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Over the subsequent four decades, Thatcherites at think tanks like the Institute of Economic Affairs and the Centre for Policy Studies (which Margaret Thatcher helped set up) described the struggle against both the Labour Party and the broader persistence of Socialism in the Communist and non-Communist world as a “war of ideas.”

Thatcherites, known collectively as the ultras, gained fresh blood in the 2010s as a group of Gen Xers too young to experience Thatcherism in its insurgent early years — including the former home secretary Priti Patel, the former foreign secretary Dominic Raab, the former minister of state for universities Chris Skidmore, Mr. Kwarteng and Ms. Truss — attempted to reboot her ideology for the new millennium.

They followed their idol not only in her antagonism to organized labor but also in her less-known fascination with Asian capitalism. In 2012’s “Britannia Unchained,” a book co-written by the group that remains a Rosetta Stone for the policy surprises of the last month, they slammed the Britons for their eroded work ethic and “culture of excuses” and the “cosseted” public sector unions. They praised China, South Korea, Singapore and Hong Kon

“Britannia Unchained” expressed a desire to go back to the future by restoring Victorian values of hard work, self-improvement and bootstrapping.

While the Gen X Thatcherites didn’t scrimp on data, they also saw something ineffable at the root of British malaise. “Beyond the statistics and economic theories,” they wrote, “there remains a sense in which many of Britain’s problems lie in the sphere of cultural values and mind-set.”

As Thatcher herself put it, “Economics are the method; the object is to change the heart and soul.” Britain needed a leap of faith to restore itself.

Ms. Truss and Mr. Kwarteng seemed to have believed that by patching together all of the most radical policies of Thatcherism (while conveniently dropping the need for spending cuts), they would be incanting a kind of magic spell, an “Open sesame” for “global Britain.” This was their Reagan moment, their moment when, as their favorite metaphors put it, a primordial repressed force would be “unchained,” “unleashed” or “unshackled.”But as a leap of faith, it broke the diver’s neck.

the money markets were not waiting for an act of faith in Laffer Curve fundamentalism after all. This was “Reaganism without the dollar.” Without the confidence afforded to the global reserve currency, the pound went into free fall.

ince the 1970s, the world of think tanks had embraced a framing of the world in terms of discrete spaces that could become what they called laboratories for new policies

The mini-budget subjected the entire economy to experimental treatment. This was put in explicit terms in a celebratory post by a Tory journalist and think tanker claiming that Ms. Truss and Mr. Kwarteng had been “incubated” by the Institute of Economic Affairs in their early years and “Britain is now their laboratory.”

The scientists at the bench discovered that the money markets would not only punish left-wing experiments in changing the balance between states and markets, but they were also sensitive to experiments that pushed too far to the right. A cowed Ms. Truss apologized, and Mr. Kwarteng’s successor has reversed almost all of the planned cuts and limited the term for energy supports.

If you didn’t study Jane Austen while you were here, you probably lack the capacity to think clearly about making a marriage decision. If you didn’t read George Eliot, then you missed a master class on how to judge people’s character. If you didn’t read Nietzsche, you are probably unprepared to handle the complexities of atheism—and if you didn’t read Augustine and Kierkegaard, you’re probably unprepared to handle the complexities of faith.

The list goes on. If you didn’t read de Tocqueville, you probably don’t understand your own country. If you didn’t study Gibbon, you probably lack the vocabulary to describe the rise and fall of cultures and nations.

The wisdom of the ages is your inheritance; it can make your life easier. These resources often fail to get shared because universities are too careerist, or because faculty members are more interested in their academic specialties or politics than in teaching undergraduates, or because of a host of other reasons

What are you putting into your mind? Our culture spends a lot less time worrying about this, and when it does, it goes about it all wrong.

my worry is that, especially now that you’re out of college, you won’t put enough really excellent stuff into your brain.

I worry that it’s possible to grow up now not even aware that those upper registers of human feeling and thought exist.

The theory of maximum taste says that each person’s mind is defined by its upper limit—the best that it habitually consumes and is capable of consuming.

