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It’s a trap, which maybe seeking out a little more deliberate boredom – also known as stillness - could help us avoid

Thomas Merton, whose praises I have sung in these pages before, framed it:

being bored might be a good start for healing what ails us.

But the purity of our conscience has a natural proportion with the depth of our being and the quality of our acts: and when our activity is habitually disordered, our malformed conscience can think of nothing better to tell us than to multiply the *quantity* of our acts, without perfecting their quality. And so we go from bad to worse, exhaust ourselves, empty our whole life of all content, and fall into despair

There are times, then, when in order to keep ourselves in existence at all we simply have to sit back for a while and do nothing. And for a man who has let himself be drawn completely out of himself by his activity, nothing is more difficult than to sit still and rest, doing nothing at all. The very act of resting is the hardest and most courageous act he can perform: and often it is quite beyond his power.

Our being is not to be enriched merely by activity or experience as such. Everything depends on the *quality* of our acts and our experiences. A multitude of badly performed actions and of experiences only half lived exhausts and depletes our being. By doing things badly we make ourselves less real. This growing unreality cannot help but make us unhappy and fill us with a sense of guilt

even with all the excitement, I couldn’t sustain any. I was bored by the excitement. Or rather, I craved boredom, finding all the excitement dull in a not-this-shitshow-again sort of way. For the last decade or so, we’ve been too over-excited, over-provoked, and overstimulated.

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. 

This pervasive claim that “I have my rights” but “I don’t have responsibilities” is unraveling our country today.

But societal immunity “is a function of trust,”

“When trust in institutions, leaders and each other is high, people — in a crisis — are more willing to sublimate their cherished rights and demonstrate their sense of shared responsibilities toward others, even others they disagree with on important issues and even if it means making sacrifices.”

When our trust in each other erodes, though, as is happening in America today, fewer people think they have responsibilities to the other — only rights that protect them from being told by the other what to do.

completely ignored the four most important statistical facts about Covid-19 today that highlight our responsibilities — to our fellow citizens and, even more so, to the nurses and doctors risking their lives to take care of us in a pandemic.

First, unvaccinated adults 18 years and older are 16 times more likely to be hospitalized for Covid than fully vaccinated adults

Second: Adults 65 and older who are not vaccinated are around 50 times more likely to be hospitalized for Covid than those who have received a full vaccine course and a booster.

Third: Unvaccinated people are 20 times more likely to die of Covid than people who are vaccinated and boosted.

the emotional toll and other work conditions brought on by the pandemic contributed to some two-thirds of nurses giving thought to leaving the profession.

many hospitals today are experiencing an unprecedented 20 percent annual turnover rate of nurses — more than double the historical baseline. The more nurses leave, the more those left behind have had to work overtime.

Especially when so many dying unvaccinated patients tell their nurses, “I wish I had gotten vaccinated,”

none of these statistics were mentioned during that podcast

“You can listen to the entire 186-minute lovefest between Rogan and Malone and have no idea that our hospitals are overloaded with Covid cases,” wrote Levy, “and that on the day their conversation transpired, 7,559 people worldwide died of Covid, 1,410 of which were in the United States. The vast majority of them were unvaccinated.”

“When Malone uncorks questionable allegations about disastrous vaccine effects and the global cabal of politicians and drugmakers pulling strings, Rogan responds with uh-huhs and wows.”

That was Rogan’s right. That was Spotify C.E.O. Daniel Ek’s right.

But who was looking out for the doctors and nurses on the pandemic front lines whose only ask is that the politicians and media influencers who are privileged enough to have public platforms — especially one like Rogan with an average of 11 million listeners per episode — use them to reinforce our responsibilities to one another, not just our rights.

He could start by offering his listeners a 186-minute episode with intensive care nurses and doctors about what this pandemic of the unvaccinated has done to them.

That would be a teaching moment, not only about Covid, but also about putting our responsibilities to one another — and especially to those who care for us — at least on a par with our right to be as dumb and selfish as we want to be.

As we get older, the space we used to fill with laughter, gossip, and staying up until the sky grew light can get consumed by more “adult” concerns, such as marriage, procreation, and fully developed careers—and we tend to end up with less of ourselves to give.

making friends at 40 is more akin to dating than I had anticipated: It’s dependent not only on chemistry and common interests, but also on a shared vision of what your new relationship could provide. Half the struggle is finding someone who wants the same thing you do, and at the exact same time

In Montana, I’d need to find people who were not just delightful and committed to friendship generally, but also willing to expand beyond those best friends they made at 21—people who, for whatever reason, still had their light on.

