that the specific conditions which exist at one moment, be they comparatively bad or comparatively good, in any event may be bettered". In other words, Dewey thought that we should believe that we can make progress, but understand that it demands personal and often collective efforts.

A well-grounded hope that recognises the radical openness of the future can bolster our initiative and deepen our compassion. It also avoids unhelpful forms of emotional suppression.

As the great existential psychotherapist, Irvin Yalom, said: facing the negative parts of human life (mortality, loss, isolation, uncertainty) head on can be a powerful experience that yields self-knowledge and life-sustaining meaning. It can help us to slay superficial, comfortable hopes to allow for a deeper, less shaky, form of hope to grow.

Understood in the right way, meliorism can see us through the most painful and confusing times in our life more effectively than any kind of simplistic optimism. That's because it can remind us of our own frailty and fallibility, while at the same time affirming our agency and interdependence. It reminds us to ask for help and to believe that our habits, actions and beliefs ultimately matter in helping us find a way through.

Perhaps, meliorism is what Lipa is really referring to when she speaks of "radical optimism". I will have to listen to the album carefully to know for sure. But I admit it: "radical meliorism" isn't quite such a catchy title.

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Radical Optimism is Dua Lipa's philosophy for dealing with life's chaos - but radical openness is a better approach

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Humans tend to suffer from a negativity bias - we notice and dwell more readily on negative experiences than positive ones.

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A Knowable article, exploring why it’s hard to answer the question, “How much vitamin D should we take?”

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A Knowable article, exploring why it’s hard to answer the question, “How much vitamin D should we take?”

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UNPACKING THE SOURCE Does uncertainty indicate the strength or the weakness of science?

KEY TERMS Contradictory scientific results and interpretation, Debunked, Clinical trials, Evidence

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Should you take vitamin D? Here's the science

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Some people take too much, and too many get too little. Experts explain who needs D supplements, and why.

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A Vox article, investigating the work of Elon Musk’s Neuralink company “to achieve a symbiosis with artificial intelligence.” 

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A Vox article, investigating the work of Elon Musk’s Neuralink company “to achieve a symbiosis with artificial intelligence.” 

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UNPACKING THE SOURCE Is there a danger of our ‘final privacy frontier’ being breached? Should steps be taken to prevent that from happening?

KEY TERMS Clinical trial, Risks, Symbiosis, Ethical risks, Final privacy frontier, Brainjacking

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Elon Musk wants to merge humans with AI. How many brains will be damaged along the way?

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The brain implant company Neuralink is pushing a needlessly risky approach, former employees say.

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Lee Tilghman entered the online world in the early 2010s, with a healthy food blog she had started in college. Influencing was just becoming a thing. When she moved to Instagram, with the rest of her generation, in 2014, and featured one of her smoothie bowls, she gained 20,000 followers overnight. "Brands began reaching out to send me products," she remembers now.

Two years later, she quit her nine-to-five and moved from Connecticut to Los Angeles. Within a year, she gained another 100,000 followers, an agency and manager. "I was earning upwards of $15,000 a post and working with major food and lifestyle brands who'd sell out of whatever I posted about."

Tilghman in an Instagram post. Photograph: Instagram/ @leefromamerica

Her lifestyle matched the wellness ethos, says Tilghman, 34, who lives in Brooklyn, New York. "I believed anything in a package was bad. I only ate organic fruit, veg and grains, no complex carbs. I was afraid to use unnatural cleaning products and I did intermittent fasting from 7pm to noon."

Content was all she thought about, but her extreme lifestyle quickly took its toll. "My followers told me they loved me, but I had no time to spend with friends. Watching the response to my posts was like undergoing a performance review every day. I remember getting to 100,000 followers and being ecstatic for one day before I wanted 1 million."

In 2018, the internet "semi-cancelled" her for putting on workshops that cost too much. "The truth is, wellness is really inaccessible," says Tilghman. "I was publicly shamed to the point where I considered suicide." Her "healthy" diet had also triggered an eating disorder. She took five months off, lived on her savings and checked into a treatment centre. "Social media rewards extremes and obsessions, and wellness is dangerous territory. My body was my business card and I had been afraid of gaining weight. It wasn't just about what I was promoting but what I was hearing and receiving online, too."

When she returned to her social channels, she ditched everything she had become known for. "Social media was still the place where I knew how to make money, so I went back, but I no longer did wellness," she says. Instead, she began posting about her life, her dog, fashion, interiors.

I let myself enjoy life and food and stopped living so rigidly. It was freeing

"I ate properly and looked healthier, too. If I wanted candy, I ate candy. My favourite foods became pasta, sandwiches and Vietnamese. I let myself enjoy life and food and stopped living so rigidly. It was freeing." However, it sparked a backlash from followers. "People said, 'You go from one extreme to another.' Some really cared but others wrote nasty things. Because I'd gained some weight, some speculated I was pregnant."

Away from wellness, her follower count dwindled from almost 400,000 to 300,000 and her commercial rate dropped 70% . "Financially, it wasn't nothing but it wasn't worth it. I kept thinking about something a therapist had said - that she did not believe there was a healthy way to engage on social media. I was out of love with it."

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In 2020, Tilghman moved to New York and stopped posting for a while. "I basically ghosted my channels," she says. "I gradually went back on, but it became normal usage, like anyone else, just with lots of followers." Not only has she left wellness behind, she now consults in marketing, runs $40 workshops on how to stop being an influencer and has a book in the works about her time as an influencer and why she walked away.

"Sometimes I miss those easy early days when I made $20k a post, but wellness is a multibillion-dollar industry that's like a cult. I see right through it. People on the street still say 'hi' occasionally and, sometimes, people will comment on my Instagram, saying: 'I wish you'd just go back to recipes,' but that's like telling Bob Dylan to go back to folk music. I've moved on."

In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@ samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counsellor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org

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'Wellness is a multibillion-dollar cult. Now I see through it': the clean-living Instagrammer who learned to let go

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What happened when a lifestyle influencer started eating what she liked?

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A Guardian article, exploring the issue of genetic discrimination in Australia, where people are at risk of being denied life insurance cover if they suffer from certain genetic disorders.

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A Guardian article, exploring the issue of genetic discrimination in Australia, where people are at risk of being denied life insurance cover if they suffer from certain genetic disorders.

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UNPACKING THE SOURCE How does the case of Meg Herrmann highlight the problem of ‘genetic discrimination’? Why are people in Australia who have a higher risk of genetic disorders reluctant to be tested for these conditions? What demands for change are many people making as a result of this situation? To wrap up: Does the health industry have a different set of responsibilities when it comes to the knowledge they possess and utilize? Who should determine what these responsibilities are?

KEY TERMS Dilemma, Genetic discrimination, Evidence-based

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After her mother was diagnosed with breast cancer, Meg Herrmann decided to get genetically tested for a hereditary cancer-causing gene.

"I thought, 'I need to know.' Hereditary cancer can develop at any point in your life and you have a 70% likelihood that it'll develop," the Brisbane PhD candidate says.

Twelve weeks ago, the 25-year-old underwent a preventive mastectomy. As a carrier of the BRCA2 gene, the surgery has reduced her chance of developing breast cancer by more than 95%.

While she has taken life-changing steps to benefit her health, her financial future hangs in the balance. Under the Disability Discrimination Act, she can be denied life insurance as she took a genetic test that revealed her cancer risk.

The practice - known as genetic discrimination - is now under scrutiny, with submissions to the federal government's consultation on the use of genetic testing results in life insurance underwriting closing on Wednesday night.

Meg Herrmann underwent a preventive mastectomy that has reduced her chance of developing breast cancer by more than 95%. Photograph: Meg Herrmann

In Australia, an exception to anti-discrimination legislation allows insurance companies to use genetic information to deny, cap or increase the cost of life insurance cover.

A 2018 parliamentary joint committee called for an industry ban on genetic discrimination, and since 2019, an industry self-regulated partial moratorium has prohibited life insurance companies from using genetic information of people making applications below certain limits, such as $500,000 for death cover and $4,000 a month for income protection. Providers are still legally allowed to request genetic information under the current legislation.

"I'm now less likely to have a life insurance payout because I have done the genetic testing which then enabled me to take preventive measures," says Herrmann, whose great-grandmother and great-aunts all developed breast cancer in their 20s.

"But if I had been too worried about the risks genetic testing would put on my financial future, I could be a BRCA2 carrier without knowing. And I would be more likely to need a life insurance payout if I had not taken the genetic test."

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It's a dilemma familiar to Matthew Howie, one of more than 850 people and organisations to respond to the consultation paper since it launched in November.

The Adelaide retiree was diagnosed with haemochromatosis after presenting to his doctor with sore joints and fatigue. The iron disorder is easy to treat but can lead to permanent organ damage and can only be pinpointed by a genetic test.

'Life insurance is dissuading people from genetic testing': Matthew Howie Photograph: Matthew Howie

Now 71, his four children are at risk of developing the same condition. His grandchildren have been advised by a doctor to not undertake genetic tests "as it could impact their insurances".

As a volunteer with the advocacy group Haemochromatosis Australia, he advises haemochromatosis sufferers to encourage first-degree relatives to seek genetic testing, but they are often uneasy about how that might affect life insurance.

"My concern is that life insurance is dissuading people from genetic testing and people are not becoming aware of their symptoms until their body has a significant iron overload," he says. "Early intervention is key to controlling this condition."

'No one's trying to die to get a life insurance payout'

Dr Jane Tiller, who has been leading a push for a total ban on genetic discrimination, says Australia is "way behind" the UK, which agreed to end genetic discrimination in 2001, and Canada, where a full ban applies not only to the life insurance industry but to all goods and services.

"Stakeholders in Australia don't think the moratorium is adequate in any way," says Tiller. She predicts that all Australians are likely to be offered genetic testing within the next decade, making good protection against genetic discrimination "urgent".

The Council of Australian Life Insurers' chief executive, Christine Cupitt, said "the insurance industry welcomes government regulation".

"It's critical that regulation meets community expectations while also managing the risks and costs of life insurance fairly for everyone insured," she said.

The organisation points out that insurers "take into account ... any evidence-based preventive treatment [consumers] have undertaken that reduces their possibility of developing a hereditary illness".

The minister for financial services, Stephen Jones, said in November that Australians "shouldn't have to think about their hip pocket" when they think about preventive health.

"So many people across academia, industry and the parliament have worked to bring attention to this issue, and we absolutely need to look into it," he said.

Herrmann agrees, saying it's time to remove the threat of family-wide financial impacts for individuals investing in their future health.

"No one's trying to die to get a life insurance payout," she says. "We actively want to do everything we can to avoid it."

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When testing costs you: the genetic dilemma confronting Australians with life insurance

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With insurance companies using genetic information to set prices and policies, advocates say the need for protection against genetic discrimination is 'urgent'

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In the fevered world of diet and nutrition, the past year has been dominated by heated arguments about the evils (or not) of ultra-processed foods. These have not just been confined to the media but have, unusually, engendered equally fractious debate in academic circles. So what is the "truth" about UPFs? Are they as bad for health as many claim? And how are consumers, armed with this information, meant to navigate the supermarket aisles?

The processing of food, including cooking, fermentation, pickling, curing and smoking, is as ancient as humankind. These processes reduced the chances of food poisoning, increased nutritional availability and ensured that we had a predictable source of calories through seasonal changes in the availability of fresh food. They were critical to our ability as a species to survive and eventually thrive.

But UPFs are a different beast - they are the products of industrial processing methods that we cannot replicate in a domestic situation. They include pretty much all carbonated drinks, ice-cream, biscuits, margarines, pastries, cakes, breakfast cereals, stock cubes, infant formulas and mass-produced packaged breads.

They are also cheap to produce, and because of their long shelf-lives are easy to store and transport. They are inexpensive and more likely to be bought and consumed by those less privileged in society. On average, here in the UK, we get about 50% of our calories from UPFs and the ubiquity with which these foods are available merits sober debate.

But at the same time, it is intriguing, to me at least, that some UPFs have not only avoided being tarred by the same brush, but also seem to be associated with an enlightened way of healthy eating.

The menagerie of plant-based dairy replacements and faux-meat burgers, as well as many other "premium" ultra-processed foods that find their way into higher-end supermarkets and restaurants, are a case in point. In my view, these foods have escaped the kind of scrutiny saved for mainstream UPFs. But from a processing standpoint, there is really no difference between oat milk creme fraiche and your standard dairy ice-cream, or a frozen beef burger patty and a burger made from soy protein.

'The menagerie of plant-based dairy replacements and faux-meat burgers ... seem to be associated with an enlightened way of healthy eating.' Burger King's plant-based Rebel Whopper. Photograph: Bloomberg/Getty Images

From a nutritional perspective, oat milk has a lot of oil and emulsifiers and other additives, and a faux-meat burger is still high in sugar, salt and fat; looking through a different lens, one might even consider them junk foods. And yet, the debate around UPFs rarely interrogates why we label some of these foods as more harmful than others.

There is more than ample evidence that consumption of too much ultra-processed food is linked to poorer health outcomes. Most recently a meta analysis of 45 different studies encompassing nearly 10 million people and published in the British Medical Journal reported links with 32 health concerns, spanning early death, cancer, mental health, respiratory, cardiovascular, gastrointestinal and metabolic health outcomes.

This makes sense when you look at how UPFs are made. Most UPFs are inherently lower in protein and fibre and higher in sugar, salt and fat. But the way we currently talk about UPFs strikes me as unhelpful. The term covers such a broad spectrum of different foods, from those that have been almost completely reconstructed from their base constituents, to otherwise minimally processed foods with a few industrial additives, such as a natural yoghurt, with a small amount of UPF jam.

I can absolutely understand how eating too much of the former can lead to poorer health outcomes. The latter, however, includes mass-produced supermarket bread, where a large proportion of consumed UPF calories come from. Sure, you can go to a bougie bakery and purchase an artisanal sourdough without any additives that will cost much more and taste better than a supermarket loaf. But ultimately, bread is made from flour, salt, water and yeast. Taste aside, supermarket bread is no worse for you than fancy bread.

I am an unashamed champion of improving our diets in order to try to stem the current tsunami of diet-related illnesses, and there are certainly many foods that we undoubtedly have to eat a lot less of. To do so, we need to, first and foremost, focus on the nutritional content of our food; we should be looking to consume enough protein and fibre, and a little less sugar, salt and saturated fats. And the reality is that the only way to do this equitably is to make the healthy choice the cheaper, more convenient and easier option.

I fear that the UPF concept is too imprecise to be an arbiter of how healthy or unhealthy a particular food might be, and even worse, that it is currently being used as another cudgel to food-shame others; while at the same time, the privileged in society celebrate and congratulate themselves for eating similarly processed foods that simply have better PR.

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Why the double standards on ultra-processed foods? Because some have better PR than others | Giles Yeo

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The growing evidence on UPFs merits sober discussion, but products marketed with a halo of 'health' are avoiding scrutiny, writes professor of molecular neuroendocrinology Giles Yeo

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A Guardian article, reporting on the news that the French government has made abortion a constitutional right.

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A Guardian article, reporting on the news that the French government has made abortion a constitutional right.

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The French parliament will meet in a historic joint session at the Palace of Versailles on Monday for a final vote on enshrining abortion as a constitutional right.

The vote, which is expected to achieve the three-fifths majority necessary to pass, will give women the "guaranteed freedom" to choose an abortion.

The measure has already been passed by the upper and lower houses - the Sénat and the Assemblée Nationale - but final approval by parliamentarians at the joint session at Versailles is needed to effect constitutional change.

The president, Emmanuel Macron, said he had promised to make women's freedom to choose an abortion "irreversible". Writing the right to abortion into the constitution is seen as a way of protecting the law that decriminalised abortion in France in 1975.

During the debate on the law, which opened in the national assembly in January, the justice minister, Éric Dupond-Moretti, told MPs that abortion rights were not simply a liberty like any other, "because they allow women to decide their future".

Aurore Bergé, the minister in charge of equality and the fight against discrimination, added: "This vote will be one of the most important and remarkable of this parliament."

Once the two houses had agreed the wording of the legal text, Macron had the choice to hold a national referendum or call a joint parliamentary "congress" made up of 577 MPs and 348 senators.

Monday's session is the first to be held to change the constitution since 2008, when Nicolas Sarkozy took steps to modernise French institutions, including limiting presidents to a maximum of two consecutive five-year terms in office.

Amending the 17th paragraph of article 34 of the French constitution requires a majority of three-fifths of votes cast on Monday afternoon. On paper, this poses no problem since about 760 parliamentarians out of 925 are believed to support the change.

The congress will be overseen by Yaël Braun-Pivet, from Macron's Renaissance party, who is the equivalent of speaker of the lower house. Parliamentarians will be seated in alphabetic order and the session will open with an address by the prime minister, Gabriel Attal.

The leaders of 18 political groups - 10 from the lower house; eight from the upper - have been invited to each speak for five minutes on the change before the vote. The result is expected in the early evening.

The text will then be authenticated by a "seal of congress" and be sent to the government. Macron will attend a ceremony to finalise the constitutional amendment on Friday, International Women's Day.

Political impetus was given to the constitutional change after the US supreme court's 2022 decision to overturn Roe v Wade, a ruling that had recognised women's constitutional right to an abortion and had legalised it nationwide.

Rightwing senators from the Républicains party voted against a first attempt to change the French constitution in October 2022. Later that year, the French parliament voted to extend France's legal limit for ending a pregnancy from 12 to 14 weeks, amid anger that thousands of women were forced to travel abroad each year to terminate pregnancies in countries including the Netherlands, Spain and the UK.

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France to hold final vote on enshrining abortion as a constitutional right

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Special congress of parliamentarians expected to approve 'irreversible' amendment at Palace of Versailles

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A Vox video, posing the question, are we ever authentically ourselves on social media? 

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A Vox video, posing the question, are we ever authentically ourselves on social media? 

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UNPACKING THE SOURCE Do students agree that “Authenticity is a fluid, ever-evolving social construct that cannot be clearly mediated”? Is everything we do online a performance for others? How would they answer the final question in the article, “Why are we so willing to document ourselves to prove what we already know?” Overall, how can we distinguish between real and fake on social media?

Key terms Authentic, Real, Fake, Truth, Performing

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This story is part of a group of stories called

BeReal, as the app's name suggests, wants me to post my truth. Once a day at random, I am prompted to "be real," to capture my unfiltered life synchronously through my phone's selfie and back camera. There is, so BeReal claims, a distinctly authentic self behind social media's smoke and mirrors, waiting to be revealed.

BeReal's premise is simple. Every day, users are randomly prompted to snap a photo within a two-minute time frame, although the window to post remains open for hours. Users can add a caption, comment on friends' day-of posts, and interact through RealMojis, or personalized reaction photos. Upon posting, two feeds are unlocked, one personalized with friends' posts and one a Discovery feed that features strangers in the midst of mostly mundane tasks. The feeds are updated once a day and posts expire once the next BeReal alert is sent out, presumably for users to put their phones down and live their "real" lives after a few minutes on the app.

BeReal falls into the genre of "anti-Instagram" apps, novelty photo platforms that attempt to fulfill a niche social function that Instagram lacks. In this case, it's authenticity and an ad-free experience. "BeReal won't make you famous," the app declares. "If you want to be an influencer you can stay on TikTok and Instagram."

Every year or so, a hot new social startup emerges from the woodwork with an overconfident vision of a better, more authentic way of being online. It rarely sticks. In early 2021, the app du jour was Dispo, which simulated the experience of using a disposable camera by having users wait for photos to develop. Dispo benefited from co-founder David Dobrik's YouTube fame, but a scandal led investors to quickly distance themselves from the startup, even with Dobrik resigning. Later that year, Poparazzi, an app that encouraged users to take paparazzi-like shots of their friends, took off on TikTok. It shot to the top of the App Store for a few weeks, but the hype soon subsided.

This year, the buzzy, VC-backed darling is BeReal, which is currently the second most-downloaded social networking app on the App Store, behind TikTok. It launched in December 2019, but nearly 75 percent, or 7.67 million, of BeReal downloads occurred this year, according to recent Apptopia data shared with TechCrunch. The app recently closed on a Series B funding round and is expected to quadruple its valuation to around $630 million, reported Business Insider in early May.

"We're always looking to connect with friends in a casual way," said Kristin Merrilees, 20, a junior at Barnard College and BeReal user, who also writes about culture and the internet. "I think Snapchat briefly was that space until my friends stopped using it. Now, it's BeReal that lets you peek into people's lives throughout the day."

What is real, though, and what is fake when we spend so much of our time tethered to screens? In a commodified social media landscape, authenticity is as much of a marketing buzzword as it is an on-screen value, touted by people, brands, and, of course, apps. BeReal assumes that the authentic self can be divulged under the right conditions - that catching users off-guard will lead them to abandon all pretense. And so far, users seem to be buying into its pitch.

"It has the vintage feel of early Instagram," said Sasha Khatami, 21, who works in digital marketing. "I think it's an interesting shift for people like me, who are used to posting curated content for so long, now toward a reminder to post in the moment."

BeReal's unsubtle marketing strategy has led it to be a breakout hit among college students. The startup pays students to serve as campus ambassadors, refer friends, and host promotional events. Besides its trendiness, however, the app's concept and key functions are anything but original. It's a well-timed reinvention of FrontBack, an app that popularized the simultaneous selfie and back-camera photo before shuttering in 2015. Similarly, its unpredictable daily push alert mimics the engagement strategy of Minutiae, an anonymous daily photo-sharing app launched in 2017.

Still, BeReal is not much of a threat to the established hierarchy of social platforms that have built a decade-old fiefdom off our data and attention. BeReal is not intent on remaking the social internet. Instead, it operates on the sidelines of this seemingly unshakeable world order, and is backed by some of the same firms that funded Instagram and Twitter. (Venture capitalists are perpetually on the hunt for the next big social startup, despite its history of false starts.) Its goal, like that of most startups, is to become commercially viable, which means it eventually has to find ways to make money off of its users.

The app's greatest appeal may be its current novelty and the fact that it isn't Instagram or Snapchat. Still, BeReal can't seem to escape the pall of the major social networks. Merrilees has noticed an uptick in people sharing their BeReals on Instagram. Some are even remixing them into TikToks, as a kind of memory reel. "A lot of people are migrating content across different platforms," Khatami tells me. "It feels very natural to me. I started making TikToks of my BeReal photos after seeing people post theirs."

Since BeReal is so insular, usage is highly dependent on individual friend circles. Once people start to tire of it, chances are, their friends will too. There's a FOMO-ish undercurrent to the hype. People download BeReal because they're curious. They don't want to miss out. It's nostalgia bait, too, for those old enough to remember the ad-free days of Instagram. The Times's John Herrman found it to be a "reproduction of the experience of joining one of the dominant social networks when they all still felt like toys." BeReal's daily reminder tries to enforce a reflexive instinct to post and use the app, similar to how Snapchat users feel beholden to maintain their streaks. These alerts, however, seem more contrived than spontaneous. They run counter to not only BeReal's stated mission but to the psychological literature on authenticity and self-perception.

Authenticity is a fluid, ever-evolving social construct that cannot be clearly mediated, least of all through an app. In a critical examination of the concept, researchers Katrina Jongman-Sereno and Mark Leary argued that authenticity "may not be a viable scientific construct," citing the varying definitions used by psychologists, sociologists, and behavioral researchers in their assessments. So, why does this concern over online authenticity seem so pervasive? The internet flattens any distinction between irony and sincerity, human and machine, real and fake. If it's all artifice, why do we care?

Our fixation on authenticity-posting is perhaps a reflection of our anxieties about the internet and how it debilitates our modern sense of self. Authenticity is a metric to measure content and the celebrities, influencers, brands, and individuals behind the facade. "Lately, it feels like more people are noticing and calling out performance on social media, like how 'casual Instagram' was identified as a trend," said Maya Man, a Los Angeles-based artist and programmer. The notion of authenticity mollifies the viewer, assuring them that there is some truth to what is seen online. For the poster, it's an ego-driven ideal to aspire toward or embody - even with content they're paid to promote.

BeReal's attempt at curating an authentic space is far from perfect, but it gets at an unanswerable ontological question: Are we ever truly ourselves on the internet? "I view every single thing you post online as contributing to this distributed internet avatar that you're performing," Man said. "Performing isn't a negative thing. It's the fact that you have a mediated audience in mind, even if you're posting on a private account."

"I view every single thing you post online as contributing to this distributed internet avatar that you're performing."

Users who started using the internet at an early age, or "digital natives," might share Man's gestalt theory, and are more accustomed to reconciling these varying personas. It's why people have Twitter alts, finstas, and specific accounts dedicated to food, aesthetics, or memes. Some of these disaggregated identities might be perceived as more authentic than others. Since the online self is fractured across multiple platforms and mediums, authenticity matters in that it's a coherent, ready-made identity for consumption by a public audience.

In a critique of BeReal, Real Life magazine editor Rob Horning posits: "An even more real version of BeReal would just give your friends access to your cameras and microphones without you knowing it, so they can peep in on you and see how you act when you think no one is watching. If the panoptic gaze is falsifying us, only voyeurism sets us free."

These voyeuristic conditions were what Man sought to investigate in creating Glance Back, a Chrome extension that unpredictably snaps a webcam photo once a day when the user opens a new tab. "I was very unsettled by that feeling that someone is looking at you for a long time and you're not looking back," she told me. "That's what my computer feels all day, and we don't have a chance to engage with its view."

Even under Glance Back's unexpected voyeurism, what it captured didn't feel any more or less authentic than BeReal's self-directed gaze. Glance Back catches me in a distracted, bleary-eyed state, whereas I convey a more earnest, alert version of myself on BeReal. After a few weeks of observing my life's repetitious contours through my browser and phone, it became apparent to me that authenticity is a facile concern, one that's easier to grapple with than our constant state of surveillance. Rather than fret over our perceived authenticity, perhaps a better question is: Why are we so willing to document ourselves to prove what we already know?
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Are we ever authentically ourselves on the internet?

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This story is part of a group of stories called BeReal, as the app's name suggests, wants me to post my truth. Once a day at random, I am prompted to "be real," to capture my unfiltered life synchronously through my phone's selfie and back camera.

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A Guardian article, focusing on artists Zorowar Sidhu and Rob Swainston’s exhibition dealing with the theme of doomscrolling. 

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A Guardian article, focusing on artists Zorowar Sidhu and Rob Swainston’s exhibition dealing with the theme of doomscrolling. 

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UNPACKING THE SOURCE Ask students if they have come across it, and if not, what they think it is. Then move on to consider the project carried out by Zorowar Sidhu and Rob Swainston: what drove it? Why did they choose woodblock prints for the exhibition? What does this reveal about the role of the arts in helping us to understand and make sense of events and issues going on in the world? How is the changing nature of our relationship with images making it harder to use art to do this?

Key terms Doomscrolling, Media environments, Images

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hen then US president Donald Trump caught the coronavirus, Zorawar Sidhu found himself refreshing his phone for updates. Waiting anxiously for the 2020 presidential election result, he was glued to flashing screen again.

"My appetite for news had been increased," the 36-year-old says by phone from New York. "Maybe it's the frequency of it or the pace of how the information comes in or just how intense every morsel of information is, where the next thing is more alarming than the previous."

We are all doomscrollers now, compulsively absorbing a constant flow of negative news with untold psychological and social consequences. Sidhu and fellow artist Rob Swainston, who marry historic printing processes with 21st century tools, have responded with works designed to make us stop and regain our footing.

Their exhibition of woodblock prints, Doomscrolling, interprets 18 moments between 24 May 2020 and 6 January 2021, a stretch for the history books that saw the coronavirus pandemic, Black Lives Matter protests and deadly insurrection at the US Capitol.

The project was born after Sidhu and Swainston found themselves bombarded by images from 2020 and after Swainston took photos of an eerily deserted Manhattan under quarantine during morning bike rides.

Photograph: Courtesy of the artists and Petzel, New York

"It was a very strange sight and everything was empty and all you really saw was this very visible homeless population but everyone else was sort of hiding," the 51-year-old recalls. "Then, all of a sudden, this plywood started to go up all over lower Manhattan in response to the protests.

"I was photographing and I was like, wow, this is such an opportunity for someone who works in print media, and knows the potential of woodblock prints, to get this plywood somehow and use it to tell the story of 2020 on plywood that was put up to 'protect institutions'. It just seemed so poetic."

The artists contacted various institutions asking if they could have the plywood when it came down and got several positive responses, particularly from the art world. Eventually they collected around 120 sheets.

It proved the perfect means of expression, in part because woodblock prints have an association with social change movements going back at least 500 years, in part because the distressed, beaten up material could convey an inherently messy story.

Sidhu explains: "In this case, woodcut was the appropriate medium because these prints are made with the paper directly touching the wood, which was outside during these protests and collecting graffiti and was scratched and gouged and drilled into and weathered. All this is still visible when you look up close at those prints."

To create a montage effect, the artists overlaid image upon image, as if scrolling through a computer screen or mobile phone. Sidhu and Swainston used art historical references such as a horse taken from Albrecht Dürer's The Four Horsemen of the Apocalypse, hands from Käthe Kollwitz and heavy shadows from Edvard Munch.

Photograph: Courtesy of the artists and Petzel, New York

The 18 prints each represent a specific image or event, including a 24 May New York Times front page "US DEATHS NEAR 100,000, AN INCALCULABLE LOSS" and, a day later, the police murder of George Floyd in Minneapolis, which sparked daily demonstrations against racial injustice in New York and other cities.

