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"Go ask him what he means by 'I now know what I need to do,'" she instructed Bremmer. "If it's a matter of him picking up an automatic rifle or something, we have to intervene."

As he clarified to Bremmer, love is what he had just realised he had to do. "Love is the most important thing," he told the baffled research assistant. "Nothing matters without

When de Wit recounted this story to me nearly two years after the fact, she still could hardly believe it. "Isn't that amazing?" she said. "It's what everyone says about this damn drug, that it makes people feel love. To think that a drug could change somebody's beliefs and thoughts without any expectations – it's mind-boggling."

Over the past few years, I've been investigating the scientific research and medical potential of MDMA for a book called "I Feel Love: MDMA and the Quest for Connection in a Fractured World". I learnt how this once-vilified drug is now remerging as a therapeutic agent – a role it previously played in the 1970s and 1980s, prior to its criminalisation

He attended the notorious "Unite the Right" rally in Charlottesville and quickly rose up the ranks of his organisation, first becoming the coordinator for Illinois and then the entire Midwest. He travelled to Europe and around the US to meet other white nationalist groups, with the ultimate goal of taking the movement mainstream

some researchers have begun to wonder if it could be an effective tool for pushing people who are already somehow primed to reconsider their ideology toward a new way of seeing things

While MDMA cannot fix societal-level drivers of prejudice and disconnection, on an individual basis it can make a difference. In certain cases, the drug may even be able to help people see through the fog of discrimination and fear that divides so many of us.

in December 2021 I paid Brendan a visit

What I didn't expect was how ordinary the 31-year-old who answered the door would appear to be: blue plaid button-up shirt, neatly cropped hair, and a friendly smile.

Brendan grew up in an affluent Chicago suburb in an Irish Catholic family. He leaned liberal in high school but got sucked into white nationalism at the University of Illinois Urbana-Champaign, where he joined a fraternity mostly composed of conservative Republican men, began reading antisemitic conspiracy books, and fell down a rabbit hole of racist, sexist content online. Brendan was further emboldened by the populist rhetoric of Donald Trump during his presidential campaign. "His speech talking about Mexicans being rapists, the fixation on the border wall and deporting everyone, the Muslim ban – I didn't really get white nationalism until Trump started running for president," Brendan said.

If this comes to pass, MDMA – and other psychedelics-assisted therapy – could transform the field of mental health through widespread clinical use in the US and beyond, for addressing trauma and possibly other conditions as well, including substance use disorders, depression and eating disorders.

A group of anti-fascist activists published identifying information about him and more than 100 other people in Identity Evropa. He was immediately fired from his job and ostracised by his siblings and friends outside white nationalism.

When Brendan saw a Facebook ad in early 2020 for some sort of drug trial at the University of Chicago, he decided to apply just to have something to do and to earn a little money

At the time, Brendan was "still in the denial stage" following his identity becoming public, he said. He was racked with regret – not over his bigoted views, which he still held, but over the missteps that had landed him in this predicament.

About 30 minutes after taking the pill, he started to feel peculiar. "Wait a second – why am I doing this? Why am I thinking this way?" he began to wonder. "Why did I ever think it was okay to jeopardise relationships with just about everyone in my life?"

Just then, Bremmer came to collect Brendan to start the experiment. Brendan slid into an MRI, and Bremmer started tickling his forearm with a brush and asked him to rate how pleasant it felt. "I noticed it was making me happier – the experience of the touch," Brendan recalled. "I started progressively rating it higher and higher." As he relished in the pleasurable feeling, a single, powerful word popped into his mind: connection.

It suddenly seemed so obvious: connections with other people were all that mattered. "This is stuff you can't really put into words, but it was so profound," Brendan said. "I conceived of my relationships with other people not as distinct boundaries with distinct entities, but more as we-are-all-on

I realised I'd been fixated on stuff that doesn't really matter, and is just so messed up, and that I'd been totally missing the point. I hadn't been soaking up the joy that life has to offer."

Brendan hired a diversity, equity, and inclusion consultant to advise him, enrolled in therapy, began meditating, and started working his way through a list of educational books. S still regularly communicates with Brendan and, for his part, thinks that Brendan is serious in his efforts to change

"I think he is trying to better himself and work on himself, and I do think that experience with MDMA had an impact on him. It's been a touchstone for growth, and over time, I think, the reflection on that experience has had a greater impact on him than necessarily the experience itself."

Brendan is still struggling, though, to make the connections with others that he craves. When I visited him, he'd just spent Thanksgiving alone

He also has not completely abandoned his bigoted ideology, and is not sure that will ever be possible. "There are moments when I have racist or antisemitic thoughts, definitely," he said. "But now I can recognise that those kinds of thought patterns are harming me more than anyone else."

it's not without precedent. In the 1980s, for example, an acquaintance of early MDMA-assisted therapy practitioner Requa Greer administered the drug to a pilot who had grown up in a racist home and had inherited those views. The pilot had always accepted his bigoted way of thinking as being a normal, accurate reflection of the way things were. MDMA, however, "gave him a clear vision that unexamined racism was both wrong and mean," Greer says

Encouraging stories of seemingly spontaneous change appear to be exceptions to the norm, however, and from a neurological point of view, this makes sense

Research shows that oxytocin – one of the key hormones that MDMA triggers neurons to release – drives a "tend and defend" response across the animal kingdom. The same oxytocin that causes a mother bear to nurture her newborn, for example, also fuels her rage when she perceives a threat to her cub. In people, oxytocin likewise strengthens caregiving tendencies toward liked members of a person's in-group and strangers perceived to belong to the same group, but it increases hostility toward individuals from disliked groups

In a 2010 study published in Science, for example, men who inhaled oxytocin were three times more likely to donate money to members of their team in an economic game, as well as more likely to harshly punish competing players for not donating enough. (Read more: "The surprising downsides of empathy.")

According to research published this week in Nature by Johns Hopkins University neuroscientist Gül Dölen, MDMA and other psychedelics – including psilocybin, LSD, ketamine and ibogaine – work therapeutically by reopening a critical period in the brain. Critical periods are finite windows of impressionability that typically occur in childhood, when our brains are more malleable and primed to learn new things

Dölen and her colleagues' findings likewise indicate that, without the proper set and setting, MDMA and other psychedelics probably do not reopen critical periods, which means they will not have a spontaneous, revelatory effect for ridding someone of bigoted beliefs.

In the West, plenty of members of right-wing authoritarian political movements, including neo-Nazi groups, also have track records of taking MDMA and other psychedelics

This suggests, researchers write, that psychedelics are nonspecific, "politically pluripotent" amplifiers of whatever is going on in somebody's head, with no particular directional leaning "on the axes of conservatism-liberalism or authoritarianism-egalitarianism."

That said, a growing body of scientific evidence indicates that the human capacity for compassion, kindness, empathy, gratitude, altruism, fairness, trust, and cooperation are core features of our natures

As Emory University primatologist Frans de Waal wrote, "Empathy is the one weapon in the human repertoire that can rid us of the curse of xenophobia."

