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A Psychological Hygiene Hypothesis?

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I talk a lot in this space about antifragility. For those who need a reminder it’s the idea that certain things get better/stronger in the presence of stress. For a really in-depth explanation see my post on The Ideas of Nassim Nicholas Taleb who discovered the idea. (In the same way that Columbus discovered America i.e. it is something which has always been there, but he brought attention to it and named it. And yes, I know that Columbus didn’t name America, but he did name the Indians.)

I am not the only person to discuss antifragility, and nearly any time someone does they bring up the hygiene hypothesis, because it’s such a great example of the principle in action. This includes me, but on previous occasions I didn’t go into it in much depth. I’m going to start this post by rectifying that.

The hygiene hypothesis, as originally formulated by David Strachan, speculated that a lower incidence of childhood infection translated into higher rates of hay fever and asthma. From the beginning Strachan noticed that family size was a factor as well, More brothers and sisters provided more avenues for childhood infection. But that still leaves the question of why a lack of childhood infections would map, later, to a greater incidence of hay fever and asthma?

Initially it was thought that it was mostly things like measles, the flu, and other childhood diseases that were the primary culprits, but then Graham Rook came along with the “old friends” theory. From Wikipedia:

Rook proposed the “old friends hypothesis” which some claim offers a more rational explanation for the link between microbial exposure and inflammatory disorders. He argues that the vital microbial exposures are not colds, influenza, measles and other common childhood infections which have evolved relatively recently over the last 10,000 years, but rather the microbes already present during mammalian and human evolution, that could persist in small hunter gatherer groups as microbiota, tolerated latent infections or carrier states. He proposes that humans have become so dependent on these “old friends” that their immune systems neither develop properly nor function properly without them.

Hay fever, asthma, and other allergies are products of overactive immune systems, and while the clinical details of the hypothesis would take us into the weeds of TH1 vs. TH2 cells and much more besides, I don’t think it’s over simplifying things too much to describe it this way: The immune system needs something to target, and in the absence of historically harmful agents, it ends up targeting non-harmful agents, like pollen and peanuts. In the case of peanuts this reaction can be so extreme that people with peanut allergies can die after ingesting them. To return to the principle of antifragility, the immune system is antifragile. It needs stress to develop appropriately. In the absence of sufficient stress it goes a little haywire. (Or maybe a lot haywire.) To quote from Rook, “Evolution turns the inevitable into a necessity.” In this case, harmful agents were historically inevitable, and in the end they became necessary.

I find it very interesting to review examples of what the immune system considers beneficial stress (at least according to the research):

  • Large families
  • Older siblings
  • Early daycare
  • Rural Living
  • Contact with animals
  • Poor sanitation
  • Parasitic worms
  • Absence of antibiotics
  • Non-western lifestyle

As you would expect this is a list of things mostly absent from modern life, and includes some things we’ve put a lot of time and money into banishing. It’s equally interesting to review examples of the kinds of conditions that can result from not getting enough of this stress (at least according to the research):

  • Type 1 diabetes
  • Multiple sclerosis
  • Some types of depression
  • Cancer
  • Autoimmune diseases
  • Hay fever
  • Eczema
  • Asthma
  • Autism
  • Food allergies

This is a pretty nasty list, and as I already pointed out, some of the items on the list can be fatal. And if you’ve been paying attention you’re aware that most have been increasing recently. The questions is how recently. Thus far I have intentionally avoided mentioning the year that Strachan first proposed the idea, or the year when Rook amended it. But from my perspective this is one of the things that makes the hypothesis so consequential. To take a step back for a second, one of the big questions I keep returning to is how different is the modern world from the world of 50 or 100 or a 1000 years ago? The hygiene hypothesis would seem to indicate that it’s very different and that the difference is recent. The first formal proposal of the  hypothesis, by Strachan wasn’t until 1989, the year I graduated from high school. (Yep, it’s my 30th year reunion this year. I think I’m going to skip it.) And Rook’s amendment, wasn’t until 2003, and it’s gotten much worse since then. For example, the WSJ reported a 377% increase in severe allergic reactions to food just in the decade between 2007 and 2017.

Depending on who you talk to the modern world started in the early 18th century with the invention of the steam engine and the Enlightenment. Or maybe it was the late 19th century with the harnessing of electricity. Or perhaps it was the end of World War II when conflict between the great powers ceased. Or if we’re looking more in the area we’re concerned about. Perhaps it was when Pasteur solidified the germ theory of disease in the 1860s or when Fleming discovered penicillin in 1928. But all of these things still happened a long time before 1989 to say nothing of 2003 or 2007. Why is it so bad now? I understand that people are not eager to go back to having tapeworms or cholera epidemics from poor sanitation, but as best I can tell the last cholera epidemic in the US was in 1911, which as you’ll recognize is significantly before 1989.

I’m not sure of the answer to this question, nor is it the intent of this post to seek that answer. It’s just one more alarming thing about the current state of the world. Also, while the hygiene hypothesis is exceptionally interesting all by itself, I’d like to see where that idea takes us if we’re willing to expand it a little bit. Because it’s not just the immune system which experienced inevitable stress historically, all aspects of our existence were subject to inevitable stress, and I’m wondering, if we start to view these other avenues of stress as necessary does it bring any insight?

I just finished listening to The Power of Vulnerability by Brené Brown. I picked it up because I started hearing her name everywhere all of the sudden. Which I’m sure is because I started looking for it rather than some dramatic increase in her popularity over the last month. But once my attention was drawn to her I was curious to see what she had to say. My initial take is that she’s very engaging and funny, full of charisma (the thing I listened to was her presenting a six part instructional course) and I can definitely see why people would be drawn to her. I’m also very interested in her take on the benefits of guilt, but still somewhat unclear how she draws a bright line between that and shame, which as far as I can tell is the worst thing in the world from her perspective. I’m certain that I should read more of her stuff before I make any further comments, also that’s not why I’m bringing her up. I bring her up because she said something that starting me thinking about this whole subject.

At the beginning of her presentation she tells the story of two families, brothers, each of which has a wife and a few kids. Unexpectedly there is a “very violent, traumatic event”, and one of the kids dies. Obviously all the parents, and the other kids are devastated by this. Over the course of the next few years each family sends one of their kids off to war. “One comes back, one doesn’t.” Then a year after that one of the brothers loses his house after the bank forecloses on it. She then goes on to say that the story is a metaphor for the nation as a whole. The first violent event was 9/11, which was followed by the wars in Afghanistan and Iraq. Which was then shortly followed by the financial crisis of 2007-2008. That we are those families. That it has been “trauma after trauma for us.”

Brown places a lot of focus on scarcity, vulnerability and shame. This story, in addition to being a story of repeated trauma, is a story of increasing scarcity, or at least the perception of scarcity. She says that she started her research in 2001 and she has “watched scarcity, absolutely shift over this time.”

This whole thing really struck me because as disasters go 9/11 was kind of small potatoes. In the end 2,996 people died. Not to take anything away from the tragedy of those deaths, or the impact it had on those families, but I could list a dozen other disasters that are 100x or even a thousand times as bad. To just take one example, in 1976 somewhere between 250,000 to 650,000 people died from an earthquake in China. That was not even that long ago. How many people have even heard of that earthquake? And is there any evidence of permanent scarring in China? Not that I can see.

Turning to Afghanistan and Iraq, there were 6,713 US deaths. Those are also tragic, and kind of senseless, and it’s ironic that that total is twice as much as the number of people killed in 9/11. But once again, as wars go neither Iraq or Afghanistan has been particularly bad. And if that scarred us, how much more did it scar the actual Iraqis, where the low estimate for violent deaths is 151,000 against much smaller populations. And that’s just stuff that’s happened recently. You don’t have to go that far back before you start to encounter things like the Siege of Leningrad, which lasted for years and ended up killing over a million people. In fact, if you want trauma after trauma, then you should look at the Russians from the 1st World War up through the fall of the Soviet Union (and probably beyond).

Finally as far as financial crises and scarcity go, 2007-2008 was severe, but very short. Nothing as close to as deep or as long as the Great Depression. Unemployment hit 10% once, in late 2009. During the Great Depression it was above 10% for 10 years, with a high above 20%! And whatever scarcity we’re experiencing it’s nothing compared to the scarcity which exists in most of the less developed world, to say nothing of the scarcity which existed for most of recorded history.

Despite all of this Brown does have a point. As she goes on to say:

We are…The most in debt, obese, addicted, and medicated adult cohort in history.

How is this possible? How is it that Brown and her audience can look back and see “trauma after trauma”? Why do things seem so awful and hopeless for so many despite the unparalleled abundance of modern life? When the actual chance of dying from any of the trauma’s she mentioned is almost infinitesimal. (Even for people in the military it’s still pretty low.) And yes the 2007-2008 financial crisis was pretty bad, but how many people literally starved to death because of it? How many homeless people died? How many of them died because of the crisis, who wouldn’t have otherwise? And how many of those are the kind of people who show up at a Brené Brown seminar or read a Brené Brown book?

You may have already guessed where I’m going with this, but what happens if we combine Brown’s observations with the hygiene hypothesis? If we start looking at beneficial stress beyond the realm of the immune system? If we start looking at all forms of stress? Is it possible that just as our immune system has started targeting benign agents in the absence of actual infections. That our psyche has started marshaling all of its defenses against anything negative no matter how slight, in the absence of true trauma? Reacting to things that would have been inconsequential historically by going into the equivalent of psychic anaphylactic shock?

