Pacific Standard July/August 2016 by James Darnborough

PACIFIC STANDARD

Special Report: The Addicted Generation PLUS:

AT SEA WITH A SEARCH-AND-RESCUE MISSION IN THE MEDITERRANEAN. P.46

“A SOCIETY THAT HAS MORE JUSTICE IS A SOCIETY THAT NEEDS LESS CHARITY.” —RALPH NADER

▼ PRAY AWAY THE GAY THE DANGER OF EX-GAY CONVERSION THERAPY. P.64 CONFLAGRATIONS A STORY OF MOTHERHOOD, MENTAL ILLNESS, AND A PLANET ON FIRE. P.56

STORIES THAT MATTER JULY/AUGUST 2016 PSMAG.COM

•••

An election season conversation with America's No. 1 public-interest crusader. P.32

JULY/AUGUST 2016 PSMAG.COM

the PS INTERVIEW with

Ralph Nader

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An estimated 5,000 Eritreans per month are heading north across the Sahara to Libya’s Mediterranean coast, where they board rickety boats bound for Italy. P.46

JULY/AUGUST 2016 • PSMAG.COM

EDITOR-IN-CHIEF

Nicholas Jackson CREATIVE DIRECTOR

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Pacific Standard (ISSN 21655197) is published bimonthly by the Miller-McCune Center for Research, Media, and Public Policy, 801 Garden Street, Suite 101, Santa Barbara, CA 93101. Periodicals Preferred postage paid at Santa Barbara, California, and additional mailing offices. Postmaster: Send address changes to Pacific Standard, P.O. Box 16026, North Hollywood, CA 91615. Subscriptions available at psmag@pubservice.com or mail to: P.O. Box 16026, North Hollywood, CA 91615. One year (six issues) $24.95. Please add $12 for subscriptions outside the U.S. and Canada. Printed by QuadGraphics. Pacific Standard™ is a trademark of the Miller-McCune Center for Research, Media, and Public Policy. All contents copyright © 2016 Miller-McCune Center for Research, Media, and Public Policy.

JULY/AUGUST 2016 • PSMAG.COM

CONTENTS

JULY/AUGUST 2016

FEATURES

VOLUME 09, NUMBER 04

THE BABY BLUES “The moods grew more extreme as the pregnancy progressed. I did not understand what was happening.” Photo by Matthew D’Annunzio

THE PS INTERVIEW: “AMERICA YOU ARE ASLEEP” An election season conversation with the nation’s No. 1 public-interest crusader, Ralph Nader. By Lydia DePillis

THE ADDICTED GENERATION Did we fail our kids by relying on prescription medication to treat ADHD? By Madeleine Thomas

PHOTO ESSAY: ADRIFT An unprecedented number of refugees are boarding unseaworthy vessels for a dangerous crossing of the Mediterranean. Photographs by Francesco Zizola

CONFLAGRATIONS A story of motherhood, mental illness, and a planet on fire. By Amy Irvine

JULY/AUGUST 2016 • PSMAG.COM

CONTENTS

JULY/AUGUST 2016

DEPARTMENTS

VOLUME 09, NUMBER 04

PRIMER

06 LETTER FROM THE EDITOR Introducing the New Pacific Standard 07 THE CONVERSATION 09 SINCE WE LAST SPOKE

IN THE PICTURE BY JOEY O'LOUGHLIN; FIELD NOTES BY BENJAMIN LOWY; THE CULTURE PAGES BY THE BOAT

17 SUBCULTURE End-of-Life Doulas

26 SAVING DEVELOPMENT AID WITH SCIENCE The case for a data-driven approach to curbing global poverty. 29

11 THE SMALL STUFF 14 KNOW IT ALL The New and Complex Face of Evangelical Christianity in American Politics

THE FIX

NOT JUST A DEADBEAT DAD A pilot model for child support enforcement that relies more on carrots than on sticks is working better than anything we’ve seen before.

THE CULTURE PAGES

18 IN THE PICTURE On the Couch

FIELD NOTES

64 CULTURE FEATURE Survival Tales From the Ex-Gay Movement

21 THE HUNGARIAN CANDIDATE

66 PACIFIC STANDARD PICKS Life, Animated

22 A PAUSE IN THE PROTEST

67 GUEST PROGRAMMER Joelle Dobrow

24 THE HIP-HOP PROFESSOR

68 CULTURE SCENE Inside Cambodia’s Floating Arts Center 69 BOOK REVIEW White Capital, Black Labor 70 SHELF HELP The Selfishness of Others

ON THE COVER Model Brook Toreno poses for photographer Christopher Leaman in Los Angeles.

70 CULTURE SCENE A Literary Festival in the Shadow of Genocide 71 SHELF HELP Killing the Competition 72 ONE LAST THING The Prison Tattoo JULY/AUGUST 2016 • PSMAG.COM

Introducing the New Pacific Standard This issue marks my first full year as editor-in-chief of Pacific Standard. While I’ve been with the magazine for years, first helping to expand our Web presence and the impact we could have through daily journalism and reporting, it’s only over the past 12 months that I have come to learn what readers want and expect from us in a bimonthly print format. This is a medium we remain committed to, but a medium that is, in the larger industry, struggling. As other publishers were moving resources from print to Web, we put our heads down nine months ago to think through how we could make a magazine worth printing in 2016. Throughout the fall and winter, the Pacific Standard team gathered in coffee shops and conference rooms to completely make over this object before you. We began by re-considering and re-affirming those things that set us apart from all the other outlets vying for your support and attention, and then we rolled up our sleeves and overhauled the magazine page by page. The result is an all-new reader experience: a distinctive and compelling combination of stories that matter with visuals that beckon. We’ve finetuned your favorite niches, created several new sections and departments, expanded the number of pages reserved for top-shelf longform features, and introduced interviews and photo essays into the mix. You’ll find the first of these—a wide-ranging conversation with Ralph Nader, and a photo essay tracing the work of a ship in the Aegean Sea rescuing refugees fleeing dictatorships, famine, and civil war—in this issue’s feature well. The new Pacific Standard is at once bold, classy, and indispensible—equally at home in your beach bag or on your coffee table. With this new format—and on the re-designed PSmag.com—we’re doubling down on our mission to combine research with narrative and investigative Pacific Standard’s editorial reporting, telling stories across platforms about society’s biggest team meets to discuss ideas for the upcoming problems and the people attempting to solve them. Whether you September/October issue, think we’ve missed the mark, or you want to let us know what we which will include a special report on food. should be doing more of, we welcome your feedback. We aspire to be a go-to destination for concerned and civically engaged citizens interested in improving both private behavior and public policy to promote a more fair and equitable world. We can’t do that without you.

Seven Things You Would Have Learned If You Read PSmag.com 1

The National Hockey League contributes as much to global warming as 50,000 houses.

Donald Trump speaks beneath a sixth-grade level.

In 2015, more journalists were harmed in Mexico than in any other year.

Popular songs present “mainly negative representations” of aging.

Thirty-nine percent of Americans think divorce is a good answer to intractable marital problems.

Pit bulls stay in shelters three times longer than similarlooking dogs that aren’t labeled by breed.

Nicholas Jackson Editor-In-Chief

JULY/AUGUST 2016 • PSMAG.COM

Nearly 18 percent of all conservation papers focus on the United States.

SEVEN THINGS BY ISTOCKPHOTO

LETTER FROM THE EDITOR

TALK TO US LETTERS@PSMAG.COM

THE CONVERSATION

PRIMER

elty to a problematic degree and are so prestigious that the competition to publish there is destructively fierce.”

Our Favorite Tweets @JohnBranchNYT: I’m such a fan of @evaholland. Is the Northwest Passage the next hot cruise destination? So well done.

The Youngest Casualties in the War on Obesity (MARCH/APRIL 2016)

MAGAZINE BY JOE TORENO; INSTAGRAM BY JOSH MANOLES

Jennifer Strange wrote on Twitter: “Plz read this to the end. Awesome reporting. The Iowa girl who refused to be weighed in public at school = my new hero.”

old anti-GMO advocate. Given the lack of evidence for GMO harm, and fraudulent studies presented by its opponents, how does this award square with your underlying theme of rational and evidence-based policymaking? —ERIC DURBROW

Here’s How We Can Improve Weight-Loss Research

How Journalists Can Help Hold Scientists Accountable

(PSMAG.COM, APRIL 7)

(PSMAG.COM, MARCH 22)

There’s one more thing “obesity” researchers could do: Make sure their studies include follow-ups of at least five years. The vast majority of people re-gain weight between three and five years; the majority of weight-loss studies only go out a year or 18 months, two years tops. No wonder there’s a huge disconnect between what the research says and what real human beings experience. —HARRIET BROWN

Thirty Under 30 (MARCH/APRIL 2016)

I read Pacific Standard because it applies science to help solve or reduce national and international problems. I was taken aback by the award to a 16-year-

Michael Schulson wrote about how science journalists are failing to keep scientists in check in the wake of scandals and debates about the field’s funding sources and methodology. At Medium, Brandon Keim responded to Schulson’s article, writing that it “contained a few valuable ideas ... embedded in a lot of sloppy thinking and misleading examples.” He continued: “The reproducibility crisis isn’t about the entirety of science; it’s mostly about areas of social science and biomedical research. And within the latter field, the problems are not evenly distributed, but most manifest in all-star journals like Science and Nature, which reward nov-

@ben_a_goldfarb: Really enjoyed @evaholland’s opus on cruising through the NW Passage. @JennyWoodman: Must read from @PacificStand on plight of Quinault ppl “Someday, it will all be under water.” @britschulte: Read every word. This is so true. Another powerful piece from @melissagira, “All Bodies, No Selves.”

•••

On Instagram

A behind-the-scenes look at @joetoreno’s shoot of the Los Angeles River from the previous issue.

Writing on her personal website, the freelance journalist Diana Crow noted: “Presenting us science reporters as if we aren’t well aware that economics and politics shape—and often warp—science DISTRACTS from the conversation about why science news coverage is the way it is.... I would love to be more able to discuss potential red flags that I see in studies with my editors, but there are a lot of constraints that restrict writers’ ability to do that, especially early in their careers.” Schulson’s article also generated a lot of ire, debate, and praise from science journalists on Twitter: Ramin Skibba said: “Excellent discussion of the challenges of science research and investigative science journalism.” The science writer David Dobbs (author of “The Social Life of Genes,” September/ October 2013) wrote: “I ... propose that it’s possible for a steaming pile to point in the right direction.” Azmat Khan, an investigative reporter, wrote: “Science has politics. Science has money. Science has scandals. Brutal but necessary honesty abt science journalism.” From BuzzFeed News’ Virginia Hughes: “Does everyone really disagree with the psmag piece as much as they claim to? Yes, painted [with a] broad brush, but is pointing to a real problem.” JULY/AUGUST 2016 • PSMAG.COM

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THE TRUST FOR PUBLIC LAND

PRIMER

SINCE WE LAST SPOKE

The Sex Offender Kids Are All Right

PHOTO BY JOHN GIBBONS

There’s a surprising new trend in sex offender management: empathy. In Pacific Standard’s March/April 2015 issue (“The Outcast at the Gate”), Alastair Gee wrote about social service organizations in California focused on re-integrating offenders into society post-imprisonment to offset the unemployment and recidivism exacerbated by laws restricting where offenders can live. Gee wrote of the approach, which is also gaining traction in Minnesota, that the aim is “to encourage people to avoid re-offending not because they are afraid of the legal consequences, but because they recognize the harm their actions can cause others and themselves.” For The New Yorker

NEW TWISTS ON PAST STORIES

in March, investigative reporter Sarah Stillman wrote about the growing number of parents and child development experts pushing for less-punitive treatment programs for juvenile offenders. Researchers told Stillman that children who commit sex crimes usually do not re-offend—they may simply have been too young to comprehend the harm their initial abuse could cause their victims. —KATE WHEELING

Defense, Still Resting Last November for PSmag. com, the journalist Steven Hsieh highlighted the overwhelming number of people facing criminal charges in St. Louis who aren’t assigned public defenders (“Who Gets a Public Defender?”). “The right to counsel is enshrined in the Constitution,” Hsieh wrote, “but the question of who exactly enjoys that right has been subject to more than a half century of arbitration.” The crisis isn’t

confined to St. Louis, as a New Orleans judge made clear in an April ruling that ordered the release of seven jail inmates accused of violent crimes due to the state’s failure to adequately fund its public defender programs. (The state is appealing the judge’s ruling.) Louisiana’s budget woes have led to understaffing in the program and long waits for low-income defendants, who are guaranteed legal counsel by a 1963 Supreme Court ruling. —JULIE MORSE

Talking Politics In our January/February 2014 issue, political scientists Lynn Vavreck and John Sides questioned the popular narrative around President Barack Obama’s 2012 re-election: that Big Data fueled his victory (“Obama’s Not-So-Big Data”). Glowing analyses of Obama’s campaign had highlighted its use of huge consumer-data troves, used to tailor social-media advertisements for specific voters. But Jeremy Bird, the campaign’s field director, cautioned against viewing data-based, digital campaigning as a truly revolutionary counterpart to traditional canvassing. A new study backs up Bird’s thinking: Researchers found that door-to-door conversations reduced transphobia among Miami residents. These conversations are successful when canvassers “connect with voters at the door on a personal level,” according to Bird, now a Hillary Clinton adviser. Successful campaigning, then, sometimes means going beyond Big Data to build authentic connections with voters. —ELENA GOORAY

JULY/AUGUST 2016 • PSMAG.COM

SHANE PARSONS, WOUNDED VETERAN

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NEWS & NOTES ON HUMAN BEHAVIOR

THE SMALL STUFF

PRIMER

QUICK STUDY

When Outsourcing Turns Deadly

THERE’S A NAME FOR THAT

WILLPOWER PARADOX

HAVE YOU EVER TRIED to motivate yourself—to improve your diet, say—with con-

fident bluster? I will quit carbs! Or: I will bike to work instead of drive! I will stop rolling my eyes at the yoga instructor! It turns out making such self-assured pronouncements might not be the best inspiration. Instead of I will, you might try something a little more speculative: Will I? A 2010 study led by the psychologist Ibrahim Senay compared the impact of declarative (I will) and interrogative (Will I?) self-talk. Participants who prepared to solve an anagram problem by thinking about whether they would work through it outperformed those who simply resolved that they would. Similarly, those who prepared by writing Will I? outperformed those who wrote I will. Writing in Scientific American, the journalist Wray Herbert took the study as proof of a “willpower paradox,” in which focusing directly on your goal—Herbert uses the example of recovering from alcohol addiction—could be less effective than asking questions about how you might achieve it. But why? A large body of research indicates that internal motivations (like pride in a job well done, or a sense of purpose) are more effective than external ones (like gold stars or demerits from your teacher). Senay theorized that questions—which, by their nature, prompt answers—might send people’s minds, however subconsciously, on the prowl for internal motivations. Indeed, in another variation of the experiment, participants who wrote Will I? not only expressed stronger intentions to exercise during the following week, but also reported stronger internal motives. So, next time you want something—even from yourself—consider asking a question, rather than giving an order.

Hospitals have taken steps in recent years to reduce the number of patients who get infections during their stay, including a renewed emphasis on hand washing. Research points to another, less-obvious remedy: Hospitals could stop outsourcing their cleaning staffs. A research team led by Adam Seth Litwin of Cornell University examined rates of a particularly nasty hospital-acquired infection, Clostridium difficile, in general acute-care hospitals in California. They found that the number of such cases “increases with the amount of outsourcing,” with hospitals that outsource half their cleaning staff experiencing double the number of cases of those that have all such employees on their own payroll. Cleaners employed by a contractor are more likely to be “under-rewarded, undertrained, and detached from the organization, and the rest of the care team,” the researchers write in the Industrial and Labor Relations Review. An unmotivated custodian is a superbug’s best friend. —TOM JACOBS

—PETER C. BAKER ILLUSTRATIONS BY ELIAS STEIN

JULY/AUGUST 2016 • PSMAG.COM

DISCOVER A FRESH PERSPECTIVE ON GREEN TEA

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PRIMER

RESEARCH GONE WILD

EVERY EAT-THISTO-LOSEWEIGHT STUDY EVER

NEWS & NOTES ON HUMAN BEHAVIOR

THE SMALL STUFF

•What Was Said

“Berries, Apples May Aid Weight Loss,” “Vitamin E Could Protect Against Liver Cancer,” “Eating Chocolate ‘Improves Brain Function’”—you’ve seen the headlines; maybe you’ve clicked on some of them. These stories often cite studies from observational epidemiology that use one of a few large-scale surveys tracking people’s diets alongside outcomes like weight change.

•The Problem With That

These data sets, like the National Health and Nutrition Examination Survey and the Nurses’ Health Study, routinely get mined by hundreds of scientist teams. John Ioannidis, a doctor who studies research accuracy at Stanford University, thinks this approach produces too much fool’s gold. “You’re practically doomed to get false positives, if you run enough analyses,” says Ioannidis of so many scientists quarrying in the

same data. If 100 teams analyze the same large survey for associations between a single alleged superfood (Kale! Açai berries!) and weight loss, for example, the standard five percent margin of error used for many science studies means five positive results will be the result of chance.

•What to Do About It

Ioannidis proposes a bold solution. Instead of rewarding survey projects with funding for spawning hundreds of studies, stop funding one-nutrient observational epidemiology altogether. We’d be better off devoting more research dollars and time to fewer, better-designed studies, he argued in an op-ed published in the journal Obesity in April. It’s hard enough to figure out what works to lose weight and keep it off. Trimming the research of barely helpful, potentially flawed studies could make this journey a little easier.

—FRANCIE DIEP

OVERHEARD

I THINK HE DID IT BECAUSE HE IS MEXICAN AND MEXICAN MEN TAKE WHAT THEY WANT.”

QUICK STUDY

Stand Your Ground, Raise Your Crime Rate? Since 2000, 25 states have passed “Stand Your Ground” laws, which give citizens who feel physically threatened the right to defend themselves with lethal force—wherever they happen to be. A recent analysis of crime rates by Mark Gius of Quinnipiac University finds the results are troubling. First, he writes in The Social Science Journal, “Stand Your Ground” states have crime rates that are either higher, or not significantly different, from other states. But more startlingly, after analyzing three decades of data, he found these statutes “result in an increase in murder, gunrelated murder, rape, and robbery.” Precisely why is unclear, but he offers one possible explanation: As more people feel they have the right to take violent action in tense situations, “minor altercations may be escalating into killings.” “Clearly,” Gius concludes, “society does not benefit when a public policy results in more crime and death.” —TOM JACOBS

—JUROR “H.C.” in Miguel Angel Pena-Rodriguez vs. Colorado, according to affidavits filed

by two fellow jurors. A 2012 study of nearly 800 Florida trials found that juries drawn from all-white pools were 16 percent more likely to convict minority defendants than white defendants. The presence of just one minority in a jury pool equalized conviction rates. The authors speculate this is because prosecutors who veto minority candidates don’t have any vetoes left for white candidates that they believe are unlikely to convict. ILLUSTRATION BY ELIAS STEIN

JULY/AUGUST 2016 • PSMAG.COM

PRIMER

KNOW IT ALL

The New and Complex Face of Evangelical Christianity in American Politics

BIBLE AS THE LAW

With some megachurches accepting gays, and Millennials spreading the gospel in increasing numbers, it’s time for a fresh look at what it means to be evangelical in America. BY LAURA TURNER

EVANGELICALS ARE NO LONGER the reliable

right-wing voting bloc they once were. With the decline of the Moral Majority, the framework for evangelical participation in public life is shifting, and the splintering of this group—25.4 percent of the United States—means that its influence will be felt in new and surprising ways. Meanwhile, the definition of “evangelical” is more expansive than we often acknowledge. It can refer to someone who places great import on the moment of religious conversion. It can mean someone who believes sharing their faith is the ultimate goal of their life. It can mean someone who believes Jesus will return to Earth. It used to be the case that “evangelical” referred to a largely white, politically homogenous group of people. Now, the group is growing in ethnic diversity. Latinos make up 11 percent of evangelicals in America, and they are coming from Pentecostal and charismatic backgrounds. And, while some black Christians are reticent to identify as evangelical because the label doesn’t necessarily correspond with their voting habits, they do place a premium on sharing their faith and emphasizing conversion, two central elements in any definition of evangelicalism. From Israel to the economy, gay issues to green, evangelical communities are evolving— even as we continue to treat this heterogeneous group as a monolith. Here’s all you need to know. 14

JULY/AUGUST 2016 • PSMAG.COM

73%

Portion of evangelical leaders in the U.S. who oppose making the Bible the law of the land.

Ronald Reagan’s declaration that “within the covers of the Bible are all the answers for all the problems men face” wouldn’t resonate among today’s leaders. It’s not that politicians don’t still appeal to the Good Book for their decisionmaking, but they are aware that we live in a more pluralistic society than ever. People with no religious affiliation are a fastgrowing group, representing one-third of the population under 30 in the U.S. As the relationship between evangelicals and the Republican Party grows more complex, church leaders are recognizing that the Bible

belongs more in sanctuaries than at the Capitol. Yet there are still evangelicals who see the Bible as having been codified in government from the beginning: “I don’t believe America is a Christian nation, but it was certainly founded on Christian principles,” says Karen Swallow Prior, professor of English at Liberty University, an evangelical school founded by Jerry Falwell. “The laws of the Bible that concern loving our neighbor are already written into U.S. laws. I believe that the Constitution contains within it sufficient Biblical principles for our nation to be a just and good nation for all people.”

