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 OF NO PA RT Y OR C L IQU E

C O N T E N T S | J U LY/A U G U S T 2 0 1 8
VO L . 3 2 2 – N O. 1

Features

44 The Raid
BY WILLIAM LANGEWIESCHE
Inside a stealth-bomber mission against an ISIS
outpost in Libya

52 Finding the Formula

for Team Chemistry
BY BEN ROWEN
The search for an elixir that turns good teams
into great ones. Does it exist?

T H E H E A LT H R E P O R T

74 Being Black in America Can

Be Hazardous to Your Health
BY OLGA KHA ZAN
Across the United States, African Americans have
a lower life expectancy than whites. In
Baltimore and other segregated cities, this gap is
as much as 20 years. One young woman’s struggle
to get healthy shows why.

COVER STORY

88 Your Child Says She’s

Trans. She Wants Hormones
and Surgery. She’s 13.
BY JESSE SINGAL
For some teens who experience persistent gender
dysphoria, a new protocol ofers profound relief.
For other kids, gender dysphoria is temporary—
and the efects of transitioning can be permanent.

58
When the Next Plague Hits
BY E D YO N G
The epidemics of the early 21st century revealed
a world unprepared, even as the risk of
pandemics continues to multiply. Much worse is
coming. Is Donald Trump prepared?

There’s nothing obviously special about the University of

Nebraska Medical Center’s biocontainment unit. But every detail
has been carefully designed to give patients access to maximal
care, and infectious diseases minimal access to anything.

P h o t o g r a p h by J O N N O R AT T M A N T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 3
 CONTENTS VOL . 322–NO. 1 0 7/ 0 8 . 1 8

Dispatches Departments

11 FA M I LY
8 The Conversation
The Dangers of Distracted Parenting
B Y E R I K A C H R I S TA K I S 120 The Big Question
When it comes to children’s development, we should worry What book or article would
less about their screen time—and more about our own. you make required reading
for everyone on Earth?

On the Cover

ST U DY O F ST U D I E S TECHNOLOGY BUSINESS

16 Gossip Is Good 20 These Are the 22 You Buy It,

B Y B E N H E A LY People in Your You Break It
The surprising virtues of Neighborhood BY B RYC E C OV E R T
talking behind people’s backs BY IAN BOGOST Private equity is killing retail.
Nextdoor, a hyperlocal
SKETCH social-media platform, BIG IN ... JAPAN

17 The Trustbuster highlights petty grievances— 24 Dad Classes for

BY ROBINSON MEYER and proves that Americans the Single Guy
Lina Khan has a novel theory have more in common than BY STEPHEN MARCHE
for how monopolies work. they think. Making men more
Her sights are set squarely marriageable, one pregnancy Photograph by
on Amazon. suit at a time Maciek Jasik

4 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
THE ALL-NE W 2019

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 CONTENTS VOL . 322–NO. 1 0 7/ 0 8 . 1 8

The Culture File Poetry

THE OMNIVORE BOOKS BOOKS 32 The Unveiling

26 The Wisdom 34 The Wrong 40 Your DNA Is B Y E D WA R D H I R S C H
of Russell Brand Way to Scout for Weirder Than
BY JA M E S PA R K E R Soccer Talent You Think
The recovering addict, BY LAURENT DUBOIS B Y N AT H A N I E L C O M F O R T
comedian, movie star, and An intense winnowing Genetic research constantly
former spouse of Katy Perry process, starting when upends our understanding
has entered a new phase: as players are very young, may of heredity—though not our
the host of a brainy, fail to spot the gifts that are zeal to control it.
philosophical podcast. crucial to the game.

30 MUSIC

The Sound of Rage and Sadness

B Y S P E N C E R KO R N H A B E R
The still-unfolding history of male angst in pop music

Essay

108 Searching for

Jean-Michel Basquiat
BY STEPHEN METCALF
Was he an artist, an art star,
or just a celebrity?

6 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C

• T H E C O N V E R S AT I O N
The Hardest Job in the World
In May, John Dickerson laid out the challenges inherent to the presidency—and
proposed a series of solutions, from presidential onboarding to vacation time.
I thoroughly enjoyed John
Dickerson’s disquisition on the
mismatch between the Oice of
the President and the president
himself. He is certainly correct
in arguing that the profes-
sional demands far outstrip
the capabilities of any human
being. Could I suggest an
idea? I would like to reduce the
number of political appointees
8 J U LY/AU G U ST 2 0 1 8
R E S P O N S E S & R E V E R B E R AT I O N S
in favor of professional career
positions. For example, we
could make all sub-Cabinet
positions part of the civil
service. This would mean the
president would appoint only
the Cabinet secretaries.
The president would be
relieved of much responsi-
bility; policies would not be
subject to so much partisan
T H E AT L A N T I C
whim; and the entire bureau-
cracy would be more eicient
and better trained.
David So
EAST ORANGE, N.J.
John Dickerson identiies the
near-impossibility of organiz-
ing an administration in the
time between the election and
the inauguration. A possible
solution to this is a constitu-
tional amendment to replace
Section 1 of the Twentieth
Amendment, which set the
inauguration date as January 20.
At the founding of the
republic, travel was diicult.
Particularly in winter, with
atrocious roads, getting from
the hinterlands to the capital
could take a month or more.
Because the votes of the
presidential electors were not
formally certiied by Congress
until well after the election, an
inauguration date of March 4
was speciied. Meanwhile, the
formation of an administration
was relatively trivial. George
Washington had ive Cabinet
oicers (including the vice
president), each of whom had
a handful of clerks, secretaries,
translators, etc. Washington
himself had a few private
secretaries. That was the extent
of the executive branch.
The situation is now
reversed. Washington, D.C.,
can be reached from any
point in the country within a
day’s travel, but forming an
administration of complexity
takes months. Thus, a return to
the original March 4 inaugura-
tion date makes sense. The
amendment efecting such a
change should also include the
provision that the president-
elect could submit Cabinet- and
sub-Cabinet-level appoint-
ments to the incoming Senate
for conirmation prior to the
inauguration. This way, the
new administration could start
with much of its infrastructure
in place on day one.
Steven K. Brierley
WESTFORD, MASS.
John Dickerson’s very detailed
article conirms a suspicion
that I have had for a long
time: The presidency is an
impossible job, and should be
divided in half. The president
would be responsible for
foreign afairs and the military.
The vice president would
 be responsible for domestic
afairs and economic policy.
Each person would be an
expert in his or her respective
area. The vice president would
no longer be selected merely
to “appeal to the base” or
“balance the ticket.”
John Nance Garner, Frank-
lin D. Roosevelt’s irst vice
president, once commented
that “the Vice Presidency is
not worth a pitcher of warm
spit.” Perhaps it is time to
totally overhaul the job
description, and in doing so
save the presidency.
John Bickford
WALHALLA, S.C.
Okay. It ain’t easy. But compe-
tent people have accomplished
the seemingly impossible with
dignity for all but our most
recent history. John Dicker-
son, don’t try to make excuses
for a failed president. He is a
pronouns throughout the
article. I tried to brush it of, but
decided that I’ll take a hit for
the team and be “that person.”
The presidency, while seem-
ingly a male position because
only men have illed it thus far,
is actually a gender-neutral job.
The world is changing
and growing, and our lan-
guage needs to relect that.
Words matter. Feeling like a
welcome part of the conversa-
tion is important.
Summer Whitesell
SEATTLE, WASH.
Reality’s End
In May, Franklin Foer described
how video manipulation is erod-
ing society’s ability to agree on
what’s true—or what’s even real.
Franklin Foer compellingly
foretells the coming “collapse
of reality” that will result from
Why Are There So Many Men Here?
In May, Caroline Kitchener published an article on
TheAtlantic.com asking, “Why Do So Few Women Write
Letters to the Editor?” The so-called confidence gap, experts
told her, is one major factor behind the gender disparity in
The Atlantic’s inbox and that of other publications. Read-
ers wrote back with their own theories (and prescriptions):
“Women don’t need more platforms to speak more often,
louder, in greater numbers, etc. How exhausting. They just
need men to shut up for a while,” one said. Jen deRose of
Irvine, California, ofered: “Women are busy.” Jeanne Lamb-
kin of Marblehead, Massachusetts, thought that women may
simply have “an extra helping of humility.” Find Kitchener’s
full article—and the subsequent letters—at TheAtlantic.com.
understanding, we should not disconnected realities. The
cede the word reality to irony response to Elon Musk’s
or subjectivism. notion that we’re all in a
Daniel Story computer simulation, and not
GOLETA, CALIF. in the “base reality,” shouldn’t
be an ofended cry of anguish;
Underlying Foer’s prose is it should be a dismissive shrug.
a misguided assumption Who cares? It’s what we’ve
that “reality” is something got. That doesn’t get us of the
we have access to or we don’t, hook for what we do with it.
something we can squander or Elias L. Quinn
salvage—in short, a commodity. WASHINGTON, D.C.

complete loser, and we are all
the worse for it.
Linda Umstead
MILILANI, HAWAII
I’m incensed that Dickerson
didn’t include Hillary Clinton
in any of his analyses. Like Mitt
Romney (whom Dickerson
holds up as an example of how
to “hit the ground running”),
Clinton spent her campaign
trying to prepare for the oice,
the degeneration of those
technological mechanisms we
now rely on for the unadul-
terated truth. Yet his choice
of words contributes to the
coming of the postmodern hell
of which he warns. Foer consis-
tently equivocates on the term
reality, sometimes meaning the
objectively true state of things
and sometimes meaning our
shared understanding of the
objectively true state of things.
This framing misses the lessons
of philosophers from the last
century, and does damage to
Foer’s own evident hope that a
reality can be maintained that
is inclusive, responsive, and
shared among a national or
even global community.
Instead of treating reality
as a commodity, we should
talk about it as a community
undertaking, an endeavor. It
is collaborative, constantly
Is the “collapse of reality” that
Mr. Foer talks about a culmina-
tion of sorts of the American
idea? If “I’m as good as you
be,” as Emerson described this
idea, it’s just a short jump to the
notion that my reality’s as good
as yours. Maybe we’ve been
collapsing reality these past
several centuries.
Stephen Sikora
BORREGO SPRINGS, CALIF.

which she was familiar with
because of her husband. She
won the votes of more people
than Trump did, and yet you
dismiss her as if she didn’t exist.
Janet Smith
HERNDON, VA.
I am trying to read “The
Hardest Job in the World,”
and ind myself continually
distracted and irritated by the
overwhelming use of male
Reality in the former sense
is not under any threat of
collapse, no matter what the
internet trolls and dema-
gogues would have us believe;
it is only reality in the latter
sense that is threatened. By
equivocating in this way, Foer
undermines the idea that there
is anything beyond our own
idiosyncratic experiences of
the world. If we are to resist
the collapse of our shared
renegotiated and contested.
If it is conceived of as a
commodity, the politics of
power will divvy it out to haves
or have-nots, spark malevo-
lence, and drive do-gooders
to start reality-preservation
NGOs. But if reality building
is more like gardening than
mining, we can work to make
it expansive rather than rush to
turn it into an “ours or theirs”
choice of facts with isolating,
Correction:
“Will Disney Kill Of the Movie
Theater?” (May) identiied
HBO Go as a subscription
streaming service. In fact, HBO
Now is the network’s streaming
service for cord cutters.
To contribute to The
Conversation, please email
letters@theatlantic.com. Include
your full name, city, and state.

E D I T O R I A L O F F I C E S & C O R R E S P O N D E N C E The Atlantic considers unsolicited manuscripts, fiction or nonfiction, and mail for the Letters column. Correspondence should be sent
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OFFICE S The Atlantic, 60 Madison Avenue, Suite 800, New York, NY 10010, 646-539-6700.

T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 9
Take a big, deep breath
clear your head forget you’re here
reading words
on paper
keep reading though
Think back
to the last time
you were in bed
on that perfect mattress
supporting every
bone in your body.
Wait, you don’t have a Casper?
Oh.

F I N D YO U R D R E A M M ATT R E S S
AT CA S P E R . C O M
 The fatherhood class in Tokyo is sort of like the prenatal ones I attended when my wife was pregnant—except that none of my classmates is actually a father
or father-to-be. Many of them will list their attendance at this class on their dating profiles with the aim of attracting a partner.
— Stephen Marche, p. 24

D I S P A T C H E S
I D E AS & P R OVO CAT I O N S
J U LY/A U G U S T 2 0 1 8

• FA M I LY

THE DANGERS
OF DISTRACTED
PARENTING
When it comes to
children’s development,
we should worry less
about their screen time—and
more about our own.
B Y E R I K A C H R I S TA K I S

S M A R T P H O N E S H A V E by now
been implicated in so many crummy
outcomes— car fatalities, sleep dis-
turbances, empathy loss, relationship
problems, failure to notice a clown on a
unicycle—that it almost seems easier to
list the things they don’t mess up than the
things they do. Our society may be reach-
ing peak criticism of digital devices.

Illustration by EDMON DE HARO T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 11


Even so, emerging research sug-
gests that a key problem remains under-
appreciated. It involves kids’ development,
but it’s probably not what you think.
More than screen-obsessed young chil-
dren, we should be concerned about
tuned-out parents.
Yes, parents now have more face time
with their children than did almost any
parents in history. Despite a dramatic
increase in the percentage of women in
the workforce, mothers today astound-
ingly spend more time caring for their
children than mothers did in the 1960s.
But the engagement between parent and
child is increasingly low-quality, even
ersatz. Parents are constantly present in
their children’s lives physically, but they
are less emotionally attuned. To be clear,
I’m not unsympathetic to parents in this
predicament. My own adult children like
to joke that they wouldn’t have survived
infancy if I’d had a smartphone in my
clutches 25 years ago.
To argue that parents’ use of screens
is an underappreciated problem isn’t to
discount the direct risks screens pose
to children: Substantial evidence sug-
gests that many types of screen time
(especially those involving fast-paced or
violent imagery) are damaging to young
brains. Today’s preschoolers spend more
than four hours a day facing a screen.
And, since 1970, the average age of onset
of “regular” screen use has gone from
4 years to just four months.
Some of the newer interactive games
kids play on phones or tablets may be
more benign than watching TV (or You-
Tube), in that they better mimic children’s
natural play behaviors. And, of course,
many well-functioning adults survived a
mind-numbing childhood spent watching
a lot of cognitive garbage. (My mother—
unusually for her time—prohibited
Speed Racer and Gilligan’s Island on the
grounds of insipidness. That I somehow
managed to watch every single episode
of each show scores of times has never
been explained.) Still, no one really dis-
putes the tremendous opportunity costs
to young children who are plugged in to a
screen: Time spent on devices is time not
spent actively exploring the world and
relating to other human beings.
Yet for all the talk about children’s
screen time, surprisingly little attention
is paid to screen use by parents them-
selves, who now suffer from what the
12 J U LY/AU G U ST 2 0 1 8 T H E
D I S PAT C H E S
technology expert Linda Stone more
than 20 years ago called “continuous
partial attention.” This condition is
harming not just us, as Stone has argued;
it is harming our children. The new
parental-interaction style can interrupt an
ancient emotional cueing system, whose
hallmark is responsive communication,
the basis of most human learning. We’re
in uncharted territory.
H I L D - development
C experts have differ-
ent names for the dyadic This is the worst possible
signaling system between
adult and child, which
builds the basic archi-
tecture of the brain. Jack
P. Shonkoff, a pediatri-
cian and the director of
Harvard’s Center on the
Developing Child, calls
it the “serve and return”
style of communication;
the psychologists Kathy Hirsh-Pasek and
Roberta Michnick Golinkoff describe a
“conversational duet.” The vocal patterns
parents everywhere tend to adopt during
exchanges with infants and toddlers are
marked by a higher-pitched tone, simpli-
ied grammar, and engaged, exaggerated
enthusiasm. Though this talk is cloying to
adult observers, babies can’t get enough
of it. Not only that: One study showed
that infants exposed to this interactive,
emotionally responsive speech style at
11 months and 14 months knew twice as
many words at age 2 as ones who weren’t
exposed to it.
Child development is relational, which
is why, in one experiment, nine-month-
old babies who received a few hours of
Mandarin instruction from a live human
could isolate speciic phonetic elements
in the language while another group
of babies who received the exact same
instruction via video could not. Accord-
ing to Hirsh-Pasek, a professor at Tem-
ple University and a senior fellow at the
Brookings Institution, more and more
studies are conirming the importance of
conversation. “Language is the single best
predictor of school achievement,” she
told me, “and the key to strong language
skills are those back-and-forth fluent
conversations between young children
and adults.”
A problem therefore arises when the
emotionally resonant adult–child cueing
AT L A N T I C
system so essential to early learning is
interrupted—by a text, for example, or
a quick check-in on Instagram. Any-
one who’s been mowed down by a
smartphone-impaired stroller operator
can attest to the ubiquity of the phenom-
enon. One consequence of such scenar-
ios has been noted by an economist who
tracked a rise in children’s injuries as
model of parenting—we are
always present physically,
thereby blocking kids’
autonomy, yet only fitfully
present emotionally.
smartphones became prevalent. (AT&T
rolled out smartphone service at diferent
times in diferent places, thereby creating
an intriguing natural experiment. Area
by area, as smartphone adoption rose,
childhood ER visits increased.) These
indings attracted a decent bit of media
attention to the physical dangers posed
by distracted parenting, but we have been
slower to reckon with its impact on chil-
dren’s cognitive development. “Toddlers
cannot learn when we break the low of
conversations by picking up our cell-
phones or looking at the text that whizzes
by our screens,” Hirsh-Pasek said.
In the early 2010s, researchers in
Boston surreptitiously observed 55 care-
givers eating with one or more children
in fast-food restaurants. Forty of the
adults were absorbed with their phones
to varying degrees, some almost entirely
ignoring the children (the research-
ers found that typing and swiping were
bigger culprits in this regard than tak-
ing a call). Unsurprisingly, many of the
children began to make bids for atten-
tion, which were frequently ignored. A
follow-up study brought 225 mothers and
their approximately 6-year-old children
into a familiar setting and videotaped
their interactions as each parent and
child were given foods to try. During
the observation period, a quarter of the
mothers spontaneously used their phone,
and those who did initiated substantially
 • FA M I LY

fewer verbal and nonverbal interactions
with their child.
Yet another rigorously designed exper-
iment, this one conducted in the Philadel-
phia area by Hirsh-Pasek, Golinkof, and
Temple’s Jessa Reed, tested the impact
of parental cellphone use on children’s
language learning. Thirty-eight mothers
and their 2-year-olds were brought into a
room. The mothers were then told that
they would need to teach their children
two new words (blicking, which was to
mean “bouncing,” and frepping, which
was to mean “shaking”) and were given
a phone so that investigators could con-
tact them from another room. When
the mothers were interrupted by a call,
the children did not learn the word, but
otherwise they did. In an ironic coda to
this study, the researchers had to exclude
seven mothers from the analysis, because
they didn’t answer the phone, “failing to
follow protocol.” Good for them!
T H A S N E V E R been easy to bal-
I ance adults’ and children’s needs,
much less their desires, and it’s naive to
Distracted adults grow irritable when
their phone use is interrupted; they not
only miss emotional cues but actually
misread them. A tuned-out parent may
be quicker to anger than an engaged
one, assuming that a child is trying to
be manipulative when, in reality, she
just wants attention. Short, deliber-
ate separations can of course be harm-
less, even healthy, for parent and child
alike (especially as children get older
and require more independence). But
that sort of separation is diferent from
the inattention that occurs when a par-
ent is with a child but communicating
through his or her nonengagement that
the child is less valuable than an email.
A mother telling kids to go out and play,
a father saying he needs to concentrate
on a chore for the next half hour—these
are entirely reasonable responses to the
competing demands of adult life. What’s
going on today, however, is the rise of
unpredictable care, governed by the
beeps and enticements of smartphones.
We seem to have stumbled into the worst
model of parenting imaginable—always
present physically, thereby blocking
children’s autonomy, yet only fitfully
present emotionally.
Fixing the problem won’t be easy,
especially given that it is compounded
by dramatic changes in education. More
young children than ever (about two-
thirds of 4-year-olds) are in some form
of institutional care, and recent trends
in early-childhood education have illed
many of their classrooms with highly
scripted lessons and dull, one-sided
“teacher talk.” In such environments, chil-
dren have few opportunities for sponta-
neous conversation.
One piece of good news is that young
children are prewired to get what they
need from adults, as most of us discover
the irst time our diverted gaze is jerked
back by a pair of pudgy, reproaching
hands. Young children will do a lot to
get a distracted adult’s attention, and if
we don’t change our behavior, they will
attempt to do it for us; we can expect
to see a lot more tantrums as today’s

imagine that children could ever be the

unwavering center of parental attention.
Parents have always left kids to entertain • V E RY S H O R T B O O K E XC E R P T
themselves at times—“messing about
in boats,” in a memorable phrase from
The Wind in the Willows, or just lounging
Castro’s Ice-Cream Headache
aimlessly in playpens. In some respects,
L I K E WA S H I N G T O N A N D J E F F E R S O N , the found-
21st-century children’s screen time is not
ing father of the Cuban Revolution, Fidel Castro,
very diferent from the mother’s helpers
loved ice cream. His friend Gabriel García Márquez,
every generation of adults has relied on
the Colombian novelist, recalled in “A Personal
to keep children occupied. When parents
Portrait of Fidel” that the leader once concluded
lack playpens, real or proverbial, may-
a large lunch by eating 18 scoops of ice cream.
hem is rarely far behind. Caroline Fra-
According to CIA documents declassified in 2007,
ser’s recent biography of Laura Ingalls
the CIA noticed Castro’s ice-cream fetish and tried,
Wilder, the author of Little House on
unsuccessfully, to plant a poison pill in his favorite
the Prairie, describes the exceptionally
chocolate milkshake. Apparently the assassin
ad hoc parenting style of 19th-century stored the pill in an ice-cream freezer, and it got
frontier parents, who stashed babies on stuck and fell apart when he tried to take it out.
the open doors of ovens for warmth and
otherwise left them vulnerable to “all
manner of accidents as their mothers
tried to cope with competing responsibili-
ties.” Wilder herself recounted a variety
of near-calamities with her young daugh-
ter, Rose; at one point she looked up from
her chores to see a pair of riding ponies
leaping over the toddler’s head.
Occasional parental inattention is not
catastrophic (and may even build resil-
ience), but chronic distraction is another Adapted from Milk! A 10,000-Year Food Fracas, by
story. Smartphone use has been associ- Mark Kurlansky, published by Bloomsbury in May
ated with a familiar sign of addiction:

Illustration by JOE MCKENDRY T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 13

 This content was created by Atlantic Re:think, the branded content studio at The Atlantic, and made
SPONSOR CONTENT possible by Fidelity Investments. It does not necessarily reflect the views of The Atlantic’s editorial staff.

Which Disruptions
Really Matter?
It seems as though every day brings
about the next big, revolutionary
technology. How do we figure out
which ones hold actual potential?

KEEPING UP WITH THE L ATEST tech trends

can feel like a full-time job. But for investors,
it’s not enough just to keep up; they
have to determine which innovations offer
meaningful opportunity and which are
simply passing fads. Sometimes, it helps
to hear from the experts.

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D I S PAT C H E S
toddlers age into school. But eventually,
children may give up. It takes two to tango,
and studies from Romanian orphanages
showed the world that there are limits to
what a baby brain can do without a will-
ing dance partner. The truth is, we don’t
really know how much our kids will sufer
when we fail to engage.
Of course, adults are also suffering
from the current arrangement. Many
have built their daily life around the mis-
erable premise that they can always be
on—always working, always parenting,
always available to their spouse and their
own parents and anyone else who might
need them, while also staying on top of
the news, while also remembering, on the
walk to the car, to order more toilet paper
from Amazon. They are stuck in the digi-
tal equivalent of the spin cycle.
Under the circumstances, it’s easier
to focus our anxieties on our children’s
screen time than to pack up our own
devices. I understand this tendency
all too well. In addition to my roles as
a mother and a foster parent, I am the
maternal guardian of a middle-aged,
overweight dachshund. Being middle-
aged and overweight myself, I’d much
rather obsess over my dog’s caloric
intake, restricting him to a grim diet of
ibrous kibble, than address my own food
regimen and relinquish (heaven forbid)
my morning cinnamon bun. Psycho-
logically speaking, this is a classic case
of projection— the defensive displace-
ment of one’s failings onto relatively
blameless others. Where screen time is
concerned, most of us need to do a lot
less projecting.
If we can get a grip on our “techno-
ference,” as some psychologists have
called it, we are likely to ind that we can
do much more for our children simply
by doing less—regardless of the qual-
ity of their schooling and quite apart
from the number of hours we devote to
them. Parents should give themselves
permission to back of from the sufocat-
ing pressure to be all things to all people.
Put your kid in a playpen, already! Ditch
that soccer-game appearance if you feel
like it. Your kid will be fine. But when
you are with your child, put down your
damned phone.
Erika Christakis is the author of The
Importance of Being Little: What Young
Children Really Need From Grownups.
16 J U LY/AU G U ST 2 0 1 8 T H E
• ST U DY O F ST U DI E S
Gossip Is Good
The surprising virtues of
talking behind people’s backs
B Y B E N H E A LY
W
ORD ON the
street is that
gossip is the
worst. An Ann Landers
advice column once char-
acterized it as “the face-
less demon that breaks
hearts and ruins careers.”
The Talmud describes it as
a “three-pronged tongue”
that kills three people: the
teller, the listener, and the
person being gossiped
about. And Blaise
Pascal observed, not
unreasonably, that “if
people really knew what
others said about them,
there would not be four
friends left in the world.”
Convincing as
these indictments
seem, however,
a significant body of re-
search suggests that gos-
sip may in fact be healthy.
It’s a good thing, too,
since gossip is pretty per-
vasive. Children tend to be
seasoned gossips by the
age of 5, [1] and gossip as
most researchers under-
stand it—talk between at
least two people about
absent others—accounts
for about two-thirds
of conversation. [2] In
the 1980s, the journalist
Blythe Holbrooke took a
stab at bringing rigor to
the subject, tongue firmly
in cheek, by positing the
Law of Inverse Accuracy:
C = (TI)v – t, in which the
likelihood of gossip being
circulated (C) equals its
THE STUDIES:
[1] Engelmann et al., “Preschoolers
Afect Others’ Reputations Through
Prosocial Gossip” (British Journal of De-
velopmental Psychology, Sept. 2016)
[2] Nicholas Emler, “Gossip, Reputation,
AT L A N T I C
hearing a piece of nega-
tive gossip, the more likely
they were to say they
had learned a lesson
from it. [7] Negative
gossip can also have a
prosocial efect on those
who are gossiped about.
Researchers at Stanford
and UC Berkeley found
that once people were
ostracized from a group
due to reputed selfishness,
timeliness (T) times its they reformed their ways
interest (I) to the power of in an attempt to regain
its unverifiability (v) minus the approval of the people
the reluctance someone they had alienated. [8]
might feel about repeating By far the most positive
it out of taste (t). [3] assessment of gossip,
Despite gossip’s dodgy though, comes courtesy
reputation, a surpris- of the anthropologist and
ingly small share of it—as evolutionary psycholo-
little as 3 to 4 percent—is gist Robin Dunbar. Once
actually malicious. [4] upon a time, in Dunbar’s
And even that portion can account, our primate
bring people together. ancestors bonded through
grooming, their mutual
back-scratching ensur-
ing mutual self-defense
in the event of attack by
predators. But as hominids
grew more intelligent and
more social, their groups
became too large to unite
by grooming alone. That’s
where language—and
Researchers at the Univer- gossip, broadly defined—
sity of Texas and the Uni- stepped in. [9] Dunbar
versity of Oklahoma found argues that idle chatter
that if two people share with and about others
negative feelings about gave early humans a sense
a third person, they are of shared identity and
likely to feel closer to each helped them grow more
other than they would if aware of their environment,
they both felt positively thus incubating the com-
about him or her. [5] plex higher functioning
Gossip may even that would ultimately yield
make us better people. A such glories of civilization
team of Dutch research- as the Talmud, Pascal, and
ers reported that hearing Ann Landers.
gossip about others made So the next time you’re
research subjects more tempted to dish the dirt,
reflective; positive gossip fear not—you may actually
inspired self-improvement be promoting cooperation,
eforts, and negative gos- boosting others’ self-
sip made people prouder esteem, and performing
of themselves. [6] In the essential task of the
another study, the worse human family. That’s what I
participants felt upon heard, anyway.
and Social Adaptation” in Good Gossip Chemistry Through Negativity” (Personal Psychology, June 2004)
(University Press of Kansas, 1994) Relationships, June 2006) [8] Feinberg et al., “Gossip and Ostra-
[3] Blythe Holbrooke, Gossip (St. Mar- [6] Martinescu et al., “Tell Me the Gos- cism Promote Cooperation in Groups”
tin’s, 1983) sip” (Personality and Social Psychology (Psychological Science, March 2014)
[4] Dunbar et al., “Human Conversational Bulletin, Dec. 2014) [9] Robin Dunbar, Grooming, Gossip,
Behavior” (Human Nature, Sept. 1997) [7] Baumeister et al., “Gossip as and the Evolution of Language (Harvard
[5] Bosson et al., “Interpersonal Cultural Learning” (Review of General University Press, 1998)
Illustration by CHRISTOPHER DELORENZO
 D I S PAT C H E S

S HORTLY AF TER I MET

Lina Khan, her cellphone rang. The call
was from a representative of a national
organization, regarding a speech it had
asked her to give. Khan was courteous on
the phone, but she winced momentarily
after hanging up. “That was the Ameri-
can Bar Association,” she confessed. “I
don’t know if I’ve passed the bar yet.”
This feeling—that Khan’s ideas are in
high demand slightly before her time—
has characterized much of her life lately.
In the past year, the 29-year-old legal
scholar’s work has been cited approvingly
by the lefty, rabble-rousing congressman
Keith Ellison and by a Trump-appointed
assistant attorney general, Makan Delra-
him. She has been interviewed by NPR
and written op-eds for The New York Times.
She has done it neither by focusing on
a hot-button issue nor by cultivating a tele-
genic demeanor. She is just a young adult—
one of many, I would learn—interested in
an old topic: antitrust law, that musty cor-
ner of American jurisprudence aimed at
curtailing monopoly power.
For the past few decades of American
life, the specter of monopoly was gener-
• SKETCH ally raised only regarding companies
that seemed custom-designed to rip of
consumers—airlines, cable providers,

THE TRUSTBUSTER Big Pharma. These were businesses that

pulled from the long-standing monopo-
list’s bag of tricks: They seemed to keep
Lina Khan has a novel theory for how
prices artiicially high, or they formed an
monopolies work—and her sights are unspoken cartel with other industry titans.
set squarely on Amazon. Typically, consumers worried most about
how monopolies would pinch their wallet.
BY ROBINSON MEYER
For Khan and her colleagues at
the Open Markets Institute, an anti-
monopoly think tank based in Wash-
ington, D.C., monopoly power includes
all of that. But it goes further. Even
when monopolies appear to beneit con-
sumers by ofering free services or low

Illustration by TIM TOMKINSON T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 17


prices, Khan contends that they can still
be deeply harmful. Among the group’s
frequent targets are some of the most
popular companies in America: Google,
Facebook, and the one to which Khan
has committed much of her published
work, Amazon. She tells a comprehen-
sive story about how these companies
make Americans less free, a story that
recently received a surprising addendum:
Last year, monopoly power cost Khan a
month’s pay.
MET KHAN on a Friday morning last
I fall at the Shops at Columbus Circle,
a glitzy mall at the southwest corner of
Central Park that now contains not one
but two Amazon properties. On the third
loor is an Amazon Books, one of more
than a dozen brick-and-mortar book-
stores the company has opened since
2015. It’s inspired less by libraries than
by Apple stores: paperbacks and Kindles
side by side on pale, sparse shelves. And
in the basement is a sprawling Whole
Foods—Amazon acquired the grocery
chain for $13.7 billion last year—its
crowded aisles lined with craft beer, for-
eign yogurts, and kohlrabi.
Khan is unassuming in person, with
a narrow face and unruly black hair. She
arrived at Amazon Books wearing the
uniform of the young, urban professional
class: black jeans, an oversize green lan-
nel shirt, a cycling-inspired backpack.
(Full disclosure: I was wearing almost
exactly the same outit.) She arrived very
slightly late and immediately apologized.
She might be a little slow, she said: She
was getting married in a week, her entire
family was in town, and it had already
been a ludicrously busy month. But I
couldn’t detect any sluggishness. A min-
ute later, she was reeling of paragraph-
length digressions on the history of
Amazon’s business and the nature of its
monopoly power.
“There’s a whole line of critique about
Amazon that’s culture-based, about how
they’re wrecking the experience of book-
stores,” Khan told me as we surveyed Neil
deGrasse Tyson’s latest tome. “I person-
ally am less focused on that element.”
Instead, she argues that Amazon
has denuded America’s book-buying
landscape in other ways. “Amazon has
massively— and I’m trying not to use
this particular word, but I can’t not use
it here—disrupted the business model in
18 J U LY/AU G U ST 2 0 1 8 T H E
D I S PAT C H E S
publishing,” she told me. “Publishers used
to be able to take risks with heavier books
that might not be as popular, and they used
to be able to subsidize them with best sell-
ers.” But Amazon’s demand for discounts
has made it harder to cross-subsidize this
way, leading to consolidation among book
publishers and reduced diversity.
This is a typically Khanian analysis. In
her telling, monopolies don’t just exploit
consumers and workers in
their part of the economy.
Even when they ofer low
prices to consumers, their
influence propagates
through the entire system.
If one part of an industry
consolidates, then all the
other parts of the industry
will feel pressure to con-
solidate too.
Amazon does not, in
some respects, look like
a monopoly. According to the National “Amazon’s Antitrust Paradox,” in the Yale
Retail Federation, it is only the country’s
seventh-biggest retailer by total sales. It
sells more than Target, but less than Wal-
greens. And Walmart, the nation’s largest
retailer, still generates nearly three times
as much revenue as Amazon.
Yet these numbers fail to capture Ama-
zon’s online dominance. About 44 cents
of every dollar that Americans spend
online go to Amazon. (The next-biggest
online retailer, Ebay, gets about six cents
of that dollar.) They also miss Ama-
zon’s prodigious growth. In 2010, when
Khan graduated from college, Amazon
employed 33,700 people. It now employs
more than 560,000, and its search for
a site for its second headquarters has
turned cities and locales across the coun-
try into desperate supplicants. Three
years ago, Amazon was worth less than
Walmart. As of this year, it is three times
as valuable as the big-box king. (Accord-
ing to an Amazon spokesperson, “In every
one of our businesses we have incredible
competition. In worldwide retail, we’re
less than 1 percent. We think our job is to
keep inventing for customers.”)
Khan didn’t start out interested in
antitrust. Seeking a job at the New Amer-
ica Foundation, a center-left think tank
in Washington, she landed in the group’s
antitrust program, whose director, Barry
Lynn, gave her an ad hoc graduate edu-
cation in the anti-monopoly movement.
She studied the book industry, then the
AT L A N T I C
chicken-farming industry. Combing the
papers for corporate-consolidation news,
she started seeing monopoly power in
everything. She realized that antitrust pol-
icy could dominate the decades to come
and that she had to understand it better.
So Khan took time of to go to law school—
and began intensively studying Amazon.
Three years later, in January 2017,
she published the result of that study,
Amazon has grown so
large that it can undercut
other companies just by
announcing that it will
soon compete with them.
Law Journal. It went viral—or at least as
viral as dense legal scholarship can go. Its
driving question is simple: How did Ama-
zon get so big?
The answers are nearly as straight-
forward. First, Khan says, Amazon has
been willing “to sustain losses and invest
aggressively at the expense of profits.”
This isn’t a controversial assertion: Ama-
zon has posted an annual proit for only
13 of the past 21 years, according to The
New York Times. Historically, it has plowed
any proits right back into cheaper prices
and R&D into everything from robotics
to image recognition. Second, Amazon is
integrated vertically, across business lines.
In addition to selling stuf online, Amazon
now publishes books, extends credit, sells
online ads, designs clothes, and produces
movies and TV shows. It is also one of the
world’s largest providers of cloud stor-
age and computing power, renting server
space to Netlix, Adobe, Airbnb, and NASA.
These two practices—predatory pric-
ing and integration across business lines—
may sound normal. But under old read-
ings of U.S. antitrust law, they are illegal.
Still, it’s unclear whether consum-
ers have seen higher prices as a result of
either strategy. As such, Amazon rejects
the “predatory pricing” label. And
Republican Senator Orrin Hatch last
August decried the new antitrust move-
ment as “hipster antitrust” and said it left
him “deeply unimpressed.”