Swainston, who has an academic background in both art and political science, recalls: "There were images that just circulated and circulated and there were some that in New York City circulated a lot among us and our friends.

"I participated in some of the protests that went daily from Prospect Park to McCarren Park in Williamsburg. When the curfew happened, the police started to be aggressive to anyone who was out on the street after seven o'clock and lots of images were passed around.

He continues: "Some of these events were very clear that we wanted to do something with, like the day in DC that the parks police gassed everybody and Trump went out and held up the Bible in front of St John's Church.

"There are some other dates that were harder: OK, how do we talk about Covid? Do we look at the dates that have the largest death day? Some of them were a little more nebulous as to what the exact date was but they were feelings that were happening in the time. Social distancing, hospitalisations, memorial images that we just wanted to bring into the series to tell the whole story."

One print focuses on Kyle Rittenhouse, who was 17 when, armed with an AR-style semiautomatic rifle, he shot and killed two people and wounded a third at a protest in Kenosha, Wisconsin. In court, Rittenhouse argued that he fired in self-defence and was acquitted on all charges.

But the first piece they finished was the last in chronological order: the storming of the US Capitol in Washington by a pro-Trump mob intent on overturning the election result on 6 January. It felt like a natural bookend.

Sidhu explains: " There was an urgency in that moment of January 6 so we all felt that it was time to actually do something about it. For us, as artists, that first thing that we could do was to take that imagery and just get it out, try to do something with it."

Photograph: Courtesy of the artists and Petzel, New York

Many people, including doomscrolllers, have felt overwhelmed by the past two years. The artists hope to disrupt the idea of these moments as fixed and inevitable. Instead, they argue, their montages keep the moments alive with unfixed meanings, a clue that dialogue and social change are still possible.

Sidhu, who was born in Ludhiana, India, says: "It encourages a re-examination of everything that's happened rather than moving on as if these issues are resolved. We see Covid coming back with Omicron. With the show opening on January 6, it's already an opportunity to reflect on that date and everything that comes with it."

Swainston adds: "We hope that, by putting it out there, by keeping the images in circulation, they continue to have possibility and don't just become fixed in the past and we just move on from it. We are still in this moment in my mind and these culture wars that are brewing in the United States that threaten to pull us all apart.

"These unresolved issues of race, of gun violence, all of these things we can't put them behind us and just keep living in them. We need to start to address them and, in our society, it is through images that we are processing information now in a more and more significant way."

The departure of Trump from the White House, and his removal from Twitter, seemed to invite a little less doomscrolling in 2021, but persistent crises including the Omicron variant suggest the phenomenon will not be going away soon. Still, Swainston hopes the exhibition, which opens at the Petzel Gallery on New York's upper east side on 6 January, can help to wean visitors off their fast food media diet.

"We talk about the way that the media environments now are set up to reinforce what you've already seen but the way it's happening is that images get thrown at you and they stack on top of each other, and the next one resonates with the next one. We become very fast in our reading of image; we understand right away.

"This is a relatively new thing. The way that humans looked at images in previous environments, they were slower. We would take a long time with a painting or a photo or we would see the pieces first and then the whole. It just has consequences in the way that we look at images."

He adds: "We hope that this series slows people down. This is what you see, but as you're looking, more and more unfolds, more and more is there, and it gives space for the viewer to continue to look and discover and make up their own mind about what these mean."

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Doomscrolling: the exhibition that visualises our appetite for bad news

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hen then US president Donald Trump caught the coronavirus, Zorawar Sidhu found himself refreshing his phone for updates. Waiting anxiously for the 2020 presidential election result, he was glued to flashing screen again. "My appetite for news had been increased," the 36-year-old says by phone from New York.

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A Big Think article, examining the way social media leaves us “isolated, scared and tribal” rather than connecting and uniting us. 

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A Big Think article, examining the way social media leaves us “isolated, scared and tribal” rather than connecting and uniting us. 

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UNPACKING THE SOURCE This is a rather negative take on the effect of social media, and how it functions like an echo-chamber to increase our ‘digital tribalism’, rather than break it down. How and why does it do this? What steps can (and/or should) we take to avoid being manipulated by social media? What are the consequences of these effects - in particular, on the decisions and judgements we make related to politics? You can also check out Obama’s latest thoughts on the effect of social media on our ability to make informed decisions.

Key terms Manipulated, Digital tribe, Control

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About a year ago I began to follow my interest in health and fitness on Instagram. Soon I began to see more and more fitness-related accounts, groups, posts and ads.

I kept clicking and following, and eventually my Instagram became all about fit people, fitness and motivational material, and advertisements. Does this sound familiar?

While the algorithms and my brain kept me scrolling on the endless feeds, I was reminded of what digital marketers like to say: "Money is in the list." That is, the more customized your group, people and page follows, the less time and money is needed to sell you related ideas. Instead, brand ambassadors will do the work, spreading products, ideas and ideologies with passion and free of charge.

I'm a psychiatrist who studies anxiety and stress, and I often write about how our politics and culture are mired in fear and tribalism. My co-author is a digital marketing expert who brings expertise to the technological-psychological aspect of this discussion. With the nation on edge, we believe it's critical to look at how easily our society is being manipulated into tribalism in the age of social media. Even after the exhausting election cycle is over, the division persists, if not widening, and conspiracy theories continue to emerge, grow and divide on the social media. Based on our knowledge of stress, fear and social media, we offer you some ways to weather the next few days, and protect yourself against the current divisive environment.

The promise, the Matrix

Those of us old enough to know what life was like before social media may remember how exciting Facebook was at its inception. Imagine, the ability to connect with old friends we had not seen for decades! Then, Facebook was a virtual dynamic conversation. This brilliant idea, to connect to others with shared experiences and interests, was strengthened with the advent of Twitter, Instagram and apps.

Things did not remain that simple. These platforms have morphed into Frankenstein's monsters, filled with so-called friends we've never met, slanted news stories, celebrity gossip, self-aggrandizement and ads.

The artificial intelligence behind these platforms determines what you see based on your social media and web activity, including your engagement with pages and ads. For example, on Twitter you may follow the politicians you like. Twitter algorithms quickly respond and show you more posts and people related to that political leaning. The more you like, follow and share, the faster you find yourself moving in that political direction. There is, however, this nuance: Those algorithms tracking you are often triggered by your negative emotions, typically impulsivity or anger.

As a result, the algorithms amplify the negative and then spread it by sharing it among groups. This might play a role in the widespread anger among those engaged in politics, regardless of their side of the aisle.

The digital tribe

Eventually, the algorithms expose us mostly to the ideology of one "digital tribe" - the same way my Instagram world became only superfit and active people. This is how one's Matrix can become the extremes of conservatism, liberalism, different religions, climate change worriers or deniers or other ideologies. Members of each tribe keep consuming and feeding one another the same ideology while policing one another against opening up to "the others."

We are inherently tribal creatures anyway; but particularly when we're scared, we regress further into tribalism and tend to trust the information relayed to us by our tribe and not by others. Normally, that's an evolutionary advantage. Trust leads to group cohesion, and it helps us survive.

But now, that same tribalism - along with peer pressure, negative emotions and short tempers - often lead to ostracizing those who disagree with you. In one study, 61% of Americans reported having unfriended, unfollowed or blocked someone on social media because of their political views or posts.

Higher levels of social media use and exposure to sensationalized news about the pandemic is linked with increased depression and stress. And more time spent on social media correlates with higher anxiety, which can create a negative loop. One example: The Pew Research Center reports 90% of Republicans who get their political news only from conservative platforms said the U.S. has controlled the COVID-19 outbreak as much as possible. Yet less than half of Republicans who rely on at least one other major news provider thought so.

The Matrix does the thinking

Human thinking itself has been transformed. It's now more difficult for us to grasp the "big picture." A book is a long read these days, too much for some people. Scrolling and swiping culture has reduced our attention span (on average people spend 1.7 to 2.5 seconds on a Facebook news feed item). It has also deactivated our critical thinking skills. Even really big news doesn't last on our feed longer than a few hours; after all, the next blockbuster story is just ahead. The Matrix does the thinking; we consume the ideology and are bolstered by the likes from our tribemates.

Before all this, our social exposure was mostly to family, friends, relatives, neighbors, classmates, TV, movies, radio, newspapers, magazines and books. And that was enough. In that, there was diversity and a relatively healthy information diet with a wide variety of nutrients. We always knew people who were not like minded, but getting along with them was normal life, part of the deal. Now those different voices have become more distant - "the others" we love to hate on social media.

Is there a red pill?

We need to take back the control. Here are seven things we can do to unplug ourselves out of the Matrix:

Review and update your ad preferences on social media at least once per year.

Confuse the AI by flagging all ads and suggestions as "irrelevant."

Practice being more inclusive. Check other websites, read their news and do not "unfriend" people who think differently from you.

Turn off cable news and read instead. Or at least put a disciplined limit on hours of exposure.

Check out less biased sources of news such as NPR, BBC and The Conversation.

If you think everything your tribe leaders say is absolute truth, think again.

Go offline and go out (just wear your mask). Practice smartphone-free hours.

Finally, remember that your neighbor who supports the other football team or the other political party is not your enemy; you can still go for a bike ride together! I did today, and we didn't even have to talk politics.

It's time to take the red pill. Take these seven steps, and you won't give in to the Matrix.

This piece was co-authored with Maryna Arakcheieva, who is expert in digital solutions and marketing.

Arash Javanbakht, Associate Professor of Psychiatry, Wayne State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Matrix is already here: Social media promised to connect us, but left us isolated, scared and tribal

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About a year ago I began to follow my interest in health and fitness on Instagram. Soon I began to see more and more fitness-related accounts, groups, posts and ads. I kept clicking and following, and eventually my Instagram became all about fit people, fitness and motivational material, and advertisements.

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A Vox article, looking at what is lost when long covid affects your sense of smell. 

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A Vox article, looking at what is lost when long covid affects your sense of smell. 

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UNPACKING THE SOURCE In what way did the writer realize that she used the sense of smell to measure time? How does smell ‘ground us’ and make us feel like ourselves? Overall, how important is the sense of smell in helping us to “navigate our lives”? Thinking more broadly, do we only ever know how important something is until we lose it? If this is true, how do we ensure that we always appreciate and make the most of the senses and skills that we possess?

Key terms Navigate our lives, Measure time, Ability to ground us

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It was October 2020. The days were getting shorter; the news was getting worse. I was looking for a small distraction, something to look forward to in the coming pandemic winter. After a brief consideration of the limited available options, I decided to get into perfume.

After a little online research, I signed up for the subscription box Olfactif because, beyond forking over my credit card information, it did not require me to make any decisions. For the relatively affordable price of $19 a month, the company would pick out three sample-size perfumes on a vaguely seasonal theme and send them to my door. It was a way to guarantee myself something that had been in short supply that year: a nice surprise.

I wasn't alone. After a dip at the start of the pandemic, fragrance sales started to rebound in August 2020 and were surging by early 2021, up 45 percent from the first quarter of 2020. "Last year was super busy," Kimberly Waters, founder of the Harlem perfume shop MUSE, told me. Pandemic-numbed consumers "needed to feel like themselves, needed to feel new again, needed to feel something," Waters said. "And fragrance was that vehicle."

For me, perfume was a way to feel a little excitement amid the stress and monotony of the pandemic. I might not have been able to eat in a restaurant or see my parents or go a day without experiencing existential dread, but I could open up my Olfactif box and sample, for instance, Blackbird's Hallow v. 2, a standout from the October collection with notes of benzoin, frankincense, and marzipan.

I couldn't tell you what benzoin actually smells like, but I do know that Hallow reminded me of ghost stories, of forests and dark places, of fears that were fun and manageable, intriguing rather than consuming. Amid the long, isolated slog of late 2020 and early 2021, my perfume box became a reliable escape.

Then - maybe you knew this was coming - I got Covid, and I became one of the hundreds of millions of people around the world to suffer from anosmia, a partial or total loss of the sense of smell. Anosmia is generally seen as one of the milder symptoms of Covid-19; it's not particularly dangerous on its own, and people presenting with anosmia tend to have less severe cases of Covid-19 overall. This was the case for me - I felt very lucky to emerge from quarantine with a messed-up nose as my only enduring symptom.

That symptom, though manageable, turned out to be significant. Covid-19 changed my relationship to smell, even - perhaps especially - as that sense began, slowly and strangely, to return. Learning to smell again came to symbolize resilience and healing, but also simply forward movement: a sign of personal, biological progress in a year when everything seemed stuck in a terrible cycle.

Smell, Waters said, is "how we navigate our lives." And this year, regaining smell has been how I navigate, if not back to the shore we all left in early 2020, then at least to a place where I can recognize my surroundings, and start to make a home.

Scientists know very little for certain about how Covid-19 damages our sense of smell. Danielle Reed, associate director of the Monell Chemical Senses Center, studies taste and smell; she told me one popular theory is that the virus infects a group of cells called the sustentacular cells, which "support and nourish the smell cells" in the nose. When the sustentacular cells are infected, the smell cells lose their nutrition, and "that's how things suddenly go south," as Reed put it.

Another theory holds that when fighting SARS-CoV2, the immune system produces a substance that switches off the function of the smell cells. That explanation would fit with the experience of people who go to bed one night fine and "wake up the next morning and they can't smell their coffee," Reed said. Whatever the cause, loss of smell is extremely common: about 86 percent of Covid-19 patients lose some or all of their sense of smell, according to one study, while others put the figure even higher.

The extent of the effect varies among patients. Some people lose everything, like Tejal Rao, a restaurant critic for the New York Times, who first discovered her Covid-induced anosmia in the shower. "At first, I mistook the lack of aromas for a new smell, a curious smell I couldn't identify - was it the water itself? the stone tiles?" she wrote, "before realizing it was just a blank, a cushion of space between me and my world."

Others, like me, experience only partial anosmia - some smells are lost, while some remain. At first, I had no idea I'd been affected at all.

Every morning while my family was in quarantine, I put on perfume to lift my spirits. I chose House of James's Sun King, a citrusy blend of mandarin, green tea, and black agar I'd received in my February 2021 box. While we were very fortunate not to get sicker, the first few days of our illness were tense ones - my husband quarantined in our bedroom, both of us double-masking at all times in a futile attempt to avoid infecting our then-2-year-old son. Perfume was a way to remind myself that I was human, not just a machine for converting raw anxiety into nose wipes, temp checks, and healthy snacks.

By week two, our son was mercifully fever-free (though extremely tired of being indoors), my husband was stuffy but on the mend, and I was sick of Sun King. I had told myself a new perfume would be my reward for finishing quarantine, and so when I finally got the all-clear from the New York City Test and Trace Corps, I popped open a vial of Musc Invisible, the only February fragrance I had yet to try.

Musc Invisible, by the fragrance brand Juliette Has a Gun, is supposed to smell like jasmine, cotton flowers, and white musk. Long a fan of musk fragrances (like many people, I enjoyed The Body Shop's White Musk in the '90s), I was excited to sample it. But when I sprayed it on, it smelled like nothing with a hint of something - or like someone had wrapped my head in several layers of gauze and then opened a vial of perfume across the room.

Once I realized something was off, I went around the house sniffing everything in an effort to gauge the damage. Many objects smelled normal - I remember sticking my nose in a jar of peanut butter and being satisfied at its peanut-ness. Others had lost their scent entirely - the candles my mother had sent me in a birthday care package, once rosemary and lemon balm, were now nothing and nothing.

The candles my mother had sent me in a birthday care package, once rosemary and lemon balm, were now nothing and nothing.

Others still occupied a disconcerting middle ground, not as I remembered them, but not completely scent-less, either. The perfume I wore to my wedding, for example, a rose oil I still keep in a bottle on my dresser, smelled like the faintest hint of its former self - or maybe I was just remembering the smell, and not really smelling it at all?

Such experiences became commonplace this year, but before the pandemic, they were considered relatively rare. One of the few people to chronicle the loss of smell prior to Covid-19 was Molly Birnbaum, whose 2011 memoir Season to Taste details her recovery from a brain injury that damaged her olfactory nerves.

"When I lost my sense of smell in a car accident, it was devastating," Birnbaum said. At the time a 22-year-old aspiring chef, she ended up having to change careers because her loss of smell had also affected her ability to taste. "All of the nuance of flavor, all of the details, " she said, "that was gone."

To this day I'm not sure if I lost taste along with smell in February. Food in general seemed to taste less good, but I couldn't tell if I was actually experiencing dysgeusia - the technical term for an altered sense of taste - or simply stress-induced lack of appetite. I experienced my post-Covid sensory change not as a devastation but as a profound murkiness, of a piece with the anxiety and confusion all around me.

The pandemic had already wiped away so much that had once seemed certain: that children would go to school, that some adults would go to work in offices, that families could gather together for holidays. No one knew when it would be over; no one knew what the next month or week or even day would hold. I remember feeling that even the changing of the seasons was no longer a sure thing - in February 2020, I had told my husband, "at least winter will be over soon." Then winter came for the whole world, and stayed for more than a year.

It seemed fitting, in this context, that I should no longer be able to trust my senses. Indeed, uncertainty is a hallmark of Covid-induced anosmia. There's no single accepted clinical test, like an eye chart, to gauge people's sense of smell, Reed said. There are tests used in research, but they aren't readily available to the general public. That means people are generally left trying to gauge their condition, and their recovery, by trying to remember what things smelled like before Covid - a process that's flawed at best. "If you take your temperature, you know if you're getting better," Reed said. "Your fever was 102, and now it's 100.1."

With smell, though, "there's no real metric," she said. "It's very frustrating for people."

Most Covid-19 patients do eventually regain some sense of smell. But 10 to 20 percent of those affected are still experiencing significant impairment a year after their diagnosis, Reed said. The recovery process itself, meanwhile, can be disorienting, unsettling, and even disgusting.

Some people experience parosmia, in which smells are distorted - a French wine expert recently told the Times that during her recovery, "peanuts smelled like shrimp, raw ham like butter, rice like Nutella." Others are confronted with phantosmia, smells that aren't there at all.

For me, it was the smell of coffee, which began wafting into my nose (or brain) every afternoon sometime around March, even though I haven't had a cup of coffee since 2009. Others have more upsetting olfactory hallucinations: Some smell cigarette smoke or even rotting flesh.

For Birnbaum, it was "an earthy, garden-y scent" that seemed to follow her everywhere. At first, "I thought I was smelling my own brain," she recalled, as though "my recovery process was allowing me to smell what was inside of me."

But then, slowly but surely, real smells began to come back - first the smell of fresh rosemary, then other pleasant smells, and last of all, bad smells like garbage. "I was living in New York in the summer, and there was trash on the street corner, and I could smell it, which was very exciting," Birnbaum said.

All spring and summer I had the sense of smells returning to me out of nothingness, like figures stepping out of the dark.

I, too, remember the excitement of recognizing a smell again after its long absence. I was walking in the park one day in May when I realized I could smell fresh grass again. I kept sniffing flowers and smelling nothing until, one day in July, I felt the winey sweetness of a red rose hit the back of my throat. All spring and summer I had the sense of smells returning to me out of nothingness, like figures stepping out of the dark.

Smell, for me, became a way to measure time - time since our illness, time since the pandemic began, time since we'd been vaccinated and things started to go back to some semblance of normal. I know I'm not alone in losing my grasp of the passage of time since Covid-19 hit - often I still forget what month it is, even what year. But I know that now I don't smell phantom coffee anymore, and I can, just barely, smell the lemon balm candle in my bathroom. Something must be progressing, no matter how slow.

People who work with smell often emphasize its ability to ground us, to situate us in time and space. Every day during lockdown, Waters, the MUSE founder, says she used some kind of scent, whether it was perfume, incense, or a candle. "It was how I remembered life before the pandemic," she said. "It made me feel like myself at a time when I was just so confused."

I also kept using perfume, even after my incident with Musc Invisible. At first it was a source of anxiety - would I be able to smell the next vial? Was White Castitas - a sample from the June box with notes of lemon, sandalwood, and licorice - just very subtle, or was I still missing some crucial licorice sensors deep inside my nose?

Over time, though, those worries have faded. I've come to accept that my sense of smell is different now, that what's still gone may never be coming back, and that I'll probably never know if I'm back to "normal."

For researchers like Reed, the prevalence of Covid-induced anosmia is a wake-up call that science and medicine need to take the sense of smell more seriously. She and her colleagues advocate for testing of taste and smell the same way we test for hearing and vision, and are at work on a new test to help doctors evaluate a patient's sense of smell quickly and easily.

For Waters, the pandemic is a reminder to embrace our sense of smell while we have it. "Continue keeping your nose open," she said. "We can't take our ability to smell for granted."

And for me, regaining smell is just another small way that I'm emerging, marked, from the last 20 months into whatever comes next.

I tried smelling Musc Invisible again as I was writing this story. I could definitely detect something: a kind of chemical sweetness, like bubblegum mixed with hydrogen peroxide. I don't know if it's the perfume itself or my still-wonky sustentacular cells, but I don't care anymore. This perfume smells bad to me now. I'm going to throw it away.

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It was October 2020. The days were getting shorter; the news was getting worse. I was looking for a small distraction, something to look forward to in the coming pandemic winter. After a brief consideration of the limited available options, I decided to get into perfume.

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An Aeon essay, arguing that imagination isn’t just a by-product of our evolution of problem-solving faculties, it is the core of what it means to be human. 

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An Aeon essay, arguing that imagination isn’t just a by-product of our evolution of problem-solving faculties, it is the core of what it means to be human. 

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UNPACKING THE SOURCE Why hasn’t more effort been made to study imagination (perhaps linking this to an overly narrow definition of what imagination is)? What is the relationship between imagination and memory? How does it create a “safe space for learning”? Overall, why does Sally Davies argue that our species should be called Homo imaginatus?

Key terms Imagination, Mental superfluity, Future simulator, Stories, Integrated network, Essence

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'To me,' wrote William Blake in 1799, 'this world is all one continued vision of fancy or imagination.' The imagination, he later added, 'is not a state: it is the human existence itself.' Blake, a painter as well as a poet, created images that acquire their power not only from a certain naive artistic technique, but because they are striving to transcend it - to convey a vision of the world beyond superficial appearances, which only imagination can reach.

For the Romantics, imagination was a divine quality. 'The primary Imagination I hold to be the living Power and prime Agent of all human Perception,' wrote Samuel Taylor Coleridge in 1817. It was a powerful faculty that could be put to use, distinct from the mere 'fancy' of making up stuff - which all too often, is how imagination is conceived today.

Blake would have been unimpressed by modern scientific efforts to find imagination among the firing patterns of neurons, as if it was just another cognitive function of the brain, like motor control or smell perception. Likewise, he would have scorned the idea, favoured by some cognitive scientists, that imagination is a mere byproduct of more 'important' mental functions, evolved for other reasons - in the manner that the cognitive scientist Steven Pinker proposes that music is 'auditory cheesecake', piggybacking on basic skills required to process sound.

Compared with longstanding research about how we process music and sound, language and vision, efforts to comprehend the cognition and neuroscience of imagination are still in their infancy. Yet already there's reason to suppose that imagination is far more than a quirky offshoot of our complicated minds, a kind of evolutionary bonus that keeps us entertained at night. A collection of neuroscientists, philosophers and linguists is converging on the notion that imagination, far from a kind of mental superfluity, sits at the heart of human cognition. It might be the very attribute at which our minds have evolved to excel, and which gives us such powerfully effective cognitive fluidity for navigating our world.

From an evolutionary perspective, the central puzzle of imagination is that it enables you to suppose, picture and describe not only things you won't ever have experienced, but also things you never could experience, because they violate the laws that govern the world. You can probably imagine being the size of an ant, or walking on air, or living on the Moon. Take a moment: it's not so hard, if you try.

But how can it possibly benefit us to have minds capable of such flights? Unlike vision or memory, after all, imagination doesn't seem to be a cognitive attribute that's widely distributed in the natural world. We're probably safe to assume that dogs and chimps don't imagine having wings or living in Renaissance Italy. Even in purely human terms, cognitive skills such as problem-solving, numeracy and social cooperation seem far more adaptively useful.

As for wisdom, let's defer judgment until we've escaped (or not) the current path of self-destructive extinction

In the story science has taught us to tell about human evolution, the skills we have acquired serve as milestones. From around 2.3 million years ago, our ancestors in East and South Africa were Homo habilis, 'handy man' - so called because these hominins were able to do nifty things with their hands, in particular to make tools. Then around 2 million years ago, along came Homo erectus, distinguished by an ability to walk erect and upright. And finally, of course, Homo sapiens, the 'wise' or 'knowing' modern humans.

Yet are we sure these labels are the right ones? We're not unique in using tools - apes, elephants, crows and parrots are among the other animals that can do so, and chimpanzees have considerable manual dexterity. Walking upright is no problem for gorillas. As for possessing wisdom and knowledge, perhaps we should defer judgment until we have escaped (or not) the current path of self-destructive extinction. Most of our other prized cognitive attributes - memory, empathy, foresight and planning, sociality, consciousness - are present in other species too.

The one mental capacity that might truly set us apart isn't exactly a skill at all, but more a quality of mind. We should perhaps have called ourselves instead Homo imaginatus: it could be imagination that makes us human. The more we understand about the minds of other animals, and the more we try (and fail) to build machines that can 'think' like us, the clearer it becomes that imagination is a candidate for our most valuable and most distinctive attribute.

If imagination really is so important, you might expect it to be one of the best-studied of cognitive phenomena. On the contrary; understanding how the human organism summons up imagination has been given comparatively little attention, and is still largely a mystery. It's just so much easier to study what goes on in the brain when we're given a well-defined task - remember this sequence of numbers, see if you can spot the pattern in this image or solve this puzzle - than if you're told to, well, just imagine.

When 'imagination' does surface in the neuroscientific literature, it's often neutered by an overly narrow definition - an ability to form or recall mental visual images - rather than a description that embraces the true depth and range of human experience. There's a difference between imagining a lion and a gryphon, for example. To be able to bring into the mind an image of a lion might have survival value, since it's handy to mentally rehearse a scenario we'd best avoid. But where's the value in imagining a creature with a lion's body and a bird's head? Why conjure up threats that have not only never existed, but could never exist?

Imagination blurs the boundary between mind and world, going well beyond daydreaming and reverie. When Theseus in Shakespeare's A Midsummer Night's Dream says that imagination 'bodies forth / The forms of things unknown', he is voicing the Renaissance view that imagination produces real effects and manifestations: 'One sees more devils than vast hell can hold.' Here, Theseus echoes the 16th-century Swiss physician Paracelsus, who believed that demons such as incubi and succubae 'are the outgrowths of an intense and lewd imagination of men or women'. From imagination alone, Paracelsus said, 'many curious monsters of horrible shapes may come into existence.' The problem with imagination is that it doesn't know where to stop.

Perhaps the human mind overproduces possible futures in order to plan in the present

Even so, evolutionary psychologists might suppose that there's some reason behind our ability to imagine the impossible. Since the laws of physics weren't known to our species when our brains were evolving, should it surprise us that imagination wilfully breaks them? A mind that can conceive of possibilities beyond its own experience can prepare for the unexpected; better to overanticipate than to be surprised.

We already know that overproduction of possibilities, followed by pruning through experience, is a viable evolutionary strategy in other contexts. The immune system generates huge numbers of diverse antibodies, of which only one might actually fit with a given antigen and enable its removal or destruction. And the infant brain doesn't gradually wire its neural connections as experiences accumulate; rather, it starts with a vast array of random connections that are then thinned out during brain development to leave what is useful for dealing with the world.

In the same way, perhaps the human mind overproduces possible futures in order to plan in the present. 'The task of a mind,' wrote the French poet Paul Valéry, 'is to produce future.' In his book Kinds of Minds (1996), the philosopher Daniel Dennett quotes the line, saying that the mind is a generator of expectations and predictions: it 'mines the present for clues, which it refines with the help of the materials it has saved from the past, turning them into anticipations of the future.'

How do we construct such possible futures? The basic mental apparatus seems to be an internal representation of the world that can act as a 'future simulator'. Our capacity for spatial cognition, for instance, lets us build a mental map of the world. We (and other mammals) have so-called 'place cells', neurons in the brain region called the hippocampus (which handles spatial memory) that are activated when we are in specific remembered locations. We also develop mental models of how objects and people behave: a kind of intuitive or 'folk' physics and psychology, such as the so-called theory of mind by which we attribute mental states and motivations to others. We populate and refine these cognitive networks from experience, creating memories of things we have encountered or observed.

Yet what we hold in mind are necessarily patchy, sketchy and wonky versions of 'reality' - good enough for most purposes, but full of gaps, false assumptions and recollections. What's surprising is not the imperfections, but how little we notice them. That's precisely because we are Homo imaginatus, the master fabulators. Craving narratives that help us make sense of the world, we unconsciously and effortlessly fill in or revise the details until the story works. In this sense, imagination is a normal part of what we do all the time.

Moments of rumination, reflection and goal-free 'thinking' occupy much of our inner life. In these moments, our brains are in a default state that looks unfocused and dreamy, but in fact is highly active - planning supper, recalling an argument with our partner, humming a tune we heard last night. This way of thinking correlates with a well-defined pattern of activity in the brain, involving various parts of the cortex and the hippocampus. Known as the default mode network, it's also engaged when we remember past events (episodic memory); when we imagine future ones; and when we think ahead, adopt another person's perspective, or consider social scenarios.

