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In 2016, mental illness and stigma are still a double helix that needs dismantling.

The media must change its behavior. Headlines are not just headlines; language is how we form perceptions. And if that language is discriminatory, the trickle-down effect is seismic.

In 2015, Britain's mental health crisis grew increasingly dismal

The idea that there is no way for the vast accumulation of money to “go right” is hardly anywhere to be seen.

extreme wealth remained morally suspect, with the rich bearing particular scrutiny and stigmatization during periods like the Gilded Age. This stigma persisted until relatively recently; only in the 1970s did political shifts cause executive salaries skyrocket, and the current effectively unprecedented inequality in income (and wealth) begin to appear, without any significant public complaint or lament.

The story of how a stigma fades is always murky, but contributing factors are not hard to identify. For one, think tanks have become increasingly partisan over the past several decades, particularly on the right: Certain conservative institutions, enjoying the backing of billionaires such as the Koch brothers, have thrown a ton of money at pseudo-academics and “thought leaders” to normalize and legitimate obscene piles of lucre. They produced arguments that suggest that high salaries naturally flowed from extreme talent and merit, thus baptizing wealth as simply some excellent people’s wholly legitimate rewards. These arguments were happily regurgitated by conservative media figures and politicians, eventually seeping into the broader public and replacing the folk wisdom of yore

I've grown very close to new people whose perspectives are radically different than mine.

It floors me: These individuals are all repositories of wisdom. They've gleaned it from experiences I'll never have, assumptions I don't share, and brains wired different than mine. I want to learn what they know.

Does that get us anywhere? A little ways, I think.

"Are we stuck with a passé traditionalism on one hand, and total laissez-faire on the other?" Is there common ground shared by the orthodox-Christian sexual ethics of a Rod Dreher and those who treat consent as their lodestar?

Gobry suggests that Emmanuel Kant provides a framework everyone can and should embrace, wherein consent isn't nearly enough to make a sexual act moral--we must, in addition, treat the people in our sex lives as ends, not means.

Here's how Kant put it: "Act in such a way that you treat humanity, whether in your own person or in the person of any other, never merely as a means to an end, but always at the same time as an end."

the disappearance of a default sexual ethic in America and the divergence of our lived experiences means we have more to learn from one another than ever, even as our different choices raise the emotional stakes.

Nor does it seem intuitively obvious that a suffering, terminally ill 90-year-old is regarding himself as a means, or an object, if he prefers to end his life with a lethal injection rather than waiting three months in semi-lucid agony for his lungs to slowly shut down and suffocate him. (Kant thought suicide impermissible.) The terminally ill man isn't denigrating his own worth or the preciousness of life or saying it's permissible "any time" it is difficult. He believes ending his life is permissible only because the end is nigh, and the interim affords no opportunity for "living" in anything except a narrow biological sense.

It seems to me that, whether we're talking about a three-week college relationship or a 60-year marriage, it is equally possible to treat one's partner as a means or as an end (though I would agree that "treating as means" is more common in hookups than marriage)

my simple definition is this: It is wrong to treat human persons in such a way that they are reduced to objects. This says nothing about consent: a person may consent to be used as an object, but it is still wrong to use them that way. It says nothing about utility: society may approve of using some people as objects; whether those people are actual slaves or economically oppressed wage-slaves it is still wrong to treat them like objects. What it says, in fact, is that human beings have intrinsic worth and dignity such that treating them like objects is wrong.

what it means to treat someone as a means, or as an object, turns out to be in dispute.

Years ago, I interviewed a sister who was acting as a surrogate for a sibling who couldn't carry her own child. The notion that either regarded the other (or themselves) as an object seems preposterous to me. Neither was treating the other as a means, because they both freely chose, desired and worked in concert to achieve the same end.

It seems to me that the Kantian insight is exactly the sort of challenge traditionalist Christians should make to college students as they try to persuade them to look more critically at hookup culture. I think a lot of college students casually mislead one another about their intentions and degree of investment, feigning romantic interest when actually they just want to have sex. Some would say they're transgressing against consent. I think Kant has a more powerful challenge. 

Ultimately, Kant only gets us a little way in this conversation because, outside the realm of sex, he thinks consent goes a long way toward mitigating the means problem, whereas in the realm of sex, not so much. This is inseparable from notions he has about sex that many of us just don't share.

two Biblical passages fit my moral intuition even better than Kant. "Love your neighbor as yourself." And "therefore all things whatsoever would that men should do to you, do ye even so to them.