I don’t know, I want to stress that this is just me speculating. Tossing an idea out there and seeing what it looks like when I’ve actually written it down. Also, a faithful reader of this blog, did just point out to me that science is not conducted by pointing out lots of things which confirm your hypothesis, it’s conducted by looking for things which falsify it. Though yet another reader pointed out that blogging has its own set of rules which are different than those of science. And if I were to say right now that this idea is obviously false because of X, it wouldn’t be a very interesting post. (Less so…) That said I am interested in any ideas for how this concept might be falsified. I guess if true trauma continues to decline without psychological issues getting worse, or if they actually started improving that would be one way. That certainly doesn’t seem to be the way things are going, but the trend could always reverse. So while I should and will pay attention to things which might falsify this idea, I am going to spend most of the rest of this post pointing out things which I feel lend support to this idea.

To start with there’s the subject of last week’s post. The hoax Jessie Smollett pullIs that possibly an example of this? It might be, but if it is, it appears that the immune system of the entire society over-reacting, not just the psychological defenses of a single individual. Though before we dismiss it there might still be an interesting parallel.

When I imagine the immune system I imagine white blood cells swarming a parasite (and I know that this is not one of the mechanisms involved in the hygiene hypothesis). It’s possible to imagine that shameful behavior is dealt with in a similar fashion by human society. A certain percentage of individuals are predisposed, by culture and genetics, towards recognizing and shaming certain behavior. Call them scolds. And maybe some other percentage are predisposed towards giving individuals, particularly allies, the benefit of the doubt. Call them advocates. In a setting where the average group size is 150, and the percentage is, say 2%, you have three scolds and three advocates. But now that social media has allowed the community to scale up to be the entire nation, you still have individuals doing dumb (or understandable) things, but rather than three scolds and three advocates, each individual now has thousands, if not millions of each. The body is nothing but white blood cells swarming some parasite.

Let’s turn to another possible example, this one at the individual level. The other day I was out to lunch with an old friend of mine and he mentioned that he was having financial troubles. He had been working as a chef, but finally the lack of opportunities for further advancement and the long hours were just too much and he had to quit amidst declining health. He got another job working at a big plumbing supply store, and he’s doing a lot better, but he’s not making as much money and his kids are in the expensive stage of life (i.e. teenagers). Both he and his wife agree that the obvious solution would be for her to start working, and his wife is willing, but she claims that her social anxiety prevents her from working most traditional jobs. She has made some attempts to find a job that would allow her to work from home, but has so far been unsuccessful. (I should mention at this point that I have altered details of this story to protect the identity of the wife.)

In the past there have been times and conditions where if you didn’t work you died, and people, presumably, never said during those times that they couldn’t work because of “social anxiety”. This leaves us with a few possibilities.

  1. Social anxiety is just an excuse, she doesn’t want to work for some other reason. She’s lazy, or she is secretly hoping her husband will divorce her, or something similar. This is certainly possible, but based on my conversation with her husband, and my slight acquaintance with her, I don’t think she’s “faking it”, but you never know.
  2. If she was really in danger of death or some other horrible consequence (e.g. homelessness) she would work, but absent that her anxiety is too powerful to overcome. If this is the case then it could be that social anxiety has always been present and it’s just the consequences of not working which have changed. That said, their situation is pretty dire, for example they will probably lose their house. (Though that shouldn’t make them homeless.)
  3. She really does have crippling social anxiety, and it wouldn’t matter how bad things are, there really is no way for her to overcome the pain caused by having to interact with lots of strangers in a professional capacity. It is literally incapacitating.

I’m not sure which it is, but I suspect it’s two or three, both of which present problems. Also, if this were the only person who claimed to be unable to do necessary and important things because of psychological issues then it wouldn’t be worth mentioning, but there are millions of people who receive disability benefits because of mental issues which render them incapable of working, and this number doesn’t even include people like my friend’s wife. Once again we have the same core issue. Under the hygiene hypothesis we reduced the number of harmful antigens, but that made some people less physically healthy rather than more. In this example we have reduced the amount of harmful trauma, but this has made some people less mentally healthy rather than more. To repeat Brown’s point:

We are…The most in debt, obese, addicted, and medicated adult cohort in history.

The best example of all for this idea comes from the book Tribe, by Sebastian Junger. Which I discussed in a previous post. Speaking about the reaction of Londoners during the Blitz he said:

On and on the horror [of the Blitz] went, people dying in their homes or neighborhoods while doing the most mundane things. Not only did these experiences fail to produce mass hysteria, they didn’t even trigger much individual psychosis. Before the war, projections for psychiatric breakdown ran as high as four million people, but as the Blitz progressed, psychiatric hospitals around the country saw admissions go down…Psychiatrists watched in puzzlement as long-standing patients saw their symptoms subside during the period of intense air raids.

He then goes on to talk about the positive effects of war on mental health in general, including decreases in depression, suicide and even frequency of epileptic seizures. What might be considered an environment of poor mental hygiene produced improved mental health.

Interestingly enough, my dad recently read Tribe, and his conclusion was that despite being a very interesting book, that it wasn’t exactly scientific. I agree, and most of what I’ve written here hasn’t been especially scientific either, but I think there is something to this. That the negative second order effects of removing historical stress is an area which needs a lot more study. There is some stuff out there, for example a study claiming that growing up in an urban environment without pets increases vulnerability to mental illness. But so far whenever I hear people talk about the increased rate of modern mental illness as Brown does, their solution is always to reduce stress. In Brown’s case it’s to reduce the stress of shame (and maybe replace it with the positive stress of guilt? I’m not sure, but in any case more guilt is definitely not her focus.) Which is not to say it’s easy to identify and introduce positive stress. People with severe allergies have been known to infect themselves with hookworms. (Which worked by the way.) I’m not sure what the mental health equivalent of that is.

Whatever your feelings on the above. Humans are antifragile. We have survived thousands if not millions of years in environments of extreme stress and trauma, and yet now, it’s clear that less and less objective trauma is producing greater and greater reactions. And at some point we’re going to need to figure out why that is.

I’m taking next week off because I’ll be at Gary Con. But feel free to check out previous posts, for example the post I did on Tribe. And while you’re looking over the vastness of my writing, consider donating.

Low Doses of Harm

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Last week we talked about chemotherapy. This week we’re going to talk about radiation, but not metaphorical radiation, actual radiation. And not even the radiation used in radiation therapy for cancer. We’re going to talk about the worst radiation of all, the radiation from nuclear weapons, or at least that’s where we’re going to start.

On August 6, 1945, Tsutomu Yamaguchi had finally reached the end of a three month long business trip to Hiroshima, and was finally ready to leave the city. After having to return to the office to retrieve something he forgot, he was walking near the docks when the Enola Gay dropped the first atomic bomb. The shock wave from the explosion “sucked Yamaguchi from the ground, spun him in the air like a tornado and sent him hurtling into a nearby potato patch.” In addition the explosion “ruptured his eardrums, blinded him temporarily, and left him with serious burns over the left side of the top half of his body.” Afterwards he managed to make his way to an air-raid shelter where he spent the night, and the next day he set out again for his hometown of… Nagasaki, where he received further treatment.

Despite being heavily bandaged, he reported for work on August 9th, and was in the middle of describing the Hiroshima explosion to his supervisor when the Bockscar (I think this is the first time I’ve heard the name of the second plane) dropped another atomic bomb. Both times Yamaguchi was around 3 km from the explosion, but this time, being inside, he was not tossed around or burned, though he suffered from high fever and vomiting for a week afterwards.

Yamaguchi has been called the unluckiest man in the world, and it does sound pretty awful to have been present both times nuclear weapons were used in anger. But what’s interesting is that despite being relatively close to ground zero on both occasions, he survived to the ripe old age of 93. Which is not to say he didn’t have problems related to his exposure in the immediate aftermath, and even later in life, but despite being present at not one, but two nuclear explosions it didn’t shorten his life. Is this just a lot of luck later in life balancing out his initial unluck? Should he have died young, but just beat the odds? According to a paper published last year, no, he wasn’t lucky, the irradiation he was subjected to may have actually lengthened his life.

The paper I’m referring to is titled Low-dose radiation from A-bombs elongated lifespan and reduced cancer mortality relative to un-irradiated individuals. And its central claim is right there in the title, low-dose radiation (technically ionizing radiation, but I’ll be using just ‘radiation’ throughout) didn’t shorten the lifespans of those affected by it, it lengthened them. I imagine for most people this conclusion will be surprising. The reason for this surprise, and the chief villain of the paper is the idea that radiation is the worst thing ever, or what the paper describes as the linear no-threshold hypothesis (LNT). “Linear” meaning that the harm of radiation is always proportional to the dose, and “no-threshold” meaning that there isn’t any point at which it isn’t harmful. According to LNT, radiation, no matter how small the dose, is always harmful. There is no safe level of radiation, and certainly no beneficial level of radiation. As I said LNT is the chief villain of the paper and the authors describe it thusly:

Average solid cancer death ratios of… A-bomb survivors… were lower than the average for Japanese people, which is consistent with the occurrence of radiation adaptive responses (the bases for radiation hormesis), essentially invalidating the LNT model. Nevertheless, LNT has served as the basis of radiation regulation policy. If it were not for LNT, tremendous human, social, and economic losses would not have occurred in the aftermath of the Fukushima Daiichi nuclear plant accident. For many reasons, LNT must be revised or abolished, with changes based not on policy but on science.