As Khan and I entered the sprawling
Whole Foods three stories below Amazon
Books, we noticed a tower of avocados. A
sign bragged that, thanks to the Amazon
merger, a single avocado now cost $1.49,
down from $2.49. Khan cracked up. “This
is peak myself,” she said. “This is hipster
antitrust, right here.”
ROM THE PROGRESSIVE ERA
F onward, the U.S. government
enacted a powerful set of antitrust laws to
curb “the Curse of Bigness,” as Supreme
Court Justice Louis Brandeis put it. The
scope of these laws was remarkable: The
Court once used them to block a shoe
company from acquiring 2 percent of the
national footwear market.
But antitrust laws could be unwieldy.
Judges sometimes struggled to know
whether they were enforcing the law or
capriciously blocking a merger. And then,
in 1978, a Yale Law professor named Rob-
ert Bork promoted a clean new theory of
antitrust law, inspired by the libertarian
Chicago school of economics.
Bork decreed that all antitrust suits
should be judged by one question: What
will most lower prices for consumers?
The answer, he said, was almost always
more mergers. When companies merge,
they get rid of redundant business units,
lower their operating costs, and become
more efficient, ultimately passing this
eiciency on to consumers as lower prices.
Within a decade, the Reagan admin-
istration turned Bork’s theory into oicial
Department of Justice policy. The busi-
ness world noticed. In 1985, there were
about 2,300 corporate mergers in the
United States, according to the Institute
for Mergers, Acquisitions and Alliances.
In 2017, there were more than 15,300, a
new record.
Bork’s views become interesting in
light of Amazon. Bork thought vertical
integration was ine: Since he believed
markets were perfectly efficient, he
assumed that a lower-cost competitor
would always butt in and ight of a would-
be monopolist. And predatory pricing? It
is “a phenomenon that probably does not
exist,” he wrote. The Chicago school, he
said, had proved that companies would
always pursue short-term profits over
long-term growth.
Amazon’s history seems to belie this
claim. For more than a decade, Wall
Street allowed the company to plow any
• SKETCH
profits into price discounts. Partly as a
result, Amazon has grown so large that
it can undercut other companies just
by announcing that it will soon compete
with them. When Amazon purchased
Whole Foods, its market cap rose by
$15.6 billion—some $2 billion more than
it paid for the chain. Meanwhile, the rest
of the grocery industry immediately lost
$37 billion in market value. (Amazon pro-
tests that it has no control over how inves-
tors value its competitors.)
When a company has such power,
Khan believes, it will almost inevitably
wield that power far and wide, distorting
not just the market itself, but the whole
of American life. With suicient power,
companies can commission studies,
rewrite regulations, bulldoze neighbor-
hoods, and impoverish education and
welfare systems by securing billions in
sweetheart tax cuts. When a company
comes to monopolize a market—when
it grows so big that it can threaten other
industries just by entering them—it
ceases to be merely a company. It
becomes an institution so powerful that
it can rule over people like a government.
“That was the insight of Brandeis,”
Khan told me. “For most people, their
everyday interaction with power is not
with their representative in Congress,
but with their boss. And if in your day-to-
day life you’re treated like a serf in your
economic relationships, what does that
mean for your civic capabilities—for your
experience of democracy?”
Khan sees the new antitrust move-
ment, above all, as a revival. Well before
Brandeis’s day, Thomas Jeferson sought
to add an anti-monopoly clause to the
Constitution. Andrew Jackson said
Americans should “take a stand against
all new grants of monopolies.” And
some legal scholars even see an anti-
monopoly instinct in the Fourteenth
Amendment’s equal-protection clause,
since monopolies can assert claims to
special protections of the law. “If Amer-
ican democracy was founded on this
set of ideas and traditions,” Khan said,
“then we just took a knife and lopped of
one half of it. It’s just gone.”
Khan knows firsthand what this
can look like. In June 2017, the Euro-
pean Union slapped Google with the
largest-ever fine of its kind. Officials
alleged that the search giant violated
anticompetition law when it ranked its
T H E
own shopping service above those of
its rivals in search results. The penalty:
$2.7 billion.
Barry Lynn’s team at New America,
which by then was known as Open Mar-
kets, was delighted. Khan helped edit
a short statement from the team, call-
ing Google’s market power “one of the
most critical challenges for competition
policymakers in the world today.” They
published it and moved on with their lives.
But a few hours later, Lynn excused
himself from a conference call that Khan
was on. Anne-Marie Slaughter, New
America’s president, was on the other line.
According to The New York Times, Eric
Schmidt, Google’s executive chairman at
the time, had seen the statement and was
unhappy about it. Schmidt had previously
been the chairman of New America, and
he and Google had given millions to the
foundation over the years. A conference
room at New America is called the Eric
Schmidt Ideas Lab.
A few days later, Slaughter emailed
Lynn to inform him that the foundation
would be spinning of his group, but with
full funding and staing. “The time has
come for Open Markets and New Amer-
ica to part ways,” she wrote. New Amer-
ica disputes many of the details of The
Times’ account, primarily the notion that
“Google lobbied New America to expel
the Open Markets program.” Google also
denied playing any role in New America’s
decision to cut ties or ever threatening
to cut of funding. Slaughter described
problems with the group’s institutional it.
However, after two months, negotiations
on the spin-of failed and the two think
tanks formally separated.
For Khan, the issue was more than
academic: It cost her a month of pay.
She’d been due to be hired back at New
America in late July, following her com-
pletion of the bar exam. But that plan was
put on hold, so Khan worked without pay
until late August, when Open Markets
established itself as a new and indepen-
dent think tank and rehired her.
It was an unexpectedly real example—
and one that hit close to home—of how
a single powerful irm can inluence the
many organizations in its orbit. As Khan
noted, not without irony: “It was a proof
of concept of our work.”
Robinson Meyer is a staf writer at
The Atlantic.
AT L A N T I C J U LY/AU G U ST 2 0 1 8 19
 D I S PAT C H E S
• TECHNOLOGY
THESE ARE THE PEOPLE
IN YOUR NEIGHBORHOOD
Nextdoor, a hyperlocal social-media platform,
highlights petty grievances—and proves that Americans
have more in common than they think.
BY IAN BOGOST
E R E A R E S OM E O F T H E T H I NG S I heard about in my
neighborhood over the past year: A thunderstorm downed
a tree, blocking a central road; a shadowy agent called “the
night clipper” arose, surreptitiously cutting overhanging
bushes while unsuspecting property owners slept; several
dogs and cats were lost, found, or “on the loose,” whatever
that means for a cat; a federal-grand-jury-summons tele-
phone scam struck; someone sought belly-dancing classes,
20 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
an apparent alternative to Pilates; and,
innumerable times, people deposited
bags of dog poop into lawn-clipping and
recycling canisters at the curb. All of this
news came courtesy of the social-media
service Nextdoor. On its website and
app, people can post recommendations,
updates, and warnings about their build-
ing, block, or neighborhood.
Anyone who has subscribed to a
neighborhood email listserv—or used the
internet—can guess what might go wrong.
Social networks connect people, but
many of those connections degrade into
vitriol. If Twitter is where you ight with
strangers, and Facebook is where you vie
with friends, then Nextdoor is where you
get annoyed with neighbors—for send-
ing “urgent alerts,” pushed late at night
to mobile phones, about questionable
emergencies; for trying to sell a tattered
massage table or used carpet shampooer
at near-retail price; for issuing nasty repri-
sals on matters large and small. But it can
also foster connections among neigh-
bors and help counter the social isolation
brought about by technology.
Nextdoor works a lot like Facebook,
but instead of a “Like” button, it ofers
a “Thank” button, encouraging a kind
of neighborly grace. More important, in
order to join, you have to prove that you
live where you say you do (by entering a
code mailed to your home address, for
example). Which means the community
you enter is not imagined or diasporic,
comprising people from the same school,
profession, or interest group—it’s physical.
You can “mute” neighbors on Nextdoor
to hide their posts, but you can’t make
them move away. Like it or not, these are
the people in your neighborhood—the
people that you meet each day, as the old
Sesame Street song goes. Not just the post-
man and the barber, but also the aspiring
belly dancer, the night clipper, the cat
looser, and all the rest.
Thanks to its popularity, the service
offers a unique window into daily life
around the country. Nextdoor’s virtual
communities—which cover more than
180,000 U.S. neighborhoods, including
more than 90 percent of those in the 25
largest cities—are becoming representa-
tive of the country’s actual populations.
What do Nextdoor users talk about?
On April 18, 2018, to pick a random day,
the nation mourned former First Lady
Barbara Bush, Japanese Prime Minister
Illustration by JOSH COCHRAN
Shinzo Abe visited Donald Trump to dis-
cuss North Korea, and the world reacted
to a deadly accident aboard a Southwest
Airlines light. But on Nextdoor, the over-
whelming majority of Americans were
focused on the impacts of late-season
snowstorms: stuck cars, downed power
lines, and especially snowplows. Grout
and kittens were on mountain-time
minds, and Oregonians seemed to be
enduring a spate of lost wallets and duck
encounters. In Florida and Colorado,
problems with telecom services domi-
nated the conversation.
This is pretty normal. Steve Wymer,
Nextdoor’s vice president of policy, told
me that the same topics arise again
and again, modulated by region and
neighborhood type. Service requests and
recommendations constitute 30 percent
of chatter, and discussions of real estate
make up another 20 percent. About
10 percent of Nextdoor conversations
relate to crime and safety, Wymer said.
(Suspicious persons come up a lot, often
amounting to sightings of people of color
in predominantly white areas. Nextdoor
has attempted to discourage posts that
use appearance as a proxy for criminality
by prompting users to add more detail
and blocking some posts that mention
race.) Public agencies such as police and
emergency-management departments
also post updates to their constituencies.
Noise complaints are another popular
subject, according to Wymer—ireworks
seem to raise particular ire—as are clas-
siieds, missing pets, and gardening tips.
Judging by the conversations on
Nextdoor, it would seem that Americans
are concerned irst about the safety and
security of their property, family, and
pets, and then with their property’s, fam-
ily’s, and pets’ upkeep and improvement.
Though the platform breeds its share
of conlict, it is notable—in contrast to
other social networks—for the com-
monality it reveals, even in these times
of unprecedented political division. No
one, Democrat or Republican, wants a
neighborhood strewed with dog poop.
ENN TAKAHA SHI OPERATE S
J a Twitter account and Facebook
page called Best of Nextdoor. Because
Nextdoor posts are private to local com-
munities, Takahashi relies on users to
submit funny or weird things they see in
neighborhood groups across the country.
(When her Twitter following recently
surpassed that of Nextdoor’s corporate
account, the company’s head of commu-
nity congratulated her, while also gen-
tly wondering whether she would blur
the neighborhood names in her posted
screenshots.) Less than a year after
launching the accounts as a loving gag,
Takahashi has built what might amount to
the most complete contemporary picture
of day-to-day American behavior, a kind
of crowdsourced Kinsey report on munici-
pal perversity.
Takahashi echoes Wymer
on noise complaints—talk of
ireworks or gunshots (they
are rarely actual gunshots)
is common, she says. Some-
times these complaints have
dramatic consequences. In
Seattle, a post about a dog’s
bad reaction to some kind
of cannon that was sounded
during Seahawks football games led to
an online dispute, and a neighborhood
meeting at a library to talk it out erupted
into a brawl. “Seattle is like the Florida
of Nextdoor,” Takahashi told me, refer-
ring to the Sunshine State’s tendency to
surface all manner of improbable events.
Los Angeles is another source of good
material: She’s received a handful of sub-
missions about unrest in parts of the city
where YouTube stars live, as fans mob the
streets trying to catch a glimpse.
Best of Nextdoor reveals a charming
cluelessness that pervades America’s
communities. People in cities can’t seem
to tell the diference between a possum
and a house cat, for example. In Alabama,
someone tried to sell an unopened box
of Hot Pockets. Near St. Louis, one resi-
dent asked why the neighborhood of
WingHaven is called “Swinghaven.” In
a suburb of San Diego, someone posted “Concerns about white man with turban
an image of a found sex toy and—not
comprehending the purpose of the
device—worried that it “looks valuable.”
But most of Takahashi’s collection cata-
logs more-mundane patterns, like the
poop-in-the-trash-bin crisis that seems
to plague all Americans. Takahashi has
amassed countless specimens, as it were,
from run-of-the-mill lamentations to
complex home- surveillance-camera-
facilitated stakeouts conducted to ind
and shame the ofending dog walker.
In our conversation, Steve Wymer
brought up Robert Putnam’s 2000 book,
T H E
Bowling Alone, about the decline of in-
person social discourse in America and
its consequences for civic life. Putnam
criticized the technological individualism
encouraged by television and the inter-
net, which had already shown a capacity
to promote selfishness. Wymer argued
that Nextdoor cuts against that trend:
The company boasts dramatic examples
of new collaborations the service helped
enable—the neighbor who donated an
organ to someone 10 doors down, whom
One user donated an
organ to someone
10 doors down, whom she
met through Nextdoor.
she wouldn’t have known were it not for
Nextdoor, and the person stranded on a
roof by Hurricane Harvey who was able to
summon a rescue boat via the service.
But usually life is less dramatic than
that. In the most-common Best of Next-
door submissions, neighbors worry about
a weird truck driving by slowly, early in
the morning. Ever vigilant, other users
respond that they have already reported
the suspicious vehicle to police, as law-
enforcement representatives on the ser-
vice encourage. Typically, the ofending
vehicle turns out to be the newspaper-
delivery person, plodding through the
suburbs to bring print news to the resi-
dents who still read it that way. Eventu-
ally, someone explains how newspaper
delivery works, and order is restored.
I’ve seen a version of this post in my
own neighborhood. Someone writes:
on bicycle.” Almost instantly, responses
arrive: “Oh, that’s Floyd, he’s harmless,”
and “Yeah, he’s been around forever.”
Some neighbors theorize that he might
be a wizard. It’s a small thing, and maybe
not one to be proud of—but the neigh-
bors’ concerns get assuaged, and Floyd
escapes torment. That’s a post worth
clicking “Thank” on.
Ian Bogost is a contributing editor at
The Atlantic and the Ivan Allen College
Distinguished Chair in Media Studies at
the Georgia Institute of Technology.
AT L A N T I C J U LY/AU G U ST 2 0 1 8 21
 D I S PAT C H E S

innovate. By 2007, according to Bloom-

berg, interest expense consumed 97 per-
cent of the company’s operating profit.
• BUSINESS It had few resources left to upgrade its
stores in order to compete with Target, or
to spif up its website in order to contend
YOU BUY IT, YOU BREAK IT with Amazon. “It’s true that they couldn’t
respond to Amazon,” Eileen Appelbaum,
How private equity is killing retail a co-director of the Center for Economic
and Policy Research, told me. “But you
B Y B RYC E C OV E R T have to ask yourself why.”
Shortly after the buyout, the com-
pany’s CEO implemented a plan to
combine and remodel Toys “R” Us and
Babies “R” Us locations. Customers liked
A N N M A R I E R E I N H A R T was one of placed around the company’s neck. Toys the changes, but the company was able to
the irst people to learn that Toys “R” Us “R” Us had a debt load of $1.86 billion revamp only 146 of its more than 1,500
was shuttering her store. She was super- before it was bought out. Immediately stores by 2010. By that point, it was facing
vising the closing shift at the Babies “R” after the deal, it shouldered more than the efects of the Great Recession. Most
Us in Durham, North Carolina, when her $5 billion in debt. And though sales had retail operations try to keep their debt
manager gave her the news. “I was almost slumped before the deal, they held rela- burden low to be ready for an inevitable
speechless,” she told me recently. Twenty- tively steady after it, even when the Great downturn; when you sell a product as
nine years ago, Reinhart was a new mother Recession hit. The company generated discretionary as toys, a recession can hit
buying diapers in a Toys “R” Us when she $11.2 billion in sales in the 12 months particularly hard. Thomas Paulson, the
saw a NOW HIRING sign. She applied and before the deal; in the 12 months before founder of the investment irm Inlection
was ofered a job on the spot. She eventu- November 2017, it generated $11.1 billion. Capital Management, which focuses on
ally became a human-resources manager Saddled with its new debt, how- companies that serve consumers, told me
and then a store supervisor. ever, Toys “R” Us had less lexibility to that when the retail landscape shifts, a
She stayed because the company
treated her well, accommodating her
schedule. She got good benefits: health
insurance, a 401(k). But she noticed a
diference after the private-equity irms
Bain Capital and Kohlberg Kravis Roberts,
along with the real-estate irm Vornado
Realty Trust, took over Toys “R” Us in 2005.
“It changed the dynamic of how the store
ran,” she said. The company eliminated
positions, loading responsibilities onto
other workers. Schedules became unpre-
dictable. Employees had to pay more for
fewer beneits, Reinhart recalled. (Bain
and KKR declined to comment; Vornado
did not respond to requests for comment.)
Reinhart’s store closed for good on
April 3. She was granted no severance—like
the more than 30,000 other employees
who are losing their job with the company.
In March, Toys “R” Us announced
that it was liquidating all of its U.S. stores
as part of its bankruptcy process, which
began last September. Observers pointed
to the company’s struggle to ight of new
competition. In its court iling, the com-
pany laid the blame at the feet of Amazon,
Walmart, and Target, saying it “could not
compete” when they priced toys so low.
Less attention was paid to the alba-
tross that Bain, KKR, and Vornado had

22 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C Illustration by REBEKKA DUNLAP

 company may need to make investments
and even adapt its business model to stay
aloat. If it’s already carrying signiicant
debt, it’s “really handcuffed,” he said.
“That’s what happened with Toys “R” Us.”
Josh Kosman, the author of The Buyout
of America, agrees: “All it takes is for earn-
ings to stop rising and level of, or even
decline a little bit, and you’re in a whole
heap of trouble.”
Toys “R” Us is hardly the only retail
operation to learn this lesson the hard way.
The so-called retail apocalypse felled
roughly 7,000 stores and eliminated more
than 50,000 jobs in 2017. For the spate of
brands that have recently declared bank-
ruptcy, their demise is as much a story
about private equity’s avarice as it is about
Amazon’s acumen.
In April 2017, an analysis by Newsday
found that of the 43 large retail or super-
market companies that had iled for bank-
ruptcy since the start of 2015, more than
40 percent were owned by private-equity
firms. Since that analysis, a number of
others have joined the list, including Nine
West, Claire’s, and Gymboree. An analy-
sis by the irm FTI Consulting found that
two-thirds of the retailers that iled for
Chapter 11 in 2016 and 2017 were backed
by private equity.
“Had these companies remained pub-
licly owned,” Paulson said, “they would
have had a much higher probability of
being able to adapt, to invest, and to with-
stand” the ups and downs of the economy.
P R I VAT E - E Q U I T Y TA K E O V E R
A is akin to a family’s buying a house:
A irm contributes what is essentially a
down payment using its own funds and
then inances the rest with debt. But in
the case of a buyout, the firm doesn’t
have to pay back the mortgage; instead,
the company it bought assumes the debt.
Private-equity firms enjoy the mis-
perception that they swoop in and save
struggling companies from the verge
of ruin. They’ve long held the promise
of beneiting these companies through
close monitoring—and debt, the theory
goes, should impose discipline on mana-
gers. That’s the model followed by a few
specialty irms, but it is far more common
for private-equity firms to seek moder-
ately successful targets where they see
an opportunity to increase proit margins.
After a few years of slimming costs and
boosting revenues, the goal is to of-load
the company, by either helping it go pub-
lic or selling it.
In some instances, private-equity irms
lend know-how that allows a company
to operate more efficiently or expand
beyond a small niche. “There’s a role for “R” Us acquired a number of companies,
private equity in certain industries that are
experiencing disruption,” Angela Kapp,
an investor who sits on the boards of
private- equity- owned
companies, told me. One
of the more celebrated
retail buyouts was KKR’s
acquisition of Dollar Gen-
Two-thirds of the retailers
eral, in 2007. After bring- that filed for Chapter 11
ing in a new management in 2016 and 2017 were
team that made changes backed by private equity.
such as upgrading the qual-
ity of the company’s prod-
ucts and tailoring them to
its customer base, the irm
helped it go public. It now has the most
stores of any U.S. retail chain. Firms “bring
resources and capabilities and [have] seen
the movie before,” Kapp said.
But that doesn’t mean the movie
always has a happy ending. “I don’t even
know if there are that many success cases
in retail,” Sucharita Kodali, an analyst at
the market-research company Forrester,
told me. She allowed that Toys “R” Us was
hardly in great shape before its acquisi-
tion, but says the buyout only made things
worse. “I think it probably hastened their
death,” she said. Even Dollar General’s
success, she argued, had a lot to do with
timing and the particular corner of retail it
occupies—the recession pushed consum-
ers toward its discount stores.
Given private equity’s poor track record
in retail, it can be diicult to see what com-
panies like Toys “R” Us hope to get from
a buyout. For private equity, however, the
appeal is clear: The deals are virtually all
upside, and carry minimal risk. Many
private-equity irms chip in only about 1 to
2 percent of the equity needed for a lever-
aged buyout, and skim fees and interest
throughout the deal. If things go well, the
irms take a huge cut of the proit when
they exit. If everything blows up, they usu-
ally still escape with nary a burn. Toys “R”
Us was still paying interest on loans it got
from KKR and Bain up until 2016, as well
as millions a year in “advisory fees” for
unspecified services rendered. Accord-
ing to one estimate, the money KKR and
Bain partners earned from those fees more
than covered the irms’ losses in the deal.
T H E
Private equity can stack the deck in
other ways, too. Firms can direct busi-
nesses they own to buy other companies
and then act as broker on the deals, reap-
ing transaction fees. After its buyout, Toys
including FAO Schwarz, eToys.com, and
assets from KB Toys (itself a failed recla-
mation project of Bain’s). Consolidating
brick-and-mortar and online toy busi-
nesses may have been a good-faith strat-
egy. What’s certain is that the deals helped
generate $128 million in transaction fees
for the owners.
O FAR , PRIVATE E QU I T Y ’S string
Sof failures in retail hasn’t caught up
with it. Pension funds and institutional
investors keep coming back to the promise
of a 12 percent (or greater) return on invest-
ment, well above what’s ofered by bonds
or even public companies. But creditors
and vendors left holding the bag when
retailers go out of business don’t have
much recourse.
One success story: Private-equity
irms helped buy out the retailer Mervyn’s
in 2004, loading it up with $800 million
in debt and spinning off its real-estate
holdings. The company went bankrupt in
2008 and liquidated its stores, yet accord-
ing to bankruptcy-court ilings, its owners
pocketed $200 million in fees and divi-
dends from 2004 to 2006. Vendors such
as Levi Strauss, which had sold clothes to
the retailer and wanted to be paid for its
goods, sued the private-equity owners.
They secured a $166 million settlement,
arguing that the owners had played a role
in driving Mervyn’s into bankruptcy. (The
owners did not admit any wrongdoing.)
In other countries where private equity
has a meaningful presence in the market,
it operates with more restrictions. Ger-
many and Denmark guarantee that most
workers receive severance, making it far
costlier for a private-equity irm to seek
AT L A N T I C J U LY/AU G U ST 2 0 1 8 23

D I S PAT C H E S
layofs to increase proit margins. In the
U.S., labor campaigns have successfully
pushed a number of retailers to pay more,
offer better benefits, and improve their
scheduling practices. But the sector’s
instability is throwing these gains into
question, and some reformers would
like to see even more radical change.
A conglomeration of workers’-rights
and financial- reform organizations is
seeking to outlaw leveraged buyouts
altogether. “They weren’t always legal,”
Charles Khan of the Strong Economy for
All Coalition, which is part of the group,
points out. Before the 1980s, companies
couldn’t finance deals with such high
levels of debt. One aim of Khan and his
allies is to once again force buyouts to
rely on a smaller portion of debt. “The
economy has existed long before pri-
vate equity,” he says. “I think it can exist
without private equity.”
Political solutions, even more-modest
ones, could be a tough sell in Congress.
Private-equity firms shower a lot of
money on Republicans and Democrats
alike. They’ve also made the most of the
revolving door between the public and the
private sectors: Barack Obama’s Treasury
secretary Tim Geithner is now the presi-
dent of the private-equity irm Warburg
Pincus; Donald Trump’s commerce sec-
retary, Wilbur Ross, founded a private-
equity irm in 2000.
While their demands may prove overly
ambitious, reformers are clear-eyed about
what will happen without a change of
some kind. Retail companies face billions
of dollars in debt coming due in the next
ive years, much of it thanks to leveraged
buyouts. More bankruptcies are on the way.
Toys “R” Us workers are making the
case for severance pay directly to law-
makers. In early May, Ann Marie Reinhart
and other former employees met with
Senator Bernie Sanders and Representa-
tive Keith Ellison. Next, they’ll take their
demands to KKR, Bain, and Vornado.
“We’ve given blood, sweat, and tears to this
company,” Reinhart told me. “So to walk
away with nothing, it’s just humiliating.”
In the meantime, Reinhart is looking
for work. She hopes she won’t have to
take another job in retail. “I could not go
through this again,” she said.
Bryce Covert is a contributing op-ed
writer at The New York Times and a
contributing writer at The Nation.
24 J U LY/AU G U ST 2 0 1 8 T H E
• B I G I N   . . . JA PA N
Dad Classes for
the Single Guy
Making men more marriageable,
one cumbersome pregnancy suit at a time
BY STEPHEN MARCHE
T
HE MAN in the
traditional kimono
is having dificulty
with the breasts. The
weight of the belly strains
his back. Simply walking
around the room—a party
room in a Tokyo condo
building—is more like
lumbering. Lying down
and getting up again is a
struggle. The rest of the
men in the Ikumen class
laugh as he tries to adjust
to the new reality. But then
we all have to try on the
pregnancy suit ourselves,
and one by one, we come
to the same conclusion: It’s
hard to be a woman.
The class is sort of
like the prenatal ones I
attended when my wife
was pregnant—except that
none of my classmates is
actually a father or father-
to-be. Some of them aren’t
even dating. Many of them
will list their attendance in
this class on their dating
profiles with the aim of
attracting a partner. The
young women they’re
hoping to interest want
to see some fatherhood
credentials up front.
AT L A N T I C
Ikumen is a portman-
teau of the Japanese word
ikuji—meaning “child-
rearing”—and the English
word men. Though the
term has been around
for years, the divide
between work and home
in Japan remains nearly
absolute. Mothers still
tend to shoulder almost all
domestic responsibilities—
an imbalance that can
be miserable, as Masako
Ishii-Kuntz, a sociology
professor, hears wherever
she goes. “I just gave a
talk this morning, and my
audience [was] all younger
mothers,” she told me in
her ofice at Ochanomizu
University. “Many of them
were talking about ‘Oh,
my husband is just simply
not interested in house-
work or child care.’ That’s
not rare at all.”
Needless to say, this
state of afairs has not
helped either women’s
success in the workforce
or the country’s critically
low birth rate, two major
sources of economic drag.
Which is where Ikumen
classes come in. They
Illustration by RAMI NIEMI
are part of a burgeoning
efort to redefine Japanese
fatherhood. An organiza-
tion called Fathering Japan
was started in 2006, for
example, to help fathers be
more involved; it provides
courses, and a sense of
community. Yet men who
forgo work to care for their
kids remain outliers.
Back at our Ikumen
class, the instructor
lectures about Japan’s
demographic crisis, the
social consequences of
the declining birth rate,
and why men should con-
sider child care a national
duty. Everybody nods
along. But besides trying
on a pregnancy suit, what
can men do to help?
For starters, the
teacher recommends,
compliment your wife.
Instead of saying things
like “Why did you sleep in
so late?,” men could ofer
words of praise: “This is
delicious.” “Your hair is set
nice.” “Your outfit looks
cute today!”
After the lecture, we
learn how to bathe an
infant. (I nearly fail the
lesson, even though I’ve
helped raise two babies
and kept them both pretty
damn clean.) Though
the skills being taught
are basic, I can’t help but
admire the students for
trying to train themselves,
in advance, to take care
of a child. Something has
to give in Japan. You can’t
promote gender equality
in the workforce and raise
the birth rate without
doing something just as
revolutionary: transforming
society’s attitudes toward
men, specifically fathers.
Bringing women into
the workplace is one
thing; bringing men fully
into the household will be
quite another.
Stephen Marche’s new
podcast, How Not to Fuck
Up Your Kids Too Bad, is
available on Audible.
 T H E

C U L T U R E
F I L E
B O O K S , A R T S , A N D E N T E R TA I N M E N T

THE OMNIVORE

The Wisdom of
Russell Brand
The recovering addict, comedian,
movie star, and former spouse of Katy
Perry has entered a new phase: as the
host of a brainy, philosophical podcast.
BY JAMES PARKER
(Brand, in this scene, is addressing a group of wonder-struck English school-
children.) “To feel adored is a buzz for me, but—what does it matter, really?”
Russell Brand has always been interesting. Excessively interesting, per-
haps: There’s an outsize, overheating quality to his charisma, as if it entered
his body superpower-style, via a laboratory accident or lying asteroid chunk.
Forty-three years old, he comes from the working-class backwater of Grays,
Essex, in England. His physical presence is slightly dazzling, unnerving, with
a subversive, greased-by-eroticism efect. The word louche attaches itself to

W
HEN YOU’VE DONE
it all, what then? When
you’ve smoked all the
crack, eaten all the
chocolate, had all the
sex, made all the money,
and been on all the talk shows—where do you go
next? Because there it is, squatting on the far side of
adulation: nothingness. “Celebrities,” the Buddhist
scholar Robert Thurman once said, “are in a very
interesting position. They’ve already achieved
great fame, success, and wealth, and they’ve real-
ized that those things alone don’t bring happiness;
that, in fact, they can be a real pain in the neck.” Or,
as Russell Brand puts it, tunneling toward enlight-
enment in the 2015 documentary Brand: A Second
Coming, “Fame and power and money is bullshit.”
him. Genetically a comedian, he is also an occasional ilm star. As the sleazily
marvelous rock-god boyfriend Aldous Snow in Forgetting Sarah Marshall, he
SHUTTERSTOCK; ADOBE STOCK; WIKIMEDIA; FLICKR
stole so many scenes that he got his own spin-of movie, Get Him to the Greek.
He is also some sort of culture-jammer, a serial causer of lutters/disturbances
in television studios and at awards ceremonies. (“Is this what you all do for a
living?” he asked during an infamous 2013 takeover of Morning Joe, a phero-
monal blitz that deprived the panel of speech and left Mika Brzezinski slurping
in panic from her water bottle.) In pre-Brexit Britain he reaped the scorn of
the political classes by appearing on current-afairs programs, long-haired and
messianically tinged, and preaching revolution: transformation of conscious-
ness, down with capitalism … love. He writes, speaks, and performs a lot about
his former addictions—to drugs, to sex—and about his need for attention. For
less than two years, he was married to the pop diva Katy Perry.
But it is in his latest incarnation—as a podcaster, of all things, clamped in
headphones and nuzzling a huge mic—that Brand has become genuinely,
slow-growingly, deep-brain interesting. The Brand who presents Under the Skin
With Russell Brand, the second season of which began in June, is part seeker and

26 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C I l l u s t r a t i o n b y R YA N O L B R Y S H
2
billion
people
around the world have access to quality
medicines, dietary supplements and food
as a result of our standards, advocacy
and education.

The foundation of quality we build helps:

• Scientists keep discovering

• Manufacturers keep producing
• Healthcare teams keep healing

Find out how we’re

empowering a healthy
tomorrow: usp.com/tomorrow
 part clown, capering at the margins of thought in
the company of scientists, anarchists, theologians,
philosophers, psychologists, Marxist scholars, doc-
umentarians, and mad professors. And Al Gore.
“Thank you so much for doing this interview and
for putting so much thought into it, Russell,” the
former vice president says, with hilarious imper-
turbability, to the gasping, insatiable person on the
other side of the studio table. He will later reward
Brand with some bass-boosted vice-presidential
chuckles and, at the end of a frantic exchange about
climate change and spiritual renewal, exclaim,
“That is entertainment!”
To the author and interrogator of capital-
ism Naomi Klein, Brand reveals that he read
her book No Logo while in Cuba, addicted to
heroin and making a commercial: “I felt some-
what conlicted … I was making a chewing-gum
commercial—the most vacuous of all products,
of course, unnecessary mimicking of mastication
while the world starves.” “Bringing capitalism
to Cuba, personally?” an amused Klein replies.
With the physicist and broadcaster Brian Cox he
has a lyrical exchange of views on the meaning of
life, Cox contending that meaning is “local and
temporary”—supplied by us, in other words, and
not by God—and Brand rather grandly demurring.
“What does it mean to you,” Cox asks, “what do
you feel like, if I say that there will come a time in
the future when there is no consciousness in the
universe? So all possibility of meaning has gone,
but the universe will still be there?” Brand barely
draws breath before responding: “I would say that
within my philosophy, consciousness and matter
have the reverse relationship to in yours. I believe
that matter emerges from consciousness, not vice
versa. So even where the astrophysical context al-
ters and evolves, as brilliant men such as yourself
and your predecessors have demonstrated that will
happen, that to me is essentially irrelevant because
it’s just part of the cosmic ballet continuing within
the framework of consciousness.” By way of proof,
he cites Herman Melville, and then the comedian
Bill Hicks. Not bad.
T IS BRAND’S presentation of himself as an
I addict, a man in recovery, a 21st-century con-
sciousness who has gone through the veil of
maya and now wants answers— or better questions,
at least—that provides the theme for what might
otherwise be a scattershot sequence of encounters.
“I used to like nice, numb drugs,” he says wistfully
to the meditation teacher Sharon Salzberg, a nota-
bly down-to-earth presence from whom, over the
course of the interview, he elicits a lovely selec-
tion of gurgling belly laughs and high, wild titters.
Aren’t we all addicts anyway, twitching over our
phone, infatuated by this, attached to that, buzz-
ing or starving for a little squirt of dopamine? The
28 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
snicker-snack of addiction is inside consumerism,
THE OMNIVORE
and inside the version of human relations that is
determined by consumerism. And the ungratiied
celebrity, he for whom the world’s ultimate blow
job has not suiced, is our paradigm. The sensual
realm has combusted before his eyes, in demon
twists of chemical vapor. He has squandered his
serotonin supply, his natural gladness endowment,
and hungry ghosts are roosting in his blackened
brain-wires. Time for a change of approach.
“We are diferent men, you and I,” Brand tells
Andy Puddicombe, a co-founder and the mesmer-
izingly everyday-English voice of the meditation
app Headspace. “I am a person that has found
flesh very, very appealing and corrupting. I’ve
found drugs very, very engaging. I like senses, I
like sensuality, I like the body. So I’ve had to come
to meditation, yoga, spirituality with a gun to my
head.” (Puddicombe gently points out that he too
has a body, of which he is quite fond.)
On his podcast, Brand is in dialogue with some
very expert people, some very large and poised intel-
lects. And in dialogue, his efervescing synapses and
manic facility with language—the tools of his trade
There’s an as a comedian—are stabilized and counterbalanced.
outsize, Not always, of course. Brand will prattle, yap, cross-
overheating talk, overuse the word ideology, and now and
quality to his again spiral of into monologue, into a heightened,
incantatory speech that sounds weirdly lubricious:
charisma, as New Age dirty talk. “My consciousness has existed
if it entered before me, and my consciousness will exist after
his body via me,” he says to, or at, the biologist Rupert Sheldrake.
a laboratory “My consciousness is part of a vital energy, a contin-
ual pranic low existing through all forms, existing
experiment beyond and through time and space, time and space
or flying aster- themselves being just referential points from this
oid chunk. biological organism …” But by and large his pranic
low is contained: He listens, he pays attention, and
the conversations prickle brilliantly along.
Your enjoyment of Under the Skin will depend
on your tolerance for Russell Brand—how much
of him you can take before you’re overloaded. But
in this medium you might be able to take more
T H E C U LT U R E F I L E I C O N S B Y N E I G H B O R H O O D ST U D I O
of him than you’d previously thought. The new
season promises conversations with Gabor Maté,
the physician and addiction expert who wrote,
“Addiction loods in where self-knowledge—and
therefore divine knowledge—are missing,” and
Jim Carrey. (Jim Carrey! There’s a guy who’s gone
of and come out on the other side of … something.)
And Brand will preen and prance and shake his
bells, proclaiming the void within him, which is the
void within us all. “That there is information avail-
able,” he says to Sheldrake, “that can’t be under-
stood within the existing template—it seems to me
bloody obvious.” So ask not whether Russell Brand
is for real. Ask yourself, rather: Am I for real?
James Parker is a contributing editor at The Atlantic.
 Seven Ways of Looking at
Pointless Suffering

The Ashtray

This Radical Land

Fishing Lessons

Is the Cemetery Dead?