Ginsberg also envisions using the drug in workshops aimed at eliminating racism, or as a means of bringing people together from opposite sides of shared cultural histories to help heal intergenerational trauma. "I think all psychedelics have a role to play, but I think MDMA has a particularly key role because you're both expanded and present, heart-open and really able to listen in a new way," Ginsberg says. "That's something really powerful."

"If you give MDMA to hard-core haters on each side of an issue, I don't think it'll do a lot of good,"

if you start with open-minded people on both sides, then I think it can work. You can improve communications and build empathy between groups, and help people be more capable of analysing the world from a more balanced perspective rather than from fear-based, anxiety-based distrust."

In 2021, Ginsberg and Doblin were coauthors on a study investigating the possibility of using ayahuasca – a plant-based psychedelic – in group contexts to bridge divides between Palestinians and Israelis, with positive findings

"I kind of have a fantasy that maybe as we get more reacquainted with psychedelics, there could be group-based experiences that build community resiliency and are intentionally oriented toward breaking down barriers between people, having people see things from other perspectives and detribalising our society,

"But that's not going to happen on its own. It would have to be intentional, and – if it happens – it would probably take multiple generations."

Based on his experience with extremism, Brendan agreed with expert takes that no drug, on its own, will spontaneously change the minds of white supremacists or end political conflict in the US

he does think that, with the right framing and mindset, MDMA could be useful for people who are already at least somewhat open to reconsidering their ideologies, just as it was for him. "It helped me see things in a different way that no amount of therapy or antiracist literature ever would have done," he said. "I really think it was a breakthrough experience."

start with epistemic bubbles

That omission might be purposeful

But that omission can also be entirely inadvertent. Even if we’re not actively trying to avoid disagreement, our Facebook friends tend to share our views and interests

An ‘echo chamber’ is a social structure from which other relevant voices have been actively discredited. Where an epistemic bubble merely omits contrary views, an echo chamber brings its members to actively distrust outsiders.

an echo chamber is something like a cult. A cult isolates its members by actively alienating them from any outside sources. Those outside are actively labelled as malignant and untrustworthy.

In epistemic bubbles, other voices are not heard; in echo chambers, other voices are actively undermined.

The way to break an echo chamber is not to wave “the facts” in the faces of its members. It is to attack the echo chamber at its root and repair that broken trust.

Looking to others for corroboration is a basic method for checking whether one has reasoned well or badly

They have been in the limelight lately, most famously in Eli Pariser’s The Filter Bubble (2011) and Cass Sunstein’s #Republic: Divided Democracy in the Age of Social Media (2017).

The general gist: we get much of our news from Facebook feeds and similar sorts of social media. Our Facebook feed consists mostly of our friends and colleagues, the majority of whom share our own political and cultural views

various algorithms behind the scenes, such as those inside Google search, invisibly personalise our searches, making it more likely that we’ll see only what we want to see. These processes all impose filters on information.

Such filters aren’t necessarily bad. The world is overstuffed with information, and one can’t sort through it all by oneself: filters need to be outsourced.

That’s why we all depend on extended social networks to deliver us knowledge

any such informational network needs the right sort of broadness and variety to work

Each individual person in my network might be superbly reliable about her particular informational patch but, as an aggregate structure, my network lacks what Sanford Goldberg in his book Relying on Others (2010) calls ‘coverage-reliability’. It doesn’t deliver to me a sufficiently broad and representative coverage of all the relevant information.

Epistemic bubbles also threaten us with a second danger: excessive self-confidence.

An ‘epistemic bubble’ is an informational network from which relevant voices have been excluded by omission

Suppose that I believe that the Paleo diet is the greatest diet of all time. I assemble a Facebook group called ‘Great Health Facts!’ and fill it only with people who already believe that Paleo is the best diet. The fact that everybody in that group agrees with me about Paleo shouldn’t increase my confidence level one bit. They’re not mere copies – they actually might have reached their conclusions independently – but their agreement can be entirely explained by my method of selection.

Luckily, though, epistemic bubbles are easily shattered. We can pop an epistemic bubble simply by exposing its members to the information and arguments that they’ve missed.

echo chambers are a far more pernicious and robust phenomenon.

amieson and Cappella’s book is the first empirical study into how echo chambers function

echo chambers work by systematically alienating their members from all outside epistemic sources.

Their research centres on Rush Limbaugh, a wildly successful conservative firebrand in the United States, along with Fox News and related media

His constant attacks on the ‘mainstream media’ are attempts to discredit all other sources of knowledge. He systematically undermines the integrity of anybody who expresses any kind of contrary view.

outsiders are not simply mistaken – they are malicious, manipulative and actively working to destroy Limbaugh and his followers. The resulting worldview is one of deeply opposed force, an all-or-nothing war between good and evil

The result is a rather striking parallel to the techniques of emotional isolation typically practised in cult indoctrination

cult indoctrination involves new cult members being brought to distrust all non-cult members. This provides a social buffer against any attempts to extract the indoctrinated person from the cult.

The echo chamber doesn’t need any bad connectivity to function. Limbaugh’s followers have full access to outside sources of information

As Elijah Millgram argues in The Great Endarkenment (2015), modern knowledge depends on trusting long chains of experts. And no single person is in the position to check up on the reliability of every member of that chain

Their worldview can survive exposure to those outside voices because their belief system has prepared them for such intellectual onslaught.

exposure to contrary views could actually reinforce their views. Limbaugh might offer his followers a conspiracy theory: anybody who criticises him is doing it at the behest of a secret cabal of evil elites, which has already seized control of the mainstream media.

Perversely, exposure to outsiders with contrary views can thus increase echo-chamber members’ confidence in their insider sources, and hence their attachment to their worldview.

‘evidential pre-emption’. What’s happening is a kind of intellectual judo, in which the power and enthusiasm of contrary voices are turned against those contrary voices through a carefully rigged internal structure of belief.

One might be tempted to think that the solution is just more intellectual autonomy. Echo chambers arise because we trust others too much, so the solution is to start thinking for ourselves.

that kind of radical intellectual autonomy is a pipe dream. If the philosophical study of knowledge has taught us anything in the past half-century, it is that we are irredeemably dependent on each other in almost every domain of knowledge

Limbaugh’s followers regularly read – but do not accept – mainstream and liberal news sources. They are isolated, not by selective exposure, but by changes in who they accept as authorities, experts and trusted sources.

we depend on a vastly complicated social structure of trust. We must trust each other, but, as the philosopher Annette Baier says, that trust makes us vulnerable. Echo chambers operate as a kind of social parasite on that vulnerability, taking advantage of our epistemic condition and social dependency.