YOUNG EVANGELICALS

65%

Portion of evangelical Millennials in 2013 who said they regularly share their faith with others, compared with 56 percent in 2010.

The practice of evangelism is on the rise among younger people. Almost every other age group—excepting those age 68 and older, who raised the number by an insignificant 1 percent—professed a decline in the importance they place on sharing their faith between 2010 and 2013. But the practice of evangelism, a.k.a. proselytizing, doesn’t vary only by age; it also varies by income. The same survey showed that individuals with low incomes (under $39,000 annually) are the most likely of any income bracket to share their faith. Proselytizing by those in the middle-income bracket ($40,000 to $60,000) has declined from 51 percent of evangelical adults in 2010 to 37 percent in 2013. Moreover, while evangelism is practiced more by Millennials than by their aging counterparts, Millennials make up a smaller percentage of evangelical Christians than Gen-Xers and Baby Boomers. The future of evangelical Christianity is passionate, but it is also shrinking—and growing older by the day. PHOTO BY CHRISTOPHER GRIFFITH

THE COMPLETE GUIDE TO OUR MOST IMPORTANT STORIES

RACE

The infusion of Latinos into evangelical churches has significant consequences, and the move is happening quickly: Latinos are the fastest-growing group within evangelicals. What does that mean for the future of evangelicalism? When it comes to voting, “I hope that we have diverse churches,” says the Reverend Dr. Gabriel Salguero, president of the National Latino Evangelical Coalition. “Because we’re Latino, people think we’re Democrats; because we’re evangelical, people think we’re Republican.” But Latino evangelicals defy easy party labels, having constituted key majorities in the elections of George W. Bush and Barack Obama. As Salguero noted, “We’re the quintessential independent voter because we have high priorities around social conservatism— Hispanic evangelicals tend to be socially conservative on issues of marriage and life and all that—but progressive on issues of economics, housing, and immigration.” The changing face of evangelicalism in America is Latino.

Because we’re Latino, people think we’re Democrats; because we’re evangelical, people think we’re Republican.” ILLUSTRATIONS BY JASON SOLO

SEXUALITY

There are four large evangelical churches in the U.S. that now explicitly accept LGBT people as members. Embracing the LGBT community is a significant move within evangelicalism, which has traditionally held that

any non-heterosexual expression of desire is a sin. As that belief changes, this growing acceptance is reflective of attitudes writ large: In 2001, the Pew Research Center found that only 13 percent of white evangelical Protestants supported gay marriage; by 2015, the number had risen to 24 percent. For these churches, changing their position on sexuality is not an exception to faith, but a result of it. “We were thrust by a divine wind into a ... careful and hopeful conversation regarding sexual orientation,” Pastor Stan Mitchell preached to his congregation at GracePointe in January 2015.

ENVIRONMENT

Not everything is trending leftward in evangelical Christianity. In 2007, 35 percent of evangelicals believed that environmental regulations were not worth the economic damage they did, agreeing with the statement that “stricter environmental laws and regulations

cost too many jobs and hurt the economy.” Seven years later, 48 percent agreed. Even as “creation care,” a movement within Christianity to protect the Earth and focus on sustainability, has grown more popular in recent years, fewer evangelicals think the national cost of protecting the

environment is a smart move. You could credit this reluctance to the cyclical effect: the idea that the national mood shifts depending on who is in the White House. But there are a number of other factors at play, including a recent poll finding that 77 percent of white evangelical Protestants

believe the severity of recent natural disasters could be attributed to Biblical “end times,” and 64 percent of white evangelicals prefer a small government over a large one, which would presumably include opposing what they see as governmental overreach in the environment.

THE ISRAEL QUESTION

Forty-six percent of white evangelicals say the U.S. is not sufficiently supportive of Israel, compared with only 31 percent of American Jews. Israel has always held a special place in evangelical theology. Even though Jews and Christians disagree about the divinity of Jesus, support for Israel has long been a central tenet of evangelical Christianity in America. In 1998, Jerry Falwell, an architect of the Moral Majority and the founder of Liberty University, worked with Israeli Prime Minister Benjamin Netanyahu to mobilize evangelical churches to oppose the expansion of Palestine. Drawing its name from a passage in the book of Isaiah, a program called On Wings of Eagles (established by the International Fellowship of Christians and Jews) provides assistance for Jews who live in embattled, anti-Semitic environments and helps them re-settle in Israel. Since 2010, a group of evangelical Christians living in Palestine has held a biennial conference called Christ at the Checkpoint. Meant to address the Israel-Palestine conflict with sympathy for both sides, Christ at the Checkpoint and its supporters have come under fire from conservative American evangelicals and Messianic Jews living in Israel, who bridle at anything less than unquestioning, vociferous support for the Israeli cause. JULY/AUGUST 2016 • PSMAG.COM

PRIMER

SUBCULTURE

BEHAVIORS, RITES & RITUALS

End-of-Life Doulas

Deanna Cochran, 55, Austin, Texas, end-of-life doula, hospice nurse, and founder of the End of Life Practitioners Collective (as told to Elena Gooray) PHOTO BY JODY HORTON

NEW TECHNOLOGIES and medicines help us live longer than ever, but there’s a growing recognition that they don’t help us arrange for a more accepting, humane death. As the surgeon and bestselling author Atul Gawande wrote in 2014 of our reliance on dignity-sapping, scorched-earth treatments to stave off the inevitable: “This experiment of making mortality a medical experience is just decades old…. And the evidence is it is failing.” That’s where end-of-life doulas come in: They help the terminally ill and their loved ones coordinate living arrangements, meetings, and medical care. At best, they help patients and families find the language to discuss the inevitable. And their numbers are growing. Maybe I’m not your typical death worker, but I enjoy life. I still honor my own grief and sadness and whine about them like everybody else. But I have to be proactive about my healing so that I can help.

COMPOSITE WORK BY CREATIVE EQUATION

Our popular culture is very death-phobic. People feel very free when they finally get to talk about death—like it’s a taboo that they get to go and explore. There’s a lot of intensity and catharsis and giggling, like, “Ooh, we get to talk about this.” I am always thinking about death. Everywhere I go, I’m talking about somebody’s death. At the grocery store, the checkout person is telling me about someone dying, or their own illness. I don’t know how that happens. If you get a terminal diagnosis and decide you’d rather take a cross-country trip or go to Disneyland, why feel like you’re suicidal for doing that instead of going through more treatment? I encourage my daughters to come with me to hospitals or funerals, if they want to. One daughter likes to do it, the

other doesn’t. I won’t push them. They do know they’re going to do a home funeral for me. We just talk about it as if it’s “What are we having for dinner?” We have an issue with dependency on all our innovations and technology to keep us alive. We are built to survive. But if we’re going to be making these choices to live at all costs, we also need medicine that’s going to give us the most peace. That’s palliative care. I have all of my feel-good stuff for my own death written down. I want light, I want sun. I want people there. I don’t want it to be so sacred people are afraid to open their mouths. I want them to laugh. I would love to be sung to. I’ve seen so much death and how unfair it can be. When you see enough of that, you realize every moment you are breathing and comfortable is beautiful. You say sorry, you ask for forgiveness, you live this moment, and you think of the next one as “How do I really want to spend this time?” JULY/AUGUST 2016 • PSMAG.COM

IN THE PICTURE

PRIMER

On the Couch

Bay Ridge, Brooklyn AT THE HEIGHT

of a reading craze in the late 1700s, one scholar warned that too much reading could cause “colds, headaches, weakening of the eyes, heat rashes, gout, arthritis, hemorrhoids, asthma, apoplexy,” and other maladies. •••

A 2009 study

found that pre-

JULY/AUGUST 2016 • PSMAG.COM

school children who scored in the top 10 percent on language tests had conversations with their parents that involved 18 more turns—statements or questions that elicited a response, as opposed to commands—per hour than children who scored in the bottom 90 percent. •••

THIS MAY be why

hearing more words in childhood correlates

with better language skills later in life. “As the number of words increases,” one of the authors of the 2009 study told Education Week, “so does the richness [and] syntactic complexity.” •••

TWENTY-SIX-

year-olds who grew up in lowincome families in Brooklyn earn $2,210 less than the average annual income, according to the economist Raj

Chetty’s study of tax data for 10 million American children. •••

THE CITIZENS’

Committee for Children, a research and advocacy group, ranked Bay Ridge as one of the best Brooklyn neighborhoods to raise children in, based on indicators like education quality, violent crime rate, and median income.

clave for decades, Bay Ridge now contains the largest Arab-American community outside of Michigan and California.

A NORWEGIAN

LAST OCTOBER,

•••

immigrant en-

•••

a federal appeals

AN ANNOTATED GUIDE TO SCENES FROM DAILY LIFE

THE ARTIST and

court ruled that a group of Muslims, including some in Bay Ridge, who had been cooperating with law enforcement on terrorism investigations might have been

targeted by the New York Police Department for surveillance efforts “solely because of their religion,” sending the case back to a lower court for reconsideration.

former Bay Ridge resident Hasan Hourani painted the image at left, depicting a scene in Egypt. Figures in ancient Egyptian art typically had upright posture, which has been linked to better moods and positive short-term

changes in levels of hormones that contribute to stress. •••

IN 2003, Hourani

drowned off the coast of the Israeli port city of Jaffa while trying to save his cousin. One of his best friends, the Israeli poet and author Dorit Rabinyan, wrote in the Guardian of his death: “New York loves people like you, people who peel the world with their fingers, like

a glowing orange dripping juice.” •••

IN 2015, the Is-

rael Ministry of Education left Rabinyan’s prizewinning book Borderlife, about a doomed romance between an Israeli woman and a Palestinian soldier, off a required-reading list for literature classes, prompting protests from teachers and principals. PHOTO BY JOEY O’LOUGHLIN

JULY/AUGUST 2016 • PSMAG.COM

FIELD NOTES DISPATCHES FROM UNFAMILIAR TERRITORY

AGBOGBLOSHIE, GHANA

Two teenagers burn the plastic and rubber off of copper wiring in a vast e-waste dump. The slum economy depends on separating garbage from reusable materials, which are then sold for small sums. PHOTO BY BENJAMIN LOWY

JULY/AUGUST 2016 â&#x20AC;¢ PSMAG.COM

The Hungarian Candidate

Just a few days before the Hungarian elections in 2014, Gabor Varadi and his running mates stood on a desolate street corner and watched their campaign manager, Bela, shimmy up a crooked utility pole to hang a campaign sign. The pole was well positioned: It sat across from a bus stop right at the mouth of Ukol, a large village in the city of Miskolc. But the sign itself was meager: just a paper flyer that pictured the four men standing shoulder to shoulder, stapled to a large rectangle of cardboard and covered in plastic wrap. The men had snickered a bit when Gabor first showed it to them. That’s not much of a sign, one of them had said. Are you kidding? Gabor had responded, leaning toward the group in a show of mock aggression. This is the best, most beautiful sign in all of Miskolc! We will win by a landslide with just this sign alone! The men had laughed. But now, with Bela up the pole, and his entourage looking on, Gabor wasn’t sure where to hang it. Too low and his rivals would tear it down or cover it with graffiti. Too high and nobody would notice it at all. Bela shifted the sign up a few inches. People won’t be able to read the words, Gabor shouted. Bela cracked a wide grin, revealing missing teeth. That’s OK, he shouted back. Most Roma can’t read anyway.

The men laughed again. With the exception of Gabor—who had grown up in a Soviet-era orphanage and had received a state-sponsored education there—it was true that their educations had been inadequate. Though Gabor had a decent apartment in the city center, his running mates lived in the Roma settlements, or ghettos, where most houses lacked electricity or running water. The men had learned that the best way to endure such indignities was to laugh at them whenever possible. Lately, though, the laughs had been harder to come by. The city’s incumbent mayor was campaigning for re-election on a promise to “eliminate the Roma ghettos.” That ambition had already translated into scores of Roma families being forced out of their homes and onto the streets. The mayor called this dislocation “economic improvement.” The Roma called it ethnic cleansing. Gabor and his friends were running for seats in Miskolc’s branch of the Roma Self Government, or RSG—a special contingent of the Hungarian government that had been created to give Roma citizens a say in the policies that affected them. Because the seats came with no voting rights and only nominal influence, many Roma had written them off as a farce. But Gabor was committed to working within the existing system. The good fight, he called it. The goal was to build relationships with the men who were pushing for evictions, and to persuade them of a different course. The string and tape Ga-

REPORTING FOR THIS STORY WAS FUNDED BY THE PULITZER CENTER ON CRISIS REPORTING.

bor had brought proved too flimsy to hold the sign in place. They needed something sturdier, Bela said. Maybe wire? Who do we know that has wire, and can bring it here to us, Gabor asked. None of the candidates owned a car, but some of them had friends who did. Big Man, a large, round fellow who was running for a spot in Gabor’s prospective administration, began making calls on his cell phone. Bela shimmied down the pole, leaned against a stone wall, and lit a cigarette. The village had been quiet. But now a string of buses arrived, discharging children and parents onto the settlement’s main road and engulfing the candidates in a sea of pink-ribboned ponytails, tattered school bags, and scruffy sneakers. Gypsies breed like rabbits, an old Roma woman standing near the bus stop said to no one in particular. Some of the fathers extricated themselves from the mass of children and joined Gabor and the candidates near the telephone pole. Hands shook hands, and talk turned quickly to the election. Would Gabor win? the fathers wanted to know. It would depend on how many of his supporters made it to the voting booths, Gabor told them. He’d arranged for volunteers from outside the settlements to taxi voters to the polls on election day, and had set aside some money for bus passes in case there wasn’t enough room in the cars. Call one of us if you can’t get yourselves to the voting stations, Gabor said. We

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FIELD NOTES

will have transportation for everyone who needs it. But transportation wasn’t the only issue. His rivals—backed by Fidesz, Hungary’s leading national party—had outspent him by at least an order of magnitude. Their campaign signs were big and professional and ubiquitous. And if that wasn’t enough, people in the settlements said party affiliates were giving out cash and clothing. Most of the voters seemed to understand that the men sponsoring those handouts were the same ones pushing for the evictions. But who could turn away such gifts when unemployment in the settlements was near total? Gabor had been advising people not to take the bait, but he had nothing to offer in exchange. Except my beautiful signs, he thought, smirking. There were reasons to be optimistic. When he called town meetings, people came. And when he spoke, they listened. A lot of them were angry, but they knew he was on their side. And however desperate the Roma were, they still had their pride; they resented those handouts as much as they relied upon them. Finally, a man arrived with wire for the sign. Bela nodded at Gabor and shimmied back up the pole. Be careful, Gabor warned. It may be electrical wire. Bela paused, then cracked another halftoothed grin. Don’t worry, he said. I will collect the electricity in my body, and use it at home. Later that week, after the votes were cast, the men had reason to beam. —JENEEN INTERLANDI

A Pause in the Protest

People from the small village of Bil’in in Palestine’s West Bank, along with foreign solidarity activists, journalists, and Israeli anarchists, hike across dusty hills to the separation wall between Israel and the occupied territories. At the edge of the border, the

“

This is the best, most beautiful sign in all of Miskolc! We will win by a landslide with just this sign alone!

”

JULY/AUGUST 2016 • PSMAG.COM

DISPATCHES FROM UNFAMILIAR TERRITORY

crowd halts and chants, “One, two, three, four, down with your apartheid wall!” Israeli soldiers have been waiting on the far side of the wall all morning, like dance partners. The two groups line up for an aggressive waltz, and everyone knows the steps. The soldiers—protected by bulletproof shields, helmets, gas masks, and flak jackets—stand in

pairs, spaced strategically, overlooking the 26-foot concrete barrier. Atop the tallest point on the Israeli side of the wall is a horde of soldiers dressed in black. They are armed with guns, tear-gas launchers, concussion grenades, and other weapons of crowd dispersal. In T-shirts and jeans, the Palestinian kids maneuver—exposed—through an open field, heaving rocks at

the closest sentries. Their throws rarely cause the soldiers to so much as flinch. This ritual takes place year-round, under every color of sky. On this July Friday in 2012, the desert sky is crystalline blue—the hue of a polished gemstone. As the protestors approach the wall—some carrying flags, some tying keffiyehs around their faces—pawping sounds

CANCUN, MEXICO

Off the coast, 450 life-size sculptures stand on the seafloor, designed by Jason deCaires Taylor to inspire conservation of the underwater world. PHOTO & SCULPTURE BY JASON DECAIRES TAYLOR

burst from behind the wall. PAWP—PAWP—PAWP, PAWP, PAWP. The noises mean it’s time to look up. In a matter of seconds, metal canisters— boiling with noxious gas— will fall from the sky. When they land, they set grass on fire, transforming the land beneath the blue gemstone into a chemical hellscape. The canisters are designed to punish those daring enough to pick them up and hurl them back. They can melt the flesh off un-gloved fingers. The canisters come in groups, shot from different directions. Move away from one coming from the left and you’re liable to step into the path of one from the right. Tear-gas canisters have killed and badly injured handfuls of protesters here in Bil’in over the years, making it all the more surreal to stand below as the projectiles burn smoky trails in the sky. Bodies, young and old, scatter. PAWPAWPAWP! I see the arcs the canisters are taking, their tails curling like incense smoke in a cathedral. Time slows. The swirling lines crisscross the clear air, flying ever closer. There’s a roaring stillness, a peculiar beauty. I stand motionless, camera limp around my neck, looking up as if the sky were a painting. For a moment, I admire the dreamlike tranquility of it all. Then, bouncing thuds circle around my feet, and canisters begin blowing open. Dry grasses explode into flames as large white clouds burst from the ground, signaling that it is time to go. —MATEO HOKE

JULY/AUGUST 2016 • PSMAG.COM

FIELD NOTES

QUARRY BAY, HONG KONG

As part of an architectural series called Look Up, photographer Andy Yeung reveals the artistry of vertical human development and construction. PHOTO BY ANDY YEUNG

The Hip-Hop Professor

Gary Bradford, a.k.a. Eldorado Red, sits quietly, hands folded on the defendant’s table in courtroom 5E at the Fulton County Courthouse in downtown Atlanta. It’s August 2014, and he’s watching a jury of 16 men and women—black and white—shift uncomfortably in their chairs as they consider his fate. In a crisp, dark-brown suit, the bespectacled Bradford presents himself as a budding 35-year-old hip-hop entrepreneur. An artist. Meanwhile, the State of Georgia is attempting to portray Eldorado Red, the Harlem-born gangsta rapper who wears Blood red and rolls with a gun-toting

posse in his music video “100 Shooters.” The prosecution played the video in court yesterday, in the hope that it would help convince the jurors that he was the kind of man capable of the charge in question: orchestrating the 2012 murder of rival rapper Lil Phat in an Atlanta parking garage. At the moment, the state’s attorneys are protesting a defense expert called in to distinguish between Bradford’s two personas. “What’s he an expert in?” asks the assistant district attorney, incredulous before the court. “African-American culture, history, literature, and music,” says Bradford’s attorney Musa Ghanayem. The assistant district attorney throws his hands up, plops down in his chair,

JULY/AUGUST 2016 • PSMAG.COM

and chuckles as the judge allows Ghanayem to summon Erik Nielson. The snickering spreads across the courtroom—particularly among the black attorneys, reporters, onlookers, and even jurors—as a short, slight white man in khakis and a navy blue blazer saunters to the witness stand. When Nielson introduces himself in a nasal tone as an assistant professor at the University of Richmond, the bewilderment—even among the white folks in the room—brims over into audible laughter. From the stand, Nielson appears unshaken. When Ghanayem asks the professor to list some of his credentials, the man in gleeclub attire obliges: A dissertation on the relationship between African-American culture and policing, con-

“

We have trouble convincing some that people from inner-city, lower-income families are capable of producing art.