"do unto others..." is extremely demanding, hard to live up to, and a very close fit with my moral intuitions.

"Do unto others" is also enough to condemn all sorts of porn, and to share all sorts of common ground with Dreher beyond consent. Interesting that it leaves us with so many disagreements too. "Do unto others" is core to my support for gay marriage.

Are our bones always to be trusted?) The sexual behavior parents would be mortified by is highly variable across time and cultures. So how can I regard it as a credible guide of inherent wrong? Professional football and championship boxing are every bit as violent and far more physically damaging to their participants than that basement scene, yet their cultural familiarity is such that most people don't feel them to be morally suspect. Lots of parents are proud, not mortified, when a son makes the NFL.

"Porn operates in fantasy the way boxing and football operate in fantasy. The injuries are quite real." He is, as you can see, uncomfortable with both. Forced at gunpoint to choose which of two events could proceed on a given night, an exact replica of the San Francisco porn shoot or an Ultimate Fighting Championship tournament--if I had to shut one down and grant the other permission to proceed--what would the correct choice be?

insofar as there is something morally objectionable here, it's that the audience is taking pleasure in the spectacle of someone being abused, whether that abuse is fact or convincing illusion. Violent sports and violent porn interact with dark impulses in humanity, as their producers well know.

If Princess Donna was failing to "do unto others" at all, the audience was arguably who she failed. Would she want others to entertain her by stoking her dark human impulses? Then again, perhaps she is helping to neuter and dissipate them in a harmless way. That's one theory of sports, isn't it? We go to war on the gridiron as a replacement for going to war? And the rise in violent porn has seemed to coincide with falling, not rising, incidence of sexual violence. 

On all sorts of moral questions I can articulate confident judgments. But I am confident in neither my intellect nor my gut when it comes to judging Princess Donna, or whether others are transgressing against themselves or "nature" when doing things that I myself wouldn't want to do. Without understanding their mindset, why they find that thing desirable, or what it costs them, if anything, I am loath to declare that it's grounded in depravity or inherently immoral just because it triggers my disgust instinct, especially if the people involved articulate a plausible moral code that they are following, and it even passes a widely held standard like "do unto others."

Here's another way to put it. Asked to render moral judgments about sexual behaviors, there are some I would readily label as immoral. (Rape is an extreme example. Showing the topless photo your girlfriend sent to your best friend is a milder one.) But I often choose to hold back and error on the side of not rendering a definitive judgment, knowing that occasionally means I'll fail to label as unethical some things that actually turn out to be morally suspect.

Partly I take that approach because, unlike Dreher, I don't see any great value or urgency in the condemnations, and unlike Douthat, I worry more about wrongful stigma than lack of rightful stigmas

In a society where notions of sexual morality aren't coercively enforced by the church or the state, what purpose is condemnation serving?

People are great! Erring on the side of failing to condemn permits at least the possibility of people from all of these world views engaging in conversation with one another.

Dreher worries about the fact that, despite our discomfort, neither Witt nor I can bring ourselves to say that the sexual acts performed during the S.F. porn shoot were definitely wrong. Does that really matter? My interlocutors perhaps see a cost more clearly than me, as well they might. My bias is that just arguing around the fire is elevating.

the consensus among therapists is that treating anxiety has become an enormous challenge for campus mental health centers.

More students are seeking help partly because the stigma around mental health issues is lessening

Because of escalating pressures during high school, he and other experts say, students arrive at college preloaded with stress. Accustomed to extreme parental oversight, many seem unable to steer themselves. And with parents so accessible, students have had less incentive to develop life skills.

Social media is a gnawing, roiling constant. As students see posts about everyone else’s fabulous experiences, the inevitable comparisons erode their self-esteem. The popular term is “FOMO” — fear of missing out.

Anxiety is an umbrella term for several disorders, including social anxiety disorder and agoraphobia. It can accompany many other diagnoses, such as depression, and it can be persistent and incapacitating.

Students who suffer from this acute manifestation can feel their very real struggles are shrugged off, because anxiety has become so ubiquitous, almost a cliché, on campus.

More often, anxiety is mild, intermittent or temporary, the manifestation of a student in the grip of a normal developmental issue — learning time management, for example, or how to handle rejection from a sorority.