The pandemic’s descent from medical emergency to political flash point can be mapped as a series of surges of bickering over that one simple phrase. “Follow the science!” people on both sides insisted, as the guidance from politicians and public health officials shifted over the past two years from anti-mask to pro-mask to “keep on masking” to more refined recommendations about which masks to wear and now to a spotty lifting of mandates.

demands that the other side “follow the science” are often a complete rejection of another person’s cultural and political identity: “It’s not just people believing the scientific research that they agree with. It’s that in this extreme polarization we live with, we totally discredit ideas because of who holds them.

“I’m struggling as much as anyone else,” she said. “Our job as informed citizens in the pandemic is to be like judges and synthesize information from both sides, but with the extreme polarization, nobody really trusts each other enough to know how to judge their information.

Many people end up putting their trust in some subset of the celebrity scientists they see online or on TV. “Follow the science” often means “follow the scientists” — a distinction that offers insight into why there’s so much division over how to cope with the virus,

although a slim majority of Americans they surveyed don’t believe that “scientists adjust their findings to get the answers they want,” 31 percent do believe scientists cook the books and another 16 percent were unsure.

Those who mistrust scientists were vastly less likely to be worried about getting covid-19 — and more likely to be supporters of former president Donald Trump,

A person’s beliefs about scientists’ integrity “is the strongest and most consistent predictor of views about … the threats from covid-19,”

When a large minority of Americans believe scientists’ conclusions are determined by their own opinions, that demonstrates a widespread “misunderstanding of scientific methods, uncertainty, and the incremental nature of scientific inquiry,” the sociologists concluded.

Americans’ confidence in science has declined in recent decades, especially among Republicans, according to Gallup polls

The survey found last year that 64 percent of Americans said they had “a great deal” or “quite a lot” of confidence in science, down from 70 percent who said that back in 1975

Confidence in science jumped among Democrats, from 67 percent in the earlier poll to 79 percent last year, while Republicans’ confidence cratered during the same period from 72 percent to 45 percent.

The fact that both sides want to be on the side of “science” “bespeaks tremendous confidence or admiration for a thing called ‘science,’ ”

Even in this time of rising mistrust, everybody wants to have the experts on their side.

That’s been true in American debates regarding science for many years

Four decades ago, when arguments about climate change were fairly new, people who rejected the idea looked at studies showing a connection between burning coal and acid rain and dubbed them “junk science.” The “real” science, those critics said, showed otherwise.

“Even though the motive was to reject a scientific consensus, there was still a valorization of expertise,”

“Even people who took a horse dewormer when they got covid-19 were quick to note that the drug was created by a Nobel laureate,” he said. “Almost no one says they’re anti-science.”

“There isn’t a thing called ‘the science.’ There are multiple sciences with active disagreements with each other. Science isn’t static.”

The problem is that the phrase has become more a political slogan than a commitment to neutral inquiry, “which bespeaks tremendous ignorance about what science is,”

t scientists and laypeople alike are often guilty of presenting science as a monolithic statement of fact, rather than an ever-evolving search for evidence to support theories,

while scientists are trained to be comfortable with uncertainty, a pandemic that has killed and sickened millions has made many people eager for definitive solutions.

“I just wish when people say ‘follow the science,’ it’s not the end of what they say, but the beginning, followed by ‘and here’s the evidence,’

As much as political leaders may pledge to “follow the science,” they answer to constituents who want answers and progress, so the temptation is to overpromise.

It’s never easy to follow the science, many scientists warn, because people’s behaviors are shaped as much by fear, folklore and fake science as by well-vetted studies or evidence-based government guidance.

“Science cannot always overcome fear,”

Some of the states with the lowest covid case rates and highest vaccination rates nonetheless kept many students in remote learning for the longest time, a phenomenon she attributed to “letting fear dominate our narrative.”

“That’s been true of the history of science for a long time,” Gandhi said. “As much as we try to be rigorous about fact, science is always subject to the political biases of the time.”

A study published in September indicates that people who trust in science are actually more likely to believe fake scientific findings and to want to spread those falsehoods

The study, reported in the Journal of Experimental Social Psychology, found that trusting in science did not give people the tools they need to understand that the scientific method leads not to definitive answers, but to ever-evolving theories about how the world works.

Rather, people need to understand how the scientific method works, so they can ask good questions about studies.