Sleep Demons

The University of Chicago Press www.press.uchicago.edu


MUSIC
The Sound of Rage
and Sadness
The still-unfolding history of male angst in pop music
BY SPENCER KORNHABER
A
T THE END OF 2017, U2’s Bono made one of his periodic
pronouncements about the state of rock and roll. “I think
music has gotten very girly,” he told Rolling Stone. “There are
some good things about that, but hip-hop is the only place for
young male anger at the moment—and that’s not good … In
the end, what is rock & roll? Rage is at the heart of it.” He was
airing the sort of conventional wisdom you most commonly hear ranted from
a barstool: Rock and roll is rooted in virility, and the genre’s decline in popu-
larity represents a worrisome triumph of the feminine. Though such gender
anxieties uncannily mirror the ones driving national politics, rock is of course
bigger than one gender or one emotion—ask Joan Jett or Courtney Barnett. If
30 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
angry men loom large in the genre’s history, it’s not
because they have tapped into some elemental well
of gender-speciic sentiment. Instead, they have
often made their mark by expanding the boundar-
ies of what anger or sadness, or anger and sadness
together, can sound like for guys.
Bono’s comment got me thinking not just about
that lineage of sound and sentiment, but about
Chester Bennington, the Linkin Park singer whose
suicide a year ago this summer I’ve had very much
in mind. By some measures the last top dog that rock
ever bred, the California group is often spoken of as
an embarrassing artifact of George W. Bush–era
cultural crudeness. But in hindsight, Linkin Park’s
trajectory, and Bennington’s, sheds light on an
evolving quest for new ways to express vulnerability.
The pop landscape that has emerged may bewilder
Bono, but space has opened up for male fury in more
malleable forms than ever—and such fury seems to
be, for better and for worse, in plentiful supply.
Linkin Park’s product was male rage in a form
the entire family could mosh to. (It’s worth not-
ing that sales igures for the band’s 2000 debut
album, Hybrid Theory, have been surpassed in
the new millennium by no rock album other than
The Beatles’ 1.) The guitarist Brad Delson’s cleanly
rumbling chords triggered the kind of shiver you
might feel while in a dinghy passing an aircraft car-
rier. Co–front man Mike Shinoda rapped in blocky
syllables, his voice a stentorian simpliication of
the voice cultivated by Public Enemy’s Chuck D.
A DJ who went by the name Mr. Hahn threaded in
nerdy-cool electronic sounds; the drummer, Rob
Bourdon, hammered with comforting steadiness;
and a bassist who called himself Phoenix shel-
lacked on an ominous tint.
The most important ingredient was Benning-
ton’s wail and whisper, a volatile fuel to be pro-
cessed by the others. To revisit the video for the
2001 Linkin Park single “Crawling” is to see his
powers at full strength, and his special appeal laid
bare. At the outset, a music-box ballerina spins, a
woman cries into a bathroom sink, a pretty key-
board melody plays, and Bennington screams. The
crying woman appears to be in an abusive relation-
ship, and the scrawny singer, his hair in peroxide-
blond spikes, seems to narrate her emotions. His
chorus—“crawling in my skin / these wounds, they
will not heal”—is a strained roar, truly volcanic. His
verses are soft and mannered. “Against my will, I
stand beside my own relection,” Bennington sings,
looking into the woman’s face. Her nose is pierced,
as is his lip.
Professional critics found such works mawk-
ish, and heavy-metal purists dissed Linkin Park
in crasser terms—gay or, yes, girly. That’s because,
for all its testosterone rage, the band violated the
notion that to be male is to be steady, unstudied,
and tough. Linkin Park’s form of nu metal—the
Illustration by CHLOE SCHEFFE
rap-rock style in vogue around the turn of the
millennium— was polished and, for the band’s
irst few albums, notably devoid of swearing. The
musicians were genre benders, stitching patches of
hard rock, hip-hop, and new wave to a veil of soft,
velvety pop. They had young fans and female fans,
and young female fans. And they had Bennington:
capable of lullaby gentleness and perpetually ix-
ated on his own victimhood.
H I S B L E N D, rather than betraying the
T history of emotionally aggrieved popular
music, fulilled a tradition of complicating
the ideal of strong, silent masculinity. Look back
at Rolling Stone’s 1969 pan of Led Zeppelin I, which
described the high-pitched wails of the lead singer,
Robert Plant, as “foppish.” Punk balked at pre-
scribed roles and reveled in sexual transgression.
New wavers like Depeche Mode knit the suppos-
edly frivolous and fey sounds of disco into their
gloom. Rock misogyny remained alive and well,
but these maneuvers encouraged men to commu-
nicate in ways that would previously have gotten
them labeled wimps.
Grunge, the scrufy rebellion of the early ’90s,
most clearly embraced the political potential of
such an evolution. The scene was no less male
dominated than many rock scenes before it had
been, but its practitioners’ moans conveyed a
sense of chafing against bodily constraints and
cultural expec tations. In grunge, the critics
Simon Reynolds and Joy Press heard “castration
blues, the lailing sound of failed masculinity.” A
song like Soundgarden’s “Big Dumb Sex” brut-
ishly satirized the previous decades’ hair-metal
machismo: “I’m going to fuck fuck fuck fuck you!”
Nirvana’s roaring disdain for the social hierarchies
of Reagan-Bush America was conveyed both in
Kurt Cobain’s sarcastic lyrics and in his onstage
cross-dressing. Sonically, the songs thrived on
dichotomies of loud/soft and pretty/grating; the
efect was less to gild aggression with sweetness
than to wring drama and verisimilitude from the
feeling of internal conlict.
The drama was rowdily amplified by the
nu metallers of the late ’90s and early 2000s, who
experimented with rhythmic contrast by placing
swampy funk and break-danceable beats amid the
thudding of metal. If the results were ugly, so was
the subject matter: pain and trauma, expressed in
even more personal terms than before. Ditching
the fantastical blather of classic metal and the
poetic abstractions of grunge, Jonathan Davis of
Korn addressed his own childhood molestation by
a babysitter by literally sobbing throughout 1994’s
“Daddy.” Grown men confessing experiences of
violation, real or ictional, thereafter became a nu-
metal trope—though in many cases accompanied
by a dose of bellowed machismo. Think of Limp
Bizkit’s breakout hit, “Nookie,” a lewd kiss-of to
MUSIC
a girlfriend who treated the singer, as he told MTV,
“like shit.”
The emergence of PG-rated Linkin Park in this
context was so exquisitely well timed, it invited
theories that the band had been focus-grouped
into life. Bennington and Shinoda’s lyrics cannily
rendered rage and alienation in generic terms,
staging battles between an “I” and a “you,” who
could be a girlfriend, a parent, or something more
nebulous. Yet real feelings roiled. Fans often talked
about how Linkin Park helped them through their
struggles. And interviews with Bennington made
clear where some of his own pain came from, and
that it was no pose.
When he was about 7, an older friend had begun
molesting him. “I was getting beaten up and being
forced to do things I didn’t want to do,” Benning-
ton told Kerrang magazine in 2008. The sexual
abuse continued for another six years, but he
remained silent about it. “I didn’t want people to
think I was gay or that I was lying,” he said, hint-
ing at the cost of chasing certain masculine ideals.
Instead of seeking help, Bennington turned to
drugs and alcohol. A cycle of addiction, recovery,
and relapse continued through two marriages, the
births of six children, and a multiplatinum music
career. Not long before the 41-year-old hanged
himself at home in Southern California last July,
Linkin Park’s he’d told friends he was struggling not to drink. An
music was autopsy found alcohol in his system.
male rage
in a form Y T H E N, L I N K I N PA R K ’ S heyday as
the entire
family could
B a hit-making force was long past. It had
ended in the aughts, and for nearly a
decade, nu metal was rarely mentioned by main-
mosh to. stream critics or forward-thinking musicians. But
whether or not the new forces on the scene—the
likes of Skrillex and Lady Gaga—were Linkin Park
fans, the band had clearly previewed the new
millennium’s pop sensibility: bombastic, melo-
dramatic, and self-consciously genre busting,
though always outitted with glimmering synthetic
textures. Meanwhile, Drake’s rise to stardom rep-
resented a breakthrough for male sensitivity in
hip-hop, on display in an aesthetic swerve toward
sinuously hybrid songs in which rap bleeds into
singing against purpled and luminous sound-
scapes. Though they might not admit it, some of
Drake’s fans were surely reared on Linkin Park.
Indeed, in retrospect Linkin Park stands out as
a signiicant evangelist for both rock and rap. The
band’s merging of hip-hop and guitar music was
committed and proud in a way that subgenre peers
like Deftones or Korn never really matched. Linkin
Park had a full-time singer, Bennington, as well as
a full-time rapper, Shinoda, who genuinely cared
about his craft’s history—even if he mostly made
clumsy additions to it. Between them, two forms of
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 31
 musical (and often male) angst traditions achieved
reconciliation: the pathos and self-loathing of rock,
and the aggrieved confidence of hip-hop. The
band’s songs read as wounded counterpunches
against abusers, finding victory in the moment
when the dams of internal repression broke. “I can-
not take this anymore,” Bennington hissed in the
irst line of the band’s irst single, “One Step Closer,”
which built up to a full-blown screaming tantrum:
“Shut up when I’m talking to you!”
Within a tight pop framework, the underlying
music looked for opportunities to hybridize as well.
Songs such as “Crawling” pushed grunge’s dichot-
omies to new extremes: A synth rif like something
you might hear at a crystal-healing meditation har-
monizes with guitar feedback that evokes a garbage-
disposal jam. My own entry point as a teen was
Linkin Park’s hugely popular, Shinoda-produced
2002 remix album, which showcases a surprisingly
deep eclecticism. Some tracks intensify the band’s
metal edge, others turn the dial toward the airy and
orchestral, and many enlist well-respected rappers
(Black Thought, Pharoahe Monch, Chali 2na). A
smash 2004 EP by Linkin Park and Jay-Z, Collision
Course, converted many black kids to rock fandom,
as tributes written since Bennington’s death attest.
ATELY, A WAVE of stylishly sullen young
L artists, many in rap, has excavated the pain-
fully unhip, angsty subcultures of the 1990s
and 2000s. Bennington’s tragedy further clari-
ied the lines of inluence. In one fan video from
August 2017, the rapper Lil Peep leads a crowd in
black T-shirts in a sing-along of Linkin Park’s “In
the End” at an event called Emo Nite. The video
is especially moving given that Lil Peep, the
21-year-old Long Islander born Gustav Åhr, died
of an overdose a few months after it was ilmed. A
bisexual fashion-magazine muse with a tattooed
face, he seemed to present a plausible future for
pop, swerving between melodic hard-rock wails
and mumbled hip-hop boasts. And what Lil Peep
rapped and sang about, in almost every song, was
drugs or suicide. His lyrics sometimes shouted out
Cobain, who killed himself at 27 in 1994, and in
one music video he glowered in front of a portrait
of Amy Winehouse, who died at 27 in 2011.
Dystopian though the thought is, Lil Peep
exemplified the arrival of self-annihilation as a
trending topic for a new generation of performers
who borrow from nu metal, grunge, emo, and punk.
The anti-anxiety medication Xanax is to many
of today’s rappers what Patrón was to rappers a
decade ago, and self-harm is referenced routinely.
One breakout duo is named $uicideboy$, and
the controversial XXXTentacion, another rising
star who loves Cobain, pretended to hang him-
self on Instagram. “Push me to the edge / all my
friends are dead,” went the chorus to Lil Uzi Vert’s
32 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
2017- dominating smash. Yet dark emotion is not
MUSIC
all that distinguishes this scene. Once again in
pop-music history, when hard anger meets soft vul-
nerability, the commingling almost always comes
with a dose of beauty and a jolt of sonic possibility.
It also, once again, comes with troubling and inex-
plicable real-life associations. Bennington’s death
was the latest in a crescendo of shocks in the rock
world, following the 2017 suicide of Soundgarden’s
Chris Cornell (a close friend of Bennington’s) and
the 2015 fatal overdose of Stone Temple Pilots’ Scott
Weiland (whose band Bennington had played in).
Meanwhile, the morbid preoccupations of Lil Peep
and his peers track all too closely with urgent social
realities like the prescription-drug epidemic and the
rising rate of suicide among young people. It does
not seem coincidental that one of the biggest songs
of 2017, Logic’s “1-800-273-8255,” measurably
increased calls to that phone number, the National
Suicide Prevention Lifeline.
In the face of these dark facts, who can avoid
pondering some sort of grim transference of
inner torment across generations? But it is safer to
simply recognize that music responds to the real
world in any era because music is created by real
people. “These wounds, they will not heal” goes
“Crawling,” and the feeling that there is no future
has proved true for too many pop creators. At least
their music, inding new boundaries to cross and
break, escapes that fate.
Spencer Kornhaber is a staf writer at The Atlantic.
THE UNVEILING
Instead of a pebble to mark our grief
or a coin to ease his passage
you placed a speaker
at the top of his head
and suddenly a drumbeat
came blasting out of the grass,
startling the mourners on the far side
of the cemetery, clanging the trees,
scattering the swifts
that had gathered around the stone
like souls of the dead,
souls that were now parting
Edward Hirsch’s to make way for a noisy spirit
most recent
book is Gabriel: rising out of the dirt.
A Poem (2014).
— Edward Hirsch
Illustration by MELINDA JOSIE
“First Republic always inds a way to help us
with creative options and solutions.”
J O N AT H A N O ’ B R I E N, Chief Operating Oicer, Proskauer Rose LLP
VA N E S S A O ’ B R I E N, Mountain Climber, Explorer and Public Speaker

(855) 886-4824 | Ŕrstrepublic.com | New York Stock Exchange symbol: FRC

MEMBER FDIC AND EQUAL HOUSING LENDER
 As Gwendolyn Oxenham writes in Under the
Lights and in the Dark: Untold Stories of Women’s
Soccer, Nadim played with friends and by her-
self, juggling the ball for hours. Eventually she
approached the coach in the town ields, and he
BOOKS
invited her to join his team. In her irst game, she

The Wrong Way scored three goals. From there, a string of youth
coaches nurtured her talent. She graduated from

to Scout for high school and college, and eventually attended

medical school; she also became a professional

Soccer Talent soccer player. Today, she is a star of the Danish

An intense winnowing process, starting
when players are very young, may fail to spot
the gifts that are crucial to the game.
BY LAURENT DUBOIS
national team and, after becoming a member of
the Portland Thorns, one of the top women’s pro-
fessional teams in the United States, now plays for
Manchester City, in England.
Bernard Appiah grew up in Teshie, a poor sea-
side town near Accra, Ghana. He played soccer
constantly as a young boy, and when he was about
8, a coach recruited him to a local team. The team
had 50 players but only two soccer balls, so, as
Sebastian Abbot writes in The Away Game: The Epic
Search for Soccer’s Next Superstars, they spent much
of their time in practice “simply running around in

I
N 2001, NADIA NADIM, a 12-year-old Afghan girl living with
her mother and sisters in a Danish refugee center, looked up and
noticed a soccer ball in the branches of a tree. On the other side
of a nearby fence were lush soccer ields where youth teams from
the local town practiced. Players sometimes sent balls lying into
the woods near the center. Spotting more, Nadim and her friends
shook the trees and threw some of the balls back over the fence.
They kept a few older ones so they could play, too.
the dust.” Appiah outplayed everyone, earning
the nickname “The Tornado.” Soon after, another
local coach recruited him to a better team, one
with proper equipment and a good practice ield,
hoping to nurture his talent for a professional
career in Ghana or abroad in Europe.
In 2007, a Spanish coach named Josep Colomer
came to Teshie on a irst-of-its-kind tour of Africa

34 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C I l l u s t r a t i o n by J O N AT H A N B A R T L E T T
in search of the best young players he could ind.
On ofer were three scholarships to Aspire Acad-
emy, a lavishly endowed new soccer-training pro-
gram in Qatar that boasted a stadium, six ields,
and speakers that piped in “the sounds of birds
chirping throughout the day.” Appiah, at that point
a young teen, was chosen as one of the best play-
ers in Ghana, and was brought to the Aspire Acad-
emy, along with 23 other players from throughout
Africa, for the inal tryouts. He was awarded one
of the coveted scholarships, and began what was
supposed to be a multiyear program of honing his
talents. His coaches pegged him as the next Lio-
nel Messi, whom Appiah met when the Argentine
superstar visited Aspire. Today, however, Appiah
lives in relative poverty in Ghana, his dreams—and
those of the coaches and institutions that invested
in him—largely evaporated.
Soccer is the most popular sport on the planet,
a universal language like no other. Billions of peo-
ple play and watch the game. Many of its great-
est players, like those in other sports, have come
from the margins of society. Part of what draws
multitudes is that soccer is a place of possibility,
where even those born into the most diicult of
circumstances can become global icons, cele-
brated for playing a game that explodes with joy
and creativity.
Yet the men’s side of professional soccer has
given rise to a merciless process of talent identii-
cation and development that operates on a global
scale. Many promising young players sign con-
BOOKS
tracts with clubs whose inances depend on buy-
ing and selling those contracts in an international
market. The “transfer fees” exchanged between
clubs have risen vertiginously over the past few
decades. Last summer, Paris Saint-Germain, a
team bankrolled by Qatari investors, set a record
by buying the Brazilian star Neymar from Bar-
celona for $263 million. For top players, as well
as the clubs and intermediaries involved in the
soccer market’s chains of speculation, there are
fortunes to be made. For the masses of aspiring
players, whose chances of succeeding are inin-
itesimal, the costs are human and in many cases
quite brutal.
Abbot and Oxenham offer us riveting por-
traits of players trying to make it, bouncing from
team to team and continent to continent, often in
deeply precarious circumstances. Their accounts
raise questions about the ethics and efectiveness
of the current soccer system. Does the ruthless
“Game selection that male athletes face—driven by a top-
down structure, an emphasis on early winnowing,
intelligence” and intensive youth training—go against the grain
can be of a game based on shifting, unpredictable play?
nurtured, And might women’s careers, which unfold dif-
but it is ferently because of the gender inequalities that
shape a notably underfunded sport, have some
difficult lessons to ofer?
to teach.
T A R T I N G I N T H E 1 9 8 0 S , European
S nation al teams and professional clubs
began organizing youth academies aimed at
identifying and cultivating male players at a very
young age. Those academies have now spread all
over the continent, and the competition among the
kids there, some brought in as young as 5 years old,
is ierce. A recent study of English academies, cited
by Abbot, concluded that out of about 10,000 kids
in the system, roughly 100 will become profes-
sionals. And among those who do get professional
contracts as teenagers, two-thirds will no longer be
playing by the time they are 21.
The net is cast wide at the youth level because it
is so diicult to determine which players have the
talent, skills, and drive that will allow them to suc-
ceed. Soccer doesn’t require a particular body type.
Lionel Messi is 5 foot 7 and sufered from growth-
hormone deiciency as a child, but was neverthe-
less recruited to the Barcelona academy when he
was 11. Nicknamed “The Flea” by his teammates,
he had amazing technique with the ball and con-
sistently outplayed them. As he matured, Messi
stood out thanks above all to what coaches call
“game intelligence”—“the ability,” as Abbot puts it,
“to evaluate a dynamic situation and execute the
right decision almost instantly.”
Game intelligence can be nurtured, but it is dif-
icult to teach. The only sureire way to cultivate it
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 35
is to play a lot. And the more structured training
approach taken by many academies may, iron-
ically, be a hindrance. Abbot invokes research
suggesting that play in informal environments—
on a patch of dirt or in the courtyard of a hous-
ing project, for example, rather than on a well-
manicured pitch under adult supervision—is key
to the development of game intelligence. In these
settings, kids also tend to one-up each other with
lashy play—dribbling adroitly around someone,
kicking the ball over a head or through a thicket
of legs, juggling the ball in the air for a while, ex-
ecuting a back-heel pass to a teammate—which is
a great way to master technical skills. Such pickup
games demand creativity and improvisation,
and reward those who are constantly observing
their surroundings and recalibrating their moves
accordingly. Coaching is no doubt useful, but
even players at academies do better when they
spend a lot of time in free-form play.
No wonder, then, that Africa, which over the
past several decades has produced some of Eu-
rope’s greatest soccer stars, has beckoned as a
vast and untapped recruiting ground. Structured
academy training of the kind now prevalent in
Europe is rare there. The next star, the thinking
goes, could be anywhere, honing his talents under
an overpass in Lagos or oceanside in Dakar. The
prospect appealed to Sheikh Jassim, the founder
of Aspire Academy. In line to be the next emir of
Qatar, Jassim had renounced the throne to focus
on his true passion, soccer. (A doctor once sum-
moned to his palace to cure his insomnia saw the
problem immediately: wall-to-wall screens in the
bedroom, showing games being played all over the
world, around the clock.) Setting out to train a great
Qatari team, Sheikh Jassim decided that import-
ing talented African players would help, and hired
Josep Colomer to search the continent.
Called Football Dreams, the enterprise was, Ab-
bot writes, “the largest soccer scouting project in
history.” The irst year, when Appiah was selected,
nearly 430,000 boys participated in the tryouts. By
2014, more than 3.5 million youths had been scouted
by the program. At one ield in Ghana, more than
100 young players showed up two days early, sleep-
ing on the ground while they waited for Aspire
Academy representatives to arrive. In the irst year,
Colomer persuaded Jassim to expand the number
of scholarships awarded by setting up an academy
in Senegal, which welcomes 20 students a year, in
addition to the few who get to train in Qatar. Still, as
In soccer’s Abbot notes, the winnowing process is “a thousand
global order, times more selective than getting into Harvard.”
Africa is
seen as a F Y O U N G P L AY E R S thronged to the try-
supplier of
raw material
I outs, it was because Aspire Academy seemed
to point the way to a professional career in
Europe—the dream that drives soccer throughout
to be refined Africa. At 8, Appiah was already a commodity. His
and then second youth coach, Justice Oteng, paid an infor-
mal transfer fee for him and other players when
sold on the they joined the team. Oteng also paid for the
international Ghana Football Association license that qualiied
market. Appiah to play in the country’s oicial leagues, and
he provided housing for several years.
For Oteng, these were speculative investments
that he hoped to recoup one day. Like Oteng, how-
ever, most local coaches don’t have direct links to
European clubs. So young players end up vulner-
able to unscrupulous agents, many of whom de-
mand money up front and never follow through on
promises to introduce players to recruiters. Such
a large number of aspiring African players are left
stranded and homeless in Europe that one retired
soccer player has created an NGO in France to help
them. He describes this trade in young players as a
kind of “modern slavery.”

battle is learning to builds as Sonja’s inner to the countryside

COVER TO COVER drive. Shifting gears is world unfolds. Stuck where she grew up,
a challenge for Sonja, in a driving lesson and especially to her
Mirror, Shoulder, a translator of Swedish or on her massage estranged sister. But
Signal crime fiction who lives therapist’s table, she gauzy nostalgia isn’t
in Copenhagen and is is elsewhere, too, as in her middle-aged
DORTHE NOR S,
TRANSLATED BY prone to bouts of dizzi- if she’d “pressed an repertoire as she nav-
MISHA HOEK STRA ness. Even working up elevator button in her igates the terrifying
G R AY WOLF the nerve to change mind.” An unmoored, on-ramp to the future
driving instructors is lonely soul in a big alone. “As women,”
THE DANISH WRITER in The Paris Review. a struggle. city, she’s grappling she says of herself
Dorthe Nors likes to For the 40-something Only a writer as with “the things and her mother in a
subject her characters protagonist of her lat- agile and profound as she cannot find the rare moment of dia-
to “the battle that you est novel—the first to Nors would dare to language to say and logue, “we’re not com-
experience on the appear in English, and proceed from such a the people she most pletely fine-tuned.” As
brink of something a finalist for the Man heavy-handed (and wants to say them to.” a novelist, Nors comes
new,” she explained Booker International humdrum) premise. Sonja’s thoughts remarkably close.
in a 2014 interview Prize last year—the The novel’s power return again and again — Ann Hulbert

36 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 Football Dreams was presented by its leaders
as an alternative to this kind of exploitation. Yet
as Appiah discovered, the pressures of the indus-
try are inescapable. With the eyes of European
teams on him as he played exhibition matches
with Aspire, a conlict developed between Oteng
and the academy over when he should go profes-
sional and who would negotiate, and proit from,
the move. The struggle over Appiah’s future even-
tually short- circuited it. He left Aspire Academy
after a year, and his attempts to get a contract in
Europe loundered, despite his top-level training
and connections to coaches there. He ended up
playing professionally in Ghana, where the pay is
low: The going salary is about $50 a month, which
sometimes is barely enough for food and shelter.
Now in his mid-20s, he remains optimistic that he
will get a break, but time is running out for him to
have a professional career in Europe.
Describing Appiah’s departure from the acad-
emy, Abbot writes that he was “headed back to
the mine where he was found.” The echoes of
colonialism are clear. In soccer’s global order,
Africa is seen as a supplier of raw material to be
refined and then sold on the international
market— or, far more likely, discarded. Encour-
aged to stake everything on the game, young
players confront intense expectations and inan-
cial pressures. One of Appiah’s classmates at the
academy did ultimately go professional in Europe,
playing for a year with Barcelona and then with
a lesser-known team. A few more-recent Aspire
graduates have gone professional as well. Still,
Abbot’s book paints a portrait of institutions so
obsessively geared toward producing the next
star that little thought is given to what is con-
sumed, and lost, in the endeavor.
H AT I F T H E S Y S T E M were struc-
W tured diferently, focused on the expe-
riences of the vast majority of aspiring
players who will fail rather than on the tiny number
who will succeed? This would be more ethical and
less exploitative, and might well produce just as
many great stars, at a much lower personal price.
As Abbot’s book highlights, the Aspire Academy
quest has yielded strikingly mixed results, espe-
cially given the massive investment involved. A
blunt truth emerges: Seeking out players when
they are very young is surely not an ideal formula
for scouting success. The development of game
intelligence remains fairly mysterious; the asset
is one whose eventual emergence can be hard to
predict early on.
What boys like Appiah may need most of all is
more time, and a comparatively modest space up-
grade. Instead of six practice ields in Qatar, he and
other young players could have used another good
one in Teshie. With better conditions there, he
might not have felt the need to leave home to hone
BOOKS
his talents, and when the time was right—when he
was old enough, and ready—he could have made a
move to Europe. Recruiters could still travel Africa
looking for star players, but they would be looking
for young men rather than boys, and have a better
chance to truly judge whether they were ready for
European club soccer. Cutting back on intensive
training in childhood might have downsides, of
course. Yet the gains, especially for the many play-
ers who never become stars, could be seen as com-
pensation enough.
H E W O R L D O F women’s soccer por-
T trayed by Oxenham provides inspiration
here. To be sure, the absence of big money
doesn’t mean freedom from exploitation. Most of
the players we meet in Under the Lights and in the
Dark are barely eking out a living, even in the U.S.
league, which is better-funded than most coun-
tries’ leagues. Marta Vieira da Silva, a star of Bra-
zil’s national team—and considered by many to be
the world’s greatest female soccer player—earns
about $40,000 a year playing with the Orlando
Pride, though she makes more from commercial
endorsements. The inancial realities reshape the
entire process and ethos of women’s soccer. Young
players can only ever think of soccer “not as a des-
tination but as a route,” writes Oxenham, once an
aspiring professional player herself. “From the
beginning of our playing careers, we prepared for
the end.”
That means the path for even the most skilled
and ambitious girls begins as, and remains, a
broader one. Like Nadim, one of the American
players in Oxenham’s book attends medical
school; a star of the German national team is in
the police academy. “I can’t just be a soccer player,”
she explains. “I’d be bored.” Gaëlle Enganamouit
THE AWAY GAME:
THE EPIC SEARCH
FOR SOCCER’S NEXT
SUPERSTARS
of Cameroon uses the money she earns playing
professionally to invest in a taxi business run by
her family back home.
SEBASTIAN ABBOT Nadim discovered soccer for herself, and got
W. W. Norton her teenage training thanks to the generous gov-
ernment support—local and national—for youth
sports throughout Denmark. She saw the ball in
the tree in part because well-equipped programs
meant that young players didn’t bother to go after
the balls they kicked into the woods. A dose of that
spirit, spreading soccer’s benefits wider, would
serve everyone, including stars. Soccer, at its heart,
is all about creating openings where there seem to
be none. Utopian though the dream of a more just
and equitable soccer system may sound, that’s only
UNDER THE LIGHTS more reason to nurse it.
AND IN THE DARK:
UNTOLD STORIES OF
WOMEN’S SOCCER
Laurent Dubois teaches at Duke University and is
GWENDOLYN OXENHAM the author, most recently, of The Language of the
Icon Game: How to Understand Soccer.
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 37

SPONSOR CONTENT
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F U T U RE
Is
HUMAN
Enterprising workers are
moving to cities in droves.
But as economic forces
threaten to pull us apart,
transforming work and life
as we know it, we must
embrace community and
pave the way for a rising
generation of entrepreneurs.
Companies must reimagine
their work spaces to support
innovation and encourage
connection and creativity.
This content was created by Atlantic Re:think, the branded content studio at The Atlantic, and made
possible by WeWork. It does not necessarily reflect the views of The Atlantic’s editorial staff.
As cities get denser, the modern
workforce is being transformed by pow-
erful forces like automation and global
competition. Looked at in one way, these
are forces that could eventually turn us
against each other, instilling in people a
sense of alienation and uncertainty that
can make urban life lonely and the future
of work seem ominous.
That may sound bleak, but there is plenty
of reason for hope. According to experts,
the disruptions to urban work life also
have the potential to bring us closer
together if harnessed correctly, giving
cities—and the companies that operate
therein—the chance to create new hives
of meaningful social interaction that can
enrich local economies.
“People tend to work better together,” says
Ethan Pollack, an associate director of
research and policy for the Aspen Insti-
tute’s Future of Work Initiative. “Humans
are inherently social beings, so as work
becomes more independent, it further
emphasizes the need to create other ways
that people can connect with each other.”
A number of urban centers are at
the forefront of addressing this change,
which is one big reason why cities in the
U.S.—and around the world—are now on
the rise. And not just cities like New York
and London. From Kansas City to Denver,
São Paulo to New Delhi, cities are all grow-
ing as young entrepreneurs migrate en
masse to urban areas, forming a constella-
tion of enterprise that dots the globe.
Recently, Long Beach, California, lost a
giant Boeing manufacturing facility, which
decimated the local economy. Rather than
shying away from the consequences of
technological innovation, though, Long
Beach was determined to embrace them.
The city set about connecting employers
with freelancers, who make up 30 percent
of the population, and brought WeWork,
the co-working giant, to its downtown
area last year.
Since then, Long Beach has seen a hearty
revival of its business district. WeWork’s
introduction to the area acted as a kind of
binding agent and economic accelerant,
allowing entrepreneurs and enterprises

“WeWork is now a critical
piece of our economic
development, job
creation, and downtown
revitalization strategy.”
Robert Garcia
Mayor of Long Beach, California
to seamlessly connect within Long Beach
and in cities around the world. “I think We-
Work can be a game changer for the future
of cities,” says Robert Garcia, the mayor of
Long Beach.
This change begins with one block, one
neighborhood, one city—but these are
just the start. If you can connect people in
meaningful ways, then neighboring cities
like Long Beach and Los Angeles, for in-
stance, won’t be solely dependent on each
other for symbiotic working relationships
and shared intellectual resources. The
network can go beyond physical location:
A growing small business in Long Beach,
for example, can easily collaborate with
designers in Detroit and an engineering
team in San Francisco while it negotiates
a partnership with a Fortune 500 company
in Chicago and sells to clients from New
York to Mexico City to Shanghai—creating
a borderless string of entrepreneurship
and cities around the globe.
“WeWork has created the physical-
world equivalent of a digital platform,
creating value by imprinting design onto
physical space, which leads to network
effects at both the individual and institu-
tional levels,” says Arun Sundararajan, a
professor at New York University’s Stern
School of Business and the author of The
Sharing Economy. “Its global constellation
SPONSOR CONTENT
WeWork’s Economic
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 ʲ
70%–80%
70%–80% of WeWork members in New York,
Los Angeles, and Chicago are new to their
neighborhood—bringing economic
activity to local restaurants and shops.
12%
New businesses are 12% more
likely to survive at WeWork than
are their peers, and 45% of member
companies credit WeWork with helping
of companies and entrepreneurs allows accelerate their growth.
members to tap into and realize value
from these economic spillovers within
their local communities and across cities.”
2x
The story of a newly revitalized city like The WeWork community creates a power-
Long Beach can serve as a model for ful economic multiplier for cities:
other locales. But thriving economies 10,000 WeWork members can create an
additional 10,000 jobs in the local economy
aren’t assured. The future depends, in
through indirect and induced spending.
large part, on how we respond to loom-
ing changes. We can fear technological
advancement. We can fear a world that
is becoming more interconnected by
the day. We can turn inward and against Read the full report at
those around us. Or we can embrace we.co/weworkimpact
change with optimism and action. We
can lasso the forces that threaten to pull
us apart and humanize both cities and
For more on how cities can
build a community for the
future, visit:
theatlantic.com/future-is-human
SOURCE
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ÃÃʂʠɧ
*ʂɸʂɵɕ