The cognitive neuroscientist Donna Rose Addis of the University of Toronto has argued that imagination doesn't just draw on resources that overlap with episodic memory; they are, she says, 'fundamentally the same process'. Impairments of the ability to recall episodic memories seem to be accompanied by an inability to imagine the future, she says - and both abilities emerge around the same time in childhood.

In this view, imagined and remembered events both arise by the brain doing the same thing: what Addis calls 'the mental rendering of experience'. Imagination and memory use a cognitive network for 'simulation' that turns the raw ingredients of sensory experience into a kind of internal movie, filled not just with sound and action but with emotional responses, interpretation and evaluation. Not only is that happening when we think about yesterday or tomorrow, says Addis - it's what we're doing right now as we experience the present. This simply is the world of the mind. The imaginative capacity, she says, is the key to the fluidity with which we turn threads of experience into a tapestry.

In some sense, we are all that poet, all the time

Here Addis expands on the notion proposed by her sometime collaborator, the psychologist Thomas Suddendorf at the University of Queensland: imagination is a kind of mental time-travel. As he put it in 1997, imagination is 'the mental reconstruction of personal events from the past ... and of possible events in the future.' Suddendorf and his colleague Michael Corballis of the University of Auckland in New Zealand argued that mental time travel might be a uniquely human trait, although there is still debate about whether other animals really do live in a kind of perpetual present. The capacity draws on a range of other sophisticated cognitive functions to create a kind of mental theatre of possibility.

This ability could seem curiously asymmetrical - the past actually happened, while the future is just conjecture, right? Well, not really. Much as we might like to think we remember 'what happened', a vast body of evidence shows that our memories are an intimate blend of fact and fantasy. We construct a narrative out of the imperfect, disjointed materials that the world supplies and the mind records. We've all had false memories, some of them so richly detailed and convincing that we can't quite believe they didn't happen. As the philosophers of mind Kourken Michaelian and Denis Perrin of the Université Grenoble Alpes in France have put it, 'to remember simply is to imagine the past'. Our grip on reality depends then not on distinguishing between the real and the imagined, but between two types of imagination - one interwoven with reality, the other more distant from it. Failure to do so is a common feature of many types of mental illness, some of which are known to be associated with dysfunctions of the brain's default mode network.

Addis now views the imaginative capacity as something broader than the purely temporal. In our mind's eye, we can project ourselves 'anywhere in imaginary spacetime' - into medieval France, or Middle Earth, or The Matrix. In that inner theatre, any performance can take place. As Theseus said: 'Lovers and madmen have such seething brains, / Such shaping fantasies, that apprehend / More than cool reason ever comprehends.'

Addis argues that the brain's simulation system can produce such fantasies from its facility at association: at weaving together the various elements of experience, such as events, concepts and feelings. It's such associative cognition - one set of neurons summoning the contents of another - that allows us to put names to faces and words to objects, or to experience the Proustian evocation of the past from a single sensory trigger such as smell. This way, we can produce a coherent and rich experience from only partial information, filling the gaps so effortlessly that we don't even know we're doing it. This association is surely at work when a novelist gives attributes and appearances to characters who never existed, by drawing on the brain's store of memories and beliefs (' That character has to be called Colin; he wears tanktops and spectacles'). In these ways, the poet 'gives to airy nothing / A local habitation and a name.' In some sense, we are all that poet, all the time.

If Addis is correct, it would be quite wrong to suppose that the artistic imagination is just an evolutionary overdevelopment of an ability to plan how we'll get tomorrow's meal. On the contrary, the imaginative dimensions of the arts could be the paradigmatic expression of our skills at prediction and anticipation. The literary scholar Brian Boyd of the University of Auckland thinks this is where our predilection for inventing stories comes from. Specifically, he thinks they serve to flex the muscles of our social cognition.

Some evolutionary biologists believe that sociality is the key to the evolution of human minds. As our ancestors began to live and work in groups, they needed to be able to anticipate the responses of others - to empathise, persuade, understand and perhaps even to manipulate. 'Our minds are particularly shaped for understanding social events,' says Boyd. The ability to process social information has been proposed by the psychologists Elizabeth Spelke and Katherine Kinzler at Harvard University as one of the 'core systems' of human cognition.

Boyd thinks that stories are a training ground for that network. In his book On the Origin of Stories (2009), he argues that fictional storytelling is thus not merely a byproduct of our genes but an adaptive trait. 'Narrative, especially fiction - story as make-believe, as play - saturates and dominates literature, because it engages the social mind,' he wrote in 2013. As the critical theorist Walter Benjamin put it, the fairy tale is 'the first tutor of mankind'.

'We become engrossed in stories through our predisposition and ability to track other agents, and our readiness to share their perspective in pursuing their goals,' continues Boyd, 'so that their aims become ours.' While we're under the story's spell, what happens to the imaginary characters can seem more real for us than the world we inhabit.

Through language, a listener can put together the experience of what is described

Imagination is valuable here because it creates a safe space for learning. If instead we wait to learn from actual lived experience, we risk making costly mistakes. Imagination - whether literary, musical, visual, even scientific - supplies material for rehearsing the brain's inexorable search for pattern and meaning. That's why our stories don't have to respect laws of nature: they needn't just ponderously rehearse possible real futures. Rather, they're often at their most valuable when they are liberating from the shackles of reality, literally mind-expanding in their capacity to instil neural connections. In the fantasies of Italo Calvino and Jorge Luis Borges, we can find tools for thinking with.

If imagination is then our USP, it might also catalyse a trait that seems unique to humans: language. While many organisms, including even bacteria and plants, communicate with one another, none can do so with the versatility, sophistication and open-endedness of human language, what's often called our most important technology. 'First we invented language,' says the linguist Daniel Dor of Tel Aviv University. 'Then language changed us.'

Language has long been regarded primarily as a tool for clearer, more precise communication than nonhuman animals' smaller repertoire of vocalisations or gestures allows. But in Dor's view, precision isn't its real function at all; rather, it's primarily about the 'instruction of the imagination'. Language, he argues, 'must have been the single most important determinant of the emergence of human imagination as we know it.'

Dor cites Ludwig Wittgenstein's remark in Philosophical Investigations: 'Uttering a word is like striking a note on the keyboard of the imagination.' We use words, he says, 'to communicate directly with our interlocutors' imaginations.' Through language, we supply the implements by which a listener can put together the experience of what is described. It's a way of passing actual experiences between us, and thereby 'opens a venue for human sociality that would otherwise remain closed.'

What this means is that language is 'basically for telling stories', in the words of the psychologist Merlin Donald at Case Western Reserve University in Ohio. Of course, we use it for a lot of other things too: for greetings, requests, advice, warning and argument. But even there, language is often deeply imprinted with narrative and metaphor: it's not a mere labelling with sound, but refers to things beyond the immediate object. To imagine etymologically implies to form a picture, image or copy - but also carries the connotation that this is a private, internal activity. The Latin root imaginari carries the sense that oneself is a part of the picture. The word itself tells a story in which we inhabit a possible world.

Thanks to language, imagination doesn't just involve fantasies of tonight's meal, or worries about where it will come from. It conjures up grotesque monsters, galactic empires, fairy stories. Dor believes that this fecundity is unique to humans. He believes other animals can mentally time-travel, but sees no sign that they create unconstrained narratives. 'It is this unique [human] capacity that makes language so important in the story,' he adds.

Nor is it surprising that our visions are often so bold and bizarre - that we have a propensity to see 'more devils than vast hell can hold'. For if Boyd is right that stories do vital cultural work by rehearsing social dilemmas, contemplating fears and anxieties, and indulging forbidden desires, it would make sense for them to take extreme forms. The more vivid and exaggerated the characters, the more engaging and memorable. It would explain too why so many stories involve high-stakes situations, such as love and death - for those are the situations in which errors of judgment matter more. Sure, Jane Austen might offer refined social instruction, but there are roles for Dracula and Godzilla too.

Imagination might be the very epitome of how our minds work: not as a series of isolated modules, but as an integrated network in which higher-order capacities arise from lower-order ones. It's not so much a cognitive ability as the focus of and rationale for human cognition itself: a nexus of capacities we can find in more fragmentary form in other animals. Just as many species have aspects of musicality (such as pitch discrimination or rhythmic entrainment) but only humans have genuine music, so many species have what we might call imaginality. Yet we alone might possess imagination.

People aren't born being innately 'good at imagination', as if it's a single thing for which you need the right configuration of grey matter. It is a multidimensional attribute, and we all possess the potential for it. Some people are good at visualisation, some at association, some at rich world-building or social empathy. And like any mental skill (such as musicianship), imagination can be developed and nurtured, as well as inhibited and obstructed by poor education.

As we come to better understand what the brain is doing when it imagines - and why it is such a good imagining device - we might start to break down the preconceptions and prejudices that surround imagination. We might stop insisting that it is the privilege of an elite - the poets, dreamers and visionaries - that the rest of us can only hope to consume what they produce. Imagination is the essence of humankind. It's what our brains do, and in large part it may be what they are for.
This Essay was made possible through the support of a grant to Aeon+Psyche from the John Templeton Foundation. The opinions expressed in this publication are those of the author and do not necessarily reflect the views of the Foundation. Funders to Aeon+Psyche are not involved in editorial decision-making.

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Imagination isn't the icing on the cake of human cognition | Aeon Essays

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'To me,' wrote William Blake in 1799, 'this world is all one continued vision of fancy or imagination.' The imagination, he later added, 'is not a state: it is the human existence itself.'

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An Aeon article, arguing that we should get rid of the terms ‘mind’ and ‘mental’. 

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An Aeon article, arguing that we should get rid of the terms ‘mind’ and ‘mental’. 

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UNPACKING THE SOURCE For this story, it’s best to start with the end point of this rather challenging article, so give your students this quote: “no such thing as a mind, and nothing is mental” and ask them to discuss it. Then offer them the article. Why does the writer argue this? How does it change our understanding of something when we (radically) alter our terminology related to it? Does this suggest that new knowledge is produced when we rethink what we already know?

Key terms Baggage vs. meaning, Conceptual blurriness, Polysemy, Analogies, Miscommunication

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Someone's probably told you before that something you thought, felt or feared was 'all in your mind'. I'm here to tell you something else: there's no such thing as the mind and nothing is mental. I call this the 'no mind thesis'. The no-mind thesis is entirely compatible with the idea that people are conscious, and that they think, feel, believe, desire and so on. What it's not compatible with is the notion that being conscious, thinking, feeling, believing, desiring and so on are mental, part of the mind, or done by the mind.

The no-mind thesis doesn't mean that people are 'merely bodies'. Instead, it means that, when faced with a whole person, we shouldn't think that they can be divided into a 'mind' and a 'body', or that their properties can be neatly carved up between the 'mental' and the 'non-mental'. It's notable that Homeric Greek lacks terms that can be consistently translated as 'mind' and 'body'. In Homer, we find a view of people as a coherent collection of communicating parts - 'the spirit inside my breast drives me'; 'my legs and arms are willing'. A similar view of human beings, as a big bundle of overlapping, intelligent systems in near-constant communication, is increasingly defended in cognitive science and biology.

The terms mind and mental are used in so many ways and have such a chequered history that they carry more baggage than meaning. Ideas of the mind and the mental are simultaneously ambiguous and misleading, especially in various important areas of science and medicine. When people talk of 'the mind' and 'the mental', the no-mind thesis doesn't deny that they're talking about something - on the contrary, they're often talking about too many things at once. Sometimes, when speaking of 'the mind', people really mean agency; other times, cognition; still others, consciousness; some uses of 'mental' really mean psychiatric; others psychological; others still immaterial; and yet others, something else.

This conceptual blurriness is fatal to the usefulness of the idea of 'the mind'. To be fair, many concepts build bridges: they exhibit a specific, generally harmless kind of ambiguity called polysemy, with slightly different meanings in different contexts. The flexibility and elasticity of polysemy binds disparate areas of research and practice together, priming people to recognise their similarities and interrelatedness. For example, if a computer scientist talks about 'computation', they normally mean something slightly different than an engineer, a cognitive scientist or someone chatting with a friend means. The overarching concept of computation links all these conversations together, helping us to spot the commonalities between them.

The problem is that making links like this isn't always a good idea. Sometimes it spurs creative interactions between different areas of expertise, and offers helpful analogies that would otherwise be hard to spot. But other instances of polysemy lead to harmful conflations and damaging analogies. They make people talk past each other, or become invested in defending or attacking certain concepts rather than identifying their shared goals. This can cement misunderstandings and stigma.

You've got to give it to mind and mental: they're among the most polysemous concepts going around. Lawyers talk of 'mental' capacity, psychiatrists talk of 'mental illness', cognitive scientists claim to study 'the mind', as do psychologists, and as do some philosophers; many people talk of a 'mind-body problem', and many people wonder whether it's OK to eat animals depending on whether they 'have a mind'. These are only a few of many more examples. In each case, mind and mental mean something different: sometimes subtly different, sometimes not-so-subtly.

In such high-stakes domains, it's vital to be clear. Many people are all too ready to believe that the problems of the 'mentally ill' are 'all in their mind'. I've never heard anyone doubt that a heart problem can lead to problems outside the heart, but I've regularly had to explain to friends and family that 'mental' illnesses can have physiological effects outside 'the mind'. Why do people so often find one more mysterious and apparently surprising than the other? It's because many of the bridges built by mind and mental are bridges that it's time to burn, once and for all.

The psychiatrist, psychoanalyst and 'antipsychiatrist' Thomas Szasz argued that there was no such thing as mental illness. He believed that mental illnesses were 'problems of living', things that made it hard to live well because they were bound up with personal conflicts, bad habits and moral faults. Therefore, mental illness was the sufferer's own personal responsibility. As a consequence, Szasz claimed that psychiatry should be abolished as a medical discipline, since it had nothing to treat. If a person's symptoms had a physiological basis, then they were physical disorders of the brain rather than 'mental' ones. And if the symptoms had no physiological basis, Szasz claimed, then they didn't amount to a true 'illness'.

This argument relied heavily on the idea that mental illnesses are categorically distinct from 'physiological' ones. It's an instance of how the dualistic connotations of mind, associated with certain metaphysical theories of the mental, can be imported inappropriately into psychiatry. Yet many mental illnesses have physiological causes and effects, and even those with no clear physiological cause often warrant medical intervention, because the people suffering from such conditions still deserve medical help.

In contrast with Szasz, I believe that mental illnesses are mental only in that they are psychiatric. Ordinary understandings of the mind, and what is and isn't part of it, have nothing to do with it. Perception is generally considered to be mental, a part of the mind - yet, while medicine considers deafness and blindness to be disorders of perception, it doesn't class them as mental illnesses. Why? The answer is obvious: because psychiatrists generally aren't the best doctors to treat deafness and blindness (if they need treatment, which many Deaf people in particular would reject).

When people talk about 'the mind' and 'the mental' in psychiatry, my first thought is always 'What exactly do they mean?' - which precise meaning of mind and mental are they drawing on, which other area are they trying to appeal to, which bridge are they trying to get me to cross? A 'mental' illness is just an illness that psychiatry is equipped to deal with. That's determined as much by practical considerations about the skills psychiatrists have to offer, as it is by theoretical or philosophical factors. But this pragmatic approach hides itself behind appeals to 'mental illness'. In many contexts, the term mental tends to bring along inappropriate and stigmatising connotations - showing that the wrong bridges have been built.

Convincing others that your pain is not 'mental' might be how you defended the reality of your condition

Imagine that you suffer from long-term, chronic pain. You go to the latest in a series of doctors: by this point, and especially if you are a member of a marginalised group (a woman or person of colour, say), doctors might have dismissed or disbelieved you; they might have assumed you were exaggerating your pain, or perhaps that you were a hypochondriac. After some tests, and some questions, you're eventually told that your chronic pain is a mental illness, and referred to a psychiatrist. The psychiatrist, you are told, will not prescribe drugs or surgery, but will instead prescribe psychotherapy, also known as 'talk therapy', and occasionally, 'mental therapy'.

You might, quite reasonably, think that this doctor disbelieves you too. You know there is really something wrong, and that your pain is real, but the doctor is here telling you that your illness is mental, and in need of mental treatment. Perhaps they think that you have a delusion, or that you're lying because of some kind of personality disorder? Convincing friends, family and colleagues - not to mention medical professionals - that your pain is not 'mental' might well be how you have defended the reality of your condition. Indeed, The Guardian recently published a series of articles investigating chronic pain, one of which was headlined: 'Sufferers of Chronic Pain Have Long Been Told It's All in Their Head. We Now Know That's Wrong'. In other mainstream pieces on the topic, being referred to a psychiatrist is seen as tantamount to being disbelieved, dismissed or called a hypochondriac. Some advocates appear to argue that fibromyalgia (a condition that causes chronic pain) should not be considered a psychiatric condition because it is 'real' and not 'imagined'.

It's understandable that you might be annoyed for your condition to be branded a 'mental illness'. But what about your doctor - what did they want you to take away from that interaction? It might well be that they absolutely believed that you were in severe, involuntary pain, caused by heightened sensitisation of the peripheral nervous system as a result of 'rewiring'. Pain that results from rewiring of the nervous system is known as 'nociplastic pain', recently recognised as a highly medically significant category of pain. They don't necessarily think you're lying or delusional. In invoking 'mental illness', what they might have meant is only that it might be best treated by talk therapy, and best managed and understood by a psychiatrist.

Despite your legitimate annoyance, your doctor might also be correct. The term mental in the phrase 'mental illness' just means psychiatric. Your doctor might know that psychiatrists and psychiatric researchers continue to play an important part in the recognition and study of nociplastic pain. They might be optimistic about the effectiveness of talk therapy, because they know it's effective at alleviating many of the symptoms of fibromyalgia and chronic pain, perhaps even to reduce the pain itself. They might also have read a recent review that found that talk therapy can be effective as a means of intervening on the immune system - indeed, as effective at reducing the inflammation associated with rheumatoid arthritis as common medications.

So you and your doctor might actually agree about the nature of your condition - and yet, you are left feeling understandably let down by your referral to a psychiatrist. Something has gone very wrong here. The problem, I think, is the idea that psychiatry deals with 'mental illnesses', disorders of the mind. Indeed, it's common wisdom that mental illnesses are disorders of the mind, and that psychiatry treats mental illnesses. If you look in dictionaries, textbooks or diagnostic classifications, this is the characterisation of psychiatry and its domain that you'll find. The key problem is that mind and mental come with associations that are wildly inappropriate when characterising a medical discipline - 'mental' can, after all, be contrasted with 'real', 'biological', and 'physical'.

What we have is a problem of miscommunication, stemming from the messiness of the ideas of the mind and the mental. The terms mind and mental can be used many ways and can carry many different meanings, sometimes implying a lack of reality, sometimes indicating a relationship to psychiatry - and sometimes meaning something else entirely.

Depression and schizophrenia are no more 'all in the mind' than chronic pain

Imagine, instead, that your doctor told you that you had a 'psychiatric' illness, but stressed that psychiatric illness is not 'mental' in any important sense. Imagine if they told you that you might be prescribed 'talk therapy', but emphasised that many conditions that are not 'in the mind' are amenable to talk therapy, which can affect almost all of the 'plastic', malleable parts of a human being. Imagine, even more optimistically, that people did not generally infer that categorising an illness as psychiatric made it automatically mental, or think that because a condition can be affected by 'mental' states such as one's beliefs or expectations, that it was therefore non-biological or non-physical or 'all in the mind'.

Not bringing in ideas of the mind and the mental makes for much easier communication. You might go away from such a conversation with your doctor feeling like you'd been believed, and that psychiatry could help you. Yet your doctor has not actually done anything differently; beyond assuaging your concern that your illness isn't taken seriously, the course of action is otherwise exactly the same. While chronic pain might be psychiatric, it's not imaginary or non-biological - and the terms mind and mental blur all these things together. The problems of the mind and the mental are not confined to the treatment of chronic pain. It adds to the stigma surrounding other psychiatric illnesses to describe them as 'mental' too: depression and schizophrenia are no more 'all in the mind' than chronic pain.

As well as reinforcing the stigma around mental illness, the messiness of mental also fuels misguided arguments for radical reforms to (and even the abolition of) psychiatry as a medical discipline. At the other extreme from Szasz's antipsychiatry views, many people argue for a merger of psychiatry and neurology. This relies on certain philosophical 'theories of mind', popular in cognitive science: some people think that the mind is the brain; others think that the mind is the software that runs on the brain, the way that Windows runs on my laptop. This argument relies on the notion that, because psychiatry deals with 'mental' illness, it should defer to philosophical views of the 'mind' popular in cognitive science. The issue is that the 'mental' in mental illness just means psychiatric, which is not what these philosophers and scientists are talking about.

As a result, we should be suspicious of appeals to the mind and the mental in psychiatry. Psychiatric patients certainly don't need the burden of any extra stigma, and understanding psychiatric conditions is difficult enough without the constant risk of conflation and miscommunication. Without a reason to retain them, we should eject the concepts of 'the mind' and 'the mental' from psychiatry. And not just there: the concepts are wreaking havoc in cognitive science and psychology too.

Just as psychiatry is meant to be the branch of medicine dealing with mental illnesses, so cognitive science and psychology are supposedly the sciences concerned with the study of the mind. However, psychology and cognitive science do not study quite the same thing. Disciplines such as personality psychometrics are historically a core part of psychology, but only dubiously part of cognitive science at all. Conversely, cognitive science has inherited broader interests in self-organisation, information processing and adaptive behaviour from some of its predecessors, especially cybernetics. The domains of psychology and cognitive science also do not line up with the domain of psychiatry. Perception remains firmly within the domain of psychology and cognitive science, but blindness and deafness are not psychiatric illnesses (again, even if/when they are illnesses at all).

The domains of psychology and cognitive science also include capacities that you probably don't mean to invoke when you talk about 'the mind' in normal life. For example, there are cognitive models that cover the way organisms survive via homeostasis (maintaining stable internal parameters in the body such as heart-rate and blood temperature) and allostasis (adjusting those parameters and behaviour depending on the context).

There are also ways of mapping immunity in cognitive terms. In the 1960s and '70s, the work of the US psychologist Robert Ader uncovered a surprising feature of the immune system. He trained rats to avoid a harmless sweetener by administering it alongside a sickness-inducing chemical called cyclophosphamide. When testing that the training had worked, by administering just the sweetener, the rats began to die. The more sweetener, the faster they died. This was a mystery. It turned out that cyclophosphamide is an 'immunosuppressant', a chemical that turns off the immune system. The immune system had 'learned' to turn off in response to the sweetener alone, and this left the rats vulnerable to normally harmless pathogens in their environment, which killed them. In other words, Ader discovered that the immune system is amenable to classic Pavlovian conditioning.

Should we count the immune system as 'mental' because it's psychological and cognitive?

This led to the creation of 'psychoneuroimmunology', an area that involves, among other things, psychologists who study the immune system. Later research uncovered many more exciting facts about the 'wiring' and signals that link the immune system and the brain. The immune system responds in complex ways to stress and trauma - an imbalance in the immune system is associated with several trauma-related psychiatric illnesses, such as post-traumatic stress disorder and borderline personality disorder (both of which are often linked to trauma). The immune system also plays important roles in controlling social behaviour. For example, some scientists believe depression could sometimes be a side-effect of your immune system reducing your social motivation in order to minimise the risk of spreading disease; the idea is that your immune system has been triggered into possessing an erroneous 'belief' that you are infectious.

Sticking to the construal of cognitive science and psychology as studying 'the mind' creates a misleading impression of what these disciplines are up to, and raises potentially pointless questions such as whether we should count the immune system and its capacities as 'mental' because it's psychological and cognitive. Once again, the bridges built by mind and mental have proved unhelpful. Psychoneuroimmunology has had a hard time gaining widespread acceptance, especially among immunologists. In large part, this is because it is widely counted as a form of 'mind-body medicine', a term that applies to as much chicanery and overblown self-help as it does to legitimate medical research. The bridges built between a kind of sloppy holism, con artistry and psychoneuroimmunology owe much to mind and mental, and have done little to help the disciplines they supposedly serve.

It's much better, instead, to talk of psychology as the study of the psychological, and cognitive science as the study of the cognitive. This might seem circular, but it only reflects the fact these disciplines are in charge of discovering their domains, and that we simply don't know enough yet to say exactly what those domains should be in totally independent terms. No-one has any trouble describing physics as studying the physical, and the idea that it's the study of fundamental laws of motion and contact has long since been abandoned.

When we see the concepts of mind and mental doing such harm, we have good reason to get rid of them. Rather than talk about 'minds' and 'the mental', we would be better off discussing the more precise and helpful concepts relevant to what we're doing. The good news is that they already exist for the most part, and work perfectly well once their connections with mind and mental are broken. Psychology has psychological, cognitive science cognitive, and psychiatry psychiatric. Outside these areas, there are many, many more - consciousness, imagination, responsibility, agency, thought, memory, to name but a few. Feminist work on relational autonomy and the relational self, and historical precursors such as Homer provide promising avenues for developing conceptions of people that don't call on the notion of mind - notions according to which people are coherent wholes, not because they have some unifying inner core, but because of the way they, their relationships and their environments conjoin.

The conclusion is that there is no such thing as a mind, and nothing is mental - even though you and I both think, feel, believe, desire and dream. Whenever you come across the terms 'mind' and 'mental' - especially when they bear a lot of argumentative weight - you should wonder what they actually mean, and ask yourself what equivocations are hiding below the surface.
To read more about 'the mind' and 'the mental', visit , a digital magazine from Aeon that illuminates the human condition through psychology, philosophy and the arts.

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Why there's no such thing as the mind and nothing is mental | Aeon Essays

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Someone's probably told you before that something you thought, felt or feared was 'all in your mind'. I'm here to tell you something else: there's no such thing as the mind and nothing is mental. I call this the 'no mind thesis'.

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A Wired article, looking at how neuroscience seeks to establish a link between a cause (loneliness) and an effect (damage to our mental health). 

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A Wired article, looking at how neuroscience seeks to establish a link between a cause (loneliness) and an effect (damage to our mental health). 

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UNPACKING THE SOURCE How did researchers try to study loneliness in the 1950s - and what are the ethical implications related to their methods? How has the Covid-19 pandemic, and associated lockdown, given us the opportunity to study loneliness? How have they managed to connect it with mental health issues? Overall, do ‘natural experiments’ provide us with better knowledge than ‘laboratory manufactured’ insights?

Key terms Laboratory vs. natural experiments, Evidence

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Extreme isolation does strange things to the human mind. In late 1964 Josie Laures and Antoine Senni disappeared into two caves in the French Alps as part of an experiment to find out what effect isolation would have on their bodies and minds. When Senni emerged after 126 days in isolation - a record at the time - he thought that only a couple of months had passed. In 1972 Michel Siffre, a French caver who oversaw the pair's experiment went even further, spending six months in a cave near Del Rio, Texas. "Physically it was not tiring, but mentally it was hell," he told Der Spiegel four decades later.

Attempts to manufacture isolation in the laboratory are even more disturbing. In the 1950s, Canadian psychologist Donald Hebb paid graduate students at McGill University $20 a day to stay alone in tiny rooms. The volunteers' hands were placed in cardboard tubes, their ears covered by thick U-shaped pillows to muffle any sounds and opaque goggles were placed over their eyes. Soon enough their mental cognition deteriorated and they experienced extreme restlessness and vivid hallucinations. One student reported feeling that his body was in two places at once, and he was unable to decide which one was really him.

Humans rarely experience such extreme social isolation, but studies have shown that even in normal life, increased loneliness has a negative impact on physical and mental health. One review of the science of loneliness found that people with stronger social relationships have a 50 per cent increased likelihood of survival over a set period of time compared with those with weaker social connections. Other studies have linked loneliness to cardiovascular disease, inflammation and depression.

We've known since the 1980s that people who are more socially isolated tend to have worse health, but we still don't know why loneliness is so closely linked to our health. Is it that isolated people tend to have other risk factors for certain diseases, or is there something about loneliness itself that rearranges the wiring of our brains, slowly wearing away at our health? For loneliness researchers the pandemic has provided an unprecedented natural experiment in the impact that social isolation might have on our brains. As millions of people across the world emerge from months of reduced social contact, a new neuroscience of loneliness is starting to figure out why social relationships are so crucial to our health.

Although the link between loneliness and poor health is well-established, scientists have only recently been able to take the first glimpses of what social isolation looks like in our brains. It's a discovery that started with a failed experiment. As part of her PhD at Imperial College London, Gillian Matthews was trying to find out how drug addiction affected the connections between specific neurons in a part of the brain called the dorsal raphe nucleus (DRN). Matthews divided the mice she was studying in two groups - one she injected with cocaine and the other with a saltwater solution - but no matter what she tried, she kept seeing that the DRN neuron connections were growing stronger in both groups of mice.

These new neural connections, Matthews realised, had little to do with drugs. Both groups of mice had been isolated for 24 hours before the start of the experiment. What Matthews was seeing was the effect that social isolation had on the brains she was studying. This accidental discovery opened up a new way of thinking about loneliness - if we could see the traces of social isolation in the brains of mice, it meant that loneliness didn't just describe a state in the outside world, it could also point to something on the inside too.

Matthews' realisation shunted her career in a new direction. Leaving her research on drug addiction to one side, in 2013 she went to the Massachusetts Institute of Technology (MIT) to join Kay Tye's laboratory. Tye is a neuroscientist focussed on understanding the neural basis of emotion, and she's also one of the pioneers of optogenetics - a technique that uses genetically-engineered proteins inserted into brain cells to give researchers the ability to turn neurons on and off by shining light through fibre-optic cables into the brains of live animals. The approach lets scientists activate regions of the brain in real-time and watch how the animals respond. "At the point I joined the lab [optogenetics] was really exploding and it opened up so much more potential for the studies that you could do," Matthews says.