After college, most of us resolve to keep doing this kind of thing, but we’re busy and our brains are tired at the end of the day. Months and years go by. We get caught up in stuff, settle for consuming Twitter and, frankly, journalism. Our maximum taste shrinks.

I’m worried about the future of your maximum taste. People in my and earlier generations, at least those lucky enough to get a college education, got some exposure to the classics, which lit a fire that gets rekindled every time we sit down to read something really excellent.

the “theory of maximum taste.” This theory is based on the idea that exposure to genius has the power to expand your consciousness. If you spend a lot of time with genius, your mind will end up bigger and broader than if you spend your time only with run-of-the-mill stuff.

the whole culture is eroding the skill the UCLA scholar Maryanne Wolf calls “deep literacy,” the ability to deeply engage in a dialectical way with a text or piece of philosophy, literature, or art.

“To the extent that you cannot perceive the world in its fullness, to the same extent you will fall back into mindless, repetitive, self-reinforcing behavior, unable to escape.”

I can’t say that to you, because it sounds fussy and elitist and OK Boomer. And if you were in front of me, you’d roll your eyes.

The novel probes how nothing in life is fixed, including the legacies of the dead and the stories we tell about our pas

“The study of history shouldn’t be backward looking,” explains a historian in “Halcyon.” “To matter, it has to take us forward.”

Ackerman was in college on Sept. 11, 2001, but what he remembers more vividly is watching the premiere of the TV miniseries “Band of Brothers” the previous Sunday. “If you wanted to know the zeitgeist in the U.S. at the time, it was this very sentimental view of World War II,” he says. “There was this nostalgia for a time where we’re the good guys, they’re the bad guys, and we’re going to liberate oppressed people.”

Ackerman, who also covers wars and veteran affairs as a journalist, says that America’s backing of Ukraine is essential in the face of what he calls “an authoritarian axis rising up in the world, with China, Russia and Iran.” Were the country to offer similar help to Taiwan in the face of an invasion from China, he notes, having some air bases in nearby Afghanistan would help, but the U.S. gave those up in 2021.

With Islamic fundamentalists now in control of places where he lost friends, he says he is often asked if he regrets his service. “When you are a young man and your country goes to war, you’re presented with a choice: You either fight or you don’t,” he writes in his 2019 memoir “Places and Names.” “I don’t regret my choice, but maybe I regret being asked to choose.”

Serving in the military at a time when wars are no longer generation-defining events has proven alienating for Ackerman. “When you’ve got wars with an all-volunteer military funded through deficit spending, they can go on forever because there are no political costs

The catastrophic withdrawal from Afghanistan in 2021, which Ackerman covers in his recent memoir “The Fifth Act,” compounded this moral injury. “The fact that there has been so little government support for our Afghan allies has left it to vets to literally clean this up,” he says, noting that he still fields requests for help on WhatsApp. He adds that unless lawmakers act, the tens of thousands of Afghans currently living in the U.S. on humanitarian parole will be sent back to Taliban-held Afghanistan later this year: “It’s very painful to see how our allies are treated.”

Looking back on America’s misadventures in Iraq, Afghanistan and elsewhere, he notes that “the stories we tell about war are really important to the decisions we make around war. It’s one reason why storytelling fills me with a similar sense of purpose.”

“We don’t talk about the world and our place in it in a holistic way, or a strategic way,” Ackerman says. “We were telling a story about ending America’s longest war, when the one we should’ve been telling was about repositioning ourselves in a world that’s becoming much more dangerous,” he adds. “Our stories sometimes get us in trouble, and we’re still dealing with that trouble today.”

But something else, something even more powerful, was going on. Many Trump supporters grew to hate his critics even more than they came to love Trump. For them, Trump’s detractors were not just wrong but wicked, obsessed with getting Trump, and hell-bent on destroying America

For Trump supporters to admit that they were wrong about him—and especially to admit that Trump’s critics had been right about him—would blow their circuits. If they ever do turn on Trump, they will admit it only to themselves and maybe a few close intimates

asking Trump supporters to focus on his moral turpitude is like asking them to stare into the sun. They can do it for a split second, and then they have to look away. The Trump years have been all about looking away.