”

DISPATCHES FROM UNFAMILIAR TERRITORY

tracts for two books about hip-hop and its use in trials and politics, and an amicus brief in a case before the Supreme Court. What Nielson doesn’t mention is that he began his scholarship as a teenager in suburban Connecticut in the early 1990s, when he wore baggy pants and hoodies and drove a Subaru that was worth less than its custom Alpine car stereo system. He loved the beat and was drawn to the antiestablishment themes in the lyrics. As a middle-class suburbanite, the experience made him keenly aware of the separation between art and life—just because he listened to rap didn’t mean he knew anything about getting shot or being harassed by police. In fact, he knew, many of the rappers behind the rhymes about gats and crack didn’t necessarily live that way. That realization has been a slow one for the rest of America. Listeners have never believed that Johnny Cash actually “shot a man in Reno,” but when Ice-T rapped about killing a cop, public outrage forced him to pull the song from his album. In the late 1990s, a Winona State University psychologist presented violent lyrics to two groups of people. One was told the lyrics were from a rap song, the other was told they were pulled from a country song. Far more people in the former group viewed the lyrics as threatening. Since the mid-2000s, when hip-hop truly entered the mainstream, prosecutors have been taking advantage of the public’s prejudice. A 2004 training manual for the National District Attor-

neys Association instructs: “Through photographs, letters, notes, and even music lyrics, prosecutors can invade and exploit the defendant’s true personality.” Since then, more and more prosecutors across the country have begun to introduce rap lyrics and videos as evidence. Nielson has emerged as one of the nation’s foremost critics of the prosecutorial tactic. “The whole purpose of your testimony is to talk about the creativity and the fictional aspect of rap,” says the assistant district attorney, during crossexamination, no longer laughing, but on the attack. “Wouldn’t you agree?” “Yes,” Nielson says. “I believe that is one of my purposes.” “But as you sit here today,” the attorney says, “you don’t know what’s fictional and what’s not fictional, do you?” “Yes, I do,” Nielson says calmly. “OK, so you’re in the mind of Eldorado Red when he’s rapping in these videos?” “See, you’re making a mistake right there, because Eldorado Red is fictional.” “OK, Gary Bradford.” “No, I’m not inside his mind.” “OK, so you don’t really know whether he believes Eldorado Red is a fictional character.” “I think you’re confusing fiction and, maybe, reality,” Nielson says. “American Psycho. Bret [Easton] Ellis, the author: well known for drawing on certain aspects of his own personal life. It’s told in the first person, but nobody believes that he actually committed the

heinous crimes, the serial killings that take place in that. We call that fiction, even if it has elements that correspond to reality.” At one point, Nielson mentions that even the name Eldorado Red is taken from an eponymous 1970s crime novel about a Detroit racketeer. He has instant recall of Bradford’s oeuvre. “In some [videos], he’s got a Learjet and a Ferrari. In others he doesn’t even have a, excuse my language, a pot to piss in,” Nielson says. “He is exploring identity through his music.” A few of the jurors, particularly the older ones, have been unable to shake their bemusement, a couple even rolling their eyes as Nielson speaks. The jurors in courtroom 5E are not alone in their skepticism. “Older, white, suburban jurors who hear people talking about shooting up things and selling drugs think, ‘Why would they be saying that without doing it?’” says John Hamasaki, a San Francisco defense attorney who regularly defends these cases and has worked with Nielson. “We have trouble convincing some that people from inner-city, lower-income families are capable of producing art. The fact that Nielson is a middle-class white guy in a suit talking about hip-hop, does that make it easier for white jurors to understand? I think having someone of his background is appealing.” After almost 30 minutes of sparring with the increasingly frustrated assistant district attorney, Nielson appears to have turned the defense’s argument on its head. The prosecutor, at

least, has lost his smile. “You don’t know whether or not Eldorado Red is, in fact, the real person or the fictional person,” the attorney says. “Do you?” It’s the professor’s turn to roll his eyes. He stifles a laugh. “I know that Eldorado Red derives from a work of fiction,” Nielson says. “And that if I’m only looking at the fictional works that Mr. Bradford has created as that character, that that is fiction.” The prosecution has had enough. “I have no further use of this...” the assistant district attorney says, turning back to his seat in exasperation. Nielson is eventually dismissed and again feels the stares and hears the giggles as he exits the courtroom— though neither is quite as intense as when he entered. It’s hard to say what impact Nielson has had here: Bradford will be acquitted of the murder charge, but convicted of conspiracy to commit a crime and participation in criminal street gang activity. By the time the verdict is read a week later, the professor is back home in Brooklyn, preparing for the next case. “We ask rappers to adopt this image of the thug, the gangster,” he says later, over a vodka cocktail at a bar near his home. “That’s what we demand, and that’s what many aspiring rappers believe is what is required. So when we dangle this offer of a legitimate way out of crime and poverty, it is deeply unfair—it’s cruel— that we punish the same thing.” —TONY REHAGEN

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THE FIX

•JACOB KUSHNER is a freelance journalist reporting on science, foreign aid, and migration. His reporting in western Kenya was funded by GiveWell, a non-profit that uses RCTs and other studies to vet the work of international charities, including GiveDirectly. @JACOBKUSHNER

SOLUTIONS, AND THE PEOPLE WORKING TOWARD THEM

Can Science Save Development Aid? Randomized controlled trials are the popular centerpiece of an emerging data-driven approach to figuring out precisely the best way to end poverty. Can a return to the scientific method fix the global aid industry? BY JACOB KUSHNER

IN APRIL OF 2014, on a flat, dry stretch of western Kenya, Loice

Ocholla described to me the ways that foreign non-governmental organizations (NGOs) have tried but failed to change her impoverished homeland. She recalled one project that distributed livestock in her neighborhood for families to raise and sell. “They give just one goat, and if it dies that is not their concern,” says Ocholla, a 26-yearold teacher and mother of two. She says that NGO has long since disappeared. Ocholla’s neighbor, Caroline Ogutu, a mother of five who farms maize and millet, likened the top-down aid projects she has seen here as “someone telling you, ‘You must buy a table’—but you already have a table, and you don’t need a table.” A few years back, one NGO decided to do things differently. It began by handing out cash transfers of approximately $1,000—close to Kenya’s average annual income of $966 right before the program launched in 2011—to each family, with

JULY/AUGUST 2016 • PSMAG.COM

ILLUSTRATION BY CHAD HAGEN

RUNNING A RANDOMIZED CONTROLLED TRIAL STAGE 1

33%

Planning the study, which includes conducting a review, training staff, and acquiring funding. STAGE 2

50%

Recruiting subjects, recording data, and measuring outcomes. STAGE 3

17%

Analyzing the results of the study and writing up a report to be considered for publication.

STAGE 3

STAGE 2

*From a Médecins Sans Frontières report on time spent on each stage of field research.

STAGE 1

no strings attached. The handouts were no wild attempt at foreign philanthropy. Rather, they were the calculated byproduct of a scientific experiment that found unconditional cash transfers to be incredibly effective at improving the livelihoods of families living in western Kenya’s Siaya County. Farmers I met who had received the cash showed me new tin roofs over their homes, pigs they were raising, electrical inverters they use to charge up neighbors’ phones for a fee—all purchased with cash from GiveDirectly. But unlike many aid interventions, the evidence that this worked is not merely anecdotal; not just some photograph of a smiling family on the charity’s website. Rather, it comes from a rigorous study of the program, which compared nearly 500 of the families that received cash to nearly 500 that did not. The study found that those receiving cash saw their assets increase 58 percent over the course of a year. By comparing families that had received the cash to families that had not, the study was able to prove that recipients fared far better than non-recipients, and that the handouts themselves— not chance—are what spurred their improvement. Called a randomized controlled trial (RCT), this type of study is little more than a real-world manifestation of a school science project. Students learn how to test a hypothesis using a control group; drug corporations use the same methods to test new pharmaceuticals, as do advertising agencies looking to evaluate the effectiveness of a television spot. As the name implies, RCTs use a control group that allows researchers to answer a question so rarely asked in the aid industry: Yes, this intervention seems to have worked—but might people’s situations have improved even without it? In science, it’s what’s known as the counterfactual. Then there’s the randomness factor. In an RCT, people suffering from poverty, poor health, or other ailments are randomly assigned to the control group or one of the treatment groups. The randomness solves the problem of individual choice—what if those who chose to participate in a given aid intervention were already the go-getters in their community, self-selecting in a way that would taint results? The RCT has become a sort of gold standard for testing interventions, but only recently has it made serious inroads into development aid, a field known for justifying its existence using anecdotal, often emotionally charged success stories rather than data. For too long, “accountability” in the aid industry has meant nothing more than ensuring that a donor’s money was spent the way an agency said it would be. Rarely did organizations examine whether their spending achieved a positive impact (improved access to water, for example), much less one that stood the test of time (meaning the well didn’t dry up). But recently, many aid organizations, including

the International Rescue Committee, a New York humanitarian aid group specializing in refugee assistance, have used RCTs to, among other things, evaluate methods for nudging parents in Liberia toward more effective parenting techniques and to create highly effective community savings-and-loan programs to combat poverty in Burundi. It’s easy to see why charities are attracted to RCTs: They can make an aid agency’s work more efficient and generate solid evidence of progress to show funders. As organizations continue to conduct more of them, RCTs are disproving many myths upon which we’ve designed development aid for years, not least of which is our longtime preference for projects over cash. If the data shows, as the RCT of GiveDirectly’s Kenya program did, that it’s most effective to hand a family $1,000 with no strings attached, then that’s precisely what we should do. RCTs are no cure-all; rather, they are the best tool we have to identify a whole range of cures that might, collectively, do the trick. RCTs can direct us toward the lowest hanging fruit— and then show us the most efficient way to pluck them from the tree. Proponents of RCTs, who sometimes refer to themselves as randomistas, believe that the sort of anecdotal appeals that we used to rely on when deciding where to donate our money—the needy, wide-eyed child photographed at an orphanage, or the smiling mother who received access to a water well dug by a foreign charity— simply aren’t enough. If the overarching criticism of development aid is that there is too little actual evidence that it works—well, they say, it’s time for more evidence, of the scientific and quantitative kind. If the randomistas are correct, the newly scientific approach to aid may usher in a sort of enlightenment—an era of unprecedented accountability that will produce new areas of knowledge that philanthropists can use to accomplish goals they’ve always aspired to. If the randomistas are wrong, it will be because their methods prove expensive and non-transferable.

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THE FIX

Critics argue that the findings of an RCT conducted in one place aren’t necessarily applicable in another. If true, this would require replicating RCTs far and wide, which could make them too expensive to be feasible. Others worry a wealth of scientific evidence alone won’t cure the deep ailments of the aid industry. Aid agencies and NGOs, they argue, might prefer to stick with the aid interventions they know rather than adopt the ones they don’t. There’s also the argument that most philanthropy is motivated by self-serving or irrational means— that donors don’t tend to base their giving on evidence and reason in the first place. Still others object to the ethics of selecting one group of people to receive a treatment while another does not. Among this last cohort is Paul Farmer, the Harvard Medical School professor who founded Partners in Health, a highly respected NGO built upon Farmer’s ideology that the poor people of the world ought not just have efficient care, but world-class care. Farmer’s ethical gripe with RCTs is this: If we test the efficacy of unproven treatments, that means we’re temporarily giving treatments that we aren’t yet sure work. There are two problems with this logic. First, by following it, we’ll never test new programs and therefore we’ll never learn what actually works. Second, the alternative Farmer is offering is to go ahead treating people in ways that haven’t been vetted by the most rigorous standards—precisely the thing he proclaims to be rallying against. A related concern is that a control group will be denied a treatment that’s believed to work, but it’s not the case that RCTs are taking away treatments. Randomistas don’t go into people’s homes and steal their mosquito nets at night. They simply offer them to people who don’t yet have them. But randomistas face the challenge of buy-in. Identifying a solution to a problem doesn’t guarantee we will succeed at implementing it. For decades, RCTs have proven the effectiveness of vaccinating children against measles, and conclusively disproven the myth that vaccinations cause autism. But that hasn’t stopped some parents from ignoring the science and refusing to vaccinate their children. Behavioral economists in support of the randomista movement, though, say RCTs may yet overcome this sort of resistance. Many RCTs don’t merely identify ideal treatments, but actually test the best ways to persuade people to participate. Studies have found, for example, that the number of organ donors skyrockets when, instead of asking someone registering for a new driver’s license whether they would like to opt in, you make them a donor by default and give them the option to opt out—an option few people take. But can this sort of nudge theory work as effectively when it comes to more complicated problems, such as the suffering that occurs when an

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The idea that simply handing out cash could effectively alleviate poverty once seemed ludicrous—until scientists began proving that it works.

authoritarian government prevents food aid from reaching its political or ethnic minorities, or the reluctance of well-to-do nations to open their doors to more refugees? The randomista movement is unlikely to fix the political environment in which aid operates. RCTs can, at the very least, help us eliminate aid programs that are wasteful or ineffective; they can guide us in directing our money toward methods proven to work. Take cash transfers, like the GiveDirectly program in Kenya: Columbia University professor Christopher Blattman conducted an RCT on a similar government program in Uganda that found that “the program increases business assets by 57 percent, work hours by 17 percent, and earnings by 38 percent.” Cash transfers are now being implemented widely, for the benefit of Afghan families and Syrian refugees, and from post-earthquake Haiti to New York City, where one organization gave away $8,700 each to thousands of poor families. In that experiment, “a randomized evaluation showed that self-employment went up and hunger and extreme hardship went down,” in Blattman’s words. There are many proposals to scale cash-transfer programs in humanitarian aid, and some have even advocated using them to provide direct dividends from resource-rich developing-world governments to their citizens (imagine if you earned money on every barrel of oil produced by ExxonMobil). Cash transfers embody precisely the sort of thing that a data-driven approach to aid can uncover: new, even unthinkable alternatives to helping the poor. The idea that simply handing out cash could effectively alleviate poverty once seemed ludicrous—until scientists began proving that it works. For too long, aid to the developing world—a multibillion-dollar industry with the intention of transforming the lives of the world’s poorest people— has been exempt from the scientific scrutiny with which we approach far less important tasks. Think of RCTs as a method for identifying the little ideas that, if scaled up, might actually get the job done.

•DWYER GUNN is a Pacific Standard contributing writer and freelance journalist. Her work has appeared in the New York Times, Slate, Psychology Today, and elsewhere. She was previously the editor of the Freakonomics blog. @DWYERGUNN

ON A SUNNY Tuesday

Not Just a Deadbeat Dad

Eight states across the country are piloting a model of child support enforcement that relies, for the first time ever, more on carrots than on sticks. And it’s working better than anything we’ve seen before. BY DWYER GUNN

in February, Lewis Griffin walked into a meeting room in the Arapahoe County Human Services Building in Aurora, Colorado. Griffin, a barber and ex-convict who’s also the co-facilitator of a fatherhood class, is a tall black man with closely cropped silvering hair—on the day I met him, he was sharply dressed in gray jeans, a neatly pressed graystriped button-down shirt, and sleek, modern glasses. Griffin has an open, friendly manner and a disarming sense of humor. When he introduced himself to me, he clasped both hands to his chest, inhaled sharply, and said with exaggerated anxiety, “I’m nervous!” The men (and one woman) gathered in the meeting room that morning all had one thing in common: They were non-custodial parents who had fallen behind on their child support payments. A few years ago, Griffin, who’s 56 and lives with his wife and 16-yearold son, was one of those parents. In 2011, a woman he had previously fathered a daughter with in an extramarital affair served him with a child support order for seven years of back payments—approximately $25,000 total. Over the next few years, Griffin mostly tried to ignore the ever-mounting debt, until a cop pulled him over and informed him that his driver’s license had been suspended. “At that point, it was like, yeah, you can run, but I mean, how far can you run? And you really can’t hide,” Griffin says. He returned to Colorado with his family in 2013 and started paying sporadically. He wanted to resolve his child support problem, he says, but he didn’t know how to navigate the seemingly impenetrable system. AND THEN Lewis Griffin got lucky. A

caseworker from the Arapahoe County

ILLUSTRATION BY CHAD HAGEN

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THE FIX

Office of Child Support Services told him about the Colorado Parent Employment Project (CO-PEP), an experimental program funded by a grant from the federal Office of Child Support Enforcement as part of its Child Support Noncustodial Parent Employment Demonstration, or CSPED. Colorado is one of eight states participating in the CSPED, which relies on a more supportive model of child support enforcement than the punitive model of years past. Participating agencies began the planning and implementation phase of the project in 2012, and the demonstration will run through September of 2017. The program, which is being evaluated by Mathematica Policy Research and the Institute for Research on Poverty at the University of Wisconsin– Madison, is a randomized controlled trial. Caseworkers identify and recruit eligible clients (specific criteria vary by state) and, once eligibility is confirmed, participants are then randomly selected to receive either standard services or additional services. At the end of the first year, the participating agencies had enrolled 3,266 noncustodial parents, and they hope to ultimately enroll 12,000. Over the last 50 years, both divorce and non-marital childbearing rates in the United States have soared. More

than 40 percent of children today are born to unmarried parents, and, in 2014, according to the U.S. Census Bureau, almost one-third of children didn’t live with both of their parents. These trends have led to a significant increase in the number of children with non-custodial parents who are expected to contribute financially through the child support system. In 2013, the government collected $32 billion in total child support and provided services to 17 million children. The non-custodial parents in these families are disproportionately low-income and face employment barriers that severely limit their ability to contribute. Surveys of CSPED participants, for example, indicate that almost 70 percent have some kind of criminal conviction; among participants who reported employment, average monthly earnings were only $683. In Colorado, that’s about 80 hours of minimum-wage work. Historically, the system has relied on punitive measures to ensure compliance. Parents who don’t, or can’t, pay face a debt load that increases with every month and an escalating set of consequences, many of which—the suspension of a professional or driver’s license, for example—can make it even harder to pay child support. “Many observers think that system

Wisconsin’s Grand Child Support Experiment HERE’S WHAT HAPPENED WHEN ONE STATE LET WELFARE RECIPIENTS KEEP THEIR CHILD SUPPORT PAYMENTS. BY DWYER GUNN

In 1997, the state of Wisconsin decided to experiment with the way it handled child support payments made to welfare recipients. In previous years, under the Aid to Families with Dependent Children (AFDC) program, recipients who also received child support

payments from a noncustodial parent were required to relinquish the bulk of what they received in child support to the state— states only “passed through” the first $50 of child support in a given month. The federal welfarereform bill (formally

JULY/AUGUST 2016 • PSMAG.COM

known as the Personal Responsibility and Work Opportunity Reconciliation Act) of the previous year gave states room to experiment with and set their own policies. The majority of states decided to eliminate the passthrough entirely and simply retain all child support payments to welfare recipients, but Wisconsin instead implemented and rigorously evaluated a temporary, experimental full pass-through and full disregard program, in which recipients

could work if the main problem was an unwillingness to pay,” says Daniel Meyer, a professor of social work at the University of Wisconsin–Madison and the principal investigator on the CSPED project. “But the problem is actually not willingness—at least for some, they don’t have the ability to pay the amount we expect, so then a system that is only about punishment is unlikely to be very effective.” The specifics of the CSPED project vary from state to state, but all of the participating agencies are expected to provide four core services: enhanced child support services (which can include things like debt forgiveness), employment assistance, parenting classes, and case management. In Arapahoe County, which has a long history of experimentation with enhanced services, CO-PEP participants have access to a wide range of extras, but most are conditioned upon participation in the parenting class, which includes both a peer support component and a curriculum that covers, among other things, communication strategies and healthy relationship building. Lewis Griffin’s caseworker, for example, promised she would get his driver’s license reinstated if he attended the first two classes. Maureen Alexander, who is supervisor of special projects for the

retained all of the child support paid to them and their full welfare benefits. The AFDC-era child support pass-through policy reflects the historic purpose of child support enforcement: to allow the government to recover the costs of supporting children whose noncustodial parents had abandoned them. The policy, however, created a host of undesirable incentives for all parents, according to researchers.

“The dad says, ‘If my kids are no better off if I pay or if I don’t, why should I pay more money?’” explains Daniel Meyer of the University of Wisconsin’s Institute for Research on Poverty. Custodial parents also had little incentive to cooperate with the system since their income remained unchanged if they

SOLUTIONS, AND THE PEOPLE WORKING TOWARD THEM

Arapahoe County Child Support Enforcement Division and has headed the CO-PEP project since its inception, believes the fatherhood class is a crucial first step. The facilitators challenge participants to build healthy co-parenting relationships and energize their efforts to find employment or secure visitation rights. “It’s made a huge difference with our clients and their desire to do better, to pay their support,” Alexander says. “Absolutely, when you start talking about kids and emotions and things that they’re not usually tapping into, and giving them the chance to actually sit there with other—mostly— guys who are going through similar things, it just changes them.” THE FINAL evaluation of the CSPED

program won’t be released for several years. Preliminary data in Colorado indicates that CO-PEP participants paid more child support and were more likely to be paying at least some child support after enrolling in the program, and Alexander believes the program has been successful. CO-PEP specialists in Arapahoe County can, for example, request financial assistance for participants’ cell phone bills, transportation (including car repairs), and clothing for interviews. The county also has a highly

established paternity or filed for support. The sociologist Kathryn Edin found that parents were cooperatively cheating the system—the mother would refuse to establish paternity and, in exchange, the father would provide financial assistance under the table, allowing the custodial parent to keep both the welfare benefits and the unofficial child support payments. Beginning in 1997, Wisconsin randomly assigned welfare recipients who

experienced job developer who has cultivated relationships with a variety of employers, including those that are felon-friendly. “She knows right away whether she’s got someone that might be able to hire them,” says Sarah Culp, a CO-PEP caseworker. “A lot of our people come in the program and, two weeks later, have a job.” Last fall, Mathematica Policy Research released a report about the first two years of the CSPED program, which focused on the planning, implementation, and enrollment phase. The report highlights the challenges of serving its unique clientele; program staff cited the need for additional training on providing employment services to clients with criminal histories or other barriers to employment, and also reported that even participants who found jobs sometimes still struggled due to low wages. Across the country, CSPED staff highlighted another significant shortcoming of the program. In general, local child support services have no authority over custody matters, yet many CSPED participants lack access to their children and cite that as a significant deterrent to payment. “Almost uniformly, staff described animosity toward custodial parents and the child support program as major barriers,” the Mathematica report

received child support into treatment and control groups. Those in the treatment group received the full pass-through and full disregard treatment, while those in the control received only some of the support paid on their behalf. A paper published in 2008 summarized the results of the experiment: Fathers in the treatment group were both more likely to pay child support and paid more—19 percent more by the third year of the experiment,

in fact. Even more interesting, the full pass-through policy didn’t end up costing the government very much—approximately $2 million, according to a cost-benefit analysis—thanks both to the short amount of time that most receive welfare benefits and to reductions elsewhere.

concluded. “In particular, due to acrimonious relationships with custodial parents, participants often did not have access to their children and thus did not want to pay ... child support.” Perhaps the biggest takeaway is how marginalized this group of parents is, and how desperately we need a strategic shift. “They give you an opportunity to find a career,” one CSPED participant told Mathematica. “We’re here to be good providers, not like everybody labels us. This is a second chance. Not to prove something to them—to commit to yourself and your family.” For Lewis Griffin, the program did indeed offer him a second chance. With his caseworker’s assistance, Griffin requested a mediation with his daughter’s mother. She forgave all of his existing debts and agreed to visitation. Now he sees his daughter on a regular basis, and has an excellent relationship with her mother. With the encouragement of the CO-PEP staff, he is undergoing additional training and hopes to eventually work with non-custodial fathers full-time. Alexander told me that they have big plans for him going forward. “I’ve settled down, I’ve become more responsible—my relationship with my wife, I understand her more,” Griffin says. “Even the way I parent ... that’s what CO-PEP has done for me.”