I am quite confident that there are plenty of echo chambers on the political Left. More importantly, nothing about echo chambers restricts them to the arena of politics

The world of anti-vaccination is clearly an echo chamber, and it is one that crosses political lines. I’ve also encountered echo chambers on topics as broad as diet (Paleo!), exercise technique (CrossFit!), breastfeeding, some academic intellectual traditions, and many, many more

Here’s a basic check: does a community’s belief system actively undermine the trustworthiness of any outsiders who don’t subscribe to its central dogmas? Then it’s probably an echo chamber.

much of the recent analysis has lumped epistemic bubbles together with echo chambers into a single, unified phenomenon. But it is absolutely crucial to distinguish between the two.

Epistemic bubbles are rather ramshackle; they go up easily, and they collapse easily

Echo chambers are far more pernicious and far more robust. They can start to seem almost like living things. Their belief systems provide structural integrity, resilience and active responses to outside attacks

the two phenomena can also exist independently. And of the events we’re most worried about, it’s the echo-chamber effects that are really causing most of the trouble.

new data does, in fact, seem to show that people on Facebook actually do see posts from the other side, or that people often visit websites with opposite political affiliation.

their basis for evaluation – their background beliefs about whom to trust – are radically different. They are not irrational, but systematically misinformed about where to place their trust.

Many people have claimed that we have entered an era of ‘post-truth’.

Not only do some political figures seem to speak with a blatant disregard for the facts, but their supporters seem utterly unswayed by evidence. It seems, to some, that truth no longer matters.

This is an explanation in terms of total irrationality. To accept it, you must believe that a great number of people have lost all interest in evidence or investigation, and have fallen away from the ways of reason.

echo chambers offers a less damning and far more modest explanation. The apparent ‘post-truth’ attitude can be explained as the result of the manipulations of trust wrought by echo chambers.

We don’t have to attribute a complete disinterest in facts, evidence or reason to explain the post-truth attitude. We simply have to attribute to certain communities a vastly divergent set of trusted authorities.

An echo chamber doesn’t destroy their members’ interest in the truth; it merely manipulates whom they trust and changes whom they accept as trustworthy sources and institutions.

in many ways, echo-chamber members are following reasonable and rational procedures of enquiry. They’re engaging in critical reasoning. They’re questioning, they’re evaluating sources for themselves, they’re assessing different pathways to information. They are critically examining those who claim expertise and trustworthiness, using what they already know about the world

none of this weighs against the existence of echo chambers. We should not dismiss the threat of echo chambers based only on evidence about connectivity and exposure.

Notice how different what’s going on here is from, say, Orwellian doublespeak, a deliberately ambiguous, euphemism-filled language designed to hide the intent of the speaker.

echo chambers don’t trade in vague, ambiguous pseudo-speech. We should expect that echo chambers would deliver crisp, clear, unambiguous claims about who is trustworthy and who is not

clearly articulated conspiracy theories, and crisply worded accusations of an outside world rife with untrustworthiness and corruption.

Once an echo chamber starts to grip a person, its mechanisms will reinforce themselves.

In an epistemically healthy life, the variety of our informational sources will put an upper limit to how much we’re willing to trust any single person. Everybody’s fallible; a healthy informational network tends to discover people’s mistakes and point them out. This puts an upper ceiling on how much you can trust even your most beloved leader

nside an echo chamber, that upper ceiling disappears.

Being caught in an echo chamber is not always the result of laziness or bad faith. Imagine, for instance, that somebody has been raised and educated entirely inside an echo chamber

when the child finally comes into contact with the larger world – say, as a teenager – the echo chamber’s worldview is firmly in place. That teenager will distrust all sources outside her echo chamber, and she will have gotten there by following normal procedures for trust and learning.

It certainly seems like our teenager is behaving reasonably. She could be going about her intellectual life in perfectly good faith. She might be intellectually voracious, seeking out new sources, investigating them, and evaluating them using what she already knows.

The worry is that she’s intellectually trapped. Her earnest attempts at intellectual investigation are led astray by her upbringing and the social structure in which she is embedded.

Echo chambers might function like addiction, under certain accounts. It might be irrational to become addicted, but all it takes is a momentary lapse – once you’re addicted, your internal landscape is sufficiently rearranged such that it’s rational to continue with your addiction

Similarly, all it takes to enter an echo chamber is a momentary lapse of intellectual vigilance. Once you’re in, the echo chamber’s belief systems function as a trap, making future acts of intellectual vigilance only reinforce the echo chamber’s worldview.

There is at least one possible escape route, however. Notice that the logic of the echo chamber depends on the order in which we encounter the evidence. An echo chamber can bring our teenager to discredit outside beliefs precisely because she encountered the echo chamber’s claims first. Imagine a counterpart to our teenager who was raised outside of the echo chamber and exposed to a wide range of beliefs. Our free-range counterpart would, when she encounters that same echo chamber, likely see its many flaws

Those caught in an echo chamber are giving far too much weight to the evidence they encounter first, just because it’s first. Rationally, they should reconsider their beliefs without that arbitrary preference. But how does one enforce such informational a-historicity?

The escape route is a modified version of René Descartes’s infamous method.

Meditations on First Philosophy (1641). He had come to realise that many of the beliefs he had acquired in his early life were false. But early beliefs lead to all sorts of other beliefs, and any early falsehoods he’d accepted had surely infected the rest of his belief system.

The only solution, thought Descartes, was to throw all his beliefs away and start over again from scratch.

He could start over, trusting nothing and no one except those things that he could be entirely certain of, and stamping out those sneaky falsehoods once and for all. Let’s call this the Cartesian epistemic reboot.

Notice how close Descartes’s problem is to our hapless teenager’s, and how useful the solution might be. Our teenager, like Descartes, has problematic beliefs acquired in early childhood. These beliefs have infected outwards, infesting that teenager’s whole belief system. Our teenager, too, needs to throw everything away, and start over again.

Let’s call the modernised version of Descartes’s methodology the social-epistemic reboot.

when she starts from scratch, we won’t demand that she trust only what she’s absolutely certain of, nor will we demand that she go it alone

For the social reboot, she can proceed, after throwing everything away, in an utterly mundane way – trusting her senses, trusting others. But she must begin afresh socially – she must reconsider all possible sources of information with a presumptively equanimous eye. She must take the posture of a cognitive newborn, open and equally trusting to all outside sources

we’re not asking people to change their basic methods for learning about the world. They are permitted to trust, and trust freely. But after the social reboot, that trust will not be narrowly confined and deeply conditioned by the particular people they happened to be raised by.

Such a profound deep-cleanse of one’s whole belief system seems to be what’s actually required to escape. Look at the many stories of people leaving cults and echo chambers

Take, for example, the story of Derek Black in Florida – raised by a neo-Nazi father, and groomed from childhood to be a neo-Nazi leader. Black left the movement by, basically, performing a social reboot. He completely abandoned everything he’d believed in, and spent years building a new belief system from scratch. He immersed himself broadly and open-mindedly in everything he’d missed – pop culture, Arabic literature, the mainstream media, rap – all with an overall attitude of generosity and trust.