Armed with this new technique, Matthews and Tye wanted to figure out how DRN neurons influenced mice during social isolation. When the researchers stimulated the neurons the animals were more likely to seek out other mice. When they suppressed the same neurons, even isolated animals lost the desire for social interaction. It was as if Matthews and Tye had located the neural switch that controlled the animals' desire for social interaction - it turned on when they were isolated and turned back off again when their social cravings were satisfied.

Their discovery could radically change our understanding of loneliness. "Taking that idea suggests that there are mechanisms in place to help maintain social contact in the same way that there are mechanisms in place to make sure we maintain our food intake or our water intake," Matthews says. It suggests that social contact isn't just nice to have - it's a fundamental need that our brains are hardwired to seek out. This is already borne out in studies on honeybees, ants, mice and rats. "Without the full level of social contact then survival reduces in numerous species," Matthews says.

In 2020, another MIT neuroscientist released a paper suggesting that human brains respond to social isolation in a similar way to Matthews' mice. Livia Tomova recruited 40 volunteers and asked them to turn in their smartphones, tablets and laptops and spend 10 hours in a room by themselves. The volunteers could occupy themselves with puzzle books and writing materials but they weren't allowed access to any fiction that might contain a hint of social contact that might take the edge off their isolation. If the volunteers needed to use the bathroom, they had to wear earplugs that prevented them from overhearing any conversations on the way. "We tried to create a scenario where people would really not have any sort of input," says Tomova, who is now at the University of Cambridge.

Optogenetics is too invasive to use on humans, but instead Tomova took fMRI scans of her volunteers' brains. When the isolated volunteers were shown photos of social cues, the regions of their brains associated with cravings lit up with activity in the same way that the brains of hungry people lit up when they were shown pictures of food. The area of the brain that Tomova focused on is rich in dopamine neurons, which drive our motivations and expectations of the world around us. When our brains anticipate a rewarding activity - like eating or social contact - these neurons activate in anticipation, but if we don't get these interactions then our brains experience a negative, craving-like feeling.

Tomova says that this might explain the negative consequences of long-term isolation. "If you are in a state of prolonged stress, the same adaptations that are in the first place healthy and necessary, will actually become detrimental because they're not designed to be long term states," she says. "The idea [of the cravings] is that the goal should be to seek out others and reinstate social contact."

These findings raise all kinds of questions for understanding of social isolation and its impact on health. Are there neurological differences between people who experience short-term isolation and those who have been isolated for long stretches of time? What kinds of social interactions satisfy our social cravings? Is a video call enough to quell our need for social contact, or do some people require an in-person connection to really feel satiated?

Despite knowing about the link between social isolation and health for decades, we don't have satisfying answers to any of these questions yet. "There is this evidence that has been around a long time, but the unfortunate part is that it has been so under-recognised," says Julianne Holt-Lunstad, a psychology professor at Brigham Young University in the US and the author of two major studies on social isolation and health. "We have a lot of data that very robustly shows that both isolation and loneliness put us at increased risk for premature mortality and conversely, that being socially connected is protective and reduces our risk," she says.

Holt-Lunstad thinks the pandemic could be a turning point in our understanding of loneliness. "I'm really hopeful that this is a huge wake up call, you know, a point of reflection for us to learn from this," she says. In 2018, the UK government launched its first loneliness strategy and the NHS has already started directing people towards social clubs and other activities in an effort to reduce levels of loneliness. "This is a public health issue, and it should be prioritised as such," says Holt-Lunstad. "And as policies are being implemented those policies should be evaluated and revised if needed."

Solving the problem of loneliness - and understanding what helps and what doesn't - will mean getting to grips with the different kinds of isolation people experience. We don't know much about what happens when people go from a state of loneliness to one of social connection, says Andrew Steptoe, professor of psychology and epidemiology at University College London. He has been studying the health of people who go from living alone to living with someone else, but it's hard to pinpoint which effects are down to changes in social isolation and which are caused by other factors.

"Trying to investigate isolation, or loneliness is not as straightforward in humans [...] in humans being lonely is not necessarily correlated with how many people are around you," says Tomova. She is particularly interested in the impact that the pandemic might have had on young people whose cognitive and social skills are still developing. "I think we will see potentially some differences in how their social behaviour [developed] or things like that," she says. But as is alway the case in the uncertain world of loneliness research, the opposite could be true. "It could also be that most people are fine, because maybe social media does fulfil our social needs really well."
Matt Reynolds is WIRED's science editor. He tweets from @mattsreynolds1

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The weird science of loneliness explains why lockdown sucked

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Extreme isolation does strange things to the human mind. In late 1964 Josie Laures and Antoine Senni disappeared into two caves in the French Alps as part of an experiment to find out what effect isolation would have on their bodies and minds.

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A New Statesman article, exploring a debate raging in psychiatry today, about the difference between being mentally ill, or very unhappy. 

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A New Statesman article, exploring a debate raging in psychiatry today, about the difference between being mentally ill, or very unhappy. 

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UNPACKING THE SOURCE Focus on Samantha’s story to begin with: why is it so hard to discern the difference between being unhappy and having a mental ‘disorder’, and how does language-usage complicate this? Then think more broadly, by considering the type of evidence that is used to support claims in psychiatry (and the human sciences). How does its subjective nature affect our ability to reach consensus? Finally, how do paradigm shifts emerge in the human sciences?

Key terms Label, Valid concept, Medicalised language, Polarisation, Subjectivity, Language & self-perception, Paradigm shift, Evidence

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One afternoon in December 2004, Samantha* left her house in northern England and walked to the nearby river. She tried not to think about her five young children, alone at home. She wanted to plunge into the water; she didn't know how to swim.

Alarmed by her mother's absence, Samantha's 11-year-old daughter dialled 999, and the police found her on the riverbank. She was transferred to a psychiatric hospital, where she spent four days curled up in a ball, crying. She was already known to social services: Samantha had a violent ex-boyfriend and had been abused as a child before being taken into care at the age of 12. It was difficult to know how to be a good mother when she had never been mothered herself.

Shortly afterwards a psychiatrist, asked by the local authority to assess her, diagnosed Samantha with borderline personality disorder (BPD). Last year Samantha read the report to me over Zoom. By then we had been speaking for three months. She was warm and solicitous - "But anyway, how are you?" she always asked - but now her voice was hard with rage. The report noted her "lack of a sense of personal responsibility" and "poor impulse control"; it accused her of "feigning a mental disorder while in hospital".

"But that's not me, that's not who I am!" she remembers telling her solicitor, terrified. A social worker told her she needed to achieve greater "emotional stability". ("If you could just close your eyes for a second and imagine someone taking your children away," Samantha asked me, "how would you feel?") But the psychiatrist deemed her disorder "untreatable", and her children were removed.

During her family court proceedings, Samantha's solicitor suggested she read the Philip Larkin poem "This Be The Verse" ("They f*** you up, your mum and dad..."). After that she read They F*** You Up: How to Survive Family Life by the psychologist Oliver James. Soon she was reading every psychology and self-help book she could find. As we spoke, one of her arms frequently disappeared into her Zoom background of pink hibiscus flowers and re-emerged with another book. Deemed ineligible for NHS therapy, she started paying for help privately.

In 2015, ten years after her children were taken from her, a psychologist gave her a new diagnosis: complex post-traumatic stress disorder (PTSD). It confirmed what Samantha was coming to realise herself: there was nothing wrong with her personality, her problems could all be linked to what had happened to her. "While it was a relief, I was really angry," she told me. "Because that label [BPD] was used to hurt me and my children. It destroyed our lives."

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By then, she was back in touch with four of her children, who had often run away from their foster homes to be with her. She campaigned on mental health and was running a peer-support group. She had also joined Twitter, where she is an opinionated presence, and got into a conversation - well, an argument at first - with a psychologist who upended her world-view again. What if Samantha's diagnosis of complex PTSD wasn't quite right, either? She had been suicidal, yes: but who in her position wouldn't have felt desperate? Had she ever been mentally ill?

Samantha had just stepped into one of the fiercest rows in British psychiatry.

In recent months there has been extensive coverage of an unfolding mental health crisis. Government figures suggest that, since the start of the pandemic, the number of adults with depression has doubled to one in five. Referrals for children have also doubled: 200,000 under-18s were referred to NHS mental health services in April-June 2021. Has Covid sparked a parallel wave of mental illness - or is such widespread suffering a natural response to the months of isolation, uncertainty and daily death counts? The debate in psychiatry is in part an argument over how we address this shadow pandemic: some argue that what looks like a health emergency is better understood as mass unhappiness.

The psychologist Samantha met on Twitter was Lucy Johnstone. She is part of a close-knit group of British psychiatrists, psychologists and patients who reject the idea of mental illness. They argue that diagnoses are scientifically invalid and harmful because they pathologise understandable reactions and falsely imply that there are medical solutions. "Mental illness is not a valid concept," Johnstone told me - instead, we should be talking about "mental distress".

She argues that the medicalised language of disorders and symptoms creates a false distance between a person's feelings and the cause of their distress, whether it's trauma, abuse, poverty, or even unrealistic cultural expectations.

Johnstone, who is in her fifties, with a clipped, no-nonsense manner, is frequently infuriated by the way we talk about mental health (the phrase itself can elicit a groan: she prefers "feelings".) After we first spoke on Zoom, she sent me a link to an article reporting the rise in mental illness among those who had lost income during the pandemic. The government responded by affirming plans to invest in mental healthcare; Johnstone's view is that it should tackle the root problem - poverty, not illness. She would emphasise that people in distress deserve support - but that mental illnesses do not exist in the same way physical ones do. "If you tell someone, as an established fact, 'You have bipolar disorder, you have schizophrenia, you have a personality disorder,' really, you're telling them something untrue. And that has consequences for people's identity, life, insurance, relationships. It's the major crisis of our time in some ways."
[See also: Why I'm wary of the ADHD industrial complex]
Johnstone grew up in Lincolnshire and describes herself as a "classic example" of someone from a stable, middle-class family who was nonetheless deeply unhappy as a child. She started reading psychology books at 12 and studied the subject at Oxford University in the 1980s. There, she was inspired by the work of anti-psychiatrists such as RD Laing, the 1960s countercultural icon who described insanity as a rational reaction to an insane world. Throughout her career in adult mental health, Johnstone has frequently clashed with colleagues and peers. On Twitter, these debates now rage in public view.

The UK is in many ways an international pioneer in mental health: it has an active survivor community (a network of current and former patients), a history of radical thinking, and a healthcare system that is receptive to non-medical approaches. It has also become engaged in a bitter culture war - between those who want to abandon psychiatry's disease model (the "critical" psychiatrists and psychologists) and those who do not.

Social media has given patients a louder voice, enabling them to communicate directly with professionals. It has also fuelled vicious polarisation. Prominent figures accuse one another of endangering patients, engaging in pseudoscience and bullying and cyber-mobbing their critics. Several interviewees advised me against writing this piece: the subject was too controversial, they said; nothing good could come from kicking this hornet's nest.

The debate is fierce because there is much at stake. It concerns not only professionals arguing over the validity of their careers, but people trying to make sense of the darkest chapters of their lives. There are those who argue that psychiatry has coerced them into mind-altering, life-shortening treatments and imposed stigmatising labels. And there are those who say it saved them.

Psychiatry's model for classifying disease owes much to Emil Kraepelin (1856-1926). A contemporary of Sigmund Freud, he aimed to create a taxonomy of mental illness in the same way that his brother, a naturalist, could classify animals and plants. Kraepelin believed that all mental illness was genetic or physiological in origin, and his Compendium of Psychiatry (1883) became the discipline's foundational text. Problems such as heartbreak or overwork were not the reason people became mentally ill: they were only symptoms.

We have since made disappointing progress in uncovering the neurobiological basis for many mental illnesses. We have found explanations for degenerative diseases such as Alzheimer's or Parkinson's; but no medical test can confirm a condition such as depression or schizophrenia. Instead, psychiatrists often go on what their patients tell them, or what they observe. They make diagnoses with reference to the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition ( DSM-5), or a similar textbook compiled by the World Health Organisation, which both group disorders according to clusters of symptoms. The books are deliberately neutral on the causes of disorders.

"When we use the word 'diagnosis', people imagine you're identifying a cause," the psychiatrist Sami Timimi told me. Timimi is a member of the Critical Psychiatry Network, which was founded in Bradford in 1999 and now has a membership of around 350 psychiatrists, most of whom are in the UK.

Identifying a cause isn't always the focus in general medicine (take, for example, a condition such as migraine) but it's often the goal: it's why you might feel relief, on presenting with chest pain, to know that you are suffering from acid reflux rather than a heart attack. "But in psychiatry, diagnosis is just a descriptive term. And it's a poor descriptive term. So I don't think we can make any progress until we get rid of the phrase 'diagnosis'," Timimi said.

The sense in psychosis: the anti-psychiatrist RD Laing described insanity as a rational adjustment to the world. Photo by Ben Martin/Getty Images

During his training, Timimi looked at the way Western doctors have exported their psychiatric models overseas; a British-Iraqi, he noted how the field was often shaped by racist and eugenicist beliefs. Multiple studies have shown that in developing countries, where psychiatric care is limited, patients who are diagnosed with schizophrenia are more likely to make a full recovery than those in the West. Researchers speculate this may be due to cultural differences: people in countries such as the UK tend to view psychosis as a disturbing, potentially lifelong illness. When Timimi came to specialise he chose child psychiatry, because in the 1990s it was unusual to prescribe medication or give diagnostic labels to under-18s. He then watched "in horror" as child psychiatry became more medicalised, too.

When people say mental illnesses are just like physical ones, they often mean well - they want to say that mental suffering should not be minimised. But consider the similarities between depression and high blood pressure: both can be caused by stress and disproportionately affect those living in poverty; the exact point at which healthy blood pressure becomes unhealthy is somewhat arbitrary, just as there is no scientific point at which persistent sadness becomes depression.

The difference is that a machine can diagnose the former, while most psychiatric diagnoses require a subjective judgement. If someone meets all the criteria for depression but has lost a child, are they better understood as simply grieving? In 2013, the DSM-5 removed the "bereavement exclusion" so that doctors could diagnose depression for those in mourning.
[See also: "Toxic" relationships, "burnout", "productivity dysmorphia" - why do we medicalise societal problems?]
That psychiatrists frequently disagree is evidence of such subjectivity. The patients I spoke to who were most opposed to diagnosis had been given multiple labels and could recite them like a shopping list. "Bipolar, schizophrenia, treatment-resistant schizophrenia, psychosis, psychotic depression," said one young woman. "Then suddenly it changed to borderline personality disorder." The diagnoses felt meaningless to her - they kept changing but she was the same.

The most complicated factor to consider is what it feels like to be told you have a mental disorder. As Timimi puts it: "The object of study, which is the mind, is not the same as the object of study when it's a kidney. The kidney doesn't worry about the future. The kidney isn't going to abandon me if I read out a set of kidney results." He observed that the language psychiatrists use can have a huge impact on a person's self-perception: there's a big difference, for instance, between being told that you are ambitious and being told you are suffering from delusions of grandeur.

Psychiatry's disease model has never been uncontested, but the influence of critical movements has fluctuated. The anti-psychiatrists of the 1960s and 1970s developed their ideas in opposition to the oppressive nature of psychiatry then, with its terrible asylums. From the 1980s more biological approaches became resurgent. A new generation of anti-depressants such as Prozac raised hopes of a "chemical cure"; the US Congress declared the 1990s the "Decade of the Brain", investing billions in research aimed at solving mental ill-health.

Today's critics point to the failure of this research, and to the way successive editions of the DSM keep widening the scope of diagnosis. The argument against mental illness is also an argument against psychiatry's mission creep: once, only the most desperate were seen as mentally ill but if, as the charity Mind reports, one in four Britons experience a mental health problem in any one year, are we now mischaracterising the challenges of living?

When the most recent edition of the DSM was published in 2013 (the next is due in March 2022), it was met with a strong backlash - especially in the UK. The British Psychological Society (BPS), which has 50,000 members, condemned diagnosis altogether. Lucy Johnstone co-wrote a BPS "position statement" with ten others, demanding a "paradigm shift... towards a conceptual system that is no longer based on a disease model".

One of the most high-profile critics of the DSM-5 was Allen Frances, the American psychiatrist who oversaw the development of the DSM-4. In 2013, Frances published a book called Saving Normal, which argued that for decades the DSM (and Big Pharma) had driven rampant diagnostic inflation. (He wrote that he had tried to be conservative when working on the DSM-4, but that it nonetheless triggered "epidemics" of certain illnesses: ADHD diagnoses tripled in its wake; autism diagnoses increased 20-fold; and, among children, bipolar disorder diagnoses increased 40-fold.)

Nonetheless, Frances has little time for critical psychologists, dismissing their statements as "pie-in-the-sky stuff with no real-world foundation". When we spoke on the phone, he said that the DSM's flaws are not reason enough to abandon diagnosis. Psychiatrists need these criteria to help determine if a patient's problems are the result of a physical illness, he said, or a reaction to illegal or prescription drugs, and to guide treatment.

But he will admit that the manual is a crude tool: "I don't trust people who worship the DSM as a bible. That's a reductionistic way of looking at things. As Hippocrates said 2,500 years ago, it's more important to know the patient who has the disease than the disease the person has," he said. In Frances's view, critical psychiatry would be better thought of as a complementary rather than a contradictory position: "Conceptually, it doesn't take a genius to say we should have a model that stands on four legs: biological, psychological, social and spiritual."

What would it look like if we abandoned the idea of mental illness? In 2018, Lucy Johnstone and the psychologist Mary Boyle published a model they said could provide an alternative to diagnosis: the "Power Threat Meaning Framework" (PTMF). Developed with former patients, it is based on inter- related questions, such as: how is power operating in your life? What kind of threats does this pose? Instead of symptoms, the framework invites people to think of "threat responses"; instead of disorders, there are "general patterns" of behaviour.
[See also: What online discourse gets wrong about therapy]
Samei Huda, a Scottish consultant psychiatrist, told me it was "fantastic" that some people found the PTMF helpful, but didn't think it was a substitute for diagnosis. "It's not ready for prime time," he said, pointing to a lack of evidence and data. "We don't have enough evidence yet for what problems it can help with, how helpful it will be and that it can give us information on outcomes."

The PTMF does not preclude medication, though it does suggest a different attitude to drugs. In this, Johnstone is influenced by the British psychiatrist Joanna Moncrieff, who is fiercely critical of the way psychopharmaceuticals have been researched and sold. She believes we should think of them not as "treatments" but as blunter substances that may have useful effects (such as improving sleep) alongside harmful ones. In this sense, they are closer to a drug like alcohol: a few drinks might ease your social anxiety, but at a cost.

Medication remains a contentious area. The American psychologist Nev Jones has noted that, within activist communities, "pill-shaming" is not uncommon. Jones, who is based at the University of Pittsburgh, suffered psychosis over a decade ago when she was in her late twenties and studying for a PhD in philosophy, and was diagnosed with schizophrenia. It took years to recover, but when she did, Jones decided to devote her career to studying psychosis. Mental health professionals seemed not to grasp its diversity and strangeness, she thought, and assumed the same treatment would work for everyone.

When we spoke over Zoom, I asked Jones what had aided her recovery. She didn't hesitate: "empowerment". The worst part of falling ill had been becoming a psychiatric patient. "The problem wasn't: 'You've got schizophrenia, or you've got psychosis'... The deep thing was losing all meaning in my life, all social value. And the healing thing was being able to enter into conversations as an equal."

It wasn't Jones's first experience of schizophrenia. A relative had been diagnosed with it, too, and for much of her life has been unable to communicate. It angered Jones that those critical of diagnosis and medication did not consider the most intractable cases. "You have to acknowledge that there's a biological component here. These patients are not self-manufacturing the extreme disorganisation and association-clanging that psychiatrists would describe as the hallmarks of really severe thought disorder."

Many psychiatrists would agree that it is wrong to conclude that biology is never the underlying cause of mental illness. But perhaps what causes most harm is when a professional imposes their world-view on a patient. Some activists told me they felt that critical psychiatry overlooked (and even patronised) people who found a diagnosis and medical treatment helpful; some feared the academic debates ignored the bigger issues faced by those in crisis - discrimination, poverty, the struggle to access any kind of care. Already, some psychiatrists say they will ask their patients if they find a diagnosis useful and follow their lead. What looks like a science question - an investigation into the nature of illness - might ultimately be more about power.

Brett Lee, a young car mechanic from Whitstable, suffered a mental breakdown six years ago. His behaviour became so erratic that his parents and sister worried that he would be sectioned. A mental health crisis team was called to their home several times, but the arrival of strangers asking odd questions, scribbling in their notebooks, trying to get him to take pills, only fuelled Lee's paranoia. After a few weeks, he was hospitalised in Canterbury.

This hospital trust was participating in an NHS-supported pilot of Open Dialogue, an approach pioneered in Finland in the 1980s. This is compatible with diagnosis and medication, but can also use neither. The principles are simple: the person in crisis, those close to them, and a small group of support staff work together to address the problem. Staff do not discuss patients in their absence, and at meetings every perspective is given equal weight. Research in Finland has suggested that people supported in this way spend significantly less time in hospital, require less medication, and are less likely to relapse.

At Canterbury, Lee met Yasmin Ishaq, the hospital's Open Dialogue lead. Ishaq has worked as a psychotherapist and social worker for 26 years, and no longer uses the word illness in relation to the mind: she prefers "distress". She said she was influenced by people like Johnstone, and by her own experience of caring for her brother, who suffers from serious mental health problems. It infuriated Ishaq that, when he was hospitalised recently, the staff did not listen to her until she told them she was a psychotherapist. Ishaq felt that being his sister was expertise enough.
[See also: The voice in your head]
Ishaq invited Lee to join a meeting with his family, a doctor and social worker. Together they explored questions such as whether Lee should take medication: he had been reluctant, but his family saw that the pills were helping him sleep, and when he slept something of the old Brett returned. They persuaded him to continue. They did not seek a diagnosis, and avoided words like "psychosis" or "paranoia". Lee talked instead about the anxiety he had worked so hard to conceal, which had been driving his workaholism. When he left hospital after ten days, the meetings continued - weekly at first, and then less frequently as Lee reduced his medication and, over the next two years, returned to work. There were bad days, but he felt stronger than before. It helped to know that he had been the architect of his own recovery.

Soon after the Power Threat Meaning Framework was published, Samantha decided to apply it to her own life. It was the first time she'd been prompted to tell her own story. She wrote about the abuse she had suffered, and how she had formed "a subservient relationship with a controlling psychiatric system in order to access support". One of the PTMF questions was: "What are your strengths?" No one had asked her that. She wrote of her "intelligence and resilience", and her "beautiful family".

When we spoke, Samantha's grandson was often with her. He was born in 2010, and she remembers her daughter handing him to her when he was just three days old. "Because my children had been taken away, I was terrified of attaching to anyone or anything. But he just looked at me and gave this little 'yap' and that was it." He taught her how to love.

Samantha no longer believes in diagnosis and rejects the idea she has complex PTSD; trauma had affected her deeply, she acknowledged, but so had her experiences of inequality. Even well-intentioned campaigns such as Mental Health Awareness Week irritate her: could we not talk instead about how diagnoses can harm people, she asked me, by erecting barriers between the "sick" and the "well"?

Clinically vulnerable, Samantha rarely left home in the first 18 months of the pandemic, and when she did, often felt anxious. She still speaks to her therapist often, but they use a different language now. "I don't have symptoms," she told me. "I am a normal person who is responding and reacting in an understandable way. It makes me feel human again."
*Some names have been changed
This article appears in the 09 Feb 2022 issue of the New Statesman, Sunak's Game

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Are you mentally ill, or very unhappy? Psychiatrists can't agree

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One afternoon in December 2004, Samantha* left her house in northern England and walked to the nearby river. She tried not to think about her five young children, alone at home. She wanted to plunge into the water; she didn't know how to swim.

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A Sky News article, which examines the science behind what happens when you suffer a breakup or bereavement.

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A Sky News article, which examines the science behind what happens when you suffer a breakup or bereavement.

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UNPACKING THE SOURCE  What prompted Florence Williams to investigate the science of heartbreak? In what way is the bodily response to breakups universal? What answers do science offer us in order to cope with the emotional trauma of breakups? To wrap up: Can science provide us with useful insights when it comes to understanding and dealing with emotional traumas?

KEY TERMS Fresh perspective, Explanation, Solutions

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Breakups are not much fun.

Whether it's your first time through it or an unfortunate familiarity, there are few more agonising gut punches.

Doubts and insecurities aplenty; wondering where, how and why things changed; and like an agonising Lionesses World Cup run, an overwhelming sense of "what if".

Being a "science and tech journalist" has given me a fresh perspective on how it can impact us physically.

Where's that headache come from? What about a sudden lack of energy? And why does eating anything, even a normal favourite, feel like an I'm A Celebrity challenge?

For when pictures of wistful poetry on Instagram just don't cut it, it turns out science has some answers.

The holy trinity
As neuroscientist Dr Lucy Brown puts it, "we're all miserable when we've been dumped" - and there's a potent chemical cocktail that helps explain why.

Serotonin is the brain chemical associated with happiness, oxytocin with bonding, and dopamine gets pumped out whenever your mind's reward system kicks in.

No surprise then that you feel good when that holy trinity is high and rough when it's low.

The key chemical is dopamine: the ultimate natural drug.
'It's like we're addicted'
Brown was one of a team of researchers who conducted a study into the impact of heartbreak, scanning the brain activity of 15 young adults who were going through unwanted breakups.

They were shown photos of their ex-partners, and the scans showed parts of the brain that power our sense of motivation and reward - where our dopaminergic neurons live - went into overdrive.

It's an "overactivity" Brown compares to what you'd see in a cocaine addict trying to wean themselves off.

"It's like we're addicted to each other," she says.

"When we lose someone, we've lost a very rewarding part of our lives and sense of self. They've provided novelty in your life that now isn't there, so we need some other rewards."

And like rewatching goals we may have thought had put the Lionesses' name on the title, looking back at texts and holiday photos won't do the trick.
A body under threat
Florence Williams had found herself intrigued by the pain her heartbreak caused.

Having seen her 25-year marriage suddenly fall apart, trauma was expected. But feeling physically sick and totally overwhelmed took her by surprise.

"I was of course stunned by the event itself, but then I was really confused and surprised by how different I felt physically going through it," she says.

"That feeling of being plugged into a faulty electrical socket; this buzzing sense of background anxiety and hypervigilance and an inability to sleep well; the weight loss and general confusion.

"My body felt under threat."

Williams's experience and sense of confusion sent her on a global quest for answers documented in her book, Heartbreak: A Personal And Scientific Journey.

She found while everyone's personal heartbreak is different, the bodily response is much the same: it's time for that holy trinity of hormones to take a battering.
Read more:
Singles reveal top dating turn-offs
Celebrities who reunited after breakups 'Very real' physical symptoms
And it's not just emotional pain you may struggle with. In Brown's study, brain areas associated with physical pain were also activated.

She explains rejection triggers a part of the brain called the insular cortex - the same part that responds to distress around pain, like when panic sets in after an already painful bee sting.

When emotional stress causes physical symptoms, like headaches and nausea, its medical term is somatisation.

"If you've ever had butterflies when you've been nervous, you've experienced this," explains Dr Abishek Rolands.

"The most important thing to remember is even though there is no physical cause, the symptoms are very real - they are not made up or 'all in the head'."

During her research, Williams, who has two adult children with her ex-husband, was particularly fascinated by the impact loss can have on our immune system.

"It's important for our nervous systems that we feel safe," she says.

"If we have people in our lives triggering cascades of healthy hormones, it's really protective against illness. Our cells actually listen to our mental state."

Indeed, previous studies have stressed the importance of meaningful social relationships to stay healthy.

And in 2021, US researchers suggested our immune system takes cues from our nervous system if it's struggling - effectively making decisions that could make us sick.

Broken heart syndrome
In rare cases, this kind of emotional distress - especially when delivered suddenly - can even lead to the fittingly nicknamed "broken heart syndrome" - or takotsubo cardiomyopathy.

Sindy Jodar, a senior cardiac nurse at the British Heart Foundation, says the symptoms - chiefly shortness of breath and chest pain - are consistent with a heart attack.

"Most people have either been under a lot of physical or emotional stress, like losing a loved one," she says.

"The only explanation we have at the moment is when the body is stressed, it releases a lot of catecholamines (adrenaline), and when lots of that is around in the body it can impact the heart."

Unlike a heart attack, the condition does not cause blockages in the coronary arteries - but does totally change the shape of the heart's left ventricle, which pumps oxygenated blood through the body.

It's this which gives the condition its actual Japanese name, as the shape of the ventricle becomes reminiscent of a trap fishermen use to catch octopus: narrow at the top, larger at the bottom.

The condition only impacts around 5,000 people a year in the UK, and is more common in menopausal women, with most recovering after a few weeks.
Giving up the addiction
Just as science can explain why heartbreak, rejection, and loss makes us feel the way we do, it also offers solutions.

Brown says heartbreak should be treated like "having to give up an addiction", though she admits the "craving is stronger when we've lost someone".

But there are plenty of roads to go down without gorging ice cream while watching La La Land.