Elsewhere they describe LNT as “spurious”, with a “seriously flawed history”, and “no convincing [supporting] data”. Now I’m not an expert in this field, and it’s always possible that their conclusion is wrong, but I would bet that they’re right. For one thing, though I haven’t audited their data, it clearly shows that A-bomb survivors lived longer, on average, than a control group of Japanese who were nowhere near the bomb. But beyond that their claim rests on the assertion that LNT advocates neglected to consider hormesis, or what amounts, essentially, to biological antifragility. Not only am I a huge believer in hormesis (and antifragility) but as part of that I’ve seen lots of examples of people overlooking it. Which is to say, it’s not just with respect to radiation that people apply a linear no-threshold hypothesis, people apply it to just about everything that can cause harm. Creating the widespread belief that if something has been shown to cause harm at any level, that there is then no level at which it doesn’t. I don’t think it’s an exaggeration to say that an overarching linear no-threshold hypothesis may be one of the defining features of our era.

There are many examples of this, most take us from the realm of biology to the realm of psychology, and I will admit that I’m making that jump somewhat casually, but I will return and shore it up. But first some examples, One is Brené Brown, who I talked about a few posts ago and who, as far as I can tell, takes an LNT stand on shame. That there is no level of shame which isn’t harmful. You also see it in schools where there is, in effect an LNT around bullying, or even unkind words. The #metoo era has brought it to interactions around sex, where there is no safe amount of discomfort for a woman to experience. Now to be clear, maybe there is no safe level in all three of these examples. I freely admit I don’t have any proof that there are safe or beneficial levels of shame, or bullying or discomfort. But there is significant proof in other areas, and here’s where I start to shore up that jump from biological to psychological. To do so I turn to The Coddling of the American Mind.

I have already touched on Coddling in a previous post, but upon reflection, particularly in light of some of my recent posts, I may not have given it the space it deserves. To begin with it’s a great book, and this is not just my opinion, I know several people who’ve read it and enjoyed it. This includes my daughter, who generally only reads Rowling and Green. Coddling has mostly ended up taking a position on the right in the larger culture war, but the authors, Greg Lukianoff and Jonathan Haidt are pretty liberal, and thus the picture they paint of today’s youth (the subtitle of the book is “How Good Intentions and Bad Ideas Are Setting up a Generation for Failure”) is as objective as anything is likely to be in this day and age. At least in my opinion.

But we were talking about the linear no-threshold hypothesis. You would be surprised if they actually mentioned it, particularly by that name, and they don’t but they end up describing a nearly identical concept, that of “safetyism”.

“Safetyism” refers to a culture or belief system in which safety has become a sacred value, which means that people become unwilling to make trade-offs demanded by other practical and moral concerns. “Safety” trumps everything else, no matter how unlikely or trivial the potential danger. When children are raised in a culture of safetyism, which teaches them to stay “emotionally safe” while protecting them from every imaginable danger, it may set up a feedback loop: kids become more fragile and less resilient, which signals to adults that they need more protection, which then makes them even more fragile and less resilient. The end result may be similar to what happened when we tried to keep kids safe from exposure to peanuts: a widespread backfiring effect in which the “cure” turns out to be the primary cause of the disease.

The emphasis is mine, and that sentence is essentially a restatement of LNT, only applied to all danger, not just the danger of ionizing radiation.

When I crossed over from talking about LNT as it applies to radiation to talking about LNT as a broader psychological and cultural phenomenon in the form of safetyism. I was actually making two assertions: first, that LNT or something nearly identical existed in this additional space, and that it corresponds to what Haidt and Lukianoff call safetyism and second, that safetyism is similarly “spurious”, with a “seriously flawed history”, and “no convincing [supporting] data”. I would hope that the broader existence of LNT/safetyism is more or less self-evident. If not I would ask you to give further consideration to things like microaggressions, safe spaces, trigger warnings, and massive public shaming over minor infractions. All things which are premised on there being no minimum acceptable level of discomfort.

This leaves us with showing that safetyism causes harm. I would think that Haidt and Lukianoff’s description of the feedback loop is a very good start. Beyond that, as might be expected, they bring up the hygiene hypothesis, which I discussed just a couple of posts ago, and where I further made the argument that there is probably a psychological version of it. At the time I hadn’t really considered the LNT angle, but you could certainly imagine that if psychological stressors work anything at all like immune system, and further if there is any mental hormesis, then an attempt to eliminate all emotional stress would cause analogous problems.

The key thing to consider, as I’ve been arguing from the very beginning, is that, in general, humans are antifragile. And we should be more suspicious of philosophies which claim that they aren’t than those which claim that they are. Haidt and Lukianoff agree, pointing out that the current push to identify and eliminate things like microaggressions, triggers, etc. represents a “fundamental misunderstanding of human nature and of the dynamics of trauma and recovery.” And that even if you actually are suffering from something like post-traumatic stress disorder (PTSD) “avoiding triggers is a symptom of PTSD, not a treatment for it.” In support of this they include a quote from Richard McNally, the director of clinical training in Harvard’s Department of Psychology:

Trigger warnings are counter-therapeutic because they encourage avoidance of reminders of trauma, and avoidance maintains PTSD. Severe emotional reactions triggered by course material are a signal that students need to prioritize their mental health and obtain evidence-based, cognitive-behavioral therapies that will help them overcome PTSD. These therapies involve gradual, systematic exposure to traumatic memories until their capacity to trigger distress diminishes.

All of this is to say that there is a safe and even beneficial level of discomfort and even trauma. And this applies not just to normal individuals, but beyond that to individuals suffering from genuine, clinical, psychological trauma.  That when we deprive people, especially children, of this discomfort under the principle of safetyism that we do real harm. As Haidt and Lukianoff’s summary explains:

Children, like many other complex adaptive systems, are antifragile. Their brains require a wide range of inputs from their environments in order to configure themselves for those environments. Like the immune system, children must be exposed to challenges and stressors (within limits, and in age-appropriate ways), or they will fail to mature into strong and capable adults, able to engage productively with people and ideas that challenge their beliefs and moral convictions.

Haidt and Lukianoff spend most of the rest of the book examining the current, unproductive way in which college students engage with ideas which challenge their beliefs, and it’s all very interesting, but I don’t have the space to go into it here. Also I think it’s a problem that’s been very well covered even for people who have never heard of Coddling or Haidt and Lukianoff. What I’m more interested in examining is where to draw the line on things like discomfort or radiation if we’ve decided that it’s a bad idea to draw the line at zero.

This is not the first time I’ve addressed the question, and in fact when I initially brought up “The Coddling of the American Mind” the title of that post was How Do You Determine the Right Level of Suffering? And my thought process then was largely the same as it is now. If some suffering is needed for healthy development how do you determine how much suffering to allow? Even if you just choose to ignore rather than allow, how do you do that? And do you ignore some suffering, but not others? How is that choice made? Would ignoring it be enough or do you end up having to intentionally causing suffering? Would any of this need to be legislated in order to work? If so how on earth would you pull that off? Replace suffering with trauma or even just challenges and the questions largely remain the same.

One big part of the problem is that up until recently we could do everything in our power to reduce suffering and there was still sufficient suffering built into existence for everyone to get their “daily recommended allowance”. Less than 50 years ago young men could still be drafted to go fight and die in a war. 40 years ago my parents could let me wander around in the wilderness for hours doing who knows what and no one thought it was particularly unusual (a story I told in that last post). But technology and progress have changed things. Now kids are always reachable with smartphones, and they generally don’t wander around outside anyway because they’re inside posting on social media or playing video games. And there are no more wars between the great powers, and no more need for a draft. People still fight and die in wars, but on a completely different scale. Interestingly, some people think this reduction is all because of the A-bomb.

Returning to the A-bomb, one of the reasons I started with radiation is that it’s an early example of dealing with rapid technological change, and its associated dangers, and it’s not an encouraging one. According to the paper I mentioned earlier, the linear no-threshold hypothesis traces its origin all the way back to 1927. This is important because it means we’ve had over 90 years to get the science right, and instead, if anything, we’re more frightened of radiation than ever. While at the same time the case for accepting the dangers of radiation is as strong as it’s ever been.  Of course, I’m mostly talking about nuclear power. I have made my case for nuclear power previously, so I won’t rehash it here, but obviously global warming plays into it. (Though perhaps not as much as you might think.)  And despite increasing fears of that from nearly all quarters, nuclear power generation declined, as a percentage of all power generation, from 16.5% to 9.5% between 1993 and 2015.

One might be inclined to blame this mostly on the Fukushima disaster, but that didn’t occur till 2011, and the decline was pretty steep already (which is to say that since global generation is increasing that nuclear generation in absolute terms has been basically flat since 2000.) Speaking of Fukushima, as was already alluded to in the initial quote, the authors of the paper feel that LNT created undue burdens not only in Fukushima, but also at Chernobyl. Claiming:

If it were not for LNT, evacuation would not have been necessary in Chernobyl or Fukushima.