It was the project of years and a major act of self-reconstruction, but those extraordinary lengths might just be what’s actually required to undo the effects of an echo-chambered upbringing.

we need to attack the root, the systems of discredit themselves, and restore trust in some outside voices.

Stories of actual escapes from echo chambers often turn on particular encounters – moments when the echo-chambered individual starts to trust somebody on the outside.

Black’s is case in point. By high school, he was already something of a star on neo-Nazi media, with his own radio talk-show. He went on to college, openly neo-Nazi, and was shunned by almost every other student in his community college. But then Matthew Stevenson, a Jewish fellow undergraduate, started inviting Black to Stevenson’s Shabbat dinners. In Black’s telling, Stevenson was unfailingly kind, open and generous, and slowly earned Black’s trust. This was the seed, says Black, that led to a massive intellectual upheaval – a slow-dawning realisation of the depths to which he had been misled

Similarly, accounts of people leaving echo-chambered homophobia rarely involve them encountering some institutionally reported fact. Rather, they tend to revolve around personal encounters – a child, a family member, a close friend coming out.

hese encounters matter because a personal connection comes with a substantial store of trust.

We don’t simply trust people as educated experts in a field – we rely on their goodwill. And this is why trust, rather than mere reliability, is the key concept

goodwill is a general feature of a person’s character. If I demonstrate goodwill in action, then you have some reason to think that I also have goodwill in matters of thought and knowledge.

f one can demonstrate goodwill to an echo-chambered member – as Stevenson did with Black – then perhaps one can start to pierce that echo chamber.

the path I’m describing is a winding, narrow and fragile one. There is no guarantee that such trust can be established, and no clear path to its being established systematically.

what we’ve found here isn’t an escape route at all. It depends on the intervention of another. This path is not even one an echo-chamber member can trigger on her own; it is only a whisper-thin hope for rescue from the outside.

Musk’s concern with bots isn’t only a bullshit tactic he’s using to snake out of a bad business deal and/or get a better price for Twitter; it’s also a great example of his shallow thinking. The man has at least some ability to oversee complex engineering systems that land rockets, but his narcissism affords him a two-dimensional understanding of the way information travels across social media.

He is drawn to the conspiratorial nature of bots and information manipulation, because it is a more exciting and easier-to-understand solution to more complex or uncomfortable problems. Instead of facing the reality that many people dislike him as a result of his personality, behavior, politics, or shitty management style, he blames bots. Rather than try to understand the gnarly mechanics and hard-to-solve problems of democratized speech, he sorts them into overly simplified boxes like censorship and spam and then casts himself as the crusading hero who can fix it all. But he can’t and won’t, because he doesn’t care enough to find the answers.

Musk isn’t playing chess or even checkers. He’s just the richest man in the world, bored, mad, and posting like your great-uncle.

Essentially, Lasch was attacking the notion, fashionable as Americans basked in their seeming victory over the Soviet Union in the Cold War, that history had a direction — and that one would be wise to stay on the “right side” of it.

Francis Fukuyama expressed a version of this triumphalist idea in his famous 1992 book, “The End of History and the Last Man,” in which he celebrated the notion that History with a capital “H,” in the sense of a battle between competing ideas, was ending with communism left to smolder on Ronald Reagan’s famous ash heap.

One of Martin Luther King Jr.’s most frequently quoted lines speaks to a similar thought, albeit in a different context: “T​he arc of the moral universe is long, but it bends toward justice.” Though he had read Lasch, Obama quoted that line often, just as he liked to say that so-and-so would be “on the wrong side of history” if they didn’t live up to his ideals — whether the issue was same-sex marriage, health policy or the Russian occupation of Crimea.

The memo goes on to list two sets of words: “Optimistic Positive Governing Words” and “Contrasting Words,” which carried negative connotations. One of the latter group was the word “liberal,” sandwiched between “intolerant” and “lie.”

So what’s the difference between a progressive and a liberal?To vastly oversimplify matters, liberal usually refers to someone on the center-left on a two-dimensional political spectrum, while progressive refers to someone further left.

But “liberal” has taken a beating in recent decades — from both left and right.

In the late 1980s and 1990s, Republicans successfully demonized the word “liberal,” to the point where many Democrats shied away from it in favor of labels like “conservative Democrat” or, more recently, “progressive.”

“Is the story of the 20th century about the defeat of the Soviet Union, or was it about two world wars and a Holocaust?” asked Matthew Sitman, the co-host of the “Know Your Enemy” podcast, which recently hosted a discussion on Lasch and the fascination many conservatives have with his ideas. “It really depends on how you look at it.”

None of this was an accident. In 1996, Representative Newt Gingrich of Georgia circulated a now-famous memo called “Language: A Key Mechanism of Control.”

The authors urged their readers: “The words and phrases are powerful. Read them. Memorize as many as possible.”

Republicans subsequently had a great deal of success in associating the term “liberal” with other words and phrases voters found uncongenial: wasteful spending, high rates of taxation and libertinism that repelled socially conservative voters.

Many on the left began identifying themselves as “progressive” — which had the added benefit of harking back to movements of the late 19th and early 20th centuries that fought against corruption, opposed corporate monopolies, pushed for good-government reforms and food safety and labor laws and established women’s right to vote.

Allies of Bill Clinton founded the Progressive Policy Institute, a think tank associated with so-called Blue Dog Democrats from the South.

Now, scrambling the terminology, groups like the Progressive Change Campaign Committee agitate on behalf of proudly left-wing candidates

In 2014, Charles Murray, the polarizing conservative scholar, urged readers of The Wall Street Journal’s staunchly right-wing editorial section to “start using ‘liberal’ to designate the good guys on the left, reserving ‘progressive’ for those who are enthusiastic about an unrestrained regulatory state.”

As Sanders and acolytes like Representative Alexandria Ocasio-Cortez of New York have gained prominence over the last few election cycles, many on the left-wing end of the spectrum have begun proudly applying other labels to themselves, such as “democratic socialist.”

To little avail so far, Kazin, the Georgetown historian, has been urging them to call themselves “social democrats” instead — as many mainstream parties do in Europe.“It’s not a good way to win elections in this country, to call yourself a socialist,” he said.

The aim of an argument should not be proving who is right, but conveying that you care about the issues,

Show the person with whom you are speaking that you care about what he or she says.

The goal should be to state your views and to hear theirs. It should not be: “I am not leaving until you admit that you are wrong, or here is what I believe, and I am not budging from this,”

And when you listen, go all in

“Don’t half-listen while figuring out what you’re going to say next,”

Don’t ‘drop the anchor’

Some people start an argument by staking their position and refusing to budge, an impulse that Dr. Cuddy called “dropping the anchor.”Instead, try to understand the other person’s point of view; it does not mean you have to agree with him or her, or that you are abandoning deeply felt objections to, for example, racism or sexism, she said.