In the early 1990s, The Journal sent me on many reporting trips to the U.S.S.R.

I saw but did not see the enormous amount of corruption that was going on. I saw but did not see that property rights alone do not spontaneously make a decent society. The primary problem in all societies is order — moral, legal and social order.

By the time I came to this job, in 2003, I was having qualms about the free-market education I’d received — but not fast enough. It took me a while to see that the postindustrial capitalism machine — while innovative, dynamic and wonderful in many respects — had some fundamental flaws.

The most educated Americans were amassing more and more wealth, dominating the best living areas, pouring advantages into their kids. A highly unequal caste system was forming. Bit by bit it dawned on me that the government would have to get much more active if every child was going to have an open field and a fair chance.

the financial crisis hit, the flaws in modern capitalism were blindingly obvious, but my mental frames still didn’t shift fast enough.

Sometimes in life you should stick to your worldview and defend it against criticism. But sometimes the world is genuinely different than it was before. At those moments the crucial skills are the ones nobody teaches you: how to reorganize your mind, how to see with new eyes.

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.

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. 

For centuries humans felt they were watched and judged by an all-seeing God who could condemn them to hell if they sinned heavily. The fear of divine punishment shaped private behaviour, applying a brake on some of our worst impulses.

it also seems sensible to assume that in the absence of an all-seeing deity threatening fire and brimstone, the brakes on devious or selfish behaviour in private will be eased, resulting in more “what’s the harm?” behaviour, more dabbling in the grey area between right and wrong, more secretive cruelty or casual selfishness.

Gradually, the fear of being watched by God and going to hell is being replaced by a fear of being recorded by technology and suffering the hell of public shame.

scandals might also act as a warning that in the age of the smartphone, the space for “getting away with it” has shrunk considerably.

The philosopher Immanuel Kant (1724–1804) argued in his Critique of Pure Reason that the human mind knows objects in innate, a priori ways. Kant claimed that humans, from birth, must experience all objects as being successive (time) and juxtaposed (space). His list of inborn categories describes predicates that the mind can attribute to any object in general. Arthur Schopenhauer (1788–1860) agreed with Kant, but reduced the number of innate categories to one—causality—which presupposes the others.

Modern nativism is most associated with the work of Jerry Fodor (1935–2017), Noam Chomsky (b. 1928), and Steven Pinker (b. 1954), who argue that humans from birth have certain cognitive modules (specialised genetically inherited psychological abilities) that allow them to learn and acquire certain skills, such as language.

For example, children demonstrate a facility for acquiring spoken language but require intensive training to learn to read and write. This poverty of the stimulus observation became a principal component of Chomsky's argument for a "language organ"—a genetically inherited neurological module that confers a somewhat universal understanding of syntax that all neurologically healthy humans are born with, which is fine-tuned by an individual's experience with their native language

In The Blank Slate (2002), Pinker similarly cites the linguistic capabilities of children, relative to the amount of direct instruction they receive, as evidence that humans have an inborn facility for speech acquisition (but not for literacy acquisition).

A number of other theorists[1][2][3] have disagreed with these claims. Instead, they have outlined alternative theories of how modularization might emerge over the course of development, as a result of a system gradually refining and fine-tuning its responses to environmental stimuli.[4]

Many empiricists are now also trying to apply modern learning models and techniques to the question of language acquisition, with marked success.[20] Similarity-based generalization marks another avenue of recent research, which suggests that children may be able to rapidly learn how to use new words by generalizing about the usage of similar words that they already know (see also the distributional hypothesis).[14][21][22][23]

The term universal grammar (or UG) is used for the purported innate biological properties of the human brain, whatever exactly they turn out to be, that are responsible for children's successful acquisition of a native language during the first few years of life. The person most strongly associated with the hypothesising of UG is Noam Chomsky, although the idea of Universal Grammar has clear historical antecedents at least as far back as the 1300s, in the form of the Speculative Grammar of Thomas of Erfurt.

