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Koselleck observes that prior to the French revolution, a crisis was a medical or legal problem but not much more. After the fall of the ancien regime, crisis becomes the “structural signature of modernity”, he writes. As the 19th century progressed, crises multiplied: there were economic crises, foreign policy crises, cultural crises and intellectual crises.

When he looked at 5,000 creative individuals over 127 generations in European history, he found that significant creative breakthroughs were less likely during periods of political crisis and instability.

Victor H Mair, a professor of Chinese literature at the University of Pennsylvania, points out that in fact the Chinese word for crisis, wēijī, refers to a perilous situation in which you should be particularly cautious

“Those who purvey the doctrine that the Chinese word for ‘crisis’ is composed of elements meaning ‘danger’ and ‘opportunity’ are engaging in a type of muddled thinking that is a danger to society,” he writes. “It lulls people into welcoming crises as unstable situations from which they can benefit.” Revolutionaries, billionaires and politicians may relish the chance to profit from a crisis, but most people world prefer not to have a crisis at all.

A common folk theory is that times of great crisis also lead to great bursts of creativity.

The first world war sparked the growth of modernism in painting and literature. The second fuelled innovations in science and technology. The economic crises of the 1970s and 80s are supposed to have inspired the spread of punk and the creation of hip-hop

psychologists have also found that when we are threatened by a crisis, we become more rigid and locked into our beliefs. The creativity researcher Dean Simonton has spent his career looking at breakthroughs in music, philosophy, science and literature. He has found that during periods of crisis, we actually tend to become less creative.

psychologists have found that it is what they call “malevolent creativity” that flourishes when we feel threatened by crisis.

during moments of significant crisis, the best leaders are able to create some sense of certainty and a shared fate amid the seas of change.

These are innovations that tend to be harmful – such as new weapons, torture devices and ingenious scams.

A 2019 study which involved observing participants using bricks, found that those who had been threatened before the task tended to come up with more harmful uses of the bricks (such as using them as weapons) than people who did not feel threatened

Students presented with information about a threatening situation tended to become increasingly wary of outsiders, and even begin to adopt positions such as an unwillingness to support LGBT people afterwards.

during moments of crisis – when change is really needed – we tend to become less able to change.

When we suffer significant traumatic events, we tend to have worse wellbeing and life outcomes.

, other studies have shown that in moderate doses, crises can help to build our sense of resilience.

we tend to be more resilient if a crisis is shared with others. As Bruce Daisley, the ex-Twitter vice-president, notes: “True resilience lies in a feeling of togetherness, that we’re united with those around us in a shared endeavour.”

Crises are like many things in life – only good in moderation, and best shared with others

The challenge our leaders face during times of overwhelming crisis is to avoid letting us plunge into the bracing ocean of change alone, to see if we sink or swim. Nor should they tell us things are fine, encouraging us to hide our heads in the san

Waking up each morning to hear about the latest crisis is dispiriting for some, but throughout history it has been a bracing experience for others. In 1857, Friedrich Engels wrote in a letter that “the crisis will make me feel as good as a swim in the ocean”. A hundred years later, John F Kennedy (wrongly) pointed out that in the Chinese language, the word “crisis” is composed of two characters, “one representing danger, and the other, opportunity”. More recently, Elon Musk has argued “if things are not failing, you are not innovating enough”.

This means people won’t feel an overwhelming sense of threat. It also means people do not feel alone. When we feel some certainty and common identity, we are more likely to be able to summon the creativity, ingenuity and energy needed to change things.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.