Mild anxiety is often treatable with early, modest interventions. But to care for rising numbers of severely troubled students, many counseling centers have moved to triage protocols.

at Penn State, who have tracked campus counseling centers nationwide for six years, have documented a trend that other studies have noted: Students are arriving with ever more severe mental-health issues

Half of clients at mental health centers in their most recent report had already had some form of counseling before college. One-third have taken psychiatric medication. One quarter have self-injured.

He argues that the real object of healing is not the body, but the mind.  A plastic surgeon is a “psychologist with a scalpel in his hand.” This idea led Pitanguy to argue for the “union” of cosmetic and reconstructive procedures.  In both types of surgery beauty and mental healing subtly mingle, he claims, and both benefit health.

“What is the difference between a plastic surgeon and a psychoanalyst?  The psychoanalyst knows everything but changes nothing.  The plastic surgeon knows nothing but changes everything.”

Plastic surgery gained legitimacy in the early 20th century by limiting itself to reconstructive operations.  The “beauty doctor” was a term of derision.  But as techniques improved they were used for cosmetic improvements.  Missing, however, was a valid diagnosis. Concepts like psychoanalyst Alfred Adler’s inferiority complex — and later low self-esteem — provided a missing link.

Victorians saw a cleft palate as a defect that built character. For us it hinders self-realization and merits corrective surgery.  This shift reflects a new attitude towards appearance and mental health: the notion that at least some defects cause unfair suffering and social stigma is now widely accepted. But Brazilian surgeons take this reasoning a step further.  Cosmetic surgery is a consumer service in most of the world.  In Brazil it is becoming, as Ester put it, a “necessary vanity.”

Pitanguy, whose patients often have mixed African, indigenous and European ancestry, stresses that aesthetic ideals vary by epoch and ethnicity.  What matters are not objective notions of beauty, but how the patient feels.  As his colleague says, the job of the plastic surgeon is to simply “follow desires.”

Patients are on average younger than they were 20 years ago.  They often request minor changes to become, as one surgeon said, “more perfect.”

The growth of plastic surgery thus reflects a new way of working not only on the suffering mind, but also on the erotic body.  Unlike fashion’s embrace of playful dissimulation and seduction, this beauty practice instead insists on correcting precisely measured flaws.  Plastic surgery may contribute to a biologized view of sex where pleasure and fantasy matter less than the anatomical “truth” of the bare body.

It is not coincidental that Brazil has not only high rates of plastic surgery, but also Cesarean sections (70 percent of deliveries in some private hospitals), tubal ligations,  and other surgeries for women. Some women see elective surgeries as part of a modern standard of care, more or less routine for the middle class, but only sporadically available to the poor.

When a good life is defined through the ability to buy goods then rights may be reinterpreted to mean not equality before the law, but equality in the market. 

Beauty is unfair: the attractive enjoy privileges and powers gained without merit.  As such it can offend egalitarian values.  Yet while attractiveness is a quality “awarded” to those who don’t morally deserve it, it can also grant power to those excluded from other systems of privilege.  It is a kind of “double negative”: a form of power that is unfairly distributed but which can disturb other unfair hierarchies.  For this reason it may have democratic appeal.  In poor urban areas beauty often has a similar importance for girls as soccer (or basketball) does for boys: it promises an almost magical attainment of recognition, wealth or power.

For many consumers attractiveness is essential to economic and sexual competition, social visibility, and mental well being.  This “value” of appearance may be especially clear for those excluded from other means of social ascent.  For the poor beauty is often a form of capital that can be exchanged for other benefits, however small, transient, or unconducive to collective change.

I liked the joy my students found when they actually earned a grade they’d been reaching for. But whereas I once thought we needed to contain grades, I now see that we may as well let them float skyward. If grade inflation is bad, fighting it is worse. Our goal should be ending the centrality of grades altogether. For years, I feared that a world of only A’s would mean the end of meaningful grades; today, I’m certain of it. But what’s so bad about that?

It’s easy to see why schools want to fight grade inflation. Grades should motivate certain students: those afraid of the stigma of a bad grade or those ambitious, by temperament or conditioning, to succeed in measurable ways. Periodic grading during a term, on quizzes, tests or papers, provides feedback to students, which should enable them to do better. And grades theoretically signal to others, such as potential employers or graduate schools, how well the student did. (Grade-point averages are also used for prizes and class rankings, though that doesn’t strike me as an important feature.)