Mind your body languageYour body language can send messages that are more compelling than the words coming out of your mouth.Try to avoid gestures that are patronizing or defensive, like crossing your arms or clenching your jaw.

Maintain eye contact in a way that is not a stare-down.Lean forward slightly to show you are interested.And no eye-rolling,

Don’t argue to winDr. Gutting says it helps to use neutral or charitable language when acknowledging opposing viewpoints, especially during arguments over politics. It lays the groundwork for a more effective argument on points of genuine weakness.

Don’t think of an argument as an opportunity to convince the other person of your view; think of it as a way to test and improve your opinions, and to gain a better understanding of the other side.

“People do give up views because of rational arguments against them,” Dr. Gutting said in the interview. “But this is almost always a long process, not the outcome of a single decisive encounter.”

Know the factsA good argument is supported by evidence, but that is just a starting point. Sometimes, especially with political back-and-forths, one side will look only at evidence supporting its own position, conveniently leaving out the full picture,

Speak and listen fearlessly

“So for me, the condition for a conversation has to be that you are unafraid to speak courageously, and you are unafraid to tell your partner exactly what it is that you think about the world.”But a two-way argument also requires fearless listening, “even if it is me talking to a white supremacist who is trying to tell me that I am inferior,” he added. “One of the conditions for the possibility of a fruitful argument is to allow for some kind of opening up in myself to hear.”

“What you need to be able to do is to speak the same language,” he said. “They believe in God, and you would say: ‘You and I believe the same thing. How is it that this God who loves you can’t possibly love me?’ Is it possible that we can agree to disagree on some issues?”

For the well-being of its users, Bejar argued, Meta needed to change course, focusing less on a flawed system of rules-based policing and more on addressing such bad experiences

The company would need to collect data on what upset users and then work to combat the source of it, nudging those who made others uncomfortable to improve their behavior and isolating communities of users who deliberately sought to harm others.

“I am appealing to you because I believe that working this way will require a culture shift,” Bejar wrote to Zuckerberg—the company would have to acknowledge that its existing approach to governing Facebook and Instagram wasn’t working.

During and after Bejar’s time as a consultant, Meta spokesman Andy Stone said, the company has rolled out several product features meant to address some of the Well-Being Team’s findings. Those features include warnings to users before they post comments that Meta’s automated systems flag as potentially offensive, and reminders to be kind when sending direct messages to users like content creators who receive a large volume of messages. 

Meta’s classifiers were reliable enough to remove only a low single-digit percentage of hate speech with any degree of precision.

Bejar was floored—all the more so when he learned that virtually all of his daughter’s friends had been subjected to similar harassment. “DTF?” a user they’d never met would ask, using shorthand for a vulgar proposition. Instagram acted so rarely on reports of such behavior that the girls no longer bothered reporting them. 

Meta’s own statistics suggested that big problems didn’t exist. 

Meta had come to approach governing user behavior as an overwhelmingly automated process. Engineers would compile data sets of unacceptable content—things like terrorism, pornography, bullying or “excessive gore”—and then train machine-learning models to screen future content for similar material.

While users could still flag things that upset them, Meta shifted resources away from reviewing them. To discourage users from filing reports, internal documents from 2019 show, Meta added steps to the reporting process. Meta said the changes were meant to discourage frivolous reports and educate users about platform rules. 

The outperformance of Meta’s automated enforcement relied on what Bejar considered two sleights of hand. The systems didn’t catch anywhere near the majority of banned content—only the majority of what the company ultimately removed

“Please don’t talk about my underage tits,” Bejar’s daughter shot back before reporting his comment to Instagram. A few days later, the platform got back to her: The insult didn’t violate its community guidelines.

Also buttressing Meta’s statistics were rules written narrowly enough to ban only unambiguously vile material. Meta’s rules didn’t clearly prohibit adults from flooding the comments section on a teenager’s posts with kiss emojis or posting pictures of kids in their underwear, inviting their followers to “see more” in a private Facebook Messenger group. 

“Mark personally values freedom of expression first and foremost and would say this is a feature and not a bug,” Rosen responded

Narrow rules and unreliable automated enforcement systems left a lot of room for bad behavior—but they made the company’s child-safety statistics look pretty good according to Meta’s metric of choice: prevalence.

Defined as the percentage of content viewed worldwide that explicitly violates a Meta rule, prevalence was the company’s preferred measuring stick for the problems users experienced.

According to prevalence, child exploitation was so rare on the platform that it couldn’t be reliably estimated, less than 0.05%, the threshold for functional measurement. Content deemed to encourage self-harm, such as eating disorders, was just as minimal, and rule violations for bullying and harassment occurred in just eight of 10,000 views. 

“There’s a grading-your-own-homework problem,”

Meta defines what constitutes harmful content, so it shapes the discussion of how successful it is at dealing with it.”

It could reconsider its AI-generated “beauty filters,” which internal research suggested made both the people who used them and those who viewed the images more self-critical

the team built a new questionnaire called BEEF, short for “Bad Emotional Experience Feedback.

A recurring survey of issues 238,000 users had experienced over the past seven days, the effort identified problems with prevalence from the start: Users were 100 times more likely to tell Instagram they’d witnessed bullying in the last week than Meta’s bullying-prevalence statistics indicated they should.

“People feel like they’re having a bad experience or they don’t,” one presentation on BEEF noted. “Their perception isn’t constrained by policy.

they seemed particularly common among teens on Instagram.

Among users under the age of 16, 26% recalled having a bad experience in the last week due to witnessing hostility against someone based on their race, religion or identity

More than a fifth felt worse about themselves after viewing others’ posts, and 13% had experienced unwanted sexual advances in the past seven days. 

The vast gap between the low prevalence of content deemed problematic in the company’s own statistics and what users told the company they experienced suggested that Meta’s definitions were off, Bejar argued

To minimize content that teenagers told researchers made them feel bad about themselves, Instagram could cap how much beauty- and fashion-influencer content users saw.

Proving to Meta’s leadership that the company’s prevalence metrics were missing the point was going to require data the company didn’t have. So Bejar and a group of staffers from the Well-Being Team started collecting it

And it could build ways for users to report unwanted contacts, the first step to figuring out how to discourage them.

One experiment run in response to BEEF data showed that when users were notified that their comment or post had upset people who saw it, they often deleted it of their own accord. “Even if you don’t mandate behaviors,” said Krieger, “you can at least send signals about what behaviors aren’t welcome.”

But among the ranks of Meta’s senior middle management, Bejar and Krieger said, BEEF hit a wall. Managers who had made their careers on incrementally improving prevalence statistics weren’t receptive to the suggestion that the approach wasn’t working. 

After three decades in Silicon Valley, he understood that members of the company’s C-Suite might not appreciate a damning appraisal of the safety risks young users faced from its product—especially one citing the company’s own data. 

“This was the email that my entire career in tech trained me not to send,” he says. “But a part of me was still hoping they just didn’t know.”