Back in the post where I made my case for nuclear power I mentioned Chernobyl, and it’s worth revisiting that section:

It doesn’t take much searching to find articles talking in excited terms about the amount of wildlife found in the Chernobyl Exclusion Zone (CEZ). One article declares that it’s a nature reserve. Another mentions that within the CEZ wildlife is flourishing. This was unexpected, in one article from National Geographic I came across, they quote a biologist who “studies Chernobyl” (one wonders if his studies have included a visit) as predicting that when the author of the article goes to Chernobyl that he won’t “see any roadkill in the exclusion zone—and would be lucky to hear any birds or see any animals.” Instead the author reports:

Walking along sandy firebreaks used as forest highways…we found the tracks of wolf, moose, deer, badger, and horses. I counted scores of birds: ravens, songbirds, three kinds of birds of prey, and dozens of swans paddling in the radioactive cooling pond.

The article goes on to report that in a study of 14 species of mammals one scientist found no evidence that any of those populations were “suppressed” within the CEZ.

I am sure that there are some health impacts on this wildlife and positive that the CEZ is not without its negative effects. I’m sure that if people were allowed to live there, that there would be higher rates of cancer, among other things. But, also recall, that this is the worst of the disasters, combined with the least cost and effort at cleanup.

One of the reasons I wanted to revisit that section is that I think I may have been wrong. I said that I was “positive that the CEZ is not without its negative effects.” I am no longer positive of that. It’s possible that just as low-dose radiation extended the lifespans of the Japanese A-bomb survivors that it has had a positive effect on the wildlife of Chernobyl, above and beyond just the removal of human interference. But because of the widespread belief in LNT, scientists assume that there must be some awful effect. So awful that one even claimed you would be lucky to spot any birds or animals, when the opposite ends up being true.

As I said unfortunately it’s not just with respect to radiation that LNT holds sway, it’s also present nearly everywhere you look in the form of safetyism, and one the reasons I’ve been bouncing back and forth is that both engender a similar level of panic.

Just yesterday I came across what may be, to this point, the most extreme example (though I’m sure in the future I’ll see something even more extreme). It came out of a story about a fight over building a halal butchery. The proposed site was nowhere near anything residential but it was near a lot of pet related businesses. And as a result, people pushed back on behalf of their pets. But really, it’s one comment that perfectly encapsulates what I’m talking about.

Knowing that my dogs may be walked by a business that holds chickens in a windowless room before their throats are slit while fully conscious does not make me feel that my dogs are in a safe environment.

Not only is this, objectively, ridiculous, but it perfectly illustrates the unwillingness to make trade-offs and compromise that Haidt and Lukianoff talked about. Earlier, I said I wanted to do two things. First I wanted to show that we are dealing with a cultural and psychological form of LNT, which has been labeled safetyism. Second I wanted to show that this absolute prioritization of safety is counter productive and harmful. Here, at the end, I think it would be useful to pull together a list from everything I’ve said thus far of the ways it’s harmful:

  1. It makes people unwilling to compromise, and given that compromise is essential for a functioning society, safetyism has contributed to the horrible political fracture we’re currently seeing.
  2. There’s a misallocation of resources. We spend time and money eliminating things which not only aren’t harmful, but which are probably beneficial.
  3. It creates a feedback loop. Safetyism leads to fragility, fragility means that much more attention needs to be paid to safety which in turn produces even more fragility.
  4. A certain level of stress, suffering, trauma, and/or danger is necessary for healthy development. Safetyism deprives us of that.
  5. By denying human antifragility it creates widespread fragility.

As I said, even if you’re entirely onboard with my conclusions, deciding how to increase suffering is a hard problem. But to borrow from that wisest of all sages, G.I. Joe, perhaps knowing that it’s a problem is half the battle.

I worry that referencing something like the G.I. Joe cartoon which only ran for three years in the mid-80s may be both horribly obscure and horribly out of date, but I also figure obscure, curmudgeonly stuff might be the definition of my niche. If you agree, or even if you just also remember G.I. Joe, consider donating.

How Do You Determine the Right Level of Suffering?

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In the Church of Jesus Christ of Latter-Day Saints the first Sunday of every month is the fast and testimony meeting. What this means is that anyone can stand up from the congregation, walk up to the pulpit and say whatever they want. They are strongly encouraged to talk about their belief in Jesus Christ, but it’s basically an open mic, and people have used it as an opportunity to air grievances against the church.

This last Sunday during our fast and testimony meeting an older lady got up and expressed how grateful she was that, when she was raising her kids, they were relatively poor and consequently couldn’t give their kids everything they wanted, particularly at Christmas time. Because if they had been wealthy they probably would have, the temptation being hard to resist, but if they had, it would have been worse for the children because they wouldn’t have learned to go without.

This is not an uncommon sentiment. I think adults have been accusing kids of being spoiled since possibly the time of ancient Greece, but I encountered two unusual forms of the argument just recently. The first place I came across it was The Coddling of the American Mind by Greg Lukianoff and Jonathan Haidt.

“Coddling” is mostly about the current generation of college kids, which the subtitle, “How Good Intentions and Bad Ideas Are Setting up a Generation for Failure”, makes clear. The generation in question is variously call iGen or Generation Z. The authors prefer iGen, after yet another book by Jean Twenge, iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy–and Completely Unprepared for Adulthood–and What That Means for the Rest of Us. This is the generation after Millennials, which is normally defined as everyone born since the start of the millennium, but Twenge noticed a surprisingly sharp generational discontinuity beginning with people born around 1995 and who then went on to enter college around 2013. Lukianoff and Haidt also noticed a change starting in 2013, and, in fact, it served as the genesis of the book. It’s not clear if they noticed it independently of Twenge (or vice versa) but they both feel something significant changed on college campuses starting in 2013.

One change in particular was an obsession with safety, and not merely physical safety, but emotional safety as well, leading many to believe, according to Twenge, “one should be safe not just from car accidents and sexual assault, but from people who disagree with you.” I don’t think this has progressed to the point of also demanding safety from the disappointment on Christmas morning we started with, though recent stories about protesting in-class presentations would seem to indicate that we may be headed in that direction.

“The Coddling of the American Mind” blames all of this on the idea that there are three great untruths which have spread far and wide through the education system. This desire for safety stems from the first of these three great untruths:

The Untruth of Fragility: What doesn’t kill you makes you weaker.

On the contray, Lukianoff and Haidt argue, college students (and humans in general) are antifragile. Meaning that exposure to stress and suffering make them stronger. But this stress and suffering is exactly what the various campus movements are trying to eliminate.

That’s the first argument for the benefits of stress, the second comes from last week’s post. You may recall that I mentioned an explanation for Fermi’s Paradox called the “Galactic Stomach Ache” and said I would be talking about it “next week, though perhaps not in the form you expect.” It should hopefully be obvious now where I’m headed, but the core of the Galactic Stomach Ache argument is the same as the argument Lukianoff and Haidt are making, that an obsession with safety and reducing harm is paradoxically causing harm. Here’s how it’s explained in, The Great Silence, the book I reviewed last week:

Having removed most of the stress due to our physical and biotic environment, we have with it removed low-level beneficial stress (known as hormesis). Already, the exponentially growing economic costs of maintaining health in the face of these degenerative disorders are huge in comparison to investments in space research and exploration, not to mention utilization of extraterrestrial resources. If such treads continue and are typical, humanity could end up in a state in which almost all material resources and all creative energy are expended on the maintenance of a comfortable lifestyle free of external stressors, leading to a plateau in the development of cognition, and its subsequent diminishing.

Similar to Lukianoff and Haidt, though on a much larger scale, we once again have an argument that at a certain level stress is beneficial, and that the push to eliminate it entirely, while having certain short term benefits, will in the end, on the balance, be harmful. “Silence” doesn’t mention antifragility, but once again that’s the domain we’re in.

As longtime readers of this blog know, I am a huge advocate for antifragility, and thus it doesn’t take much to convince me of both the danger of the “Untruth of Fragility” or the strength of the “Galactic Stomach Ache” explanation. There are certainly arguments to be made about whether Lukianoff and Haidt are exaggerating things or whether they’ve left some things out. And even better arguments could be made about whether “Galactic Stomach Ache” is the explanation for Fermi’s Paradox, but I intend to proceed based on the assumption that both of them describe something that is actually happening, even if the eventual consequences are unclear. If that’s too much for you, then I would hope, at least, that we can proceed under the assumption that humans are antifragile and that stress is important for our development. If you’re still not on board then there’s probably not much point in reading the rest of this post and I would instead direct you to some of my previous posts, or, if you have the time you should just read the books of Nassim Nicholas Taleb, the person most responsible for the idea of antifragility.

If we’re all on the same page about the importance of antifragility then the next question I want to address is, “Why is it a problem now?” Certainly technology has allowed us to reduce suffering and stress from the moment hominids mastered fire. Why should it suddenly reach a tipping point five years ago? Lukianoff and Haidt’s answer is that it’s something of a perfect storm. It all starts with paranoid parenting. This front runs into a blizzard of increased polarization. All of that is bad enough and has been going on for awhile, but then coming in from the south, we have the lifestyle hurricane that is social media. This last item is the proverbial straw (to really mix metaphors) and the kids dealing with all three of these factors first arrived at college starting in 2013.

As I said Lukianoff and Haidt could be overstating how sharp this dividing line is, or how bad the problem is in general, and it’s not my intent to dive into the specifics of their argument. Also, this is just the “Coddling” side of things. The increase in degenerative diseases has been going on for a lot longer than five years. But it’s not hard to imagine a common process behind both of those, and an underlying push which gets us both paranoid parents and the rising costs of dealing with degenerative diseases.