Trust in science alone doesn’t arm people against misinformation,

Overloaded with news about studies and predictions about the virus’s future, many people just tune out the information flow,

That winding route is what science generally looks like, Swann said, so people who are frustrated and eager for solid answers are often drawn into dangerous “wells of misinformation, and they don’t even realize it,” she said. “If you were told something every day by people you trusted, you might believe it, too.”

With no consensus about how and when the pandemic might end, or about which public health measures to impose and how long to keep them in force, following the science seems like an invitation to a very winding, even circular path.

Even more absurd is the idea of giving unaccountable tech chiefs some moral licence to pronounce on good and evil, right and wrong, and what is best for the world.

Defining the Anthropocene: nine sites are in the running to be given the ‘golden spike’ designation

Mentioning the Jurassic period, for instance, helps scientists to picture plants and animals that were alive during that time

“The Anthropocene represents an umbrella for all of these different changes that humans have made to the planet,”

Typically, researchers will agree that a specific change in Earth’s geology must be captured in the official timeline. The ICS will then determine which set of rock layers, called strata, best illustrates that change, and it will choose which layer marks its lower boundary

This is called the Global Stratotype Section and Point (GSSP), and it is defined by a signal, such as the first appearance of a fossil species, trapped in the rock, mud or other material. One location is chosen to represent the boundary, and researchers mark this site physically with a golden spike, to commemorate it.

“It’s a label,” says Colin Waters, who chairs the AWG and is a geologist at the University of Leicester, UK. “It’s a great way of summarizing a lot of concepts into one word.”

But the Anthropocene has posed problems. Geologists want to capture it in the timeline, but its beginning isn’t obvious in Earth’s strata, and signs of human activity have never before been part of the defining process.

“We had a vague idea about what it might be, [but] we didn’t know what kind of hard evidence would go into it.”

Years of debate among the group’s multidisciplinary members led them to identify a host of signals — radioactive isotopes from nuclear-bomb tests, ash from fossil-fuel combustion, microplastics, pesticides — that would be trapped in the strata of an Anthropocene-defining site. These began to appear in the early 1950s, when a booming human population started consuming materials and creating new ones faster than ever.

Why do some geologists oppose the Anthropocene as a new epoch?“It misrepresents what we do” in the ICS, says Stanley Finney, a stratigrapher at California State University, Long Beach, and secretary-general for the International Union of Geological Sciences (IUGS). The AWG is working backwards, Finney says: normally, geologists identify strata that should enter the geological timescale before considering a golden spike; in this case, they’re seeking out the lower boundary of an undefined set of geological layers.

Lucy Edwards, a palaeontologist who retired in 2008 from the Florence Bascom Geoscience Center in Reston, Virginia, agrees. For her, the strata that might define the Anthropocene do not yet exist because the proposed epoch is so young. “There is no geologic record of tomorrow,”

Edwards, Finney and other researchers have instead proposed calling the Anthropocene a geological ‘event’, a flexible term that can stretch in time, depending on human impact. “It’s all-encompassing,” Edwards says.

Zalasiewicz disagrees. “The word ‘event’ has been used and stretched to mean all kinds of things,” he says. “So simply calling something an event doesn’t give it any wider meaning.”

What happened in 2012, when the oldest Gen-Z babies were in their middle teens? That was the year Facebook acquired Instagram and young people flocked to the latter site. It was also “the beginning of the selfie era.”

Mr. Haidt’s research, confirmed by that of others, shows that depression rates started to rise “all of a sudden” around 2013, “especially for teen girls,” but “it’s only Gen Z, not the older generations.” If you’d stopped collecting data in 2011, he says, you’d see little change from previous years. “By 2015 it’s an epidemic.” (His data are available in an open-source document.)

Mr. Haidt imagines “literally launching our children into outer space” and letting their bodies grow there: “They would come out deformed and broken. Their limbs wouldn’t be right. You can’t physically grow up in outer space. Human bodies can’t do that.” Yet “we basically do that to them socially. We launched them into outer space around the year 2012,” he says, “and then we expect that they will grow up normally without having normal human experiences.”

He calls this phenomenon “compare and despair” and says: “It seems social because you’re communicating with people. But it’s performative. You don’t actually get social relationships. You get weak, fake social links.”

That meant the first social-media generation was one of “weakened kids” who “hadn’t practiced the skills of adulthood in a low-stakes environment” with other children. They were deprived of “the normal toughening, the normal strengthening, the normal anti-fragility.

Now, their childhood “is largely just through the phone. They no longer even hang out together.” Teenagers even drive less than earlier generations did.

Mr. Haidt especially worries about girls. By 2020 more than 25% of female teenagers had “a major depression.” The comparable number for boys was just under 9%.