But it’s not clear that grades work well as motivators. Although recent research on the effects of grades is limited, several studies in the 1970s, 1980s and 1990s measured how students related to a task or a class when it was graded compared to when it was ungraded. Overall, graded students are less interested in the topic at hand and — and, for obvious, common-sense reasons — more inclined to pick the easiest possible task when given the chance. In the words of progressive-education theorist Alfie Kohn, author of “The Homework Myth,” “the quality of learning declines” when grades are introduced, becoming “shallower and more superficial when the point is to get a grade.”

Even where grades can be useful, as in describing what material a student has mastered, they are remarkably crude instruments. Yes, the student who gets a 100 on a calculus exam probably grasps the material better than the student with a 60 — but only if she retains the knowledge, which grades can’t show.

I still can’t say very well what separates a B from an A. What’s more, I never see the kind of incompetence or impudence that would merit a D or an F. And now, in our grade-inflated world, it’s even harder to use grades to motivate, or give feedback, or send a signal to future employers or graduate schools.

According to a 2012 study by the Chronicle of Higher Education, GPA was seventh out of eight factors employers considered in hiring, behind internships, extracurricular activities and previous employment. Last year, Stanford’s registrar told the Chronicle about “a clamor” from employers “for something more meaningful” than the traditional transcript. The Lumina Foundation gave a$1.27 million grant to two organizations for college administrators working to develop better student records, with grades only one part of a student’s final profile.

Some graduate schools, too, have basically ditched grades. “As long as you don’t bomb and flunk out, grades don’t matter very much in M.F.A. programs,” the director of one creative-writing program told the New York Times. To top humanities PhD programs, letters of reference and writing samples matter more than overall GPA (although students are surely expected to have received good grades in their intended areas of study). In fact, it’s impossible to get into good graduate or professional schools without multiple letters of reference, which have come to function as the kind of rich, descriptive comments that could go on transcripts in place of grades.

suggests that GPAs serve not to validate students from elite schools but to keep out those from less-prestigious schools and large public universities, where grades are less inflated. Grades at community colleges “have actually dropped” over the years, according to Stuart Rojstaczer, a co-author of the 2012 grade-inflation study. That means we have two systems: one for students at elite schools, who get jobs based on references, prestige and connections, and another for students everywhere else, who had better maintain a 3.0. Grades are a tool increasingly deployed against students without prestige.

The trouble is that, while it’s relatively easy for smaller colleges to go grade-free, with their low student-to-teacher ratios, it’s tough for professors at larger schools, who must evaluate more students, more quickly, with fewer resources. And adjuncts teaching five classes for poverty wages can’t write substantial term-end comments, so grades are a necessity if they want to give any feedback at all.

It would mean hiring more teachers and paying them better (which schools should do anyway). And if transcripts become more textured, graduate-school admission offices and employers will have to devote more resources to reading them, and to getting to know applicants through interviews and letters of reference — a salutary trend that is underway already.

When I think about getting rid of grades, I think of happier students, with whom I have more open, democratic relationships. I think about being forced to pay more attention to the quiet ones, since I’ll have to write something truthful about them, too. I’ve begun to wonder if a world without grades may be one of those states of affairs (like open marriages, bicycle lanes and single-payer health care) that Americans resist precisely because they seem too good, suspiciously good. Nothing worth doing is supposed to come easy.

Alfie Kohn, too, sees ideology at work in the grade-inflation panic. “Most of what powers the arguments against grade inflation is a very right-wing idea that excellence consists in beating everyone else around you,” he says. “Even when you have sorted them — even when they get to Harvard! — we have to sort them again.” In other words, we can trust only a system in which there are clear winners and losers.

The idea behind the class is deceptively simple, and many of the lessons — such as gratitude, helping others, getting enough sleep — are familiar.

“A lot of people are waking up, realizing that we’re struggling,

All semester, hundreds of students tried to rewire themselves — to exercise more, to thank their mothers, to care less about the final grade and more about the ideas.

But in ways small and large, silly and heartbreakingly earnest, simple and profound, this class changed the conversation at Yale. It surfaced in late-night talks in dorms, it was dissected in newspaper columns, it popped up, again and again, in memes.

It’s the application that’s difficult, a point Santos made repeatedly: Our brains often lead us to bad choices, and even when we realize the choices are bad, it’s hard to break habits.

In a way, the class is the very essence of a liberal-arts education: learning, exploration, insight into oneself and the world. But many students described it as entirely unlike any class they had ever taken — nothing to do with academics, and everything to do with life.