“Policy enforcement is analogous to the police,” he wrote in the email Oct. 5, 2021—arguing that it’s essential to respond to crime, but that it’s not what makes a community safe. Meta had an opportunity to do right by its users and take on a problem that Bejar believed was almost certainly industrywide.

fter Haugen’s airing of internal research, Meta had cracked down on the distribution of anything that would, if leaked, cause further reputational damage. With executives privately asserting that the company’s research division harbored a fifth column of detractors, Meta was formalizing a raft of new rules for employees’ internal communication.

Among the mandates for achieving “Narrative Excellence,” as the company called it, was to keep research data tight and never assert a moral or legal duty to fix a problem.

“I had to write about it as a hypothetical,” Bejar said. Rather than acknowledging that Instagram’s survey data showed that teens regularly faced unwanted sexual advances, the memo merely suggested how Instagram might help teens if they faced such a problem.

The hope that the team’s work would continue didn’t last. The company stopped conducting the specific survey behind BEEF, then laid off most everyone who’d worked on it as part of what Zuckerberg called Meta’s “year of efficiency.

If Meta was to change, Bejar told the Journal, the effort would have to come from the outside. He began consulting with a coalition of state attorneys general who filed suit against the company late last month, alleging that the company had built its products to maximize engagement at the expense of young users’ physical and mental health. Bejar also got in touch with members of Congress about where he believes the company’s user-safety efforts fell short. 

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

The Pew Research Center survey asked people different questions but found similar doubts about AI. Just 15 percent of respondents said they were more excited than concerned about the increasing use of AI in daily life.

“It’s fantastic that there is public skepticism about AI. There absolutely should be,” said Meredith Broussard, an artificial intelligence researcher and professor at New York University.

Broussard said there can be no way to design artificial intelligence software to make inherently human decisions, like grading students’ tests or determining the course of medical treatment.

Most Americans essentially agree with Broussard that AI has a place in our lives, but not for everything.

Most people said it was a bad idea to use AI for military drones that try to distinguish between enemies and civilians or trucks making local deliveries without human drivers. Most respondents said it was a good idea for machines to perform risky jobs such as coal mining.

Roman Yampolskiy, an AI specialist at the University of Louisville engineering school, told me he’s concerned about how quickly technologists are building computers that are designed to “think” like the human brain and apply knowledge not just in one narrow area, like recommending Netflix movies, but for complex tasks that have tended to require human intelligence.

“We have an arms race between multiple untested technologies. That is my concern,” Yampolskiy said. (If you want to feel terrified, I recommend Yampolskiy’s research paper on the inability to control advanced AI.)

The term “AI” is a catch-all for everything from relatively uncontroversial technology, such as autocomplete in your web search queries, to the contentious software that promises to predict crime before it happens. Our fears about the latter might be overwhelming our beliefs about the benefits from more mundane AI.

it’s worth acknowledging that adhering to these necessary rules cuts against some core aspects of human nature. I’m of the opinion that people should not bring their “whole self” to work — no one owes an employer that — but it’s also impossible to bring none of your personal self to work.

There are good reasons that both formal and informal boundaries are a necessity in the workplace and academia

New financial constraints on family formation are a potential cause, as implied by another striking finding in the Journal poll — 78 percent of adults lack confidence this generation of children will enjoy a better life than they do.

Yet a recent analysis for the Aspen Economic Strategy Group by Melissa S. Kearney and Phillip B. Levine, economics professors at the University of Maryland and Wellesley College, respectively, determined that “beyond the temporary effects of the Great Recession, no recent economic or policy change is responsible for a meaningful share of the decline in the US fertility rate since 2007.”

Their study took account of such factors as the high cost of child care, student debt service and housing as well as Medicaid coverage and the wider availability of long-acting reversible contraception. Yet they had “no success finding evidence” that any of these were decisive.

Kearney and Levine speculated instead that the answers lie in the cultural zeitgeist — “shifting priorities across cohorts of young adults,”

A possibility worth considering, they suggested, is that young adults who experienced “intensive parenting” as children now balk at the heavy investment of time and resources needed to raise their own kids that way: It would clash with their career and leisure goals.

another event that year: Apple released the first iPhone, a revolutionary cultural moment if there ever was one. The ensuing smartphone-enabled social media boom — Facebook had opened membership to anyone older than 13 in 2006 — forever changed how human beings relate with one another.

We are just beginning to understand this development’s effect on mental health, education, religious observance, community cohesion — everything. Why wouldn’t it also affect people’s willingness to have children?

one indirect way new media affect childbearing rates is through “time competition effects” — essentially, hours spent watching the tube cannot be spent forming romantic partnerships.

a 2021 review of survey data on young adults and adolescents in the United States and other countries, the years between 2009 and 2018 saw a marked decline in reported sexual activity.

the authors hypothesized that people are distracted from the search for partners by “increasing use of computer games and social media.

during the late 20th century, Brazil’s fertility rates fell after women who watched soap operas depicting smaller families sought to emulate them by having fewer children themselves.

This may be an area where incentives do not influence behavior, at least not enough. Whether the cultural shift to lower birthrates occurs on an accelerated basis, as in the United States after 2007, or gradually, as it did in Japan, it appears permanent — “sticky,” as policy wonks say.

Making friends can be hard—but there may be more opportunities than we think. Doing these interviews has taught me that connection can come from anywhere, at any time, if both parties are open to it.

“You have to look for friendship in places you would never expect it.”

Paying attention goes a long way when forging these unexpected friendships—noticing when you click with someone, being open to chance encounters.

as much as we may feel like our social networks are set and settled, it’s never too late to meet someone who will be important to you for the rest of your life. I spoke with more than one group who was surprised and grateful to have found one another in middle age, a period when work and family responsibilities tend to peak and keeping up with friends is not always easy.

I’m inspired by the people I’ve spoken with who imagined something different for themselves: the friends who bought a house together, who went to therapy together, who have raised their children together, who committed to an “arranged friendship,” whose friendship has fueled their fight for justice.

they won’t grow without intention. This is the hardest part of friendship. It takes energy and thought, and our mental and physical resources are often spread thin. In other words, friendships take work. But I have never liked framing our friendships as labor. Showing up for our friends takes effort, yes, but it shouldn’t be drudgery. It should be a joy.

One thing that seems to make keeping up with friends easier is ritual. I personally find that the effort of coordinating hangs (or even phone calls) is the biggest barrier to seeing my friends. It’s much easier when something is baked into my schedule, and all I have to do is show up.

Some have organized a book club, a monthly hike, or a regular dinner party. Others have committed to a group chat that runs all day every day, or a Dungeons & Dragons campaign that’s lasted for 30 years. In addition to keeping groups close, these traditions can fuel a friendship and give it a shared culture.

Imagination

Society has a place for friendships, and it’s on the sidelines. They’re supposed to play a supporting role to work, family, and romance. It takes imagination not to default to this norm, and to design your life so that friendship plays the role you really want it to.