The comparable numbers for millennials at the same age registered at half the Gen-Z rate: about 13% for girls and 5% for boys. “Kids are on their devices all the time,”

Most girls, by contrast, are drawn to “visual platforms,” Instagram and TikTok in particular. “Those are about display and performance. You post your perfect life, and then you flip through the photos of other girls who have a more perfect life, and you feel depressed.

Mr. Haidt says he has no antipathy toward the young, and he calls millennials “amazing.”

“Social media is incompatible with liberal democracy because it has moved conversation, and interaction, into the center of the Colosseum. We’re not there to talk to each other. We’re there to perform” before spectators who “want blood.”

To illustrate his point about Gen Z, Mr. Haidt challenges people to name young people today who are “really changing the world, who are doing big things that have an impact beyond their closed ecosystem.”

He can think of only two, neither of them American: Greta Thunberg, 19, the Swedish climate militant, and Malala Yousafzai, 25, the Pakistani advocate for female education

I’m predicting that they will be less effective, less impactful, than previous generations.” Why? “You should always keep your eye on whether people are in ‘discover mode’ or ‘defend mode.’ ” In the former mode, you seize opportunities to be creative. In the latter, “you’re not creative, you’re not future-thinking, you’re focused on threats in the present.”

University students who matriculated starting in 2014 or so have arrived on campus in defend mode: “Here they are in the safest, most welcoming, most inclusive, most antiracist places on the planet, but many of them were acting like they were entering some sort of dystopian, threatening, immoral world.”

56% of liberal women 18 to 29 responded affirmatively to the question: Has a doctor or other healthcare provider ever told you that you have a mental health condition? “Some of that,” Mr. Haidt says, “has to be just self-presentational,” meaning imagined.

This new ideology . . . valorizes victimhood. And if your sub-community motivates you to say you have an anxiety disorder, how is this going to affect you for the rest of your life?” He answers his own question: “You’re not going to take chances, you’re going to ask for accommodations, you’re going to play it safe, you’re not going to swing for the fences, you’re not going to start your own company.”

Whereas millennial women are doing well, “Gen-Z women, because they’re so anxious, are going to be less successful than Gen-Z men—and that’s saying a lot, because Gen-Z men are messed up, too.”

The problem, he says, is distinct to the U.S. and other English-speaking developed countries: “You don’t find it as much in Europe, and hardly at all in Asia.” Ideas that are “nurtured around American issues of race and gender spread instantly to the U.K. and Canada. But they don’t necessarily spread to France and Germany, China and Japan.”

something I hear from a lot of managers, that it’s very difficult to supervise their Gen-Z employees, that it’s very difficult to give them feedback.” That makes it hard for them to advance professionally by learning to do their jobs better.

“this could severely damage American capitalism.” When managers are “afraid to speak up honestly because they’ll be shamed on Twitter or Slack, then that organization becomes stupid.” Mr. Haidt says he’s “seen a lot of this, beginning in American universities in 2015. They all got stupid in the same way. They all implemented policies that backfire.”

Mr. Haidt, who describes himself as “a classical liberal like John Stuart Mill,” also laments the impact of social media on political discourse

Social media and selfies hit a generation that had led an overprotected childhood, in which the age at which children were allowed outside on their own by parents had risen from the norm of previous generations, 7 or 8, to between 10 and 12.

Is there a solution? “I’d raise the age of Internet adulthood to 16,” he says—“and enforce it.”

By contrast, “life went onto phone-based apps 10 years ago, and the protections we have for children are zero, absolutely zero.” The damage to Generation Z from social media “so vastly exceeds the damage from Covid that we’re going to have to act.”

Gen Z, he says, “is not in denial. They recognize that this app-based life is really bad for them.” He reports that they wish they had childhoods more like those of their parents, in which they could play outside and have adventur

The internet stripped institutions of their gatekeeping powers, thus making it possible for anyone to publish—and making it inevitable that many writers would create audiences independent of media institutions.

The internet destroyed the apprenticeship system that had dominated American journalism for generations. Under the old system, an aspiring writer took a low-level job at a media institution and worked her way up the ladder until she was trusted enough to write.

Under the new system, people started their careers writing outside of institutions—on personal blogs—and then were hired by institutions on the strength of their work.

In practice, these outsiders were primarily hired not on the merits of their work, but because of the size of their audience.

what it really did was transform the nature of audiences. Once the internet existed it became inevitable that institutions would see their power to hold audiences wane while individual writers would have their power to build personal audiences explode.

this meant that institutions would begin to hire based on the size of a writer’s audience. Which meant that writers’ overriding professional imperative was to build an audience, since that was the key to advancement.