There’s no longer the same stigma around mental-health issues, he said. “Now, so many people are admitting they want to lead happier lives.”

The impact is not limited to Yale. Stories about PSYC157 spread around the world. Santos created a pared-down version of the class and offered it to anyone on the online education site Coursera.

She taught students about cognitive biases.

“We called it the ways in which our minds suck,” Forti said. “Our minds make us think that certain things make us happy, but they don’t.”

Then, they had to apply the lessons

There was a palpable difference on campus, several students said, during the week when they performed random acts of kindness.

The biggest misconception people have about the class is that Santos is offering some kind of easy happiness fix. “It’s something you have to work on every day. . . . If I keep using these skills, they’ll, over time, help me develop better habits and be happier.

So many students have told her the class changed their lives. “If you’re really grateful, show me that,” she told them. “Change the culture.

for now students stood and clapped and clapped and clapped, beaming, drowning out even Kanye with their standing ovation. As if they had nothing but time.

Yet research shows that men who take parental leave become equal partners in raising their children, beyond the time they take off before or after a baby is born.

In many countries where parental leave is mandated, such as Canada and across Europe, leave can be shared between men and women any way parents like. Data show that mothers typically take the majority of that leave, while fathers take very little.

Research shows that in nations that foster a culture that rewards overtime work, men do less housework and women do more.

Employers need to encourage men to use them, without fear of repercussions, for the policies to be successful.

Her reason for coming was obvious. She was around 40 weeks pregnant

She was an office worker in Ohio when she became pregnant by a man who wasn’t going to marry her. The most remarkable part of her story was this: When she knew she was about to give birth, she drove westward out of Ohio, stopping at Indianapolis only because it was the first big city she encountered

She arranged to place the baby for adoption and gave birth the next day.

The baby was me. If she’d driven farther, I’d be a native of Chicago or St. Louis, but Indianapolis it was

Life is a journey, and I was born on a road trip.

Secrecy was considered best for all concerned. In recent decades, open adoption has been replacing this practice, but rules governing past adoptions change slowly, and I was barred from seeing my birth records.

Everything I just told you about my biological parents was unknown to me growing up; they were such a blank that I could not even imagine what they might be like.

I accepted this until I became an adoptive parent in 2012 and a social worker suggested that my adopted daughter might want to know my story someday

She’s from China, and like many international adoptees, she also had no story of her biological family.

I requested my records from the State of Indiana and was denied.

Next I called the Children’s Bureau, where a kind woman on the phone had my records in her hands, but was not allowed to share them.

Typed notes from the Children’s Bureau recorded a visit with my biological mother in the hospital. Asked how she felt, she cried

It’s been nearly two years since I first read those documents, and I’m still not over it. Knowing that story has altered how I think about myself, and the seemingly simple question of where I’m from

It’s brought on a feeling of revelation, and also of anger. I’m not upset with my biological mother; it was moving to learn how she managed her predicament alone.

Her decisions left me with the family that I needed — that I love. Nor am I unhappy with the Children’s Bureau, which did its duty by preserving my records.

I am angry that for 50 years, my state denied me the story of how I came to live on this earth. Strangers hid part of me from myself.

While I now have the privilege of knowing my information, many people’s stories are still hidden.

About 2 percent of U.S. residents — roughly six million people — are adoptees

A majority were adopted domestically, with records frequently sealed, especially for older adoptees

I was never able to tell a doctor my family medical history when asked. It’s one of those little things that never bother you until it does.

The people who blocked me from learning my past must have thought their motives were pure.

Closed adoption began as “confidential” adoption in the early 20th century, enabling parents and children to avoid the stigma of illegitimacy.

Records were sealed to all but people directly involved

But nobody asked if I wanted my identity hidden from me.

Should adoptees and biological families contact each other, after the law forbade it for so long?

Not without mutual consent:

information alone is powerful.

As records are opened, people’s privacy should be respected; that’s why I’m withholding my biological mother’s name and any details that might identify her. But my story is mine, and other adoptees have a right to recover theirs.

Once veterans got service dogs, they described themselves in surveys as more satisfied with their lives, said they felt a greater sense of well-being and deemed themselves as having better relationships with friends and loved ones.

There can also be a new sense of stigma that goes along with making a disability that might otherwise be hidden readily apparent. Someone who has PTSD might not stick out until they get a service dog that is always present.