Attention only gets you so far without action. When opportunity arises, you have to put yourself out there, and that requires courage, vulnerability, and a willingness to let things be awkward.

The man who gave his friend a kidney and the woman who gave birth to her best friend’s quadruplets remind me that there are friends who choose to love each other radically every day. Their love does not stand on the sidelines.

The beauty and the challenge of friendship is its diversity. A friendship can be whatever you want it to. Each one is a canvas whose only limit is our imagination.

Grace

All of the forces I’ve mentioned so far—accumulation, attention, intention, ritual, and imagination—are ideals. They’re impossible to fully live up to. Life often gets in the way.

I do love the concept of grace, of a gift so profound that it could never be earned or deserved. And so when I cite grace here as the final and most important force in friendships, I mean it in two ways. One is the forgiveness that we offer each other when we fall short. The other is the space that creates for connections—and reconnections—that feel nothing short of miraculous.

Many of the people I spoke with—who, in many cases, love each other so much that they nominated themselves to be interviewed about their friendship—told me that they don’t see each other that often, or that they don’t talk as much as they would like. I’ve come to believe that friendship doesn’t always have to be about presence; it can also be about love that can weather absence.

Sometimes, people have assumed that I must be a really great friend, given how much time I’ve spent thinking about this. And I’m not. I try to be, but I tend to retreat too much into myself and my romantic relationship and don’t prioritize my friends as much as I’d like to.

But absence doesn’t have to last forever. “The Friendship Files” includes many stories of second chances and rekindlings.

Accumulation

Attention

Intention

Ritual

onic constipation, a functional bowel disorder, affects approximately 14% of adults worldwide [1]. Slow transit constipation (STC) is the major cause of chronic constipation which is characterized by markedly prolonged colonic transit time as a result of the colonic motility function disorde

Usually, patients with STC suffer from a common sense of abdominal pain, nausea, depression and sickness, which seriously influence their social ability and health-related quality of life [4–6

Current clinical treatments include cathartics, prokinetics and aggressive surgery which can increase bowel movement frequency to a certain degree.

However, pharmacological interventions is prone to drug dependency and relapse after drug withdrawal [3]

Surgical treatments such as subtotal colectomy and total colectomy in STC patients may adversely affect the quality of life due to the risk of postoperative diarrhea or incontinence, and result in a heavy healthcare burden

The enteric nervous system (ENS), located in the intestinal wall, regulates various functions including contraction of intestine, homeostasis and blood flow [10]. As the ‘second brain’, the ENS contains large amounts of neurons working independently from the central nervous system [11]. Researches have identified that STCs are mostly caused by disorders of the relevant nerves, especially the ENS [12,13].

McCallum et al. [35] found that gastric electrical stimulation in combination with pharmacological treatment could also enhance emptying in patients with gastroparesis. Especially, gastric electrical stimulation has been approved as a clinical therapy method for gastroparesis and obesity in European and American countries [36].

we employed pulse train stimulation and implanted electrodes at the proximal colon in dogs.

After CES treatment, we observed the colonic transit time of the sham treatment group was longer than that of CES treatment and control groups, and electrical stimulation significantly enhanced the colonic electromyogram (EMG) signal.

histopathology and TEM analysis showed increased ganglia and synaptic vesicles existing in the colon myenteric plexus of the CES treatment group as compared with that of the sham CES group

Our results suggested that CES might reduce the degeneration of the myenteric plexus neurons, thereby contributing to the therapeutic effect on STC beagles.

the defecating frequency and the feces characteristics of STC beagles returned to normal after CES treatment. The result indicated that CES could improve the symptoms of STC.

The colonic EMG signal was strongly promoted by CES

Especially, the colonic EMG signal of the beagles with STC was remarkably enhanced by CES (Figure 3), indicating that CES could not only improve the colonic content emptying, but also enhance the EMG signal to promote colonic motility.

Colonic electrical stimulation (CES), a valuable alternative for the treatment of STC, was reported to improve the colon motility by adjusting the bioelectrical activity in animal models or patients with STC [17]. However, little report focuses on the underlying nervous mechanism to normalize the delayed colonic emptying and relieve symptoms. We hypothesized that CES may also repair the disorders of the relevant nerves and then improve the colonic motility.

The first study regarding the CES to modulate colonic motility was performed by Hughes et al. [37]. Since then, many researchers employed short-pulse CES in canine descending colon or pig cecum [20,21,38]. Researchers also applied long-pulse CES to stimulate the colon of human or animals [39]

Recently, studies showed that the prokinetic effect of pulse train CES is better than that of short-pulse CES or long-pulse CES [25]

Our study indicated that CES could enhance the colonic motility, and then accelerate the colonic content emptying. Thereafter, we investigated the underlying mechanism and presumed that CES might improve the STC symptom through the repairment of the ENS.

The neuropathy in ENS is considered to be responsible for various kinds of disordered motility including STC and the related pathophysiologic symptoms [40]. In agreement with this view, our study discovered the decreased number of ganglia in the myenteric plexus, as well as the destruction of the enteric nerve axon terminals and synaptic vesicles in the sham CES group beagles

The present study proves that CES with pulse trains has curative effects on the colonic motility and content emptying in STC beagles. The up-regulation of intestinal nerve related proteins such as SYP, PGP9.5, CAD and S-100B in the colonic myenteric plexus suggests that CES might reduce the degeneration of the myenteric plexus neurons, thereby producing the therapeutic effect on STC beagles. Further investigation for the underlying mechanism of nerve regeneration is necessary to better understand how CES promotes the recovery of delayed colonic motility induced by STC.

Just like midlife, quarterlife can bring its own crisis — trying to separate from your parents or caregivers and forge a sense of self is a struggle. But the generation entering adulthood now faces novel, sometimes debilitating, challenges.

Many find themselves so mired in day-to-day monetary concerns, from the relentless crush of student debt to the swelling costs of everything, that they feel unable to consider what they want for themselves long term

“We’ve been constrained by this myth that you graduate from college and you start your life,” she said. Without the social script previous generations followed — graduate college, marry, raise a family — Ms. Byock said her young clients often flailed around in a state of extended adolescence.

nearly one-third of Gen Z adults are living with their parents or other relatives and plan to stay there.

Many young people today struggle to afford college or decide not to attend, and the “existential crisis” that used to hit after graduation descends earlier and earlier

Ms. Byock said to pay attention to what you’re naturally curious about, and not to dismiss your interests as stupid or futile.

Experts said those entering adulthood need clear guidance for how to make it out of the muddle. Here are their top pieces of advice on how to navigate a quarterlife crisis today.

She recommends scheduling reminders to check in with yourself, roughly every three months, to examine where you are in your life and whether you feel stuck or dissatisfied

From there, she said, you can start to identify aspects of your life that you want to change.

“Start to give your own inner life the respect that it’s due,”

But quarterlife is about becoming a whole person, Ms. Byock said, and both groups need to absorb each other’s characteristics to balance themselves out

However, there is a difference between self-interest and self-indulgence, Ms. Byock said. Investigating and interrogating who you are takes work. “It’s not just about choosing your labels and being done,” she said.