“Given the timelimited nature of cash assistance, the benefits to the government of retaining child support as a reimbursement for cash payments is also limited,” Meyer and his co-authors wrote in the 2008 paper. “In contrast, the benefits to children of establishing paternity and setting a pattern of child support payments are potentially much more enduring.” The 2006 reauthorization of the Personal

Responsibility and Work Opportunity Reconciliation Act decreased many of the costs associated with these policies, and, in recent years, a number of states have implemented them. Today, 25 states passthrough and disregard a portion of child support to welfare recipients. Last year, Colorado became the first to pass a full pass-through and full disregard policy (Minnesota has a full pass-through, but not a full disregard policy), which will be implemented by 2017.

JULY/AUGUST 2016 • PSMAG.COM

I N

T H E

AMERICA YOU ARE ASLEEP.

E R V I

AN ELECTION SEASON CONVERSATION WITH THE NATION’S NO. 1 PUBLIC-INTEREST CRUSADER, RALPH NADER.

•••

INTERVIEW BY LYDIA DEPILLIS PHOTOS BY REED YOUNG

IT'S BEEN AN INTERESTING COUPLE OF YEARS for left-wing populist movements, from Occupy Wall Street and Black Lives Matter to Bernie Sanders’ insurgent run for president. Driven by widening inequality and fanned by social media, some have already brought about real changes—like the fight for a $15 minimum wage across the country—while others have quietly faded away. Few people have a longer-term perspective on what it takes to have an impact than public-interest crusader and political maverick Ralph Nader, who, over the span of five decades, has leveraged the courts, the media, and the electoral system to win hefty gains for consumers and the environment. A five-time candidate for president, he’s sitting this election out, working the channels through his role with the Center for Study of Responsive Law, the research and advocacy organization he founded in 1968. The center is housed at the Carnegie Institution for Science in Washington, D.C., where we met in a grand, bookshelf-lined conference room and talked politics, elections, and organizing for change as the late-afternoon sun slanted through tall windows.

Let’s start out with Bernie Sanders. Despite your similarity on issues, he’s running as a Democrat, rather than a thirdparty candidate, like you did. How do you think that’s influenced the race? I don’t think it influenced him at all in terms of content. I think the difference is that he’s inside the Democratic Party, playing by the rules—but he’s getting frozen out by the establishment Democrats, which is remarkably similar. The Congressional Black Caucus turned against him; they turned against me. The members of Congress of the Democratic Party overwhelmingly are against him, which is pretty amazing, since he obviously represents a large segment of Democratic voters and independent voters. And it’s not just that. It’s the Democratic National Committee, the way they rig the debates. It was so obvious that they were favoring Hillary Clinton. He had great opportunities in the debates to really rebut her, and he blew it—whether he didn’t want to be seen as coming on too strong or he didn’t think about it in the moment. When she was asked to release the Goldman Sachs transcripts for the third or fourth time, and she went through the same thing, saying, “I’ll release it when others release it,” all he could have said was: “Well, Secretary Clinton, that’s not exactly leadership. You’re not setting an example. You’re a follower.” A rebuttal, delivered quietly, can be devastating. So after it’s over I’ll make that point to them—say: “See, you didn’t want to return my calls. You didn’t want me to appear with you. You didn’t want to take any of my advice.” So you tried to make these points to him? Oh, yeah. I haven’t had a return call in 15 years, and I’m not the only one. He’s been a lone ranger. And he’s gotten a long way without our advice. People even now can’t get through to his staff. These are people who are on his side, who write articles for Salon and so on. They just can’t get through. There comes a time when you do need to return calls. You may have gone as far as you can on your own. Do you think he’s had any impact on her positions? He’s gotten her to mimic him, in less-than-believable language, but she’s talking minimum wage; she’s saying, “I’m going to go to Wall Street and I’m going to nail them.” She’s talking that way because that’s the technique the Clintons use. They blur you rhetorically, and then they go back to business as usual. Nobody believes her on Wall Street. The Clintons have gotten a long way on rhetoric—very clever rhetoric to African Americans, for example. When at the debates someone asked, “Do you have any blind spots when it comes to race?” it was just masterful, the way she handled it. And he handled it the way someone would in 1970, using words like ghetto. We are a culture extremely vulnerable to rhetoric. Look how far Donald Trump has gotten. Now that you mention it, Trump is a fascinating phenomenon. What does his popularity tell you about the electorate and what they want?

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Well, and you see this when you walk past construction sites and you talk with white male workers, they feel they have been verbally repressed. It’s hard for someone your age to understand what I’m about to say. They like to stand on a corner and whistle at a pretty lady. They like to flirt. But they can’t do that anymore. Multiply that across the continuum. You can’t say this about that, and you can’t say that about this. And the employer tells you to hush. And perhaps your spouse tells you to hush, and your kids tell you to hush. So they have a whole language that they inherited—ethnic words like Polack. A lot of these people grew up on ethnic jokes, which are totally taboo now. Do you know, Lydia, there are no ethnicjoke books in bookstores anymore? There used to be? All the time. There were Negro-joke books, Jewish-joke books, Polish-joke books, Italian-joke books. They used ethnic jokes to reduce tension in the 1930s, ’40s, ’50s. And they’d laugh at each other’s jokes and hurl another one. But it still flows through ethnic America, you know. There are hundreds of things that people would like to say. So here’s this guy—he doubles down on them, he blows their minds. So that’s the first way he got their attention. Do you think Trump has a point about political correctness? That we’ve gotten too uptight? Oh, yeah. You see it on campuses—what is it called, trigger warnings? It’s gotten absurd. I mean, you repress people, you engage in anger, and what you do is turn people into skins that are blistered by moonbeams. Young men now are far too sensitive because they’ve never been in a draft. They’ve never had a sergeant say, “Hit the ground and do 50 push-ups and I don’t care if there’s mud there.” Another thing: Trump is extremely clever with the use of language. Short sentences, no prepositional phrases, immediately understood. And he is a father figure. “Don’t worry, I’ll give you the jobs, take care of the terrorists.” And when he stumbles, he reverses. He said he didn’t want higher wages, and then he reversed himself within a week, said: “Look, I can change my mind. Don’t worry. The wall. Who’s going to pay for it? Mexico. I heard they might not pay for it. You know what? The wall just got 10 feet higher.” There’s a certain skill in that. And the third thing is, he’s a hybrid. I call him a Rep-Dem. He’s got Social Security, Medicare, he’s probably got a hidden single-payer guy, because he’s been around Canada, Western Europe, understands how it works, talks to business people, they don’t have to pay premiums, all of that. And then he’s big on public works. So that reassures even white, male conservatives and others that he’s not going to be a crazed conservative like Ted Cruz and the rest of them. And having said that—and this is really important—if you’re a billionaire, you can create a third party, because there’s a huge slice of the electorate that doesn’t like either party. A lot of them don’t vote, or they vote least-worst. But they like

someone who can’t be bought. Sanders can’t be bought. He’s proven he doesn’t have to go to Park Avenue for fat-cat fundraisers—and that’s a great breakthrough, by the way. The Democrats who said for decades, “We believe in campaign finance reform, but we’re not going to unilaterally disarm”— well, he did unilaterally disarm. And then he was equipped with the 27-buck average people. So what Trump has done, brilliantly, is to say: “I don’t need these fat cats on Wall Street. I’m spending my own money.” And that has huge resonance. But that’s not the enduring aspect of the campaign which most of the press has missed. I don’t know how much you know about the Commission on Presidential Debates. It’s a private, non-profit corporation. The Democrats and the Republicans wanted to get rid of the League of Women Voters running the debates, because they were too uppity, so they created this. It’s been funded entirely by corporations—Anheuser-Busch, Ford, AT&T. So here you have this corporation deciding on behalf of the two parties how many debates, the form of the debates, the moderators, the whole works. I didn’t think it could get much worse than that. Now we get to 2016, and the debates are inventories for profits for commercial media. So now we have Fox, CNN, they take turns sponsoring the debates. And they’re getting huge ratings because Trump has helped turn it into a circus. Just think, you’ve got the profit-seekers at Fox and CNN and all the others deciding who gets on the debate, the duration of the debate, where’s the debate. Are we kidding? The commercialization of debates in primaries? And nobody comments on it? You’ve written recently about the potential for left-right alliances to make progress on things like free trade, which both the Tea Party and the far left oppose. How come they couldn’t stop the Trans-Pacific Partnership from moving forward this year? Oh, they’re likely to win on TPP—and the vote was close on fast track. But one reason is, there’s a difference between 535 members of Congress and shifting opinion back home. There’s a lag time, but it’s clicking more and more, as conservatives think, “What’s all this doing to our sovereignty?” It would help, wouldn’t it, if a candidate said, “This is a leftright issue”? But they’re appealing to primary voters, who are very partisan. So they can’t even utter the words without being attacked for sacrilegious rhetoric. But that would really nourish the quality of the campaign. The issues that are really operational are criminal-justice reform, minimum wage, opposition to crony capitalism or corporate welfare, violations of civil liberties under the Patriot Act. Those are the big ones, but others are emerging. For example, there’s left-right support for getting rid of the Electoral College. And then cracking down on corporate crime, like breaking down the big New York banks. You get down to where people live, work, and raise their families, and the ideological differences tend to diminish. Another issue that crosses party lines is civil liberties and technology. And that’s tricky, because some people are just as troubled by companies controlling our data as they are by the government controlling it—like in the case of Apple versus the Federal Bureau of Investigation. Who do you trust more in this instance? Well, you’ve got basically three monopolies: Facebook, Apple, and Google. I mean, Apple has competition, but Facebook and Google are as close to global monopolies as you can imagine. And they get our information for free—very personal information—and they make money from it. So I’m not saying it’s like Scylla and Charybdis, but you’ve got these companies that are violating people's privacy, and they’re encouraging more and more disclosure of personal information. They do it in a very clever way. It’s not just “likes” now. We’re permitted to use five or six other words. And who decreed that we’re not allowed to send anything longer than 140 characters? So they do have almost governmental powers.

But I side with Apple on this one, because the government is completely untrustworthy. National Security Agency dragnet-snooping is a five-year felony, and they got away with it. You’ve written about how enlightened billionaires are needed to help guide us in the right direction. I wonder what you think about the new class of Silicon Valley philanthrocapitalists, like Mark Zuckerberg, pledging to put all his wealth into a charitable LLC. Is that what you had in mind when you wrote Only the Super-Rich Can Save Us!? There’s a distinction between charity and justice. Charity is soup kitchens. Justice is giving people the opportunity to not have to go to soup kitchens—like giving them decent jobs. What you’re talking about is overwhelmingly charity. Some of them are embarrassingly promoting their own industry, if indirectly. That’s what Bill Gates did—you know, computers for all classrooms. It’s also a good business strategy. But justice means confronting power. It means getting controversial. It means incurring retaliation. I had a multibillionaire once tell me, “Ralph, we all know how to make lots of money, but we don’t have a clue what to do with it.” There’s a strong case that for a billion dollars we could get corporate tax reform, with lobbies in every district, plus Capitol Hill, plus media. You want to invest in justice? Here’s what you’re going to have to invest to make it happen. The abolitionist movement, women’s rights, gay rights, the civil rights movement—they all had money behind them, from Philadelphia, New York, Boston. Wealthy people could do a lot in the area of support for a major, multitrillion-dollar investment in repairing America, which would create a lot of jobs. Civic training for middleand high-school youth—because schools don't teach that; they teach computer science. They could reform securities laws to give investors more power. It’s endless. Do you think social media has been a benefit or a harm to organizers? Well, it’s been a great benefit to Sanders. But I think, on balance, it’s destroying the brains of your generation. In terms of sheer time and sheer trivia and sheer narcissism and sheer emotional pain, it’s unparalleled, right down to fifth graders. And I don’t think we’ve begun to analyze what’s happening to all of us—but more to the younger generations. The New York Review of Books just had a review of four books on what the smartphone is doing to people. And they polled young women at Baylor University, how many hours they’re into this: 10 a day. This isn’t just like you’re watching television. This is total immersion. And it’s just going to get worse. That means shorter attention spans, less sociability. They can’t talk to each other on the phone anymore.

THE ESSENTIAL RALPH NADER

Born: February 27, 1934, in Winsted, Connecticut. Family Business: Highland Arms Restaurant in Winsted. Oldest Family Rivalry: In 1955, Nader’s mother reportedly refused to let go of the hand of Senator Prescott Bush—father of George H.W., grandfather of George W. and Jeb—until

JULY/AUGUST 2016 • PSMAG.COM

But what if they’re talking to each other through their phones? Yeah, but it’s not voice. They don’t like to talk by voice. They’re too sensitive. And it’s exclusive of the family, taking you out of your household. It’s a very isolated thing. One girl said she had 600 text messages a day, and she’d die without her phone. At first, we all said: “Oh, it’s going to be so much easier to organize now. No stamps, no long-distance calls, instant massive audiences.” It’s not happening. You get petitions— but now they’re totally drowning in petitions, you know, over at Change.org. You can’t even get crowdsourcing much anymore, because the clutter defeats its original utility, so it devours itself. What about something like Black Lives Matter, which I think has made quite an impact on the discourse? Yeah, but how far does Black Lives Matter go? Is it raising money for offices and permanent staff? It’s like Occupy Wall Street. They had the same technology. It gets you to first base, and it doesn’t get you further. Well, what if it serves a purpose in the moment—which is to make an impact on the debate—and doesn’t carry on as an institution? OK, well, there’s a negative, which is demoralization when they can’t get there. You’ve already seen that with Black Lives Matter. They’re so sensitive to injustice, and then they don’t see any response to their work. One young man committed suicide. The tension is incredible. And what will happen when the press turns on them? The press finished off Occupy. The minute they were ejected it was no longer news. Not that they knew how to organize anything. Not that they knew how to take any advice from the ’70s and ’60s. One big piece of advice I have for organizers is to stop writing off Congress. A lot of these groups have written off Congress as gridlocked and hopeless, including the climate folks, but it’s a sort of self-fulfilling prophecy, you know, because the people who haven’t written off Congress are the corporate lobbyists. A lot of mass demonstrations just go into the ether because they’re not lobbying members of Congress, yet a lot of the things these groups want have to go through Congress. I think if Occupy Wall Street had picked minimum wage, they would still be around. Do you see any promising young movements or leaders that you think are the real deal? Well, how do you see them? Those kinds of people don’t get on the talk shows anymore. The nightly news once made leaders out of people who mobilize neighborhoods. They were such civic celebrities that they could hold their own

he agreed to build a dry dam in Winsted (the town had been decimated by a catastrophic flood earlier that year). Early Sacrifice: Turning down a full scholarship from Princeton University. His father said it should go to a student who couldn’t pay. First Job After Graduate School:

Serving as a cook in the U.S. Army. Skill He Was Taught: Mandarin, as a student earning a degree in East Asian Studies. Skill He Acquired Without Training: Hitchhiking, the mode of transportation he chose when he moved from Hartford, Connecticut, where he had opened a small law office, to

Washington, D.C., to start his public service career in 1963. Most Famous Protest While at Princeton University: Wearing a bathrobe to class, to oppose what he viewed as the conformist campuswide outfit of khakis and a button-down. Biggest Mistake: Forgetting the only copy of his manuscript

JUSTICE MEANS CONFRONTING POWER. IT MEANS GETTING CONTROVERSIAL.”

news conferences and communicate to people over Channel 7, Channel 5, Channel 9. And there used to be local talk shows that were hungry for local news. But it’s completely obliterated now. Look at the evening news: It’s beyond satire. Oh, I meet these people, all over the country. Nobody knows their name, except their own community. What are they doing, these people? They’re doing what Jesse Jackson did, Gloria Steinem did, Ralph Nader did, Barry Commoner did, Paul Ehrlich did—but they don’t appear on television anymore. The media’s been completely commercialized and corporatized. It’s so bad that people like you don’t even watch it. Like, do you ever watch Saturday afternoon network shows? I never watch TV. None of your generation does. Do you know what’s on it? You can’t believe how bad it is. About an hour of these bicycle gymnasts competing. Then you have paid infomercials. Then you have horrible third-run B-grade movies. And sometimes you have sports, but most of that’s on cable now. And the most insipid shows you can imagine. I turn it on once in a while to see what they’re doing with my property—you know, public airwaves, we all own it—and I just can’t believe it. Nothing else is going on in this country? Nothing else that merits programs on Saturday afternoon TV? And I say, “America, you are asleep.” There are all kinds of wonderful things going on, but they don’t accelerate and diffuse. Because they’re not part of the media, they’re shut out. I hear you are a voracious reader and recommender of books. What have you been recommending? And do you think books have the impact they used to? Well, we are living in a golden age of muckraking books and muckraking documentary films. Ten times as many films come out now than when I came to Washington. Books on the coal industry; books on the tax code; books on Wall Street, Goldman Sachs; books on the copper industry ravaging Arizona; the cocoa industry—all over the world. And yet they have less effect. Democracy is too underdeveloped to receive them. That’s why I say there aren’t enough institutions. OK, say you turn on 60 Minutes and there’s a terrific investigative report about student-loan rackets. This was an actual case, maybe five years ago. 60 Minutes used to have a real wallop, but it keeps going down. Why is it going down? Well, fewer congressional hearings pick it up. Prosecutorial budgets? Squeezed. Consumer groups? It’s not a growth industry. They’re overloaded. Our health-research group is overwhelmed following up on what’s reported on the drug

of Unsafe at Any Speed: The DesignedIn Dangers of the American Automobile in the back seat of a taxi. (He re-wrote it from scratch.) Favorite Weapon: Pie. While campaigning in San Francisco for the Green Party’s 2003 California gubernatorial candidate, Peter Camejo, Nader got pied in the face by

industry in the Washington Post and the New York Times. So the consumer groups are not growing to keep up with the abuses and the growth of the economy. There’s no citizen group on nanotech. Hello! That is an extremely tumultuous technology. I wish I could start a group that did nothing but follow up on Post and Times investigative reports. Why? Because at least if they produced something, and they followed up, it would appear in the newspaper! Let’s say they did the student-loan story, and there was a really powerful group of people in their 20s and 30s with student-loan debt. And let’s say they had 35 full-time people here and around the country—lawyers—going after Sallie Mae. They’d have picked something like that up. It would’ve been sensational. To step back here for a moment: What is the thing that you’ve fought for the longest that you haven’t achieved? Mechanisms for starting new citizen groups. All democratic societies have to be organized. It isn’t enough to just know what’s wrong and say what should be done. As Jean Monnet once said: “Without people, nothing’s possible. But without institutions, nothing’s enduring.” I organized my Princeton University alumni class to start a project that places students into civic-action groups around the country and the world. And my Harvard Law School class started 16 centers for law and justice. And I have thought, if we actually showed that this worked—that it’s 10 years working, it’s 15 years working—there are alumni classes all over the country who would say: “Hey, that looks like a lot of fun. Why don’t we do it?” And that’s my greatest regret: not spreading that model, because it would have massively nourished the fibers and the productivity of a democratic society.

•LYDIA DEPILLIS is an economics reporter at the Houston

Chronicle who previously covered labor for the Washington Post. @LYDIADEPILLIS

Museum of Tort Law in Winsted, which he claims is the only law museum in the Western Hemisphere.

an unidentified man. Nader threw the dessert back at his attacker. What He’s Done in His Free Time: Created the American

Comedy High Point: Inspecting blowup sex dolls for a Saturday Night Live skit in January 1977. Email address: N/A. But you can send snail mail to Ralph Nader, P.O. Box 19312, Washington, DC 20036

Personal Courtroom Victory: Suing General Motors after the company hired private detectives to discredit him. Nader received $425,000 and used the money to launch the Center for Study of Responsive Law. Number of Groups He Founded or Helped Found: Over 50 (including the Center for Auto Safety, Essential Information,

Public Citizen, and the Multinational Monitor). Things We Owe Nader Some Thanks For: Seatbelts, airbags, the Environmental Protection Agency, the Occupational Safety and Health Administration, the Freedom of Information Act, and 20 other pieces of legislation protecting consumer safety and opposing corruption.

JULY/AUGUST 2016 • PSMAG.COM

Did we fail

our kids by

relying on

prescription

medication to

treat ADHD?