Sarah Everard in London. Soon Chung Park, Hyun Jung Grant, Suncha Kim, Yong Ae Yue, Delaina Ashley Yaun, Xiaojie Tan and Daoyou Feng in Atlanta.

Eight women, two continents apart, killed in the space of two weeks. The suspects in both cases are men.

London, Ms. Everard disappeared while walking home from a friend’s house, and was found dead a week later. A police officer was charged with kidnapping and murdering her.

In Atlanta, a gunman stormed three massage parlors and shot and killed eight people — seven of them women, six of them Asian — raising speculation that the attack was racially motivated

In the days after Ms. Everard’s body was found and protests calling for deeper social change grew across the United Kingdom

the British government announced an experimental pilot program (though there is no fixed start date yet) that would categorize cases of gender-based violence and harassment motivated by misogyny as hate crimes.

“Across the country, women everywhere are looking to us not just to express sympathy with their concerns, but to act,”

“Stop telling them to stay at home and be careful, and start finding those responsible for the violence.”

In Atlanta, the arrested suspect told the police he had a “sexual addiction,” according to the Cherokee County Sheriff’s Office, prompting some activists to call for him to be charged with a hate crime there, too.

“What can’t be forgotten is the hate crime statute says ‘because of gender’ as well,”

“The angle of misogyny has to be looked at.”

Do ‘sweat the small stuff’

As women around the world watched the two events unfold, they started sharing their own stories on social media of having been in similar situations that had the potential to escalate and turn similarly violent.

Women spoke of all of the things that they — like Ms. Everard — did “right,” including walking on well-lit streets, and talking on the phone or clutching their keys in their pockets while doing so — and described how they still ended up in dangerous situations.

Asian women spoke of all of the ways in which sexism and racism coalesce to expose them to a unique form of harassment that can lead to violence and abuse.

Their stories confirm that violence against women isn’t an aberration, but a “global public health” crisis of “epidemic proportions,”

In the United States, one online survey in 2018 found that 81 percent of women had experienced some kind of sexual harassment during their lifetimes. In the United Kingdom, 97 percent of women aged 18 to 24 said they had been sexually harassed, according to UN Women UK.

These numbers are all from before the coronavirus pandemic; with the onset of the health crisis, domestic abuse surged and public spaces became eerily empty, leaving women feeling increasingly worried about their safety.

Violence against women is consistently underreported because women are scared of retaliation for speaking out or they fear the stigma associated with sexual violence,

UN Women’s initiative to end gender-based violence.

“We’re not joining the dots, nobody is making connections,

“There is a big picture here that we are just repeatedly missing. There are connections between the normalized daily behaviors that we brush off and the more serious abuses.”

a woman recalls that when she was in school, at age 13 or 14, a few girls complained to a teacher that the boys in their class had been groping them and the teacher said that they were “being oversensitive.

In another example, a woman recalls waiting at a bus stop when a man walked up to her and grabbed her bottom but everyone around her who had witnessed the incident remained silent.

a woman recalls how a man sat directly opposite her on the train and touched himself and then got off the train on the next stop, as if nothing had happened.

There is plenty of evidence to suggest that misogyny and gender-based violence are also correlated with broader threats

a spike in gender-based violence — particularly domestic violence — correlates with “rising levels of insecurity in society more broadly.”

A sudden disappearance of girls from schools, for example, could point to a rise of fundamentalist views

“If only we were to listen to women and pay attention to the misogyny and aggression and violence that they deal with on a daily basis.”

As pervasive as sexism, misogyny and gender-based violence are, none are inevitable and they can be countered

“The term ‘violence against women’ is a passive construction — there’s no active agent, it’s a bad thing that happens to women,” he explained, but it’s as if “nobody’s doing it to them.”

“shifts the accountability off of men and the culture that produces them and puts it onto women.”

The second step is recognizing that male aggression against women is a manifestation of a broader systemic problem. “There’s this impulse to pathologize the individual perpetrators — that somehow the individual perpetrator is some monster who just kind of crawled out of the swamp,

“But if you accept the concept that it’s systemic, then there are policy implications and political implications and introspection that can be uncomfortable.

“And how that message plays in the community, how you talk about it, how you have police understand it.”

“Making misogyny a crime is like making racism a crime — it’s unfortunate, it’s ugly and we wish people wouldn’t do it, but you can’t punish somebody for saying something,” he said.