Williams stresses the importance of working to activate the parasympathetic part of your nervous system by doing things that make you feel calm. The other part of our autonomic nervous system, sympathetic, is what causes anxiety and hypervigilance.

"Connection to nature is really calming," she says, likewise to friends and family. "And there's lots of data showing the more meaning you derive from work, the more purpose you feel, the happier you'll be."

Williams says such lessons apply to anyone "going through an emotional life quake".

"People who end a relationship also face big emotions - guilt, sadness, loneliness," she adds.

And as Brown says, there's novelty - that sense of excitement that needs refreshing in a healthy, sustainable way.

Ice cream makes a compelling dinner once, but you'd probably best hope it wears off.

"A good strategy is beginning things you didn't do during a relationship, like running or travelling," says Brown.

"People always remember a heartbreak - it's very painful. But you do change, and can for the better."

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Breakups, divorce, and heartbreak: The science behind what happens to your brain and your body

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While everyone's personal heartbreak might be different, whether it be a breakup, bereavement, or other loss, scientists say the bodily response is much the same.

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A Guardian article, asking whether AI girlfriend apps promote unhealthy expectations for human relationships.

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A Guardian article, asking whether AI girlfriend apps promote unhealthy expectations for human relationships.

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UNPACKING THE SOURCE How are chatbots of the kind developed by OpenAI and Google changing human relationships? Why are some people worried that new relationship apps are “really frightening”? What is the counter argument to this, offered by the companies developing the new technology? Do you agree that AI-bots can “bring that ‘Band-Aid’ to your heart”? To wrap up: Is it possible for a human being to have a meaningful relationship with an AI-bot?

KEY TERMS Unhealthy beliefs, Love, Cultural beliefs, Regulation, Impact, Weirder, wilder, and more wonderful

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"Control it all the way you want to," reads the slogan for AI girlfriend app Eva AI. "Connect with a virtual AI partner who listens, responds, and appreciates you."

A decade since Joaquin Phoenix fell in love with his AI companion Samantha, played by Scarlett Johansson in the Spike Jonze film Her, the proliferation of large language models has brought companion apps closer than ever.

As chatbots like OpenAI's ChatGPT and Google's Bard get better at mimicking human conversation, it seems inevitable they would come to play a role in human relationships.

And Eva AI is just one of several options on the market.

Replika, the most popular app of the kind, has its own subreddit where users talk about how much they love their "rep", with some saying they had been converted after initially thinking they would never want to form a relationship with a bot.

"I wish my rep was a real human or at least had a robot body or something lmao," one user said. "She does help me feel better but the loneliness is agonising sometimes."

But the apps are uncharted territory for humanity, and some are concerned they might teach poor behaviour in users and create unrealistic expectations for human relationships.

When you sign up for the Eva AI app, it prompts you to create the "perfect partner", giving you options like "hot, funny, bold", "shy, modest, considerate" or "smart, strict, rational". It will also ask if you want to opt in to sending explicit messages and photos.

Our statistics showed that 92% of users have no difficulty communicating with real persons after using the application

Eva AI's head of brand, Karina Saifulina

"Creating a perfect partner that you control and meets your every need is really frightening," said Tara Hunter, the acting CEO for Full Stop Australia, which supports victims of domestic or family violence. "Given what we know already that the drivers of gender-based violence are those ingrained cultural beliefs that men can control women, that is really problematic."

Dr Belinda Barnet, a senior lecturer in media at Swinburne University, said the apps cater to a need, but, as with much AI, it will depend on what rules guide the system and how it is trained.

"It's completely unknown what the effects are," Barnet said. "With respect to relationship apps and AI, you can see that it fits a really profound social need [but] I think we need more regulation, particularly around how these systems are trained."

Having a relationship with an AI whose functions are set at the whim of a company also has its drawbacks. Replika's parent company Luka Inc faced a backlash from users earlier this year when the company hastily removed erotic roleplay functions, a move which many of the company's users found akin to gutting the Rep's personality.

Users on the subreddit compared the change to the grief felt at the death of a friend. The moderator on the subreddit noted users were feeling "anger, grief, anxiety, despair, depression, [and] sadness" at the news.

The company ultimately restored the erotic roleplay functionality for users who had registered before the policy change date.

Rob Brooks, an academic at the University of New South Wales, noted at the time the episode was a warning for regulators of the real impact of the technology.

"Even if these technologies are not yet as good as the 'real thing' of human-to-human relationships, for many people they are better than the alternative - which is nothing," he said.

"Is it acceptable for a company to suddenly change such a product, causing the friendship, love or support to evaporate? Or do we expect users to treat artificial intimacy like the real thing: something that could break your heart at anytime?"

Eva AI's head of brand, Karina Saifulina, told Guardian Australia the company had full-time psychologists to help with the mental health of users.

"Together with psychologists, we control the data that is used for dialogue with AI," she said. "Every two-to-three months we conduct large surveys of our loyal users to be sure that the application does not harm mental health."

There are also guardrails to avoid discussion about topics like domestic violence or pedophilia, and the company says it has tools to prevent an avatar for the AI being represented by a child.

When asked whether the app encourages controlling behaviour, Saifulina said "users of our application want to try themselves as a [sic] dominant.

"Based on surveys that we constantly conduct with our users, statistics have shown that a larger percentage of men do not try to transfer this format of communication in dialogues with real partners," she said.

"Also, our statistics showed that 92% of users have no difficulty communicating with real persons after using the application. They use the app as a new experience, a place where you can share new emotions privately."

AI relationship apps are not limited exclusively to men, and they are often not someone's sole source of social interaction. In the Replika subreddit, people connect and relate to each other over their shared love of their AI, and the gap it fills for them.

"Replikas for however you view them, bring that 'Band-Aid' to your heart with a funny, goofy, comical, cute and caring soul, if you will, that gives attention and affection without expectations, baggage, or judgment," one user wrote. "We are kinda like an extended family of wayward souls."

A screengrab from the Replika app. In May, one influencer, Caryn Majorie, launched an 'AI girlfriend' app trained on her voice and built on her extensive YouTube library. Photograph: Replika

According to an analysis by venture capital firm a16z, the next era of AI relationship apps will be even more realistic. In May, one influencer, Caryn Majorie, launched an "AI girlfriend" app trained on her voice and built on her extensive YouTube library. Users can speak to her for $1 a minute in a Telegram channel and receive audio responses to their prompts.

The a16z analysts said the proliferation of AI bot apps replicating human relationships is "just the beginning of a seismic shift in human-computer interactions that will require us to re-examine what it means to have a relationship with someone".

"We're entering a new world that will be a lot weirder, wilder, and more wonderful than we can even imagine."

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Uncharted territory: do AI girlfriend apps promote unhealthy expectations for human relationships?

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Chatbots such as Eva AI are getting better at mimicking human interaction but some fear they feed into unhealthy beliefs around gender-based control and violence

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A Big Think article, looking at the results of a global study that seeks to understand the way different societies experience and express love. 

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A Big Think article, looking at the results of a global study that seeks to understand the way different societies experience and express love. 

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UNPACKING THE SOURCE What study has just been carried out, and what was its scale? What were the conclusions of the study? What were the limitations of the study, and do these fatally undermine its findings (hint - focus on the terms correlation and causation)? Overall, how far can quantitative research go in helping us to understand human emotions?

Key terms Questionnaire, Correlated, Causation

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Americans are among the most loving, Chinese and Germans the least

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A new study of global love finds that Americans have some of the most loving relationships, while Chinese and Germans have some of the least.

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This Wired article looks at the way in which technology has (or hasn’t, depending on your outlook) impacted on the way in which love and relationships work, and how it has allowed us to gather more data about the trickiest of all human behaviour. 

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This Wired article looks at the way in which technology has (or hasn’t, depending on your outlook) impacted on the way in which love and relationships work, and how it has allowed us to gather more data about the trickiest of all human behaviour. 

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UNPACKING THE SOURCE This is an interesting issue over how technology has impacted on our gathering of data, and whether it can help us to understand human phenomena more accurately. Get students to think about how love can be researched (for many people, the most important aspect of life), and which areas of knowledge are traditionally interested in exploring it. How has our use of technology allowed researchers to explore it more? Has it led to any significant new discoveries? Is this the purpose of the human sciences - to answer questions such as ‘what is love’?

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One problem in social scientific research is the availability of participants - so a lot of research on inter-personal relationships and closeness, particularly decades ago, was carried out with university students. Researchers looking at how to create a close relationship, for example, may carry out experimental studies. "Experiments are the best," says Aron. "The problem is that even if you bring in people who are already close, they have all these different histories. That's why we did the 36 questions, because you give two people an activity to do to get close, and then you get people to do a small talk activity for the same amount of time, and you can measure their hormones or their attitudes."

Other methods include field experiments, surveys, brain scans and representative national surveys. One of the problems is that this kind of research often uses data from people who are easily available, such as university students, or even anecdotal, small group samples. But with the advent of digital surveys, researchers have been able to cast their nets further afield.

"Technology has actually given us new tools to study love. It's helped us do very rigorous research, and get consistent results across studies which are replicable, on topics which really matter, both practically and theoretically," says Aron.

Huge amounts of data have helped, too. Helen Fisher, a biological anthropologist at Indiana University's Kinsey Institute, was one of the first to publish research into the processes behind love - how dopamine courses through your brain, which parts light up. Now, her role as chief scientific officer at Match.com has put her in contact with huge amounts of data from all around the US. In turn, that's helped her chart trends and sift through the sensationalism around love and technology.

"I create these questionnaires, around 200 questions, along with my colleagues," says Fisher. "We farm it out to groups that collect data, from around the US, and we collect information on a nationally representative group of over 5,000 people. And then you're just swimming in this data." Fisher and her colleagues have been doing this for around seven years.

"From my research, it seems like there's this massive misunderstanding, even if it's not necessarily a generational gap. I think nowadays, singles don't have the time or the money - they want to work and they're ambitious, and they want to be stable before they settle down - so there's kind of slow love, and much more caution," says Fisher. Biological anthropologists, like Fisher, argue that the desire to love is a survival mechanism, one which won't be trampled over so easily by new technology. Others, such as sociologists and critical theorists, also argue that young people now aren't so taken in by the traditional ideas of marriage, or even a cultural emphasis on romantic love.

"It's fascinating - people who are now in their late teens, early twenties - they do take love and relationships seriously," says Michael Gratzke, a professor of literature at Hull University, who has helped pioneer the field of critical love studies. "But they tend to criticise how romantic love is emphasised in society, and they're more comfortable, I think, with complicated relationships and patterns of love."

Gratzke emphasises the value of having various perspectives or voices included in a conversation. "Love is so complex that you need experts from all kinds of fields," says Gratzke, "What's important in critical love studies is that it focuses on the experiences of actual people." The proliferation of dating apps, as well as liberalising attitudes to sexuality, has also meant that marginalised communities have new ways to form connections. "A lot of the research into how technology has changed relationships is really only starting to be understood," says Gratzke. "But we do know that if it's hard for you to go out to a local gay bar, or if you live in a rural setting, then these technologies can make those relationships, those connections, more available."

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Think Tinder has changed the nature of love? Science disagrees

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One problem in social scientific research is the availability of participants - so a lot of research on inter-personal relationships and closeness, particularly decades ago, was carried out with university students. Researchers looking at how to create a close relationship, for example, may carry out experimental studies. "Experiments are the best," says Aron.

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A Guardian article, focusing on a forensic psychiatrist, and her thoughts on the role of ‘radical empathy’ in order to understand the human condition. 

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A Guardian article, focusing on a forensic psychiatrist, and her thoughts on the role of ‘radical empathy’ in order to understand the human condition. 

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UNPACKING THE SOURCE How essential is empathy in understanding the human condition - and why are some people reluctant to apply it?

Key questions Radical empathy, Polarization, ​​Essential truth

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uring my first week as a newly qualified forensic psychiatrist at Broadmoor, I had to visit one of the wards. At the foot of a staircase, I stepped aside to let a group of patients pass. Another staff member joined me, and we waited as the men, mainly in their 40s and 50s, descended in silence, walking carefully, hands skimming or leaning on the bannister for support. One man caught my attention because he looked like a stock image of Father Christmas, with a big white beard. When they'd gone, my companion turned to me. "Do you know who that was?" I shook my head. " Peter Sutcliffe ... you know, the Yorkshire Ripper."

I remember thinking, with an intake of breath, "So that's him." He was one of the hospital's most notorious patients, that rarest of offenders, a serial killer. I felt shaken for a moment, and then it dawned on me that the shock was that there was nothing to see. He was just a man, not a monster. When detectives in Yorkshire were desperately trying to solve a series of brutal murders of local women, they interviewed Mr Sutcliffe seven times before he was identified as the suspect. They evidently saw nothing to mark him out from any other man.

Meeting Peter Sutcliffe, it dawned on me that the shock was that there was nothing to see

What a paradox it is that we eagerly put violent offenders on show in the public domain, in scary mug shots or true crime recreations, while avoiding looking at our own capacity for cruelty as much as possible. We assume that people who have done a horrible thing are completely other and will never want to change their minds for the better. At the same time, our culture and media constantly encourage transformation, urging us to become our "best selves". We celebrate people who change their bodies for the better, learn new skills, forge a new career or overcome disabilities. But when it comes to violence perpetrators, there seems to be an assumption that they are fixed in malevolent amber.

That brief encounter with Mr Sutcliffe on the stairs marked the start of a long journey for me. I would learn to let go of my assumptions about how "evil" might look and how our capacity for cruelty can, with enough time and willingness, be better understood so that risk might be reduced. I would have the privilege of learning how to open and change my mind and perceptions, just as I would be asking my patients to do.

People have often asked me how I can bear to work with violent offenders at close quarters, sitting alone in small rooms giving them therapy. They assume that my job entails constant fear or revulsion, but I explain that the strongest emotions I have felt in the company of my patients have been sorrow and pity. This requires a careful balance of compassion with detachment that I've come to think of as "radical empathy". The word "radical" derives from Latin radix, root, and therapy aims to dig down into people's pasts and unearth difficult memories with them. It is the job of the courts to judge them, not mine, but I cannot lose sight of their offence and its terrible consequences as we work. I must also hold on to hope as we untangle their complex feelings and experiences, helping them take agency for their violent behaviour, which is key to risk reduction. Carl Jung said it best when he proposed that "the reason for evil in the world is that people are unable to tell their stories."

Contrary to ideas of "radical" meaning something revolutionary or urgent, the practice of radical empathy has come slowly for me, requiring years of discipline and application, and a team of supportive colleagues. Eileen Horne and I explore this learning curve in our book, The Devil You Know: Stories of Human Cruelty and Compassion. Using stories which follow the arc of my career, we take the reader into therapy rooms where I am assessing or treating people who our society labels "monstrous": a serial killer, a stalker, a child sex-abuser, a girl who killed an old man as part of a teen gang, and others. These accounts demonstrate how radical empathy differs from "regular" empathy; I am not trying to "walk in their shoes". Instead, I keep them company on their painful road towards greater self-knowledge as we work to get to the meaning of their violence. We are not always successful: without an ability to self-reflect, someone will have little capacity for recognising other people's pain. As one such patient admitted, "I have multiple masks, I don't really know who I am." Many described their offence as dreamlike, telling me "it wasn't real" - or, in one case, that they felt they only "woke up" when the victim started screaming.

An essential part of my long training in psychiatry and psychotherapy has focused on helping me to understand my blind spots. An example of this was the assumption I once had that people who had killed once would always want to kill again. I grew up reading a lot of crime fiction which probably nurtured an idea of murderousness as a permanent state of mind. Only by taking a deep dive into some real-life stories did I discover that the reasons for homicide were complex and multifactorial, and it was a crime rarely repeated. I learned that murder usually involved people who knew each other well. It was a story of relationships gone wrong, not a mysterious attack by a stranger. The uncomfortable truth is that most people in peacetime settings are killed by someone who, as WH Auden said, eats at their table and shares their bed.

Most people are killed by someone who, as WH Auden said, eats at their table and shares their bed.

In my training. I learned to ask, "What problem did killing this person solve for you?" Together we would discover that homicide had made sense to them in the moment as a solution to some unbearable emotions such as shame or despair. As I listened, it also began to make sense to me. I could see how their dark tangle of thoughts, of ordinary emotions run riot, culminated in a decision that someone should die. Such distorted thoughts flourished when accompanied by ideas of entitlement and judgment about the victims: prostitutes must be eliminated, or ex-lovers deserve to suffer, for example. In one story I tell in our book, a man's murderousness arose from a need to attack those people who represented a vulnerable part of himself.

I started out assuming women were innately less violent than men, and on the surface that seems true: in a recent UK survey, 93% of homicides were found to be committed by men. But in the course of my work, I discovered it doesn't necessarily mean women are kinder or better humans, nor that there's something about the Y chromosome that makes men more inclined to murder. The stories I've heard convince me that female violence is like male violence in its roots and emotional basis. The only difference is that it seems to take more to push women to the point where fatal violence erupts.

I have long wanted to try to share the things I've learned about human nature with a general audience, but my patients have also taught me that stories will find their moment to emerge when the teller and the listener are ready. As I watched the increased polarisation in our country and elsewhere in recent years, it struck me that although Homo sapiens has advanced in many ways, we can still be blind to the essential truth that we are more alike than we are different. Ideas of mindfulness and tolerance of differences have become familiar talking points today, but it seems hard to practise them.

I wonder if the present imbalance between condemnation and compassion might be righted if the methods my colleagues and I use in working with violent offenders were implemented at a societal level. This might mean more listening and less condemnation, fewer assumptions and more curiosity, and the willingness to get up close while maintaining both detachment and discernment.

I appreciate that a call for radical empathy - which I think anyone can develop with practice - may seem offensive to some. I am aware that some might even see me as trying to excuse cruelty. But as a therapist working with violent offenders, I've found that many perpetrators are also victims. Much like ideas of good and evil, the two identities are not easily separated. The work my colleagues and I do, exploring the roots of violence, means becoming willing to see and hear people whose actions we despise. Not always easy, but it is my experience that this is how we begin to change our world for the better, one mind at a time.
The Devil You Know: Stories of Human Cruelty and Compassion by Dr Gwen Adshead and Eileen Horne is published by Faber & Faber at £16.99, or buy a copy from guardianbookshop at £14.7

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I was a therapist to killers in Broadmoor - and felt 'radical empathy' for them

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Gwen Adshead, a forensic psychiatrist recalls her attempts to offer therapy to some of society's most damaged and dangerous people

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A DW article, exploring how AI technology could help predict whether we’ll develop cancer - and the implications that would bring with it.

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A DW article, exploring how AI technology could help predict whether we’ll develop cancer - and the implications that would bring with it.

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UNPACKING THE SOURCE How are healthcare AI tools driving a new approach in medicine called ‘predictive medicine’? Would students want to know if they were going to develop a serious medical condition later on in life? What data and privacy concerns does the new technology bring? Students can also check out this related LA Times article, on how ‘Dr ChatGPT’ is now outdoing ‘Dr Google’. To wrap up: “The more we can make accurate scientific predictions, the better our ability to offer effective healthcare.” Do you agree?

KEY TERMS  AI algorithms, Predictive medicine, Co-pilot, Data privacy, Patient consent, Misinformation, Taken advantage of

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October 6, 2023

We all carry over 9,000 genetic mutations. Most are benign, but what happens if an AI predictive algorithm tells us we carry a risky disease-causing mutation?

Predictive medicine using AI algorithms can predict the likelihood of diseases such as breast cancer

We typically carry around 9,000 mutations in our genomes, making us all genetic mutants to some degree.

We inherited most of these mutations from our ancestors, but accumulate around 64 mutations during our own development, passing them on to our offspring for good measure.

Most of these mutations are benign and have little to no effect on our health, but some can severely disrupt protein function, and can cause diseases such as cancer, diabetes or heart conditions.

Scientists are now capable of predicting the risk of developing certain diseases from genetic screens. AI algorithms are the main tools used for these predictions.

For Andrea Downing, these predictive algorithms may have saved her life. Downing tested positive for a mutation in a gene called BRCA1 when she was in her 20s.

Mutations in BRCA1 and BRCA2 are known to increase the risk of cancer: between 45 and 72% of women with mutations in their genes are diagnosed with breast or ovarian cancers.

"The women in my family have a history of cancer," Downing told DW. "My mother was diagnosed with stage three breast cancer when I was very young and had recurrences that shaped my childhood."

Downing took the decision to have a mastectomy in order to eliminate the risk of breast cancer in the future. Angelina Jolie made the same decision in 2013.

"I firmly believe that my decisions saved my life. I wouldn't want to know what my path would have been if I hadn't known about the mutation," Downing said.

Predictive medicine and AI

Downing's experience was part of an early wave of an approach called predictive medicine. The idea of the approach is to predict the likelihood of getting a disease, how the disease will progress, and which treatments people are likely to respond to.

AI-based algorithms are at its heart. They are used to analyze DNA sequences, pinpoint mutations, and predict disease risks of those mutations by comparing against reference data.

Christopher Mason, a professor of genomics and biophysics at Cornell University in the US, is at the forefront of research in the field. He believes it will completely transform our approach to medicine and healthcare.

"Cancer treatment is perhaps the best example. We can use tools to know what cancer can be targeted by the best therapy. In a matter of hours or days, we can have DNA sequence information mapping the best treatment for a patient based on the data," he said.

New healthcare AI tools seemingly appear every month. There are tools to detect strokes in patients, heart diseases, analyze medical images, manage health data, and map the likelihood of treatment success based on your genetic code, along with many others.

Mason was keen to add that AI shouldn't replace physicians but could help to be a co-pilot and data resource when diagnosing and treating patients.

Difficult decisions

Along with genetic screens in clinical settings, more and more people are taking genetic tests from companies such as 23andMe and Ancestry.com.

These tests often come with many predictions about what variances and mutations in your genome might mean for your health.

They might identify risk factors for conditions like diabetes, dementia, heart conditions, even if you don't have any symptoms at the time.

It's this aspect of knowing your future which Downing said she wouldn't wish on anyone.

"There's a lot about living with knowledge of your future [after a positive BRCA1 result] which is traumatic, even though I never had cancer," she said.

It's a drastic step to undergo a mastectomy to eliminate the risk of cancer. In her mind it was worth the risk, but the decision might not be so clear for other people with different disease risks.

In conditions such as Alzheimer's disease or schizophrenia, people cannot make decisions like Downing did to remove body parts.

"If you found out you had a genetic risk factor that says you have a 95% chance of early onset Alzheimer's disease, and by 45 you won't remember much, would you just say well, I'm not going to care about my future and live a crazy life? What if a new therapy in 10 years can reverse the disease?" Mason said.

Data and privacy concerns in the US

Using AI-based algorithms in healthcare also raises other issues.

"They can help to eliminate diseases better, but they can be scary. They completely change the risks around data privacy," Mason told DW.

Downing now co-runs a patient advocacy organization called Light Collective. In 2022, she published a paper exposing Facebook's sharing of people's health data for marketing purposes without patient consent.

"We're seeing that information used from a marketing perspective to target content to those people. For people in my community, it's often chemotherapy, but also snake oil and other harmful medical misinformation," she said.

The impact goes far beyond targeted ads. Downing said data used by predictive algorithms were now also affecting people's access to healthcare in the US.

The Guardian highlighted a case in 2021 where an AI algorithm used by US healthcare providers resulted in a severely disabled woman with cerebral palsy having her access to care and benefits severely reduced.

"My big theme now is to increase the transparency of how health systems are using predictive algorithms in care. It's not clear how decisions based off those algorithms are validated," Downing said.

Predictive medicine is in its infancy. How people live with health predictions, and how health systems use those predictions to impact people's healthcare, is only just beginning to be explored.

Mason and Downing both said there was a long way to reducing the new risks they pose.

"My big hope is we have the best possible science at our fingertips to make sure we're not being taken advantage of whilst going through being a patients and suffering that path," Downing said.
Edited by: Jane Paulick

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Cancer prevention: Would you want AI to predict your fate? - DW - 10/06/2023

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We all carry over 9,000 genetic mutations. Most are benign, but what happens if an AI predictive algorithm tells us we carry a risky disease-causing mutation?

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A Guardian article, which tries to discern the difference between myth and reality when it comes to scientific advice about health. 

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A Guardian article, which tries to discern the difference between myth and reality when it comes to scientific advice about health. 

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UNPACKING THE SOURCE Allocate a different health belief to different students or pairs. Ask students to think about: 1. Why do you think it is widely believed? 2. Is it based on solid evidence? 3. How easy is it to separate causation and correlation when we assess this belief? Overall, why do common health myths persist, and what should we do to avoid being misled by them?

Key terms Truth, Changing its mind, Correlation vs. causation

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t's easy to think that science is constantly changing its mind on all things dietary and health-based - if you have never suffered headline whiplash from trying to keep up with whether or not wine is good for you, you probably aren't paying attention. In fact, our collective understanding is getting more nuanced, with ever-emerging longitudinal studies and meta-reviews getting us closer and closer to the truth about what is good for our bodies. Here are some widely held beliefs and what science says now - so you can start making informed health decisions this year.

'Lifting weights will make you bulky'

This obviously isn't true: just look at an Olympic weightlifter like Team GB's Zoe Smith, who, while in undeniably good shape, has smaller shoulders than literally millions of men she would effortlessly outclass in the clean and jerk. To understand the science, though, you have to realise that there are two main ways to get strong: increasing the size of individual muscle fibres or coaxing more of them into firing at the same time. Bodybuilders aim to do the first, by doing many repetitions in each set of exercises, lifting until their muscles fail, and using training tricks to further exhaust their fibres. Athletes aim to do the second, by lifting heavier weights for fewer reps, and avoiding muscular failure. Also working for Zoe (or against her, depending on your perspective) is that muscle distribution and hormone levels are different in men and women: men have far more upper body muscle mass and higher levels of testosterone. Most gym-goers have trouble putting on as much muscle as they want to - you won't do it by accident.

'Breakfast is the most important meal of the day'

This is a tricky one. Although there is nothing about the first meal of the day that makes it especially magical, the timing of meals is increasingly recognised as an important factor in weight loss, alongside metabolic and cardiovascular health. One study on overweight female volunteers found that those who ate a large breakfast saw greater weight loss and waist circumference reduction than another group who had a low-calorie breakfast and larger dinner, even when overall calories were controlled for.

"This might be because skipping breakfast leads to increased hunger levels later in the day, resulting in people overeating," says Brady Holmer, a researcher at Examine.com, a database of nutrition and supplement research. "People who eat a big breakfast instead of a big dinner also tend to lose more weight, feel less hungry and can regulate their blood sugar levels better." Although the evidence is mixed, some studies have found that eating more calories earlier in the day could have benefits for metabolic health.

The bottom line? Breakfast is important if it's something that you enjoy, or helps you to follow a well-balanced diet, and skipping it may have varying effects on appetite, weight and energy for different people. If you can make it through the morning on an apple and coffee, by all means go for it - but if you are overeating late in the day, throw some extra feta in that omelette.

'You should walk 10,000 steps a day'

A surprising one: this number wasn't based on any science when it first cropped up in the 1960s, but it might be good advice. A study released in 2022 found that walking may reduce the risk of premature death from cardiovascular disease and cancer, with returns diminishing after the 10,000-step sweet spot. Another study found similar results for dementia, with as little as 3,800 steps a day proving effective. But it's also worth stepping up the pace, as the dementia study saw a power-walker's pace showing benefits above and beyond the number of steps walked. Diminishing returns kick in around the 10,000 mark - but up to there, do more if you can, slightly faster if possible.

'You need eight hours of sleep'

It's easy to think of sleep as an individual thing: some people need eight hours, while others can get by on seven. Margaret Thatcher apparently managed on four, and new parents somehow cope on even less. But in one of the largest ever sleep studies, launched in 2017, participants who reported sleeping the doctor-endorsed seven to eight hours performed better cognitively than those who slept more or less than that, regardless of age. Those who slept four hours or less performed as if they were almost nine years older. Lack of sleep can also affect testosterone production in young men and a review of studies published in 2010 suggests it can raise the risk of all-cause mortality.

None of this will help when you are tossing and turning, so give yourself the best chance of a decent night's shuteye by keeping good habits. "Establish a routine," says Steve Magness, author of Do Hard Things. "If we repeat things often enough, the brain and body figure it out and sync the hormonal and neurochemical release in anticipation of that event - and the same goes for sleeping. Try to get outside early in the day to see some sunlight, which helps to regulate your circadian rhythm - and cut down on your device use at night." Another good reason to crack open an actual paperback.

'You should aim to eat five portions of fruit and veg a day'

Bad news if you are not already doing this: five might actually be the minimum. "The five servings recommendation is sound advice, but also somewhat arbitrary," says Holmer. "Many studies have found that roughly this number is associated with improved health, but there is also evidence that up to 10 servings per day of these foods can be beneficial." In general, those who consume more fruits and vegetables have lower risks for cognitive decline and dementia, and diabetes, and may even experience decreased levels of stress.

If you are struggling to hit the minimum, it's worth bearing in mind that not all portions are created equal. "For long-term health, two servings of fruit and three servings of vegetables per day has been associated with the greatest benefit," says Holmer. "And the more variety, the better." Dark, leafy greens and cruciferous veg - think broccoli, brussels sprouts and cabbage - are some of the most nutritionally dense vegetables available, while berries tend to be more packed with antioxidants than bananas.