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BOOKS
Your DNA Is Weirder
Than You Think
Genetic research constantly upends our understanding
of heredity—though not our zeal to control it.
BY NATHANIEL COMFORT
I
N 1555, Holy Roman Emperor Charles V announced his plans
to abdicate, and his 28-year-old son, Philip II, became the king
of Spain the following year. The throne was Philip’s natural—
hereditary—right. The Habsburg dynasty, to which Charles and
Philip belonged, had raised strategic matrimony to an art form,
using marriage bonds among relations distant and close to seize
control over much of Europe. Power came with a price, however:
severe, recurring mental and physical problems. Charles’s
mother was Joan the Mad; his son Philip was said to be “of weakly frame and
of a gloomy, severe, obstinate, and superstitious character.” Philip’s descen-
dant Charles II was 4 before he could talk and 8 before he could walk. He died
40 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
in 1700, not yet 40, childless and sterile. Geneti-
cists have calculated that he was more inbred than
he would have been had his parents been siblings.
After his death, the Spanish Habsburg dynasty
collapsed, crushed under the weight of a heredity
that as yet had no name.
Though Renaissance nobles could not have
missed the unfortunate traits that ran like fractures
through the House of Habsburg, not until the 1830s
did the term heredity acquire its modern conno-
tation as a biological legacy. Because the term irst
speciied material inheritance, often from eldest
son to eldest son, we tend to think about heredity
in terms of straight lines: bloodlines, patrilines,
and eventually germ lines. Our word for a dia-
gram of the lines of descent—pedigree—is probably
derived from the French pé de grue, or “crane’s
foot,” evoking an image of a pencil-like leg ending
in straight, splayed toes.
Yet linear thinking doesn’t begin to do hered-
ity justice, and in his sprawling, magisterial new
book, the science writer Carl Zimmer shows why.
She Has Her Mother’s Laugh brims with rich stories
and colorful actors—some sinister, some brilliant,
some both—and delves into scientiic research,
history, and ideas made intimate through the au-
thor’s personal experiences. The result explodes
any unitary idea of heredity. Zimmer limns por-
traits of multiple intersecting heredities, more
like the web of a spider than the foot of a bird.
Despite this proliferation, dreams of human con-
trol over the process continue to soar.
I l l u s t r a t i o n b y M AY U KO F U J I N O
 The biological concept of heredity came too
late for the Habsburgs, but not for Francis Galton,
a half-cousin of Charles Darwin. When Galton
looked at distinguished pedigrees in the 1860s,
he saw concentrations of virtues: intelligence,
good looks, strength of character. This Victorian
gentleman, who gave us the phrase nature versus
nurture, convinced himself that talent and charac-
ter were hereditary, because they ran in families.
After abandoning the awkward word viriculture, he
christened the science of hereditary improvement
“eugenics,” from the Greek for “wellborn.”
Galton’s eugenic scheme relied on persuasion
and social incentives to discourage those he con-
sidered unit from reproducing, while encourag-
ing procreation among the posh and brilliant. The
result, he earnestly believed, would be a “galaxy of
genius.” Later editions of eugenics were less opti-
mistic. If you take Galton’s recipe, add Mendel’s
peas and Morgan’s fruit lies, simmer in the politics
and culture of the Progressive era, and stir vigor-
ously, you get the American eugenics movement—
dogmatic, ideological, and coercive. (Sadly, some
choice examples of its rhetoric may be found in the
archives of this magazine.) Serve warm to German
fascists, and you get the Final Solution.
It is all too easy to shake our heads at the cruelty
and naïveté of the eugenic creed, which held that
society could be “cured” of crime, disease, and
poverty by eliminating the “unit” from the gene
pool, or to tsk-tsk at the monstrous conidence that
led eugenicists to believe they understood heredity
well enough to engineer it. Much more diicult is
to bear in mind that in 20 years, many of today’s
received truths will also be thought wrong. Playing
God is always harder than it looks.
T E P B Y M E A S U R E D S T E P, Zimmer
S walks us deep into the thickets of genetics
and genomics, revealing complications and
exceptions that challenge what we think we know
about heredity. Following his own family tree, Zim-
mer shows us that counterintuitive facts lie even in
the humble pedigree. If you pursue your lineage far
enough, the branching forks of a family tree begin
to rejoin, such that if your ancestry is European
back to the time of Charlemagne, you are related
to Charlemagne himself!
To focus in is to ind chromosomes playing all
sorts of tricks. Take, for example, chimeras. To the
ancient Greeks, the Chimera was a ire-breathing
hybrid monster; to a biologist, chimeras are organ-
isms that comprise cells from two diferent individ-
uals. Ranchers are familiar with one type of chimera,
the freemartin, which results when a cow carries
opposite-sex twins. Connected by a shared placenta,
the fetal calves exchange stem cells. The bull calf
grows up into a more or less normal bull, while the
heifer—the freemartin—has undeveloped ovaries
and exhibits masculinized behavior (and is particu-
BOOKS
larly tasty on the grill). Where does one calf end and
the other begin?
Zimmer describes a bizarre twist on the free-
martin: a girl with different-colored eyes and
ambiguous genitals who appeared at a Seattle
genetics clinic. Her ovaries proved to have only
XX chromosomes—typical female—but her other
tissues were mixtures of XX and XY. Further
analysis showed that she had started out as oppo-
site-sex twins. But early in development, the two
embryos had fused, becoming a single, highly un-
usual child. Like a verse from the old Ray Stevens
novelty song “I’m My Own Grandpa,” this girl was
her own twin brother.
But chimeras are not just oddities. You surely
know one. In pregnant women, fetal stem cells
can cross the placenta to enter the mother’s blood-
It is all stream, where they may persist for years. If Mom
gets pregnant again, the stem cells of her irstborn,
too easy to still circulating in her blood, can cross the placenta
scoff at the in the other direction, commingling with those of
monstrous the younger sibling. Heredity can thus low “up-
confidence stream,” from child to parent—and then over and
down to future siblings.
that led The genome, Zimmer goes on to reveal, eludes
eugenicists to tidy boundaries too. Forget the notion that your
believe they genome is just the DNA in your chromosomes. We
understood have another genome, small but vital, in our cells’
mitochondria—the tiny powerhouses that supply
heredity well energy to the cell. Though the mitochondrial genes
enough to are few, damage to them can lead to disorders of
engineer it. the brain, muscles, internal organs, sensory sys-
tems, and more. At fertilization, an embryo re-
ceives both chromosomes and mitochondria from
the egg, and only chromosomes from the sperm.
Mitochondrial heredity thus lows strictly through
the maternal line; every boy is an evolutionary
dead end, as far as mitochondria are concerned.
Beyond the genome are more surprises. School-
children learn that Darwin’s predecessor, the great
French naturalist Jean-Baptiste Lamarck, got
heredity wrong when he suggested that traits
acquired through experience—like the giraffe’s
neck, elongated by straining and stretching to
reach higher, perhaps tenderer, leaves—could be
passed down. The biologist August Weismann
famously gave the lie to such theories, which col-
lectively are known as “soft” heredity. If Lamarck-
ism were true, he said, chopping the tail of mice
and breeding them, generation after generation,
should eventually produce tailless mice. It didn’t.
SHE HAS HER Lamarck wasn’t lurking in the details.
MOTHER’S LAUGH: Recent research, however, is giving Lamarck a
THE POWERS, measure of redemption. A subtle regulatory sys-
PERVERSIONS, tem has been shown to silence or mute the efects
AND POTENTIAL
OF HEREDITY
of genes without changing the DNA itself. Envi-
CARL ZIMMER ronmental stresses such as heat, salt, toxins, and
Dutton infection can trigger so-called epigenetic responses,
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 41
 turning genes on and of to stimulate or restrict
growth, initiate immune reactions, and much
more. These alterations in gene activity, which are
reversible, can be passed down to ofspring. They
are hitchhikers on the chromosomes, riding along
for a while, but able to hop on and of. Harnessing
epigenetics, some speculate, could enable us to
create Lamarckian crops, which would adapt to a
disease in one or two generations and then pass the
acquired resistance down to their ofspring. If the
disease left the area, so would the resistance.
All of these heredities— chromosomal, mito-
chondrial, epigenetic—still don’t add up to your
entire you. Not even close. Every one of us carries
a unique lora of hundreds if not thousands of mi-
crobes, each with its own genome, without which
we cannot feel healthy—cannot be “us.” These
too can be passed down from parent to child—but
may also move from child to adult, child to child,
stranger to stranger. Always a willing volunteer,
Zimmer allowed a researcher to sample the mi-
crobes living in his belly-button lint. Zimmer’s
“navelome” included 53 species of bacteria. One
microbe had been known, until then, only from
the Mariana Trench. “You, my friend,” the scien-
tist said, “are a wonderland.” Indeed, we all are.
I T H T H I S I N M I N D, reconsider the
W ongoing effort to engineer heredity.
The motto of the Second International
Eugenics Congress, in 1921, was “Eugenics is the
self-direction of human evolution.” Since then,
controlling heredity has become technically much
easier and philosophically more complicated. When,
in the 1970s, the first genetic engineering made
medical gene therapy feasible, many of its pioneers
urged caution, lest some government try to create
a genetic Fourth Reich. In particular, two taboos
seemed commonsense: no enhancement, only
therapy (thou shalt not create a master race); and
no alterations in germ-line tissues, only in somatic
cells (thou shalt not make heritable modiications).
To today’s genetic engineers, those parameters
seem quaint. Researchers can now convert mature
somatic tissue taken from, say, a cheek swab into
stem cells able to become any type of cell, even
sperm and eggs. New technologies such as the
gene-editing technique known as CRISPR have
greatly expanded the repertoire of engineering.
Ethical quandaries abound. Although injecting
the hormone erythropoietin can be lifesaving for
people with severe anemia, it is illegal for athletes.
What about gene therapy to raise one’s “natural”
erythropoietin production? Is it better to elimi-
nate gene variants for sickle cell anemia and thal-
assemia, or to retain the malaria resistance those
genes confer? What kinds of side effects would
seem tolerable in order to raise your child’s IQ by
a few points?
42 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
The ethics of some reproductive technologies
BOOKS
become blurrier in light of the newly complex
understanding of heredity’s cross currents. A
maternal surrogate, for example, will likely ex-
change stem cells with the fetus she carries, open-
ing the door to claims that baby and surrogate are
related. If the surrogate later carries her own baby,
or that of a diferent woman, are the children re-
lated? Parenthood becomes even stranger with
so-called mitochondrial-replacement therapy. If
a woman with a mitochondrial disorder wants
a biological child, it is now possible to inject the
nucleus of one of her eggs into a healthy woman’s
egg (after removing its nucleus), and then perform
in vitro fertilization. The result is a “three-parent
baby,” the irst of which was born in 2016. Zimmer
doesn’t presume to make ethical judgments about
procedures such as this, but warns that “informed
consent” in such cases can be unexpectedly thorny.
And why stop with people? A so-called gene
drive could enable researchers to release into
nature organisms that would genetically engineer
one another, spreading a desirable trait through-
out a population within a couple of generations.
Every one of Scientists imagine using this process to create
us carries a pest-proof crops, malaria-free mosquitoes, and
unique flora limitless other innovations in agriculture and pub-
of hundreds if lic health. Trials are in progress.
not thousands
of microbes,
Engineering the global genome could save mil-
lions of lives—or produce a chimeric hybrid of Gat-
taca and Jurassic Park. We could alter the gene pool
each with its of the future in ways we cannot yet even imagine,
own genome, let alone understand. Zimmer is excited about the
possibilities, but in a world where headlong innova-
without which tion always trumps careful contemplation, he urges
we cannot scientists and the public to learn from history. “We
be “us.” would do well,” he writes, “to look back at how the
tools we’ve already invented have altered our eco-
logical inheritance over the past ten thousand years.”
An old saw of biology runs “Evolution is clev-
erer than you are.” And ecology, involving as it
does the dovetailed evolution of countless organ-
isms in a constantly changing world, is cleverer
than evolution. In Zimmer’s pages, we discover
a world minutely threaded with myriad streams
of heredity lowing in all directions, in variegated
patterns and diferent registers—from a newt’s
truncated, regenerating tail; to the pond in which
the newt paddles; to the meadow where the pond
ills and dries, ills and dries, down the centuries.
The computing power alone required to play pup-
pet master for such a scene, tugging and twirling
the strings of its DNA, is staggering. Whether we
have the wisdom to nurture nature is a question
that Zimmer leaves, held aloft like a dandelion
puf, for us to contemplate.
Nathaniel Comfort is a professor of the history of
medicine at Johns Hopkins University.
It’s time to say NO to trying to fit square-peg kids
into round holes, and YES to raising them from
a place of acceptance and joy.

T oday one out of five kids has ADHD,

dyslexia, autism, giftedness, anxiety, or
other neurodifferences. These are children that
Deborah Reber, bestselling author and mother of
a twice-exceptional son, calls “differently wired,”
and the challenges of raising them are many. Now,
weaving together personal stories with a tool kit
of expert advice, she offers a groundbreaking
how-to and manifesto that will help parents help
their children fully realize their best selves.

“Differently Wired will help parents of

children who think differently to accept their
child for who they are and facilitate their
successful development.”
—TEMPLE GRANDIN, author of Thinking
in Pictures and The Autistic Brain

“A wonderfully engaging and much-needed

book that I will enthusiastically recommend
to so many parents and professionals I meet
on a regular basis.”
—BARRY M. PRIZANT, PhD, CCC-SLP, author of
Uniquely Human: A Different Way of Seeing Autism

“A ‘must read’ for all parents raising children with multiple exceptionalities.”
—DR. MICHAEL POSTMA, EdD, interim director of SENG
(Supporting the Emotional Needs of the Gifted)

“Building on the premise that we should celebrate our children’s uniqueness

instead of apologizing for it, Deborah Reber provides real tools and
practical advice for parents to confidently support their child’s journey.”
—AMANDA MORIN, Writer/Expert at Understood and author of
The Everything Parent’s Guide to Special Education

Available now, wherever books are sold.

 Here’s one way to ight ISIS: Send one
of the most advanced and expensive
military aircraft in the U.S. arsenal from
a base in Missouri to drop GPS-guided
500-pound bombs on a group of
70 ragtag ighters sleeping in the Libyan
desert. (Spoiler alert: They died.)

44 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 T
H
E
BY WILLIAM LANGEWIESCHE
I L LU ST R AT I O N S BY OW E N F R E E M A N

R
A
I
D
 School, in Nevada. The airplanes had been fawned over for days
by ground crews, but in ine aeronautical tradition the respon-
I. sibility for their condition lay ultimately with the pilots. They
TARGET loaded their gear into the cockpits, gaining access by climbing
a short ladder and pulling themselves up through a hatch in
The B-2 stealth bomber is the world’s most exotic strategic air- the loor. They then performed a traditional walk-around, fol-
craft, a subsonic lying wing meant to be diicult for air defenses lowed by extensive system checks and light-plan entries. This
to detect—whether by radar or other means—yet capable of carry- took about 90 minutes. No problems were discovered. They
ing nearly the same payload as the massive B-52. It came into ser- closed the cockpit hatches, strapped into their seats, and while
vice in the late 1990s primarily for use in a potential nuclear war still in the hangars started their engines. Each B-2 has four jet
with the Soviet Union, and clearly as a irst-strike weapon rather engines—not clunky cylinders but turbofans embedded sleekly
than a retaliatory one. First-strike weapons have destabilizing, in the wings, like gills in a shark, so as to limit radar, infrared,
not deterrent, efects. It is probably just
as well that the stealth bomber was not
quite as stealthy as it was meant to be, and
was so expensive—at $2.1 billion each—
that only 21 were built before Congress
refused to pay for more. Nineteen of
them are now stationed close to the geo-
graphic center of the contiguous United
States, in the desolate farmland of central
Missouri, at Whiteman Air Force Base.
They are part of the 509th Bomb Wing,
and until recently were commanded by
Brigadier General Paul W. Tibbets IV,
whose grandfather dropped the atomic
bomb on Hiroshima. B-2 bombers are still
primarily regarded as a nuclear-delivery
system, meaning that their crews are by
selection the sort of men and women
capable of deining success as a precisely
lown sortie at the outset of mass annihi-
lation. No one should doubt that, if given
the order to launch a nuclear attack, these
crews would carry it out. In the meantime,
they have occasionally lown missions of
a diferent sort—make-work projects such
as saber rattling over the Korean penin-
sula, and the opening salvos in Serbia,
Afghanistan, and Iraq—to tactical advan-
tage without American discomfort.
Such was the state of affairs in the
small hours of the morning at Whiteman
on January 17, 2017, during the last days
of the Obama administration. Six years
had passed since any B-2 had lown in combat. But now, in the and acoustic signatures. The engine start is automated—a push-
privacy of their bespoke, climate-controlled, single-occupancy button afair that requires monitoring but rarely fails.
hangars, several of them had been loaded with 80 GPS-guided Once the engines had started, the B-2s emerged in unison
bombs for use against enemies who had been spotted on the from their hangars and pivoted to form a single-file line. A
ground in a faraway country. The preparations had been hushed: low overcast blackened the sky. The air was cold and moist—
Relatively few people on the base, even among those assembling conditions conducive to engine-induction icing while the plane is
and loading the bombs, knew that this was something other than idling on the ground, one of several weather-related weaknesses
a training run. from which the B-2 sufers as a result of the uncompromising pur-
In the B-2, the only inhabitable space is the cockpit, and the pose of its design. Because of the potential for icing, the pilots
light crew consists of merely two people. Though they are cross- were eager to get their ships into the air. Spaced 500 feet apart,
trained to perform any role in light, the one in the right seat is the B-2s taxied briskly toward the top of the runway—an array
the mission commander, who handles the weapons and military of wings with no fuselages, no tails, and no vertical stabilizers,
communications, and the one in the left seat is considered the barely recognizable as airplanes except for their hefty landing
pilot, who performs the lesser tasks of lying the airplane and gear and the whine of their hidden engines. The irst three took
dealing with air traic control. On that January morning, all of 30 seconds apart and were swallowed by the night. The others,
of the crew members were mid-ranking men and graduates of which had been spun up in case the primary aircraft experienced
advanced B-2 training at the United States Air Force Weapons problems, taxied back to their hangars and shut down. When I

46 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
later expressed surprise at this level of redundancy, one of the
pilots explained that it had been necessary to ensure the bombs
would be released at the chosen time: within the irst several sec-
onds of January 19, 2017. The timing seemed so arbitrary that I
asked about the reasoning behind it. My question was amateur-
ish, and the pilot did not appreciate it. “I was not privy to those
discussions,” he said. “I just go when they tell me to go.”
The B-2s were going to Libya. The most expensive and capa-
ble tool in the Air Force arsenal had just been deployed against
a group of ighters in the desert, asleep in scattered locations
across two camps. The plan was for the B-2s to ly 6,000 miles
and drop a 500-pound bomb on every one of those ighters.
THE PREPARATIONS
HAD BEEN HUSHED:
FEW PEOPLE ON THE
BASE, EVEN AMONG
THOSE ASSEMBLING
AND LOADING
THE BOMBS, KNEW
THAT THIS WAS
SOMETHING OTHER
THAN A TRAINING RUN.
II.
INTO THE
NIGHT
B-2 pilots make ighter pilots look like dandies. Their mission
requires them to ly straight and level, and to live the same way.
What passes for jauntiness among them is the use of the word jet
for the airplane and gas for the fuel. Sometimes they call them-
selves drivers. They give one another nicknames. But that’s as
cute as it gets.
The three jets that took of last January each weighed 336,500
pounds and carried more than 129,500 pounds of gas—enough,
for instance, for them to get from Missouri to Maine and back
without aerial refueling. Immediately after takeof, the drivers
retracted the landing gear and switched on the autopilot; the three
airplanes turned eastward and climbed at a gentle 3,000 feet a
minute, doing a relatively sedate 320 miles an hour. Once they
reached the mid-30,000-foot range, they cruised, maintaining a
stacked-in-trail formation: the lead airplane lowest, followed by
the second airplane a little way back and slightly higher, followed
by the tail airplane in the same basic geometry. With the seats
raised high, visibility from the cockpits was good. The seats were
extremely comfortable, and part of an elaborate ejection system.
Crews are required to wear helmets and masks during phases
of light when ejection might be required— on takeof, landing,
and aerial refueling, and over hostile territory. For now the pilots
removed the gear and put on Bose headsets. The ride was smooth
and above the weather, under winter stars and a waning moon.
Their course passed south of Chicago, north of New York, and
across New England. Traic was light. The commander of the
lead airplane was a slightly built captain in his early 30s with a
wife and an infant daughter at home. He probably should have
taken the opportunity to unstrap from his seat and stretch out in
the back of the cockpit. The space there is occupied by a toilet, a
microwave oven, and typically a couple of Styrofoam coolers con-
taining food the pilots pack for themselves. It allows just enough
room for an average-size man to lie down. Managing sleep on
long-duration lights is a crucial part of the job. Some crews bring
a cot for the purpose, and others roll out a camping pad. For this
light, the commander didn’t even try.
I’ll call him Scatter. He was lying his irst combat mission. He
had been preparing for it for 10 years. I can say this much about
him: He grew up in Pittsburgh, graduated from high school in 2003,
and went to college in North Dakota to get a degree in aviation. He
wanted to be an airline pilot. He had a cousin who had been an
Army tank commander in Kosovo. His cousin said, “Hey, man, you
should check out the military. I think you’d be good at it.” Scatter
joined the ROTC, enjoyed it, and received his Air Force commis-
sion upon graduation, in 2007. By then he had several commercial-
pilot licenses. The Air Force sent him to pilot training in Texas for
two years and assigned him to ly B-52s out of Louisiana. He lew
B-52s for the next three years, accumulating 900 hours of light
time. In 2013 he transferred to the B-2, which he called a pretty
cool airplane, the varsity bomber, and one that, unlike the old-
fashioned, overcrewed B-52, involves its pilots fully in all aspects
of the light. There was a negative to the move as well: Because
Whiteman had more than 100 B-2 pilots, and because 100 hours
of maintenance were required for every hour of light, time at the
controls was extremely limited—no more than 100 hours a year—
and it could be a struggle to meet the minimum combat-readiness
requirement of two flights a month. So Scatter, who had just
emerged from intensive training at the Air Force Weapons School,
considered himself lucky to have met the minimum, and then to
have been chosen to command the lead ship that night. He was up
past his bedtime, but not inclined to doze of.
Over Maine, in the darkness, the planes joined up with four
KC-135 tankers—one to fuel each of the three B-2s, and a spare to
provide redundancy. The KC-135 is a four-engine jet, a derivative
of the old Boeing 707. It carries a crew of three or four. These had
lown to the intercept from bases as far away as California. Scatter
led his light into a modest descent, to altitudes where the heavily
laden B-2s would have more thrust available for maneuvering.
The formation then split apart as each airplane approached its
assigned tanker from behind and below. Aerial refueling is the
most challenging piece of lying that B-2 pilots face. It is accom-
plished entirely by hand, with the autopilot of, in all weather
conditions, sometimes with both airplanes blacked out. It
requires the B-2 to be held in an unusually restrictive position in
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 47
relation to the tanker, and speciically to the boom that delivers
fuel through a door located on the top of the bomber, aft of the
cockpit and out of sight. Whoever came up with that design did
not have pilots’ needs much in mind. When I mentioned this to
Scatter, he shrugged it of. He said, “The airplane is very much
built to go into combat and be low-observable. It is not built to
make it easy on us. For us to ly in weather or even for us to ly
in a national airspace system, I can’t even just tell my airplane
to go to a ive-letter ix”—the worldwide navigational waypoints
embedded in the databases of other aircraft—“I have to enter the
lat./long., because the airplane is designed to go bomb a country.
It’s not designed to ly into LAX.”
FOR THE HANDFUL OF SURVIVORS, RUNNING FRANTIC-
ALLY, THE ORDEAL WAS NOT YET OVER. WITH THEIR
HELLFIRE MISSILES , REAPER DRONES MOVED IN AND
BEGAN PICKING OFF ANYONE TRYING TO GET AWAY.
The B-2 is designed to fly into the maelstrom when Los
Angeles is burning and GPS signals have been jammed. It is
made to defeat the world’s most advanced air-defense sys-
tems. In addition to its conventional navigational capabilities,
it has autonomous systems that operate independently from
any ground- or space-based transmitters. The primary one is
an inertial unit that slowly drifts, as inertial units do, but can
be recalibrated in light by using a stellar navigation system
that observes stars day and night, or alternatively by using the
airplane’s synthetic-aperture radar to pick out ground features
at thousands of locations worldwide, which are known to an air-
borne database. It is impressive what you can persuade yourself
to think you need once a supplier like Northrop perceives that
there is no limit to cost.
But ighting a nuclear war is getting ahead of things. The
intended target now was a fractured country with no air defenses
at a time when GPS satellites were functioning unimpeded, and
indeed would be guiding the bombs. The refueling took 15 min-
utes. When it was over, the tanker crews went of to land some-
where local and get some rest. Dawn was approaching. The B-2s
climbed back to cruising altitude, and their crews ran a inal
operational check. It showed that every system and weapon in
all three airplanes was functioning correctly. Scatter cleared the
third B-2 to return to Missouri, and he led the light, now of two,
into the irst Atlantic crossing of his bombing career.
III.
SQUIRTERS
The origin of the mission was the NATO intervention in Libya
in March 2011, during the Arab Spring—an initiative that Presi-
dent Barack Obama later admitted was one of the worst of his
administration. The intervention meant that the United States
would be married to the confusion that followed the downfall of
the Libyan dictator Muammar Qaddai. Qaddai came from the
coastal town of Sirte, halfway between Tripoli and Benghazi. In
strongman style, he had spent decades building it into a monu-
ment to himself. After he was driven from Tripoli, he retreated to
Sirte, and for a few months made a stand, until rebels overran the
place. On October 20, 2011, an American drone strike stopped a
48 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
convoy in which he happened to be leeing. Rebels captured and
killed him. By then, ighting and air strikes had nearly destroyed
Sirte. The long-sufering residents began rebuilding under the
precarious protection of a militia with Islamist ties, while the rest
of Libya descended into a welter of factions aspiring to national
power. In 2014, soon after the Islamic State gained ground in
Syria and Iraq, Libyan militants began declaring their allegiance
to its leader, Abu Bakr al-Baghdadi, and his cause. By early 2015
they were able to iniltrate Sirte, shift the aspirations of the mili-
tia members in place, and declare the town part of the blessed
caliphate. Militants from outside Libya joined them, until their
numbers in the city swelled to about 2,000. They imposed their
version of Islamic law, leveled usurious taxes, and committed
various atrocities. They made propaganda videos of their heroics
and posted them online.
In Washington this was seen as America’s problem. Ever
since the disintegration of the Qaddafi regime, the Obama
administration had been struggling to invent a new Libyan
state—one not quite to its taste, but complete at least with a
single capital and government. The solution settled on by the
international community was an assembly that was founded in
late 2015 as the Government of National Accord and declared
by foreign diplomats to be the sole legitimate executive author-
ity in Libya, even though it could not control the capital and
much of Libya violently opposed it.
In 2016, militia forces from the city of Misrata, apparently
seeking legitimacy, declared their allegiance to the Govern-
ment of National Accord and with 6,000 ighters advanced to
retake Sirte from ISIS. They arrived in May and got bogged down
in house-to-house ighting against die-hard militants holding
strong positions. Overseeing the battle from afar was the U.S.
Africa Command, one of the Pentagon’s 10 joint-combat groups,
based in Stuttgart, Germany. Africa Command had a few Special
Forces on the ground to observe and advise, as well as drones
over the city and a wealth of other resources as needed. The
drones were lown remotely by pilots in the United States. Early
in the ight they were given authority to ire on individually speci-
ied targets. This seems to have had little efect. In July 2016 a
new commanding oicer arrived in Stuttgart, a Marine Corps
general named Thomas D. Waldhauser. In August he ordered
an increase in air strikes, with carrier-based Marine Corps Har-
rier jets and helicopter gunships joining in. Over the following
few months, the U.S. carried out nearly 500 strikes. That may
seem like a lot, but these were pinpoint hits, and actually an exer-
cise in restraint. President Obama had insisted on the need to
avoid civilian casualties. Speaking about Africa Command, an
observer at the Pentagon explained to me that it had faced the
standard frustration of counterinsurgency campaigns: “They
didn’t know who was who in the zoo.” Gradually, however, ISIS
was worn down and defeated.
Of the original 2,000 ISIS fighters, many had died, but a
good number had managed to slip away, even though check-
points had been set up around Sirte. Africa Command knew it.
In the Air Force, escapees are called “squirters” because, rather
than being crushed, they squirt out from the pressure of strikes.
In Sirte, some squirters turned around and launched attacks
from the rear. Others squirted into the cities, where they dis-
appeared. One relatively small group—no more than 100 men—
squirted into the desert about 30 miles southwest of town. They
established two camps, about 10 miles apart. The Pentagon
would later state that they were planning attacks on Europe.
On the evidence, they were also unusually inefectual people.
Despite the known presence of American drones overhead, they
had chosen to congregate in the open desert, away from any
protections ofered by the presence of civilians. Their incompe-
tence was Waldhauser’s liberation. For once there was no need
to know who was who in the zoo.
IV.
“READY TO
DO THIS?”
Early last January, Waldhauser concluded that taking action was
a matter of grave national importance. Cost was apparently not a
factor. The objective was to kill every man in the two ISIS camps
without placing Americans at signiicant risk. The use of Special
Forces was unlikely to achieve either goal. Only air strikes would
do. Now there was a choice to be made among weapons plat-
forms: Navy cruise missiles; Air Force drones; Navy, Air Force, or
Marine Corps ighter-bombers; Army or Marine Corps helicopter
gunships; Air Force strategic bombers; or some combination of
these options. In theory, the decision-making process should
have been clean. Waldhauser would have come up with several
courses of action as well as a recommendation, and he would
have run the package through the Joint Chiefs of Staf to the sec-
retary of defense, who would have taken it across the Potomac
to the National Security Council, and ultimately to the president
for a decision. The president could have responded with a simple
conirmation of the recommended plan and an order to proceed—
leaving the operational details to the military.
In this case, after the initial presentation was made, long
discussions ensued in the White House. As usual, the weap-
ons had constituencies at the Pentagon. The Navy in particular
made a case for its cruise missiles, at more than $1 million each,
because they would allow the killing to be done from ofshore. The
problem was that the targets, though clustered around the two
camps, did not dwell in structures that could be hit, and tended
to spend their days and nights widely dispersed. A cruise-missile
strike would likely allow many to escape. In the end, the idea of
using Air Force heavy bombers prevailed because of their ability
to deliver dozens of self-steering, individually targeted bombs;
then to linger in the vicinity, waiting for surveillance assess-
ments from the drones; and if necessary to deliver more bombs.
The Air Force has three types of heavy bombers, any of which
could have done the job. The choice of the B-2 was surprising
because it is by far the most expensive airplane to ly and main-
tain, and Libya post-Qaddai had no air defenses that might
require a stealth capability to penetrate. Bombing ignorant gun-
men camped out in a desert of a non-country is a far cry from
launching an attack against a modern military adversary. But the
high cost of the mission was perhaps an attraction by bureau-
cratic if not military logic—you may lose money if you don’t
spend it—or the B-2s might have just needed some work to do.
The Air Force says simply that after a formal process of consid-
eration, the B-2 was deemed the appropriate platform.
Here’s how the process worked: Waldhauser wanted the B-2.
While his request was being studied at the White House, the Joint
Chiefs of Staf formally asked Strategic Command about the avail-
ability of the assets. Stratcom is headquartered at Ofutt Air Force
Base, in Nebraska, where the B-29s that demolished Hiroshima
and Nagasaki—the Enola Gay and the Bockscar—were built, in
1944. Stratcom occupies a building named after Curtis LeMay. It
passed word of a possible B-2 strike to one of its subordinate units,
Air Force Global Strike Command, which is headquartered at
Barksdale Air Force Base, in Louisiana. Global Strike Command
controls all of the Air Force’s heavy bombers and intercontinental
ballistic missiles. It contacted the 509th Bomb Wing, home to the
B-2s at Whiteman. All the way down through the chains of com-
mand, the only thing anyone asked was “Are your guys available
and ready to do this?” Stupid question. The 509th is the direct
descendant of a bomber group formed in 1944 for the purpose of
dropping nuclear weapons on Japan. It was commanded last Janu-
ary by the grandson of its commander then. Hundreds of military
personnel at Whiteman—pilots and ground crews alike—had been
training for years, and were not just ready but straining to go.
Preparations for the air strike began immediately, more
than a week before the launch. The planning was shrouded in
secrecy, most of it taking place in a secure basement. The room’s
screens displayed classiied information from the military’s vast
command, control, and intelligence systems, and were closely
linked to a team at Global Strike Command in Louisiana, which
was making the targeting decisions. The feeds included video of
the intended targets, streaming in from the armed drones that
were maintaining a round-the-clock watch overhead. The light
crews and B-2s—both primary and standby—were selected. On
Wednesday evening, January 11, six days before the launch, the
munitions squadron received orders to assemble several hundred
bombs. The assembly involved 3,500 pieces and 78,000 pounds
of explosives. The task, starting Thursday morning at 5 a.m.,
was carried out in 30 hours by more than 100 people working
12-hour shifts. The senior sergeant in charge knew that this
was for real and not just another exercise. Many of the people
doing the work were young recruits, new to the Air Force, but they
got the job done. The sergeant said, “Trust the process. Trust the
training.” He himself seemed young to me when I met him, but he
had been in the Air Force for 18 years, and was planning to retire in
another two. He loved the Air Force for the lifestyle it had aforded
him. He did not have to go into the ield as he would have if he had
joined the Army. About the ield, he said, “They call it ‘the suck.’ ”
Compared with any Army outpost, Whiteman is Pleasantville.
The sergeant was proud of his team. Thinking back on the efort,
he told me, “They were in Missouri— central Missouri—ighting
terrorists all the way from here. They got to see what they had
raised their hands for, what they had signed up to do.”
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 49
 seemed surreal. The pilots crossed the coastline, entered their
V. launch acceptability regions about 10 miles from their targets,
opened their bomb-bay doors exactly on schedule, and released
BENGHAZI ON their weapons as planned. Scatter released 62 of his 80, and the
THE LEFT other aircraft commander released 23. That left 75 bombs in the
airplanes should another attack be needed. The B-2s did not
In advance of the mission, the pilots were told to go home for a lurch when the bombs were released. A slight vibration could
mandatory crew rest of three days, but they all had wives and be felt when the bomb-bay doors opened, but that was all. The
young children, and that weekend there was an ice storm. Fatigue doors were open only for about 30 seconds. From above, Scatter
was of no concern to Scatter when he got the call on Monday after- saw the impacts as orange glows through an undercast of cloud.
noon to report for duty. He drove to the base in his paid-of 2002 The efect was oddly beautiful.
Dodge Ram truck. The light across the Atlantic was smooth. At
35,000 feet the skies were clear. To avoid the political complica-
tions of overlying countries on such a raid, the route to the Medi-
terranean lay farther south than the shortest great-circle course. VI.
The pilots were in contact with oceanic air traic control. Commu- RIPPED APART
nication between military aircraft and controllers is routine, and
necessary for safety in ordinary airspace; the controllers would
have assumed that the B-2s were on a training mission. It looked different on the ground. The ISIS camps consisted
The pilots were in contact as well with their Air Force mission of a few small structures with walled dirt yards—too small to
controller in Louisiana. And they were busy. A quarter of their serve as living quarters, but useful for the storage of weapons.
bombs had been programmed before takeof to hit any vehicles They stood along a rarely traveled track, in terrain that for all its
or physical structures, but the rest of the bombs had to be pro- desolation allowed for a scattering of bushes and scrubby trees.
grammed in light based on the latest information coming from For several weeks, the Air Force drones had watched the scene
the drones—essentially, the precise geographic coordinates of from above, establishing detailed proiles known as “patterns
individual ISIS ighters who could be seen settling in for the night. of life,” which mapped out daily activities, mealtimes, and the
That information began to low to the airplanes two hours shy outdoor locations to which individuals dispersed in the darkness
of their reaching the Mediterranean. The programming-and-
conirmation process took hours. Scatter told me, “It’s not like
Steve Jobs designed the interface.”
Night came quickly after a short day. Once they passed into
the Mediterranean, the pilots used their radar to ind three tank-
ers that had come from Germany to meet them for their second
refueling, and to map some thunderstorms that were active in
the area at the time. Because of its composite structure, the B-2 is
particularly vulnerable to static discharges and lightning strikes,
and is required to stay 40 miles away from thunderstorms—twice
as far as other airplanes.
During the refueling and afterward, the B-2 pilots spoke with
European air traic control. The skies cleared. Approximately
250 miles north of the Libyan coastline, the pilots turned south,
switched of their transponders, and disappeared from air-traic-
control radar. They had now been lying for 15 hours. Still of-
shore, they went into a holding pattern that had been planned as
a cushion to allow them to get the timing just right. It was nearly
midnight Zulu Time—two in the morning local time. They heard
the mission controller order the drones to clear out to the south,
and authorize them to return immediately after the strike to kill
anyone who survived. The drones were MQ-9 Reapers armed
with laser-guided supersonic Hellire missiles. Their pilots were
sitting in front of control panels back in the United States. Scatter
was surprised by the blanket authorization to ire. He had never
heard that one before.
The B-2s left the holding pattern and moved toward the
camps at 35,000 feet, on autopilot, doing 480 miles an hour.
They spread into a rough line-abreast formation, each headed
for a virtual hockey puck in the sky, a “launch acceptability re-
gion,” where all they had to do was release the bombs, which
would guide themselves to their targets. As the B-2s approached
the coast, Scatter could see the lights of Misrata on the right and
Benghazi on the left. For some reason he thought of vacation-
ing with his family in Europe. He told me that the view of Libya

50 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
to sleep—typically by certain bushes or trees. The images in day-
light were high resolution and in full color. The images at night
were of the ghostly night-vision kind. There were no women or
children. The combatants spent their days talking and some-
times handling small arms, or perhaps explosives. They had
some Japanese pickup trucks, which they tried to hide under
camoulaged tarpaulins.
It was a chilly night on the ground, with temperatures in the
40s. From my own experience in that desert, I imagine that the
ISIS ighters were sleeping fully clothed and wrapped in blankets,
and perhaps were nestled for comfort in undulations of the ter-
rain. If any were awake, they would not have heard the jets high
overhead; the only forewarning of the attack would have been a
brief sound of rushing air before the irst bomb hit.
For the next 30 seconds, the bombs came at them with
demonic accuracy. Each 500-pound bomb was set to deto-
nate just above its target for maximum lethality, operating
more through overpressure than fragmentation. The resulting
vacuum condition sucks air from the lungs while the shock wave
pulverizes bone and ruptures or liqueies the internal organs of
anyone within about 50 yards. That is how most of the ISIS ight-
ers died: hugging the earth to no avail as their innards turned to
mush and the night was ripped apart by the explosions.
For the handful of survivors, the ordeal was not yet over. The
dust had hardly settled when the Reaper drones moved back in,
looking for squirters. Figures could be seen in real time, run-
ning frantically. With their Hellire missiles, the Reapers began
THE MOST
EXPENSIVE
TOOL IN
THE AIR
FORCE
ARSENAL
HAD BEEN
DEPLOYED
AGAINST
A GROUP
OF FIGHTERS
ASLEEP IN
THE DESERT.
WHEN THE
CREWS GOT
BACK TO
MISSOURI,
THEY FOUND
A MEAL OF
STEAK AND
EGGS AND
BEER LAID
OUT FOR THEM.
picking of anyone spotted trying to get away. Killing with Hell-
ires is very diferent from killing with GPS-guided bombs. It
requires the Reaper crews to get personal, laying a laser device
on magniied images of each individual victim and then watch-
ing the missile as it strikes. A Hellire missile has a blast radius
of 50 feet and a “wounding radius” of up to 300 feet. It could
kill hundreds of people as easily as it could kill one. Once the
Hellires had mopped up, the only sound in the desert was the
hum of the Reapers’ engines.
VII.
CRICKETS
After releasing their bombs, the B-2s banked gently to the left
and retreated to a holding position safely offshore. The ride
was smooth, pressurized, and comfortable. Plans called for
the bombers to stay quietly on station for another six hours in
case their services were needed again. Scatter explained it this
way: “You’ve got a desert with people camped out in the middle
of nowhere. You drop a bomb on them; it’s like kicking an ant-
hill. They may run. They may need a reattack.” Scatter listened
on the mission-control frequency over the next hour, until the
Reaper crews inished up. It was obvious, even without a formal
battle-damage assessment, that the toll on the ground was heavy.
Eventually the mission controller asked for any signs of life, and
the Reaper crews answered in the negative. Scatter said, “Then
it was just, like, crickets on the radio.”
Not long after, the B-2s got the clearance to return to Missouri.
They refueled over the Mediterranean south of France. Then
they went over the Strait of Gibraltar and out across the Atlan-
tic. The return trip seemed slow, as return trips do. Scatter spent
much of the time writing a formal mission report. He left his seat,
stretched out on the loor in the back of the cockpit, and took a
two-hour nap. His pilot did the same. In the other B-2, the aircraft
commander took an oicially issued “go pill” to stay alert. He got
out of his seat, stripped down to nothing, sponged himself with
camping towelettes, washed his face, brushed his teeth, put on a
fresh light suit, and made sure that his hair looked good. He told
me a lot of guys do the same thing, and it refreshes them. I took it
as further evidence that the Air Force is not the Army.
They refueled again over Maine, with the same crews who
had refueled them on the way out. When they got back to Mis-
souri, the weather was low, and they had to shoot an approach to
200 feet of the ground before they could make out the runway
at Whiteman. They had been 33 hours in the air. As the second
B-2 came in, the control tower canceled its landing clearance
because of a coyote on the runway. The pilot was too tired to be
bothered. He called back, “Negative. I’m landing this jet,” and
the coyote obliged by getting out of the way. When they taxied
to the ramp and shut down their engines, they were surprised to
ind a ilm crew waiting, along with half the colonels on the base.
A meal of steak and eggs and beer had been laid out for them.
Scatter got home that afternoon. He had been up since for-
ever, but he’d have to stay awake a little while longer. His wife put
the baby in his arms. She had an errand to run.
William Langewiesche, a former national correspondent for
The Atlantic and a professional pilot, has written about subjects
including aviation, national security, and North Africa.
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 51
THE SEARCH
FOR THE
ELIXIR THAT
TURNS GOOD
TEAMS INTO
GREAT ONES
N THE FINAL REGUL AR- SEA S ON GAME for the 1977