This evidence is all the more impressive when one considers that most children do not receive reliable corrections for grammatical errors.[9] Indeed, even children who for medical reasons cannot produce speech, and therefore have no possibility of producing an error in the first place, have been found to master both the lexicon and the grammar of their community's language perfectly.[10] The fact that children succeed at language acquisition even when their linguistic input is severely impoverished, as it is when no corrective feedback is available, is related to the argument from the poverty of the stimulus, and is another claim for a central role of UG in child language acquisition.

Researchers at Blue Brain discovered a network of about fifty neurons which they believed were building blocks of more complex knowledge but contained basic innate knowledge that could be combined in different more complex ways to give way to acquired knowledge, like memory.[11

experience, the tests would bring about very different characteristics for each rat. However, the rats all displayed similar characteristics which suggest that their neuronal circuits must have been established previously to their experiences. The Blue Brain Project research suggests that some of the "building blocks" of knowledge are genetic and present at birth.[11]

modern nativist theory makes little in the way of specific falsifiable and testable predictions, and has been compared by some empiricists to a pseudoscience or nefarious brand of "psychological creationism". As influential psychologist Henry L. Roediger III remarked that "Chomsky was and is a rationalist; he had no uses for experimental analyses or data of any sort that pertained to language, and even experimental psycholinguistics was and is of little interest to him".[13]

, Chomsky's poverty of the stimulus argument is controversial within linguistics.[14][15][16][17][18][19]

Neither the five-year-old nor the adults in the community can easily articulate the principles of the grammar they are following. Experimental evidence shows that infants come equipped with presuppositions that allow them to acquire the rules of their language.[6]

Paul Griffiths, in "What is Innateness?", argues that innateness is too confusing a concept to be fruitfully employed as it confuses "empirically dissociated" concepts. In a previous paper, Griffiths argued that innateness specifically confuses these three distinct biological concepts: developmental fixity, species nature, and intended outcome. Developmental fixity refers to how insensitive a trait is to environmental input, species nature reflects what it is to be an organism of a certain kind, and the intended outcome is how an organism is meant to develop.[24]

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.

We need not wonder what the basic objections will be: Third Wave Antiracism isn’t really a religion; I am oversimplifying; I shouldn’t write this without being a theologian; it is a religion but it’s a good one; and so on

It is not an argument against protest

I am not writing this thinking of right-wing America as my audience.

This is not merely a complaint.

Our current conversations waste massive amounts of energy in missing the futility of “dialogue” with them. Of a hundred fundamentalist Christians, how many do you suppose could be convinced via argument to become atheists? There is no reason that the number of people who can be talked out of the Third Wave Antiracism religion is any higher.

our concern must be how to continue with genuine progress in spite of this ideology. How do we work around it?

My interest is not “How do we get through to these people?” We cannot, at least not enough of them to matte

We seek change in the world, but for the duration will have to do so while encountering bearers of a gospel, itching to smoke out heretics, and ready on a moment’s notice to tar us as moral perverts.

We will term these people The Elect. They do think of themselves as bearers of a wisdom, granted them for any number of reasons—a gift for empathy, life experience, maybe even intelligence.

they see themselves as having been chosen, as it were, by one or some of these factors, as understanding something most do not.

“The Elect” is also good in implying a certain smugness, which is sadly accurate as a depiction.

But most importantly, terming these people The Elect implies a certain air of the past, à la Da Vinci Code. This is apt, in that the view they think of as sacrosanct is directly equivalent to views people centuries before us were as fervently devoted to as today’s Elect are

Following the religion means to pillory people for what, as recently as 10 years ago, would have been thought of as petty torts or even as nothing at all; to espouse policies that hurt black people as long as supporting them makes you seem aware that racism exists;

o pretend that America never makes any real progress on racism; and to almost hope that it doesn’t because this would deprive you of a sense of purpose.

being with him wasn’t like being with a conventional person; it was like being with an entity who was playing the role of Donald Trump. And that role had no sense of continuity. He was fully immersed in whatever dominance battle he was fighting at that moment.