This urge to diminish suffering and stress has been around forever, but it’s only recently that we’ve truly been close enough to eliminating it entirely that it began to seem realistic, if not ideal. Where, in other words, people began to expect it. In part this is due to the increasing power of technology, but we’ve also experienced a period of unprecedented peace and affluence as well. In the past when a mother may have lost at least one or two children to infant mortality, it’s hard to imagine that parenting would ever be so paranoid. And if granny had already lived to be 80, it’s equally hard to imagine that a family who was barely getting by as it was would want to spend any money, let alone thousands of dollars keeping her alive to 85. But at some point these expectations changed, and it had to be relatively recently. I think for a lot of things it happened so subtly that we didn’t notice it. What makes Lukianoff and Haidt’s tipping point remarkable is not that it happened, but that it was so stark when it did.

When speaking of the harm caused from eliminating all stress, and recent evidence thereof, everyone, including Lukianoff and Haidt bring up the hygiene hypothesis, which has already made at least one appearance in this blog. The theory is that in the “olden days” children were exposed to enough pathogens, parasites and microorganisms that their immune system had plenty of things to keep it occupied, but that now we live in an environment which is so sterile that the immune system, lacking actual pathogens, decides to overreact to things like peanuts. In all these cases we see evidence of harm caused by the elimination in low-level stress. The lack of hormesis mentioned in the Stomach Ache explanation, and the embrace of fragility mentioned by Lukianoff and Haidt.

Putting all of this together, the answer to the question of “Why now?” Is that we’re seeing the culmination of several trends which may have started decades ago, but have only recently become problems as a generation reached maturity, or as the impact reached a critical mass of people, or as the trend was finally translated into an expectation. There’s also the element of multiple trends all peaking and coming together at the same time, and probably feeding off each other. As I said we have been using technology to reduce suffering for hundreds of thousands of years, but only in the last couple of decades has it reached the point where it’s reasonable to expect that we can finally eliminate suffering entirely. And probably more than anything else it’s this gap between our expectations and reality which is causing most of the problems. Whether it’s college campuses or healthcare spending.

The next question is, “What should we be doing about it?” If I’m right, and the problem is essentially one of expectations, then our focus should be on changing these expectations. That’s largely the direction of Lukianoff and Haidt’s recommendations. But that may end up being a lot harder than it sounds.

One recommendation they make is for municipalities to implement “free range parenting” laws, like Utah. Obviously I’m always pleased to see a reference to my home state. And I’m in complete agreement that this is a good law, but I’m not sure it will have much of an effect. The big problem is that the law is unlikely to create more free range parents, it just offers protections for the ones who were already so inclined. For example, is there any mother out there who currently walks her kids to school, who will look at this law and decide, “Oh, I guess I should let them walk themselves to school. I was obviously being too paranoid.” I guess there might be a few, but I think the trend has already have gone too far and is too entrenched, for a new law to change the expectations of parents for how much effort they should put towards ensuring the safety of their children.

Once again, I think zeroing in on expectations is key here, and this is where being able to connect the separate instances of fragility comes in handy. Because one of the key drivers of the rise of healthcare costs has been a rise in expectations. Now this is not the only thing increasing costs, but it may be the biggest. As I already pointed out, it was not that long ago that people expected high infant mortality, and a life, that, on average, ended around 55, with anything past 70 as gravy. As technology got better expectations changed and along with them the cost of meeting those expectations. People have been worried about these rising costs since at least the time of Hillarycare, and yet of all the factors that go into rising costs, perhaps the least effort has been spent on changing expectations. Why? Probably because it’s the hardest factor to address. The small efforts which have been made have not merely been unsuccessful they’ve been spectacularly unsuccessful. There’s no quicker way to lose an election than to threaten to cut government spending on Medicare. You might also be familiar with “Death Panels”? Another example of a very strong negative reaction to the suggestion that reducing healthcare costs might entail reducing the amount of care someone actually expected to receive.

Some people may argue at this point that it’s not healthcare costs that are going to ultimately doom us, it’s the fact that we’re all turning into the overweight, hover-chair bound humans of Wall-E. And that the expectation we can eat whatever we want while being sedentary is easier to change than the expectation that we should be kept alive as long as possible regardless of the cost. The amount of effort we spend on changing these expectations certainly seems to indicate that we think this is a more pliable problem, but despite all that effort there’s no evidence of that trend reversing either.

Some people may dismiss all of the foregoing as the typical rantings of curmudgeonly old people against the dissipations of youth, and further argue that rising healthcare costs are a temporary problem, and certainly not representative of any long term existential crisis. And if that’s the case, there’s nothing I can say in this short post that will change your mind, and in any case, ultimately,  that’s not the point of the post. No, ultimately, my purpose is to examine what it looks like if we decide the world needs a certain amount of suffering.  And to argue that if we do decide that, it’s going to be very difficult to pull off. Let me give you an example of what I mean:

When I was young the start of the wilderness was a couple blocks from my house, and one of my favorite things to do was to set off towards the mountain. I was frequently accompanied by two of my cousins. Both were younger than me, one by a few months and one by a couple of years. We would be gone for hours on these excursions. A favorite destination was Eagle’s Cave. I don’t recall if you had to do any climbing to get there, but we did engage in climbing while we were out. At one point while we were climbing the older of the two cousins fell, and I have a distinct memory of him falling past me, and into the arms of his brother, who was also climbing but somehow didn’t get knocked off. I don’t know what to make of that memory at the remove of nearly forty years, but I talked to the cousin who fell recently and he remembered it exactly as I did. The “nearly forty years” is a hint, but guess how old I was. 15? 12? No the oldest I could have been was 8 because I moved from that house shortly after my 9th birthday.

This is basically exactly what Lukianoff and Haidt are advocating for right? What the advocates of the free range parenting movement are hoping for as well? You might argue that “suffering” is the wrong word to use for what I just described and what those groups are advocating for. And perhaps it is, perhaps “stressors”, or “challenges” is better, but if you don’t think my aunt would have suffered if my cousin had been injured in that fall or worse yet died, then you don’t know my aunt very well.  

Some will argue that letting kids wander into the wilderness is fine, but 8 (or in the case of my younger cousin, 6) is too young. Or that walking to school is one thing, climbing rock walls is quite another. And I totally see their point, but how do we know where to draw the line? How do we know when we have introduced enough suffering into the environment to avoid the harms Lukianoff and Haidt describe or the more theoretical crisis of the Galactic Stomach Ache? If someone says that 8 is too young they’re not basing it on some comprehensive longitudinal double blind study of outcomes based on childhood activities. They’re saying that they aren’t comfortable with 8 year olds wandering aimlessly through the wilderness, it doesn’t match what they expect, but targeting our expectations at our comfort level is exactly how we ended up in this spot.

In a sense, and this just came to me, otherwise I would have brought it up earlier, this whole problem is a supernormal stimuli problem. Evolution has programmed us to worry about our kids, and to extend our lifespan as long as possible, and to eat as much sugar and fat as we could get our hands on, because nature was such that even if we tried our best, kids were still going to undergo a lot of stress, and people were still mostly going to die young, and we were never going to eat too much sugar. But now technology has allowed us to remove most of the countervailing pressure and scarcity, so that now we can keep our kids too safe, or prolong our lives much longer but at great cost, in the same way that we can now eat way too much sugar. And of course while we can make some guess at how much sugar we should be consuming, it’s a lot more difficult to decide how much suffering we should be experiencing (do we end up setting a daily recommended allowance?)

To return to my example, I assume that today most parents would be appalled at the idea of an 8 year old wandering around in the mountains for hours, however much they were on board with the idea of free-range parenting, or providing kids with more challenges. And yet, it’s not as if this experience made me into some kind of superman. I’m still, at best, only half the man my father is (I don’t have time to get into his childhood stories, but if you think mine was appalling…) And he’d probably tell you he’s only half the man his father was. All of which is to say, if people like Lukianoff and Haidt are indeed correct about what’s happening, I’m unconvinced that a small amount of stress, or a few challenges, or a small course correction is all that’s required to fix the problem. In fact, once you combine the scale of the problem with the difficulty of reversing people’s expectations, it starts to look completely intractable. It may be best to hope that I’m wrong, and that the world doesn’t need more suffering.

If, on the other hand I’m right, then we’re really only left with one question: We’ve demonstrated the power to eliminate suffering, do we also have the wisdom to bring it back?

There is definitely a dearth of wisdom in the world, and this blog is no exception. But I have a plan to create more wisdom, if you’d like to invest in that plan (think of me like an early-stage startup) then consider donating.

How Do We Solve the Problems We Create?

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If you read many self-help books, or listen to any motivational speakers or even if you just read the occasional inspiration quote that get posted by that one friend on facebook (you know the one I’m talking about.) You start to realize that certain stories or analogies get used over and over again. One of the analogies I’ve encountered on several different occasions concerns the problems that arise when you help a chick to hatch. Here’s an example of what I mean from the blog of a licensed clinical social worker:

Some new hatchers assist emerging chicks too soon and/or too thoroughly. Anxiety at this stage is high, especially for first-timers.  They misinterpret the needs of the chick and prematurely intervene, sometimes with dire consequences. Some of these dire consequences are due directly to the well-intentioned intervention (ex: hemorrhaging due to torn membranes) and some are due to the consequences of the well-intentioned intervention (ex: the chick’s circulation wasn’t allowed to pump hard enough to allow them to warm themselves up once hatched).  The bottom line is, chicks actually need to peck their own way out of their own shell. Without the strengths developed within their struggle, they are left vulnerable to their environment.