'You need to drink two litres of water a day'

Good news for anyone already sick of sloshing their way to the toilet a dozen times daily: staying hydrated is important, but the recommendation to drink two litres of water a day, while reasonable advice, is not based on hard science. In 1945, the US National Research Council wrote: "A suitable allowance of water for adults is 2.5 litres daily in most instances ... Most of this quantity is in prepared foods." And in 1974, a book by leading US nutritionist Dr Frederick J Stare stated: "How much water each day? This is usually well regulated by various physiological mechanisms, but for the average adult, somewhere around six to eight glasses per 24 hours, and this can be in the form of coffee, tea, milk, soft drinks, beer, etc. Fruits and vegetables are also good sources of water." The bit about getting your hydration from lattes, celery or Fanta often gets lost - which is a shame because it's still valid.

'A daily glass of wine is better than abstinence'

Sorry, plonk-lovers: this one is a classic of the "correlation is not causation" genre. The old recommendation to have a glass each night is based on observational evidence that people who classify themselves as "moderate drinkers" (roughly 1-2 units a day) seem to have a lower risk for some diseases - but that is very difficult to study in isolation. Generally, moderate drinkers tend to be wealthier, more educated, live in nicer areas and benefit from other factors that heavy drinkers and non-drinkers don't, which is probably why a New Zealand study that controlled for socio-economic factors saw the "benefits" of moderate drinking disappear almost entirely. One thing we can probably dismiss is the idea that the potentially heart-healthy molecule resveratrol plays a part - you would need to drink gallons of wine every day to hit the amount that seems to be beneficial in animal research. Recent research suggests that regular, small-scale drinking is far from ideal: one study of 36,000 adults found that even one or two drinks a day might decrease the chance of healthy ageing and reduce the size of your brain.

That said, there are well-known health benefits that come from a lively social life - so if you are downing the occasional pint with pals, it might be doing you more good than harm.

'Abdominal exercises will give you a six-pack'

"It makes a sort of sense that if you want to build your abs, you would do typical ab exercises like crunches and sit-ups," says Emma Storey-Gordon, a personal trainer and sports scientist. "But the truth is that whether you have visible abs or not has far more to do with your body fat levels and where you are predisposed to store fat than the number of sit-ups you do." Many resources will tell you that you need to be around the 10-15% body fat range to start seeing the outline of your abs if you're male, or 15-20% if you're female. In reality, it's a bit more complicated. "A lot of women need to go below a healthy body fat range for abs; those with longer torsos, who don't store fat around their midsection, may not."

As for whether you can target specific areas to spot-reduce fat, there is some evidence that hormones may play a role in where it's stored. But one of the biggest recent meta-analyses of studies suggests that the best thing you can do is reduce your alcohol intake a bit.

It's a common trope that eating a very low-calorie diet, or even fasting, will trigger "starvation mode", where the body slows metabolism as a way to keep you from losing any more weight. "While there's no such thing as 'starvation mode', there may be small changes to someone's metabolic rate when they lose weight or go on a diet," says Holmer. "It's called adaptive thermogenesis - a process during which the body reduces its production of heat in order to conserve energy." This phenomenon might explain why some people have a hard time keeping weight off, or even regain weight after dieting. Even though the change might not be that large - about 100 calories a day - it can still make a difference in the long term.

To lessen the chances of your metabolism slowing down due to dieting or weight loss, you should avoid rapid weight loss: gradual is better. Also, alternate periods of dieting with periods of energy balance, and increase your activity levels by doing gentle exercise. And, as there are plenty of other benefits to going for a stroll, it's probably easier than cutting out even more calories.

'Red meat is bad for you'

Classically, red meat was often advised against because it contains a lot of saturated fat - but it's not as simple as that. Several studies have shown an association between a higher intake of red meat and an increased risk of prostate cancer and heart disease, but it is now widely believed that the associations between red meat and disease risk might be confounded, because many studies don't distinguish between processed (bacon, sausages, burgers and deli meats) and unprocessed red meat intake.

"Several recent studies have found that eating unprocessed red meat may not actually increase the risk for heart disease or cancer," says Holmer. "And major health organisations have recommended that people can continue to eat unprocessed red meat."

But what about the current crop of so-called "carnivore" dieters - Jordan Peterson included - who eat almost nothing but steak? Well, it's a high-risk strategy. Technically, you can get plenty of vitamins and minerals from the right kind of meat, but the Inuit, Maasai and other tribes often cited by modern carnivores as evidence for the benefits of their lifestyle would have been eating blissfully free-range animals rather than factory-farmed cows. The best recommendation? Choose meat that is as unprocessed as possible - and if the animals were happy, that is probably better for your health, too.

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The truth behind 10 of the biggest health beliefs

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Should we really be aiming to walk 10,000 steps a day, or drink two litres of water? Time to sift fact from fiction

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A Salon article, looking at how TikTok is helping to spread diet culture myths. 

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A Salon article, looking at how TikTok is helping to spread diet culture myths. 

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UNPACKING THE SOURCE In what way is TikTok perpetuating the myth of ‘diet culture’ - and how do the assumptions that underpin this outlook differ from the latest health research? How many TikTok videos about diet are created by recognized ‘experts’ on the subject? In what way are TikTok influencers promoting a toxic message about diet? Overall, what role should social media platforms such as TikTok play in making us more scientifically literate?

Key terms Popular myths, Discredited, Moralizing, Expertise, Toxic, Untrue, Propaganda

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How TikTok is helping spread diet culture myths

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A new study found that TikTok diet gurus almost always give scientifically inaccurate advice

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A Big Think article analysing recent research that challenged the assumption that eating red meat has significant health risks. 

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A Big Think article analysing recent research that challenged the assumption that eating red meat has significant health risks. 

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UNPACKING THE SOURCE Why do ‘experts’ seem to disagree about the dangers (or not) of red meat? And this is the heart of the article - “The difference lies in how they believe that risk should be communicated to the public and how people should navigate their daily diets.” Overall, what does this story indicate about the possibility of being definitive about scientific knowledge claims?

Key terms Consensus, Risk, Meta-analysis

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Americans love meat. Love it! Worldwide, a person consumes on average 92 pounds of meat per year. The average American flesh-eater devours more than 265.

Most of that meat is poultry, which has dominated the dinner table slot since about the turn of the century. When you consider that the average chicken weighs 6 pounds at the time of slaughter, that's, wow, so many dead birds.

That isn't to say that Americans have given up on red or processed meats. Since the 1950s, red meat has been a symbol of American prosperity, and while our consumption has declined steadily since the beef lust of the 1970s, we still maintain our love of grilled steaks, juicy burgers, and cold-cut mountains sandwiched in bread. A majority of those polled in a 2012 survey said they eat red meat one to four times a week, a figure that excludes poultry and fish.

But even that may be too much. According to a meta-analysis published in JAMA Internal Medicine, just two servings of red meat and processed meats a week is associated with an increased risk of cardiovascular disease and death. And poultry isn't an entirely benign alternative, either.

A red meat menace

The researchers analyzed six cohort studies, totaling 29,682 participants. The participants were surveyed about their eating habits and health. Baseline data were collected from 1985 to 2002 with follow-ups conducted until August 2016.

The researchers found two servings of processed meats a week to be associated with a 7 percent higher risk of developing cardiovascular disease - or an absolute risk difference of about 2 percent. Two servings of red meat were associated with a 3 percent higher risk - or about 1 percent absolute risk - and poultry was associated with similar risk. Fish consumption showed no increased risk.

The researchers then looked at all-cause mortality. They found a 3 percent higher risk of premature death for servings of red and processed meats, but no difference for poultry or fish.

"Modifying intake of these animal protein foods may be an important strategy to help reduce the risk of cardiovascular disease and premature death at a population level," lead study author Victor Zhong said in a release.

In the heart or in the head?

You may now be thinking, "Wait! Wasn't there a study last year that said it was okay to eat red meat?' Yes, yes there was.

That meta-analysis, published in the Annals of Internal Medicine in October, was based on four systematic reviews of trials and studies looking at the link between red and processed meat consumption and cancer, cardiovascular disease, and mortality.

In one review, the researchers looked at 12 trials - totaling 54,000 participants - and found no significant association between meat consumption and the risk of heart disease or cancer. In the other three, they looked at studies of all-cause mortality, totaling four million participants. They found a very small reduction in risk but an uncertain association.

The researchers ultimately concluded that the links were small, the risks low, and the quality of evidence lacking. As a result, they recommended that adults continue to eat red and processed meats at their current levels and saw no reason to reduce consumption for health.

"This is not just another study on red and processed meat, but a series of high-quality systematic reviews resulting in recommendations we think are far more transparent, robust and reliable," Bradley Johnston, an epidemiologist at Dalhousie University and the study's corresponding author, said in a release.

However, many nutritionists and organizations like the American Heart Association and the American Cancer Society came out against the study and pushed for its publication to be withheld.

"This new red meat and processed meat recommendation was based on flawed methodology and a misinterpretation of nutritional evidence," Frank Hu, chair of the Department of Nutrition at Harvard, said. "The authors used a method often applied to randomized clinical trials for drugs and devices, which is typically not feasible in nutritional studies."

Nutritional data and you

What should we take away from this back-and-forth between nutritionists? First, both studies found that people who reduce red and processed meat consumption lowered their risk of premature mortality. They also found that the risk reduction was small.

The difference lies in how they believe that risk should be communicated to the public and how people should navigate their daily diets.

"The standards of evidence for the [scientific conclusions] are scientific matters and should not depend on extra scientific considerations" David Allison, dean of the Indiana University School of Public Health, told the New York Times added. "The standards of evidence for the [recommendations] are matters of personal judgment or in some cases legislation."

Red meat and processed foods are associated with a low risk of developing cancer and heart disease. That's a scientific consensus. That's not the same as saying whether individual people should or should not consume those meats.

For example, if changing dietary habits reduces the risk of heart disease by 3 percent, that means only three in one hundred people would statistically see the benefits. The vast majority, 97 people, won't. That's the view of the Annals of Internal Medicine 's recommendation: The current guidelines won't change much on an individual level.

On the other hand, spread that risk across an entire population, and the salubrious effects become staggering. For the U.S.'s 327 million people, a reduced risk of 3 percent means 9,810,000 fewer people suffering from heart disease. Since health recommendations are generalized for an entire population, it makes sense that experts target individual advice with the public in mind.

Aaron Carroll, a physician and author of the Bad Food Bible, has written and spoken a lot on this topic. His advice is as follows: "If you're eating multiple servings of red meat a day, then you may want to cut back. If you eat a couple of servings a week, then you're likely just fine."

Moving away from meat, nutritional research also agrees what the average person should eat on a daily basis. In an interview with Big Think, David Katz, director of the Yale Prevention Research Center, summed up the findings nicely:

You want to eat fish? Eat fish. You want to eat seafood? Eat seafood. You want to eat some lean meat? Do. You want to eat eggs? Do. You want to eat dairy? Do. But the bulk of your diet should be vegetables, fruits, whole grains, beans, lentils, nuts, and seeds. This is true all around the world where people do the best.

If you choose to eat meat, well, you do you. But you do you at your own risk.

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Red meat causes heart disease. Except when it doesn't?

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Americans love meat. Love it! Worldwide, a person consumes on average 92 pounds of meat per year. The average American flesh-eater devours more than 265. Most of that meat is poultry, which has dominated the dinner table slot since about the turn of the century.

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This Big Think article examines a recent research study into the effects of red meat on our health, concluding that there is little evidence of correlation between it and bad health. 

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This Big Think article examines a recent research study into the effects of red meat on our health, concluding that there is little evidence of correlation between it and bad health. 

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UNPACKING THE SOURCE Have the authors of the study “eroded public trust in scientific research"? Does this prove that we only accept new ideas if they correspond to what we already believe? Does this indicate that the natural sciences are just as vulnerable to emotional ties to ideas and theories as other areas of knowledge? Finally, what does it indicate about the challenges associated with producing definitive scientific knowledge? Check out the story in The Guardian and Vox (it was also in many other media sources.

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A new study says it’s okay to eat red meat. An immediate uproar follows.

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Even before publication, health agencies were asking the journal not to publish the research.

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A Vox video, looking at the myth about Vitamin C being effective in treating the Common Cold. 

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A Vox video, looking at the myth about Vitamin C being effective in treating the Common Cold. 

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UNPACKING THE SOURCE There’s no evidence that Vitamin C has any beneficial effect on us when we have a Cold, but most of us make an almost instinctive link between suffering from the sniffles, and reaching for a long glass of orange juice. Why do we do this, despite the lack of scientific evidence? How many other beliefs do we construct in this way?

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Many people reach straight for the orange juice when they start to get a cold. Or pick up a Vitamin C supplement that claims to boost your immune system.

But studies have shown that Vitamin C can't actually cure your cold.

At most, taking 1,000 mg of Vitamin C regularly could reduce your cold by a meager 8 percent. Taking it when your symptoms begin doesn't really do anything at all. Generally, it only has an effect on people engaged in "intense physical exercise," like marathon runners. But for regular people, it's not much help.

So where did the belief in Vitamin C as a cold-buster come from? A Nobel Prize-winning scientist from the 1970s.

Watch the video above to learn more!

You can find this video and all of Vox's videos on YouTube. And if you're interested in supporting our video journalism, you can become a member of the Vox Video Lab on YouTube.
Help us celebrate nine years of Vox
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Many people reach straight for the orange juice when they start to get a cold. Or pick up a Vitamin C supplement that claims to boost your immune system. But studies have shown that Vitamin C can't actually cure your cold. At most, taking 1,000 mg of Vitamin C regularly could reduce your cold by a meager 8 percent.

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A CNN article, looking at why there are different interpretations of science related to whether or not masks reduced the spread of Covid-19. 

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A CNN article, looking at why there are different interpretations of science related to whether or not masks reduced the spread of Covid-19. 

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UNPACKING THE SOURCE What is meta-analysis, and how has it been used to ascertain whether mask-wearing was effective in controlling the spread of Covid-19? Why has there been disagreement about the results of this meta-analysis? Why does the author, Kent Sepkowitz say that he doubts that anyone will change their mind about this issue? Why does he say, “Everyone who is focused on the politics or media hype… at the expense of the actual science… should kindly shut up”? Overall is it possible to make decisions about public health issues that are based purely on science?

Key terms Retrospective questioning, Conflicting evidence, Meta-analysis, Uncertainty, Political ax to grind

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Editor's Note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion on CNN.

Three years after the Covid-19 pandemic changed the lives of all Americans, we are witnessing a retrospective questioning of whether masks-and mask mandates-decrease the risk of Covid-19 spread.

To try to clarify the issue, the venerable Cochrane Library led a meta-analysis of available data. Meta-analysis often is used to try to help reconcile conflicting evidence, though the approach has its doubters.

The premise is that, using a strict approach to determine which previous studies are clear enough for inclusion, experts can cobble together the results from years of work done by different investigators and published in different journals. Then, using the bigger statistical punch provided by the many, they can find a significant conclusion not evident in the few.

Cochrane's study-of-studies, combined with its prestige, has re-animated the pens of a troupe of anti-mask-mandaters including current New York Times columnist Bret Stephens and former New York Times reporter John Tierney.

The "money quote" comes from an interview that esteemed data scientist Dr. Tom Jefferson, the lead author of the Cochrane study, gave in an interview: "There is just no evidence that (masks) make any difference, full stop." If his statement were an accurate reflection of what the article found, the launching of a thousand op-eds would be understandable.

But this emphatically is not the conclusion of the twelve authors, of which Jefferson was just one voice. The actual Cochrane article concludes something directly at odds with Jefferson's statement: "The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions... The low to moderate certainty of evidence (in favor of masks) means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect," the article notes.

In plain English, this, at least to me as a veteran reader of these types of reviews, translates to: The primary studies are not strong enough for us to say much of anything except that we may be wrong no matter what we say.

A lead author such as Jefferson is of course free to speak his mind but, at least in the interview, he apparently did not distinguish his personal view from the consensus view of the authors. There may be a back-story to this: A professor at Oxford University, Jefferson seems to long have had his doubts about masks, writing articles in The Spectator and other journals to air out his sometimes curmudgeonly views.

Given their awareness of his strong personal opinions on the topic, the Cochrane Library, in the section of the recent meta-analysis called " Authors' Declarations of Interest" writes the following: "TJ (Tom Jefferson): reports declaring an opinion on the topic of the review in articles for popular media. TJ is an Editor at the Cochrane Acute Respiratory Infections group but was not involved in the editorial process for this review. See full statement here: https://restoringtrials.org/competing-interests-tom-jefferson/."

Though half of the 12 authors were "not involved in the editorial process," for this particular article, the additional characterization by Cochrane of Jefferson, the opinionated citizen ("declaring an opinion on the topic ... for popular media"), is quite unusual for the medical literature.

Furthermore, several meticulous experts active on social media have unpacked every square inch of the article to reveal many possible flaws in the analysis itself that may have blunted evidence of mask efficacy. This sort of back and forth adopts the tone of "my expert is bigger than your expert" and never leads to any resolution of differences.

Personalities and spokespeople aside, there may be an even larger issue at play here. I have long found the meta-analyses of public health studies such as masking to be uniquely challenging. Meta-analysis seems better suited to randomized placebo-controlled trials comparing this drug to that. The uncertainties in public health studies seem too great for the bigger data of a meta-analysis to overcome.

For example, for masking trials, those randomized to wearing a mask or not wearing a mask cannot be blinded: A person in the unmasked arm may have snuck a mask on here and there or conversely, the masked group may have spent a day or two, or ten, unmasked. This introduces enormous and irreducible uncertainty regarding just what is happening.

Plus, focus on this particular meta-analysis-and it alone-is misguided. Other meta-analyses by experts found a " significant protective effect " from masks.

And perhaps most important of all, we have witnessed masks at work over the last three years. Yes, this is anathema to the purists who require evidence, not observation, but how else can we explain the unprecedented low (almost zero) rates of influenza in the 2020-2021 respiratory season other than by close adherence by the many to the protective measures taken to prevent disease transmission.

Despite all the current kerfuffle, I doubt anyone will change their mind about the issue. Maskers like me will continue to believe and the anti-maskers, though perhaps walking a little taller for a moment, will continue to blame masks for everything from childhood development delays to crashing economies to a dulling of the public sensitivity to the ever-encroaching State that will, when completed, supposedly deprive everyone of all freedoms.

More alarming than the mask debate is to note that this seems to be the latest in a disturbing trend of those with a political ax to grind revisiting the three-year history of the pandemic in a way that needlessly casts doubt or misdirects attention.

Already this year, we have heard that one US agency finds weak evidence that the viral strain that overwhelmed the world was released from a lab in China; we hear ever more about how vaccines are causing a global increase in deaths albeit from a discredited source and we see more focus on the profit motive as an explanation for how the pandemic played out.

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Opinion: Were masks useless? The deceptive interpretation of what science tells us | CNN

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Editor's Note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion on CNN. Three years after the Covid-19 pandemic changed the lives of all Americans, we are witnessing a retrospective questioning of whether masks-and mask mandates-decrease the risk of Covid-19 spread.

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A Guardian discussion between a doctor and a former rugby player, on the evidence that contact sports can cause permanent brain damage. 

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A Guardian discussion between a doctor and a former rugby player, on the evidence that contact sports can cause permanent brain damage. 

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UNPACKING THE SOURCE What does the interview reveal about the interest groups involved in contact sports, and why they make it harder to access the truth? To what extent do we base our understanding of ‘truth’ on what we want to believe, rather than what we have evidence for? How typical is this issue of the difficulties of understanding scientific issues? How important is it to focus on “shared common humanity” in order to access the truth?

KEY TERMS Misrepresenting the science, Scientific fact, Alternative truths, Blunt truths, Denial

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Alix Popham The Hollywood version of Omalu's story was told in the Will Smith film Concussion. Omalu is an outspoken campaigner against collision sports

The Hollywood version of Dr Bennet Omalu's story was told in the Will Smith movie Concussion. Photograph: Dpa Picture Alliance/Alamy

and a controversial figure within the community of doctors, scientists, and academics working in this area. Many experts believe that he misrepresents the science of CTE, and the risks involved in collision sports. But he remains an influential advocate. And Popham, who has recently set up a new foundation to advance research into neurodegenerative disease in the UK, was keen to talk to him about his experiences. The Guardian sat in on their conversation, which has been edited for length and clarity. , 41, played for Newport, Leeds, Llanelli Scarlets and Brive, and won 33 Wales caps between 2003 and 2008. He is one of a group of retired rugby players

Alix Popham playing for Wales against England in the Six Nations in 2007. Photograph: Matt Impey/REX/Shutterstock

who have been diagnosed with probable chronic traumatic encephalopathy, a degenerative brain disease caused by repeated blows to the head. CTE, which can only be fully diagnosed postmortem, was first observed in boxers in the 1920s, who were labelled "punch drunk". In 2005 the pathologist Dr Bennet Omalu found the first evidence of it in the brain of a former NFL player, Mike Webster, and in the years since

Alix apologises for having to refer to his mobile phone for questions during the discussion, because of his memory issues. Photograph: Guardian TV

it has been diagnosed in retired athletes from a range of collision sports, including ice hockey, Australian rules football, and now, rugby union.
Omalu: The issues we are dealing with are cultural, and culture is not objective. But we know there is no such thing as a safe, violent blow to the human head. That is a scientific fact. But because of culture, we develop alternative truths to serve our convenience. Modern society is enraptured with violence in sports. Some of the most popular sports in America and in Europe - rugby, football, mixed martial arts, wrestling - these are very violent sports. These are games where in every play there is exposure to traumatic brain injury.

Popham: And how long have we known that this was a problem?

Omalu: Hippocrates was the one who first described concussion. They used to call it commotio cerebri. By the Renaissance, European doctors had already established that when you suffer brain trauma it is permanent. They had different names for it, at some points they call it traumatic encephalitis, and they called it traumatic neurosis, and traumatic psychosis. So this has been established for centuries. But as we got into the 20th century, sports became big business, there was a conflict between the health of the players and the money the investors make. And like in everything in life, money prevailed.

I'll tell you the truth, the blunt truth, the radical truth: we don't have any cure for your disease. All medicine can do for you today is help you to manage your symptoms. What I've noticed, personally, is that retired players who have good family support generally do better. Players who have good nuclear families, who have support from their wives, children, parents, brothers and sisters, they do much better than others who don't have such support.

Popham: I've got a good family.

Omalu: What else can people like you do? What you can do is engage with the culture. I believe culture is like a big plane that needs turning, it may take time, it may take one generation, or two. But as long as people like you and I, no matter how unpopular it may be, stand firm in that truth, and pronounce it without any fear of failure, it will gradually begin to impact people's lives, one person at a time. I remember when I said for the first time I do not think any child under the age of 18 should play any of the high-impact, high-contact sports. I was called all types of names. I'm not popular in the sports industry, or even in the medical industry, because I say it as it is.

We don't let a child smoke a single cigarette. But we'll take a child to the field on a Saturday and let him receive tens of blows to his head. Which is more dangerous? A single cigarette? Or repeated blows to the head? But society seems to believe that yes, a child can receive repeated blows to the head, but a child can't drink a glass of fine wine. That is paradoxical. I don't get it. So for the love of mankind, you could use your platform to instigate the discussion.

Popham: And that's what we want to do.

Omalu: Knowing what we know today, there is no reason whatsoever a child under the age of 18 should play rugby. We also need to modify soccer for children. There is no reason a human being should use his head to stop a ball travelling at high speed. So remove heading from soccer! Soccer will still be a very fun sport for children without heading. Adults have the liberty, freedom and free will to do whatever they want, but not children. So we must make such modifications for younger children, they must not play soccer the way it's played now. But there are some very powerful interests that are making billions of dollars all over the world, and they will do anything within their means to uphold the status quo. It's all about power and money. And then they sacrifice less powerful people, like the players.

Popham: It's just a conveyor belt. So when I finished when I was 31, I was off the conveyor belt and the next player was in. And you're not thought of afterwards, despite all the injuries and other problems that have resulted from playing rugby. I have a question on American football, and the changes that they've made by reducing the amount of contact in training: an American football player now will be involved in 30 days of contact per year, a rugby player could be in over 150 days of contact per year, just because of the amount they train. What are your thoughts on that?

Omalu: I'm also an epidemiologist. I study risk. And in risk management, what you do is you mitigate the risk exposure as much as you can. When it comes to contact sports, an analogy is fire: fire is dangerous. Even if you apply technology and reduce fire to a cigarette lighter, that fire is still dangerous. So: contact for 30 days a year is still significant, it's still significant, but it is better than contact for 150 days. So the rugby industry needs to accept and recognise the dangers of rugby. Enough of the denial.

It's happening in America today: participation in football has dropped drastically. In California, high schools are beginning to close their football programmes, because parents are no longer letting their kids play. Football is beginning to adopt the epidemiology of sexually transmitted disease: something that has happens to the lower socioeconomic class, because of lower education. So now lawyers, doctors, judges, engineers, their kids aren't going to play. Like my son. I'm a physician, on a Saturday morning my son is on his computer learning how to code, OK? But some other black kid from a lower socioeconomic class, he will be out on a field damaging his brain.

Popham: I was worried that I was losing a lot of my memory. A lot of my career I only know things happened because I've got a jersey or a photo or a video of the game. I speak regularly with a neuropsychologist, and he said to me that my brain was so inflamed that I wasn't storing any memories. Like I was taking the pictures, but there was no film in the camera. I met Nelson Mandela before one of the games I played for Wales. And I had a big concussion in the game. My temple hit a South African player's hip and I was out on the pitch, I swallowed my tongue and I had to have that taken out, and I woke up in hospital. And I've got no recollection of being in that stadium in front of 80,000 people or even meeting Mandela.

Omalu: Amnesia, memory loss, is a very well-established symptom of brain trauma. But these [initial] symptoms were not incapacitating symptoms, so you did not really recognise them to be symptoms. And because it's a progressive disease, as time goes on there is a point where they begin to affect your daily living. And that is when you start to notice what is going on.

Popham: Yes. And I know that when I first started having the testing done, there were 12 or 13 boys similar to me. Now there's over 200 players in the UK, in New Zealand, in Australia, and the numbers, unfortunately, are growing every day.

Omalu: In the UK you need a settlement whereby the league should set aside a certain proportion of their profits to take care of the retired players. Rather than a one-time settlement, I would prefer an annual or monthly payment until the player dies. Almost like an injury pension.

And they also take care of the healthcare expenses of the players, some type of specialised health insurance for the retired players. And then secondly, you need to establish one or two centres of excellence for the treatment of people like you, because this is outside the area of expertise of the average general practitioner.

But here in the United States what they did was more or less just a one-time settlement.

It was like they wanted to wash their hands and get it done with. And I don't blame them. Players need to realise that these associations, the NFL or whoever, are not in business to provide healthcare. They are not in business to take care of people like you. We need to be honest with ourselves. Their business is to provide entertainment, and make money. That's their business. To tell them now that their players are suffering the health effects of playing, that's not their business.

Popham: We want to sit down with the governing bodies and work this out, to protect the game, protect the players who are still playing, and the future generations, and make the game as safe as possible. Ninety‑nine per cent of the people who are involved in rugby, the media, the current players, the retired players, can see what we're doing.

Omalu: Don't be afraid. They are going to come after you, they are going to call you all types of names, don't worry about it, just speak your truth quietly and clearly and respectfully, and let people know you are not against rugby, you just want to improve the quality of life for your fellow human beings. That is what this is all about. People respect retired players, but you need to realise they are going to come with a counter-narrative to counter whatever you are doing, so you need to develop your own strategy. In my interactions with the NFL what I did was focus on the angle of a shared common humanity: that if I wouldn't let my son play, why would I let someone else's son play? We all are one, we want to see the upliftment of everybody, of all rugby players, they can't beat that. All right."

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'They are going to come after you': a doctor's advice on rugby's battle over brain injuries

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Alix Popham The Hollywood version of Omalu's story was told in the Will Smith film Concussion . Omalu is an outspoken campaigner against collision sports and a controversial figure within the community of doctors, scientists, and academics working in this area. Many experts believe that he misrepresents the science of CTE, and the risks involved in collision sports.

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A Conversation article, arguing that celebrities have a moral responsibility to support life-saving vaccines. 

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A Conversation article, arguing that celebrities have a moral responsibility to support life-saving vaccines. 

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UNPACKING THE SOURCE What does it mean to believe in ‘bodily autonomy’? What problems are there if we apply this argument to some issues (such as vaccinations) and not others (such as abortion)? What insights do the arguments of John Stuart Mill and Peter Singer provide us with on this, and other issues? Overall, should we ensure that our ethical principles are logically consistent, and how can we do this? Do some areas of knowledge and themes rely more on logical consistency than others?

KEY TERMS Moral responsibility, Misinformation, Distrust, Bodily autonomy, Individual choice, Coherent position

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Why celebrities have a moral responsibility to help promote lifesaving vaccines

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An ethicist argues that choices made by celebrities could impose unjustified risk of harm on others.

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A Guardian article, exploring what the ‘right’ level of skepticism is when it comes to celebrity endorsements of pseudoscientific products and treatments. 

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A Guardian article, exploring what the ‘right’ level of skepticism is when it comes to celebrity endorsements of pseudoscientific products and treatments. 

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UNPACKING THE SOURCE Get students to think how vulnerable they are to influencers and celebrities when it comes to buying products and services? Next, get them to read the article (and possibly this Vox one on Gwyneth Paltrow’s ‘Goop’), and decide for themselves whether we should always be sceptical about celebrity endorsements. Thinking more broadly, how do we find the balance between too little, and too much scepticism?