In other words, they’d have to show that the man assaulted her because she’s a woman, which is a tough standard to meet.

In the United States, a crime motivated by gender bias is considered a hate crime at the federal level and in 35 states.

Reporting hate crimes also requires a police force that is trained to appropriately respond to those complaints.

But that would only broaden the powers of law enforcement, which several women’s rights groups argue wouldn’t do much to prompt deeper cultural change.

. Many still felt, according to the survey, that incidents like name calling or groping seemed too normal for the police to take seriously.

“So what’s the point of me going to the police station and sitting there for two hours with a policeman who probably just thinks, ‘Why are you wasting my time?’”

Soon enough, however, articles appeared widely that tried to make a connection between African American cocaine use and criminality.

one of the book's most eye-opening aspects is its challenge of the long-running association between drugs and addiction.

It must also interfere with a person's job, parenting or personal relationships. Other indications of addiction may be high tolerance, withdrawal symptoms, or persistence in repeated failed efforts to quit.

"What about the notion that drugs led to poverty and crime in my neighborhood?" he asks. "Well, that is simply an ugly fantasy, an incredibly effective one to be sure.

that it's a pre-existing kind of personal vulnerability — psychological and/or circumstantial — that precedes the drugs themselves that can lead to addiction.

And when addiction does occur, there should be safe spaces for people to get help,

There are no cures in psychiatric medicine. We don't have a cure for depression, nor do we have a cure for schizophrenia or anxiety.

We merely have medications and therapies that treat symptoms, and this allows patients to function better, despite their illnesses."

"such issues affect only 10 percent to 30 percent of those who use even the most stigmatized drugs, such as heroin or methamphetamine."

but also because it seemingly provides a simple solution to complicated problems faced by poor and desperate people.

But he also so importantly emphasizes that anti-drug laws have disproportionately ruined the lives of people of color;

Drug Use for Grown-Ups makes the case for people having the right to use drugs if they want to.

What we have now, instead, is racist mass incarceration and social shame prevailing (and drugs hardly scarce anyway).

He persuasively argues for us, as Americans, to chart a more humane course for how we see drugs in our society — a course rooted in personal freedom without social stigma.

This is not to say that Alzheimer’s- and dementia-related memory impairments are fiction — they are very real — but every lapse of short-term memory doesn’t necessarily indicate a biological disorder.

Some aspects of memory actually get better as we age. For instance, our ability to extract patterns, regularities and to make accurate predictions improves over time because we’ve had more experience.

Second, older adults have to search through more memories than do younger adults to find the fact or piece of information they’re looking for. Your brain becomes crowded with memories and information.

The cerebrum has two halves, or hemispheres, that are further divided into four regions, or lobes. The frontal lobes, located behind the forehead, are involved with speech, thought, learning, emotion, and movement.

Behind them are the parietal lobes, which process sensory information such as touch, temperature, and pain.

At the rear of the brain are the occipital lobes, dealing with vision

Lastly, there are the temporal lobes, near the temples, which are involved with hearing and memory.

The second-largest part of the brain is the cerebellum, which sits beneath the back of the cerebrum.

diencephalon, located in the core of the brain. A complex of structures roughly the size of an apricot, its two major sections are the thalamus and hypothalamus

The brain is extremely sensitive and delicate, and so it requires maximum protection, which is provided by the hard bone of the skull and three tough membranes called meninges.

Want more proof that the brain is extraordinary? Look no further than the blood-brain barrier.

This led scientists to learn that the brain has an ingenious, protective layer. Called the blood-brain barrier, it’s made up of special, tightly bound cells that together function as a kind of semi-permeable gate throughout most of the organ. It keeps the brain environment safe and stable by preventing some toxins, pathogens, and other harmful substances from entering the brain through the bloodstream, while simultaneously allowing oxygen and vital nutrients to pass through.

One in five Americans suffers from some form of neurological damage, a wide-ranging list that includes stroke, epilepsy, and cerebral palsy, as well as dementia.

Alzheimer’s disease, which is characterized in part by a gradual progression of short-term memory loss, disorientation, and mood swings, is the most common cause of dementia. It is the sixth leading cause of death in the United States

50 million people suffer from Alzheimer’s or some form of dementia. While there are a handful of drugs available to mitigate Alzheimer’s symptoms, there is no cure.

Unfortunately, negative attitudes toward people who suffer from mental illness are widespread. The stigma attached to mental illness can create feelings of shame, embarrassment, and rejection, causing many people to suffer in silence.