P h ot o s b y C h r i st o p h e r L e a m a n

JULY/AUGUST 2016 â&#x20AC;¢ PSMAG.COM

The biggest thing I hate about it is that I’m a drug addict. If I’m being completely honest, I’m dependent on it. There’s a lot of anger and self-loathing that comes with that. Trying to go off it is so hard. I’m afraid of being fired from my job, not being able to support myself. It’s truly terrifying. It’s not like I was ever an all-star in everything. I felt like just to be average I had to take these stimulants. Who would I have been if I could have just been left to my own devices and figured it out? I don’t know. These are the thoughts that plague the medicated, the adults in their twenties who take prescription stimulants for attention deficit/hyperactivity disorder (ADHD) and have done so since childhood. By some accounts, the number of 26- to 34-year-olds taking ADHD medication rose roughly 84 percent between 2008 and 2012 40

JULY/AUGUST 2016 • PSMAG.COM

alone. “Basically we have millions of people in a society-wide experiment,” says Lawrence Diller, a behavioral and developmental pediatrician and family therapist based in Walnut Creek, California. Diller wrote Running on Ritalin, his first book, during a frenzied boom in stimulant prescriptions in the mid’90s. From 1990 to 1998—the year in which the book was published—the number of children and adults diagnosed with ADHD rose from about 900,000 to nearly five million nationwide, he wrote. By the time his fourth book, Remembering Ritalin, was published in 2011, at least 6 percent of children in the United States between the ages of four and 17 were being medicated for ADHD. The phenomenon concerned him deeply. Diller felt the medical and mental-health communities were understating or outright ignoring the addictive nature of prescription stimulants and their high potential for abuse among those aged 14 and older. Just as alarming was what seemed like a steep rise in ADHD diagnoses and stimulant prescriptions nationwide—particularly given how little was known about the long-term effects of the drugs. “It was appalling,

just appalling, what was going on with the medical industry and the drug companies,” he says. Prescription stimulants like Ritalin were considered a godsend when they first started being used to help hyperactive, unfocused kids succeed in school. So many children were on ADHD drugs in the ’90s that lines would form outside the school nurse’s office, where students went to take their midday doses. But almost 20 years have passed since Diller predicted that the tidal wave of prescriptions written in the ’90s would come to shape an entire generation. Now, those children are all grown up and living on their own. As adults, many find themselves unable to get off the drugs. Some fear losing their jobs, while others fear losing the only self they have come to know—a self with a prescription drug dependency that’s difficult to kick. “SMALL THINGS like driving are a big

deal when I’m not on my medicine,” says Brittany, 22, a 2015 college graduate and marketing intern. “Grocery shopping, that’s extremely hard for me. I just wander and wander and wander, because I have no direction.” Setting a correct alarm and waking

MODEL: BROOK TORENO; HAIR AND MAKE-UP: VAL CHANG

There’s this frustration, this anxiousness, not knowing who I actually am without the medication. When I go off it now, I can’t get through simple chores, errands, tasks, anything.

up on time can seem like huge accomplishments for an adult with ADHD. Even answering a single email can be a maddening affair, derailed entirely by an interruption as simple as a text message. Whereas most working adults are already feeling productive and on track within the first hour or two of a typical 9-to-5, someone with ADHD may still be trying to figure out where to begin. Carly Thompson, a career counselor at a community college in Maryland, helps her clients with ADHD re-learn the most basic daily coping skills, like breaking large tasks into more manageable pieces. Over the last few years, Thompson has noticed an uptick in the number of adults with ADHD who lack the confidence to hone in on a fulfilling career path. They have come to rely on a tiny pill in order to meet the demands of life, school, and work. Some have developed an innate mis-

DANIEL 29, Phoenix, Arizona, works for a major insurance company

I was a pretty crazy kid. Very outgoing, but very distractible. Around the start of second grade, my mother decided to take me to see a doctor. I went through the DSM test, got diagnosed, and started on Ritalin. I was really smart; it just wasn’t turning into good grades. Pretty much as soon as I started taking medication, my grades became phenomenal. By the end of second grade I was doing awesome in school, and crushed it all the way through high school. In college, I decided that I was going to try my own behavior modification method. For the first year I did pretty good in school, still getting all As and Bs. Before, I was an all-As, AP-class, super-nerd kid. But I was satisfied with my As and Bs in college because I had more of a social life than I had ever had. I think part of

trust of their own instincts, due in part to persistent struggles with ADHDfueled impulsiveness. Others fear that years of stimulant use have left them emotionally or physically dependent, and that they simply cannot function at all without the drugs. Before becoming a career counselor, Thompson worked with a licensed professional counselor at a community mental-health agency, where she spent three years diagnosing issues like bipolar disorder, schizophrenia, and anxiety. Over time, diagnosing young children with ADHD became the job’s biggest drawback. “I was almost more reluctant to give that diagnosis than any other one,” she says, “because I knew the medication. I myself was on Adderall for about 10 years on and off. It got to a point when I was like, ‘I don’t know if I’m capable of doing things without this medicine.’ I started seeing these little kids and I

the reason I was able to come out of my shell so much was because I stopped taking stimulant medications, which made me feel wired and anxious socially. For a brief time there was a re-adjustment period emotionally, but that ended up being a really good thing. I felt a lot more positive and outgoing and happy and fun to be around. I developed the social skills at that time in my life that I use in my current job. When I got this job, I knew that I was going

feel really zoned out. It’s difficult to focus on a dinner conversation at times. I’ll catch myself being caught in my own thoughts, as opposed to present and in the moment. It sucks that I have an issue that requires me to be on medication for the rest of my life. That’s probably the hardest thing I’ve had to come to terms with. You feel like you are lacking something that everybody else has. In an ideal world, I’d love to get off it. I just don’t think it’s possible. Even if I weren’t

to fail if I didn’t get myself strictly back on a medication regimen. It worked like a charm. I’ve been killing it like I used to again. Still, it depresses me that this is something I have. It depresses me that it’s difficult for my fiancée to deal with. When I’m coming down at the end of my day, I

doing such a stressful, high-stakes job, just living day to day and not being all over the place would be difficult if I wasn’t on some kind of medication. Now, is that because I started taking it when I was so young, or is it just because I have ADD and I’m always going to have ADD? I don’t know.

started thinking: ‘There’s got to be a different way. I don’t want to give this experience to them.’” When Thompson was diagnosed with ADHD in college, her psychiatrist presented stimulants as the only course of treatment available to her. She started taking Adderall when she was 18 years old. Seven years later, when she had just finished graduate school, she tried weaning herself off stimulants for the first time. She was exhausted by their physical and emotional side effects, namely the cravings for isolation, erratic sleep patterns, and extreme appetite swings that had come to pervade her life. “I was willing to trade off all the benefits of the medicine for just feeling free from it,” Thompson says. She lasted a full year without stimulants before the workplace environment of her first job became too overwhelming, and she started taking them again. Now 29, Thompson says she has been medication-free for the last six months or so. “I really don’t think I would have been able to make it through college without it,” she says. “But now, picking up on the skills I know now, it’s a really different story. I didn’t have anybody teaching those skills back then. I learned them by becoming a counselor. I learned how to help myself.” METHYLPHENIDATE, more commonly

known as Ritalin, was the first widely used medication to treat ADHD, and remains among the most popular. The drug was developed in 1944 by the Swiss pharmaceutical company Chemische Industrie Basel. After a series of experiments, chemist Leandro Panizzon eventually synthesized the stimulant from a family of medicines called piperazines, known for their stimulating abilities. Ritalin, named after Panizzon’s wife, Marguerite, was patented stateside in 1954 to treat psychological disorders and a variety of other ailments, including narcolepsy, depression, chronic fatigue, and barbiturate overdoses. The drug was licensed by the Food and Drug Administration the following year, about the same time that psychiatrists began diagnosing children with hyperactivity. No one anticipated a prescription epidemic at the time. In 1970, it was estimated that 150,000 kids were taking stimulant medication in the U.S. JULY/AUGUST 2016 • PSMAG.COM

By 2012, 4.8 million privately insured people nationwide had taken ADHD medication. “It appears that America suffered an increase in this psychiatric disorder of 100,000 percent in just one generation,” writes Nicolas Rasmussen, author of On Speed: The Many Lives of Amphetamine, “from tens of thousands in the 1960s to tens of millions today.” The psychostimulants used to treat ADHD today include methylphenidate (commonly known as Ritalin or Concerta), amphetamine-dextroamphetamine (Adderall), dextroamphetamine (Dexedrine, Dextrostat), lisdexamfetamine (Vyvanse), and dexmethylphenidate (Focalin). Ritalin and Focalin are not amphetamine based, but Adderall, Dexedrine, and Vyvanse are. When Adderall was approved by the FDA to treat ADHD in 1996, it explod-

BRITTANY 22, Charleston, South Carolina, marketing intern

ed in popularity, and now rivals Ritalin in terms of overall usage. Some nonstimulant medications, such as Strattera, are available now as well, though they are generally considered less effective than the psychostimulants. An ADHD diagnosis is based on a set of subjective criteria developed by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM lists 18 symptoms total, nine each for “inattention” and “hyperactivityimpulsivity.” They include being easily distracted, forgetful, fidgety, or restless. Children up to age 16 have to meet six or more symptoms from each of the two categories, while adolescents 17 and older have to meet five or more. Symptoms also have to be present for at least six months, affect two or more settings like home, school, and work,

My pediatrician was always like: “You’ve got to take your medicine. Don’t forget to take your medicine. Take it every day.” In college I switched to my adult doctor, and he was kind of adamant about, “You really don’t want to be relying on this for the rest of your life.” Slowly we started the process of, maybe don’t take it on weekends, maybe don’t take it on days where you only have one class. When I graduated, it was

Things are extremely overwhelming to me when I’m not on my medicine. I keep putting things off, even though normally I’m not that kind of person. But when I’m not on my medicine that is the kind of person I am. I know it’s the right thing to figure out a way to function without it. But it helped me so much throughout my life that I really wish there was some way that I could just keep taking it. I feel very overwhelmed trying to figure out a different approach to all of this. I intern three days a week, so I definitely take it those days. The other days it’s kind of up in the

sort of, OK, how badly do you really think you need this? That was when I had to say, I really can’t do anything without it. But I am slowly trying to wean myself off. So I take it some days, and I don’t take it others, and I notice a real difference between those days.

air. Some mornings I’ll wake up really late and just be like, “Well, if I take it now I’m not going to bed until 2 a.m.,” so I won’t take it. Then other days I’ll be like, “I have to go to the post office today, so I should probably take my medicine, otherwise I’ll never make it.”

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When I first got to college, I remember telling my roommate that I took Adderall, and she was like: “Oh my gosh, that’s so cool. I wish I could get on Adderall.” And I was like: “What are you talking about? That’s the weirdest thing I’ve ever heard.” People kept asking me if they could have some of my medicine, and I would be like: “No. I need that.” That was when I realized that this is really altering who I am. It alters the way I act, and the way I react to things, and what I do—kind of like a recreational drug. A kid in one of my classes said he liked taking Adderall better than doing cocaine, and I was like: “What? How are these things even comparable?” No wonder I feel so crazy when I’m off my medication. I’m dependent. Looking back, I’m not so sure that I really couldn’t have done it without the medicine. I think if I had been retested, my course would have been altered. I haven’t been re-tested for ADHD since I was seven. I kind of would have liked the chance to do it on my own.

and must be present before a child turns 12. The average age at which an American child is diagnosed with ADHD is around seven, according to the Centers for Disease Control and Prevention (CDC), but more severe cases are often flagged earlier. Primary-care providers like pediatricians make about half of all first diagnoses, though psychologists and psychiatrists diagnose ADHD as well. Boys are diagnosed more than twice as often as girls. The CDC provides a checklist of symptoms on its website for parents, teachers, coaches, or daycare providers—anyone who interacts with the child—to fill out and bring to a diagnosing clinician as part of the process. The checklist includes attributes such as, “Often has trouble keeping attention on tasks or play activities,” and “Often has trouble waiting one’s turn.” Yet how does one truly quantify “a lot of fidgeting” or “high distractibility,” particularly in a naturally energetic kid? And how much of that fidgeting and distractibility is just a normal part of growing up? Because ADHD symptoms must affect a child in more than one setting, a diagnosis necessitates that parents, teachers, babysitters, and others fill out the questionnaire. Given the subjectivity of the criteria and the variability of opinion among the people involved, some critics argue that as many as half of the stimulant prescriptions written for children may be doled out to those who don’t fully meet the DSM criteria. “There is no biological test or even marker for ADHD,” Diller says. “All those things create ambiguity. And so the range of people who have it, to who continues to have it after childhood, is very variable in all the studies.” Adderall, Ritalin, and Dexedrine are all classified by the Drug Enforcement Administration as Schedule II drugs, given their high potential for misuse, abuse, and psychological or physical dependency. Other Schedule II drugs include Vicodin, cocaine, OxyContin, and opium. Diller believes there is reason to be cautious about long-term use of ADHD drugs. “In my experience, the kids who have been on it for years improve behaviorally, but many of them wind up still feeling psychologically dependent when, in my opinion, they no longer need

it,” he says. He mentions the risks of dependence to families, but also recognizes that there’s a tradeoff. “We have to weigh the short-term benefits of getting them through the next five years of school.” Dependency is determined by the presence of physical or mental symptoms during withdrawal from repeated substance use, like night sweats or irritability. It is possible to become dependent on a substance even when used as directed. Addiction is defined by the National Institute on Drug Abuse as compulsive drug use, despite harmful consequences to one’s life. There is a fine line between dependency and addiction, and the two are often conflated, with addiction being the more commonly used term in everyday conversation. “I felt like I was addicted to it,” says Amy, 31, a graduate student who started taking Adderall in high school. She abused her medication in college, mostly as an appetite suppressant. She also sold extra pills during finals, and to friends in search of a poor man’s substitute for cocaine. Cocaine and amphetamine work somewhat similarly. Both flood the brain with dopamine, a neurotransmitter, or chemical messenger. Depending on its location in the brain, dopamine can influence pleasure, motivation, attention, psychosis, or desire. “In my practice, if I use the word ‘amphetamine,’ parents immediately are in shock,” says William Graf, a professor of pediatrics and neurology at the University of Connecticut School of Medicine and Connecticut Children’s Medical Center. “If you say ‘stimulant medication’ or ‘Adderall,’ people don’t blink.” When asked to comment on the possibility that users can become dependent on or addicted to their product, a representative from Teva Pharmaceuticals, makers of a generic form of Adderall, responded that the medication “is a Schedule II controlled substance, and the package insert clearly states the risks associated with incorrect dosage, misuse or abuse and recommends that doctors properly monitor patients.” Janssen Pharmaceuticals, makers of Concerta, an extendedrelease form of methylphenidate, acknowledges that the medication “should be given cautiously to patients

with a history of drug dependence or alcoholism, and that chronic abusive use can lead to marked tolerance and psychological dependence.” Other manufacturers of ADHD medications have issued similar statements. When Carly Thompson voiced her concerns about developing a stimulant dependency to her psychiatrist, she was advised to follow a basic weaning plan: three pills daily for one week, two pills daily the next, and one pill a day the week after, before stopping entirely. There was no mention, she says, of any withdrawal symptoms common among prescription stimulant users, which include exhaustion, night sweats, and feelings of severe self-doubt and worthlessness. She wishes she had known what she was getting into when she filled her first prescription. “This is addictive, you can become dependent on this, this is very hard to get off of, we don’t know the long-term effects—that’s all written down from what you get from the pharmacist,” Thompson says. “In my experience, no one says to you or to the parent: ‘Do you really understand what this means?’” The physical addiction is one thing, but the mental aspects of withdrawal might be even worse. “Everything feels so much harder,” she says. “It’s just a mind fuck.” MEDICATION MAY be the easiest way to

treat ADHD, but it is not the only way, nor is it necessarily the most effective way, at least not when it is the sole form of treatment. The fact is, even after more than half a century of prescribing stimulants for hyperactivity, the national medical communities still don’t agree on the best approach to treating ADHD. Organizations like the American Academy of Child & Adolescent Psychiatry recommend medication, therapy, or both, depending on the individual needs of the child. The American Psychological Association also endorses both treatments, but notes that little is known regarding which order is most effective—medication, or therapy, first. In 2006, a report from its Working Group on Psychotropic Medications for Children and Adolescents raised the question of whether a behavioral treatment-first approach could lower societal use of

stimulants overall. “Given that ADHD is recognized as a chronic disorder and treatment needs to be implemented over long periods of time, a relevant question is when, if ever, can treatment be stopped?” the report asks. “These are questions practitioners and parents face on a daily basis that beg answers.” Behavioral therapy aims to reshape negative thought patterns and problematic behaviors through a consistent restructuring of one’s daily environment. Strict rules and routines and reward systems for jobs well done are common tactics, as are honing in on specific challenges, like arriving to work on time, and developing step-by-step approaches to staying on track. Keeping meticulous checklists, planners, and schedules is encouraged. Other goals include strengthening critical reasoning, controlling impulsive behavior, and navigating feelings of self-deprecation and insecurity that inhibit proactive decision-making. Therapy may provide lasting benefits throughout one’s life, but stimulants are only effective for the four to 12 hours that they remain in the body’s system, says William Pelham, director of the Center for Children and Families at Florida International University. “The guidelines recommend behavioral treatments and pharmacological treatments, but, in practice, typically medication is the first and only intervention,” he says. “And that’s what pediatricians are taught to do.” Pelham was the lead researcher of a study published earlier this year that suggests that beginning with behavioral therapy instead of stimulants could prove far more beneficial for children overall. He and his research team randomly assigned 152 children diagnosed with ADHD, ages five to 12, to either a low-dose stimulant or low-intensity behavioral therapy at the beginning of the school year from 2006 to 2008. Therapy included working with teachers to improve specific school goals (like listening to directions) and setting up ways to measure and impact progress (like a daily report card). Additional tutoring, timeouts, and homework-skills training were used at school as well, if needed. Parents were tasked with attending weekly parenting-skills training proJULY/AUGUST 2016 • PSMAG.COM

grams and setting up a daily report card for jobs well done at home. Children in the therapy group took socialskills training classes as well. After eight weeks, any child in Pelham’s study who didn’t improve was assigned a second treatment at random. A child initially prescribed lowdose medication, for example, either started taking a higher dose or began therapy but remained on a low-dose medication regimen. By the end of the year, ADHD symptoms improved across the board, regardless of which treatment came first. Children who went to therapy first and took medication later—the most successful pairing, Pelham’s team found— performed best on classroom observations and parent/teacher ratings, however. Therapy-first children also required less disciplining throughout the school year. Medicating first, followed by therapy, was the least effective option; it was much harder to change a child’s behavior if they had already been medicated for some time. Parents were also substantially less likely to show up to behavioral training if their child had been previously medicated. Why bother if a pill seemed 44

JULY/AUGUST 2016 • PSMAG.COM

to be doing the trick? “If pediatricians start with their first treatment as medication for ADHD, and they start with a low dose of treatment, it will be very helpful for about half the kids,” Pelham says. “However, for the other half of the kids, if they started with a low dose of medication, they’ve essentially ruined the opportunity to add psychosocial treatments, meaning they unwittingly undermined the parents’ motivation to learn new parenting skills, and the teachers’ motivation to implement programs in the classroom. Doctors don’t realize that they’re doing that, but that’s what this study shows.” IN HER WORK AS a career counselor,

Carly Thompson has seen firsthand what can happen when young people aren’t given the chance to learn how to cope with life’s challenges on their own. “We just take pills because the doctor says it’s going to help us,” she says. “I think the bigger issue is, people are struggling in some way with how to focus in their lives.” “Knowing how hard it is to get off of it, I wish that I had been able to do something about it when I was 15,”

Brittany says. “I feel like I still would have had it in me at that point to relearn things. And because I would have still been at home, I would not have been in charge of my own care so much.” As an adult with rent and bills to pay, she feels she has a lot more at stake now. For his part, Diller remains skeptical about how many children need to stay on medication into adulthood. Of the nearly 3,700 children he has treated for ADHD, he has prescribed stimulants to fewer than half of them. Of those, only a small minority still required medication into their twenties and thirties, he says. Most of his patients matured enough neurologically to get by without them. Or they found other niches outside of the standardized school or work environments in which to flourish. “You get no lasting benefit from taking stimulant drugs,” Pelham says. “You have to take them every day for your whole life. Who cares whether you still have eight of the required DSM symptoms of ADHD? It’s how are you functioning in life,” he says. “Medication during childhood has zero impact on how people turn out as adults in terms

of their functioning in daily life.” Meanwhile, in an already fastpaced culture, a society that is hyperaware of hyperactivity, in which focus and output are highly valued, the number of adults seeking diagnoses later in life is also on the rise. In 2013, the DSM criteria were updated to include specific guidelines for diagnosing adult ADHD. Over the four years prior, between 2008 and 2012, the number of adults taking ADHD medication had already increased by roughly 53 percent. And not only is the number of adults taking stimulants for ADHD rising, the age group to which stimulants are first being prescribed is getting lower. Data from the CDC— presented at the Georgia Mental Health Forum at the Carter Center in 2014—indicates that nearly one in 225 toddlers between the ages of two

AMY 31, San Francisco Bay Area, graduate student

I started taking it in maybe sixth grade or seventh grade. I think I was 12. My parents took me to a psychologist, and they said that I had ADHD and just put me on drugs. I think I was on some form of Ritalin. I remember in junior high I had to go to the nurse’s office to take a pill every day. There was a stationery store on campus and I would get “school bucks” for the store to take my pill. In high school I think I went on Adderall, and I stayed on Adderall until I was 25. I abused it a lot in college. I abused it a lot after college. I felt like I was kind of addicted to it. In college, no one could afford to buy uppers, like drugs, so people would want to snort Adderall. They’d treat it like cocaine. Shut the back door and snort it. Sometimes we’d just get drunk and pop a pill. We wanted to party and wanted an upper.

and three were being medicated for ADHD, based on Georgia Medicaid claims. The CDC estimates that as many as 10,000 toddlers nationwide may be taking ADHD medication, despite a lack of research into the risks of prescribing the drugs to children that young. One risk concerns appetite suppression, a common side effect of stimulant medication, which can cause nutritional deficits in young children. Melissa, a 28-year-old assistant to a financial advisor who took Ritalin in grade school, recalls coming home with her lunchbox full, day after day. “There were a few months when I actually stopped growing,” she says. Sleep problems, not surprisingly, are also associated with stimulant use. “I had horrible insomnia,” Brittany says. “When I was about 10 years old, they put me on Ambien to

Definitely around finals time, everybody was like, “Can I buy pills off you?” I would sell 15 pills a week during finals. Ten dollars a pill. I only had the blue 10 milligrams. I definitely had a pill cutter too. I remember someone stole pills from me once—in my house, out of my bathroom drawer. But honestly, I think I used it more as an appetite suppressor. And to work out. I would go to the gym for two hours. I was always pretty thin because I played a bunch of sports in high school

that counterbalanced it. I think I had to, because I was taking so much Adderall. I don’t take anything now at all. I go to the therapist—she is kind of therapy plus life coach, transitions and stuff. I also just know myself now. I have to have my day planned or I’ll easily get distracted. At six o’clock I’ll go to the gym—I have to tell myself that. If not, I’ll never do it. I’ll find myself somewhere else. So many people in my graduate program take Adderall. This first-year had it just sitting out

and college, but I think I got really skinny at one point. I was super neurotic about it. I would always carry the bottle around to count my pills to make sure I had everything. I felt I couldn’t function without it. I also smoked a lot of weed in college. I think

in the open the other day—a full bottle. She popped a pill while she was on her computer. I was like: “Whoa. I would have never have done that. I won’t do that.” What if that’s how younger people are now? They’re just so used to taking pills.

counteract the Adderall. I would take a little quarter of one to go to bed a couple times a week.” The American Academy of Pediatrics doesn’t even address children under the age of four in its practice guidelines to treat ADHD. And while the package insert for methylphenidate explicitly cautions against its use by those under the age of six, prescriptions for the drug tripled among preschoolers nationwide between 1991 and 1995 alone. Two other popular stimulants, dextroamphetamine and Adderall, are being administered at even younger ages. According to a paper from the American Academy of Child and Adolescent Psychiatry, these drugs have been approved by the FDA for use in children as young as three, “even though there are no published controlled data showing safety and efficacy.” This trend is “totally mind-blowing,” Graf says. “You’re giving amphetamines to little children. It should be evident why one would be concerned. I was taught as an intern that we never give Ritalin below the age of six, ever,” he adds. “There is a place, rarely, for medication for out-of-control behavior in a four-year-old, but not with any of the stimulants.” Has ADHD become so deeply ingrained within our society that widespread stimulant use is simply accepted? Has it become so normalized that anyone who occasionally gets distracted can go running to the doctor’s office for a prescription? Have we become, as Diller predicted, a culture running on Ritalin? Graf recalls an afternoon driving in the car with his daughter, as she flipped the radio from song to song. “I think I have a little bit of ADHD,” she said. “She was joking, of course,” Graf says, “but the fact is that it trickles down to kids’ day-to-day vocabulary. I think there are a lot of people out there who are convinced they have a little ADHD and now they’re being medicalized. I think this is epidemic. The locomotive has left the station and it’s moving forward. This is the way we’re raising kids these days.”