I wonder if the era of the short-attention spans and the online avatars is creating a new character type: the person who doesn’t experience life as an accumulation over decades, but just as a series of disjointed performances in the here and now, with an echo of hollowness inside.

McAdams calls Trump an “episodic man,” who experiences life as a series of disjointed moments, not as a coherent narrative flow of consciousness

“He does not look to what may lie ahead, at least not very far ahead,” McAdams writes. “Trump is not introspective, retrospective or prospective. There is no depth; there is no past; there is no future.”

In his book, “The Strange Case of Donald J. Trump,” the eminent personality psychologist Dan McAdams argues that Trump could continually lie to himself because he had no actual sense of himself. There was no real person, inner life or autobiographical narrative to betray.

As the philosopher Alasdair MacIntyre once observed, you can’t know what to do unless you know what story you are a part of.

Before the introduction of Botox and hyaluronic acid dermal fillers in 2002 and 2003, respectively, aesthetic work was serious, expensive. Nose jobs and face lifts required general anesthesia, not insignificant recovery time, and cost thousands of dollars (in 2000, a facelift was $5,416 on average, and a rhinoplasty $4,109, around $9,400 and $7,000 adjusted).

In contrast, the average price of a syringe of hyaluronic acid filler today is $684, while treating, for example, the forehead and eyes with Botox will put you out anywhere from $300 to $600

We copied the beautiful and the rich, not in facsimile, but in homage.

In 2018, use of Botox and fillers was up 18% and 20% from five years prior. Philosophies of prejuvenation have made Botox use jump 22% among 22- to 37-year-olds in half a decade as well. By 2030, global noninvasive aesthetic treatments are predicted to triple.

The trouble is that a status symbol, without status, is common.

Beauty has always been exclusive. When someone strikes you as pretty, it means they are something that everyone else is not.

It’s a zero-sum game, as relative as our morals. Naturally, we hoard of beauty what we can. It’s why we call grooming tips “secrets.”

Largely the secrets started with the wealthy, who possess the requisite money and leisure to spare on their appearances

Botox and filler only accelerated a trend that began in the ’70s and ’80s and is just now reaching its saturation point.

we didn’t have the tools for anything more than emulation. Fake breasts and overdrawn lips only approximated real ones; a birthmark drawn with pencil would always be just that.

Instagram Face, on the other hand, distinguishes itself by its sheer reproducibility. Not only because of those new cosmetic technologies, which can truly reshape features, at reasonable cost and with little risk.

built in to the whole premise of reversible, low-stakes modification is an indefinite flux, and thus a lack of discretion.

Instagram Face has replicated outward, with trendsetters giving up competing with one another in favor of looking eerily alike. And obviously it has replicated down.

Eva looks like Eva. If she has procedures in common with Kim K, you couldn’t tell. “I look at my features and I think long and hard of how I can, without looking different and while keeping as natural as possible, make them look better and more proportional. I’m against everything that is too invasive. My problem with Instagram Face is that if you want to look like someone else, you should be in therapy.”

natural looks have always been, and still are, more valuable than artificial ones. Partly because of our urge to legitimize in any way we can the advantages we have over other people. Hotness is a class struggle.

As more and more women post videos of themselves eating, sleeping, dressing, dancing, and Only-Fanning online, in a logical bid for economic ascendance, the women who haven’t needed to do that gain a new status symbol.

Privacy. A life which is not a ticketed show. An intimacy that does not admit advertisers. A face that does not broadcast its insecurity, or the work undergone to correct it.

Upper class, private women get discrete work done. The differences aren’t in the procedures themselves—they’re the same—but in disposition

Eva, who lives between central London, Geneva, and the south of France, says: “I do stuff, but none of the stuff I do is at all in my head associated with Instagram Face. Essentially you do similar procedures, but the end goal is completely different. Because they are trying to get the result of looking like another human being, and I’m just beautifying myself.”