Be patient.

Quarterlifers may feel pressure to race through each step of their lives, Ms. Byock said, craving the sense of achievement that comes with completing a task.

But learning to listen to oneself is a lifelong process.

Instead of searching for quick fixes, she said, young adults should think about longer-term goals: starting therapy that stretches beyond a handful of sessions, building healthy nutrition and exercise habits, working toward self-reliance.

“I know that seems sort of absurdly large and huge in scope,” she said. “But it’s allowing ourselves to meander and move through life, versus just ‘Check the boxes and get it right.’”

take stock of your day-to-day life and notice where things are missing. She groups quarterlifers into two categories: “stability types” and “meaning types.”

“Stability types” are seen by others as solid and stable. They prioritize a sense of security, succeed in their careers and may pursue building a family.

“But there’s a sense of emptiness and a sense of faking it,” she said. “They think this couldn’t possibly be all that life is about.”

On the other end of the spectrum, there are “meaning types” who are typically artists; they have intense creative passions but have a hard time dealing with day-to-day tasks

“These are folks for whom doing what society expects of you is so overwhelming and so discordant with their own sense of self that they seem to constantly be floundering,” she said. “They can’t quite figure it out.”

That paralysis is often exacerbated by mounting climate anxiety and the slog of a multiyear pandemic that has left many young people mourning family and friends, or smaller losses like a conventional college experience or the traditions of starting a first job.

Stability types need to think about how to give their lives a sense of passion and purpose. And meaning types need to find security, perhaps by starting with a consistent routine that can both anchor and unlock creativity.

perhaps the prototypical inspiration for staying calm in chaos: Yoda. The Jedi master is “one of the few images we have of what feeling quiet amid extreme pain and apocalypse can look like,

Even when there seems to be little stability externally, she said, quarterlifers can try to create their own steadiness.

establishing habits that help you ground yourself as a young adult is critical because transitional periods make us more susceptible to burnout

He suggests building a practical tool kit of self-care practices, like regularly taking stock of what you’re grateful for, taking controlled breaths and maintaining healthy nutrition and exercise routines. “These are techniques that can help you find clarity,”

Don’t be afraid to make a big change.

It’s important to identify what aspects of your life you have the power to alter, Dr. Brown said. “You can’t change an annoying boss,” he said, “but you might be able to plan a career change.”

That’s easier said than done, he acknowledged, and young adults should weigh the risks of continuing to live in their status quo — staying in their hometown, or lingering in a career that doesn’t excite them — with the potential benefits of trying something new.

quarterlife is typically “the freest stage of the whole life span,

Young adults may have an easier time moving to a new city or starting a new job than their older counterparts would.

Know when to call your parents — and when to call on yourself.

Quarterlife is about the journey from dependence to independence, Ms. Byock said — learning to rely on ourselves, after, for some, growing up in a culture of helicopter parenting and hands-on family dynamics.

there are ways your relationship with your parents can evolve, helping you carve out more independence

That can involve talking about family history and past memories or asking questions about your parents’ upbringing

“You’re transitioning the relationship from one of hierarchy to one of friendship,” she said. “It isn’t just about moving away or getting physical distance.”

Every quarterlifer typically has a moment when they know they need to step away from their parents and to face obstacles on their own

That doesn’t mean you can’t, or shouldn’t, still depend on your parents in moments of crisis, she said. “I don’t think it’s just about never needing one’s parents again,” she said. “But it’s about doing the subtle work within oneself to know: This is a time I need to stand on my own.”

The corporate gig, as a social media director for a tech platform, was a revelation. “I could just show up to work and do work,” Ms. Tilghman said. After she was done, she could leave. She didn’t have to be a brand. There’s no comments section at an office job.

In 2019, a Morning Consult report found that 54 percent of Gen Z and millennial Americans were interested in becoming influencers. (Eighty-six percent said they would be willing to post sponsored content for money.)

If social media has made audiences anxious, it’s driving creators to the brink. In 2021, the TikTok breakout star Charli D’Amelio said she had “lost the passion” for posting videos. A few months later, Erin Kern announced to her 600,000 Instagram followers that she would be deactivating her account @cottonstem; she had been losing her hair, and her doctors blamed work-induced stress

Other influencers faded without fanfare — teens whose mental health had taken too much of a hit and amateur influencers who stopped posting after an algorithm tweak tanked their metrics. Some had been at this for a decade or more, starting at 12 or 14 or 19.

She posted less, testing out new identities that she hoped wouldn’t touch off the same spiral that wellness had. There were dancing videos, dog photos, interior design. None of it stuck. (“You can change the niche, but you’re still going to be performing your life for content,” she explained over lunch.)

Ms. Tilghman’s problem — as the interest in the workshop, which she decided to cap at 15, demonstrated — is that she has an undeniable knack for this. In 2022, she started a Substack to continue writing, thinking of it as a calling card while she applied to editorial jobs; it soon amassed 20,000 subscribers. It once had a different name, but now it’s called “Offline Time.” The paid tier costs $5 a month.

Casey Lewis, who helms the After School newsletter about Gen Z consumer trends, predicts more pivots and exits. TikTok has elevated creators faster than other platforms and burned them out quicker, she said.

Ms. Lewis expects a swell of former influencers taking jobs with P.R. agencies, marketing firms and product development conglomerates. She pointed out that creators have experience not just in video and photo editing, but in image management, crisis communication and rapid response. “Those skills do transfer,” she said.

Understanding how empathy can immobilize us like that is a critical step for helping others — and ourselves.

Early researchers labeled it compassion fatigue and described it as the cost of caring.

Having concluded that nothing they do will make a difference, they start to become indifferent.

The symptoms of empathic distress were originally diagnosed in health care, with nurses and doctors who appeared to become insensitive to the pain of their patients.

Empathic distress explains why many people have checked out in the wake of these tragedies

when two neuroscientists, Olga Klimecki and Tania Singer, reviewed the evidence, they discovered that “compassion fatigue” is a misnomer. Caring itself is not costly. What drains people is not merely witnessing others’ pain but feeling incapable of alleviating it.

In times of sustained anguish, empathy is a recipe for more distress, and in some cases even depression. What we need instead is compassion.

empathy and compassion aren’t the same. Empathy absorbs others’ emotions as your own: “I’m hurting for you.”

Compassion focuses your action on their emotions: “I see that you’re hurting, and I’m here for you.”

“Empathy is biased,” the psychologist Paul Bloom writes. It’s something we usually reserve for our own group, and in that sense, it can even be “a powerful force for war and atrocity.”

Dr. Singer and their colleagues trained people to empathize by trying to feel other people’s pain. When the participants saw someone suffering, it activated a neural network that would light up if they themselves were in pain. It hurt. And when people can’t help, they escape the pain by withdrawing.