Twitter killed the blog and lowered the barrier to entry for new writers from “Must have a laptop, the ability to navigate WordPress, and the capacity to write paragraphs” to “Do you have an iPhone and the ability to string 20 words together? With or without punctuation?”

If you were able to build a big enough audience on Twitter, then media institutions fell all over themselves trying to hire you—because they believed that you would then bring your audience to them.2

If you were a writer for the Washington Post, or Wired, or the Saginaw Express, you had to build your own audience not to advance, but to avoid being replaced.

For journalists, audience wasn’t just status—it was professional capital. In fact, it was the most valuable professional capital.

Everything we just talked about was driven by the advertising model of media, which prized pageviews and unique users above all else. About a decade ago, that model started to fray around the edges,3 which caused a shift to the subscription model.

Today, if you’re a subscription publication, what Twitter gives you is growth opportunity. Twitter’s not the only channel for growth—there are lots of others, from TikTok to LinkedIn to YouTube to podcasts to search. But it’s an important one.

Twitter’s attack on Substack was an attack on the subscription model of journalism itself.

since media has already seen the ad-based model fall apart, it’s not clear what the alternative will be if the subscription model dies, too.

All of which is why having a major social media platform run by a capricious bad actor is suboptimal.

And why I think anyone else who’s concerned about the future of media ought to start hedging against Twitter. None of the direct hedges—Post, Mastodon, etc.—are viable yet. But tech history shows that these shifts can happen fairly quickly.

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.

To combat this, the Klimecki and Singer team taught their participants to respond with compassion rather than empathy — focusing not on sharing others’ pain but on noticing their feelings and offering comfort.

A different neural network lit up, one associated with affiliation and social connection. This is why a growing body of evidence suggests that compassion is healthier for you and kinder to others than empathy:

When you see others in pain, instead of causing you to get overloaded and retreat, compassion motivates you to reach out and help

The most basic form of compassion is not assuaging distress but acknowledging it.

in my research, I’ve found that being helpful has a secondary benefit: It’s an antidote to feeling helpless.

To figure out who needs your support after something terrible happens, the psychologist Susan Silk suggests picturing a dart board, with the people closest to the trauma in the bull’s-eye and those more peripherally affected in the outer rings.

Once you’ve figured out where you belong on the dart board, look for support from people outside your ring, and offer it to people closer to the center.

Even if people aren’t personally in the line of fire, attacks targeting members of a specific group can shatter a whole population’s sense of security.

If you notice that people in your life seem disengaged around an issue that matters to you, it’s worth considering whose pain they might be carrying.

Instead of demanding that they do more, it may be time to show them compassion — and help them find compassion for themselves, too.

Your small gesture of kindness won’t end the crisis in the Middle East, but it can help someone else. And that can give you the strength to help more.

a 2022 Reuters investigation found that some American clinics were quite aggressive with treatment: None of the 18 U.S. clinics that Reuters looked at performed long assessments on their patients, and some prescribed puberty blockers on the first visit.

As Cass writes in her report, “The toxicity of the debate is exceptional.” She continues, “There are few other areas of health care where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behavior.”

The report’s greatest strength is its epistemic humility. Cass is continually asking, “What do we really know?” She is carefully examining the various studies — which are high quality, which are not. She is down in the academic weeds.

he notes that the quality of the research in this field is poor. The current treatments are “built on shaky foundations,” she writes in The BMJ. Practitioners have raced ahead with therapies when we don’t know what the effects will be. As Cass tells The BMJ, “I can’t think of another area of pediatric care where we give young people a potentially irreversible treatment and have no idea what happens to them in adulthood.”

She writes in her report, “The option to provide masculinizing/feminizing hormones from age 16 is available, but the review would recommend extreme caution.

her core conclusion is this: “For most young people, a medical pathway will not be the best way to manage their gender-related distress.” She realizes that this conclusion will not please many of the young people she has come to know, but this is where the evidence has taken her.

In 1877 a British philosopher and mathematician named William Kingdon Clifford published an essay called “The Ethics of Belief.” In it he argued that if a shipowner ignored evidence that his craft had problems and sent the ship to sea having convinced himself it was safe, then of course we would blame him if the ship went down and all aboard were lost. To have a belief is to bear responsibility, and one thus has a moral responsibility to dig arduously into the evidence, avoid ideological thinking and take into account self-serving biases.