But the more rapidly it replicates, and the clearer our manuals for quick imitation become, the closer we get to singularity—that moment Kim Kardashian fears unlike any other: the moment when it becomes unclear whether we’re copying her, or whether she is copying us.

what he restores is complicated and yet not complicated at all. It’s herself, the fingerprint of her features. Her aura, her presence and genealogy, her authenticity in space and time.

Dr. Taktouk’s approach is “not so formulaic.” He aims to give his patients the “better versions of themselves.” “It’s not about trying to be anyone else,” he says, “or creating a conveyor belt of patients. It’s about working with your best features, enhancing them, but still looking like you.”

“Vulgar” says that in pursuing indistinguishability, women have been duped into another punishing divide. “Vulgar” says that the subtlety of his work is what signals its special class—and that the women who’ve obtained Instagram Face for mobility’s sake have unwittingly shut themselves out of it.

While younger women are dissolving their gratuitous work, the 64-year-old Madonna appeared at the Grammy Awards in early February, looking so tragically unlike herself that the internet launched an immediate postmortem.

The folly of Instagram Face is that in pursuing a bionic ideal, it turns cosmetic technology away from not just the reality of class and power, but also the great, poignant, painful human project of trying to reverse time. It misses the point of what we find beautiful: that which is ephemeral, and can’t be reproduced

Age is just one of the hierarchies Instagram Face can’t topple, in the history of women striving versus the women already arrived. What exactly have they arrived at?

Youth, temporarily. Wealth. Emotional security. Privacy. Personal choices, like cosmetic decisions, which are not so public, and do not have to be defended as empowered, in the defeatist humiliation of our times

Maybe they’ve arrived at love, which for women has never been separate from the things I’ve already mentioned.

I can’t help but recall the time I was chatting with a plastic surgeon. I began to point to my features, my flaws. I asked her, “What would you do to me, if I were your patient?” I had many ideas. She gazed at me, and then noticed my ring. “Nothing,” she said. “You’re already married.”

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.

Since the 1960s, advances in resuscitation had helped to revive thousands of people who might otherwise have died. About 10% or 20% of those people brought with them stories of near-death experiences in which they felt their souls or selves departing from their bodies

According to several international surveys and studies, one in 10 people claims to have had a near-death experience involving cardiac arrest, or a similar experience in circumstances where they may have come close to death. That’s roughly 800 million souls worldwide who may have dipped a toe in the afterlife.

In the 1970s, a small network of cardiologists, psychiatrists, medical sociologists and social psychologists in North America and Europe began investigating whether near-death experiences proved that dying is not the end of being, and that consciousness can exist independently of the brain. The field of near-death studies was born.

in 1975, an American medical student named Raymond Moody published a book called Life After Life.

Meanwhile, new technologies and techniques were helping doctors revive more and more people who, in earlier periods of history, would have almost certainly been permanently deceased.

“We are now at the point where we have both the tools and the means to scientifically answer the age-old question: What happens when we die?” wrote Sam Parnia, an accomplished resuscitation specialist and one of the world’s leading experts on near-death experiences, in 2006. Parnia himself was devising an international study to test whether patients could have conscious awareness even after they were found clinically dead.

Borjigin, together with several colleagues, took the first close look at the record of electrical activity in the brain of Patient One after she was taken off life support. What they discovered – in results reported for the first time last year – was almost entirely unexpected, and has the potential to rewrite our understanding of death.

“I believe what we found is only the tip of a vast iceberg,” Borjigin told me. “What’s still beneath the surface is a full account of how dying actually takes place. Because there’s something happening in there, in the brain, that makes no sense.”