In the United States, where anxiety disorders are the most common forms of mental illness, only about 40 percent of sufferers receive treatment. Anxiety disorders often stem from abnormalities in the brain’s hippocampus and prefrontal cortex.

Attention-deficit/hyperactivity disorder, or ADHD, is a mental health condition that also affects adults but is far more often diagnosed in children.

ADHD is characterized by hyperactivity and an inability to stay focused.

Depression is another common mental health condition. It is the leading cause of disability worldwide and is often accompanied by anxiety. Depression can be marked by an array of symptoms, including persistent sadness, irritability, and changes in appetite.

The good news is that in general, anxiety and depression are highly treatable through various medications—which help the brain use certain chemicals more efficiently—and through forms of therapy

The day-to-day work of a pilot is unstable, and often unpredictable. They’re away from home, and from their families, for long stretches of time. The job isn’t a typical 9-to-5— instead, pilots fly overnight from timezone to timezone, at strange hours.

To reduce fatigue, which is linked to stress, rules and regulations from the Federal Aviation Administration (FAA) limit the number of hours a pilot can fly and how much rest they need. During a 24-hour period, a pilot flying alone can’t log more than eight hours, for example, and they have a ten-hour minimum rest period before taking off.

But if stress creeps past that midpoint, performance starts to drop off. Too-high levels of stress mean exhaustion, panic, and blunted brain power. That’s when mistakes happen.

CRM training is designed to help pilots and crew members develop efficiency communication and decision-making skills. “It was also saying, this is what fatigue looks like, and this is how to recognize it in your co-pilot,” Bowen says. From that point on, she says, the airlines worked to develop a culture where pilots would hold other pilots accountable when they weren’t fit to fly. “It was about not protecting their buddy, but protecting overall safety,” Bowen says.

Pilot mental health is another big issue to tackle, says Quay Snyder, a former Air Force flight surgeon and a member of the Aerospace Medical Association Working Group on Pilot Mental Health. Pilots are often reluctant to acknowledge the effect that emotional stressors might have on their ability to fly, he says.

“They’re slow to recognize mental health issues,” he says, “and they might think there’s a stigma against asking for help.”

“Pilots trust pilots,” he says. “Hearing from a peer could help a pilot recognize that they may not be fit to fly. Hearing it from a physician doesn’t carry much weight, but hearing it from a peer does.”

“When did it become taboo in this country to talk about getting healthy?” my friend Bill Maher asked in a recent monologue. “Fat shaming doesn’t need to end; it needs to make a comeback. Some amount of shame is good. We shamed people out of smoking and into wearing seat belts. We shamed them out of littering and most of them out of racism.”

On one side are helpless victims, who react to any debate with cries of oppression, and take no responsibility for their own physical destiny; on the other are brutal realists, with a callous touch, often refusing to see the genetic, social, and psychological complexity of fatness, or that serious health issues are not universal among heavier types

This is our reality. We are neither angels nor beasts, but we partake of both. We can rarely make the ugly beautiful, and if we do, it’s a moral achievement. However much we try, we will never correct the core natural inequalities and differences of our mammalian existence. But we can hazard a moral middle, seeing beauty in many ways, acknowledging the humanity of all shapes and sizes, while managing our health and weight in ways that are not totally subject to the gaze of others.

is to grapple with complexity in a way that can be rigorously empirical and yet also humane.

We are all driven by instinctive attraction, but men are particularly subject to fixed and crude notions of hotness. Beauty will thereby always be the source of extraordinary and extraordinarily unfair advantage, even if it captures only a tiny slice of what being human is about.

the two stances reflect our two ideological poles — not so much left and right anymore as nurture and nature. One pole argues nature doesn’t independently exist and everything is social; and one blithely asserts that nature determines everything. Both are ruinous attempts to bludgeon uncomfortable reality into satisfying ideology.

What we needed, in some ways, for our collective mental health, was a catalyst for greater physical socialization, more human contact, and more meaningful community. What we’re getting, I fear, is the opposite

a watchdog group, claimed that a candidate named Kevin had a ten to thirty per cent lower chance of being hired for a job than a competitor named Arthur.

Kevins also have a hard time in such countries as Germany, where the practice of name discrimination is referred to as “Kevinismus,” and an app that purports to help parents avoid it is called the Kevinometer.

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.”