•MADELEINE THOMAS is a staff writer for Pacific Standard. The names of those featured in the sidebars accompanying this story have been changed. @MADELEINETWNSND

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PHOTOS BY FRANCESCO ZIZOLA

ritrea, a sliver of a nation wedged between Sudan, Ethiopia, and the Red Sea, is experiencing an exodus at a scale rivaled only by war-torn Syria. An estimated 200,000 Eritreans have left the country of six million since 2009. When three United Nations commissioners were denied entry by the government to investigate human rights violations, they instead surveyed roughly 700 Eritreans who had recently migrated to neighboring states like Ethiopia, or as far as northern Europe and the United States. Many emigrants, describing their reasons for leaving, cited a nationwide system of mass surveillance designed to ensure that nobody evades forced labor or conscription, and that everybody stays loyal to the government. “In Eritrea, everyone is a spy—local housewives, farmers, they know when you arrive and when you leave,” one Eritrean told the U.N. investigators. “Your own neighbors report you to the authorities.” Issued last June, the report—which the Eritrean government has aggressively disputed—indicates that torture and detention are common punishments for those accused of political disloyalty or socially “deviant” behavior. ¶ Meanwhile, an estimated 5,000 Eritreans per month are heading north across the Sahara to Libya’s Mediterranean coast, where they board rickety boats bound for Italy. Last summer, the international medical relief organization Médecins Sans Frontières (Doctors Without Borders) had three ships patrolling the Mediterranean to rescue refugees from overloaded, sinking vessels. In August, photographer Francesco Zizola joined a series of rescue missions on board the Bourbon Argos, where he took the images that appear on the following pages. ¶ Not all of the passengers rescued on those missions were Eritrean. MSF also reported Nigerians, Gambians, and Somalis aboard. The instabilities driving the so-called refugee crisis in the region are too numerous and disparate for bodies like the U.N. and the European Union to mount a coherent response. So the exodus continues. Migrants now represent a larger share of the population than at any time in recorded history.

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•FRANCESCO ZIZOLA’s photography focuses on social and humanitar-

ian issues in the developing world as well as in Western countries. He has published seven books, including Born Somewhere, an extensive work on the living conditions of children in 27 different countries. All of the images in this photo essay are copyright Francesco Zizola/NOOR.

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N F L A G R AT I O N S A STORY OF MOTHERHOOD, MENTAL ILLNESS, AND A PLANET ON FIRE.

BY AMY IRVINE PHOTOS BY MATTHEW D'ANNUNZIO

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THE YEAR RUBY turned five, it was hard

to say which was more imbalanced— the planet, or this mother. Spring was more manic than usual, even for our remote corner of southwest Colorado. One minute, drab skies hurled galvanized sheets of freezing rain. The next, a blinding white sun scorched the ground. Hard winds gnashed at our aspen saplings—bending the trees to the earth like supplicants, their new leaves so dry they curled like paper held to a flame. Seismic activity increased—small but noticeable tremors in an otherwise stable landscape. Then a rash of small brushfires erupted. Things trembled and burned all around. They fit a larger pattern, those mad swings in weather and shudders of ground. Every aspect of the natural world is shifting, due largely to human influence. Ice shelves recede, oceans rise, and man-made earthquakes are induced by fracking. Here in the American Southwest, red dust—having been kicked up by oil and gas exploits, cattle grazing, off-road vehicles, and bulldozers paving the way for unconscionably large homes—darkens alpine snowfields, causing them to melt a month earlier than they used to. In the brushy, upper woodland deserts, vegetation is already bone dry, and then lightning happens, abandoned campfires smolder, and a tossed cigarette may as well be a blowtorch to roadside grasses. What was once a five-month fire season now lasts for seven—more than half the year—and in just over three decades, the average number of thousand-acre-plus wildfires has nearly doubled. Western landscapes, already parched by years of sustained drought and hotter temperatures— places already deemed monumental tinderboxes due to years of fire suppression on millions of acres of public lands—may all go down in flames. IT WAS IN the midst of all this upheaval

that I awoke one morning to find a black widow on the wall above our bed. The next day, one paraded blatantly across my daughter’s pillow, while another fell out of her shoe. Two more strolled casually along the baseboard beneath the sink, where I stood barefoot to wash dishes. Throughout the month I JULY/AUGUST 2016 • PSMAG.COM

continued to find their black orbs, as dark and oily as French-roast coffee beans, crouched on every surface. Outside, along the foundation, their sticky, sloppy webs looked like half-assed latticework. The invasion was too much for an already distraught mother whose grasp on reality had grown whisper thin. My husband, Herb, dismissed it as coincidence—the fact that I had been dreaming about so many of this same species of spider—for he believed I made far too much of things. But I was certain: The widows had spilled out of my lopsided mind into the light of day. War was declared. I mean handson, in-the-trenches battle. I bought spider traps, squeezed putty into crevices, and vacuumed daily every nook. I even bought two geckos and turned them loose, after reading that these slender, chirping lizards were known for eating arachnids. One scurried under the refrigerator, never to be seen again; the other was found behind the toilet, so desiccated it looked like a shred of crepe paper, post-birthday party. Still, the spiders grew thicker by the week. Then other bugs crossed the threshold. Tiny brown sugar ants plastered the bathroom counters, and the most aggressive wasps I’d ever seen built nests at six-foot intervals beneath the eaves—attacking like fighter planes whenever we stepped outside. I called the Colorado Department of Agriculture to ask if such infestations were normal. “It’s the drought,” the woman explained. Throughout the West, many insect and spider populations have exploded in the hotter, drier weather. While bark beetles are causing widespread devastation in Western forests, wasps are setting up shop in watered gardens, and spiders of all kinds are crawling indoors in search of relief from the heat. I resorted to poison. Compared to other pesticides, permethrin sounded less harmful. I was told it was derived from chrysanthemum flowers, biodegradeable, and far less toxic to humans. How bad could it be? I thought. The bug man showed up in a crisp 58

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white golf shirt with short sleeves. No mask. No gloves. “Aren’t you going to cover up?” I asked. “It’s hot, lady,” he scoffed, as he slung a large canister over his shoulder and tested the nozzle, sending a vaporous cloud my way. Ruby was already in the car with our bags and dogs; we were vacating the house for a week, until the spray had done its magic and dissipated. As we drove away, Ruby asked, “Will it really be safe, mama, to go back home?” I assured her it was. It had to be. IN THE MONTHS after we returned

home, my thyroid grew sluggish, while the same gland in my daughter revved up, her heart and metabolism erupting into a firestorm of frenetic activity. I felt cold and muddle-headed. But Ruby was a

continuously stoked furnace. Sleep was hard-earned, and her brain was furiously addled. Her symptoms, we would learn, were caused by an autoimmune disorder in which antibodies attack the thyroid. She had always been a restless sleeper, but now her body began to buck and shake throughout the night—a condition known as nocturnal epilepsy. As our lives tipped further out of balance, I began to wonder if maybe

Ruby had been right. Maybe we never should have come home at all. The days grew hotter, gustier. On the worst of them, Herb took off for a walk in the canyon below our mesa—claiming that both the crazy weather and my moods were throwing him off-kilter. So I talked Ruby into curling up to read with me. When she asked for a glass of water, I got up and headed to the kitchen, but stopped short in front of the east-facing windows. Not more than a mile away, the edge of our mesa was crowned with fire. Like soldiers, the flames marched in neat rows, with 50-mile-an-hour winds battering their backsides. They joined forces to become a great wave, red and undulating, headed straight toward our home. My heart ricocheted between sternum and spine. Thoughts bent at odd angles, then ran to extremes: The redcoats are coming. Does one fight? Or take flight? I turned to find Ruby standing there, her wide hazel eyes darting back and forth between the fire and me. Taking her small hand, I tried to feign reason and calm while I explained. “We are going to pack a few things, just like we did when we had the house sprayed, OK?” My voice was shriller than I intended. Ruby nodded, then ran into our bedroom and dove under the bed. When she wriggled back out, every suitcase and duffel bag we owned was in tow. She hauled them to her room and filled them with stuffed animals while I made a few calls—to friends who lived even closer to the flames, to compare my perceptions to theirs, to see if things were as ominous as they appeared. I had not yet learned the reasons why my mind kept spinning some disjointed take on reality. All I knew then was that my husband, along with friends, neighbors, my daughter’s teachers and doctors, thought my responses to things were hyperbolic, neurotic. It was possible that I was blowing the whole thing out of proportion. I WAS ONE of those mothers who

joyfully marked on the calendar the date when sperm collided with

egg. But it was only a matter of days before the tectonic plates of my internal landscape began to shift and slide. And just like that, the woman my husband had married was replaced by some disastrous and incendiary force of nature. The moods grew more extreme as the pregnancy progressed. I did not understand what was happening. Other pregnant women had faces that shone like tulips—even as they worked and exercised right up through their first contractions. When I saw them in the grocery store, it took everything in me not to run them over with my cart. But encounters with other expecting women were rare, given that a staggering sense of nausea kept me almost exclusively at home—in bed or near the toilet— for the entire pregnancy. There was a dense flu-like feeling so relentless that I was forced to quit my job. Inside the house and horizontal, I watched Law & Order obsessively. Simple tasks, like feeding the dogs, required an hour-long recovery. I almost appreciated the migraines, if only for a change in symptoms. Mind you, I was no wimp. Prior to getting pregnant, I’d been a nationally ranked competitive rockclimber, a National Park Service ranger, and a wildlands firefighter. A woman who ate organic foods before it was a thing, and traded her plastic, BPA-laden waterbottle for stainless steel, also ahead of the trend. Still, nothing worked to ease that pregnancy—neither the natural supplements I started with nor the pharmaceuticals I resorted to. And then, this breathtaking rosebud of a girl was born and things just got worse. Ruby was one month early, colicky, and she nursed incessantly. I thought this was a good thing, because all the research showed that breastfeeding was best for children’s immunity. I’d even gone off my antidepressant for this task—a fact I was proud of but which, in hindsight, may not have helped matters, because after giving birth I was in a constant state of fight or flight. I had no idea where I left off and others began. I could barely boot up my computer, pay bills, or put air in the car tires. Any one of these tasks unleashed waves

of panic that landed me back on the couch, which by now was threadbare from all the time I had spent there. Personal hygiene was forgotten. Not that it mattered, as sex was a bird flown out the window, and my good dietary and exercise habits were impossible to re-claim. It was all I could do to nurse and soothe my daughter. To be clear, I sought help—and a lot of it—both during the pregnancy and after. Each appointment began with me saying: “Something isn’t right. I don’t sleep. The baby doesn’t sleep … we are sick all the time….” The doctors called it “the baby blues,” even when I insisted it was more than that. “It’s normal,” they would say as they washed their hands and checked their watches before breezing out the door to the next patient. When I complained to other mothers, they were quick to say: “Buck up. This precious time will be over before you know it.” I’d just stand there slackjawed, wondering what kind of monster I was to be so incapable of relishing my time with this small miracle of a being who, in spite of it all, made me wild with devotion. I spent most days inside, pitching back and forth furiously in a rocking chair that, had there been an odometer on it, would have registered the equivalent of a trip to the moon and back. As I rocked and nursed, rocked and nursed, in the same pajamas I’d worn for a week, I scanned constantly the windows and doors— to make certain they were locked against intruders. On the rare occasion I forced myself outside to walk along the road, the sound of a car coming sent me diving into the trees for cover, convinced that some deranged man was about to grab the baby from the sling on my chest and head for the hills. FREUD POPULARIZED the term hys-

teria, but it has been around since Hippocrates, who believed that a uterus made sick from a lack of sexual activity “not only produces toxic fumes but also takes to wandering around the body, causing various kinds of disorders such as anxiety, sense of suffocation, tremors, sometimes even convul-

sions and paralysis.” These notions seem bizarre and outdated, yet it is still socially acceptable, whenever a woman’s thoughts or behaviors are deemed errant, to suggest that hormones may be the culprit. Few women would deny that hormones can upset our equilibrium. New mothers are especially vulnerable. The thoughts and feelings we may experience due to hormonal shifts can range from slightly more emotionally charged to seriously deranged—although we may not even understand ourselves where we are on that continuum. It wasn’t until just before Ruby’s 10th birthday that I would learn, from a pair of 2014 New York Times articles, about maternal mental illness, a term used to describe not just postpartum depression but an array of mood disorders that can occur during or after pregnancy and range from mild to severe. One article noted that maternal mental illness is caused by a “complex interplay of genes, stress and hormones,” and cited recent research suggesting that “in the year after giving birth … at least one in eight and as many as one in five women develop symptoms of depression, anxiety, bipolar disorder, obsessive-compulsive disorder or a combination.” What a relief to know that I hadn’t simply imagined this dark, inflammatory state of mind. That I wasn’t just a bad mother. The information would come too late to repair the damage done to my marriage, which would end a year later, or to magically heal my relationship with my daughter, who would for years feel very anxious about my state of mind, and question repeatedly the veracity of my love for her— traits that are common in children born to depressed new mothers, and that can have lasting effects. Maternal mental illness (also known as perinatal mental illness) can take many forms. Depression is by far the most common. Anxiety disorders and bipolar disorders are less common. The rarest but most serious is postpartum psychosis, which occurs in one or two out of every thousand births. Any of these conditions can occur out of the JULY/AUGUST 2016 • PSMAG.COM

blue—to highly functioning, emotionally healthy women, although previous psychiatric history is one of the strongest predictors of which mothers will develop a form of maternal mental illness. Women with disorders like OCD or major depression can have disturbing thoughts of harming themselves or their children, and for those with postpartum psychosis, the compulsion may be so overwhelming they act on it. A woman with untreated postpartum psychosis has a 4 percent risk of infanticide and a 5 percent risk of suicide. Consider Andrea Yates, who, after struggling with severe psychiatric episodes, drowned her five children. Even with overwhelming proof of Yates’ compromised, psychotic state, a Houston jury delivered a guilty verdict in threeand-a-half hours. “A woman with postpartum psychosis who commits infanticide needs treatment rather than punishment,” argued Dr. Margaret Spinelli in a 2004 paper in The American Journal of Psychiatry that examined the Yates case. In a 2006 re-trial, the conviction was overturned, and Yates was found not guilty by reason of insanity. The narrative of maternal mental illness is problematic in a society that believes women should experience motherhood as a state of bliss. The Diagnostic and Statistical Manual of Mental Disorders (DSM), considered the reference bible for psychiatric illnesses, didn’t even include a reference to postpartum depression until the end of the 20th century. Like climate change, maternal mental illness has been considered an exaggeration by some. But in 2013, JAMA Psychiatry published findings from a study by Dr. Katherine Wisner in which 14 percent of 10,000 mothers being screened for postpartum depression were diagnosed with one form or more of maternal mental illness. One-third of those cases began during pregnancy, and nearly one-fifth of those who screened positive reported thoughts of self-harm. Among the diagnosed women, 69 percent had unipolar depressive disorders, 23 percent had bipolar disorders, and 6 percent had anxiety disorders. Wisner’s study was wide60

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ly reported, and it gave the public and health-care providers a sense of the scope and breadth of the problem. Nevertheless, in the years since the study, very few laws have been proposed or enacted at the state and federal level to encourage outreach, screening, and treatment for postpartum psychiatric disorders. Imagine, for a moment, how many women may yet go untreated for various forms of maternal mental illness. How many have been or may still be punished, or incarcerated. And how many maternal infanticides—one of the most underreported forms of death in the United States—may have happened because of an untreated maternal mental illness? As with most psychiatric disorders, little about the different forms of maternal mental illness is clearcut. Today, even the more severe forms remain difficult to identify— for patient and health-care provider alike—given that other factors, such as sleep deprivation, can mask them. Many women keep quiet about their struggles for fear their child will be taken away if they were to disclose how bad things really are. And then there are mothers like me, who seek help but are met with dismissiveness, left to suffer inside our own private conflagrations. I FOUGHT FOREST fires in the back-

country the year that one-third of Yellowstone burned. It was 1988, and the government had assigned to me a squad of firefighters on a blaze in Idaho—guys with zero backcountry experience, freshly recruited as they exited prison gates on various kinds of parole. I was 22 years old then, and used to spending nearly every day outdoors—on duty as a ranger and off duty as a climber. I was fit and trained for fires and medical emergencies, while my crew was made of men who were tattooed and dubious. They laughed when I was first introduced as their boss; the largest and scariest of them said he wasn’t taking orders from “some scrawny bitch.” We bonded, though, over Skoal Long Cut. And they learned to trust me. When we lost radio contact with the command center and the wind shifted, so the fire doubled back

on us—this was pre-GPS—I got my squad out of the burn zone because I was the only one who kept my cool. After that, even the big scary guy who had done time for things he said I “didn’t want to know about” listened. The problem turned out to be the only other woman in our squad. Let’s call her Eva. She began to melt down several times a day. While we hacked at smoking tree roots with our pulaskis, Eva would wander away from the line, perch herself on some breezy vantage point, then take off her boots to massage her feet, much to the rest of the squad’s dismay. One evening, on the long hot climb out of a blackened gorge where we’d put in 10 hours of hard work, Eva lost it. She tore off her pack and threw it down the steep slope up which we had just trudged, then threw her pulaski too. Next, she tore off her brightyellow Nomex shirt and threw it to the ground and, standing there in a grungy, sweat-stained bra and government-issued green pants that rode too far above the waist, she leaped forward and landed squarely on the shirt, which she ground into the earth with the ash-caked Vibram soles of her boots. “I…” Stomp. “Can’t…” Stomp. “Fucking…” Stomp. “Do this!” Then Eva fell to the ground and raked her fingers through the black steamy soil and wailed. The sound was piteous, like a drowning cat. We looked on with an awe that flirted dangerously with reverence—because, male or female, secretly each of us wanted to fall apart too. We were hot, tired, and filthy. There had been little to eat, save unidentifiable, Army-issued meat in a can, because so much of the West was on fire that summer, and crews were spread too thin. Rations and equipment were low; one of my men had suffered a serious injury and we waited hours for an evacuation because the choppers were doing double-duty, dumping buckets of retardant and hauling supplies. That night, Eva cornered me near the latrines. Her red hair, frizzy and unwashed, stood on end and her gray eyes were feral. She wanted to apologize, she said, for