Over the next 30 years, researchers collected thousands of case reports of people who had had near-death experiences

Moody was their most important spokesman; he eventually claimed to have had multiple past lives and built a “psychomanteum” in rural Alabama where people could attempt to summon the spirits of the dead by gazing into a dimly lit mirror.

near-death studies was already splitting into several schools of belief, whose tensions continue to this day. One influential camp was made up of spiritualists, some of them evangelical Christians, who were convinced that near-death experiences were genuine sojourns in the land of the dead and divine

It is no longer unheard of for people to be revived even six hours after being declared clinically dead. In 2011, Japanese doctors reported the case of a young woman who was found in a forest one morning after an overdose stopped her heart the previous night; using advanced technology to circulate blood and oxygen through her body, the doctors were able to revive her more than six hours later, and she was able to walk out of the hospital after three weeks of care

The second, and largest, faction of near-death researchers were the parapsychologists, those interested in phenomena that seemed to undermine the scientific orthodoxy that the mind could not exist independently of the brain. These researchers, who were by and large trained scientists following well established research methods, tended to believe that near-death experiences offered evidence that consciousness could persist after the death of the individua

Their aim was to find ways to test their theories of consciousness empirically, and to turn near-death studies into a legitimate scientific endeavour.

Finally, there emerged the smallest contingent of near-death researchers, who could be labelled the physicalists. These were scientists, many of whom studied the brain, who were committed to a strictly biological account of near-death experiences. Like dreams, the physicalists argued, near-death experiences might reveal psychological truths, but they did so through hallucinatory fictions that emerged from the workings of the body and the brain.

Between 1975, when Moody published Life After Life, and 1984, only 17 articles in the PubMed database of scientific publications mentioned near-death experiences. In the following decade, there were 62. In the most recent 10-year span, there were 221.

Today, there is a widespread sense throughout the community of near-death researchers that we are on the verge of great discoveries

“We really are in a crucial moment where we have to disentangle consciousness from responsiveness, and maybe question every state that we consider unconscious,”

“I think in 50 or 100 years time we will have discovered the entity that is consciousness,” he told me. “It will be taken for granted that it wasn’t produced by the brain, and it doesn’t die when you die.”

it is in large part because of a revolution in our ability to resuscitate people who have suffered cardiac arrest

In his book, Moody distilled the reports of 150 people who had had intense, life-altering experiences in the moments surrounding a cardiac arrest. Although the reports varied, he found that they often shared one or more common features or themes. The narrative arc of the most detailed of those reports – departing the body and travelling through a long tunnel, having an out-of-body experience, encountering spirits and a being of light, one’s whole life flashing before one’s eyes, and returning to the body from some outer limit – became so canonical that the art critic Robert Hughes could refer to it years later as “the familiar kitsch of near-death experience”.

Loss of oxygen to the brain and other organs generally follows within seconds or minutes, although the complete cessation of activity in the heart and brain – which is often called “flatlining” or, in the case of the latter, “brain death” – may not occur for many minutes or even hours.

That began to change in 1960, when the combination of mouth-to-mouth ventilation, chest compressions and external defibrillation known as cardiopulmonary resuscitation, or CPR, was formalised. Shortly thereafter, a massive campaign was launched to educate clinicians and the public on CPR’s basic techniques, and soon people were being revived in previously unthinkable, if still modest, numbers.

scientists learned that, even in its acute final stages, death is not a point, but a process. After cardiac arrest, blood and oxygen stop circulating through the body, cells begin to break down, and normal electrical activity in the brain gets disrupted. But the organs don’t fail irreversibly right away, and the brain doesn’t necessarily cease functioning altogether. There is often still the possibility of a return to life. In some cases, cell death can be stopped or significantly slowed, the heart can be restarted, and brain function can be restored. In other words, the process of death can be reversed.

In a medical setting, “clinical death” is said to occur at the moment the heart stops pumping blood, and the pulse stops. This is widely known as cardiac arrest

In 2019, a British woman named Audrey Schoeman who was caught in a snowstorm spent six hours in cardiac arrest before doctors brought her back to life with no evident brain damage.

That is a key tenet of the parapsychologists’ arguments: if there is consciousness without brain activity, then consciousness must dwell somewhere beyond the brain

Some of the parapsychologists speculate that it is a “non-local” force that pervades the universe, like electromagnetism. This force is received by the brain, but is not generated by it, the way a television receives a broadcast.