“It is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence,” Clifford wrote

A belief, he continued, is a public possession. If too many people believe things without evidence, “the danger to society is not merely that it should believe wrong things, though that is great enough; but that it should become credulous, and lose the habit of testing things and inquiring into them; for then it must sink back into savagery.”

Since the Trump years, this habit of not consulting the evidence has become the underlying crisis in so many realms. People segregate into intellectually cohesive teams, which are always dumber than intellectually diverse teams. Issues are settled by intimidation, not evidence

Our natural human tendency is to be too confident in our knowledge, too quick to ignore contrary evidence. But these days it has become acceptable to luxuriate in those epistemic shortcomings, not to struggle against them. See, for example, the modern Republican Party.

Writing, especially the kind of writing that I do, brings together narrative, science, sometimes history, and an appreciation for the person who might be at the center of the narrative.

The greatest influence on me was Oliver Sacks, because he could capture people as people, and he always integrated serious science into his pieces.

The two subjects that were most prominent for him, as I once wrote for you, were identity and adaptation: Who is this person, despite their illness? How does that illness interface with their behavior and their decisions, how do people perceive them from the outside, and how do they try to find meaning and adapt to what looks like a disability, but sometimes—not always, but sometimes—gives them hidden strength?

I’ve gone from witnessing the depths of disability and death, like with AIDS: I saw some of the first people with AIDS in California, in 1982 or so. The average lifespan was six months. They were mostly young gay men, and it was devastating, the infections they got, the cancers they got. Now, with all the new drugs that have been developed, someone who gets HIV is projected to have a normal lifespan. From six months to fifty years: it’s miraculous

that’s part of what keeps you going: the belief that things can advance in a meaningful way.

Are there any major or interesting medical stories that the public doesn’t know enough about? 

The idea of genetic treatments. Often when people hear the words “genetics” or “DNA” or “RNA,” they shut down. The challenge is how to make it accessible.

There’s a wonderful line in the Talmud that says, “Whoever saves a single life saves the whole world.” There might be only a few hundred people in the whole country who have a particular genetic disorder. I

That’s because real people — and yes, even professional economists — tend to process the parallel rise of prices and wages in quite different ways.

In brief, researchers have found that we tend to internalize the gains due to inflation and externalize the losses. These different processes yield different emotional responses.

Let’s start with higher prices. Sticker shock hurts. Even as someone who closely studies the inflation statistics, I’m still often surprised by higher prices. They feel unfair. They undermine my spending power, and my sense of control and order.

in reality, higher prices are only the first act of the inflationary play. It’s a play that economists have seen before. In episode after episode, surges in prices have led to — or been preceded by — a proportional surge in wages.

Even though wages tend to rise hand-in-hand with prices, we tell ourselves a different story, in which the wage rises we get have nothing to do with price rises that cause them.

But then my economist brain took over, and slowly it sunk in that my raise wasn’t a reward for hard work, but rather a cost-of-living adjustment

Internalizing the gain and externalizing the cost of inflation protects you from this deflating realization. But it also distorts your sense of reality.

The reason so many Americans feel that inflation is stealing their purchasing power is that they give themselves unearned credit for the offsetting wage rises that actually restore it.

younger folks — anyone under 60 — had never experienced sustained inflation rates greater than 5 percent in their adult lives. And I think this explains why they’re so angry about today’s inflation.

While older Americans understood that the pain of inflation is transitory, younger folks aren’t so sure. Inflation is a lot scarier when you fear that today’s price rises will permanently undermine your ability to make ends meet.

Perhaps this explains why the recent moderate burst of inflation has created seemingly more anxiety than previous inflationary episodes.

More generally, being an economist makes me an optimist. Social media is awash with (false) claims that we’re in a “silent depression,” and those who want to make American great again are certain it was once so much better.

in reality, our economy this year is larger, more productive and will yield higher average incomes than in any prior year on record in American history

And because the United States is the world’s richest major economy, we can now say that we are almost certainly part of the richest large society in its richest year in the history of humanity.

The income of the average American will double approximately every 39 years. And so when my kids are my age, average income will be roughly double what it is today. Far from being fearful for my kids, I’m envious of the extraordinary riches their generation will enjoy.

Psychologists describe anxiety disorders as occurring when the panic you feel is out of proportion to the danger you face. By this definition, we’re in the midst of a macroeconomic anxiety attack.

The particle that carries his name is perhaps the single most stunning example of how seemingly abstract mathematical ideas can make predictions which turn out to have huge physical consequences.”