I Los Angeles Dodgers, Dusty Baker hit a home run, giving

him 30 for the season and making him the fourth Dodger
to reach that milestone that year, a Major League Baseball
record. As Baker rounded third, a rookie who had recently
entered the game, Glenn Burke, approached the plate from the
on-deck circle and, seized by joy, raised his hand high above
his head. Baker was taken aback by the gesture and, in a mix
of celebration and confusion, decided to smack Burke’s hand.
Their high ive was clumsy, but then again it had every right to
be: Reportedly, it was the irst one ever.
Baseball has always been a strange mix of social and solo.
In American fashion, the game stresses the collective, but
demands that you play for yourself. Despite all the intimacy of
the sport’s language—crowding the plate, touching base—its play
is quite lonely. Other sports require a tacit harmony between
players—setting a pick for a teammate, blocking for someone
10 yards behind. In contrast, a baseball hitter stands in the
solitary coninement of the batter’s box, facing a pitcher on the
desert island of the mound. The players on the defense align
themselves, except for the occasional shift, to be as far from one
another as the limits of the ability to recuperate lost space per-
mit. Defensive errors are unfailingly—and oicially—attributed

52 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 FINDING THE
FORMUL A FOR
TE AM
CHEMISTRY
BY BEN ROW EN

I L LU S T R AT I O N S BY I S R A E L G . VA R G A S

T H E AT L A N T I C J U LY/AU G U SY
T 2 0 1 8 53
to individual players. The rule book, irrespective of out-of-play
butt slaps and handshakes, does not sanction contact.
And yet somehow, despite this loneliness—or perhaps because
of it—the sport is now at the center of an intensifying search for
the nebulous, nearly mythical quality of team chemistry. In the
popular conception, almost all great teams are alike in possessing
it. But what exactly the quality is, and just how strongly it governs
success, remains unclear. The ’77 Dodgers possessed some of it,
but apparently not enough: After storming into the World Series,
they lost to a feuding New York Yankees squad that had been cyni-
cally described as “the best team money could buy.”
In 2014, Harvard Business Review deemed chemistry the “Holy
Grail” of performance analytics, the statistical discipline that
irst swept the sport wholesale some 20 years ago. The choice of
image was telling; the Grail, of course, remains elusive. Nonethe-
less, a number of research groups are now taking a bet that they
can pin down chemistry, through advanced math or anthropologi-
cal forays into the clubhouse. Some researchers, believing that
team chemistry may emerge from literal chemistry, are collecting
and analyzing biometrics: testosterone levels, hormonal states.
Whatever the approach, much of the research is led by
outsiders— economists and organizational-development scholars
who seek to use baseball, as it is frequently used, to better
understand the American workforce. Because individual
success or failure is so easy to isolate in baseball, the sport
itself is also easy to study; individual performance can be
related clearly to team success. “Moneyball” is already
used to explain changes in everything from company
hiring to restaurant operations. Now, it is hoped, solving
baseball chemistry might advance corporate teamwork
where Myers-Briggs tests and other methods have failed.
“Baseball is a team game,” Pete Rose, the former
player and manager, once said. “But nine men who reach
their individual goals make a nice team.” Surely that’s
too simple. A good team helps those men reach their
individual goals, and harnesses them to something
larger. The question is how.
N IT S T YPICAL INVOCATION, chemistry is a cop-
I out—an after-the-fact explanation of why a team won,
especially against the odds. It lets us avoid uncomfort-
able truths: that baseball, like the workforce, is not always
a meritocracy; that mediocre teams can capitalize on luck
to beat very good ones; that the sport can be cosmically
unjust. In the postgame twilight, chemistry coalesces as
a narrative—the “It’s not you, it’s me” of baseball heart-
break. It rings hollow, but is not provably false.
The 2012 San Francisco Giants were widely lauded by sports
bufs and journalists alike for their extraordinary chemistry,
following their improbable World Series victory. The team
made it through the three rounds of the playofs, as the under-
dog each time, and twice fought back from a two-game deicit,
on the brink of elimination.
Barry Zito, then a declining Giants pitcher who miraculously
outdueled opposing pitcher and reigning American League MVP
Justin Verlander in a game that had been billed as “one of the great
mismatches of World Series history,” told me recently about the
team’s postseason turning point, which he ofered as proof of its
chemistry. It was a speech, he said, made early in the playofs by
Hunter Pence, a mid-season acquisition. The team was down two
games to none in its opening-round, best-of-ive playof series, and
would have to win the next three games straight—all on the road.
54 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
Pence spoke up after the team’s manager, Bruce Bochy, concluded
his pregame talk. No one had expected remarks from a player, let
alone a newish one. And no one expected such intensity: Pence
made feverish eye contact, and allegedly spoke with the passion
of a revivalist preacher about the need for the team to reawaken.
It seems to have worked. The Giants, of course, did win that
night, and they won the next two games as well, and then they
won the next two series to become the champs. You could argue
that Pence’s motivational speech, and its taken-to-heart recep-
tion, proves the team had a superior clubhouse atmosphere.
Alternatively, you could note that the Giants didn’t play par-
ticularly well in the game right after the speech—they got just
one hit in the irst nine innings. Grant Brisbee, who used to run
McCovey Chronicles, a Giants blog, says that luck almost cer-
tainly gave them the win. With two outs in the top of the 10th
inning and two runners on base, Joaquin Arias, a scrap-heap
pickup who had entered the game earlier to pinch-hit, knocked a
ground ball toward Scott Rolen, the Cincinnati Reds’ third base-
man. Rolen is the ifth-best defender ever at third base according
to one analytics site, Fangraphs, and in the top 20 of all time by
traditional stats such as ielding percentage. And yet, as the ball
approached Rolen, it took an in-between hop and bobbled of his
SOME
RESEARCHERS
BELIEVE TEAM
CHEMISTRY
MAY EMERGE
FROM LITERAL
CHEMISTRY:
TESTOSTERONE
LEVELS,
HORMONAL
STATES.
mitt. Buster Posey scored on the error, giving the Giants a lead
they wouldn’t relinquish. One lucky bounce might have been
responsible for San Francisco’s championship.
That’s not to say the team lacked chemistry. (Though the
Giants missed the playofs altogether in 2013, they made another
improbable run to the championship in 2014; they’d also won in
2010.) But chemistry has a way of getting entangled with con-
current explanations. “It’s a lot easier for us to process a narra-
tive,” Brisbee told me, “rather than ‘This guy was standing two
inches to his left, and that changed the whole postseason.’ ”
HERE IS NO I IN TE AM, but there is in statistics. Baseball,
T like no other sport, has stats that make a special snowlake
out of every player. During the moneyball era of the early
2000s, these stats proliferated, and their relative importance
was hotly debated, as analysts tried to ind clearer links between
individual performance and team success. But for the most part,
to the analytics community of that era, chemistry was not worth
investigating. Some thought it couldn’t be measured or, worse,
was total “bullshit,” as the analyst Rob Neyer once put it. Billy
Beane, the Oakland Athletics’ general manager who became syn-
onymous with the moneyball revolution, believed that chemistry
existed, but that it was brought about by winning, not the other
way around.
Still, front oices did consider chemistry, as any hiring body
would. Zito, who played for the Athletics before he joined the
Giants, told me that Beane “had a good grip of how signings would
afect the clubhouse.” The team, Zito said, was highly compatible,
and would often gather for dinners.
Meanwhile, as the moneyball movement grew, its acolytes
began to think they might be missing something. Performance
analytics do not predict team success with anything close to cer-
tainty. PECOTA, one of the top stats-based projection systems, was
of by an average of nine wins per team in its best season, accord-
ing to Neil Paine of FiveThirtyEight. Luck and injuries play a large
part in statistics falling short. Even so, researchers and writers are
coming to think, there’s ample space for chemistry to play a role.
Two economists at the Federal Reserve Bank of Chicago and
one from Indiana University recently attempted to locate team
chemistry by inding places where existing performance metrics
fall short. In a paper titled “In Search of David Ross,” presented
at the 2017 MIT Sloan Sports Analytics Conference, R. Andrew
Butters, Scott A. Brave, and Kevin Roberts looked at teams whose
win/loss record difered greatly from what would be predicted by
the sum of individual performance. Studying more than 15 sea-
sons’ worth of data, they identiied the speciic players who were
on teams that repeatedly overperformed. These players, the
economists hypothesized, create chemistry—they have shown
repeated ability to elevate their team above the sum of its parts.
David Ross, the paper’s namesake, is “the epitome of where
advanced metrics and player intangibles are at odds,” the
authors wrote. Ross is a retired journeyman who played only one
full season as a starter during his 15-year career, which ended in
2016. He nevertheless won championships as a backup catcher
with both the Boston Red Sox and the Chicago Cubs, and wrote
a memoir, with Don Yaeger, a sports journalist, called Teammate.
Wherever he went, as the economists conirmed, teams seemed
to play better than their individual player statistics suggested
they should have.
I spoke with Ross during Major League Baseball’s Winter Meet-
ings in December. He was advising the Cubs, and had some time
on his hands. (The meetings, typically a frenzy of free-agent sign-
ings, were of to a plodding start; the only news was that the canon-
ical team-chemistry guy, the ex-Yankee and now Miami Marlins
co-owner Derek Jeter, was spatting with his team’s star players.)
In a general sense, Ross told me, chemistry isn’t hard to snif out—
“It’s like walking into a bar and getting a vibe.” But what specii-
cally it’s made of, and how it can be measured, is a harder question.
Ross said that chemistry is “deinitely something that can be
learned.” The foreword to his memoir, written by Theo Epstein,
the Cubs’ president of baseball operations and a former Red Sox
general manager, explicitly notes that when Epstein was inter-
ested in acquiring Ross in August 2008 for the Red Sox, he heard
reports that the catcher was “not a good teammate” in Cincin-
nati. Ross attributes this old reputation to a time, early in his
career, when he barged into the team manager’s oice to com-
plain that he wasn’t starting.
In the book, Ross writes about learning to better communicate
with players over time, and highlights one moment in 2016 when
the Cubs’ rookie catcher, Willson Contreras, signaled for an of-
speed pitch to try to fool a hitter ahead in the count, instead of
directing the pitcher to pitch around him to face a better matchup.
Ross noticed the mistake from the bench as he read the sign from
Contreras, but he waited a few innings before addressing it. If you
call out mistakes immediately after the fact, he notes, you catch
people at their most defensive, and if you address every one of
them, you can lose goodwill.
The analysis by the economists echoes some of what Ross
told me. They found that players do seem to “learn” to create
chemistry—intangible contributions to team success tend to rise
with age and, for the most part, only become appreciable in play-
ers’ mid-to-late 30s, which is very late in a player’s career. (Good-
chemistry players may also just stick around the league longer.) In
many cases, the economists found, stars make the largest intan-
gible contributions, just as they make the largest tangible ones—
Mike Trout, the best current player by performance metrics, is also
the best by raw chemistry rating. By contrast, many “clubhouse
cancers”—players who worsen a team’s chemistry—began their
career with seeming star potential, but never really panned out.
Perhaps the stars are better able to inluence a clubhouse by
dint of their on-ield prowess (or, critics of the Fed paper may
note, perhaps they simply cover for other players’ poor perfor-
mance on the field); maybe the never-turned-into-stars leak
toxic embitterment. This is speculation. The Fed economists
weren’t studying clubhouse behavior, nor were they seeking to
understand the particular alchemy by which chemistry is cre-
ated. Other analysts, however, are doing just that. Which brings
us back to the high ive.
A S T Y E A R , according to Wall Street Journal reports, a
L research group was granted access to the San Francisco
Giants’ minor-league ailiate in San Jose, where it installed
cameras with the goal of monitoring associations between dug-
out interactions—high fives, back pats—and team success. A
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 55
 similar efort is under way in the major leagues, where Dacher Bezrukova, a professor at the University at Bufalo School of
Keltner and Hooria Jazaieri, psychologists at UC Berkeley, are Management, looked at the demographic breakdowns of all 30
conducting research with the goal of inding associations between MLB teams over ive seasons, analyzing age, race, nationality,
the supposed subtle physical tells of chemistry and team success. tenure, and salary, on the theory that while diversity was neces-
The entire approach might seem absurd. Can a high ive or ist sary for success, teams with players who were isolated—those
bump really create—or even stand in for—camaraderie, in all its without any or many demographic peers—would develop “fault-
complexity? Then again, as Barry Zito told me, “guys that don’t lines,” or breaks in chemistry that might be exposed and exacer-
respect each other won’t go out of their way to congratulate each bated when the team struggled. Her model shows that these fault
other after a big moment.” And a celebratory touch can demon- lines could be mitigated if players in the underrepresented group
strate a deeper level of acceptance and intimacy. Notably, Glenn happened to be clustered together in similar roles (Latino play-
Burke, the rookie who ofered a raised hand to Dusty Baker after ers sitting together in the bull pen as relief pitchers, for example).
the latter’s historic home run, was out of the Over the course of a season, she found, a team
closet to his teammates by the time of that with fewer fault lines will win more games, all
game back in 1977, the irst openly gay player
in American professional sports. That moment
MANY “CLUBHOUSE else being equal.
Bezrukova’s work has been criticized for
of contact, in retrospect, helps undercut regres- CANCERS”— being demographically reductive. Its conclu-
sive but still prevalent assumptions about base- sions are uncomfortably similar to the thought
ball’s culture. PLAYERS WHO processes of general managers who balked
Research is still in progress, but David
Ross told me he’s dubious. He said chemistry
QUANTIFIABLY at integration before Branch Rickey signed
Jackie Robinson, for instance. But players
is “deinitely not about high ives and rah-rah WORSEN A TEAM’S seem to agree that being isolated makes the
stuff; it’s about respect.” Nonetheless, his
book seems to place a high premium on the
CHEMISTRY— game tougher to play. Johnny Cueto, a pitcher
on the 2017 Giants, which inished the season
gesture. Ross recounts barking at the Atlanta BEGAN THEIR 64–98, has spoken about feeling alone as the
Braves’ irst-string catcher, Brian McCann, after squad’s only Dominican pitcher for most of
McCann once forgot to ofer him a high ive, as CAREER WITH the season: “When I was with Kansas City, it
was their usual custom, when Ross returned
to the dugout after a half inning of defensive
SEEMING STAR was a team, I think; it was a very happy bunch
because we had a lot of players” from the
work. He also writes about creating a new high POTENTIAL, BUT Dominican Republic. “But here, it’s diferent.”
ive to celebrate home runs, which he calls the In 2014, ESPN the Magazine used a
“cock bump”—the two players square up to each NEVER REALLY model designed by Bezru kova and Ches-
other and thrust, bumping their cups. And he
has strong praise for other ritualistic acts, most
PANNED OUT. ter Spell, a Rutgers University business
professor, in its preseason MLB predictions,
notably the naked dance his Cubs teammate selecting both the Giants and the Royals—
Anthony Rizzo did, to the musical accompaniment of the theme the eventual World Series participants—as two of the strongest
from Rocky, before each of the inal three games of the 2016 World teams on the chemistry metric. This remains, to date, the stron-
Series. It kept the team loose, he said, despite being on the brink of gest evidence that chemistry research can have predictive value.
elimination—and the Cubs miraculously won all three.
Russell Carleton, a writer for Baseball Prospectus, has found HATEVER INSIGHTS INTO CHEMISTRY the study of
evidence that chemistry can be cultivated in the long term
through careful organizational management—one analysis of
his, for example, reveals that having less roster turnover from
W baseball eventually enables, their application to the game
may be tricky. Understanding chemistry is an interesting
philosophical problem; creating it is a practical one. Research
year to year helps a team slug more home runs. But he also notes has no value if players (or, for that matter, other types of work-
that undigniied rituals, like Rizzo’s dance, can go a long way to ers) won’t buy into its conclusions. “Twenty-something hyper-
creating cohesion more spontaneously. A child psychologist by competitive males aren’t always well known for being in touch
training, Carleton has been a consultant to three Major League with their feelings,” Carleton told me. The study of chemistry
Baseball teams. In 2015, when Ben Lindbergh and Sam Miller— has been hampered by that fact.
baseball geeks and former editors at Baseball Prospectus—were Even so, the turn of the analytics crowd toward intangibles
given control of the Sonoma Stompers, a team 10 levels below the might be welcome in some quarters. Many players have been
majors, they turned to Carleton for guidance on creating chem- resistant to much of the new analytics, charging that they suck all
istry, a skill outside their wheelhouse. In their book, The Only the joy and humanity from the game. When the 2017 Washington
Rule Is It Has to Work, they detail Carleton’s advice: Corporate Nationals, a team highly regarded by the analytics crowd, clinched
icebreakers are ine, but also have a water-balloon ight—or any a postseason berth last September, the outielder Jayson Werth
other activity that would be welcome at a 12-year-old’s birthday touted the team’s superior chemistry, claiming that it was some-
party. (Notably, childish spectacles—holding bufoonish dress- thing the “people upstairs who read books and do math, bullshit
up days, bringing bear cubs to practice—are a core team-building like that,” could not understand.
activity deployed by Joe Maddon, the Cubs’ manager, to keep As it happened, neither the analysts nor Werth had the team
his players energized.) As Carleton likes to say: “The irst rule of right: For the fourth time in four recent playof appearances—on
child psychology is that it applies throughout all of life.” account of something unmeasurable, or just by dumb luck—the
So does high-school psychology, according to other research- Nationals were eliminated in the irst round as the higher seed.
ers who are looking, essentially, at the isolation of individual play-
ers and the development of cliques on diferent teams. Katerina Ben Rowen is an associate editor at Paciic Standard.

56 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
June 24-30, 2018
WHEN
THE
NEXT
PLAGUE
HITS
The epidemics of the early 21st century revealed a world unprepared, even as the risk

Workers at the University

of Nebraska Medical
Center’s biocontainment
unit practicing safe proce-
dure on a mannequin

58 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 | T H E H E A LT H R E P O R T |

of pandemics continues to multiply. Much worse is coming. Is Donald Trump ready?

PHOTOGRAPHS BY JONNO RATTMAN

A
T 6 O’CLOCK IN THE MORNING, shortly after the sun spills
over the horizon, the city of Kikwit doesn’t so much wake up as
ignite. Loud music blares from car radios. Shops ly open along
the main street. Dust-sprayed jeeps and motorcycles zoom east-
ward toward the town’s bustling markets or westward toward
Kinshasa, the Democratic Republic of the Congo’s capital city.
The air starts to heat up, its molecules vibrating with absorbed
energy. So, too, the city.
By late morning, I am away from the bustle, on a quiet,
exposed hilltop some ive miles down a pothole-ridden road. As I
walk, desiccated shrubs crunch underfoot and butterlies lit past.
The only shade is cast by two lines of trees, which mark the edges
of a site where more than 200 people are buried, their bodies
Atlanta, scientists identiied the virus. It took the name Ebola
from a river near Yambuku. And, having been discovered, it
largely vanished for almost 20 years.
In 1995, it reemerged in Kikwit, about 500 miles to the south-
west. The first victim was 35-year-old Gaspard Menga, who
worked in the surrounding forest raising crops and making char-
coal. In Kikongo, the predominant local dialect, his surname
means “blood.” He checked into Kikwit General Hospital in
January and died from what doctors took to be shigellosis—a
diarrheal disease caused by bacteria. It was only in May, after the
simmering outbreak had lared into something disastrous, after
wards had illed with screams and vomit, after graves had illed
with bodies, after Muyembe had arrived on the scene and again
sent samples abroad for testing, that everyone realized Ebola
was back. By the time the epidemic abated, 317 people had been
infected and 245 had died. The horrors of Kikwit, documented
by foreign journalists, catapulted Ebola into international infamy.
Since then, Ebola has returned to the Congo on six more occa-
sions; the most recent outbreak, which began in Bikoro and then
spread to Mbandaka, a provincial capital, is still ongoing at the
time of this writing.
Unlike airborne viruses such as influenza, Ebola spreads
only through contact with infected bodily luids. Even so, it is
capable of incredible devastation, as West Africa learned in 2014,
when, in the largest outbreak to date, more than 28,000 people
were infected and upwards of 11,000 died. Despite the relative
diiculty of transmission, Ebola still shut down health systems,
piled into three mass graves, each about 15 feet wide and 70 feet crushed economies, and fomented fear. With each outbreak, it
long. Nearby, a large blue sign says IN MEMORY OF THE VICTIMS reveals the vulnerabilities in our infrastructure and our psyches
OF THE EBOLA EPIDEMIC IN MAY 1995. The sign is partly obscured that a more contagious pathogen might one day exploit.
by overgrown grass, just as the memory itself has been occluded These include forgetfulness. In the 23 years since 1995, new
by time. The ordeal that Kikwit sufered has been crowded out by generations who have never experienced the horrors of Ebola have
the continual eruption of deadly diseases elsewhere in the Congo, been born in Kikwit. Protective equipment to shield doctors and
and around the globe. nurses from contaminated blood has vanished, even as the virus
Emery Mikolo, a 55-year-old Congolese man with a wide, has continued to emerge in other corners of the country. The city’s
angular face, walks with me. Mikolo survived his own encounter population has tripled. New neighborhoods have sprung up. In one
with Ebola in 1995. As he looks at the rest- of them, I walk through a market, gazing at
ing place of those who didn’t, his solemn delectable displays of peppers, eggplants,
demeanor cracks a bit. In the Congo, when avocados, and goat meat. Pieces of salted
people die, their bodies are meant to be ish sell for 300 Congolese francs—about
cleaned by their families. They should be the equivalent of an American quarter.
dressed, caressed, kissed, and embraced. Juicy white grubs go for 1,000. And the
These intense rituals of love and com- biggest delicacy of all goes for 13,000—a
munity were corrupted by Ebola, which
THE ORDEAL roasted monkey, its charred face pre-
harnessed them to spread through entire KIKWIT served in a deathly grimace.
families. Eventually, of necessity, they SUFFERED The monkey surprises me. Mikolo
were eliminated entirely. Until Ebola, “no is surprised to see only one. Usually, he
one had ever taken bodies and thrown HAS BEEN says, these stalls are heaving with mon-
them together like sacks of manioc,” CROWDED keys, bats, and other bushmeat, but rains
Mikolo tells me.
The Congo—and the world—first
OUT BY THE the night before must have stranded any
hunters in the eastern forests. As I look
learned about Ebola in 1976, when a CONTINUAL around the market, I picture it as an eco-
mystery illness emerged in the northern ERUPTION logical magnet, drawing in all the varied
village of Yambuku. Jean-Jacques Muy- animals that dwell within the forest—and
embe, then the country’s only virologist,
OF DEADLY all the viruses that dwell within them.
collected blood samples from some of DISEASES The Congo is one of the most bio-
the irst patients and carried them back ELSEWHERE diverse countries in the world. It was
to Kinshasa in delicate test tubes, which here that HIV bubbled into a pandemic,
bounced on his lap as he trundled down
IN THE eventually detected half a world away,
undulating roads. From those samples, CONGO. in California. It was here that monkey-
which were shipped to the Centers pox was irst documented in people. The
for Disease Control and Prevention in country has seen outbreaks of Marburg

60 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 virus, Crimean-Congo hemorrhagic fever, chikungunya virus,
yellow fever. These are all zoonotic diseases, which originate in
animals and spill over into humans. Wherever people push into
wildlife-rich habitats, the potential for such spillover is high.
Sub-Saharan Africa’s population will more than double during
the next three decades, and urban centers will extend farther
into wilderness, bringing large groups of immunologically naive
people into contact with the pathogens that skulk in animal
reservoirs—Lassa fever from rats, monkeypox from primates
and rodents, Ebola from God-knows-what in who-knows-where.
Survivors of the Kikwit Ebola epidemic, from left: Emilienne Luzolo,
Shimene Mukungu, and Emery Mikolo in 1995. Mikolo, the first of the three to be
infected, later donated his antibody-rich blood to Luzolo and Mukungu.
On average, in one corner of the world or another, a new infec-
tious disease has emerged every year for the past 30 years: MERS,
Nipah, Hendra, and many more. Researchers estimate that
birds and mammals harbor anywhere from 631,000 to 827,000
unknown viruses that could potentially leap into humans. Valiant “To write about infectious diseases is almost to write of some-
eforts are under way to identify them all, and scan for them in
places like poultry farms and bushmeat markets, where animals
and people are most likely to encounter each other. Still, we likely
won’t ever be able to predict which will spill over next; even long-
known viruses like Zika, which was discovered in 1947, can sud-
denly develop into unforeseen epidemics.
The Congo, ironically, has a good history of containing its dis-
eases, partly because travel is so challenging. Most of the country
is covered by thick forest, crisscrossed by just 1,700 miles of road.
Large distances and poor travel infrastructure limited the spread
of Ebola outbreaks in years past.
But that is changing. A 340-mile road, lanked by deep val-
leys, connects Kikwit to Kinshasa. In 1995, that road was so badly
EMERY MIKOLO
maintained that the journey took more than a week. “You’d have
to dig yourself out every couple of minutes,” Mikolo says. Now
the road is beautifully paved for most of its length, and can
be traversed in just eight hours. Twelve million people live in
Kinshasa—three times the combined population of the capitals
afected by the 2014 West African outbreak. About eight inter-
national lights depart daily from the city’s airport.
If Ebola hit Kikwit today, “it would arrive here easily,” Muy-
embe tells me in his office at the National Institute for Bio-
medical Research, in Kinshasa. “Patients will leave Kikwit
to seek better treatment, and Kinshasa will be contaminated
immediately. And then from here to Belgium? Or the U.S.?” He
laughs, morbidly.
“What can you do to stop that?,” I ask.
“Nothing.”
N E H U N D R E D Y E A R S AG O,
O in 1918, a strain of H1N1 flu
swept the world. It might have
originated in Haskell County, Kansas,
or in France or China—but soon it was
everywhere. In two years, it killed as
many as 100 million people—5 percent
of the world’s population, and far more
than the number who died in World War I.
It killed not just the very young, old, and
sick, but also the strong and it, bringing
them down through their own violent
immune responses. It killed so quickly that
hospitals ran out of beds, cities ran out of
coins, and coroners could not meet the
demand for death certiicates. It lowered
Americans’ life expectancy by more than a
decade. “The lu resculpted human popu-
lations more radically than anything since
the Black Death,” Laura Spinney wrote in
Pale Rider, her 2017 book about the pan-
demic. It was one of the deadliest natural
disasters in history—a potent reminder of
the threat posed by disease.
Humanity seems to need such remind-
ers often. In 1948, shortly after the irst
flu vaccine was created and penicillin
became the first mass-produced anti-
biotic, U.S. Secretary of State George Marshall reportedly
claimed that the conquest of infectious disease was imminent.
In 1962, after the second polio vaccine was formulated, the Nobel
Prize–winning virologist Sir Frank Macfarlane Burnet asserted,
thing that has passed into history.”
Hindsight has not been kind to these proclamations. Despite
advances in antibiotics and vaccines, and the successful eradi-
cation of smallpox, Homo sapiens is still locked in the same epic
battle with viruses and other pathogens that we’ve been ighting
since the beginning of our history. When cities irst arose, dis-
eases laid them low, a process repeated over and over for millen-
nia. When Europeans colonized the Americas, smallpox followed.
When soldiers fought in the irst global war, inluenza hitched a
ride, and found new opportunities in the unprecedented scale of
the conlict. Down through the centuries, diseases have always
excelled at exploiting lux.
Humanity is now in the midst of its fastest-ever period of
change. There were almost 2 billion people alive in 1918; there
are now 7.6 billion, and they have migrated rapidly into cities,
which since 2008 have been home to more than half of all human
beings. In these dense throngs, pathogens can more easily spread
and more quickly evolve resistance to drugs. Not coincidentally,
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 61
the total number of outbreaks per decade Bill Gates, whose foundation has
has more than tripled since the 1980s. studied pandemic risks closely, is not a
Globalization compounds the risk: Air- man given to alarmism. But when I spoke
planes now carry almost 10 times as many
THE WHITE with him upon my return from Kikwit,
passengers around the world as they did HOUSE he described simulations showing that a
four decades ago. In the ’80s, HIV showed IS NOW HOME severe lu pandemic, for instance, could
how potent new diseases can be, by kill more than 33 million people world-
launching a slow-moving pandemic that TO AN wide in just 250 days. That possibility,
has since claimed about 35 million lives. INATTENTIVE, and the world’s continued inability to
In 2003, another newly discovered virus,
SARS, spread decidedly more quickly. A
CONSPIRACY- adequately prepare for it, is one of the
few things that shake Gates’s trademark
Chinese seafood seller hospitalized in MINDED optimism and challenge his narrative of
Guangzhou passed it to dozens of doctors PRESIDENT. global progress. “This is a rare case of me
and nurses, one of whom traveled to Hong being the bearer of bad news,” he told me.
Kong for a wedding. In a single night, he
WE SHOULD “Boy, do we not have our act together.”
infected at least 16 others, who then NOT UNDER- Preparing for a pandemic ultimately
carried the virus to Canada, Singapore, ESTIMATE boils down to real people and tangible
and Vietnam. Within six months, SARS things: A busy doctor who raises an eye-
had reached 29 countries and infected
WHAT brow when a patient presents with an
more than 8,000 people. This is a new THAT COULD unfamiliar fever. A nurse who takes a
epoch of disease, when geographic barri- MEAN. travel history. A hospital wing in which
ers disappear and threats that once would patients can be isolated. A warehouse
have been local go global. where protective masks are stockpiled. A
Last year, with the centennial of the 1918 factory that churns out vaccines. A line on
lu looming, I started looking into whether a budget. A vote in Congress. “It’s like a
America is prepared for the next pandemic. chain—one weak link and the whole thing
I fully expected that the answer would be no. What I found, after falls apart,” says Anthony Fauci, the director of the National Insti-
talking with dozens of experts, was more complicated—reassuring tute of Allergy and Infectious Diseases. “You need no weak links.”
in some ways, but even more worrying than I’d imagined in others.
Certainly, medicine has advanced considerably during the past MONG ALL KNOWN PANDEMIC THREAT S, inlu-
century. The United States has nationwide vaccination programs,
advanced hospitals, the latest diagnostic tests. In the National
Institutes of Health, it has the world’s largest biomedical research
A enza is widely regarded as the most dangerous. Its vari-
ous strains are constantly changing, sometimes through
subtle mutations in their genes, and sometimes through dramatic
establishment, and in the CDC, arguably the world’s strongest reshules. Even in nonpandemic years, when new viruses aren’t
public-health agency. America is as ready to face down new sweeping the world, the more familiar strains kill up to 500,000
diseases as any country in the world. people around the globe. Their ever-changing nature explains why
Yet even the U.S. is disturbingly vulnerable—and in some the lu vaccine needs to be updated annually. It’s why a disease
respects is becoming quickly more so. It depends on a just-in- that is sometimes little worse than a bad cold can transform into
time medical economy, in which stockpiles are limited and even a mass-murdering monster. And it’s why lu is the disease the U.S.
key items are made to order. Most of the intravenous bags used has invested the most in tracking. An expansive surveillance net-
in the country are manufactured in Puerto Rico, so when Hurri- work constantly scans for new lu viruses, collating alerts raised by
cane Maria devastated the island last September, the bags fell doctors and results from lab tests, and channeling it all to the CDC,
in short supply. Some hospitals were forced to inject saline with the spider at the center of a thrumming worldwide web.
syringes—and so syringe supplies started running low too. The Yet just 10 years ago, the virus that the world is most prepared
most common lifesaving drugs all depend on long supply chains for caught almost everyone of guard. In the early 2000s, the CDC
that include India and China—chains that would likely break in a was focused mostly on Asia, where H5N1—the type of lu deemed
severe pandemic. “Each year, the system gets leaner and leaner,” most likely to cause the next pandemic—was running wild among
says Michael Osterholm, the director of the Center for Infectious poultry and waterfowl. But while experts fretted about H5N1 in
Disease Research and Policy at the University of Minnesota. “It birds in the East, new strains of H1N1 were evolving within pigs
doesn’t take much of a hiccup anymore to challenge it.” in the West. One of those swine strains jumped into humans in
Perhaps most important, the U.S. is prone to the same forget- Mexico, launching outbreaks there and in the U.S. in early 2009.
fulness and shortsightedness that befall all nations, rich and The surveillance web picked it up only in mid-April of that year,
poor—and the myopia has worsened considerably in recent years. when the CDC tested samples from two California children who
Public-health programs are low on money; hospitals are stretched had recently fallen ill.
perilously thin; crucial funding is being slashed. And while we tend One of the most sophisticated disease-detecting networks in
to think of science when we think of pandemic response, the worse the world had been blindsided by a virus that had sprung up in
the situation, the more the defense depends on political leadership. its backyard, circulated for months, and snuck into the country
When Ebola lared in 2014, the science-minded President unnoticed. “We joked that the inluenza virus is listening in on
Barack Obama calmly and quickly took the reins. The White our conference calls,” says Daniel Jernigan, who directs the CDC’s
House is now home to a president who is neither calm nor Inluenza Division. “It tends to do whatever we’re least expecting.”
science-minded. We should not underestimate what that may The pandemic caused problems for vaccine manufacturers,
mean if risk becomes reality. too. Most lu vaccines are made by growing viruses in chicken

62 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 © 2018 Optum,® Inc. All rights reserved.
HOW WELL
GETS DONE.
Knowing not guessing.
Implementing not theorizing.
This is how fragmented care becomes more connected.
How higher quality is delivered at a lower cost.
How chronic illness becomes not so chronic.
How data is gathered and analysis inspires action.
How collaboration becomes more contagious.
This is how we tackle the biggest challenges
in health care and build
a healthier world.