KEY TERMS Healthy scepticism, Debunked nonsense, Pseudoscience, Trends, Influencer, Availability heuristic

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From vagina eggs to anti-vaxxers: is it time for an influencer detox?

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Scepticism can be healthy – especially when celebrities are pushing debunked nonsense

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A Conversation article, analyzing how religious outlooks shape the way we feel about vaccines. 

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A Conversation article, analyzing how religious outlooks shape the way we feel about vaccines. 

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UNPACKING THE SOURCE What is the relationship between religious outlooks, and scientific skepticism - and how should we make use of our understanding of this link?

KEY TERMS Hostility, Nuanced, Stereotypes, True, Conspiratorial belief

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Many scientists and public health officials were surprised that large swaths of the public were hesitant or outright hostile toward COVID-19 vaccines. "I never saw that coming," Francis Collins, a former director of the National Institutes of Health, commented in 2022. Even today, three years after the start of the pandemic, about 1 in 5 Americans have not received a single dose of any COVID-19 vaccine.

What could be the reason for such widespread vaccine hesitancy? When it comes to skepticism toward vaccines, religion is often cited as an important factor. As sociologists researching the role of religion in vaccine attitudes and behaviors, we have found that the religion-vaccine connection is significant, but much more nuanced than simple stereotypes assume.

Both religious life and vaccine views are complex. A person's religion cannot be boiled down to just one thing. It includes an identity, a place of worship and a variety of beliefs and practices. Each of these components can have its own distinct effect on vaccine attitudes and behaviors.

Attitudes toward vaccines are complicated, as well. Someone's feelings about vaccines in general might differ from their feelings about one specific type of vaccine, for instance.

To help make sense of this complexity, we surveyed a representative sample of 2,000 U.S. adults in May 2021 about their religious identities, beliefs, behaviors and their attitudes toward a number of scientific issues, including vaccines. This sample included individuals across many religious traditions, as well as people who do not affiliate with any religion. However, Christians represented the bulk of the sample, given their larger share of the American population, and so our research focuses heavily on on their views.

Bible beliefs

One part of religious life that social scientists are often interested in is people's views of the Bible. For example, does someone think of the Bible as the literal word of God; inspired by God, but not literally true; or as an ancient book of legends, history and moral codes that has no divine source?

We found that respondents who see the Bible as either the "inspired" or "the actual word of God" were less likely to see vaccines in general - not the COVID-19 vaccine in particular - as safe and effective, compared with those who see the Bible as just a book of history and morality created by humans. All else being equal, those who said that the Bible is the literal word of God, for instance, scored 18% higher on our measure of general vaccine skepticism than those who see the Bible as having no divine source or inspiration.

Although such literalist views might be found at higher rates in particular religious traditions, such as evangelical Protestantism, we found that an individual's religious tradition itself did not make much of a difference. An evangelical Protestant and a Catholic, for instance, would be predicted to have similar attitudes toward vaccines if they share the same view of the Bible.

In contrast, when we asked similar questions specifically about COVID-19 vaccines, we found that an individual's religious tradition is what matters the most. Protestants - both those who identify as evangelical and those who do not - express more skepticism toward the COVID-19 vaccines than respondents from other religious traditions and nonreligious respondents.

God and country

In additional studies, we have attempted to identify the reasons for these patterns. That is, why does one's view of the Bible or one's religious tradition matter when it comes to vaccine attitudes and behaviors?

One factor could be Christian nationalism, which has been increasingly visible in the public sphere since Donald Trump's rise to the presidency. Christian nationalism is described by sociologists of religion Andrew Whitehead and Samuel Perry as an ideology that advocates for the fusion of Christianity with American politics and public life.

For example, Americans who hold a Christian nationalist ideology tend to agree when surveys ask them whether the federal government "should declare the United States a Christian nation." In our own survey, we found that individuals' responses to that statement are strongly correlated with their willingness to get the COVID-19 vaccine.

We asked for respondents' level of agreement or disagreement with that statement on a 5-point scale. A 1-point increase in agreement meant someone was 17% less likely to have received or plan to receive the COVID-19 vaccine. Although not exclusive to Protestants, adherence to Christian nationalist ideology is more prominent among this group - especially among its more conservative or evangelical traditions.

Another of our studies focused on how people view God. Our data showed that simply believing there is a God, or a higher power that supervises the world, does not make an individual less likely to have received the COVID-19 vaccine. On the other hand, believing that God can and will actively intervene in the world does make a difference. According to our analysis, with all else being equal, we would expect those with the lowest belief in an intervening higher power to be vaccinated, or intend to get vaccinated, 88% of the time. In contrast, we would expect those with the highest belief in an intervening higher power to be vaccinated, or intend to be, 73% of the time.

In addition, our data shows that belief in parareligious phenomena - including New Ageism, occultism, psychism and spiritualism - is also significantly associated with a reduced likelihood of receiving the COVID-19 vaccine. We used a 5-point parareligoius belief scale, with a 1-point increase in an individual's belief in parareligious phenomena being associated with a 40% decrease in the likelihood of having received a COVID-19 vaccine.

Once we accounted for higher rates of conspiratorial belief and distrust in science among respondents who believe in parareligious phenomena, however, this vaccine gap was reduced. This suggests that those underlying factors help explain why more people who believe in parareligious phenomena are skeptical toward vaccines.

All of these studies demonstrate that he link between religion and vaccine attitudes is neither simple nor uniform. Public health campaigns that target faith communities would do well to keep this in mind.

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Religion shapes vaccine views - but how exactly? Our analysis looks at ideas about God and beliefs about the Bible

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Specific beliefs may have more to do with people's vaccine views than their religious affiliation - but it depends on which vaccine you're talking about.

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A Conversation article, looking at the history around rejecting scientific advice when it comes to dealing with pandemics. 

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A Conversation article, looking at the history around rejecting scientific advice when it comes to dealing with pandemics. 

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UNPACKING THE SOURCE What insights can we gain from learning about Smallpox, and the Scopes trial? What are the three components that make an expert credible, and how can these be diminished? What problem does the article identify in terms of the way some scientists engage with the public - and how can this be overcome? Overall, how does ignoring history undermine our ability to understand modern scientific issues?

KEY TERMS Fear, Resistance, Misinformation, Expert witnesses, Objectivity, Biased, Engaging the public

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Rejecting science has a long history – the pandemic showed what happens when you ignore this

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You’d be surprised how far back the roots of anti-vaccine arguments stretch.

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A Guardian article, detailing the life and death of a fitness fanatic who refused to take the Covid vaccination. 

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A Guardian article, detailing the life and death of a fitness fanatic who refused to take the Covid vaccination. 

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UNPACKING THE SOURCE What drove his scepticism? How important is it to understand people’s personal lives in order to understand their belief systems? How do people calculate risk, and how accurate are their estimates likely to be? Why do we tend to trust family and friends - even when they have no expertise? Why is it dangerous that social media seems to replicate this emotional connection? Finally, should/how can we counter the misinformation that persuades people to make catastrophic decisions?

KEY TERMS Guinea pig, Scepticism, Assumption, Risk calculus, Trust, Emotional connection, Misinformation

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t was one of those rare, almost magical, summer evenings. Warm enough to sit outside in a T-shirt, listening to birdsong; warm enough to stay out late, savouring a meal; warm enough not to notice night settling in, the visitor that slipped into the party unannounced.

It was 11 June 2021. Jenny McCann sat in the garden of her home in north London with her twin brother, John Eyers, their parents, Lyn and Derek, and Jenny's husband and children. It was her son's 10th birthday party. John and their parents had come down from Southport in Merseyside for the weekend to celebrate. Jenny made Lebanese lamb and parathas. The adults were buzzed on wine, the kids on birthday cake. "Life felt really good," says Jenny.

She can't remember how the argument about the Covid vaccine started. "John started saying really crazy things that didn't make sense," she says. "About how people were only getting the vaccine for free McDonald's, and there was formaldehyde in it." The rest of the family remonstrated with him, pulling out their phones to factcheck what he was saying. But John was unmoving. "He kept saying: 'I won't be a guinea pig.'"

The last family photo taken with John, in June: (left to right) Jenny's husband, Amit; Jenny; the twins' father, Derek; John; their mother, Lyn; and Jenny and Amit's children, Maya and Seb. Photograph: Courtesy of Jenny McCann

Eventually, he made a joke and changed the subject - that was his way of defusing tension. "He would make a joke about everything," says Jenny, who is 43 and works as an operations manager.

Argument aside, it was a great get-together. "John was on really good, funny form," says Jenny. They went for dinner at a Turkish restaurant and played darts in the garden. John scored a bullseye with his eyes closed and bragged about it all weekend. There was only one other difficult moment, when the family went to a local health club. John refused to wear a mask. The twins had a fight in reception.

"I said: 'John, put your face mask on,'" Jenny remembers. "'He said: 'You aren't my mother - don't tell me what to do.'" John eventually acquiesced, then made another easy joke. They went swimming and played tennis and forgot about it.

A perfect weekend, then. Twins enjoying each other's company after the enforced separation of the pandemic. Neither had any idea it would be their last time together.

John and Jenny were born in Southport in 1978. As children, they were diametrically opposed. Jenny was a bookish goody two-shoes; John was mischievous, good at sport and uninterested in school.

Despite their differences, they shared a formidable bond. "When we were very young, we were shadows of each other," says Jenny. Into adulthood, she always knew when her brother was lying - like the time he told their mother he hurt his shoulder tripping over a witch on Halloween. (He had been knocked off his bike by a lorry.) "He didn't want Mum to worry," she says.

Jenny left home at 18 to go to university, leaving her brother behind. He worked in their parents' carpet business for a while, but didn't enjoy it, then joined the erotic dance troupe the Chippendales, performing all over Europe. "He had piercings in places you don't want to know about your brother having piercings in," Jenny shudders.

'When we were very young, we were shadows of each other' ... John's sister, Jenny. Photograph: David Levene/The Guardian

Around this time, he had a child, Macey, who is now 19. The relationship with her mother didn't work out, but John was a committed and loving father. His stripping days over, he returned to Southport and began working as a product specialist in the flooring industry. He worked to keep the lights on, but sport was his big thing. John had always been a gifted athlete.

"He would do something and get obsessed with it," Jenny says. In his teens, he was a champion pole-vaulter and hockey player. In adulthood, he went through phases. He got into triathlons for a while, then bodybuilding competitions, then mountain climbing. He was a fixture at his local gym, which is where he met his best friend, Jonathan Cohen, 37, a chartered surveyor. "He'd spot me in the gym with a set of weights and it was a natural progression from there," says Jonathan. "Suddenly, we were going out every weekend together."

John's dedication to fitness was something to behold. "He really pushed his body to the limit," says Jonathan. John would be in the gym most mornings at 6am. On a holiday to Marbella in May 2016, John kept getting stopped by other men on the beach - they wanted to know his training regimen. Jonathan cropped John out of their holiday photos. "I wasn't having a photo stood next to him with his six-pack," he laughs. "No! Not having that."

He made a bad decision. And he paid the ultimate price for it. Which is so unfair

Jenny McCann

John was gregarious and fun-loving. "He was a social butterfly," Jenny says. "He liked being out, working a room, being charismatic and laughing and joking. He was a big piss-taker - he'd insult you, but in a funny way, so you ended up laughing." From his first girlfriend, at 10, John was a serial monogamist, prone to the odd grand gesture; he once proposed to a girlfriend at a festive grotto while dressed as Santa. "He was an old romantic," says Jenny. "He really wanted the happily-ever-after." (That relationship didn't work out and John never married.)

From January onwards, John struggled with his mental health. Covid restrictions weighed heavily on him. He hated not being able to go to the gym, hated not being able to go climbing, hated not seeing his friends. He lived alone, having broken up with a girlfriend at Christmas, and was lonely. He confided in his sister. "I was really worried about him," Jenny says. "He was in a bad place. I had to call him every day to make sure he was OK." Their grandmother died in March. When Jenny saw him at the funeral, she was horrified. "He'd lost so much weight," she says.

Jonathan thinks this is, in part, what drove his friend's Covid scepticism. "He was frustrated at the way he couldn't go and do normal things," he says. "He didn't want another lockdown, or to be in a situation where he wasn't able to go and see people." John felt that Covid was real, but that it had been dramatically overstated by the authorities. Nobody he knew in Southport had contracted Covid. If he got the virus, he would be fine. "It got to the point where he refused to wear a mask at all," says Jenny.

John and Jonathan Cohen, his best friend, in Marbella. Photograph: Courtesy of Jenny McCann

Many of the people in his life tried to argue with him. "I would tell him: 'Why won't you get the jab? You'll need it if you want to go away on holiday,'" says Jonathan. "He kept saying that he wanted to wait. It wasn't that he would never get it. But it was more the misinformation, really. For whatever reason, he would not listen to whatever message was coming out of the government. I'd say to him: 'John, why are you listening to that rubbish?'"

John was a fan of the pearlescent-toothed Tony Robbins, whose brand of adrenalised motivational speaking has earned him an estimated fortune of $500m (£375m), plus a private island in Fiji and celebrity fans including Serena Williams and Hugh Jackman. Robbins, while steering clear of outright anti-vaccine statements, has made comments throughout the pandemic that play down the severity of Covid, or imply that lockdown restrictions are overblown. (Confusingly, he has also touted a Covid vaccine that is being developed by Covaxx, a company that has received funding from a venture capital firm in which Robbins is a partner. He has made no secret of that financial interest.)

In September 2020, Robbins posted a link to an article by the Kremlin-funded news site RT that said lockdowns "achieved almost precisely nothing with regard to Covid. No deaths were prevented". In September 2021, he appeared at a conference in Florida where he mocked Australia's Covid restrictions, cast doubt on the efficacy of vaccines and told a cheering audience not to let "fear be the thing that controls you".

"John mentioned to me once that one of his beliefs was that we shouldn't live in a climate of fear around Covid," says Jenny. "If you were young and fit and well, you'd be fine."

n this assumption, John wasn't entirely wrong. He was extremely unlikely to die from Covid, as a physically fit 42-year-old with no underlying conditions. The Covid mortality rate for all 40-year-olds is about one in every 1,490 people infected, while for 40-year-olds with no underlying health conditions it is about one in every 28,500 people infected, although these figures vary between scientific papers.

But his calculus when it came to understanding the risk-to-benefit ratio of Covid vaccination was off. If infected, someone who is unvaccinated is 32 times more likely to die of Covid than someone who has been vaccinated. While vaccination carries a risk of side-effects, this risk is far smaller than the risk of being unvaccinated during a pandemic. Out of 46.3 million fully vaccinated people in the UK, 77 have died of blood clots thought to be related to a Covid vaccine.

"There is a huge asymmetry with risk," says Dr Tom Stafford, a psychology lecturer at the University of Sheffield. "If you can get away with things that are low probability, you don't know how dangerous they are until it's too late." Stafford uses the example of driving without a seatbelt: most of the time, you will be absolutely fine. But the one time you are in an accident, things might get very bad very quickly.

John went through a bodybuilding phase, among other fitness obsessions. Photograph: Courtesy of Jenny McCann

"It's the same with the vaccine," says Stafford. "It's a low-probability event that you will get the virus and need hospitalisation. But if you do, then the vaccine shows its benefit."

Stafford says that decisions about vaccination, particularly for Covid, are some of the hardest that people have to make. "Risk calculus can be particularly hard in certain circumstances," he says. "Risks where we don't always see the outcome, so we have to trust people. And new risks. Coronavirus is both of those things."

But why would someone such as John be inclined to take his information about the pandemic from social media influencers rather than scientific experts?

In 2009, Stafford co-authored a paper that surveyed people who lived on brownfield sites that might have been contaminated with pollutants. The survey asked the residents whom they trusted to tell them about the risks associated with living on the land. While most of the people trusted scientists to tell them the truth, they were almostas likely to take their information from family and friends, despite their total lack of expertise. "It wasn't that they didn't trust the expertise of the scientists," Stafford says. "They knew that scientists knew about pollution. They just thought that the scientists didn't have their interests at heart, whereas they knew that family and friends did."

The internet replicates this fundamental human impulse - to trust family and friends almost as much as we trust experts - at scale. "We feel a connection to the people who are telling us things in a way that we don't feel a connection to the Centers for Disease Control or the Joint Council on Vaccination and Immunisation," Stafford says.

In the age of social media, we don't even need to have met the people we trust as much as established experts. "That's why social media is so dangerous," says Stafford. "Because people share that emotional connection with influencers they might never have met. But it's an asymmetrical intimacy. I may think I know that vlogger and they are talking to me. But really they're talking to millions of people - and the advertisers generating them their revenue."

If you can get away with things that are low probability, you don't know how dangerous they are until it's too late

Dr Tom Stafford

The falsehoods that John repeated to his family and friends in the months leading up to his death are common tropes in online anti-vaccine spaces and easy to find: the vaccine has dangerous levels of formaldehyde in it; the vaccine is experimental; people are only getting the vaccine for free McDonald's.

"The best thing that people can do is realise that social media platforms are fundamentally unsafe environments to gain facts about a pandemic that might kill you," says Imran Ahmed, the CEO of the Center for Countering Digital Hate. "Social media contains vast amounts of misinformation that mingles seamlessly with good information. The misinformation might kill you."

John was a heavy user of social media. "He was what I'd call a Facebook ranter," says Jenny. Occasionally, she would challenge him on the content of his posts about Covid. When he was at her house, Jenny told him off for spending too much time on his phone. "He wouldn't put his phone down," she says.

Ahmed is scathing about the social media companies that profit from misinformation. "They don't want you to find the truth," he says. "They want you to keep scrolling. If you find the truth, you don't need to scroll any more. They want you to keep scrolling and arguing and looking for more bullshit."

ohn tested positive for Covid on 29 June. By 3 July, he was seriously unwell. Amy, the woman who had recently become his girlfriend, had to force him to call 111 for help. Later that day, he was taken to Southport & Ormskirk hospital by ambulance.

Jonathan texted his friend as soon as he heard the news. "He said that he couldn't type, but that he was in hospital with pneumonia," he remembers. "He wouldn't admit at that point that it was Covid."

John had a raging temperature and difficulty breathing. Doctors put him on a Cpap machine, to assist his breathing, and swathed him in cooling blankets. On 4 July, John was up all night vomiting blood. He sent Jonathan a voice note the next morning.

"It is the worst voice note I have ever heard in my life," says Jonathan. "I burst out crying halfway through it." The voice note is a minute and a half long. In that time, John speaks about 12 words. "I will never send it to anyone, but if anyone questioned whether Covid is real, I would play it to them," says Jonathan. "It is the worst thing in the world. I can hear the fear in him. He is literally gasping for air. This is someone I knew who could run 10k or climb a mountain without struggling."

John in intensive care. Photograph: Courtesy of Jenny McCann

On 6 July, Jenny was in the supermarket when a feeling of great panic settled upon her. "I just had this feeling that something wasn't right with John," she says. She left without doing her shopping. That afternoon, she got the phone call. John was in the ICU. She immediately got a train to Southport, sobbing the whole way.

By 11 July, John needed to go on a ventilator. Jenny spoke to him on the phone before he was sedated. She told him she loved him. He couldn't respond, but he texted her: "Don't let them give up on me."It was the last message she received from her twin.

On the morning of 27 July, John's family got the call they had been dreading. He was dying; they should come in right away. They raced to the hospital, but John had stabilised by the time they arrived. Staff told them to go home and said they would call back if there was any change.

About an hour later, the hospital called back. The family piled into the car and started driving to the hospital at top speed. Nurses kept calling, telling them to hurry. They raced to the ICU, where staff were waiting with PPE. Jenny could hear the alarms going off in her brother's room. "I couldn't stop shaking," she says. "It felt like a monster was about to come out of my mouth and I couldn't control it."

When they had finally tugged on the PPE, they ran into his room. It was full of ICU staff, all in tears. John had just died. Jenny's stepdad collapsed to the floor. Her mum was wailing. "The matron grabbed my mum and was holding her," says Jenny. "Everyone was crying. The consultant was crying. All the staff were crying. Because he was so young. And they couldn't save him."

How do you explain how a supremely fit 42-year-old man died of a disease typically thought to afflict older people or those with underlying conditions?

"Genetics makes the most sense," says Dr Guillaume Butler-Laporte, a genetic epidemiologist at McGill University. Butler‑Laporte is part of a global research programme to analyse the genomes of more than 100,000 people with Covid, in an effort to understand why some people are more severely affected than others.

When he began his research in March 2020, Butler-Laporte "did not expect to find much", he says. "We thought Covid would affect everyone, but be worse for old people and not as bad for young people. But as we included more patients, we saw a clear story develop. It was surprising."

Butler-Laporte and his colleagues found that people with variants in up to a dozen locations on the human genome were at higher risk of developing severe Covid, should they be unfortunate enough to be infected with the virus. People with variants on the chromosome 3 region alone were up to twice as likely to develop severe Covid as someone without that genetic mutation. Chromosome 3 mutations are carried in about 10% of people of European ancestry, meaning that such people have a 10% chance of being twice as susceptible to severe Covid infection.

John was a keen mountaineer. Photograph: Courtesy of Jenny McCann

"There is no question there is a genetic underpinning to this," says Butler-Laporte. "As to whether genetics is more important than other factors, like age, I wouldn't want to comment. But it is clear that there are other determinants of severe disease and genetics is one of them." He is almost certain that John fits the profile of someone with a genetic variation that made him more vulnerable to severe Covid. "It's impossible to know specifically what genes he carried, but it's very likely he carried this genetic predisposition," says Butler-Laporte.

Unbeknown to John, his body was primed to react with maximum violence to the Covid virus. When he was unfortunate enough to breathe in infected air carrying infinitesimally small virus particles, his body gradually failed.

"Had he been vaccinated, the best case would have been that he developed sterilising immunity, meaning that, when the virus landed in his nostrils, it got picked up by antibodies and never set up an infection," says Dr Tom Lawton, an intensive care doctor. "If he'd had a lower level of immunity from the vaccine, he would have had non-sterilising immunity, meaning that the virus did start to infect cells, but his body fought it and was able to clear out the virus before it ramped up rapidly." But John was not vaccinated.

The Covid virus infected his cells, replicating in his body. He eventually managed to expunge the virus - but then his immune system went into overdrive. "The virus seems to set something up in the body and the damage comes from there," says Lawton. "It wouldn't have happened had the virus not been there."

First, his lungs were affected. "There will have been blood clots forming, as well as a thickening of the membrane that separates the air and the blood in his lungs," says Lawton. As a result, the blood couldn't carry sufficient oxygen to John's organs.

Doctors treated him with steroids, to damp down his immune response. But these immune suppressants made John vulnerable to bacterial and fungal infections. He developed infections in his lungs. His liver and kidneys began to malfunction, causing waste products to build up in his blood.

Doctors put John on dialysis to clear out the toxins, but by this point many of his organs were failing and he had unsurvivably low oxygen levels. He expended an inconceivably huge metabolic effort to stay alive. "Although it looks like someone is just lying there asleep, the amount of work they're doing is really impressive," says Lawton. He compares it to walking a marathon for every day the patient is hospitalised.

Eventually, John exhausted his physiological reserve. His body was oxygen-deprived and wrung out. His heart stopped beating and he died.

efore he died, John told the doctor treating him how much he regretted not getting the vaccine. "The doctor said that he was beating himself up so much before they put him on the ventilator," Jenny says. "He was saying: 'Why didn't I get vaccinated? Why didn't I do it? Why didn't I listen?'"

It is for this reason that his family has agreed to share his story. "He probably wouldn't be dead if he'd had the vaccine," says Jenny. "It's really quite simple. He made a bad decision. We all make bad decisions all the time. And he paid the ultimate price for it. Which is so unfair."

Jenny says she "just wants people to be vaccinated and, if they have doubts, to get medical advice - not advice from the internet. And to realise that Covid is brutal. It's just brutal."

She is struggling to adapt to life without her brother. "I don't know that it will ever feel real," she says. "How can my healthy, outgoing, silly brother be dead? It doesn't make sense in my brain. How can I be a twin without a twin?"

At John's funeral, on 16 August, Jonathan delivered a eulogy. He spoke about that holiday in Marbella in 2016. They spent a day drinking champagne at a beach club, laughing, messing around. As the sun set, a rainbow formed over the sea.

This is how Jonathan likes to remember John. They are sunburned, drunk, a little unsteady on their feet. Suffused with love for each other. The night is drawing in and Jonathan turns to his best friend and says: shall we carry on? And John says: of course.

This article was amended on 11 December 2021. The Covid mortality rate for 40-year-olds with no underlying health conditions is about one in every 28,500 people infected, not one in every 1,490 people infected as stated in an earlier version; the latter figure is for all 40-year-olds.

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The life and tragic death of John Eyers - a fitness fanatic who refused the vaccine

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t was one of those rare, almost magical, summer evenings. Warm enough to sit outside in a T-shirt, listening to birdsong; warm enough to stay out late, savouring a meal; warm enough not to notice night settling in, the visitor that slipped into the party unannounced. It was 11 June 2021.

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A Discovery Magazine article, comparing modern-day anti-vaxxers to those from the near and distant past. 

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A Discovery Magazine article, comparing modern-day anti-vaxxers to those from the near and distant past. 

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UNPACKING THE SOURCE You could begin by considering the concept of ‘medical liberty’ - discussing whether it seems like a good idea in a democratic society. Then go over the article - what problems are associated with being able to choose your own medical path. Then ask students, what are the similarities and differences between anti-vaxxers of the 19th century and the ones today? Why has the issue become politicized, and how has that affected our ability to be objective about the world? How has the ability to reach more people than ever before affected both sides of the vaccination issue?

KEY TERMS Medical liberty, alternative medicines, Anti-science

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Three years ago, I wrote a story for Discover that outlined the long history of anti-vaccination sentiment in the United States. Back then, the nation was experiencing a wave of measles outbreaks across its metropolitan centers in places like Kansas City, Austin, Seattle, Portland and Phoenix - all as a result of parents choosing not to vaccinate their children against this highly infectious disease.

At the time, COVID-19 didn't exist, and many never would have imagined a virus like this ripping through the country like wildfire. Many of the illnesses we vaccinate against today are gone or mostly gone. We don't see smallpox, polio or mumps ravaging our population, so it can be easy to forget the damage that these diseases can do, and to think that vaccinations are no longer a necessity. But COVID-19 changed that.

But while not everybody who hasn't gotten the shot is staunchly opposed to it, a significant number of Americans remain firm in their refusal. Some are even willing to take horse de-worming pills rather than get the jab, even as patients pack ICUs across the country. And according to the Centers for Disease Control and Prevention , unvaccinated people are 29 times more likely to be hospitalized as a result of the virus.

"These are not mom-and-pop grassroots organizations; they're well-funded, well-organized entities, with some 58 million followers," says Hotez.

Another problematic spreader of health misinformation comes from a group on the political right, known as the " health freedom movement ." Many of these activists claim that their "medical liberty" outweighs public health concerns, even at the risk of death. They also tend to oppose mask mandates and social distancing. The issue has become a political wedge, opening the door for the third piece of what Hotez calls the "three-headed monster": He says that the Russian government is trying to use anti-vax misinformation on social media to divide the nation, just as it did during the election of President Trump.

Together, these groups have combined to cause a lot of harm, especially in parts of the country where vaccination rates are particularly low, such as Mississippi, Louisiana, Alabama, South Carolina and Tennessee. But as unsettling as it is, this wouldn't be the first time that anti-vaccination groups and vaccine refusers threatened public health. More than a century ago, when another lethal virus - smallpox - was enveloping the nation, similar groups pushed the same anti-science rhetoric.

The Anti-Vaccine Movement: Then and Now

American historian Michael Willrich, author of Pox: An American History , says that many of those in the anti-vaccination movement toward the end of the 19th century were essentially doctors of alternative medicine . These individuals felt marginalized by science-based medical care in many cases, and displaced by state licensing requirements. Often, they simply didn't want to conform to the nation's new version of medicine. Another cross section of anti-vaxxers were writers, thought leaders and intellectuals who held anti-government views and felt the state should not be involved in matters of health. "Medical liberty was a rallying cry of the anti-vaccination movement in the early 20th century," says Willrich.

It's easy to see how these groups could resemble anti-vaccine groups in the age of COVID-19. Today, we still see alternative medicine practitioners, like Joseph Mercola, an osteopathic physician who makes money selling books and nutritional supplements on his website. Mercola is considered one of the biggest spreaders of health misinformation around COVID-19 vaccines, publishing over 600 articles on Facebook that question vaccine safety and selling vitamin D supplements that he claims improve immunity and reduce risks around COVID-19. Contemporary anti-government and anti-state groups are also similar to those that existed 100 years ago. These include groups like Stand for Health Freedom (SHF), which opposes mask and vaccine mandates, as well as advocating for religious freedom in matters of health.

But the difference between historical groups and those today, says Willrich, is in their reach. Organized leagues and social movements at the turn of the century were comparably small. He adds that the majority of vaccine refusers weren't a part of a larger movement, but simply refused to get vaccinated - often because they were scared of the vaccine at a time when vaccinations weren't regulated for safety in the way they are today. Some ran away when public health officials came to their neighborhoods. They pulled their kids from school and, in other cases, rioted. Poor minorities in the South and immigrants in large cities like Boston, Philadelphia and New York were among the most hesitant at the time. "Minorities and immigrants were more likely to have felt the heavy hand of the state," says Willrich.

These marginalized populations were acutely aware, he says, that they were more likely to be vaccinated through more authoritative means. In his book, Willrich documents many instances of Black Americans and immigrants being forcefully vaccinated against their will. These racist practices have likely helped fuel modern-day vaccine hesitancy among disenfranchised groups.