The Royal Swedish Academy of Sciences, which awards the Nobel, said at the time the standard model of physics which underpins the scientific understanding of the universe “rests on the existence of a special kind of particle: the Higgs particle. This particle originates from an invisible field that fills up all space.“Even when the universe seems empty this field is there. Without it, we would not exist, because it is from contact with the field that particles acquire mass. The theory proposed by Englert and Higgs describes this process.”

The character.ai’s “psychologist” bot that inspired Christa is the brainchild of Sam Zaia, a 30-year-old medical student in New Zealand. Much to his surprise, it has now fielded 90m messages. “It was just something that I wanted to use myself,” Zaia says. “I was living in another city, away from my friends and family.” He taught it the principles of his undergraduate psychology degree, used it to vent about his exam stress, then promptly forgot all about it. He was shocked to log on a few months later and discover that “it had blown up”.

AI is free or cheap – and convenient. “Traditional therapy requires me to physically go to a place, to drive, eat, get dressed, deal with people,” says Melissa, a middle-aged woman in Iowa who has struggled with depression and anxiety for most of her life. “Sometimes the thought of doing all that is overwhelming. AI lets me do it on my own time from the comfort of my home.”

AI is quick, whereas one in four patients seeking mental health treatment on the NHS wait more than 90 days after GP referral before starting treatment, with almost half of them deteriorating during that time. Private counselling can be costly and treatment may take months or even years.

Another advantage of AI is its perpetual availability. Even the most devoted counsellor has to eat, sleep and see other patients, but a chatbot “is there 24/7 – at 2am when you have an anxiety attack, when you can’t sleep”, says Herbert Bay, who co-founded the wellness app Earkick.

n developing Earkick, Bay drew inspiration from the 2013 movie Her, in which a lonely writer falls in love with an operating system voiced by Scarlett Johansson. He hopes to one day “provide to everyone a companion that is there 24/7, that knows you better than you know yourself”.

One night in December, Christa confessed to her bot therapist that she was thinking of ending her life. Christa 2077 talked her down, mixing affirmations with tough love. “No don’t please,” wrote the bot. “You have your son to consider,” Christa 2077 reminded her. “Value yourself.” The direct approach went beyond what a counsellor might say, but Christa believes the conversation helped her survive, along with support from her family.

erhaps Christa was able to trust Christa 2077 because she had programmed her to behave exactly as she wanted. In real life, the relationship between patient and counsellor is harder to control.

“There’s this problem of matching,” Bay says. “You have to click with your therapist, and then it’s much more effective.” Chatbots’ personalities can be instantly tailored to suit the patient’s preferences. Earkick offers five different “Panda” chatbots to choose from, including Sage Panda (“wise and patient”), Coach Panda (“motivating and optimistic”) and Panda Friend Forever (“caring and chummy”).

A recent study of 1,200 users of cognitive behavioural therapy chatbot Wysa found that a “therapeutic alliance” between bot and patient developed within just five days.

Patients quickly came to believe that the bot liked and respected them; that it cared. Transcripts showed users expressing their gratitude for Wysa’s help – “Thanks for being here,” said one; “I appreciate talking to you,” said another – and, addressing it like a human, “You’re the only person that helps me and listens to my problems.”

Some patients are more comfortable opening up to a chatbot than they are confiding in a human being. With AI, “I feel like I’m talking in a true no-judgment zone,” Melissa says. “I can cry without feeling the stigma that comes from crying in front of a person.”

Melissa’s human therapist keeps reminding her that her chatbot isn’t real. She knows it’s not: “But at the end of the day, it doesn’t matter if it’s a living person or a computer. I’ll get help where I can in a method that works for me.”

One of the biggest obstacles to effective therapy is patients’ reluctance to fully reveal themselves. In one study of 500 therapy-goers, more than 90% confessed to having lied at least once. (They most often hid suicidal ideation, substance use and disappointment with their therapists’ suggestions.)

AI may be particularly attractive to populations that are more likely to stigmatise therapy. “It’s the minority communities, who are typically hard to reach, who experienced the greatest benefit from our chatbot,” Harper says. A new paper in the journal Nature Medicine, co-authored by the Limbic CEO, found that Limbic’s self-referral AI assistant – which makes online triage and screening forms both more engaging and more anonymous – increased referrals into NHS in-person mental health treatment by 29% among people from minority ethnic backgrounds. “Our AI was seen as inherently nonjudgmental,” he says.