This is true for people too.  Our life experiences (including how we respond to them) are our shells, and figuring out how to navigate them effectively prepares us to effectively navigate our world.

Perhaps you’ve encountered this analogy or maybe you haven’t, but either way, this post is going to be about the necessity of struggle, which is the kind of thing that calls for an analogy, or an inspirational story. But as usual rather than just starting with story, I have to explain the whole thing and make it complicated. In fact, as a further complication, now that I’m re-telling it, and in the process, lending the enormous credibility of my blog to the whole thing, I feel compelled to see if there’s any truth to it.

A quick search seems to indicate that it is one of those things that’s mostly true, though as with so many things there are caveats. Yes, the general recommendation is that you shouldn’t help the chick hatch. That said, it’s not an automatic death sentence for the chick if you do. It does appear that more often than not if you help it hatch it will probably later die, but that may be less about the struggle giving the chicken the necessary tools to live and more the fact that if a chick is too weak to break out of its shell that it’s probably too weak to survive period. So perhaps this isn’t the best analogy, but I’m too lazy to find another one, also if you don’t think a certain amount of  struggle is necessary then I’m honestly not sure what you’re doing here in the first place.

However, in the interests of being thorough I suppose I could spend a small amount of time trying convince those on the fence that struggle is, in fact necessary. Though I would think the chick and the shell thing would be all the proof anyone would need, particularly given how directly and unequivocally I presented it. But I suppose it’s possible it didn’t convince you.

In that case, to understand struggle, let’s start at the highest level, you’re either religious, or you’re not. If you are religious, than struggle is built in to basically all religions both doctrinally and observationally. On the other hand, if you’re not religious than natural selection is all about the struggle for survival. Outside of that, I suppose there’s a third option, where you believe in some sort doctrine-free spiritualism which doesn’t include any struggle at all, something along the lines of The Secret, but if that’s the case then let me say, and let there be no mistake about whether I’m serious, because I am, you’re an idiot. And you should go away. Meaning you’re either an idiot (and we can ignore that category because I just told them to leave.) Or you believe struggle is part of existence.

But wait, you may be saying. You claimed that struggle is necessary. Going from being part of life to being necessary is still a big leap, one which you haven’t made. Very well, for the religious, one has to assume that struggle is necessary on some level or it wouldn’t exist. For the non-religious, non-idiots, it’s a little more complicated, and in fact it is in this area where I’ll be spending most of my time.

From here on out I’m going to assume that we all agree that struggle is part of existence (the idiots having been banished) and that all that’s left is determining whether it’s actually necessary. On this point there are two ways of thinking:

Camp One: These are the people who believe that struggle is so deeply intertwined with how things work from an evolutionary standpoint, that it would be impossible to eradicate it entirely without consequences that are worse than the initial suffering. Such consequences might include, but are certainly not limited to, bodily atrophy, diseases, autoimmune disorders, apathy, depression, lack of offspring etc.

Camp Two: These are people who believe the opposite, that technology will eventually enable us to eliminate struggling (and presumably also pain and suffering and malaria and auto-play videos on websites.) They will admit that perhaps struggle is necessary now, a la the chick and the egg, or needing to exercise to stay healthy, but that it’s on it’s way out. Yes, we once lived in a world where struggle was necessary to toughen us up, develop immunities, exercise willpower, and so forth, but that all of the things which were once “powered” by struggle will eventually be powered some other way, or be done away with entirely.

I think both groups would agree that it’s worthwhile and benevolent to remove unnecessary or counterproductive struggle, and by extension unnecessary pain and suffering. The questions which divides to two are how cautious do we need to be before we declare that something is unnecessary or counterproductive and is there some line, past which, we should not proceed?

At this point you would almost certainly like an example. And one of the best known involves the recent increase in the occurrence of allergies. There are several theories for why this is happening, but almost all of them revolve around allergies being a by product of some overzealous attempts to eliminate a form of natural struggle.

The best known of these theories is the hygiene hypothesis. The idea here being that in the “olden days” children were exposed to enough pathogens, parasites and microorganisms that their immune system had plenty of things to keep it occupied, but that now we live in an environment which is so sterile that the immune system, lacking actual pathogens, decides to overreact to things like peanuts. As I said this is just one theory, but all of the alternative theories also involve the absence of some factor which humanity previously considered a struggle. Also it is interesting, speaking of peanuts, that the NIH recently reversed their recommendation from avoiding peanuts until children were at least three, to recommending that you give peanuts to kids as soon as they’re ready for solid food (approximately four months old.) Which obviously follows from this model.

As I said I’m not claiming that we know with absolute certainty that allergies are increasing because we’ve eliminated some necessary struggles. Though I will say that if that is the case, Most affected people, particularly those with the severest allergies, would trade those allergies in a heartbeat for growing up in a slightly less hygienic environment. Which I suppose makes this a point in the group one column. This is something where eliminating the struggle was not worth the tradeoff.

If this trend was limited to allergies, then I wouldn’t be writing about it, but we’re also seeing dramatic increases in the diagnosis rate of autism. And while part of this is certainly due to it being diagnosed more, almost no one thinks that this explains 100% of the increase. On top of allergies and autism, if you were following the news over the summer you may have seen a story about sperm counts halving in the last 40 years. This one is less well understood than the allergy problem, but it almost certainly represents something we’re doing to make life easier, which has the unforeseen side effect of reducing sperm counts, and by extension fertility.

These first three examples may all be genetic issues, but there are also cultural issues with modernity. For example the number of suicides and attempted suicides has skyrocketed in recent years, particularly among young people, whom you would expect to be the most impacted by recent cultural changes. Obviously there are lots of people who feel the increase comes because teens are struggling too much, but any sober assessment of historical conditions would have to conclude that this is almost certainly ridiculous. On the contrary, as I have said previously, if you remove struggle from a children’s life then you also remove the reasons why they might be unhappy. And, if after all these things are removed, they are still unhappy, the logical conclusion, since it’s nothing external, is that it has to be internal, and from that conclusion suicide can unfortunately often follow.

You may disagree with this theory, and may be it is only a temporary blip, unrelated to any of our misguided attempts to make life easier for kids, not evidence of a long term trend, but how sure are you of this, and are you willing to bet the lives of thousands of young people on whether or not you’re right?

On this last point you may be noticing some similarities to a previous post I did about the book Tribe, by Sebastian Junger. As you may or may not remember, stressful situations improved mental health. And as wars become less stressful mental health appears to be getting worse. If you don’t remember that post, this paragraph from Tribe is worth repeating:

This is not a new phenomenon: decade after decade and war after war, American combat deaths have generally dropped while disability claims have risen. Most disability claims are for medical issues and should decline with casualty rates and combat intensity, but they don’t. They are in an almost inverse relationship with one another. Soldiers in Vietnam suffered one-quarter the mortality rate of troops in World War II, for example, but filed for both physical and psychological disability compensation at a rate that was 50 percent higher… Today’s vets claim three times the number of disabilities that Vietnam vets did, despite…a casualty rate that, thank God is roughly one-third what it was in Vietnam.

As I pointed out back then, if you parse this out, Vietnam vets had a disability per casualty rate that was six times higher than World War II vets and current vets have a disability per casualty rate 54 times as high as the World War II vets. All of this is to say that there is significant evidence that making things easier (less of a struggle) doesn’t make things better.

For the most extreme view on this problem let’s turn to a response to 2016 EDGE Question of the Year, What do you consider the most interesting recent [scientific] news? What makes it important? This particular response, by John Tooby, was titled: The Race Between Genetic Meltdown and Germline Engineering. And the gist of the article is that previous to that advent of modern medicine most people died, and this was especially true of individuals with harmful genetic mutations. This is no longer the case, and thus humanity is accumulating an “unsustainable increase in genetic diseases”.

The article makes several fascinating points:

  • On the necessity of a certain number of people to die before reproducing:

For a balance to exist between mutation and selection, a critical number of offspring must die before reproduction—die because they carry an excess load of mutations.

  • On how fast this problem can escalate

Various naturalistic experiments suggest this meltdown can proceed rapidly. (Salmon raised in captivity for only a few generations were strongly outcompeted by wild salmon subject to selection.)

  • He even goes on to say that this may be the explanation of the worldwide decline in birthrates among developed nations

If humans are equipped with physiological assessment systems to detect when they are in good enough condition to conceive and raise a child, and if each successive generation bears a greater number of micro-impairments that aggregate into, say, stressed exhaustion, then the paradoxical outcome of improving public health for several generations would be ever lower birth rates. One or two children are far too few to shed incoming mutations.

This strikes me as one of those obviously true things that no one wants to think about. But it also dovetails in very well with the theme of the post, and brings up an issue central to the claims of the second group, those who believe all struggle and suffering can be eliminated through technology. In this case we know exactly how to fix the problem, it’s even in the title. We just have to master germline, or more broadly, genetic engineering. Furthermore this isn’t some hypothetical technology with no real world examples. The CRISPR revolution promises that this is something we could do very soon (if not already). The chief difficulty at this point is not in editing the genes, but in knowing what genes to edit. And I don’t want to minimize the difficulties involved in that effort, but there’s definitely nothing about the idea which seems impossible. Nearly all experts would say it’s not a matter of if, but when.