optum.com

Data and Analytics | Pharmacy Care Services | Population Health Management | Health Care Delivery | Health Care Operations
 eggs—the same archaic method that’s been used for 70 years.
Every strain grows differently, so manufacturers must con-
stantly adjust to each new peculiarity. Creating lu vaccines is
an artisanal afair, more like cultivating a crop than making a
pharmaceutical. The process works reasonably well for seasonal
lu, which arrives on a predictable schedule. It fails miserably for
pandemic strains, which do not.
In 2009, the vaccine for the new pandemic strain of H1N1 lu
arrived slowly. (Then–CDC Director Tom Frieden told the press,
“Even if you yell at the eggs, it won’t grow any faster.”) Once the
pandemic was oicially declared, it took four months before the
doses even began to roll out in earnest. By then the disaster was
already near its peak. Those doses prevented no more than 500
deaths—the fewest of any lu season in the surrounding 10-year
period. Some 12,500 Americans died.
The egg-based system depends on chickens, which are them-
selves vulnerable to lu. And since viruses can mutate within the
eggs, the resulting vaccines don’t always match the strains that
are circulating. But vaccine makers have few incentives to use
anything else. Switching to a diferent process would cost billions,
and why bother? Flu vaccines are low-margin products, which
only about 45 percent of Americans get in a normal year. So when
demand soars during a pandemic, the supply is not set to cope.
American hospitals, which often operate unnervingly close to
full capacity, likewise struggled with the surge of patients. Pedi-
atric units were hit especially hard by H1N1, and staf became
exhausted from continuously caring for sick children. Hospitals
almost ran out of the life-support units that sustain people whose
lungs and hearts start to fail. The health-care system didn’t break,
but it came too close for comfort—especially for what turned out
to be a training-wheels pandemic. The 2009 H1N1 strain killed
merely 0.03 percent of those it infected; by contrast, the 1918
strain had killed 1 to 3 percent, and the H7N9 strain currently
circulating in China has a fatality rate of 40 percent.
“A lot of people said that we dodged a bullet in 2009, but nature
just shot us with a BB gun,” says Richard Hatchett, the CEO of
the Coalition for Epidemic Preparedness Innovations. Tom
Inglesby, a biosecurity expert at the Johns Hopkins Bloomberg
School of Public Health, told me that if a 1918-style pandemic
hit, his hospital “would need in the realm of seven times as many
critical-care beds and four times as many ventilators as we have
on hand.”
That the U.S. could be so ill-prepared for lu, of all things,
should be deeply concerning. The country has a dedicated
surveillance web, antiviral drugs, and an infrastructure for mak-
ing and deploying lu vaccines. None of that exists for the major-
ity of other emerging infectious diseases.
S I WALK DOWN a seventh-loor hallway of the Uni-
A versity of Nebraska Medical Center, Kate Boulter, a
nurse manager, points out that the carpet beneath my
feet has disappeared, exposing bare loors that are more easily
cleaned. In an otherwise unmarked corridor, this, she says, is the
irst sign that I am approaching the biocontainment unit—a spe-
cial facility designed to treat the victims of bioterror attacks, or
patients with a deadly infectious disease such as Ebola or SARS.
There is nothing obviously special about the 4,100 square
feet, but every detail has been carefully designed to give patients
maximal access to the best care, and viruses minimal access to
anything. A supply room is stocked with scrubs, underwear, and
socks, so that no piece of clothing staf members wear at work
will make its way home. There are two large autoclaves—pressure
64 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
cookers that use steam to sterilize equipment—so that soiled lin-
ens and clothes can be immediately decontaminated. The space
is under negative air pressure: When doctors enter the hallway, or
any of the ive patient rooms, air lows in with them, preventing
viruses from drifting out. This also dries the air. Working here,
I’m told, is murder on the skin.
Almost everything in the unit is a barrier of some form. Floor
seams are welded. Light and plumbing ixtures are sealed. The
ventilation and air-conditioning systems are separate from those
for the rest of the hospital, and rigorously iltered. Patients can be
wheeled in on a tented gurney with built-in glove ports; it looks
like a translucent caterpillar whose legs have been pushed inward.
A separate storage room is stocked with full-body suits, tape for
sealing the edges of gloves, and space-suit-like hoods with their
own air ilter. A videoconferencing system allows team members—
and family—to monitor what happens in the patient rooms without
having to suit up themselves. A roll of heavy-duty metallic wrap-
ping paper can be used to seal the body of anyone who dies.
The unit is currently empty, as it has been for most of its exis-
tence. The beds are occupied only by four hyperrealistic manne-
quins, upon which nurses can practice medical procedures while
wearing cumbersome protective layers. “We’ve named all the
mannequins,” Boulter tells me. Pointing to the largest one: “That
one’s Phil, after Dr. Smith.”
Phil Smith began pushing the hospital to build the
biocontainment unit in 2003, back when he was a professor
of infectious diseases. SARS had emerged from nowhere, and
monkeypox had broken out in the Midwest; Smith realized the
U.S. had no facilities that could handle such diseases, beyond
a few high-security research labs. With support from the state
health department, he opened the unit in 2005.
And then, nothing happened.
For nine years, the facility was dormant, acting mostly as an
overlow ward. “We didn’t know if it would be needed, but we
planned and prepared as if it would,” says Shelly Schwedhelm, the
head of the hospital’s emergency-preparedness program, who for
years kept the unit aloat on a shoestring budget. Her eforts paid
of in September 2014, when the State Department called, telling
Schwedhelm and her team to prepare for possible Ebola patients.
Over 10 weeks, the unit’s 40 staf members took care of three
infected Americans who had been evacuated from West Africa.
They worked around the clock in teams of six, some stafers treat-
ing the patients directly, others helping their colleagues put on
and take of their gear, and still others supervising from the nurses’
station. Two of the patients—Rick Sacra, a physician, and Ashoka
Mukpo, a journalist—were cured and discharged. The third—a
surgeon named Martin Salia—was already sufering from organ
failure by the time he arrived, and died two days later. A green-
marble plaque now hangs in the unit to honor him.
The University of Nebraska Medical Center is one of the best
in the country at handling dangerous and unusual diseases, Ron
Klain, who was in charge of the Obama administration’s Ebola
response, tells me. Only the NIH and Emory University Hos-
pital have biocontainment units of a similar standard, he says,
but both are smaller. Those three hospitals were the only ones
ready to take patients when Ebola struck in 2014, but within two
months, Klain’s team had raised the number to 50 facilities. It
was “a lot of hard work,” he says. “But ultimately, we had 144
beds.” A more contagious and widespread disease would have
overwhelmed them all.
Preparing hospitals for new epidemics is challenging in the
United States, Klain says, because health care is so decentralized:
“You and I could decide that every hospital should have three beds
capable of isolating people with a dangerous disease, and Trump
could agree with us, and there’s no way of making that happen.”
Hospitals are independent entities; in this fractured environ-
ment, preparedness is less the result of governmental mandate
and more the product of individual will. It comes from dedicated
visionaries like Smith and skilled managers like Schwedhelm,
who can keep things going when there’s no immediate need.
The trio of Ebola patients in 2014 produced 3,700 pounds of
contaminated linens, gloves, and other waste among them, all
of which demanded careful handling. Treating them cost more
than $1 million. That kind of care quickly reaches its limits as an
epidemic spreads. In June 2015, the Samsung Medical Center, in
Seoul—one of the most advanced medical centers in the world—
was forced to suspend most of its services after a single man with
MERS arrived in its overcrowded emergency room. American
hospitals wouldn’t fare much better. But at the very least, they
can plan for the worst.
Schwedhelm, with a 100-person team, has been creating plans
for how every aspect of hospital operation would need to work
during a pandemic. How much should hospitals stockpile? How
would they provide psychological support during a weeks-long cri-
sis? How could they feed people working longer-than-usual shifts?
When would they cancel elective surgeries? Where could they get
extra disinfectant, mop heads, and other cleaning supplies?
At a single meeting, I hear two dozen people discuss how
they would care for the 400 or so patients on the hospital’s
organ-transplant list. How would they get such patients into the
facility safely? At what point would it become too risky to pump
Counterclockwise from bottom right: Phil Smith, who opened
Nebraska’s biocontainment unit in 2005; Shelly Schwedhelm,
who directs the hospital’s emergency-preparedness program;
a containment vessel for infected patients
them with immunosuppressants? If ICUs are full, where could
they create clean spaces for post-transplant recovery? It matters
that the hospital has considered these questions. It matters just
as much that the people in charge have met, talked, and estab-
lished a bond.
The members of the team running the biocontainment
unit all work in diferent parts of the hospital, as pediatricians,
critical-care specialists, obstetricians. But even during the unit’s
long dormancy, Schwedhelm would gather them for quarterly
training sessions. That’s why, when the moment came, they were
ready. When they escorted the Ebola patients of their respective
planes, the staf members recalled what they had learned during
practice drills.
“We do a lot of team building,” Boulter says, showing me a
photo of the group at a ropes course.
“It was the scariest thing I’ve ever done,” Schwedhelm says.
They followed that up with something more sedate—a movie
night in the hospital auditorium. They watched Contagion.
IKWIT GENERAL HOSPITAL has no biocontainment
K unit. Instead, it has Pavilion 3.
Emery Mikolo, who works at the hospital as a nurse
supervisor, takes me into the blue-walled, open-windowed
building that is now the pediatrics ward. In one room, mos-
quito nets are suspended hammocklike over 16 closely packed
beds, on which mothers care for young children and newborn
babies. This is a place of new life. But in 1995, it was the infamous
“death ward,” where Ebola patients were treated. Exhausted doc-
tors struggled to control the outbreak; outside the hospital, the
 military established a perimeter to turn back leeing patients. allowed the virus to spread among the staf of Kikwit’s hospital,
The dead were laid in a row on the pavement. just as it did among nurses in Dallas, where an infected patient
We walk into another room, which is largely empty except landed in September 2014. In Kikwit, a lack of running water
for a poster of a cartoonish girafe, a few worn mattresses, and makes hygiene a luxury, but even in the U.S., getting medical
some old bed frames. Mikolo touches one of them. It was his, he professionals to wash their hands or follow other best practices is
says. He looks around quietly and shakes his head. Many of the surprisingly hard; every year, at least 70,000 Americans die after
people who shared this room with him were his colleagues who picking up infections in hospitals. And most of all, the people in
had become infected while they cared for patients. Ebola’s symp- both countries worry that brief spates of foresight and prepared-
toms are sometimes mythologized: Organs don’t liquefy; blood ness will always give way to negligence and entropy.
seldom pours from oriices. But the reality is no less gruesome. In the U.S., attention and money have crested and then crashed
“It was like a horror movie,” he says. “All these people I worked with each new crisis: anthrax in 2001, SARS in 2003. Resources,
with—my friends—throwing up, screaming, dying, falling out of hurriedly assembled, dwindle. Research into countermeasures
bed.” At one point, delirious with fever, he too rolled of his mat- izzles. “We fund this thing like Minnesota snow,” Michael Oster-
tress. “There was vomit and piss and shit on the ground, but at holm says. “There’s a lot in January, but in July it’s all melted.”
least it was cool.” Take the Hospital Preparedness Program. It’s a funding
Many of the people who worked at the hospital during the plan that was created in the wake of 9/11 to help hospitals ready
outbreak are still there. Jacqui, a nurse, worked in Pavilion 3 and themselves for disasters, run training drills, and build their surge
returned there only three years ago. She was terriied at irst, capacity— everything that Shelly Schwedhelm’s team does so well
but she soon habituated. I ask whether she’s worried that Ebola in Nebraska. It transformed emergency planning from an after-
might return. “I’m not afraid,” she says. “It’s never coming back.” hours avocation into an actual profession, carried out by skilled
If it does, is there any protective equipment at the hospital? specialists. But since 2003, its $514 million budget has been halved.
“No,” she tells me. Another fund—the Public Health Emergency Preparedness
Mikolo laughs. “Article 15,” he says. program—was created at the same time to help state and local
Article 15 is something of a Congolese catchphrase, referring health departments keep an eye on infectious diseases, improve
to a ictional but universally recognized 15th article of the coun- their labs, and train epidemiologists. Its budget has been
try’s constitution, “Débrouillez-vous”—“igure it out yourself.” I pruned to 70 percent of its $940 million peak. Small wonder,
hear it everywhere. It is simultaneously a
testament to the Congolese love for droll
humor, a weary acknowledgment of hard-
Ron Klain was appointed the “Ebola czar” by President Obama in 2014
ship, a screw-you to the establishment,
to provide speed and order to a federal response that required
and a motivational mantra. No one’s going many agencies and was marked by unclear lines of responsibility.
to ix your problems. You must make do with
what you’ve got.
In a nearby room, dried blood dots
the loor around an old operating table,
where a sick lab technician once passed
Ebola to five other medical staff mem-
bers, starting a chain of transmission that
eventually enveloped Mikolo and many
of his friends. The phlebotomist who
drew the blood samples that were used to
conirm Ebola also still works at the hos-
pital. I watch as he handles a rack of sam-
ples with his bare hands. “Ask someone
here, ‘Where are the kits that protect you
from Ebola?,’ ” Donat Kuma-Kuma Kenge,
the hospital’s chief coordinator, tells me.
“There aren’t any. I know exactly what I’m
meant to do, but there are no materials—
here, in the place where there was Ebola.
“Débrouillez-vous,” he adds.
The hospital’s challenges are con-
siderable, but as I walk around, I realize
that they are familiar. Even though the
United States is 500 times as wealthy
as the Congo, the laments I heard from
people in both countries were uncannily
similar— different in degree, but not in
kind. Protective equipment is scarce in
the Congo, but even America’s stock-
piles would quickly be depleted in a seri-
ous epidemic. Unfamiliarity with Ebola

66 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
then, that in the past decade, local health
departments have cut more than 55,000
jobs. That’s 55,000 people who won’t be
there to answer the call when the next
THOUGH
epidemic hits. THE U.S.
These sums of money are paltry com- IS VASTLY
pared with what another pandemic might
cost the country. Diseases are exorbi-
WEALTHIER
tantly expensive. In response to just 10 THAN THE
cases of Ebola in 2014, the U.S. spent
$1.1 billion on domestic preparations,
CONGO, THE
including $119 million on screening and LAMENTS
quarantine. A severe 1918-style flu pan- I HEARD
demic would drain an estimated $683 bil-
lion from American cofers, according to
IN BOTH
the nonproit Trust for America’s Health. COUNTRIES
The World Bank estimates that global ABOUT HOW
output would fall by almost 5 percent—
totaling some $4 trillion.
THINGS
The U.S. is not unfamiliar with the COULD GO
concept of preparedness. It currently WRONG
spends roughly half a trillion dollars on
its military—the highest defense budget
WERE
in the world, equal to the combined bud- UNCANNILY
gets of the next seven top countries. But SIMILAR.
against viruses—more likely to kill mil-
lions than any rogue state is—such consis-
tent investments are nowhere to be found.
T A M O D E R N BU I L D I N G in
A Holly Springs, on the outskirts of Raleigh, North Caro-
lina, I walk down a wide corridor where the words IT
REALLY IS A MATTER OF LIFE AND DEATH have been stenciled
on a yellow wall. The walkway leads to a refrigerator-cool ware-
house, where several white containers sit on a blue pallet. The
containers are full of flu vaccine, and each holds enough to
immunize more than 1 million Americans. When their contents
are ready to be used, they head toward a long, Rube Goldberg–
esque machine that dispenses the vaccine into syringes—more
than 400,000 a day.
Instead of eggs, the facility grows lu viruses in lab-grown dog
cells, which ill 5,000-liter steel vats one loor above. The cells
are infected with lu viruses, which quickly propagate. The tech-
nique is faster than using eggs, and produces vaccines that are a
closer match to circulating strains.
This facility is the result of a partnership between the pharma-
ceutical company Seqirus and a government agency called the
Biomedical Advanced Research and Development Authority.
Established in 2006, BARDA acts more or less as a venture-capital
irm, funding the development of vaccines, drugs, and other epi-
demic countermeasures that would otherwise be unproitable. In
2007, it entered into a $1 billion partnership to create the Holly
Springs plant, which started making vaccines in 2011. “No one
would have taken the risk of disposing of egg manufacturing
unless they could reach the scale we have here,” says Marie Mazur,
Seqirus’s vice president of pandemic response.
The facility will soon be able to make 200 million doses of vac-
cine within the irst six months of a new pandemic—enough to
immunize more than one in every three Americans. Six months
is still a long time, though, and there are limits to how quick the
process can be. To vaccinate people during that window, Seqirus
also prepares vaccines against the lu strains that BARDA deems
most likely to cause a pandemic. Those
doses are stockpiled, and can be used to
immunize health-care workers, govern-
ment employees, and the military while
the Holly Springs plant churns out more.
Yet even this strategy is imperfect.
When H7N9 irst appeared in China, in
2013, the plant did its job, creating a vac-
cine that was then stockpiled. Since then,
H7N9 has mutated, and the hoarded
doses may be inefective against the cur-
rent strains. “We occasionally have to
chase a pre-pandemic,” says Anthony
Fauci, the National Institute of Allergy
and Infectious Diseases (NIAID) direc-
tor. “We have to do it,” but the strategy
remains wasteful and reactive.
What society really needs, Fauci tells
me, is a universal lu vaccine— one that
protects against every variant of the
virus and provides long-term protection,
just as the vaccines against measles and
mumps do. One vaccine to bind them
all: It’s hard to overstate what a win that
would be. No more worrying about strain
mismatches or annual injections. “It
would be the epitome of preparedness,”
Fauci says, and he has committed his
institute to developing one.
Flu viruses are studded with a mole-
cule called hemagglutinin (the H in H1N1 and other such names),
which looks like a stumpy Pez dispenser. Vaccines target the head,
but that’s the part that varies most among strains, and evolves most
quickly. Targeting the stem, which is more uniform and stable,
might yield better results. The stem, however, is usually ignored by
the immune system. To draw attention to it, Fauci’s team decapi-
tates the molecule and sticks the stem onto a nanoparticle. The
result looks like a lu virus, but encourages the immune system to
go after the stable stem instead of the adaptable head. In a prelimi-
nary study, his team used this approach to build a vaccine using
an H1 virus, which then protected ferrets against a very diferent
H5N1 strain.
This type of work is promising, but flu is such an adaptive
adversary that the quest for a universal vaccine might take years,
even decades, to fulill. Progress will be incremental, but each
increment will have value in itself. A universal-ish vaccine that, say,
protected against all H1N1 strains would have prevented the 2009
pandemic. And reducing lu’s menace, even in some of its variants,
would free up resources and intellectual capacity for dealing with
other deadly diseases for which no vaccines exist at all.
Many of those diseases strike poor countries irst and are—for
now—rare. Creating vaccines for them is painstaking and often
unprofitable, and therefore little gets done. Last year, to help
change that, the Coalition for Epidemic Preparedness Innovations
was created, and now has $630 million pledged by governments
and nonproits. It will focus irst on Lassa fever, Nipah, and MERS,
and its ambition is to yank promising vaccines out of developmen-
tal purgatory, push them through trials, and stockpile them by the
hundreds of thousands. (One goal is to avoid a repeat of 2014,
when Ebola ravaged West Africa while an experimental vaccine
that could potentially have stopped it was languishing in a freezer,
where it had been for a decade.)
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 67
 More important, the coalition is look-
ing to fund so-called platform technolo-
gies that could create a vaccine against
any new virus far more quickly than can
be done today: within 16 weeks of its
discovery. Most current vaccines work by
presenting the immune system with dead,
weakened, or fragmented microbes. Every
microbe is unique, so every vaccine must
be unique, which is one reason they’re so
time-consuming to create. But by loading
key parts of a given microbe onto a stan-
dard molecular chassis, scientists could
build plug-and-play vaccines that could
be swiftly customized.
In the same way that movable type
revolutionized printing by allowing peo-
ple to rapidly set up new pages without
carving bespoke woodblocks, such vac-
cines could greatly accelerate the defense
against emerging infections. In 2016, a
team of researchers used the concept to
create a vaccine against Zika that is now
being tested in clinical trials across the
Americas. The process took four months—
the shortest development time in vaccin-
ology’s 222-year history.
The possibilities of vaccine science—
a universal flu vaccine, plug-and-play
platforms—are exciting. But they are only
possibilities. No matter how brilliant and
dedicated the people involved, they face
a long and uncertain road. Missteps and
failures are assured along the way; dogged
efort and consistent support are essential
to sustain the journey. These latter neces-
Anthony Fauci, who as head of the National Institute of Allergy and Infectious Diseases has,
sities, unavoidably, bring us to politics— until now, helped every president starting with Ronald Reagan manage pandemic risk,
where they are, predictably, in short supply. says the responses of the presidents varied widely. He has yet to meet with Donald Trump.

NTHONY FAUCI’S oice walls

A are plastered with certificates,

magazine articles, and other mementos from his 34-year
career as NIAID director, including photos of him with various pres-
idents. In one picture, he stands in the Oval Oice with Bill Clinton
and Al Gore, pointing to a photo of HIV latching onto a white blood
cell. In another, George W. Bush fastens the Presidential Medal
of Freedom around his neck. Fauci has counseled every president
from Ronald Reagan through Barack Obama about the problem of
epidemics, because each of them has needed that counsel. “This
transcends administrations,” he tells me.
Reagan and the elder Bush had to face the emergence and
proliferation of HIV. Clinton had to deal with the arrival of West
Nile virus. Bush the younger had to contend with anthrax and
SARS. Barack Obama saw a lu pandemic in his third month in
oice, MERS and Ebola at the start of his second term, and Zika
at the dusk of his presidency. The responses of the presidents
varied, Fauci told me: Clinton went on autopilot; the younger
Bush made public health part of his legacy, funding an aston-
ishingly successful anti-HIV program; Obama had the keenest
intellectual interest in the subject.
And Donald Trump? “I haven’t had any interaction with him
yet,” Fauci says. “But in fairness, there hasn’t been a situation.”
There surely will be, though. At some point, a new virus will
emerge to test Trump’s mettle. What happens then? He has no
background in science or health, and has surrounded himself
with little such expertise. The President’s Council of Advisers
on Science and Technology, a group of leading scientists who
consult on policy matters, is dormant. The Oice of Science and
Technology Policy, which has advised presidents on everything
from epidemics to nuclear disasters since 1976, is diminished.
The head of that oice typically acts as the president’s chief sci-
entiic consigliere, but to date no one has been appointed.
Other parts of Trump’s administration that will prove crucial
during an epidemic have operated like an Etch A Sketch. Dur-
ing the nine months I spent working on this story, Tom Price
resigned as secretary of health and human services after using
taxpayer money to fund charter flights (although his replace-
ment, Alex Azar, is arguably better prepared, having dealt with
anthrax, lu, and SARS during the Bush years). Brenda Fitzgerald
stepped down as CDC director after it became known that she
had bought stock in tobacco companies; her replacement, Robert
Redield, has a long track record studying HIV, but relatively little
public-health experience.

68 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 Rear Admiral Tim Ziemer, a veteran malaria fighter, was
appointed to the National Security Council, in part to oversee
the development of the White House’s forthcoming biosecurity
strategy. When I met Ziemer at the White House in February, he
hadn’t spoken with the president, but said pandemic prepared-
ness was a priority for the administration. He left in May.
Organizing a federal response to an
emerging pandemic is harder than one
might think. The largely successful U.S.
response to Ebola in 2014 beneited from
the special appointment of an “Ebola
czar”—Klain—to help coordinate the many
agencies that face unclear responsibilities.
In 2016, when Obama asked for $1.9 bil-
lion to ight Zika, Congress devolved into
partisan squabbling. Republicans wanted
to keep the funds away from clinics that
worked with Planned Parenthood, and
Democrats opposed the restriction. It
COMMUNITIES
took more than seven months to appropri-
ate $1.1 billion; by then, the CDC and NIH
had been forced to divert funds meant to
deal with lu, HIV, and the next Ebola.
How will Trump manage such a situ-
ation? Back in 2014, he called Obama
a “psycho” for not banning lights from
Ebola-afflicted countries, even though
no direct lights existed, and even though
health experts noted that travel restric-
tions hadn’t helped control SARS or H1N1.
70 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
Counterintuitively, light bans increase the odds that outbreaks
will spread by driving fearful patients underground, forcing
them to seek alternative and even illegal transport routes. They
also discourage health workers from helping to contain foreign
outbreaks, for fear that they’ll be denied reentry into their home
country. Trump clearly felt that such Americans should be denied
reentry. “KEEP THEM OUT OF HERE!”
he tweeted, before questioning the evi-
dence that Ebola is not as contagious as
is commonly believed.
Trump called Obama “dumb” for
deploying the military to countries sufer-
ing from the Ebola outbreak, and he now
SEVERE commands that same military. His dislike
of outsiders and disdain for diplomacy
OUTBREAKS could lead him to spurn the cooperative,
TEAR outward-facing strategies that work best
to contain emergent pandemics.
Perhaps the two most important
APART, things a leader can personally provide
FORCING in the midst of an epidemic are reliable
information and a unifying spirit. In
PEOPLE the absence of strong countermeasures,
TO FEAR severe outbreaks tear communities apart,
THEIR forcing people to fear their neighbors; the
longest-lasting damage can be psycho-
NEIGHBORS. social. Trump’s tendency to tweet rashly,
delegitimize legitimate sources of infor-
mation, and readily buy into conspiracy
theories could be disastrous.

M E R Y M I KO L O G R E E T S M E WA R M LY, with one
E outstretched hand. We shake, do a little ankle tap, and
say, “Nous sommes ensemble”—“we are together.” This is
the greeting of the Kikwit Ebola Survivors’ Association, of which
Mikolo is a co-founder and the vice president. Fifteen of the 42
members ile into the breakfast room of Hotel Kwilu, the men in
simple shirts and the women in glorious kaleidoscopic dresses.
The youngest are in their mid-30s, the oldest in their late 70s.
They speak softly as they reconnect over plates of bread, cheese,
and Nutella.
There is still no deinitive treatment for Ebola. In 1995, like
most of the survivors, Mikolo fought the virus of on his own, over
three grueling weeks. After he recovered, he donated his blood—
and the virus-ighting antibodies within it—to others, saving the
lives of Shimene Mukungu and Emilienne Luzolo, who are also
here today. Blood spreads Ebola. Sometimes, blood cures it.
The outbreak destroyed entire families. Afterward, some of
the survivors found themselves the sole providers for several
children. Others were orphans. Worst of all, they became pariahs.
“Here, for we who live in communities, it is solitude that kills us,”
Mikolo says. He rolls up his trouser leg and shows me the scars
inlicted by fearful neighbors, who hurled stones at him when he
tried to return home. Like others, he discovered that his house
and belongings had been burned.
The survivors banded together. “We had to take care of our-
selves,” Norbert Mabanza, the association’s president, tells me.
“Those with a little bit of strength could support those who were
weaker. Débrouillez-vous.”
I listen to their stories in the company of Anne Rimoin, an
epidemiologist from UCLA. During her 16 years working in the
Left to right:
A plaque
memorializing
Dr. Martin Salia,
who died from
Ebola at the
University of
Nebraska Medical
Center in 2014;
a worker sealing
her gloves;
mother and
baby mannequins
used for practicing
treatment
Congo, Rimoin has shown that monkeypox is on the rise, helped
discover a new virus, and worked to create the irst truly accu-
rate maps of the country, down to the most-isolated villages. The
Congo is a second home for her. When Rimoin’s father died
shortly before her wedding, Muyembe, the virologist who irst
encountered Ebola, lew to Los Angeles to walk her down the aisle.
Rimoin emphasized to me the social rupture that disease out-
breaks wreak on unprepared communities, and the diiculty of
repair. She also said that until the Congo and other developing
countries can control the diseases at their doorsteps, it is impera-
tive for richer nations like the United States to help them. That was
a truth acknowledged by every expert I spoke with: The best way to
prevent pandemics is to contain outbreaks at their source. The U.S.
cannot possibly consider itself protected if other nations are not.
America’s prior investments in global health preparedness—
the largest of any nation’s—have already made a tangible difer-
ence. In 2010, the CDC helped Uganda set up a new surveillance
system for viral hemorrhagic fevers like Ebola and Marburg.
Health workers there are now trained to recognize these diseases,
and have tools for collecting samples safely. Labs have diagnostic
equipment. Response teams are ready to go. “It’s been incred-
ible to watch,” says Inger Damon, who oversaw the CDC’s 2014
Ebola response. “It used to take two weeks to respond to an out-
break. By the time you understood what was going on, you’d have
20 to 30 cases, and eventually hundreds. Now they can respond
in two days.” Sixteen outbreaks have been detected since 2010,
but they were typically much smaller and shorter than before.
Half of them involved just one case.
And in July 2014, in the midst of the West African Ebola
outbreak, those investments very likely prevented a horrific
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 71
 Emery Mikolo
in March 2018
in Pavilion 3,
which housed
Kikwit’s Ebola
patients in 1995,
and is now a
pediatrics ward
catastrophe that might otherwise still be unfolding today. A Libe-
rian American man brought the virus into Lagos, Nigeria, home
to 21 million people and one of Africa’s busiest airports. “If it had
gone out of control in Lagos, it would have gone all over Africa for
years,” Tom Frieden, the former CDC director, says. “We were
right on the edge of the abyss.”
But Nigeria responded quickly. For years, it had used invest-
ments from the U.S. and other countries to build infrastructure
for eradicating polio. It had a command center and a crack team
of CDC-trained epidemiologists. When Ebola hit Lagos, the
team dropped its polio work. It found every person who’d con-
tracted Ebola, and every person with whom those infected had
had contact. In only three months, after just 19 cases and eight
deaths, it brought Ebola to heel and stopped it from spreading to
any other country.
With patience and money—not even very much money com-
pared with the vastness of rich-country spending—this kind of
victory could be commonplace. An international partnership
called the Global Health Security Agenda has already laid out
a road map for nations to plug their vulnerabilities against
infectious threats. Back in 2014, the U.S. committed $1 billion
to the efort over ive years. With it came a clear, if implicit,
statement: Pandemic threats should be a global priority. Nous
sommes ensemble.
Given that sense of commitment, and with the related fund-
ing in hand, the CDC made a large bet: It began helping 49 coun-
tries improve their epidemic preparedness, on the assumption
that demonstrating success would assure a continued low of
money. But that bet now looks uncertain. Trump’s budget for
2019 would cut 67 percent from current annual spending.
If investments start receding, the CDC will have to wind
down its activity in several countries, and its ield oicers will
look for other jobs. Their local knowledge will disappear, and the
72 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
relationships they have built will crumble. Trust is essential for
controlling outbreaks; it is hard won, and not easily replaced. “In
an outbreak, there’s so little time to learn things, make connec-
tions, learn how to not ofend people,” Rimoin tells me. “We’re
here in the Congo all the time. People know us.”
Until Rimoin arrived in Kikwit last summer, the Ebola survi-
vors had for decades refused to collaborate with outsiders. “Oth-
ers see us as people to study,” Mikolo tells her. “But you came
to us with friendship and humanity. You haven’t abandoned us.”
Indeed, while Rimoin is studying the blood of the survivors, she
is also trying to set up a clinic where survivors, half of whom are
medically trained, can provide primary care to one another and
to their communities. She has used donations and some of her
own money to help Mabanza, the association’s president, get a
master’s degree in public health.
Rimoin and I take the same light out of Kinshasa; she will
likely be back in a few months. I think about her ties to the
Congo as our plane soars over one of the most biodiverse rain
forests in the world, on the irst of three legs that will put me back
within a stone’s throw of the White House in 28 hours. Below
my light path, the sparks of a new Ebola outbreak are lickering,
unbeknownst to me or any of the scientists with whom I’d spo-
ken. (It would be discovered in the weeks that followed.)
I think about the survivors of Kikwit, and how our connected-
ness is both the source of our greatest vulnerability and the
potential means of our salvation. I think about whether it is pos-
sible to break the old cycle of panic and neglect, to fully transition
from Débrouillez-vous to Nous sommes ensemble. I think about this
amid bouts of restless sleep, as the plane lies westward across
the Atlantic, stuck in the shadow of the world, until inally, dawn
ED YONG
catches up.
Ed Yong is a staf writer at The Atlantic.
 Cheryl Windless thought it was a simple flu infection. But,
she was in severe cardiogenic shock and many of her organs
were failing. She was given only a ten percent chance of survival.
One hospital wouldn’t admit her because they thought she
couldn’t be saved. At Mount Sinai Heart, doctors performed
emergency surgery to implant a HeartMate II left ventricular
assist device (LVAD), which functions like an artificial heart.
In fact, it was a typical Mount Sinai success story: one that began
with very little hope of success.
1 - 8 0 0 - MD-SINA I
mou n t s i n a i .or g/m s he a r t

OUR
DOCTORS WORK ON HEARTS

OTHER DOCTORS

DON’T HAVE THE HEART

TO TOUCH.
Kiarra Boulware
and her niece
at Penn North,
an addiction-
recovery center
in Baltimore
BEING BLACK | TH E H E ALTH REP O RT |

IN AMERICA
CAN BE
HAZARDOUS
Across the United
States, African
Americans have a
lower life expectancy
than whites. In
Baltimore and other
segregated cities,
this gap is as much
as 20 years. One
young woman’s
struggle to get better

TO YOUR
shows why.