In order for this argument to hold, something else has to be true: near-death experiences have to happen during death, after the brain shuts down

To prove this, parapsychologists point to a number of rare but astounding cases known as “veridical” near-death experiences, in which patients seem to report details from the operating room that they might have known only if they had conscious awareness during the time that they were clinically dead.

At the very least, Parnia and his colleagues have written, such phenomena are “inexplicable through current neuroscientific models”. Unfortunately for the parapsychologists, however, none of the reports of post-death awareness holds up to strict scientific scrutiny. “There are many claims of this kind, but in my long decades of research into out-of-body and near-death experiences I never met any convincing evidence that this is true,”

In other cases, there’s not enough evidence to prove that the experiences reported by cardiac arrest survivors happened when their brains were shut down, as opposed to in the period before or after they supposedly “flatlined”. “So far, there is no sufficiently rigorous, convincing empirical evidence that people can observe their surroundings during a near-death experience,”

The parapsychologists tend to push back by arguing that even if each of the cases of veridical near-death experiences leaves room for scientific doubt, surely the accumulation of dozens of these reports must count for something. But that argument can be turned on its head: if there are so many genuine instances of consciousness surviving death, then why should it have so far proven impossible to catch one empirically?

The spiritualists and parapsychologists are right to insist that something deeply weird is happening to people when they die, but they are wrong to assume it is happening in the next life rather than this one. At least, that is the implication of what Jimo Borjigin found when she investigated the case of Patient One.

Given the levels of activity and connectivity in particular regions of her dying brain, Borjigin believes it’s likely that Patient One had a profound near-death experience with many of its major features: out-of-body sensations, visions of light, feelings of joy or serenity, and moral re-evaluations of one’s life. Of course,

“As she died, Patient One’s brain was functioning in a kind of hyperdrive,” Borjigin told me. For about two minutes after her oxygen was cut off, there was an intense synchronisation of her brain waves, a state associated with many cognitive functions, including heightened attention and memory. The synchronisation dampened for about 18 seconds, then intensified again for more than four minutes. It faded for a minute, then came back for a third time.

n those same periods of dying, different parts of Patient One’s brain were suddenly in close communication with each other. The most intense connections started immediately after her oxygen stopped, and lasted for nearly four minutes. There was another burst of connectivity more than five minutes and 20 seconds after she was taken off life support. In particular, areas of her brain associated with processing conscious experience – areas that are active when we move through the waking world, and when we have vivid dreams – were communicating with those involved in memory formation. So were parts of the brain associated with empathy. Even as she slipped irre

something that looked astonishingly like life was taking place over several minutes in Patient One’s brain.

Although a few earlier instances of brain waves had been reported in dying human brains, nothing as detailed and complex as what occurred in Patient One had ever been detected.

In the moments after Patient One was taken off oxygen, there was a surge of activity in her dying brain. Areas that had been nearly silent while she was on life support suddenly thrummed with high-frequency electrical signals called gamma waves. In particular, the parts of the brain that scientists consider a “hot zone” for consciousness became dramatically alive. In one section, the signals remained detectable for more than six minutes. In another, they were 11 to 12 times higher than they had been before Patient One’s ventilator was removed.

“The brain, contrary to everybody’s belief, is actually super active during cardiac arrest,” Borjigin said. Death may be far more alive than we ever thought possible.

“The brain is so resilient, the heart is so resilient, that it takes years of abuse to kill them,” she pointed out. “Why then, without oxygen, can a perfectly healthy person die within 30 minutes, irreversibly?”

Evidence is already emerging that even total brain death may someday be reversible. In 2019, scientists at Yale University harvested the brains of pigs that had been decapitated in a commercial slaughterhouse four hours earlier. Then they perfused the brains for six hours with a special cocktail of drugs and synthetic blood. Astoundingly, some of the cells in the brains began to show metabolic activity again, and some of the synapses even began firing.