her crazy behavior. She wanted me to know that she’d had an abortion the week before, and her guess was that her hormones were out of whack. She was feeling anemic, too, from post-surgical bleeding. She held up a Ziploc full of thick white pads and shrugged. I didn’t know then what a wild ride being pregnant was, how reproductive hormones skyrocket a hundredfold but, once the womb is emptied—be it by birthing a baby, having a miscarriage, or choosing an abortion—those same hormones plummet, causing a disturbance of brain chemistry in some women. That night with Eva I played nice and feigned support, but as soon as I could escape, I bolted to the mess tent to find my supervisor so I could request a discharge for her. I felt odd that I could hang in this camp full of men who catcalled when I walked by, but wanted distance from Eva, and fast. It would be years—decades really—before I would connect the stars between Eva’s meltdown and the time when I was 16 and finally, after a year-long romance, said Yes to my boyfriend. That first time was not without planning and protection, but the condom broke and I found myself alone, looking for a doctor who would scrape away my insides but neglect to tell me that, for a long time afterwards, I would feel wildly out of control, my redhot heart burning away acres of grief and shame. THE WAKE-UP call in this story is

this: Our interior ecosystems are as complex and delicate as the exterior ones we inhabit. Mental, physical, and emotional well-being all depend largely on the proper function and balance of reproductive hormones, thyroid hormones, and various others that, optimally, function together in exquisite synchronicity. Any one of these tips slightly off-center, and brain chemistry is altered. Some of these hormonal changes occur naturally, but others can be attributed to chemicals in our environment. I’d been so overwhelmed by my day-to-day crises that it took me a while to look

more closely at permethrin, which I discovered is suspected of being an endocrine-disrupting chemical (EDC)—much like BPA, PCBs, and DDT, the pesticide made infamous by Rachel Carson’s Silent Spring. Once absorbed by the body, EDCs either block or mimic hormones produced by the endocrine glands— the pituitary, thyroid, adrenal, thymus, pancreas, ovaries, and testes—all of which release carefully measured amounts of hormones into the bloodstream to act as the Pony Express, traveling to different parts of the body with messages that control vital functions such as metabolism, sleep, mood, reproduction, and immunity. EDCs are found in plastics, pesticides, toiletries, food, water, packaging, toys, computers, and building materials, to name a few. They wreak havoc on hormonal health in some wildlife populations and in lab animals too, and research suggests that they may do so in humans, especially at critically early stages of development. A scientific statement, published last year by the widely respected Endocrine Society, represents “a comprehensive review of the literature on seven topics for which there is strong mechanistic, experimental, animal, and epidemiological evidence for endocrine disruption.” These include: obesity and diabetes, female reproduction, male reproduction, hormone-sensitive cancers in females, prostate cancer, thyroid function, and neurodevelopment and neuroendocrine systems. In other words, EDCs can influence our most basic functions—how we think, learn, feel, grow, mate, parent, eat, and fight. I don’t mean to suggest that permethrin was the cause of my health issues, or my daughter’s, but even the possiblity caused me ample concern. EDCs are ubiquitous, they accumulate in the body, and, despite a lot of research to date, there is still little consensus on how they interact and whether they cause adverse effects in humans at low-dose and environmental exposure levels. Of the thousands of chemicals we interact with daily, few have been tested specifically for endocrineJULY/AUGUST 2016 • PSMAG.COM

disrupting effects. What testing is done is typically done on animals, and at high doses, but low-dose exposures may be the bigger threat. Dr. Carol Kwiatkowski, executive director of The Endocrine Disruption Exchange, an advocacy organization that focuses primarily on human health and environmental problems caused by low-dose and ambient exposure to chemicals that interfere with development and function, believes that EDCs are a formidable threat. “This year marks the 25th anniversary of the science community’s recognition of EDCs,” she says. “We are seeing more thyroid issues and other endocrine problems than ever, and yet we still understand so little about non-lethal levels of EDCs— which are minuscule and yet very influential. The science needs to change, so that EDCs are studied at the levels that the body’s natural hormones influence endocrine function—which is in the parts per trillion. One part per trillion is comparable to a single drop of water in 20 Olympic swimming pools.” One drop, and the effects ripple outward. THE DAY I NEARLY took my child’s life

began when I touched her head and found that it was, for the fourth day in a row, red hot with fever. “You

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can give her Motrin at night so she can sleep, but during the day, let it burn,” the doctor had told me. “It’s the body’s way of fighting the illness.” Believing that the medicine might harm her kidneys and liver— maybe even cause brain damage—I was OK with letting her burn. She cried for three nights straight, and I stayed awake for the duration, certain I had somehow failed her. By the fourth day, when she wasn’t getting any better, I marched out to the car at five in the morning, my child tucked under my arm like a football. Her red, fever-soaked curls left a damp spot on my shirt. We were in Salt Lake City then, visiting my mother, who was still asleep when we left. En route to the hospital, rain assaulted the vehicle with a vengeance, and I took it personally—for I was that far gone by then. As the world outside the windshield bled through the glass, I saw only dark distortions of things once familiar. The wipers wagged in my face, and the wretched wails in the backseat began to dislodge things in me, things I had believed to be permanently affixed. Then my blue Subaru veered away from the hospital and headed south. We were pulled along by dark horses on a boulevard that skirted the base of the Wasatch Range, the great citadel of peaks that borders the eastern

edge of the city. There was the clattering of shod hooves on the rushing ribbon of pavement, the flash of yellow centerline between their legs. And somewhere, far more distant, the garish blare of horns, and shriek of brakes. We careened left into a canyon lined with stark white granite. My seatbelt was off now, the alarm sounding for this breach in safety, ding-ding, and it dinged in my skull, behind my eyes, as the horses leaned into the V of earth and the timpani of hooves thundered in my body. The steeds, lathered now, sought a good solid bend in the road—one without a guardrail but where the canyon dropped away anyway. And there it was, shining dead ahead, one voluptuous curve amid many—and the great, heaving beasts skidded to a stop. Ruby’s wails rose from the backseat. A stainless-steel sippy cup hit me squarely upside the head. I glanced at her in the rearview mirror but the mirror was cockeyed so instead I caught the reflection of my own face. It had split in two, like a log halved by an axe. A glistening black matter oozed forth. It fascinated, the way it slid down my arms, my neck, my chest, then pooled in my lap, wet and warm like those days before Ruby was toilet-trained, when I’d take her out of the bath and set her on my thighs to towel dry her hair. The adorable child peed every time. The car idled and the horses pawed at the gravel and out of the liquid in my lap rolled small, dark dots. At first they were flat, twodimensional figures, like circles of finely rolled dough with little black toothpicks sticking out the sides. They looked like black suns drawn by sad children. And then the dots plumped up and out, so that they were now bulbous black orbs perched atop eight articulated needle-nosed legs. The spiders formed ranks of 10 or so. A group would rise up and then scuttle away to make room for the next group, and there was a rhythm to it, in the rising and scuttling, rising and scuttling, which I found soothing. Every now and then a flash of red was visible on

their slick round underbellies, as the spiders moved out in every direction—down my legs and across the floor, over my hands and onto the steering wheel, up my shoulders and into my hair. Then they spilled down the headrest into the back of the car, where Ruby was still strapped and screaming. All of this slid smoothly, like easing a canoe into a river, into an ill-formed logic, which is this: The female of many species, in a state of psychological or environmental stress, has been known to kill, even cannibalize, her young. Take the neighbors’ cat, to which two kittens had been born earlier that year. Ruby and I had been invited to bear witness to the miracle, but the bedraggled and weary mother, still a skinny juvenile herself, had no sooner pushed them out than her small jaws engulfed the black one— her mouth dilating, then contracting, like a python’s—until the kitten was back inside of her. As if the dark thing had never been born at all. And there was a polar bear at the Nuremberg Zoo, in Germany. Her name was Vilma. About a month after giving birth to two seemingly healthy cubs, she reportedly ate them, “bones and all.” Imagining how those cubs would have been faced with a snowless life on concrete, behind bars, I remember thinking, when I read about her, “What a tender thing to do.” So it made perfect sense, just then, that the canyon would soon devour my daughter and me both. It was the most natural response to a wholly unnatural situation. Somehow the hood of the car came to face the great maw of the canyon squarely. The boulderstrewn canyon bottom beckoned. I toed the gas pedal. Imagined the plunge. The glorious sound of steel and bones on stone. Who knows how long we sat there. But finally, the clouds overhead broke, and silver shards of light tumbled into the canyon. Steam rose in wisps off the hood of the still-idling car. I rolled down the window just in time to hear the clatter of rockfall. Then silence. The world around me holding its breath, and my own body poised between two conclusions.

My daughter had her neck craned forward, her eyes wide and fixed. On me. She looked like a baby vulture, ravenous for whatever scraps its mother could regurgitate. I don’t remember turning the car around, but suddenly we were driving back to the city in total quiet, no other creatures in our company. And when I finally carried my nowcool daughter into the emergency room, through the automatic doors that hissed shut behind us, I began to shake. Not with relief, or chill, but with a violence that begged to be exorcised from my body. Out of the corner of my eye I could make out the waiting area, the vague shapes of people there, leaning forward, trying to make sense of my shuddering figure and the small, frail child in my arms. Straight ahead, figures in white and green rose from the desk, briskly moving forward with outstretched arms to catch my daughter as I thrust her outward. “What’s wrong?” The nurse quickly scanned Ruby for signs of harm. “Take her, please.” My jaw shook the words off a dry wooden tongue. “You must take her and make her better. I cannot do this. I will kill us both.” AFTER MUCH TRIAL and error, suc-

cessful treatment for me came in a complex combination of bioidentical estrogen and testosterone, thyroid replacement, DHEA and melatonin supplements, along with a higher dose of my prior antidepressant. Sleep, exercise, and steady meaningful employment are possible again, and I am a far better mother—which is vital, given that my daughter’s autoimmune condition and nocturnal epilepsy remain constant. Not a day or night goes by now when I am not keenly aware of how our assaults on the planet marginalize our own chances of survival—whether by changing the climate or changing the chemistry of our own bodies. We are entering a new era of volatility. That day on the mesa, after the wind changed direction and drove the fire back the way it came, the adults—husbands and wives, mothers and fathers—tucked jackets and

blankets under their butts and sat with legs dangling over the rim. Just behind us, away from the edge, our children played hide-and-seek in a stand of pinion and juniper. We held up glasses of red wine to a dusky sky and toasted our good fortune. Flecks of gray fell onto our eyelashes, into our goblets. The kids pretended it was dirty snow. We drank anyway, as the fire marched steadily up another landmass, not ours. It worked its way through a grove of ancient ponderosa, many over 150 feet tall, in steep pristine terrain that had seen neither cow nor chainsaw. Up each trunk the yellow flames slid like fingers on a rail, until they were combing through the crown, where the boughs were thick with needles and cones. There they bloomed suddenly, a riot of red and orange. When the tallest tree fell, there was an exquisite moment when everything was suspended and resonant, like a bow drawn slowly across a cello. The flaming crown was falling through the gray smoke in space, and then the trunk fell too, toward the smoldering, sharply slanted slope. Along the way, it took out smaller, younger trees, and then everything was one burning mass that hit the ground and tumbled, sparks flying into the sky like meteors. For once I didn’t want to think about tipping points, or the inevitable doom at which they hinted. Our family was intact. Photo albums and stuffed animals had been preserved. And we’d be returning home that night, where the black widows had at last been defeated. I looked over at Herb. His face was gauzy in the thin veil of smoke. There may have been a smile on his lips as he raised his glass to me. To us. Just beyond my reach, our daughter danced in circles, her arms out and face upturned. Her eyes were open to the falling ash.

•AMY IRVINE lives and writes in

Telluride, Colorado. She is the author of Trespass: Living at the Edge of the Promised Land, and a recipient of the Orion Book Award and the Ellen Meloy Desert Writers Award. JULY/AUGUST 2016 • PSMAG.COM

THE CULTURE PAGES WHERE CULTURE MEETS CONSCIENCE

SURVIVAL TALES FROM THE EX-GAY MOVEMENT TWO MEMOIRS UNDERLINE THE EMOTIONAL AND MORAL DANGERS OF EX-GAY CONVERSION THERAPY. BY ROSS UFBERG

GARRARD CONLEY wasn’t planning on coming out to his parents;

he wasn’t even planning on coming out to himself, really. But everything changed, Conley says, when he was raped by a male college friend—a friend who went on to spread gossip about Conley being gay in an apparent effort to ensure he would be shamed into silence. When they found out, Conley’s parents sent him to Love in Action (LIA), an ex-gay Christian ministry—since 2012, it’s been known as Restoration Path—in Memphis, Tennessee, that blended what critics have called dubious psychological techniques with fire-and-brimstone rhetoric to bring “sinful” gays back into the fold. That’s how Conley found himself in June 2004 sitting across a desk from John Smid, LIA’s longtime director, who promised him:

JULY/AUGUST 2016 • PSMAG.COM

“Once you enter the group, you’ll be well on your way to recovery. The important thing to remember is to keep an open mind.” This opening scene in Boy Erased, Conley’s tenderly written memoir of growing up a gay teenager in the Ozark Mountains with devout Missionary Baptist parents, encapsulates Conley’s fraught relationships with the many around him who said they loved him while insisting on the evils of his “lifestyle.” Conley’s memoir ends with a hard-earned self-acceptance, the brutal clarity of which sets him starkly apart from his former LIA mentor. Some readers will mistrust the suspiciously overeager Smid they meet in Boy Erased, even (or perhaps especially) if they read Smid’s own book, Ex’d Out: How I Fired the Shame Committee, his 2012 account of how he left the movement that he’d helped shape. Together, these stories underline a corrosive hypocrisy at the heart of conversion therapy—the strange idea that it is virtuous to dissimulate one’s sexuality, despite all the evidence that such an approach is doomed to fail. Much of Conley’s memoir recounts and addresses conversion therapy, a form of counseling (vigorously opposed by the American Psychiatric Association) that aims to change the sexual orientation of patients by treating homosexuality as a mental disorder that can be cured. But as Conley moves in and out of his time at LIA, the memoir also draws a close portrait of a Southern boy’s life that renders the book a complicated act of catharsis. Where Conley comes from, family and God are the pillars upon which the town is stabilized. There is no seat in the parlor for a homosexual, and the author’s acute awareness of being the odd man out dominates his struggle to understand himself. Conley attended LIA as an outpatient. People spent anywhere from weeks to years going through LIA’s treatment; Conley was there for a two-week assessment to determine how long he’d have to stay. He went to sessions all day, and at night returned to his suite at the Hampton Inn, where he was staying with his mother for the

PHOTO BY HENRY HUNG

duration of the program. LIA was very explicit about where the participants could go in their free time: “There was a map on one of the facility’s walls that listed the few areas in the city without any malls, restaurants, movie theaters, secular bookstores, or porn shops. Every part of the city was forbidden except for places with the word ‘Christ’ in it, really.” He spent most of his evenings doing LIA homework—assignments such as “trying to come up with another sinful transgression for my Moral Inventory.” Composing a Moral Inventory, a term LIA borrowed from Alcoholics Anonymous, was an exercise that aimed to suss out deep-rooted moral failures in a patient’s past that had brought him into sin; to LIA’s way of thinking, only when all of these past transgressions came to light could one begin to get fixed. One of the counselors at the program, a man named Danny Cosby, was a recovering alcoholic— Conley writes, “LIA had hired him as a counselor because they believed his extensive AA experience was the only prerequisite for curing any and all forms of addiction.” If alcohol and drug addictions could be overcome, the reasoning went, so could addictions to “deviant” sexual behaviors. One of Cosby’s main talking points throughout the therapy sessions was the importance of sports, stressing that “a lack of sports in childhood could lead to effeminate behavior.” The therapy sessions were grounded not in research-based psychology or sexuality studies, but in a particular flavor of Christianity that does not accept homosexual behavior or affect among its followers—that meant no sexual activity, of course, but also that boys should avoid resting their hands on their hips (gay men prefer that stance), and girls had to wear bras at all times (lesbians don’t wear bras, they burn them). In 2012, Smid was featured on an episode of the radio show This American Life; by then, he had left LIA and repudiated the methodology and philosophy he’d spent 22 years practicing and preaching. Having married at 19, Smid divorced his first wife six years

later and lived for a period as a gay man; then he converted from Catholicism to Evangelicalism in 1982 and devoted his days to averting homosexual temptation in himself and teaching others to do the same. Six years after his conversion, he married a second time, to a woman named Vileen, who, as he writes in his book, was “aware that my attractions haven’t changed in general towards men but that I love her deeply and make choices daily to remain faithful to our marriage and have not regretted that decision.” After Smid wrote Ex’d Out, he divorced Vileen, began dating, and eventually married a man, Larry McQueen, whom he met at a gay Christian conference. I found Smid on the website of Grace Rivers Ministry, a loose organization that he founded a few years ago to spread the message that it’s OK to be gay and Christian. The Ministry is not an active church; it is mainly a platform for Smid’s blog (he compiled early posts to form his book), which he continues to write from his home near Paris, Texas. He is actively ex-ex-gay, and he spends a lot of time contacting people he counseled in the past. He says he remembers Conley, as he does most of the people who passed through LIA. For most of them, the therapy failed. “I actually have a list of the people that went to the program,” Smid told me. “I really cared about these people. The way I cared about them was amiss. Of the ones that I’ve contacted—about 200—I can only think of a handful who continue to live what I would consider an ex-gay life or an ex-gay conviction. The vast majority of the 200 people I’ve talked to are on a spectrum of angry and bitter and resentful about the treatment, or completely settled and living successful lives as gay people.” SMID, IN CONLEY’S portrayal of him,

was a zealot, but not an unkind one. He was frank about his own personal struggle with the “Satanic” force of homosexuality; this frankness was, in fact, front and center in his treatment philosophy. Smid advocated complete openness: Patients had to confess dreams, thoughts, and fantasies in

front of the group. Smid speaks with confidence and authority about his past: Just as 20 years ago he knew that Christianity was incompatible with homosexuality, today he knows there’s no reason the two can’t go together. And while Smid’s regret over LIA seems genuine, there’s something discomfiting about the publicity, and the self-congratulatory undertone, of his mea culpa. Conley emerges as the keener theologian: In his writing and in conversation, he is constantly doubting, reflecting, and thinking about how his actions might affect others. “I really believe in doubt,” he told me. The denouement of Conley’s memoir involves two moments that are tautly connected. Conley’s father had always been devout, and at one point felt the calling to become a minister. His long-anticipated ordination ceremony took place exactly at the midpoint of his son’s treatment at LIA. Conley relates how, moments before the ceremony was to begin, he tinkered with a slide on the projector to change the text from large caps to small caps—brother conley’s ordination—“a small tweak that always makes slides look better.” This, knowing that the faith his father so sincerely and fervently embraced condemned homosexuality. Moments later, as part of the ordination, the soon-to-be-preacher was asked in front of 200 congregants, “Will you do everything you can to fight against the sin of homosexuality in the church?” With his wife and gay son beside him on the stage, Brother Conley answered in the affirmative. WHEN CONLEY returned to LIA after

his father’s ordination, something had fundamentally changed. He realized: “LIA was telling me on a daily basis that a loss of self meant a gain in virtue, and a gain in virtue meant I was drawing closer to God and therefore closer to my true heavenly self.... I came to therapy thinking that my sexuality didn’t matter, but it turned out that every part of my personality was intimately connected. Cutting one piece damaged the rest.” Smid

JULY/AUGUST 2016 • PSMAG.COM

THE CULTURE PAGES

taught that homosexuality was the result of trauma, “often linked to generational sin.” In order to cure homosexuality, one needed to understand “where the sin came from in the first place. How it trickled down from father to son, mother to daughter.” The breaking point came when it was Conley’s turn in the Lie Chair, where he sat in the middle of a circle of LIA staff and patients and was instructed to dig up long-hidden feelings of anger toward his father that, he was told, he surely must be harboring and which contributed to his gayness. But despite their differences, Conley didn’t—and doesn’t—hate his father. And so he refused to participate, walking out of the session, out of the building, and out of a situation that threatened who he was to the very core. Smid would eventually do precisely the same thing, though not quite in the same fashion as Conley. Smid left LIA in 2008, and the departure would eventually lead him to what he describes as satisfaction and fulfillment. “I’ve never believed that I could have the kind of relationship that [my husband and I] have,” he told me. “I’m just thrilled with my life today.” Conley has found a fulfilling path too. He has a boyfriend and a job he enjoys; they live together in Bulgaria, where Conley teaches English and advocates for LGBTQ rights. The first time we met I found myself sitting next to him in a restaurant in Sofia, the Bulgarian capital; we were at a writing conference, and several of the participants were attempting to oneup the others with stories of painful childhoods. Conley, thin and slight of build, was mostly quiet. It took a bit of plying before he told us the story of his childhood—a tale of love, but also of good and evil. As Conley later told me when we spoke over the phone: “The one great thing about writing this book is that there were very clear villains.” For years, Smid was the face of that villain Conley speaks of. I asked Smid how he feels about having so forcefully preached a doctrine he now believes is false gospel. “I was so entrenched in religious doctrine that I just couldn’t hear anything else,” Smid said.