BY OLGA KHAZAN
Photographs by Jared Soares

T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 75

O N E M O R N I N G T H I S PA S T
SEPTEMBER, KIARRA
B O U LWA R E B O A R D E D
T H E 2 6 B U S T O B A LT I M O R E ’ S
B O N S E C O U R S H O S P I TA L ,
where she would seek help for the most urgent prob-
lem in her life: the 200-some excess pounds she
carried on her 5-foot-2-inch frame.
To Kiarra, the weight sometimes felt like a great
burden, and at other times like just another fact of
life. She had survived a childhood marred by death,
drugs, and violence. She had recently gained control
over her addiction to alcohol, which, last summer,
had brought her to a residential recovery center in
the city’s Sandtown neighborhood, made famous by
the Freddie Gray protests in 2015. But she still strug-
gled with binge eating—so much so that she would
eat entire plates of quesadillas or mozzarella sticks
in minutes.
As the bus rattled past rowhouses and corner
stores, Kiarra told me she hadn’t yet received the
CPAP breathing machine she needed for her sleep
apnea. The extra fat seemed to constrict her airways
while she slept, and a sleep study had shown that she
stopped breathing 40 times an hour. She remem-
bered one doctor saying, “I’m scared you’re going to
die in your sleep.” In the haze of alcoholism, she’d
never followed up on the test. Now doctors at Bon
Secours were trying to order the machine for her, but
insurance hurdles had gotten in the way.
Kiarra’s weight brought an assortment of old-
person problems to her 27-year-old life: sleep apnea,
diabetes, and menstrual dysregulation, which made
her worry she would never have children. For a while,
she’d ignored these issues. Day to day, her size mostly
made it hard to shop for clothes. But the severity of her
situation sank in when a diabetic friend had to have a
toe amputated. Kiarra visited the woman in the hospi-
tal. She saw her tears and her red, bandaged foot, and
resolved not to become an amputee herself.
Kiarra arrived at the hospital early and waited in
the cafeteria. Bon Secours is one of several world-class
hospitals in Baltimore. Another, Johns Hopkins Hospi-
tal, is in some respects the birthplace of modern Amer-
ican medicine, having invented everything from the
medical residency to the surgical glove. But of course
76 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
Kiarra resolved
to get healthy
after visiting
a diabetic friend
in the hospital
who’d had her
toe amputated.
Kiarra’s own
diabetes is
already causing
her vision to blur.
not even the best hospitals in America can keep you
from getting sick in the irst place.
It was lunchtime, but Kiarra didn’t have any cash—
her job, working the front desk at the recovery center
where she lived, paid a stipend of just $150 a week.
When she did have money, she often sought comfort
in fast food. But when her cash and food stamps ran
out, she sometimes had what she called “hungry
nights,” when she went to bed without having eaten
anything all day.
When I’d irst met Kiarra, a few months earlier, I’d
been struck by how upbeat she seemed. Her recov-
ery center—called Maryland Community Health
Initiatives, but known in the neighborhood as Penn
North—sits on a grimy street crowded with men sell-
ing drugs. Some of the center’s clients, fresh of their
habits, seemed withdrawn, or even morose. Kiarra,
though, had the bubbly demeanor of a student-
council president.
She described the rough neighborhoods where
she’d grown up as fun and “familylike.” She said
that although neither of her parents had been very
involved when she was a kid, her grandparents had
provided a loving home. Regarding her diabetes, she
told me she was “grateful that it’s reversible.” After
finishing her addiction treatment, she planned to
reenroll in college and move into a dorm.
Now, though, a much more anxious Kiarra sat
before her doctor, a young white man named Tyler
Gray, who began by advising Kiarra to get a Pap smear.
“Do we have to do it today?” she asked.
“Is there something you’re concerned about or ner-
vous about?,” Gray asked.
Kiarra was nervous about a lot of things. She
“deals by not dealing,” as she puts it, but lately she’d
had to deal with so much. “Ever since the diabetes
thing, I hate hearing I have something else,” she said
softly, beginning to cry. “I’ve been fat for what seems
like so long, and now I get all the fat problems.”
“I don’t want to be fat,” she added, “but I don’t
know how to not be fat.”
 Kiarra’s struggles with her weight are imbued with this sense, that getting
thin is a mystery she might never solve, that diet secrets are literally secret.
On a Sunday, she might diligently make a meal plan for the week, only to ind
herself reaching for Popeyes fried chicken by Wednesday. She blames herself
for her poor health—as do many of the people I met in her community, where
obesity, diabetes, and heart disease are ubiquitous. They said they’d made
bad choices. They used food, and sometimes drugs, to soothe their pain. But
these individual failings are only part of the picture.
In Baltimore, a 20-year gap in life expectancy exists between the city’s
poor, largely African American neighborhoods and its wealthier, whiter areas.
A baby born in Cheswolde, in Baltimore’s far-northwest corner, can expect
to live until age 87. Nine miles away in Clifton-Berea, near where The Wire
was ilmed, the life expectancy is 67, roughly the same as that of Rwanda, and
12 years shorter than the American average. Similar disparities exist in other
segregated cities, such as Philadelphia and Chicago.
These cities are among the most extreme examples of a national phe-
nomenon: Across the United States, black people sufer disproportionately
from some of the most devastating health problems, from cancer deaths and
diabetes to maternal mortality and preterm births. Although the racial dis-
parity in early death has narrowed in recent decades, black people have the
life expectancy, nationwide, that white people had in the 1980s—about three
years shorter than the current white life expectancy. African Americans face
a greater risk of death at practically every stage of life.
Except in the case of a few specific ailments, such as nondiabetic
kidney disease, scientists have largely failed to identify genetic diferences
that might explain racial health disparities. The major underlying causes,
many scientists now believe, are social and environmental forces that afect
African Americans more than most other groups.
To better understand how these forces work, I spent nearly a year report-
ing in Sandtown and other parts of Baltimore. What I found in Kiarra’s
struggle was the story of how one person’s eforts to get better—imperfect as
they may have been—were made vastly more diicult by a daunting series of
obstacles. But it is also a bigger story, of how African Americans became stuck
in profoundly unhealthy neighborhoods, and of how the legacy of racism can
literally take years of their lives. Far from being a relic of the past, America’s
racist and segregationist history continues to harm black people in the most
intimate of ways—seeping into their lungs, their blood, even their DNA.
was a little girl, Baltimore
  W H E N  K I A R R A  
was, as it is today, mired in
violence, drugs, and poverty. In 1996, the city had
the highest rate of drug-related emergency-room
visits in the nation and one of the country’s highest
homicide rates.
With her father in and out of jail for robbery and
drug dealing, Kiarra and her mother, three siblings,
and three cousins piled into her grandmother’s
home. It was a joyous but chaotic household. Kiarra
describes her grandmother as “God’s assistant”—a
deeply religious woman who, despite a house burst-
ing with hungry mouths, would still make an extra
dinner for the addicts on the block. Kiarra’s mother,
meanwhile, was “the hood princess,” a woman who
would do her hair just to go to the grocery store. She
was a teen mom, like her own mother had been.
Many facets of Kiarra’s youth—the fact that her
parents weren’t together, her father’s incarceration,
the guns on the corners—are what researchers con-
sider “adverse childhood experiences,” stressful
events early in life that can cause health problems
in adulthood. An abnormally large proportion of the
children in Baltimore—nearly a third—have two or
more ACEs. People with four or more ACEs are seven
times as likely to be alcoholics as people with no ACEs,
and twice as likely to have heart disease. One study
found that six or more ACEs can cut life expectancy
by as much as 20 years. Kiarra had at least six.
She and others I interviewed recall the inner-
city Baltimore of their youth fondly. Everyone lived
crammed together with siblings and cousins, but
people looked out for one another; neighbors hosted
back-to-school cookouts every year, and people took
pride in their homes. Kiarra ran around with the
other kids on the block until her grandma called her
in each night at 8 o’clock. She made the honor roll in
ifth grade and got to speak in front of the whole class.
She read novels by Sister Souljah and wrote short sto-
ries in longhand.
Yet Kiarra also describes some jarring incidents.
When she was 8, she heard a loud bop bop bop outside
and ran out to ind her stepbrother lying in the street,
dead. One friend died of asthma in middle school;
another went to jail, then hanged himself. (Other peo-
ple I spoke with around Penn North and other recov-
ery facilities had similarly traumatic experiences. It
seemed like every second person I met told me they
had been molested as a child, and even more said their
family members had struggled with addiction.)
Kiarra told me she got pregnant by a friend when
she was 12, and gave birth to a boy when she was 13.
Within a year, the baby died unexpectedly, and Kiarra
was so traumatized that she ended up spending more
than a month in a psychiatric hospital. When she
came home, her boyfriend physically and sexually
abused her. He “slapped me so hard, I was seeing
stars,” she said.
She took solace in eating, a common refuge for
victims of abuse. One 2013 study of thousands of
women found that those who had been severely
physically or sexually abused as children had nearly
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 77
double the risk of food addiction. Kiarra ate “everything, anything,” she
said, “mostly bad foods, junk food, pizza,” along with chicken boxes—the
fried-chicken-and-fries combos slung by Baltimore’s carryout joints.
At irst, she thought the extra weight looked good on her. Then she started
feeling fat. Eventually, she said, “it was like, Fuck it. I’m fat.” As her high-
school graduation approached, she tried on the white gown she’d bought just
weeks earlier and realized that it was already too tight.
Kiarra didn’t know many college-educated people, but she wanted to go to
Spelman, a historically black college in Georgia, and join a sorority. Her fam-
ily talked her out of applying, she said. Instead, she enrolled in one local col-
lege after another, but she kept dropping out, sometimes to help her siblings
with their children and other times because she simply lost interest. After
accumulating $30,000 in student loans, she had only a year’s worth of credits.
So Kiarra put college on hold and worked at Kmart and as a home health
aide—solid jobs but, as she likes to say, “not my ceiling.” She longed for a
purpose. Sometimes, she had an inkling that she was meant to be an impor-
tant person; she would picture herself giving a speech to an auditorium full
of people. But she remained depressed, stuck, and, increasingly, obese.
She began doing ecstasy, and, later, downing a pint of vodka a day. She
remembers coming to her home-health-aide job drunk one time and leaving
a patient on the toilet. “Did you forget me?” the woman asked, half an hour
later. Kiarra broke down crying.
Soon after, she checked into Penn North for her irst try at recovery. This
past year’s attempt is her third.
97 percent black, and half of its families live in
  S A N D T O W N  I S  
poverty. Its homicide rate is more than double that
of the rest of the city, and last year about 8 percent of the deaths there
were due to drug and alcohol overdose. Still, its top killers are heart dis-
ease and cancer, which African Americans nationwide are more likely to
die from than other groups are.
78 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
The way African Americans became trapped in
Baltimore’s poorest—and least healthy—neighbor-
hoods mirrors their history in the ghettos of other
major cities. It began with outright bans on their
presence in certain neighborhoods in the early
1900s and continued through the 2000s, when pol-
icy makers, lenders, and fellow citizens employed
subtler forms of discrimination.
In the early 1900s, blacks in Baltimore dispropor-
tionately sufered from tuberculosis, so much so that
one area not far from Penn North was known as the
“lung block.” In 1907, an investigator hired by local
charities described what she saw in Meyer Court, a
poor area in Baltimore. The contents of an outdoor
toilet “were found streaming down the center of this
narrow court to the street beyond,” she wrote. The
smell within one house was “ ‘sickening’ … No provi-
sion of any kind is made for supplying the occupants
of this court with water.” Yet one cause, the housing
investigator concluded, was the residents’ “low stan-
dards and absence of ideals.”
When blacks tried to lee to better areas, some
had their windows smashed and their steps smeared
with tar. In 1910, a Yale-educated black lawyer
named George McMechen moved into a house in
a white neighborhood, and Baltimore reacted by
adopting a segregation ordinance that The New York
Times called “the most pronounced ‘Jim Crow’ mea-
sure on record.” Later, neighborhood associations
urged homeowners to sign covenants promising
never to sell to African Americans.
 For much of the 20th century, the Federal Hous-
ing Administration declined to insure mortgages
for blacks, who instead had to buy homes by signing
contracts with speculators who demanded payments
that, in many cases, amounted to most of the buyer’s
income. (As a result, many black families never reaped
the gains of homeownership—a key source of Ameri-
cans’ wealth.) Housing discrimination persisted well
beyond the Jim Crow years, as neighborhood associa-
tions rejected proposals to build low-income housing
in aluent suburbs. In the 1990s, house lippers would
buy up homes in Baltimore’s predominantly black
neighborhoods and resell them to unsuspecting irst-
time home buyers at inlated prices by using falsiied
documents. The subsequent foreclosures are a major
reason so many properties in the city sit vacant today.
Some of Baltimore’s rowhouses are so long-
forsaken, they have trees growing through the win-
dows. These dilapidated homes are in themselves
harmful to people’s health. Neighborhoods with
poorly maintained houses or a large number of
abandoned properties, for instance, face a high risk
of mouse infestation. Every year, more than 5,000
Baltimore children go to the emergency room for
an asthma attack—and according to research from
Johns Hopkins, mouse allergen is the biggest envi-
ronmental factor in those attacks.
The allergen, found in mouse urine, travels
through the air on dust, and Johns Hopkins research-
ers have found high levels of it on most of the beds
of poor Baltimore kids they have tested. When kids
Kiarra lives inhale the allergen, it can spark inlammation and
in Sandtown, mucus buildup in their lungs, making them cough
the Baltimore and wheeze. These attacks can cause long-term
neighborhood
harm: Children with asthma are more likely to be
made famous by
the Freddie Gray
obese and in overall poorer health as adults. Getting
protests, where rid of the mice requires sealing up cracks and holes in
heart disease and the house—a process that can cost thousands of dol-
cancer are the lars, given the state of many Baltimore homes.
leading killers. The mice, of course, are just one symptom of the
widespread neglect that can set in once neighbor-
hoods become as segregated as Baltimore’s are. One
study estimated that, in the year 2000, racial seg-
regation caused 176,000 deaths—about as many as
were caused by strokes.
SOME OF BALTIMORE’S ROWHOUSES
ARE SO LONG-FORSAKEN, THEY HAVE
TREES GROWING THROUGH THE
WINDOWS. THEY ARE IN THEMSELVES
HARMFUL TO PEOPLE’S HEALTH.
Penn North’s aging air con-
  A L L  S U M M E R,  
ditioners strained against the
soupy heat outside. For Kiarra, the irst few months
at the recovery center felt like boot camp. The staf
woke the residents before 7 a.m., even if they didn’t
have anywhere in particular to be. Kiarra’s days were
packed with therapies: acupuncture in the mornings,
meant to help reduce cravings; individual meetings
with peer counselors; Narcotics Anonymous ses-
sions, in which dozens of strangers slumped on metal
folding chairs and told stories of past drug binges.
Once a week, Kiarra would leave her post at the
front desk and walk across an empty playground for an
appointment with her psychotherapist, Ms. Bea (who
asked that I not use her full name). Kiarra would climb
the steep, narrow staircase of Penn North’s clinical
building, then stop at the landing to catch her breath.
Ms. Bea’s goal was to help Kiarra understand how
her substance abuse, her weight, and her diicult
childhood were interconnected. Like many young
people in Baltimore, Kiarra had spent her life trying
to attain ordinary things—love, respect—that seemed
always to skid beyond her grasp. She wanted male
attention, but then she got pregnant. The baby made
her happy, but the baby died. Her siblings started
having kids and she loved them, but she was jealous.
She fell into a deep-sink depression. She’d eat a sec-
ond dinner, then get so drunk that she’d scream at her
friends. She’d realize that she was going to wake up
to a blistering hangover and would keep drinking. It
was coming anyway, so why not? “Struggle days,” she
called these times.
During one appointment in August, Kiarra told
Ms. Bea that she had been attending Overeaters
Anonymous meetings by phone. Something another
member had shared, about why people are some-
times reluctant to shed weight, had stuck with her.
“He was saying when you lose the fat, you lose a part
of you,” Kiarra recalled.
A few years earlier, she had founded a club for
plus-size women called Beautiful Beyond Weight,
with some of her best friends. The goal was to help
overweight women feel better about themselves.
They put on fashion shows that she described as
“Beyoncé big, but on a Christina Aguilera budget.”
She worried that if she lost too much weight, the
other girls in the club would think she was a hypocrite.
She decided she would aim to be “slim-thicc”—not
too skinny.
“So imagine if you were a size 14,” Ms. Bea said.
“What would be happening here—with you?”
Ms. Bea was trying to help Kiarra see how she
sometimes uses her size as a form of protection, a
way of making her feel invisible to men, so that she
could eventually work through her fear.
In Kiarra’s experience, disappearing could be use-
ful. She told me that once, when she was 17, before
she had gotten so big, she met a guy in an online chat
room. She went over to his place, where they watched
TV and started having sex. But then—the skid—his
three friends barged into the room and raped her. She
led, half-dressed, as soon as she could.
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 79
 “Yeah,” Kiarra said, envisioning herself many sizes smaller. “I wouldn’t
be able to take it.”
concentrating sometimes, and she thinks
  K I A R R A  H A S  T R O U B L E  
  the
reason might be that she and her
brother were exposed to lead from old paint. When Kiarra was 6, her grand-
mother heard that a girl living in another property owned by the same land-
lord had been hospitalized. She took Kiarra to get tested. The results showed
that the concentration of lead in her blood was more than six times the level
the Centers for Disease Control and Prevention considers elevated—an
amount that can irreversibly lower IQ and reduce attention span. Kiarra, too,
was hospitalized, for a month.
Scientists and industry experts knew in the 19th century that lead paint
was dangerous. “Lead is a merciless poison,” an executive with a Michigan
lead-paint company admitted in a book in 1892. It “gradually afects the
nerves and organs of circulation to such a degree that it is next to impossible
to restore them to their normal condition.” But as late as the 1940s and ’50s,
trade groups representing companies that made lead products, including
the Lead Industries Association, promoted the use of lead paint in homes
and successfully lobbied for the repeal of restrictions on that use. Lead-paint
companies published coloring books and advised their salesmen to “not for-
get the children—some day they may be customers.” According to The Balti-
more Sun, a study in 1956 found that lead-poisoned children in the slums of
Baltimore had six times as much lead in their systems as severely exposed
workers who handled lead for a living.
In speeches and publications, Lead Industries Association oicials cast
childhood lead poisoning as vanishingly rare. When they did acknowledge
the problem, they blamed “slum” children for chewing on wood surfaces—
“gnaw-ledge,” as Manfred Bowditch, the group’s health-and-safety director,
called it—and their “ignorant parents” for allowing them to do so. In a letter to
the Baltimore health department, Bowditch called the lead-poisoned toddlers
“little human rodents.”
Even after stricter regulations came along, landlords in segregated
neighborhoods—as well as the city’s own public-housing agency—neglected
LIFE EXPECTANCY AT BIRTH IN BALTIMORE
BY NEIGHBORHOOD
85–89
80–84
75–79
70–74
65–69
SANDTOWN-
WINCHESTER AND
HARLEM PARK
2017 NEIGHBORHOOD HEALTH PROFILES/BALTIMORE CITY HEALTH
DEPARTMENT (NO DATA AVAILABLE FOR DETENTION FACILITIES)
properties, allowing old paint to chip and leaded dust
to accumulate. Some landlords, seeking to avoid the
expense of renovating homes and the risk of tenant
lawsuits, refused to rent to families with children,
since they would face the greatest risk from lead
exposure. Poor families feared that if they com-
plained about lead, they might be evicted.
Partly because of Maryland’s more rigorous
screening, the state’s lead-poisoning rate for chil-
dren was 15 times the national average in the ’90s;
the majority of the poisoned children lived in the
poor areas of Baltimore. In some neighborhoods,
70 percent of children had been exposed to lead.
The city’s under-resourced agencies failed to
address the problem. Clogged by landlords who
hid behind shell companies, Baltimore’s lead-paint
enforcement system had ground to a halt by the
time Kiarra was poisoned. According to Tapping Into
The Wire, a book co-authored by Peter L. Beilenson,
the city’s former health commissioner, Baltimore
didn’t bring a single lead-paint enforcement action
against landlords in the ’90s. (A subsequent crack-
down on landlords has lowered lead-poisoning rates
dramatically.)
When Kiarra was 14, her family sued their land-
lord for damages, but their lawyer dropped the case
because the landlord claimed he had no money and
no insurance with which to compensate them. Kiarra
remembers her grandmother not wanting to give up,
demanding of the lawyer, “What do you mean there’s
nothing you can do?”—only to get lost in a tangle of
legal rules she didn’t fully understand.
this past August,
  O N   A   H O T   S AT U R D AY  
Kiarra brought her
nieces with her to work and corralled them in the
front oice. She was babysitting that day, and staing
was short at the center. The girls climbed restlessly
on the stained oice chairs and under the tables.
Kiarra is close with her family. She spends much
of her free time texting her favorite sisters on her
cracked cellphone, and she talks to her grandmother
every few days. Any familial strife upsets her deeply:
She can vividly recount a long list of times her mother
disappointed her. Then again, sometimes she feels like
she’s the one who has let everyone down, with all her
drinking and dropping out.
Near the end of the day, Kiarra’s cellphone rang.
It was her father, calling to yell at her because she
hadn’t come to see him recently. “I’ve been busy,”
Kiarra told him.
When Kiarra was little, and when her father
wasn’t incarcerated, he had provided for his
children—unlike many dads she knew. She’d sought
his approval by researching Islam, his religion, and
trying to reconcile it with the strict Christianity of her
grandmother’s home. A few years ago, she tried to
impress him by joining a tough-seeming social club
that turned out to be too much like a gang. (It “wasn’t
a good it,” she told me.)
On some level, she still respected her father. But
he had an explosive personality and struggled with

EVEN AMONG
PEOPLE MAKING
$175,000 A
YE AR OR MORE ,
BL ACKS ARE
MORE LIKELY
TO SUFFER
FROM CERTAIN
DISE ASES THAN
WHITES ARE .
depression and addiction. Kiarra told me he taught her
what men are supposed to be: ierce protectors who
sometimes turn their wrath on the women in their lives.
Kiarra usually tried to see her father’s outbursts as
a cry for help. But today, she decided to confront him.
Their conversation escalated as they accused each
other of failing at fatherhood and daughterhood.
“How many of my plays have you been to?,”
Kiarra demanded.
Her father launched into a tirade. “I will come for
your fucking dumb ass!,” I overheard him yell at one
point. “You going to respect me!”
“Respect works both ways,” Kiarra said. “I’m not
that little girl that’s gonna let you slap the shit out of me.”
What bothered Kiarra most was that her father had
never hit his other daughter that way, so why her? Why
did it feel like he was always rejecting her? (Her father
later conirmed that he had hit her as a child, saying,
“Discipline is a must, whatever form you choose.”)
As he continued screaming—“I’m gonna put your
fuckin’ head in the dirt”—Kiarra’s eyes glazed over.
“Death gotta be better than here,” she said.
She hung up, then wiped away tears. Just today,
he had called her at 12:30 a.m., 3:48 a.m., 7:47 a.m.,
11:24 a.m., 3:33 p.m., and 4:44 p.m. One time when she
didn’t answer the phone, Kiarra said, he showed up in
person at Penn North.
Her father called back, rambling less coherently
than before. “How much of my life did you spend
incarcerated?,” Kiarra asked him. When she was little,
she would go out hustling with him. “I was 14 fucking
years old seeing dead fucking bodies, and you’re talking
about where the fuck did this drinking shit come from?”
Kiarra hung up, this time for good. Then she wept. “As long as I’m fucked up,
this man is cool, but as soon as I decide I want to get my fucking life together
it’s like …” Her voice trailed of. She turned and told me she wanted to go to
McDonald’s. “McDonald’s is killing me,” she said, “but it’s a special treat.”
She ordered her usual—a McDouble and a McChicken, along with a sweet
tea—and waited silently amid the beeping of the cash registers.
people I met at Penn North were optimistic and sur-
  MOST OF THE  
rounded by iercely loyal friends. But their lives also
seemed, like Kiarra’s, unrelentingly stressful. Between the hugs and hand-
shakes, I heard a lot of trepidation. I have to move again … Where will I go?
Will I get this job at Target? Will I ever walk again? Will I get to eat today?
Research shows that this kind of day-in, day-out worry can ravage a per-
son’s health. Certain stressful experiences—such as living in a disordered,
impoverished neighborhood—are associated with a shortening of the telo-
meres, structures that sit on the tips of our chromosomes, which are bundles
of DNA inside our cells. Often compared to the plastic caps on the ends of
shoelaces, telomeres keep chromosomes from falling apart. They can also
be a measure of how much a body has been ground down by life.
Some researchers think stress shrinks telomeres, until they get so short
that the cell dies, hastening the onset of disease. Diferent kinds of prolonged
emotional strain can afect telomeres. In one study, mothers who had high
stress levels had telomeres that were as short as those of a person about a
decade older. Another study found that children who spent part of their
childhood in Romanian orphanages had telomeres that shortened rapidly.
Arline T. Geronimus, an expert on health disparities at the University of
Michigan, has found that African Americans have more stress-related wear
and tear in their bodies than white people do, and the diference widens with
age. By measuring telomere length in hundreds of women, Geronimus esti-
mated that black women were, biologically, about seven and a half years
older than white women of the same age.
Unrelenting stress also afects our daily behaviors: Stress causes some
people to eat more, especially calorically dense foods, and to sleep less.
On average, African Americans get about 40 minutes less sleep each night
than white people do. Among women in one recent study, poor sleep alone
explained more than half the racial disparity in cardiovascular-disease risk.
Living in a dangerous neighborhood like Sandtown requires a vigilance
that can lood the body with adrenaline and cortisol. These hormones are
supposed to kick in only long enough for us to get away from an immediate
threat. If they trickle through us constantly, they can raise the risk of heart
disease and compromise the body’s immune system.
These kinds of changes in body chemistry aren’t limited to people living
in poverty. Even well-of black people face daily racial discrimination, which
can have many of the same biological efects as unsafe streets. Thomas
LaVeist, the dean of Tulane’s School of Public Health and Tropical Medicine,
has found, for example, that even among people earning $175,000 a year or
more, blacks are more likely to sufer from certain diseases than whites are.
In an emerging ield of research, scientists have linked stress, including
from prejudice, to compounds called methyl groups attaching to our genes,
like snowlakes sticking to a tree branch. These methyl groups can cause
genes to turn on or of, setting disease patterns in motion. Recently, a study
linked racial discrimination to changes in methylation on genes that afect
schizophrenia, bipolar disorder, and asthma.
Several studies also show that experiencing racism might be part of the
reason black women are about 50 percent more likely than white women to
have premature babies and about twice as likely to have low-birth-weight
babies. Researchers think the stress they experience might cause the body
to go into labor too soon or to mount an immune attack against the fetus.
This disparity, too, does not appear to be genetic: Black women from sub-
Saharan Africa and the Caribbean are less likely to have preterm births than
African American women are, possibly because they’ve spent less time living
in America’s racist environment.
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 81
 the fall, Kiarra kept her doctor
  T H RO U G H O U T  
appointments, and she began
working out at the small gym at Penn North, placing a
picture of Chrissy Lampkin, the curvaceous girlfriend
of the rapper Jim Jones, on her treadmill as motivation.
But Kiarra still wasn’t losing much weight. Like most
Americans, she got advice from her friends on what
to eat—but that advice at times proved confusing and
contradictory. She tried a boiled-egg diet, which left her
with hunger pangs and a lot of leftover eggs in the fridge.
She went seven days without meat but wound up eating
more starches, which sent her blood sugar soaring.
One bright day in late September, Kiarra returned
to Bon Secours to see Ebony Hicks, a behavioral-
health consultant who, like Kiarra’s doctor, works
through Health Care for the Homeless, a Baltimore
nonproit that cares for the very poor. Hicks began by
asking Kiarra what her goal was. Kiarra said getting
down to an even 200 pounds “would be awesome.”
Her weight remained, stubbornly, about 150 pounds
higher than that. But she stayed optimistic, writing
down Hicks’s aphorisms about needing to be patient
and not expecting immediate results—“Anything over-
night usually lasts about a night!”—in a notebook she’d
brought with her.
Gently, Hicks asked Kiarra what she had eaten
that day.
“French fries,” Kiarra said.
“All you’ve had is french fries?,” Hicks asked.
“Mm-hmm.”
It was 3:30 in the afternoon.
They walked to a room across the hall, and Kiarra
stepped onto a scale.
“I gained two pounds,” she said quickly, “so now
I’m depressed. I eat too much.”
“We have to work on getting you more regularly
eating throughout the day,” Hicks said.
Kiarra asked whether “detox tea,” something
she’d heard about from a friend, was healthy.
“You can detox with lots of iber-illed vegetables,”
Hicks said.
“What’s that?,” Kiarra asked.
Hicks pulled up a web page describing fruits and veg-
etables that contain iber. She listed them of one by one.
Would Kiarra eat avocados?
No.
Coconut? Also no.
“I do eat berries,” Kiarra said. “Let’s put that
down.” Kiarra doesn’t know why she dislikes so
many fruits and vegetables. Her grandmother cooked
healthy meals, putting turkey in big pots of greens for
lavor. She had a rule that you could never leave the
table without eating your vegetables. Kiarra would
fall asleep at the table.
Hicks gamely pressed on. “Peas? You like peas?”
“I think I’m going to throw up,” Kiarra said, grimacing.
“Chickpeas,” Hicks ofered. “You ever ate hummus?”
“What is hummus?”
has long been Kiarra’s legal
  F R I E D  F O O D   
high—cheap, easily acquired,
something to brighten the gloomiest day. It is also
82 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
ONE REASON COLLEGE GRADUATES
LIVE LONGER, RESEARCHERS BELIEVE,
IS THAT EDUCATION ENDOWS
PEOPLE WITH THE SENSE THAT THEY
CONTROL THEIR OWN DESTINY.
one of the few luxuries around.
Predominantly black neighborhoods tend to become what researchers
call “food swamps,” or areas where fast-food joints outnumber healthier
options. (Food deserts, by contrast, simply lack grocery stores.) One study
in New York found that as the number of African Americans who lived in
a given area increased, so did the distance to the nearest clothing store,
pharmacy, electronics store, oice-supply store. Meanwhile, one type of
establishment drew nearer: fast-food restaurants.
That’s not a coincidence. After the riots of the 1960s, the federal govern-
ment began promoting the growth of small businesses in minority neigh-
borhoods as a way to ease racial tensions. “What we need is to get private
enterprise into the ghetto, and put the people of the ghetto into private enter-
prises,” President Richard Nixon said around the time he created the Oice of
Minority Business Enterprise, in 1969. As Chin Jou, a senior lecturer at the Uni-
versity of Sydney, describes in her book, Supersizing Urban America, fast-food
companies were some of the most eager entrants into this “ghetto” market.
Fast-food restaurants spent the next few decades “rushing into urban mar-
kets,” as one Detroit News report put it, seeking out these areas’ “untapped
labor force” and “concentrated audience.” In the 1990s, the federal govern-
ment gave fast-food restaurants inancial incentives to open locations in inner
cities, including in Baltimore. The urban expansion made business sense.
“The ethnic population is better for us than the general market,” Sidney Felten-
stein, Burger King’s executive vice president of brand strategy, explained to
the Miami Herald in 1992. “They tend to have larger families, and that means
larger checks.” (Supermarket chains didn’t share this enthusiasm; in part
because the widespread use of food stamps causes an uneven low of custom-
ers throughout the month, they have largely avoided expanding in poor areas.)
Fast-food executives looked for ways to entice black customers. Burger
King made ads featuring Shaft. KFC redecorated locations in cities like Bal-
timore to cater to stereotypically black tastes, and piped “rap, rhythm and
blues, and soul music” into the restaurants, Jou writes. “Employees were
given new Afrocentric uniforms consisting of kente cloth dashikis.” A study
from 2005 found that TV programs aimed at African Americans feature
more fast-food advertisements than other shows do, as well as more com-
mercials for soda and candy. Black children today see twice as many soda
and candy ads as white children do.
 The marketing and franchising onslaught worked,
and the diets of low-income people changed dramati-
cally. Before the rise of fast food and processed foods,
many low-income black families grew their own food
and ate lots of grains and beans. In 1965, one study
found, poor and middle-income blacks ate healthier—
though often more meager—diets than rich whites
did. But over the next few decades, the price of meat,
junk food, and simple carbohydrates plummeted,
while the price of vegetables rose. By the mid-’90s,
28 percent of African Americans were considered by
the U.S. Department of Agriculture to have a “poor”
diet, compared with just 16 percent of whites.
Vocational-Technical High School,
  AT   C A R V E R      
which Kiarra and Freddie Gray
attended at the same time, only about a third of
students go on to enroll in college—yet another fac-
tor that could be contributing to the area’s low life
expectancy, given that college graduates outlive
high-school dropouts in every racial category.
One reason college graduates live longer,
researchers believe, is that education endows people
with the sense that they control their own destiny.
Well- educated people seek out more nutritional
information because they’ve been told they can
achieve anything—why not perfect health, too?
Kiarra, by contrast, wasn’t yet sure what she could
Kiarra some- accomplish. She wanted to live up to an image in her
times asks mind of a “ly, crazy, daring, dream-chasing girl,” but
Steve Dixon, she cycled between getting excited about new possi-
the director of
bilities and being lattened by setbacks. Sometimes,
Penn North,
for advice
she would dream of turning Beautiful Beyond Weight
on how to into a business—one that would sell T-shirts and caps
find her pur- with empowering messages for plus-size women. But
pose in life. she wasn’t really sure how to do that.
When Kiarra felt especially adrift, she would visit
Steve Dixon, Penn North’s director, in his tiny oice at
the end of the hall, and ask him for advice on inding her
purpose. He would tell her to pray and meditate. “When
you pray, it’s like you’re talking to God,” Kiarra told me
once. “But when you meditate, it’s God talking to you.”
In November, some combination of prayer, medi-
tation, and research led Kiarra to enroll in a medical-
assistant training program. The class added another
$7,000 to her student-loan debt, but Kiarra seemed
to thrive in it, and a few weeks before Christmas,
she was excitedly planning her post–Penn North
life. Once she had her medical-assistant certiicate
in hand, she would move to Philadelphia, get a job
at Temple University, and take classes to become a
registered nurse. Eventually, she hoped to become
a nursing professor. That future held everything she
wanted: helping people, being a leader, making her
own money, having her own place.
Feeling chipper, she decided to browse the wigs at
a nearby store, stroking the hairpieces and whisper-
ing to the best ones that she would be back for them
on payday. She had a new reason to get dolled up: a
truck driver, “ine as wine” and with no kids—and,
accordingly, no messy entanglement with another
woman. She tried to boss him around, but he told
her to mind her own business, and she kind of liked
that. His birthday was approaching, and she wanted
to take him someplace fancy. She would wear a black
dress, and he would wear a black suit.
To help pay for everything, Kiarra decided to reg-
ister as a Lyft driver. All that was required was a $250
deposit; she began calling around to diferent rela-
tives to raise the money.
Twenty-seventeen, she thought, had been her
best year yet.
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 83
 a bitter cold settled
  A  F E W  W E E K S  L AT E R ,    
through the East
Coast, and Kiarra’s sunny mood had faded. Things
had ended with the truck driver over some mean
Facebook posts and the fact that he’d lied to her
about not having kids. She was also reconsidering
her plans for the future, now thinking that instead
of setting her sights on Temple, she should focus on
graduating and inding a job—any job—that would
pay well enough and provide insurance that would
cover her extensive health-care needs. Her grand-
mother said driving for Lyft in Baltimore was too
dangerous. She might not move to Philly after all.
But a new opportunity presented itself. Because
of a change in her insurance plan, Kiarra had to
switch doctors. Right away, her new doctor asked
her whether she had considered bariatric surgery.
Kiarra said she was scared of the complications, such
as digestive problems and infections, but the doctor
reassured her that complications are rare. She was
interested in the gastric sleeve, a procedure that
would dramatically reduce the size of her stomach,
causing hormonal changes that would help her lose
much of her body fat.
Kiarra still felt conlicted about losing her identity
as an overweight woman. She couldn’t relate to the
people on the Overeaters Anonymous calls who said
they hated their bodies. She liked hers. “People say,
‘Hey, you’re fat,’ ” she said. “And I’m like, ‘That’s obvi-
ous.’ ” But she was motivated by her diabetes—which
was already causing her vision to blur and her feet
to tingle—along with the looming threat of other “fat
diseases,” as she called them, frightening ones like
heart failure. She igured that if she really wanted to
have a successful plus-size clothing brand, she’d at
least have to live long enough to see it happen.
She decided on the spot to go forward with the sur-
gery, worried that she might change her mind other-
wise. She signed up for the mandatory pre-op classes
that prepare participants to eat just half a cup of food
for every meal, at least initially, after the surgery.
Her mother was nervous, but her sisters were all for
it. Her grandmother told her to put it in God’s hands.
Kiarra had orga-
  E A R L I E R  T H AT  M O N T H ,  
nized a birthday
party for her 2-year-old niece, Brooklynn, in Penn
North’s community room, decking out the dingy
yellow walls with pink balloons and ribbons. Within
a few weeks, it was decided that Kiarra would gain
custody of Brooklynn for a while so that Kiarra’s sis-
ter could go back to get her high-school diploma.
Kiarra was happy with this arrangement—she
already sometimes referred to Brooklynn as her
“daughter-girl”—and she began to see Brooklynn as
a reason to stay on track. Juggling coursework and
single parenthood exhausted her at times, but she
wanted to be the successful role model for Brooklynn
that she never had herself. In the chatty toddler who
loved dress-up and Moana, Kiarra had found, if not
her purpose, at least a purpose. “It feels like the Earth
is full, you know?” she told me one day this spring.
KIARRA FIGURED THAT IF SHE REALLY
WANTED TO HAVE A SUCCESSFUL
PLUS-SIZE CLOTHING BRAND,
SHE’D AT LEAST HAVE TO LIVE LONG
ENOUGH TO SEE IT HAPPEN.
Her new status as the child’s guardian meant that her stay at Penn North
could be extended, through some alchemy of program deinitions, for nearly
another year. Staying on would mean cheap housing for Kiarra and Brook-
lynn, two people who desperately needed it.
With that settled, Kiarra turned her attention to the six-month process of
hoop-jumping that was required to qualify for the gastric-sleeve surgery. The
irst pre-op class was an hour and a half long and took place at a hospital 30
minutes from Penn North. Kiarra thought the time commitment seemed
excessive; with a smirk, she wondered aloud why the doctors couldn’t just tell
her and the other patients, “Y’all fat. We gonna cut you up.”
But the doctors needed Kiarra to understand that the surgery was not
something to take lightly. To qualify, she would have to get her sleep apnea
and diabetes under control. She would have to keep a food journal, submit to
behavioral evaluations, write an essay explaining why she no longer wanted
to be morbidly obese. For the rest of her life, she’d need to wait 30 minutes
between eating a meal and drinking a beverage. When one of Kiarra’s class-
mates said that after the surgery, eating too much would cause you to get
violently sick for an hour, Kiarra recoiled a little.
All of the rules and obligations seemed more intense than Kiarra had
expected. “Six months, you’re going on like 16 appointments,” she said.
“Whoo, that’s a lot.” Given all she had to contend with, I wondered whether she
would end up meeting the requirements—and, given the stakes, what might
happen to her if she didn’t.
Tony Conn, a Penn North stafer with whom Kiarra is close, calls her a
“wonderful, brilliant person.” Early on in my reporting, he told me her biggest
law is that she sometimes doesn’t see things through to the end. “As soon as
[something] looks like it’s gonna come to light, she’s like, ‘Okay, I did that. So
let’s ind something else,’ ” he said.
But lately, Kiarra had shown a new sense of calm and dedication. One day
while she worked the front desk, an older man lirted with her as he signed
the attendance sheet.
“When you look in the mirror,” he said, “and see how beautiful you are, what
do you say to yourself?”
“We’ve come a long way,” she said quietly. “Let’s stay there.”
Olga Khazan is a staf writer at The Atlantic.