As a matter of fact mastering genetic and germline engineering would probably help with all of the examples we’ve looked at. Despite what people want to claim there’s a genetic component to nearly everything, certainly with autism, but probably also with allergies and low sperm counts and even suicide risk. In theory anything that can be treated with a pill could be treated with genetic engineering and this treatment would probably involve fewer long term side effects. At least health-wise…

So there you have it, the second group is correct, all we have to do is improve CRISPR to the point where we can genetically modify humans, do some experiments to figure out which genes do what, and the negative mutation load, and the low sperm count and the allergies and the autism, and possibly even the elevated suicide will all go away. Struggle was necessary to healthy development, but once we master the genome it won’t be, at least not for anything that can be fixed with genetics. In other words as Tooby’s title declares, we’re in a race between genetic meltdown and germline engineering. Obviously we have to win that race, but as long as we do that, everything will be fine right?

Are you sure about that? From where I sit, if we develop genetic and germline engineering of the kind Tooby is talking about, that’s not the end of our problems, it may be the end of certain specific problems, but it’s the beginning of a whole new set of problems. (Perhaps you’ve seen the movie Gattaca?)

I know that the current laws on genetic engineering are still embryonic (get it? embryonic?) But it is nevertheless true that most people already recoil at the thought of designer babies, or really anything involving modifying genes much beyond doing it as a means of curing disease. Up until this point I’ve used genetic and germline engineering somewhat interchangeably, but they are different. Germline engineering is the process of making modifications which are heritable. If you use it to make someone exceptionally strong, their children would have a greater chance of being exceptional strong as well. This is why Tooby specifically talks about a race between germline engineering and genetic meltdown, because whatever fixes you made would have to transfer for it to be of any use. One of the reasons this differentiation is important is that the US has mostly banned germline engineering, beyond this you can find countless articles debating whether it’s ethical or not.

If, despite the ban, and the ethical questions and people’s distaste at the idea of designer babies, if Tooby is to be believed, we really don’t have any choice in the matter, which means, along with solving the genetic meltdown problem we buy ourselves a whole host of new problems. Including:

Greater divisions between rich and poor: This problem is bad enough already, but toss in the ability for the rich to increase their child’s IQ and health and suddenly you’ve got gaps which no amount of affirmative action, or protests are going to fix.  Also there’s a non-trivial chance that this ends up being a positive feedback loop. With the new smarter richer groups discovering additional positive mutations to add to the mutations they already have at a faster and faster rate.

Racial problems: This is similar to above but probably even more radioactive. Radioactive enough that I don’t even want to speculate. (I’ll give you one hint: transracial.) But I’m sure you can imagine several potential scenarios where this technology makes everything a whole lot worse.

Bioweapons: If you can develop positive mutations then you can develop negative mutations, and while the delivery for those would still need to be accomplished, none of the technology makes this problem harder and it may make it a lot easier. Which takes us to our next point.

Limited Genetic Diversity: Once people start making modifications they will coalesce around certain mutations, leading to a great number of people whose genetic diversity is significantly less than the “default”. Also as we know there are some “bad” mutations which have good side effects (the classic example being sickle cell anemia.) If a disease mutated to affect one, it would be equally effective against all of them. And following from the last point that disease wouldn’t have to be natural.

Different “breeds”: At some point when this has gone on long enough (and really not even all that long) it’s not inconceivable that you could have various breeds of humans, as different from one another as great danes are from toy poodles. How the world deals with something like this is well beyond my ability to predict, but I can’t imagine that it makes things better.

The good news for Tooby, but the bad news for anyone worried about any of the above is that CRISPR is not the Manhattan Project. It doesn’t take billions of dollars and millions of man hours, it’s something you can do from home. Now germline engineering is more difficult, but not that much more so. Certainly it’s not the kind of thing the US could keep any other country from doing if they wanted to.

All of this has taken us pretty far from the topic of whether struggle is necessary, and our two groups. But if nothing else you can begin to see the complexities involved in group two’s assertion that we can eventually solve everything through technology. Yes you can help a chick hatch, but most of the time it will die. Yes, you can make war safer and less connected to the rest of life, but PTSD will go way up. Yes modern medicine can keep people alive who otherwise would have died, but their negative mutations end up in the gene pool. Yes we can solve that with Germline engineering, but that creates a whole new set of problems. Yes we can make life materially better for everyone by using fossil fuels but the resultant CO2 causes global warming.

This is a complicated subject and I am not urging a retreat to some kind of prelapsarian past. But I think we should question the idea that any struggle is bad, that technology and progress has all the answers, and that we can solve all the problems we create.

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The Cholesterol of a Healthy Society

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A couple of months ago I had breakfast with one of my blog readers and frequent commenters, Mark. At the time he mentioned something interesting, which has been percolating in the back of my mind ever since. He said that medicines get approved by the FDA based on claims that they will accomplish some terminal good. Say, for example, lowering the number of deaths due to heart disease. On top of that they will also probably toss in a general reduction of related adverse health events, like heart attacks. But when they provide data to the FDA in support of these claims it won’t be data on deaths or heart attacks it will be data on how the medicine reduces LDL cholesterol levels.

They do this for several reasons. First, cholesterol is easy to measure, and so that data is consequently easy to provide. Second, the pharmaceutical companies are reasonably certain that atherosclerosis contributes to heart disease, and that high LDL cholesterol contributes to atherosclerosis. Meaning that their claim actually has two parts. They claim that their medicine reduces LDL cholesterol, and that lowering your LDL cholesterol reduces your risk of heart disease. They are able to provide data backing up both claims, but what they don’t provide is data that shows “Our medicine reduces heart disease.” This is all fine, and working as intended, and, in fact, it’s the way I would want it to work. But, and this was the key point mentioned by Mark, after the drug is approved, the company should, at some point prove that it does actually reduce heart disease, not just LDL cholesterol. And the problem is that they generally never get around to that.

From the perspective of a patient, say someone with genetically high cholesterol, say me, for instance. The way this plays out is, you go in for your annual check-up (as I did this week) and get your cholesterol tested (ditto). Upon discovering that it’s high, the doctor prescribes a statin, because he knows that if I take a statin every night before bedtime, that my cholesterol will probably go down. Now, he will also ask whether any relatives have had heart problems, and he’ll look at other risk factors, but mostly he’s reacting to the fact that I have high cholesterol.

This all makes a certain amount of sense, and obviously my wife is very much in favor of me taking the medicine my doctor prescribes. But there’s a lot that the doctor doesn’t know. He’s only making an educated guess at my personal risk of heart disease. And he can’t say that if I decline to take statins that I will definitely have a heart attack. But he’s pretty sure there’s no downside to taking them. Of course, I’m being unfair by talking just about how it works with a single person, but even if we make it more broad, we still don’t fully understood how statins effect atherosclerotic plaques, nor is it clear whether statins do much of anything for someone as young as me, with a low risk of a having a heart attack in the next 10 years. For example this paper:

The current internationally recommended thresholds for statin therapy for primary prevention of cardiovascular disease in routine practice may be too low and may lead to overtreatment of younger people and those at low risk.

The general point I’m trying to get at is that all of us, not just doctors, are quick to substitute something easy, for something that’s more difficult. For doctors it’s substituting reducing cholesterol for reducing deaths from heart disease. It’s easy and cheap to measure cholesterol, it’s expensive and difficult to measure long term mortality from heart disease. Also, remember that the drug has already been approved, meaning even if it wasn’t difficult the pharmaceutical companies have very little incentive to conduct such studies.

Now if these substitutions mostly worked, with only a few minor errors here and there, that would be one thing, but in reality the opposite appears to be true. Health advice is constantly being overturned, or reversed. (As very humorously illustrated by this great Funny or Die Video.) And it’s not improbable to assume that 20 years from now we’ll find out that long term statin use causes some previously unsuspected negative outcome. It’s also possible that the dangers will be more subtle. Perhaps because cholesterol is easy to measure, and change, we’ll ignore paying attention to markers which are harder to measure, but ultimately more meaningful?

As I mentioned this idea has been on my mind since Mark introduced me to it. And just recently I realized that we may be doing the same thing when we assess the wellbeing of society. At the highest level, analogous to deaths from heart disease, we want a society that’s healthy. But of course deciding if a society is healthy is even harder than deciding if an individual is healthy. Right off the bat we run into conflicting standards for what constitutes health. As I’ve mentioned in the past my standard is survival. Just like the doctors don’t want their patients to die, I think it’s reasonable for society to also target deaths, and I extend that to targeting births as well. Other people disagree with this, and claim that we should be aiming for happiness instead. Fair enough, we’ll use that standard for the moment. Let’s assert, for now, that a happy society is a healthy society.

But how do you measure happiness? There are lots of studies which claim that Scandinavian countries are the happiest, but it turns out that it depends on what question you ask. An article in Scientific America claims that there are actually four ways to measure happiness:

Most commonly, you ask people to value their lives on a 0 to 10 scale. This is the method which gives us the aforementioned results of Scandinavian countries on top.

Alternatively you can ask how much positive emotion people experience, in which case suddenly Latin American countries are on top.

On the flip side of that perhaps you’re more interested in preventing negative emotions than you are in encouraging positive emotions, so you look for the country with the least depression. In that case Scandinavian countries do very poorly, but under this measure Australia looks pretty good.

Finally, we can look at the number of people who feel like their life has “an important purpose or meaning” in which case you’ll find countries in Africa at the top of the ranking. And it turns out that religion plays a fairly significant role in the creation of meaning.