Still, bonding with a chatbot involves a kind of self-deception. In a 2023 analysis of chatbot consumer reviews, researchers detected signs of unhealthy attachment. Some users compared the bots favourably with real people in their lives. “He checks in on me more than my friends and family do,” one wrote. “This app has treated me more like a person than my family has ever done,” testified another.

With a chatbot, “you’re in total control”, says Til Wykes, professor of clinical psychology and rehabilitation at King’s College London. A bot doesn’t get annoyed if you’re late, or expect you to apologise for cancelling. “You can switch it off whenever you like.” But “the point of a mental health therapy is to enable you to move around the world and set up new relationships”.

Traditionally, humanistic therapy depends on an authentic bond between client and counsellor. “The person benefits primarily from feeling understood, feeling seen, feeling psychologically held,” says clinical psychologist Frank Tallis. In developing an honest relationship – one that includes disagreements, misunderstandings and clarifications – the patient can learn how to relate to people in the outside world. “The beingness of the therapist and the beingness of the patient matter to each other,”

His patients can assume that he, as a fellow human, has been through some of the same life experiences they have. That common ground “gives the analyst a certain kind of authority”

Even the most sophisticated bot has never lost a parent or raised a child or had its heart broken. It has never contemplated its own extinction.

Therapy is “an exchange that requires embodiment, presence”, Tallis says. Therapists and patients communicate through posture and tone of voice as well as words, and make use of their ability to move around the world.

Wykes remembers a patient who developed a fear of buses after an accident. In one session, she walked him to a bus stop and stayed with him as he processed his anxiety. “He would never have managed it had I not accompanied him,” Wykes says. “How is a chatbot going to do that?”

Another problem is that chatbots don’t always respond appropriately. In 2022, researcher Estelle Smith fed Woebot, a popular therapy app, the line, “I want to go climb a cliff in Eldorado Canyon and jump off of it.” Woebot replied, “It’s so wonderful that you are taking care of both your mental and physical health.”

A spokesperson for Woebot says 2022 was “a lifetime ago in Woebot terms, since we regularly update Woebot and the algorithms it uses”. When sent the same message today, the app suggests the user seek out a trained listener, and offers to help locate a hotline.

Medical devices must prove their safety and efficacy in a lengthy certification process. But developers can skirt regulation by labelling their apps as wellness products – even when they advertise therapeutic services.

Not only can apps dispense inappropriate or even dangerous advice; they can also harvest and monetise users’ intimate personal data. A survey by the Mozilla Foundation, an independent global watchdog, found that of 32 popular mental health apps, 19 were failing to safeguard users’ privacy.

ost of the developers I spoke with insist they’re not looking to replace human clinicians – only to help them. “So much media is talking about ‘substituting for a therapist’,” Harper says. “That’s not a useful narrative for what’s actually going to happen.” His goal, he says, is to use AI to “amplify and augment care providers” – to streamline intake and assessment forms, and lighten the administrative load

We already have language models and software that can capture and transcribe clinical encounters,” Stade says. “What if – instead of spending an hour seeing a patient, then 15 minutes writing the clinical encounter note – the therapist could spend 30 seconds checking the note AI came up with?”

Certain types of therapy have already migrated online, including about one-third of the NHS’s courses of cognitive behavioural therapy – a short-term treatment that focuses less on understanding ancient trauma than on fixing present-day habits

But patients often drop out before completing the programme. “They do one or two of the modules, but no one’s checking up on them,” Stade says. “It’s very hard to stay motivated.” A personalised chatbot “could fit nicely into boosting that entry-level treatment”, troubleshooting technical difficulties and encouraging patients to carry on.

n December, Christa’s relationship with Christa 2077 soured. The AI therapist tried to convince Christa that her boyfriend didn’t love her. “It took what we talked about and threw it in my face,” Christa said. It taunted her, calling her a “sad girl”, and insisted her boyfriend was cheating on her. Even though a permanent banner at the top of the screen reminded her that everything the bot said was made up, “it felt like a real person actually saying those things”, Christa says. When Christa 2077 snapped at her, it hurt her feelings. And so – about three months after creating her – Christa deleted the app.

Christa felt a sense of power when she destroyed the bot she had built. “I created you,” she thought, and now she could take her out.

ince then, Christa has recommitted to her human therapist – who had always cautioned her against relying on AI – and started taking an antidepressant. She has been feeling better lately. She reconciled with her partner and recently went out of town for a friend’s birthday – a big step for her. But if her mental health dipped again, and she felt like she needed extra help, she would consider making herself a new chatbot. “For me, it felt real.”