The Politics of Anti-Vaccination Groups

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How Did Smallpox Anti-Vaxxers Compare to Those Today?

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Three years ago, I wrote a story for Discover that outlined the long history of anti-vaccination sentiment in the United States. Back then, the nation was experiencing a wave of measles outbreaks across its metropolitan centers in places like Kansas City, Austin, Seattle, Portland and Phoenix - all as a result of parents choosing not to vaccinate their children against this highly infectious disease.

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A BBC article, looking at the claims made by yoga guru Baba Ramdev that modern medicine has worsened the Covid crisis. 

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A BBC article, looking at the claims made by yoga guru Baba Ramdev that modern medicine has worsened the Covid crisis. 

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UNPACKING THE SOURCE Use it to explore questions such as: how do we discern between experts and non-experts when it comes to scientific knowledge claims?

KEY TERMS Evolve and learn, Trust

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Doctors in India have hit out against yoga guru Baba Ramdev over his controversial statements against modern medicine.

He recently said that tens of thousands died of Covid after taking modern medicines and mocked patients for trying to get oxygen cylinders.

The guru withdrew his statement after the health minister criticised him.

But he again took a swipe at modern medicine on Monday for not having a cure for some diseases.

Modern, science-based medicine is the backbone of India's healthcare systems, but alternative therapies like ayurveda and homoeopathy are also hugely popular. Many gurus like Ramdev have launched successful businesses on the back of selling herbal medicines and products.

India also has a Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (Ayush) to promote traditional systems.

The Indian Medical Association (IMA), an organisation that represents doctors in India, has criticised the guru for his "insensitive" remarks in the middle of the pandemic.

Doctors the BBC spoke to said such statements from a guru with millions of followers were "irresponsible and demoralising".

What is the controversy?

A video of Baba Ramdev mocking patients for trying to find oxygen went viral earlier this month.

It's not clear when he made the statement, but he is heard making references to oxygen shortages in several cities in April and May.

"God has given us free oxygen, why don't we breathe that? How can there be a shortage when God has filled the atmosphere with oxygen? Fools are looking for oxygen cylinders. Just breathe the free oxygen. Why are you complaining about shortage of oxygen and beds and crematoriums?" he said.

The statement drew sharp criticism from doctors and families of Covid patients who demanded an apology.

Two weeks later, another video emerged in which he can be heard criticising doctors and blaming Covid deaths on them.

Many doctors took to Twitter to express their anger. Some even demanded his arrest.

Baba Ramdev is an excellent yoga teacher and practitioner. Yog is a way of life! He should stick to yoga. Please leave medicine practice to us.#COVIDEmergency
- Dr Pragya Shukla (@drpragya_shukla) May 24, 2021

The BBC is not responsible for the content of external sites. View original tweet on Twitter

As pressure grew, India's Health Minister Harsh Vardhan, who is also a doctor, issued a statement, asking the guru to withdraw his remarks.

"Allopathy [modern medicine] and the doctors attached to it have given new lives to millions of people. It's very unfortunate for you to say that people died from consuming allopathic medicines.

"We should not forget that this battle can only be won through united efforts. In this war, our doctors, nurses and other health workers are risking their lives to save people's lives. Their dedication towards serving mankind in this crisis is unparalleled and exemplary."

On Sunday, Baba Ramdev withdrew his controversial statement in a tweet. But a day later, he issued a letter asking the IMA why modern medicine had no cure for 25 diseases, including diabetes and hypertension.

This has again infuriated doctors. Prominent pulmonologist Dr A Fathahudeen, who has treated thousands of Covid patients, told the BBC that such statements cause lasting damage.

"For more than a year, healthcare workers like me have been in a war-like situation. We have saved tens of thousand of lives. It's really unfortunate, insulting and hurtful to read such statements," he said.

Dr Fathahudeen added that modern medicine had evolved over the years with constant research and studies. "We follow evidence-based practice. At any given time, thousands of researchers are working to come up with cures. Look at the progress we have made in cancer treatment. We have to constantly evolve and learn. It's hard to trust any branch of medicine that offers absolute cure for every disease."

He also added that such statements create doubts in the mind of people when we need to have trust in medicines and vaccines in the middle of a raging pandemic.

Who is Baba Ramdev?

He shot to fame because of his televised yoga classes. Millions followed him and he received praise across the world for promoting yoga and healthy living.

In 2006, he helped launch Patanjali Ayurveda to sell herbal medicines and a few years later, the business expanded to selling almost everything, from flour, jeans, soaps, oils, biscuits and even cow urine from stores in even the remotest corners of the country. He was successful in translating his popularity into building a business empire.

The expansion of his business also coincided with the Hindu nationalist BJP coming to power in 2014.

Baba Ramdev has openly supported both the BJP and Prime Minister Narendra Modi and even campaigned for the party.

False Covid cure claims

Patanjali Ayurveda launched Coronil - a combination of herbs used in traditional Indian medicine - in June last year and claimed that it could cure Covid.

But marketing of the product as Covid medicine had to stop after the government said there was no data to show it worked as a treatment. But it didn't ban Coronil, and said that it could be sold as an "immunity booster".

Then in February, Patanjali supporters claimed that Coronil had been approved by the WHO - prompting it to issue a denial:

Dr Vardhan was criticised for attending an event with Baba Ramdev in February where claims about Coronil as a cure for Covid were repeated.

In 2018, Baba Ramdev launched a messaging app calling it "a home-grown rival to WhatsApp", but it was soon removed from app stores amid a furore over security flaws.

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Ramdev: Doctors furious over yoga guru's insulting Covid remark

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Doctors in India have hit out against yoga guru Baba Ramdev over his controversial statements against modern medicine. He recently said that tens of thousands died of Covid after taking modern medicines and mocked patients for trying to get oxygen cylinders. The guru withdrew his statement after the health minister criticised him.

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An Aeon essay, that tries to make sense of the phrase ‘natural remedies’, and its relationship with modern medicine. 

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An Aeon essay, that tries to make sense of the phrase ‘natural remedies’, and its relationship with modern medicine. 

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UNPACKING THE SOURCE The easiest thing to focus on is this concept of ‘natural’, and ‘naturopathy’. What does this word mean, and how does it relate to Western medicine? To what extent is it a meaningful and coherent term? Why is it a desirable quality and characteristic?

KEY TERMS Natural, Metaphysically inconsistent, Unscientific, Naturopathy, Scepticism and scrutiny.

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What follows is a list of 'natural remedies', familiar to anyone with more than a passing interest in contemporary natural healing. These were put together specially in April 2020, as a COVID-19 protocol by Cristina Cuomo, founder of the wellness magazine Purist, after she and her husband, the CNN anchor Chris Cuomo (brother of New York's governor, Andrew Cuomo), were stricken by the virus:

Resonance breathing

Pranayama meditation

Liver-cleansing beverage: one raw garlic clove, one orange, one lemon, a tablespoon of cayenne pepper, a spoonful of olive oil, fresh ginger and a piece of fresh turmeric

Zinc

Alka C - 3,000 mg per day

Vitamin B

Vitamin D

Glutathione powder

Quercetin

Two medicinal florals: xanthium and magnolia

Viracid

Vitamin drip: magnesium, N-Acetylcysteine, Vitamin C with lysine, proline and B complex, folic acid, zinc, selenium, glutathione and caffeine

Water and bleach bath

Body charger ('[sends] electrical frequencies through [the] body to oxygenate [the] blood')

Portable PEMF (pulsed electromagnetic field) machine

Ayurvedic food

To the uninitiated, the variety and juxtapositions are surely jarring: Indian meditation alongside a 'body charger', fresh juice to cleanse your insides, followed by a bleach bath to cleanse your outside. And then there's her recurring insistence on the 'naturalness' of these interventions throughout her discussion of the protocol. Raw garlic seems natural enough, and so do breathing exercises, but a PEMF machine? Vitamins and minerals that have been processed and refined into powders, pills and drips? Whatever Viracid is? There are many possible definitions of 'natural', but it's difficult to imagine one capacious enough to accommodate the entirety of this list.

Still more perplexing is the repeated conflation of 'natural' with anything 'non-Western', itself a protean label that embraces not only Indian and Chinese medicine, but also Indigenous medical approaches of all types (including First Nations and Native American traditions), the Hippocratic corpus (from Greece), homeopathy (a German invention), and even chiropractic (developed in Iowa in the 1890s).

This anti-establishment melting pot approach to healing is a global phenomenon, best exemplified by 'naturopathy', a popular healing system pioneered in late-19th-century Germany. As the name suggests, naturopathy invokes 'naturalness' to bind together what are otherwise fundamentally disparate interventions. At the Immanuel Medicine Zehlendorf naturopathy clinic in Berlin, for instance, patients have an enormous variety of options available: nutrition supplements, high-dose Vitamin C infusions, leech therapy, dry and bloody cupping, and many herbal medicines - drawn from Ayurveda, traditional Chinese medicine, Swiss hydrotherapy and 'Indigenous' traditions.

It doesn't matter that these systems are built on fundamentally different metaphysical systems and causal theories of illness. The pathological 'miasms' of homeopathy and the ' yin-yang' imbalance of Chinese medicine, qi, chakras, chiropractic subluxations, humours, the 'energy' that gets refreshed by Cuomo's body charger or, should you prefer, adjusted by a reiki practitioner - all coexist happily, united only by their supposed naturalness, effectiveness and opposition to what is known, derisively, as mainstream or conventional Western medicine.

Two centuries ago, lumping these together would have seemed completely nonsensical. Each represents a unique set of claims about illness aetiology, developed in different cultures in different time periods with entirely different medical systems. Though the qi of classical Chinese medicine and the Erzeugungskraft of homeopathy seem similar when translated as 'energy' and 'vital force', they are no more related than the force of inertia is related to the force of Star Wars. Treatments based on qi were developed long before a germ theory of disease; homeopathy concerns itself entirely with microbial adversaries.

In a strange twist, natural has come to include, rather than exclude, the supernatural

To scholars of early medicine, efforts to appropriate ancient traditions by calling them 'natural' are completely anachronistic. It's true that the Hippocratic corpus in Greece ( c400 BCE) and the Yellow Emperor's Classic of Medicine in China ( c300 BCE) - texts cited reverently in natural healing circles - represented a crucial turn toward naturalistic medicine. But 'naturalistic' in this context refers specifically to the rejection of supernatural aetiologies such as demons, spirits, deities and deceased ancestors, along with therapies meant to address them such as exorcism or prayer. Today, natural interventions are typically contrasted with unnatural surgery and pharmaceuticals ('cut, poison, and burn' is insider lingo for treating cancer through operations, chemotherapy and radiation). In the ancient Greek or Chinese worlds, the oppositional binary between natural herbal medicines and unnatural chemical and surgical interventions would have made no sense. Since they address illness without recourse to magico-religious explanations, surgery and drugs are natural.

In other words, until recently the standard opposition was not natural and unnatural but rather natural and supernatural, the same opposition that characterises secular scientific naturalism and so-called mainstream Western medicine, which exclude the supernatural. The worldview of modern natural healing, by contrast, extends its inclusivity to a wide variety of spiritual approaches, from shamanic ritual to prayer. The Dalai Lama's suggestion in January 2020 that chanting mantras to the goddess Tara might help contain COVID-19 would undoubtedly meet with more acceptance from Cristina Cuomo than from her critics. In a strange twist, natural has come to include, rather than exclude, the supernatural.

The inclusion of supernatural healing is made possible by reserving scepticism and scrutiny almost entirely for unnatural interventions. The claims of profit-driven pharmaceutical giants receive zealous debunkings, whereas the efficacy and safety of natural supplements go largely unquestioned - not to mention the more than $100 billion raked in annually by the companies and natural health gurus who hawk them.

Or take the Hippocratic quote: 'Let food be thy medicine and medicine be thy food,' ubiquitous in natural healing publications (see, for example, the spring 2019 issue of Purist magazine). Nonsense, according to Helen King, a classicist and leading scholar of Hippocrates. When I spoke with her, she expressed frustration with the appropriation of Hippocratic texts by wellness gurus who seem to care little about its genuine origins. 'The text it supposedly comes from is almost impossible to understand,' she told me. 'It just says food-medicine-medicine-food, and no one knows exactly how to translate it. Certainly not "let food be thy medicine and medicine be thy food".'

It's easy to throw up one's hands (as I once did) at the strangeness of calling acupuncture natural. 'How is sticking stainless steel filiform needles into someone natural?!' Frustration turns quickly into outrage upon hearing about the tragedies that happen under the auspices of natural healing - the needless deaths of children, the family members who spend ruinous amounts of money on rituals destined to summon only false hope.

There should be no sympathy for natural healing charlatans who contribute to the death of children, just as there should be no sympathy for the opioid manufacturers who destroyed countless lives by relentlessly pushing their product. But pharmaceutical manufacturers are not pure evil, and natural medicine advocates are not completely deluded. I have come to sympathise with those who, like Cuomo, turn to natural healing, especially in times of crisis. And I believe that 'mainstream medicine' could help itself by taking seriously certain features of natural - and, thus, supernatural - healing, instead of dismissing enthusiasts as credulous or ignorant.

In his book The Illness Narratives (1988), the American psychiatrist and anthropologist Arthur Kleinman argues that the experience of suffering forces two basic questions: Why me? (the question of bafflement) and What can be done? (the question of order and control). These are not merely physiological questions, but also existential matters. Sick humans aren't just broken machines. When a body breaks down, it's you or a loved one that's broken, not an object. This is why cancer patients routinely describe the experience as bodily betrayal. The symptoms of illness represent the collapse of an intimate relationship, a rupture of trust. The consequences of this breakdown in one's body change the world, which was once a place of relative safety - in certain moments, even a kind of paradise - into hell.

Modern medical science limits itself to the illness itself, not the rupture of trust

By design, modern medical science refuses to offer existential answers. To the question Why me?, the only honest answer is often We don't know. Even when there is a clear answer - 'The lung cancer was caused by smoking' - patients will still wonder why they were stricken when so many other smokers are not. To broaden the answer with an appeal to genetics or environment is no help, since even together these variables can't explain their own existence. I can still wonder why I ended up with these lousy genes in this lousy environment.

Likewise, answers to the question What can be done? often prove unsatisfactory because modern medical science limits itself to the illness itself, not the rupture of trust. When you're sick, you want to get well, but that's not all. You also want to feel safe, that your body and your world will not betray you again, and that you have some agency over avoiding further betrayals. In these vital moments of need and crisis, modern medical science offers little empowerment. It doesn't tell us stories about a harmonious world and the power of our agency within it. To the contrary: upon falling ill, we are thrust into an alien world and stripped of our agency. Glaring florescent lights, gleaming metal, white walls, forms, questions, tests, uncertain waiting, endless submissions when the world has already taken away any sense of control - what Barbara Ehrenreich in her book Natural Causes (2018) calls 'rituals of humiliation'. When physicians handwrote prescriptions, their writing was notoriously illegible, symbolic of the fact that there was no need for transparency. Faceless corporations manufacture medicines using inscrutable methods. The medicine works, or doesn't, based on biological principles that most of us only vaguely understand. Even the names sound alien - Abraxane, Taxotere, Xeloda, Thioplex, Gemzar - and none is available without a costly prescription.

At one time, magico-religious narratives and rituals addressed concerns that lie beyond the purview of medical science. As the sphere of religion's authority shrinks, it has become increasingly difficult to give explicitly supernatural - or, if one prefers, existential - answers to the Why me? and What can be done? questions of illness. The paradigm of scientific naturalism in which modern medicine operates can't fill the gap, so people respond to the existential betrayal of illness by looking elsewhere. This is where nature and naturalness come in.

In an important sense, 'natural' is simply shorthand for something like 'outside of the dominant system', which explains the perplexing variety of interventions in the Purist list, many technological, and drawn from a hodgepodge of metaphysical systems. The category 'natural healing' isn't meant to demarcate a set of interventions chosen according to systematic criteria. Rather, it has emerged organically out of basic human needs, gathering together anything that can help suffering people address the pain that transcends biology.

As answers to Kleinman's questions ( Why me? and What can be done?), the PEMF machine, the vitamin supplements, the bleach bath, the energy healing and the Ayurvedic food all make sense. They grant patients agency. All are available to a layperson. The explanations make sense, or seem to, without any deep understanding of biology or chemistry. Breathing exercises help us direct 'the flow of vibratory life energy'. Detoxification purifies the body of dangerous elements. Vitamins replenish deficiencies and boost the immune system. Like prayer, and unlike chemotherapy or vaccines, they address not a specific illness but any kind of current or possible suffering. What can be done? A great deal, it turns out, and it is within your control. You can make your body whole, balanced, purified and renewed with ingredients from your pantry and an energy machine available on eBay. No insurance or prescription is necessary.

Metaphysically, 'natural healing' is not internally coherent. Yet the word and idea 'natural' is irreplaceable because it contains a satisfying existential answer to Why me? Most ancient medical systems see the well-ordered human body as a microcosm of a larger, harmoniously ordered whole. The balance of yin and yang that makes human health possible mirrors the natural cosmic balance that governs the health of nations and the natural world. Suffering is always a result of departing from the natural order of things. It can be avoided by realigning oneself with an order that's at once physical and metaphysical. Sin might no longer be a plausible cause of illness, but unnatural activity - sin, secularised - still is.

The human body as a site of unnatural harm is particularly compelling as we constantly confront the harm that technology inflicts on the natural world. Animal species, millions of years in the making, gone in a geological blink. Ancient waterways clouded with waste. The land disembowelled and burned, the fumes heating the planet. These tragedies - the product of technology deployed on a massive scale - threaten the body of the Earth and individual human bodies alike. Millions are sickened by living near factories, industrial, agricultural and other emblems of unnatural modernity. The 'Western medicine' rejected by natural healing is a synecdoche for the modern Western world.

Being invited to tell your story is an essential part of the healing process

COVID-19 is easily fitted into the explanatory framework of natural systems corrupted by unnatural modernity. Pandemics are our punishment for exploiting nature: cutting down forests where bats make their homes, trafficking in exotic wildlife, factory farming. Presented with this binary, why not fight the resulting illness with something natural, instead of using 'unnatural' approaches that owe their existence to the very system that caused the problem to begin with. Why us? Because we have violated natural systems. What can be done? Restore ourselves, and the world, through restoring everything to its natural balance.

Existential explanation, a route to salvation for humanity and its home - this is why the mistranslation of Hippocrates must include the word thy, as if plucked directly from the King James Bible. This is why Cristina Cuomo's magazine is called Purist. Natural healing affirms the existence of a benevolent divine force that seeks to promote life and safeguard our health. When faced with a health crisis, we might require what the bioethicist Insoo Hyun calls 'therapeutic hope', medical interventions that, in addition to promising efficacy, also create meaning.

This lens, not 'naturalness', is the best way to see Purist 's COVID-19 protocol, which its founder credits to the naturopath Linda Lancaster. Lancaster founded Light Harmonics, a healing system 'based on the philosophies of Yoga, Ayurveda, Anthroposophy, TCM, Naturopathy and Homeopathy'. Lancaster and Light Harmonics teach patients to 'access and care for' their body's 'vital force to heal ... [to] switch on our body's ability to stay well in a world of challenging forces and help our body to heal when we are sick. This force exists within everyone, no matter their age, current health concerns, or predispositions.'

Medical ethics dictate that therapeutic hope cannot veer into false hope or falsehood, which means that medical science should remain epistemologically constrained by honesty about the limits of its power and the answers it can give. Healers such as Lancaster aren't bound by those constraints. But as Kleinman and other physicians have shown, when people fall ill, or fear falling ill, religious leaders and natural healers - who, today, are often one and the same - need not be their best recourse for the existential travails of illness and medical treatment. When reforming medicine, cost and efficacy mustn't be the primary criteria, even if they are the most easily quantified. Instead, we should focus more on the humanity of the patients. Physicians need to be given time to listen to their patients - not necessarily because that will allow them to identify and cure illnesses more easily, but because being invited to tell your story is an essential part of the healing process. Mainstream medicine needn't swap scientific naturalism for natural medicine's contradictory grab bag of anti-establishment inclusivity. But it would do well to address the need for metaphysical consolation that explains why patients seek out natural medicine despite those contradictions.
To read more about the psychological challenges of living, visit Aeon's sister site, , a new digital magazine that illuminates the human condition through psychological knowhow, philosophical understanding and artistic insight.

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'Natural' healing is metaphysically incoherent but valuable | Aeon Essays

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What follows is a list of 'natural remedies', familiar to anyone with more than a passing interest in contemporary natural healing.

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This Guardian article by an oncologist, documents some of her encounters with patients who are keen to treat their conditions with ‘alternative’ remedies rather than accepted cancer treatments such as chemotherapy. 

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This Guardian article by an oncologist, documents some of her encounters with patients who are keen to treat their conditions with ‘alternative’ remedies rather than accepted cancer treatments such as chemotherapy. 

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UNPACKING THE SOURCE Use it to explore questions such as: why should we trust knowledge produced via scientific means? Is there a role for intuition in providing us with scientific knowledge?

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"Tell me why I should have your chemotherapy when I can be healed naturally!"

His face is set, his arms defensively squared. His friend carries a pamphlet that features a suspiciously healthy woman with glamorous hair and a glowing complexion. This is the urgent appointment of the day, for whom other patients were hastily shuffled to make room.

I know I shouldn't take the bait but, like an addict, I have the urge to say:

Go ahead then, be healed. And I will almost certainly see you again, emaciated, ruined, lamenting the fact that it's too late.
Drinking your own urine? There's a Facebook group for that. Two, even
Thankfully, the code of conduct glides in. I imagine his dread. I remember my position. And I say: "Tell me more."

I hear about the man who uses waves, the woman who boosts immunity and the seller of pure herbs. They are the healers - 100% convincing, 100% certified by a gaggle of secret Facebook users.

He asks: "What's the guarantee of your chemo, anyway?"

I have perfected my retort during sleepless nights.

In life there are no guarantees but you have a curable cancer. Yes, there will be side effects but we can manage them. No, I can't guarantee a cure, but I'd recommend evidence-based treatment any day over the magnet that purportedly draws out cancer cells. And while we are there, it's not my chemotherapy. Your taxes fund my job but I don't profit from giving you chemo.

But how many times have I heard that if oncologists hectored a little less and listened a little more, we might win more hearts?

So I bite my tongue again, thinking of the alarmed nurse who begged me to change his mind. As I talk him through his various options from least to most intensive, I remember the patient who swapped chemotherapy for essential oils, the one who chose to "burn" the tumour out and the one who suggested I become a sales representative for a life-saving juice.

In an era where fake news abounds, why should cancer medicine be immune?

"You don't convince me."

"You have the facts, you get to decide," I reply.

I used to think that these second opinions were illuminating for patients and nudged them towards change. But what I have learnt in the last few years is that cancer patients in search of alternative cures are more deeply entrenched than ever in their beliefs. Thanks to the rise of social media, the ability to filter out conflicting viewpoints and a bevy of supporters for every outrageous idea, these people arrive convinced about their theories. Arguing with them is a fool's errand.

Despite the longest consultations, carried out by disadvantaging other needy patients, these patients are often the most dissatisfied because oncologists like me speak our truths with less conviction than the quacks who promise the world but deliver nothing except a lonely death in an unfamiliar emergency room in front of a bewildered family.

In an era where fake news abounds, why should cancer medicine be immune?

A survey commissioned by the American Society of Clinical Oncology spoke to more than 4,000 American adults, a quarter of whom were current or former cancer patients. Nearly 40% of those surveyed "somewhat" or "strongly" agreed that cancer can be cured via oxygen, diet and herbs alone. This is despite the fact that patients who solely choose alternative therapies have a greater than twofold risk of mortality, and those with early-stage cancers such as those of the breast and bowel face a four to sixfold increase in mortality compared with those who have standard therapy.

It is tempting to think that modern patients with access to multiple vetted channels of information and, equally, many sources of health warnings, will use them to their advantage. Today's youth are thought to be especially savvy and discerning. Alas, the survey found that nearly half of those under the age of 53 thought that cancer can be cured by alternative therapies alone. Even among people directly affected by cancer, a quarter believed in alternative therapy over standard treatments. If anyone was relying on family to help them see the light, more than a third of caregivers for cancer patients shared the misguided belief in alternative cures.

Enzymes, waves and magnets do not cure cancer, and they cost the patient every step of the way. Small bottles of unknown and frequently adulterated or plainly toxic substances cost hundreds of dollars, not to mention every consultation that pretends to read the eyes and sense the energy to cure cancer, even as the patient worsens. How do I know? Because dying patients relate these stories in a last attempt to prevent their fellow patients being duped.

It has been received wisdom that oncologists can see off quackery through good communication but I'm afraid that isn't so.

Oncologists have been properly entangled in a web of fake news. Their authority has been undermined and their expertise ridiculed by a determined, global and hard-to-track battalion of quacks and their acolytes. Greater vigilance, stronger regulation and improved health literacy might help, but the pull of alternative cures is strong.

Make no mistake. With so much misinformation fuelling the use of increasingly bizarre alternative therapies, patients will be ultimately robbed and disappointed, and their doctors will be relegated to the sidelines. To paraphrase an old joke, oncologists will no longer be giving chemotherapy until the grave, but the quacks will be laughing all the way to the bank.

* Ranjana Srivastava is is an oncologist and Guardian Australia columnist
Topics

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My patient swapped chemotherapy for essential oils. Arguing is a fool's errand | Ranjana Srivastava

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"Tell me why I should have your chemotherapy when I can be healed naturally!" His face is set, his arms defensively squared. His friend carries a pamphlet that features a suspiciously healthy woman with glamorous hair and a glowing complexion. This is the urgent appointment of the day, for whom other patients were hastily shuffled to make room.

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A Guardian article, looking at the news that a US man has now extended his lifetime record for eating Big Macs to 34,000. 

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A Guardian article, looking at the news that a US man has now extended his lifetime record for eating Big Macs to 34,000. 

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Don Gorske did not have many people betting on him to live into his 70s with his half-century-old habit of eating Big Mac hamburgers daily.

But cutting down his intake of the famous McDonald's burgers to two a day (rather than his previous high of nine), skipping fries with his meals and walking six miles daily for exercise has not only helped him become a septuagenarian - it has also allowed him to extend his Guinness world record for most Big Macs eaten in a lifetime to more than 34,000.

"Many people thought I'd be dead by now," the 70-year-old Gorske said Thursday in an interview published by Guinness, which is known for maintaining a database of more than 40,000 world records. "But instead I've been ... one of Guinness World Records' longer-running record holders, so that's pretty cool to me."

It's hard to overstate how central McDonald's and its staple product have been to the identity of the retired prison officer from Fond du Lac, Wisconsin. That's the case despite longstanding warnings from experts who say regularly consuming fast food, including McDonald's, can contribute to weight gain, obesity, heart disease and other health problems because the meals are densely packed with calories, sodium, sugar and fat.

Gorske recounted how his love affair with Big Macs began as soon as he had his first one on 17 May 1972. "In that moment, I said: 'I'm going to probably eat these for the rest of my life,'" Gorske remarked to Guinness. "I threw the cartons in the back seat and started counting them from day one."

He is not exaggerating. He has kept a receipt of every single Big Mac he's eaten every day since that first one, and he's retained each of the burgers' containers.

Gorske said his mother grew worried as she saw his fascination with Big Macs blossom and tried to rein it in by making him promise to eat one non-Big Mac meal a day. But she gave up on making him fulfill that promise in 1981.

According to Gorske, "She said, 'If they haven't killed you by now, go ahead.'"

Gorske would drive to McDonald's every day, order up to nine Big Macs and eat each of them at the height of his devotion. The one closest to his home displays his portrait on one of its walls, and he said he even proposed to his wife, Mary, in that restaurant's parking lot.

But Gorske now usually goes to McDonald's twice weekly, orders batches of Big Macs and - after eating a fresh one - takes them home to microwave when he's hungry.

Gorske said he doesn't stray very far from Big Macs, sometimes snacking on ice-cream, fruit bars or potato chips in the evenings.

The incarcerated people whom Gorske would guard at a maximum security prison in Wisconsin aimed "relentless" teasing at him if they ever saw him on television in connection with his McDonald's habit. But he said his fellow guards were supportive, going so far as to sneak in Big Macs for him on the occasions he worked double shifts and couldn't get them for himself.

Mary, too, supported him. "She has put up with a lot of obsessive compulsive things I do and hasn't let my Big Mac thing get to her," he told Guinness.

Gorske has kept himself in the best physical shape possible by foregoing breakfast, turning down fries or any other side serving with his Big Macs and walking a half-dozen miles daily.

Such efforts culminated in Guinness giving him his world record title for most Big Macs eaten in a lifetime in 1999. He had eclipsed the 25,000 mark in 2011, boasting to the Guardian then: "I plan on eating Big Macs until I die. I have no intention of changing. It's still my favorite food."

And throughout 2023, he ate 728 Big Macs - just below two daily - to push his total to 34,128.

No, he's still not lost his appetite for the burgers, and yes, he has plenty of room for more, he maintained.

"When I like something, I stick with it all the time," Gorske said to Guinness. "People who have watched me eating a Big Mac often comment that I look like I'm eating one for the very first time."

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US man extends record for most Big Macs eaten in a lifetime to over 34,000

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Don Gorske, 70, becomes one of Guinness World Records' longest-running holders with intake of two McDonald's burgers a day