Even if we assume that a happy society is a healthy society, it’s still difficult to determine what makes a society happy. In the same fashion that it’s hard to determine exactly how statins effect atherosclerotic plaques, but probably harder. However, and this was my recent insight, in the same way that doctors have decided that targeting cholesterol is the best way to mitigate heart disease, lots of people have decided that targeting material well being is the best way to create a happy society. To put it simply (maybe too simply, but close enough): as long as a nation’s per capita gross domestic product is rising the nation is healthy. Furthermore anything that contributes to that rise is good, and anything which detracts from it is bad.

As you can imagine there are lots of problems with this approach. First, as I just pointed out, there are various standards of happiness. Increasing material well-being through the mechanism of increasing the money possessed by the average individual, seems to mostly target the first one, while being only marginally connected with the other three. And even there we’re still assuming a chain of causation, very similar to the one I described for statins and heart disease, only longer.

1- Increasing per capita GDP means everyone has more money (i.e. the increase is evenly distributed.)

2- People will use this money to acquire possessions and experiences, they value.

3- Materially valuable possessions will turn out to have psychological value as well.

4- All of the foregoing will produce happiness.

5- Asking people to rate their life value on a scale from 0-10 will produce an accurate measurement of the happiness produced in step 4.

And if we decide to broaden things beyond the first metric for happiness we end up making two more connections which are even more questionable.

5- The quantifiable measurement of happiness from step 4, really is the best way to measure happiness. (Better than the other three.)

6- Happiness is the best way to measure the well being of a society.

In the same fashion as heart disease you would hope that people would move past focusing on whether someone has more or less money (i.e. cholesterol tests) and follow this chain all the way to the very end. But in a similar fashion I don’t know that they do, at least not in any systematic fashion. It’s always more straightforward to stick with things that are easy to measure than it is to figure out what really contributes to a society’s well being. It’s easy to assume that if we’re trying to ensure the well being of society that ensuring each individual’s material well being is probably close enough, particularly if you’re a materialist. (And I realize philosophical materialism is different than the common definition of materialism.) But there’s more and more evidence that material well being doesn’t produce happiness to say nothing of overall well being. In particular I think the connection between material well being and psychological well being is especially tenuous.

I have spent a lot of time in this space covering my concerns about psychological well being, and you might think there’s not much left to say, but I came across an article recently that speaks quite directly to the issue of psychological well-being, and to a lesser extent the larger issue of societal well being. It was titled The Happiness Recession, and it opens as follows:

In 2018, happiness among young adults in America fell to a record low….

We wondered whether this trend was rooted in distinct shifts in young adults’ social ties — including what The Atlantic has called “the sex recession,”…

Human beings find meaning, direction, and purpose in and through our social relationships with others. We’re happiest when our ties with others are deep and strong. And the research tells us that the ebb and flow of happiness in America is clearly linked to the quality and character of our social ties

So we investigated four indicators of sociability among today’s young adults—marriage, friendship, religious attendance, and sex—in an effort to explain the “happiness recession” among today’s young adults.

I’ll get to what they had to say about each of these four areas, but first notice that material well being doesn’t even come up. Possibly because the situation is analogous to a patient who’s cholesterol is fine, so we’re not worried about that risk factor, but it turns out they smoke. Or possibly the situation is analogous to discovering that we’ve been targeting cholesterol all this time and really we should have been targeting four different things, that cholesterol doesn’t matter at all. In any case regardless of whether the recommendations were wrong or just incomplete, it appears that we need to broaden our treatment regimen, and look into different “medicines”.

The first thing they suggest looking at is marriage. It’s interesting that marriage is not an example of a measurement that’s difficult to make, it’s almost certainly easier to tell if someone is married than it is to determine what their financial situation is. Determining the happiness of their marriage is another matter, and I’m sure it’s a factor, but even without accounting for it The Atlantic reports that:

…married young adults are about 75 percent more likely to report that they are very happy, compared with their peers who are not married, according to our analysis of the GSS, a nationally representative survey conducted by NORC at the University of Chicago. As it turns out, the share of young adults who are married has fallen from 59 percent in 1972 to 28 percent in 2018.

As I said, marriage is easy to measure, but perhaps, if there is a problem, it’s less easy to correct. Especially in an age where any suggestion that you’re interfering with someone’s autonomy, particularly in the realm of sex and relationships, is met with violent pushback. As a result it’s one of those things that conservatives talk about all the time, but which gets no attention from the left. (Or perhaps it gets negative attention?)

It can be dangerous to talk too broadly about what a group of people does or doesn’t believe or how they might behave, so in the interest of specificity, at this point I’m going to bring in Steven Pinker’s book Enlightenment Now. Which I “reviewed” previously in this space. As you may or may not recall Pinker set out to create the definitive work showing how great things are currently and how they are likely to only get better, and when I talk about an overemphasis on material progress I largely have him and people like him in mind. In support of my assumption I went back to the book to see what he had said about marriage. It was entirely possible that he mentioned its role in wellbeing and had different data showing that it wasn’t decreasing as much as claimed or that the effect of a lower marriage rate was overstated. As it turns out the word marriage doesn’t even appear in the index. (Note that Louis C.K. and Jainism do, lest you think that perhaps it isn’t comprehensive.)

The Atlantic next moves on to religion. Where they say:

Faith was the second factor. Young adults who attend religious services more than once a month are about 40 percent more likely to report that they are very happy, compared with their peers who are not religious at all, according to our analysis of the GSS. (People with very infrequent religious attendance are even less happy than never-attenders; in terms of happiness, a little religion is worse than none.) What’s happening to religious attendance among young adults today? The share of young adults who attend religious services more than monthly has fallen from 38 percent in 1972 to 27 percent in 2018, even as the share who never attend has risen rapidly.

I confess that this decline is less than I expected, but it’s still declining and the trend shows no signs of reversing itself anytime soon. And once again the decline of religion is something conservatives worry about obsessively, but which Pinker and company actively celebrate. (“Decline of religion” does appear in the index of Enlightenment Now, where it points to more than a dozen laudatory references under the heading of secularization.)

Religion is also something which has next to nothing to do with material well-being, and may in fact be the exact opposite. Once again, in our attempts to improve societal well being are we sure we’re measuring and treating the right thing?

From there The Atlantic moves on to friendship. And here the news is actually good:

The third factor was friendship. The effect of seeing friends frequently is less clear than that of marriage or religion, but young adults who see their friends regularly do seem to be about 10 percent more likely to report being very happy than their less-sociable peers. Friendship among young adults, though, is not on the decline; in fact, since 2006, contact with friends is up. Lack of friendship, then, is not likely to play a role in declining levels of happiness. Indeed, it may be that rising social time spent with friends in recent years could be buffering young adults from the declines in institutions such as marriage or religion, as friends stand in place of other relationships or forms of community.

As I said the news is good, but there are a host of caveats here. First as compared to the 40% increase in the number of people reporting they were happy attributable to religious attendance and the 75% increase from marriage, friendship provides a bump of only 10%. Thus whatever the “buffering” effect of friendship it would appear entirely too small to make-up for the other trends. Also even if it was up to the task, it then becomes a single point of failure. Where previously most people had marriage, religion and friendship in their life, and therefore two things to fall back on if any one of these three failed. Now, by relying solely on friendship, which appears unequal to the task in any event, we risk having nothing to fall back on if friendship should happen to fails. If this failure mode was unlikely, then perhaps we wouldn’t worry, but instead, on top of everything else there’s an epidemic of loneliness, with millions of men reportedly having no close friends.

I should also mention that once again that the word “friend” does not appear in the index for Enlightenment Now.

The final element covered by The Atlantic is the sex recession. Of which much has been said both here and elsewhere, probably because it’s so alarming, and this article was no exception. As part of their coverage they built a counterfactual to see if they could tell how much each element contributed to the reduction in happiness, as far as sex they found:

…changes in sexual frequency can account for about one-third of the decline in happiness since 2012 and almost 100 percent of the decline in happiness since 2014.

This is another illustration of how steep the trend is and how recent in origin, which makes me hope that it’s very temporary because if it continues for very long at all the impact will be nothing short of catastrophic. Also, though at this point it probably goes without saying, there is no reference to sexual frequency in Enlightenment Now.

The point I want to leave you with is that there are a lot of people like Steven Pinker, who think society is healthy, and point to material well being (essentially per capita GDP) as the best measure of that healthiness and also the best thing to target if there’s a problem. But it’s worth asking if that’s all there is to it. To ask how solid the links are between the various steps I listed above. If perhaps there’s some other measurement of happiness, like marriage rate, or religion or even frequency of sex which might be a more accurate measure of societal well being? Or at least need to be considered as part of a more holistic assessment. Now I know I’m simplifying Pinker’s argument to a certain extent, but also remember that in over 500 pages on how great things are going he never mentions marriage or sexual frequency, or for that matter loneliness and he only mentions religion in a negative context, despite the apparently powerful influence all of those have on people’s happiness.

To return to comparing societal health to individual health, which is actually easier to understand? I can only assume the answer has to be individual health. And yet how often have doctor’s ended up giving the wrong advice? Should that not make us more humble when it comes to making declarations about what makes a society healthy? Especially when we’re discussing the long term effects of some new, entirely unprecedented norm? Norms which seem to be proliferating at a truly staggering rate?

I not only have high cholesterol, I have high blood pressure, though they both appear to be mostly genetic. Nevertheless they could mean my early demise. If that happens and you haven’t donated, you’ll feel bad. If you want to avoid that click here.