JULY/AUGUST 2016 • PSMAG.COM

Smid and Conley are OK now, and it could be tempting to see these two stories as having happy endings. The truth is more complicated. These days, Smid is reaching out to apologize to many of the people whose lives he had sought to shape during his LIA years. When I ask Conley about Smid’s religious and personal epiphany—God doesn’t hate gays, and I’m gay—Conley says he’s glad for Smid, but sees some hypocrisy: “To me, this is a man who has decided to control the dialogue once again.” Smid, Conley says, “is a good Christian in the sense that he believes that forgiveness should be offered and granted. And I think that his life is not going to make sense unless he can also bend the narrative to fit this weird development of his.” For his part, Smid says he considered how to go about issuing his apologies seven years ago, when he first left the ex-gay movement. “There will be those whose pain is such that my public presence is a trigger,” Smid wrote me in an email. “I understand that completely. However, I don’t believe it would have been best for me to have just shrunk into the background. In my experience there have been far too many people that have been helped from me being more public about it all.” Smid can’t guarantee he’ll read Conley’s book, though he says he’ll take a look at it. Whether or not Smid’s contrition is sincere, there’s still nothing he can do to erase the 22 years he spent on a very different, much more pernicious sort of mission. Conley’s Boy Erased emerges as a graceful rebuttal to that mission and an unlikely triumph of hope: Conley reflects on execrable circumstances without self pity—rather, with the humility of a man who survived but still doesn’t know all the answers. He shows us how what was learned can be unlearned—and how what was nearly erased can be slowly, carefully, patiently re-drawn.

• ROSS UFBERG is a writer and trans-

lator in New York City, and co-founder of New Vessel Press. @ROSSUFBERG

Pacific Standard Picks BY ALISSA WILKINSON

LIFE, ANIMATED When Owen Suskind was diagnosed with regressive autism at the age of three, his family feared he would be dependent and uncommunicative for the rest of his life. That is, until they witnessed his geek-out over Aladdin—which sparked their son’s interest in and skill at talking with other people. Based on the 2014 book by Owen’s father, the writer Ron Suskind, the documentary Life, Animated demonstrates how young autistic people can learn to navigate life with the help of personal projects and hobbies: While Owen took to Disney movies, others have found their road maps in history or superheroes. Yet Life, Animated is no straightforward story of assimilation: As director Roger Ross Williams shows, while Disney introduced Owen to the norms of the neurotypical world, it also taught his family how to see through his eyes. Landing in theaters July 8, Life, Animated promises to demystify the autistic experience in more ways than one. FOR MORE SELECTIONS FROM OUR CULTURE WRITERS AND EDITORS, VISIT PSMAG.COM.

WHERE CULTURE MEETS CONSCIENCE

FILM

GUEST PROGRAMMER:

Joelle Dobrow

PHOTO BY ALYSON ALIANO

Joelle Dobrow is a former producer-director of non-fiction television, and a member of the Original Six, a group of women directors who researched and built a pioneering case alleging gender discrimination in Hollywood starting in 1979. She is now an arts-management consultant in Los Angeles. Read more about Dobrow in our online story, “The Original Six: The Story of Hollywood’s Forgotten Feminist Crusaders,” by Rachel Syme.

“[The film] makes you very grateful to be an American citizen. The amount of freedom and justice we have as American women stands in stark contrast to the situation in Turkey.”

Mustang In Turkish-French director Deniz Gamze Ergüven’s first feature-length film, five adolescent girls are imprisoned at home and forced into arranged marriages after a villager sees them playing an innocent game with a group of local boys.

Why “The reason I liked it is because I didn’t like it: Mustang makes you very grateful to be an American citizen. The amount of freedom and justice we have as American women stands in stark contrast to the situation in Turkey.”

Lightspeed A digital magazine that publishes original science fiction and fantasy short stories, Lightspeed issues new tales with contemporary resonance every month; in addition to alien species, previous topics include health care and spirituality.

Why “Every single story touches on issues of contemporary life, projected in the future— it provides a way for us to look at and consider ourselves in a safe, fictional context, one that always compels the reader to ask questions.”

Saving Capitalism: For the Many, Not the Few Former Secretary of Labor Robert B. Reich writes a searing indictment of inequality in America—in which he mounts evidence against the myth that the “free market” is operating of its own accord.

Why “What makes this book interesting is how Reich shows how some Tea Party talking points dovetail with progressive politics. He proves himself to be quite the showman in the audiobook too: When quoting experts, he uses different accents.”

Createquity Founded in 2007, Createquity is a virtual think tank and arts blog dedicated to researchbacked, solutionsoriented stories and journalism that bridge cultural subjects with politics, economics, education, and more.

Why “In addition to studying arts ecosystems, Createquity looks at how art is used as a tool for social change. Recently, it’s been examining how the equitable altruism theory may threaten future arts donations. You have to check it out.”

MAGAZINE

BOOK

WEBSITE

VISIT PSMAG.COM FOR MORE OF DOBROW’S RECOMMENDATIONS.

JULY/AUGUST 2016 • PSMAG.COM

Inside Cambodia’s Future Floating Arts Center An ambitious attempt to elevate Phnom Penh’s arts scene. BY DARA BRAMSON

THE CAMBODIAN captain navigates

sideways, inching closer to a 97-meterlong rust-red ship that dwarfs our open-air vessel. “That’s our entry point, get ready to jump!” yells Dana Langlois, our guide and one of the foreign locals working to turn The Boat, as it’s known, into the future floating arts center of Phnom Penh. Moments later, I and about two dozen passengers climb through the firstfloor window one-by-one and find ourselves in a dim room littered with piles of bricks and pipes. Single file, we tiptoe over a mound of sand and through a dark hallway lined with rubble to arrive in a sun-soaked room—filled only with snaking ropes on the floor—that will soon be a research library. From 2010 to 2014, this vessel was planned as a 100-room floating hotel, but then sat idle and unfinished on the banks of the Tonlé Sap River. When

JULY/AUGUST 2016 • PSMAG.COM

the French-Cambodian hotel investor’s money ran out, so did the laborers: Scattered tools are abandoned on a workbench; a camouflage hammock is still secured to the bow. We follow Langlois around each of the six floors, peering into empty art studios that still look like the hotel suites they’d been designed as—some eerily outfitted with engraved wooden bed frames covered in plastic—and future exhibition areas where a dozen brand-new air conditioners still await installation. We peer over the railing to the lush, green, trash-strewn shore, where young boys play volleyball beside dilapidated homes; in the distance, the hectic streets of Phnom Penh are thick with never-ending honking from cars, tuk-tuks, and motorcycles that weave between traffic and ride up on curbs, the drivers hollering at would-be passengers. As in many developing capitals, Phnom Penh’s chichi rooftop bars look down on rickety homes and piles of garbage. Every so often, thoughtful street art or a carefully curated gallery, restaurant, or café reveals itself. It’s easy to see how The Boat—with its opportunities for young local artists and free programming—could enrich the city. “We want to cultivate a local patronage for the arts,” says Langlois, who has lived in Phnom Penh since 1998. She says funding earmarked for

the arts typically ends up being refunneled into education or health budgets. “Contemporary art is quite new here, so we hope to engage the public and make sure it’s accessible.” Their mid-year goal, depending on their fundraising, is to dock at a nearby mooring site, build an access bridge, and get The Boat’s main floor up and running. The floor plan—impressive for a project initiated just months ago—includes a café, art galleries, and shops, all on the main level alone. Additional funding will allow for the construction of new stories that will include offices for rent, two restaurants, exhibition space, and an open-air stage and cinema during the dry season. While the founders aim to support artists from around the globe working on individual and collaborative projects, they intend to prioritize Cambodian visual, performing, and media artists. This is an essential aspect of the initiative in a country that continues to re-build its cultural capital in the wake of a 1975–79 genocide, during which nearly two million people— roughly 21 percent of the population— and 80 to 90 percent of the country’s artists lost their lives. The founders are attuned to the project’s challenges, most notably the colonial history of Cambodia. “We are very self-conscious that we are white people,” Langlois says. “It’s difficult in a post-colonial context with so many interventions, but I’d like to think that I have sensitivity—I live here, I’m raising my kids here, I’m not parachuting in, and I’m conscious about the local impact.” This aspect of The Boat, in particular, is what inspired the founders to maintain a local emphasis and a model that would enable most events to be free and open to the public. As we return to port, The Boat towers over the shore, turning the heads of passersby; Langlois points out the landmarks of the capital, a city where she hopes this strange floating idea might propel an artistic renaissance.

•DARA BRAMSON is a researcher and freelance journalist based in Kraków, Poland. @DARABRAMSON

PHOTO COURTESY OF THE BOAT

THE CULTURE PAGES

WHERE CULTURE MEETS CONSCIENCE

WHITE CAPITAL, BLACK LABOR

THE RACIAL HIERARCHY OF AMERICAN INDUSTRY WAS BUILT ON THE RUINS OF SLAVERY. A NEW BOOK ON THE HISTORY OF BLACK WORKERS SHOWS HOW FAR WE HAVE—AND HAVEN’T—COME. BY MALCOLM HARRIS

Paul R.D. Lawrie’s book Forging a Laboring Race: The African American Worker in the Progressive Imagination is about two concurrent problems that faced American policymakers at the dawn of the 20th century: the so-called “labor problem” and the “Negro problem.” The first was about how to turn an agrarian workforce into a skilled and semi-skilled industrial one; the second about how to incorporate black Americans into the nation as free people. Although we’ve named and conceived of the two separately, they remain historically inextricable. There was never one without the other. Ending slavery obviously didn’t end racism, but it did force it to mutate. A divine order with black permanently subservient to white couldn’t hold if the groups were now supposed to be equal under the law. Black Americans could no longer be counted as property; they were to join the ranks of labor. How, then, were the government and employers supposed to understand racial difference? Racial theology was on the wane with abolition, but racial science was just kicking into gear, and eugenics—the study and promotion of racial hygiene—caught on. If the white god of slavery was dead, then the order of races was a question for scientific investigation and policy expertise. With the United States entering World War I, Lawrie writes that “the Negro, which heretofore had served as a regional—generally southern—metaphor for the racial perils of progress, now became in both theory and practice a national industrial agent: the ‘Negro problem’ was now an American problem.” A sizable portion of white intellectuals thought the problem would solve itself. Frederick L. Hoffman, an actuary at Prudential Insurance, pioneered the quantitative evaluation of free black workers. Until then, black and white Americans had been insured at the same rates, but the numbers couldn’t justify it: White workers lived longer. Using measurements of venereal disease, criminality, and respiratory capacity, Hoffman predicted that, exposed to competition with white workers, African Americans would quickly go extinct. That did not happen. Nor were white workers by virtue of their whiteness any better at industrial tasks. Lawrie does a good job illustrating the central absurdity of racial science. It’s arbitrary, and racists could make up reasons why black people breathe easier than whites, or the opposite: why they have resistance to disease, or susceptibility. Some thought black-white race mixing produced weaker hybrids; others (citing France’s lauded Dumas family) said the white race could benefit from “just a splash” of blackness. Whatever the difference, it could be found, measured, and used to explain white supremacy. But the new course of anti-black racism did not operate in isolation from other social phenomena. Public and private policymakers were turning to Taylorism and scientific management to structure industrial production, and every black American tested by industrial and state scientists was measured both as a representative of their race and as a laborer. The Negro and labor problems were intertwined, and progressives thought the government could solve them both with sound science and a firm hand. The Division of Negro Economics (within the Department of Labor) was the short-lived federal answer to the intertwined problems of multiracial modernity, and with its pro-black agenda the DNE relied on a non-biological

Forging a Laboring Race: The African American Worker in the Progressive Imagination • Paul R.D. Lawrie • NYU Press

idea of racial difference. The cultural school (including Franz Boas and W.E.B. Du Bois) explained measurable distinctions between black and white Americans as a product of separate and unequal social environments. Given the right opportunities and access—nothing too overwhelming at first—black people could eventually be just as good as white people. But those opportunities, whether from the DNE or the Urban League or another reform organization, weren’t everything they were cracked up to be. The DNE was most effective, Lawrie writes, at “forging links between white capital and black labor.” The Urban League wanted to create a new black professional class, but it had more success moving black southern agricultural workers into northern agricultural jobs. Additionally, the government-mediated relationship between white capital and black labor only antagonized white labor, which didn’t want the competition. The hope that economic rationality would dissolve racial difference went unfulfilled. The truth was that white capital found the color line useful, both to break up solidarity and to lower wages. The “Negro problem” was not a problem at all. It was a solution to the only problem capital has ever recognized: how to get more for less.

•MALCOLM HARRIS is a freelance

writer and editor at The New Inquiry. @BIGMEANINTERNET

JULY/AUGUST 2016 • PSMAG.COM

THE CULTURE PAGES

A Literary Festival in the Shadow of Genocide Can a polite little arts event help re-unify Sri Lankan culture? BY MELISSA PETRO

Shelf Help The Selfishness of Others: An Essay on the Fear of Narcissism • Kristin Dombek

For years now, an everexpanding ecosystem of books, articles, and support websites has insisted that we are in the midst of a narcissism epidemic: that legions of narcissists (or “narcs”) lurk among us normal, empathetic humans, preying on our natural goodwill to temporarily slake their bottomless selfishness. In this slim but far-reaching book, cultural critic Kristin Dombek casts a skeptical eye on the entire narcissism discourse. This means much more than puncturing the comically flimsy social science meant to prove the epidemic exists. Skipping nimbly between Greek myth, psychoanalytic theory, academic philosophy, and MTV’s My Super Sweet 16, Dombek uses our “narciphobia” as a lens for examining all interpersonal relationships: why they mean so much, why they hurt, and why we should be wary of responding to hurt by labeling those who hurt us as infected by an incurable disease.

—PETER C. BAKER

JULY/AUGUST 2016 • PSMAG.COM

“GALLE IS A VERY beautiful place.

Jaffna is also a very beautiful place. There is no difference. Everywhere, everybody is the same.” My tuk-tuk driver is trying to convince me there is just one Sri Lanka. We are driving down Galle’s Matara Road, the highway that skirts the ocean, where bare-chested fishermen untangle nets next to fiberglass boats resting on the coral sand. The southwestern tip of the country, known for its beaches, sunsets, and rocky bluffs, is a very different landscape from what you’ll find in the northern and eastern regions of Sri Lanka, the part of the country most affected by its 25-year civil war. My driver is partially correct: Both cities are, in their ways, beautiful. But the difference between the two is stark. Galle is a reflection of how a country’s elite might enjoy, alongside their conquerors, the spoils of colonialism; Jaffna, with its heritage of Tamil oppositional militants, including the famous Tamil Tigers, is a reflection of a society marginalized by “divide and rule.” I had set off that morning, perhaps naively, believing that language

might bring the two together. Galle is home to the Galle Literary Festival, one of the country’s central cultural events. Founded in 2005 by a British-Australian hotelier named Geoffrey Dobbs, the festival has grown from a relatively private gathering of Dobbs’ intellectual friends into a marker of national pride. The sprawling event includes readings, film screenings, panels, and literary lectures as well as gourmet lunches and dinners with participating authors. This year’s festival marks seven years since the country’s civil war came to a brutal end with the defeat of the Tamil insurgency in 2009, and less than six months after a September 2015 report by the United Nations called for the Sri Lankan government to account for crimes against humanity: unlawful killings, enforced disappearances, and sexual violence perpetuated by the military against civilians—all of which, citizens say, persist to this day. In 2011, a number of respected writers, including Noam Chomsky, Arundhati Roy, and Tariq Ali boycotted the festival in protest

PHOTO BY MELISSA PETRO

• Farrar, Straus and Giroux

WHERE CULTURE MEETS CONSCIENCE

of what they described as its relative silence regarding the country’s gross human rights abuses, including the Sri Lankan government’s alleged involvement in attacks on journalists and writers. The festival was canceled for the next three years. But, after nearly three decades of civil war, Sri Lankans want peace—and the festival is back, though it feels less political than you might expect, largely because the artists and organizers prize progress over accountability— and they’re more interested in unifying Sri Lanka than in settling scores. At the festival, organizers have set up an outdoor lounge area they call the “lit café,” where attendees laze on colorful blankets and pillows under beach umbrellas; colored lanterns hang from shade trees. A live band strikes up as an excited crowd spills out from the morning’s plenary. A three-day festival pass to readings and panels (excluding extras such as workshops, excursions, and poetry readings) costs 10,000 Sri Lankan Rupees—about $68, slightly more than the average Sri Lankan makes in a month. Whereas the occasional tourist wanders in off the street, it seems that most participants have come to Sri Lanka solely to attend the festival. Journalists in Panama hats and shorts or capris mingle with artists, authors, and aspiring writers. Two older white women glide by in colorful, flowing skirts, their oversized jewelry clinking. I sit under an umbrella with two young women—one Sinhalese, one Tamil. They talk openly about the intimidation they once felt, and how that suppression is lifting. “Finally we have freedom. Just one year ago, nobody wanted to talk about politics. We were scared.” Now, under the current administration, there are fewer restrictions and increased access to regions of the country previously off limits. “Freedom is out there, but right now we don’t know what to do with the freedoms we’re being given.” Sri Lanka is changing, the women promise—as is its literary festival. This year’s organizers added two minifestivals to the schedule of events: a three-day preview event, which took

place the week before in Kandy, and another two-day event that will kick off the following week in Jaffna. The latter event is of particular interest, since Jaffna, the predominantly Tamil region to the north, is the area most affected by the war. This inclusion is billed as an exciting development, a marker of progress. A few days before the events in Jaffna begin, Sri Lankan-American writer and festival panelist Nayomi Munaweera tweets: “Growing up, Jaffna was a foreign land we only heard about and never imagined we could see.” The festival there is being held in the Jaffna Public Library, which was burned in 1981 by the Sinhalese police, destroying more than 97,000 books. Some see the inclusion as mere lip service to national unity. A local Tamil journalist named Uthaya Shalin lamented that the organizers and presenters were not representative of the local Tamil population. Whereas much of the international community is calling for continued investigations into crimes against humanity, there are Sri Lankans who, for various reasons, dismiss these demands for justice. Some, like my tuktuk driver that morning, are former military. Many Sri Lankans simply don’t know exactly what happened. How could they with such widespread suppression of the media? Others know but are afraid. In Jaffna, most don’t speak Sinhala, let alone English. Even in their native Tamil, they struggle to find the words. In the market, I met a man who spoke enough English to assure me the Tigers were “all dead or captured.” He asked me where I was from and if I was with the Central Intelligence Agency. Sri Lankans, it seems, are tired. Like all of us, they want normalcy, peace. Many, particularly those least affected by the war, advocate for development over accountability. They welcome any sign of the re-assimilation of Tamil culture into wider Sri Lankan culture—in reality, but perhaps even more so in the eyes of foreigners.

Shelf Help Killing the Competition: Economic Inequality and Homicide • Martin Daly • Transaction Publishers Areas where income inequality is highest also tend to have the highest homicide rates: This has long been recognized among academics, if not the general public. In his newest book, influential Canadian psychologist Martin Daly surveys the impressive array of statistics that prove this correlation—and then goes a step further, arguing that inequitable resource distribution actually causes interpersonal violence. Human males, Daly claims, evolved to be acutely sensitive to relative disparities—and willing to stage violent confrontations to ensure their rank. But this hardly means, for Daly, that humans are genetically doomed to violence. When inequality is reduced, physical confrontation should become less worthwhile and homicides decrease. This book is required reading for anyone open to looking anew at the stubborn question of why we keep killing each other.

—PETER C. BAKER

• MELISSA PETRO is a writer based in New York City. @MELISSAPETRO

JULY/AUGUST 2016 • PSMAG.COM

THE CULTURE PAGES

ONE LAST THING

The Prison Tattoo PHOTOGRAPH BY SAM KAPLAN

JULY/AUGUST 2016 • PSMAG.COM

OBJECTS THAT MATTER

CAPTIVITY WILL beget invention. Modern American

prisoners can jury-rig tattoo machines out of objects available at the commissary. A bit of a pen, a warped toothbrush, and a nine-volt battery get you a fully functional ink gun—the latest technology in a centuries-long tradition of tattooing in prisons worldwide. Tattoos have served as ritualistic totems in a variety of cultures for millennia. In Japan, it was during the Kofun Period (300 to 600 C.E.) when tattoos began to assume connotations of criminality: Criminals were branded with a tattoo, much as slaves were in the Western Roman Empire. Like some sailors, prisoners embrace the underworld connotations of tattoos, and, in both cases, tattoos can be personal signifiers within otherwise uniform environments. Conversely, some tats 2005 can indicate group cohesion: The To combat higher rates traditional mottled blue of the of hepatitis C and HIV/ AIDS among prisoners, American prison tattoo is as likely Canada established tattoo to denote gang membership as it parlors in six prisons. It was a promising way to is to say “I ♥ Mom.” prevent infection—until the Despite the allure, prison ink government closed those can prove a liability. When senparlors a year later. tencing a prisoner, judges in some states can consider gang tattoos cause for enhanced penalties, depending on the crime. On rare occasions, a tat can even function as evidence: In 2008, the Los Angeles County Sheriff’s Department nailed Anthony Garcia for shooting John Juarez in a liquor store four years earlier. The tip-off? Garcia, a member of the Pico Rivera gang, was now sporting a tattoo that depicted the 2004 shooting in punctilious detail—including the store’s holiday decorations and the direction in which the victim’s body had fallen. Garcia confessed and was convicted of first-degree murder in April 2011. —TED SCHEINMAN

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MANY INSECT AND SPIDER POPULATIONS HAVE EXPLODED IN THE HOTTER, DRIER WEATHER. WHILE BARK BEETLES ARE CAUSING WIDESPREAD DEVASTATION IN FORESTS, WASPS ARE SETTING UP SHOP IN GARDENS, AND SPIDERS ARE CRAWLING INDOORS IN SEARCH OF RELIEF FROM THE HEAT. P.56