84 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
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FOR ALL

Carolinas HealthCare System is

 SPONSOR CONTENT – MARCH ON WASHINGTON FILM FESTIVAL

Witnessing From the 1947 Partition of India

History
to the 1963 March on Washington

By Riddhi Sarkar

hen Cassandra Joseph was growing up, her Listening to Joseph, I could not help thinking about some

W family never spoke about the fact that her an-

cestors had been slaves or that the family was
living in a segregated America. In her home, there was com-
similarities between her story and that of my own grand-
mother Priti Basu.

plete silence on the topics of slavery and the systemic
oppression faced by African Americans for generations.
But by the time Joseph got word that Dr. Martin Luther King
Jr. was coming to her hometown in 1963, she was 21 years
old and had come to understand the truth about her family
history. She knew she had to drop everything and go.
As soon as she started recounting to me what happened
in Washington, D.C., on August 28 of that year—which she
recalled was a bright and sunny day—the hint of excitement
in her voice was unmistakable. She told me how glad she
was that she decided to leave work that day to participate in
the now famous March on Washington for Jobs and Free-
dom. She recalled Mary Travers from the American folk
group Peter, Paul, and Mary accidentally stepping on her
foot just before the trio’s onstage performance; the crowd
singing “We Shall Overcome” in unison; seeing small chil-
dren in strollers and on the backs of their parents.
The memories of the day are forever etched in her mind,
as they are for many of the ordinary people who sacrificed
careers, families, and even their personal safety to make
up the massive effort that is now often reduced to a few
speeches by a few famous people. Highlighting the con-
tributions of ordinary citizens—the students who risked
being kicked out of school to demonstrate on campus, the
canvassers who wore the soles of their shoes thin while
trying to register voters—was the goal of the 2017 March
on Washington Film Festival, which every year strives to tell
the stories of the untold events and unsung heroes of the
civil-rights era.
When my grandmother was four years old, her family fled its
hometown of Bandar, in the Chittagong region that is now
part of Bangladesh, to Kolkata, India, to escape riots and re-
ligious and political tension after India’s independence from
Great Britain, in 1947. Their first six months were spent at a
government refugee camp, after which the family settled
down in the outskirts of Kolkata. Although it proved dif-
ficult to start a new life from scratch, her family was lucky
that they were able to have made it safely across the border.
Her uncle crossed the border in 1947 on a train on which he
and one other passenger were the lone survivors after all
the Hindus aboard were murdered. My grandmother told
me that he had been able to escape by hiding in the bath-
room of the train.
When the Indian subcontinent was broken apart during
the 1947 partition of India, it marked an upheaval across
the region, with many families having to leave their homes
overnight as new borders were hastily drawn along religious
lines. India was finally free from British rule, but the event
led to one of the largest mass migrations in history and left
a scar on the lives of many. Yet there was a silence around
personal aspects of the topic in affected families for years
afterward. Like Joseph’s family, my grandmother’s house-
hold never discussed their family history at home. Even my
mother knew little about her mother’s migration experience
while she was growing up. My grandmother only opened up
to me when I implored her to tell me more.
My grandmother, despite being one of the smartest students
at her school, had to give up her education and abandon
her dreams of becoming a doctor because her family had
 SPONSOR CONTENT – MARCH ON WASHINGTON FILM FESTIVAL

very little after they migrated as refugees. Taking care of the here must be a reason my grandmother never spoke
home and getting her married became bigger priorities T much about her history until her own granddaughter
for her family than paying for her education, thus cutting was 18—and why Joseph’s family also remained silent
short her career aspirations. I also learned about the strug- about its own. A deeply rooted pain caused by history
gles her parents faced in keeping her and her siblings safe that I can only imagine sometimes stops us from having a
among the violence caused by the partition of India. In the conversation about it. But events like the March on Wash-
days prior to the family’s migration, her mother would stay ington Film Festival are powerful agents in sparking intel-
awake holding her every night, waiting for daylight at a lectual and moral curiosity. In rekindling conversation about
Muslim neighbor’s home since their own was at risk of be- the civil-rights movement and the sacrifices people made
ing burned down—just like many other Hindu homes in the during those seminal events in our nation’s history, we
neighborhood—in the religiously mo- create a space for dialogue that is
tivated riots. To know that even in the crucial to understanding where we
midst of the tension between Hindus are today and to shaping our future
and Muslims there were individuals No matter how painful as a fair and just society. These con-
who looked beyond religion to help versations can start right at home,
it is to talk about the past,
those in need gives me hope about simply by questioning where we
creating a more peaceful world by if we remain silent and come from. No matter how painful it
fighting the tension that still exists do not dig deep, the voices is to talk about the past, if we remain
among religions. If tolerance, love, silent and do not dig deep, the voices
compassion, and open-mindedness
of our ancestors will of our ancestors will be forever lost,
could transcend religious dogmas be forever lost. and with them a chance to create
then, they certainly can now. and chronicle an accurate represen-
tation of history.
While speaking with my grandmother,
I learned that her father had put his medical career second While it is essential to pay tribute to the work of prominent
and activism first, often joining local activists in protesting leaders who advanced civil rights, we must never stop
the nearly 200 years of British colonization of India. Inciden- seeking more witnesses of history and voices of unsung
tally, it is that fight for independence—particularly Mahatma heroes—people who were less famous than King or Gand-
Gandhi’s civil-disobedience strategy used to free India from hi but who did their part in our societal march to equality
the shackles of British imperialism—that inspired Martin for all. If we do not recognize the contributions of Cassandra
Luther King Jr. to use that very tactic in the American civil- Joseph, of my grandmother Priti Basu and her parents, we
rights movement years later. are ignoring the fullness of history and thereby the op-
portunity to learn from the work not just of icons but of
y grandmother told me all of this during the summer
M after my 18th birthday. After my grandparents were
everyday people like you and me.

married and started a family, they made numerous sacrifices I do not need expensive tripods or fancy recording equip-
to ensure that their children would have more opportunities ment to preserve an important story; a genuine curiosity to
than they had. As I sat across the table from my grandmother learn and ask critical questions is a great first step. Anyone
in Kolkata two years ago, just as I was preparing to take off to can be a storyteller, and that is a gift we can give to honor
attend American University, in Washington, D.C., I made sure the legacy of the past and, in the process, contribute to a
this story of her sacrifices—the story of my family—would be better future.
properly preserved. I turned on my iPhone’s video recorder
one evening before leaving, trying my best to balance the
phone on a stack of old newspapers and books. Then, with
pen and paper in hand and a determination to ask long-bur-
Riddhi Sarkar is a student at American
ied questions that would help me get to the bottom of my
University. Her essay, “Witnessing
family’s migration story, I dived right into interviewing her.
History,” was a winner of the Freedom’s
Seeing how grateful my grandmother was to have her story
Children Student Journalists
shared was an unforgettable moment. By logging her story
Competition for the 2017 March on
and those of other witnesses, in my role as a citizen historian
Washington Film Festival.
for the 1947 Partition Archive, I am part of a movement that
adds to the body of knowledge on the partition of India by
gleaning witness accounts.
 After a dark history in which transgender kids were routinely ignored,
“repaired,” or persecuted, a new protocol of social and physical transition has
emerged. For teens who experience persistent gender dysphoria, this protocol
can provide profound relief from suffering. For some kids, however, gender
dysphoria is temporary. And the effects of transitioning can be permanent.

BY JESSE SINGAL
PHOTOGRAPHS BY MACIEK JASIK

88 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 | TH E H E ALTH REP O RT |

YO U R C H I L D S AY S S H E ’ S T R A N S .

SHE WANTS

H O R M O N E S AND S U R G E RY.

SHE’S 13.
 L A I R E I S A 1 4 -Y E A R- O L D G I R L with short
auburn hair and a broad smile. She lives outside Phila-
delphia with her mother and father, both professional
scientists. Claire can come across as an introvert, but
she quickly opens up, and what seemed like shyness
reveals itself to be quiet self-assuredness. Like many
kids her age, she is a bit overscheduled. During the
course of the evening I spent with Claire and her
mother, Heather—these aren’t their real names—
theater, guitar, and track tryouts all came up. We
also discussed the fact that, until recently, she wasn’t
certain she was a girl.
Sixth grade had been diicult for her. She’d strug-
gled to make friends and experienced both anxiety
and depression. “I didn’t have any self-conidence
at all,” she told me. “I thought there was something
wrong with me.” Claire, who was 12 at the time, also
felt uncomfortable in her body in a way she couldn’t
quite describe. She acknowledged that part of it had
to do with puberty, but she felt it was more than the
usual preteen woes. “At irst, I started eating less,”
she said, “but that didn’t really help.”
Around this time, Claire started watching YouTube
videos made by transgender young people. She was
particularly fascinated by MilesChronicles, the chan-
nel of Miles McKenna, a charismatic 22-year-old. His
1 million subscribers have followed along as he came
out as a trans boy, went on testosterone, got a double
mastectomy, and transformed into a happy, healthy
young man. Claire had discovered the videos by acci-
dent, or rather by algorithm: They’d showed up in her
“recommended” stream. They gave a name to Claire’s
discomfort. She began to wonder whether she was
transgender, meaning her internal gender identity
didn’t match the sex she had been assigned at birth.
“Maybe the reason I’m uncomfortable with my body is I’m
supposed to be a guy,” she thought at the time.
Claire found in MilesChronicles and similar You-
Tube videos a clear solution to her unhappiness. “I
just wanted to stop feeling bad, so I was like, I should
just transition,” she said. In Claire’s case, the irst step
would be gaining access to drugs that would halt
puberty; next, she would start taking testosterone to
develop male secondary sex characteristics. “I thought
that that was what made you feel better,” she told me.
In Claire’s mind, the plan was concrete, though
neither Heather nor her husband, Mike, knew about
any of it. Claire initially kept her feelings from her
parents, researching steps she could take toward
transitioning that wouldn’t require medical inter-
ventions, or her parents’ approval. She looked into
ways to make her voice sound deeper and into bind-
ers to hide her breasts. But one day in August 2016,
Mike asked her why she’d seemed so sad lately. She
explained to him that she thought she was a boy.
This began what Heather recalls as a complicated
time in her and her husband’s relationship with their
daughter. They told Claire that they loved and sup-
ported her; they thanked her for telling them what
she was feeling. But they stopped short of encourag-
ing her to transition. “We let her completely explore
this on her own,” Heather told me.
90 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
To Claire’s parents, her anguish seemed to come
out of nowhere. Her childhood had been free of gen-
der dysphoria—the clinical term for experiencing a
powerful sense of disconnection from your assigned
sex. They were concerned that what their daughter
had self-diagnosed as dysphoria was simply the tra-
vails of puberty.
As Claire passed into her teen years, she continued
to struggle with mental-health problems. Her parents
found her a therapist, and while that therapist worked
on Claire’s depression and anxiety—she was waking
up several times a night to make sure her alarm clock
was set correctly—she didn’t feel qualiied to help her
patient with gender dysphoria. The therapist referred
the family to some nearby gender-identity clinics that
ofered transition services for young people.
Claire’s parents were wary of starting that process.
Heather, who has a doctorate in pharmacology, had
begun researching youth gender dysphoria for herself.
She hoped to better understand why Claire was feel-
ing this way and what she and Mike could do to help.
Heather concluded that Claire met the clinical crite-
ria for gender dysphoria in the DSM-5, the American
Psychiatric Association’s diagnostic manual. Among
other indications, her daughter clearly didn’t feel like
a girl, clearly wanted a boy’s body, and was deeply
distressed by these feelings. But Heather questioned
whether these criteria, or much of the information
she found online, told the whole story. “Psychologists
know that adolescence is fraught with uncertainty
and identity searching, and this isn’t even acknowl-
edged,” she told me.
Heather said most of the resources she found for
parents of a gender-dysphoric child told her that if
her daughter said she was trans, she was trans. If
her daughter said she needed hormones, Heather’s
responsibility was to help her get on hormones. The
most important thing she could do was airm her
daughter, which Heather and Mike interpreted as
meaning they should agree with her declarations that
she was transgender. Even if they weren’t so certain.
S H E A T H E R WA S S E A R C H I N G for
A answers, Claire’s belief that she should
transition was growing stronger. For
months, she had been insistent that she wanted both
testosterone and “top surgery”—a double mastec-
tomy. She repeatedly asked her parents to ind her
doctors who could get her started on a path to physi-
cal transition. Heather and Mike bought time by
telling her they were looking but hadn’t been able to
ind anyone yet. “We also took her kayaking, played
more board games with her and watched more TV
with her, and took other short family trips,” Heather
recalled. “We also took away her ability to search
online but gave her Instagram as a consolation.”
They told her they realized that she was in pain, but
they also felt, based on what they’d learned in their
research, that it was possible her feelings about her
gender would change over time. They asked her to
start keeping a journal, hoping it would help her
explore those feelings.
 Claire humored her parents, even as her frustration
with them mounted. Eventually, though, something
shifted. In a journal entry Claire wrote last November,
she traced her realization that she wasn’t a boy to one
key moment. Looking in the mirror at a time when she
was trying to present in a very male way—at “my baggy,
uncomfortable clothes; my damaged, short hair; and
my depressed-looking face”—she found that “it didn’t
make me feel any better. I was still miserable, and I
still hated myself.” From there, her distress gradually
began to lift. “It was kind of sudden when I thought:
You know, maybe this isn’t the right answer—maybe it’s
something else,” Claire told me. “But it took a while to
actually set in that yes, I was deinitely a girl.”
Claire believes that her feeling that she was a boy
stemmed from rigid views of gender roles that she
had internalized. “I think I really had it set in stone
what a guy was supposed to be like and what a girl
was supposed to be like. I thought that if you didn’t
follow the stereotypes of a girl, you were a guy, and if
you didn’t follow the stereotypes of a guy, you were a
girl.” She hadn’t seen herself in the other girls in her
middle-school class, who were breaking into cliques
and growing more gossipy. As she got a bit older, she
found girls who shared her interests, and started to
feel at home in her body.
Heather thinks that if she and Mike had heeded
the information they found online, Claire would
have started a physical transition and regretted it
later. These days, Claire is a generally happy teenager
whose mental-health issues have improved markedly.
She still admires people, like Miles McKenna, who
beneited from transitioning. But she’s come to real-
ize that’s just not who she happens to be.
H E N U M B E R O F self-identifying trans
T people in the United States is on the rise. In
June 2016, the Williams Institute at the UCLA
School of Law estimated that 1.4 million adults in
the U.S. identify as transgender, a near-doubling
of an estimate from about a decade earlier. As of
2017, according to the institute, about 150,000 teen-
agers ages 13 to 17 identiied as trans. The number of
young people seeking clinical services appears to be
growing as well. A major clinic in the United King-
dom saw a more than 300 percent increase in new
referrals over the past three years. In the U.S., where
youth gender clinics are somewhat newer—40 or so
are scattered across the country—solid numbers are
harder to come by. Anecdotally, though, clinicians
are reporting large upticks in new referrals, and wait-
ing lists can stretch to ive months or longer.
The current era of gender-identity awareness has
undoubtedly made life easier for many young people
who feel constricted by the sometimes-oppressive
nature of gender expectations. A rich new language
has taken root, granting kids who might have felt
alone or excluded the words they need to describe
their experiences. And the advent of the internet has
allowed teenagers, even ones in parts of the country
where acceptance of gender nonconformity contin-
ues to come far too slowly, to ind others like them.
But when it comes to the question of physical inter-
ventions, this era has also brought fraught new chal-
lenges to many parents. Where is the line between
not “feeling like” a girl because society makes it dif-
icult to be a girl and needing hormones to alleviate
dysphoria that otherwise won’t go away? How can
parents tell? How can they help their children gain
access to the support and medical help they might
need, while also keeping in mind that adolescence is,
by deinition, a time of fevered identity exploration?
There is no shortage of information available for
parents trying to navigate this diicult terrain. If you
read the bible of medical and psychiatric care for
transgender people—the Standards of Care issued by
the World Professional Association for Transgender
Health (WPATH)—you’ll find an 11-page section
called “Assessment and Treatment of Children and
Adolescents With Gender Dysphoria.” It states that
while some teenagers should go on hormones, that
decision should be made with deliberation: “Before
any physical interventions are considered for adoles-
cents, extensive exploration of psychological, family,
and social issues should be undertaken.” The Ameri-
can Psychological Association’s guidelines sound a
similar note, explaining the
beneits of hormones but also
noting that “adolescents can
become intensely focused on
their immediate desires.” It
goes on: “This intense focus How can parents
on immediate needs may cre-
ate challenges in assuring that
get children
adolescents are cognitively the support
and emotionally able to make they might need
life-altering decisions.”
The leading professional while keeping
organizations ofer this guid-
ance. But some clinicians
in mind that
adolescence is,
are moving toward a faster
process. And other resources, by definition,
including those produced by a time of identity
major LGBTQ organizations,
place the emphasis on accep-
exploration?
tance rather than inquiry. The
Human Rights Campaign’s
“Transgender Children &
Youth: Understanding the
Basics” web page, for example, encourages parents
to seek the guidance of a gender specialist. It also
asserts that “being transgender is not a phase, and
trying to dismiss it as such can be harmful during a
time when your child most needs support and valida-
tion.” Similarly, parents who consult the pages tagged
“transgender youth” on GLAAD’s site will ind many
articles about supporting young people who come out
as trans but little about the complicated diagnostic
and developmental questions faced by the parents of
a gender-exploring child.
HRC, GLAAD, and like-minded advocacy groups
emphasize the acceptance of trans kids for under-
standable reasons: For far too long, parents, as well
as clinicians, denied the possibility that trans kids
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 91
 and teens even existed, let alone that they should be
allowed to transition. Many such organizations are
primarily concerned with raising awareness and cor-
recting still-common misconceptions.
A similar motive seems to animate much of the
media coverage of transgender young people. Two
genres of coverage have emerged. Dating back at
least to the 1993 murder of the Nebraska 21-year-old
Brandon Teena, which inspired a documentary as
well as the ilm Boys Don’t Cry, a steady stream of hor-
ror stories has centered on bullying, physical assault,
and suicide—real risks that transgender and gender-
nonconforming (TGNC) young people still face.
More recently, a wave of success stories has
appeared. In many of these accounts, kids are lost,
confused, and frustrated right up until the moment
they are allowed to grow their hair out and adopt a
new name, at which point they inally become their
true self. Take, for example, a Parents.com article
in which a mother, writing
pseudonymously, explains
that she struggled with
her child’s gender- identity
issues for years, until inally
For many turning to a therapist, who,
young people after a 20-minute evaluation,
in early studies, pronounced the child trans.
Suddenly, everything clicked
transitioning into place. The mother writes:
appears to “I looked at the child sitting
have greatly between my husband and
me, the child who was smil-
alleviated their ing, who appeared so happy,
dysphoria. who looked as if someone
But it’s not finally saw him or her the
way she or he saw him or
the answer herself.” In a National Geo-
for everyone. graphic special issue on gen-
der, the writer Robin Marantz
Henig recounts the story of a
mother who let her 4-year-old,
assigned male at birth, choose
a girl’s name, start using female pronouns, and attend
preschool as a girl. “Almost instantly the gloom lifted,”
Henig writes.
Accounts of successful transitions can help fami-
lies envision a happy outcome for a sufering child.
And some young people clearly experience some-
thing like what these caterpillar-to-butterly narra-
tives depict. They have persistent, intense gender
dysphoria from a very young age, and transitioning
alleviates it. “Some kids don’t waver” in their gender
identity, Nate Sharon, a psychiatrist who oversaw a
gender clinic in New Mexico for two and a half years,
and who is himself trans, told me when we spoke in
2016. “I’m seeing an 11-year-old who at age 2 went
up to his mom and said, ‘When am I going to start
growing my penis? Where’s my penis?’ At 2.”
But these stories tend to elide the complexities
of being a TGNC young person, or the parent of one.
Some families will ind a series of forking paths, and
won’t always know which direction is best. Like
92 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
Claire’s parents, they may be convinced that their
child is in pain, but also concerned that physical
transition is not the solution, at least not for a young
person still in the throes of adolescence.
E A R E S T I L L in the earliest stages of
W understanding how physical transitioning
afects dysphoric young people. While the
speciics depend on your child’s age, and can vary
from case to case, the transition process for a persis-
tently dysphoric child typically looks something like
the following. First, allow your child to transition
socially: to adopt the pronouns and style of dress of
their authentic gender, and to change their name if
they wish. As your child approaches adolescence, get
them puberty-blocking drugs, because developing
the secondary sex characteristics of their assigned
sex could exacerbate their gender dysphoria. When
they reach their teen years, help them gain access
to the cross-sex hormones that will allow them to
develop secondary sex characteristics in line with
their gender identity. (Until recently, hormones were
typically not prescribed until age 16; it’s now more
common for 15- and 14-year-olds, and sometimes
even younger kids, to begin hormone therapy.)
In the United States, avoiding puber ty became
an option only a little more than a decade ago, so
researchers have just begun tracking the kids
engaged in this process, and we don’t yet have
comprehensive data about their long-term out-
comes. Most of the data we do have involve kids
who socially transitioned at an early age, but who
hadn’t yet physically transitioned. The information
comes from a University of Washington researcher
named Kristina Olson. Olson is the founder of the
TransYouth Project, which is following a cohort of
about 300 children for 20 years—the longest such
longitudinal study based in the U.S. The kids she is
tracking appear to be doing well—they don’t seem
all that diferent, in terms of their mental health and
general happiness, from a control group of cisgender
kids (that is, kids who identify with the sex they were
assigned at birth).
At the prestigious Center of Expertise on Gender
Dysphoria, at Vrije Universiteit University Medical
Center, in Amsterdam—often referred to simply
as “the Dutch clinic”—an older cohort of kids who
went through the puberty-blockers-and-cross-sex-
hormones protocol was also found to be doing well:
“Gender dysphoria had resolved,” according to a
study of the group published in 2014 in Pediatrics.
“Psychological functioning had steadily improved,
and well-being was comparable to same-age peers.”
These early results, while promising, can tell us
only so much. Olson’s indings come from a group of
trans kids whose parents are relatively wealthy and
are active in trans-support communities; they volun-
teered their children for the study. There are limits to
how much we can extrapolate from the Dutch study
as well: That group went through a comprehensive
diagnostic process prior to transitioning, which
included continuous access to mental-health care at
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a top-tier gender clinic—a process unfortunately not
available to every young person who transitions.
Among the issues yet to be addressed by long-
term studies are the efects of medications on young
people. As Thomas Steensma, a psychologist and
researcher at the Dutch clinic and a co-author of
that study, explained to me, data about the potential
risks of putting young people on puberty blockers
are scarce. He would like to see further research into
the possible efects of blockers on bone and brain
development. (The potential long-term risks of cross-
sex hormones aren’t well known, but are likely mod-
est, according to Joshua Safer, one of the authors of
the Endocrine Society’s “Clinical Practice Guideline”
for treatment of gender dysphoria.)
Meanwhile, fundamental questions about gen-
der dysphoria remain unanswered. Researchers still
don’t know what causes it—gender identity is gen-
erally viewed as a complicated weave of biological,
psychological, and sociocultural factors. In some
cases, gender dysphoria may interact with mental-
health conditions such as depression and anxiety, but
there’s little agreement about how or why. Trauma,
particularly sexual trauma, can contribute to or
exacerbate dysphoria in some patients, but again, no
one yet knows exactly why.
To reiterate: For many of the young people in the
early studies, transitioning— socially for children,
physically for adolescents and young adults—appears
to have greatly alleviated their dysphoria. But it’s not
the answer for everyone. Some kids are dysphoric
from a very young age, but in time become com-
fortable with their body. Some develop dysphoria
around the same time they enter puberty, but their
sufering is temporary. Others end up identifying as
nonbinary—that is, neither male nor female.
Ignoring the diversity of these experiences and
focusing only on those who were efectively “born
in the wrong body” could cause harm. That is the
argument of a small but vocal group of men and
women who have transitioned, only to return to their
assigned sex. Many of these so-called detransitioners
argue that their dysphoria was caused not by a deep-
seated mismatch between their gender identity and
their body but rather by mental-health problems,
trauma, societal misogyny, or some combination of
these and other factors. They say they were nudged
toward the physical interventions of hormones or sur-
gery by peer pressure or by clinicians who overlooked
other potential explanations for their distress.
Some of these interventions are irreversible. Peo-
ple respond diferently to cross-sex hormones, but
changes in vocal pitch, body hair, and other physical
characteristics, such as the development of breast tis-
sue, can become permanent. Kids who go on puberty
blockers and then on cross-sex hormones may not
be able to have biological children. Surgical inter-
ventions can sometimes be reversed with further
surgeries, but often with disappointing results.
The concerns of the detransitioners are echoed by
a number of clinicians who work in this ield, most of
whom are psychologists and psychiatrists. They very
94 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
much support so-called airming care, which entails
accepting and exploring a child’s statements about
their gender identity in a compassionate manner. But
they worry that, in an otherwise laudable efort to get
TGNC young people the care they need, some mem-
bers of their ield are ignoring the complexity, and
luidity, of gender-identity development in young
people. These colleagues are approving teenagers
for hormone therapy, or even top surgery, without
fully examining their mental health or the social and
family inluences that could be shaping their nascent
sense of their gender identity.
That’s too narrow a deinition of airming care, in
the view of many leading clinicians. “Airming care
does not privilege any one outcome when it comes to
gender identity, but instead aims to allow exploration
of gender without judgment and with a clear under-
standing of the risks, beneits, and alternatives to any
choice along the way,” Aron Janssen, the clinical direc-
tor of the Gender and Sexuality Service at Hassenfeld
Children’s Hospital, in New York, told me. “Many peo-
ple misinterpret airming care as proceeding to social
and medical transition in all cases without delay, but
the reality is much more complex.”
To make sense of this complex reality—and
ensure the best outcome for all gender-exploring
kids—parents need accurate, nuanced information
about what gender dysphoria is and about the many
blank spots in our current knowledge. They don’t
always get it.
OR GENDER-DYSPHORIC PEOPLE, physi-
F cal transition can be life enhancing, even
lifesaving. While representative long-term
data on the well-being of trans adults have yet to
emerge, the evidence that does exist—as well as the
sheer heft of personal accounts from trans people
and from the clinicians who help them transition—is
overwhelming. For many if not most unwaveringly
gender- dysphoric people, hormones work. Surgery
works. That’s relected in studies that consistently
show low regret rates for the least-reversible physi-
cal procedures to address gender dysphoria. One
2012 review of past studies, for example, found that
sex-reassignment surgery “is an efective treatment
for [gender dysphoria] and the only treatment that
has been evaluated empirically with large clinical
case series.” A study on “bottom surgery,” or surgery
designed to construct a penis or vagina, found that
from 1972 to 2015, “only 0.6 percent of transwomen
and 0.3 percent of transmen who underwent [these
procedures] were identiied as experiencing regret.”
Those of us who have never sufered from gender
dysphoria can have a hard time appreciating what’s
at stake. Rebecca Kling, an educator at the National
Center for Transgender Equality, in Washington, D.C.,
told me that before she transitioned she felt as if she
were constantly carrying around a backpack full of
rocks. “That is going to make everything in my life
harder, and in many cases is going to make things
impossible,” she said. “Of course being able to remove
that heavy burden has added comfort and stability in
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 my sense of myself and my body.” Other
trans people have ofered similar descrip-
tions of gender dysphoria—a weight, a
buzzing, an unavoidable source of rumi-
nation and worry. Hormones and surgery
grant transgender people profound relief.
Historically, they have been denied
access to that relief. Christine Jorgensen,
the first American to become widely
known for transitioning through hor-
mones and surgery, in the 1950s, had to go
to Denmark for her care. The trans histo-
rian Genny Beemyn notes that Jorgensen’s
doctor “received more than 1,100 letters
from transsexual people, many of whom
sought to be his patients,” in the months
after Jorgensen was treated. As a result
of the requests, “the Danish government
banned such procedures for non-citizens.
In the United States, many physicians sim-
ply dismissed the rapidly growing number
of individuals seeking gender-affirming
surgeries as being mentally ill.”
Today, the situation in the U.S. has
Max Robinson improved, but the lack of access to tran-
went on cross-sex sition services continues to be a problem.
hormones when Whether trans people in this country can
she was 16 and
access treatments such as hormones and
had a double
surgery depends on a variety of factors,
mastectomy
when she was 17.
ranging from where they live to what
Now 22, she has their health insurance will cover (if they
detransitioned have any) to their ability to navigate piles
and identifies of paperwork. Erica Anderson, a trans
as a woman. woman and clinical psychologist who
works at the Child and Adolescent Gen-
der Center, at UC San Francisco’s Beniof
Children’s Hospital, had no luck when
she tried to get hormones from an endocrinologist in “informed consent” protocols, built on the philoso-
Philadelphia just a decade ago. “Even I, with my edu- phy that trans adults, once informed of the potential
cation and resources, was denied care and access,” beneits and risks of medical procedures, have a right
she told me. “The endocrinologist simply said, ‘I to make their own decisions about their body and
don’t do that.’ I ofered to provide her the guidelines shouldn’t have their need for services questioned by
from her own Endocrine Society,” Anderson said. mental-health and medical professionals.
“She refused and wouldn’t even look me in the eye. This shift is seen by many trans people and advo-
No referral or ofer to help. She sent me away with cates as an important course correction after decades
nothing, feeling like I was an undesirable.” of gatekeeping—aloof professionals telling trans peo-
Many trans people have stories like Anderson’s. ple they couldn’t get hormones or surgery, because
For this reason, among others, trans communities they weren’t really trans, or hadn’t been living as a
can be skeptical of those who focus on negative tran- trans person long enough, or were too mentally ill.
sition outcomes. They have long dealt with “profes-
sionals who seem uncomfortable giving trans people OR GENDER- QUESTIONING CHILDREN
the go-ahead to transition at all,” Zinnia Jones, a
trans woman who runs the website GenderAnalysis,
F and teens, the landscape is diferent. A minor’s
legal guardian almost always has to provide
told me in an email. They have also faced “unneces- consent prior to a medical procedure, whether it’s
sarily protracted timelines for accessing care, a lack of a tonsillectomy or top surgery. WPATH and other
understanding or excess skepticism of our identities organizations that provide guidance for transitioning
from clinicians, and so on.” young people call for thorough assessments of patients
Groups like WPATH, the primary organization before they start taking blockers or hormones.
for psychologists, psychiatrists, endocrinologists, This caution comes from the concerns inherent
surgeons, and others who work with TGNC clients, in working with young people. Adolescents change
have attempted to reverse this neglect in recent years. signiicantly and rapidly; they may view themselves
A growing number of adult gender clinics follow and their place in the world differently at 15 than

96 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C PHOTOGRAPH BY CHLOE AFTEL

 they did at 12. “You’ve got the onset of
puberty right around the age where they
develop the concept of abstract thinking,”
said Nate Sharon, the New Mexico psychi-
atrist. “So they may start to conceptualize
gender concepts in a much richer, broader
manner than previously—and then maybe
puberty blockers or cross-sex hormones
aren’t for them.” That was true for Claire:
A shift in her understanding of the nature
of gender led her to realize that transition-
ing was not the answer for her.
For younger children, gender identity
is an even trickier concept. In one experi-
ment, for example, many 3-to-5-year-olds
thought that if a boy put on a dress, he
became a girl. Gender clinicians some-
times encounter young children who
believe they are, or want to be, another
gender because of their dress or play
preferences—I like rough-and-tumble play,
so I must be a boy—but who don’t meet the
criteria for gender dysphoria.
In the past, therapists and doctors
interpreted the fluidity of gender iden-
tity among children as license to put
gender-bending kids into the “right” box
by encouraging—or forcing—them to
play with the “right” toys and dress in
the “right” clothes. Until about ive years
ago, according to one clinician’s estimate,
social transition was often frowned upon.
For decades, trans-ness was sometimes
tolerated in adults as a last-ditch out-
come, but in young people it was more
often seen as something to be drummed
out rather than explored or accepted. So-
called reparative therapy has harmed and humiliated
trans and gender-nonconforming children. In her
book Gender Born, Gender Made, Diane Ehrensaft, the
director of mental health at UC San Francisco’s Child
and Adolescent Gender Center, writes that victims of
these practices “become listless or agitated, long for
their taken-away favorite toys and clothes, and even
literally go into hiding in closets to continue play-
ing with the verboten toys or wearing the forbidden
clothes.” Such therapy is now viewed as unethical.
These days, mainstream youth-gender clinicians
practice airming care instead. They listen to their
young patients, take their statements about their gen-
der seriously, and often help facilitate social and physi-
cal transition. Airming care has quickly become a
professional imperative: Don’t question who your cli-
ents are—let them tell you who they are, and accept
their identity in a nurturing, encouraging manner.
The airming approach is far more humane than
older ones, but it conlicts, at least a little, with what
we know about gender-identity fluidity in young
people. What does it mean to be affirming while
acknowledging that kids and teenagers can have
an understanding of gender that changes over a
short span? What does it mean to be airming while
acknowledging that feelings of gender dysphoria can
be exacerbated by mental-health diiculties, trauma,
or a combination of the two?
Clinicians are still wrestling with how to define
airming care, and how to balance airmation and
caution when treating adolescents. “I don’t want to
be a gatekeeper,” Dianne Berg, a co-director of the
National Center for Gender Spectrum Health, at the
University of Minnesota, told me. “But I also worry that
in opening the gates, we’re going to have more adoles-
cents that don’t engage in the relective work needed
in order to make sound decisions, and there might
end up being more people when they are older that
are like, Oh, hmm—now I am not sure about this.”
HEN MAX ROBINS ON was 17, getting a
W double mastectomy made perfect sense to
her. In fact, it felt like her only option—like
a miraculous, lifesaving proce-
dure. Though she had a wom-
an’s body, she was really a man.
Surgery would inally ofer her
a chance to be herself.
I met Max, now 22, in an Affirming care
airy café in the quiet southern- is far more
Oregon town where she lives.
She was wearing a T-shirt
humane
with a flannel button-down than older
over it. On her head, a gray philosophies.
winter cap; at her feet, a
shaggy white service dog. By But it conflicts,
the time we met, we’d spoken at least a little,
on the phone and exchanged a
number of emails, and she had
with what we
told me her story—one that know about
suggests the complexity of gender-identity
gender-identity development.
Max recalled that as early
fluidity in
as age 5, she didn’t enjoy being young people.
treated like a girl. “I ques-
tioned my teachers about why
I had to make an angel instead
of a Santa for a Christmas craft,
or why the girls’ bathroom pass had ribbons instead
of soccer balls, when I played soccer and knew lots
of other girls in our class who loved soccer,” she said.
She grew up a happy tomboy—until puberty.
“People expect you to grow out of it” at that age, she
explained, “and people start getting uncomfortable
when you don’t.” Worse, “the way people treated me
started getting increasingly sexualized.” She remem-
bered one boy who, when she was 12, kept asking her
to pick up his pencil so he could look down her shirt.
“I started dissociating from my body a lot more
when I started going through puberty,” Max said. Her
discomfort grew more internalized—less a frustration
with how the world treated women and more a sense
that the problem lay in her own body. She came to
believe that being a woman was “something I had to
control and ix.” She had tried various ways of making
her discomfort abate—in seventh grade, she vacillated
between “dressing like a 12-year-old boy” and wearing
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 97
 revealing, low-cut outits, attempts to defy and accede
to the demands the world was making of her body. But
nothing could banish her feeling that womanhood
wasn’t for her. She had more bad experiences with
men, too: When she was 13, she had sex with an older
man she was seeing; at the time, it felt consensual, but
she has since realized that a 13-year-old can’t consent
to sex with an 18-year-old. At 14, she witnessed a
friend get molested by an adult man at a church slum-
ber party. Around this time, Max was diagnosed with
depression and generalized anxiety disorder.
In ninth grade, Max irst encountered the concept
of being transgender when she watched an episode
of The Tyra Banks Show in which Buck Angel, a trans
porn star, talked about his transition. It opened up a
new world of online gender-identity exploration. She
gradually decided that she needed to transition.
Max’s parents were skeptical at irst but eventually
came around, signing her up for sessions with a thera-
pist who specialized in gender-identity issues. She
recalled that the specialist was very open to putting
her on a track toward transition, though he suggested
that her discomfort could have other sources as well.
Max, however, was certain
that transitioning was the
answer. She told me that she
“refused to talk about anything
“I’m a real-live other than transition.”
When Max was 16, her
22-year-old therapist wrote her a referral
woman with a to see an endocrinologist who
scarred chest and
a broken voice
could help her begin the pro-
cess of physical transition by
prescribing male hormones.
and a 5 o’clock The endocrinologist was
shadow because skeptical, Max said. “I think
what she was seeing was a
I couldn’t face lesbian teenager,” not a trans
the idea of one. At the time, though, Max
growing up to be interpreted the doctor’s reluc-
tance as her “being ignor-
a woman,” said ant, as her trying to hurt me.”
Cari Stella, a Armed with the referral from
her therapist, Max got the
detransitioner. endocrinologist to prescribe
the treatment she sought.
Max started taking tes-
tosterone. She experienced
some side efects—hot lashes, memory issues—but
the hormones also provided real relief. Her plan all
along had been to get top surgery, too, and the ini-
tially promising efects of the hormones helped per-
suade her to continue on this path. When she was 17,
Max, who was still dealing with major mental-health
issues, was scheduled for surgery.
Because Max had parental approval, the surgeon
she saw agreed to operate on her despite the fact
that she was still a minor. (It’s become more com-
mon for surgeons to perform top surgeries on teen-
agers as young as 16 if they have parental approval.
The medical norms are more conservative when it
comes to bottom surgeries; WPATH says they should
98 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
be performed only on adults who have been living
in their gender role for at least one year.) Max went
into the surgery optimistic. “I was convinced it would
solve a lot of my problems,” she said, “and I hadn’t
accurately named a lot of those problems yet.”
Max was initially happy with the results of her
physical transformation. Before surgery, she wasn’t
able to fully pass as male. After surgery, between her
newly masculinized chest and the facial hair she was
able to grow thanks to the hormones, she felt like she
had left behind the sex she had been assigned at birth.
“It felt like an accomplishment to be seen the way I
wanted to be seen,” she told me.
But that feeling didn’t last. After her surgery, Max
moved from her native California to Portland and
threw herself into the trans scene there. It wasn’t a
happy home. The clarity of identity she was seeking—
and that she’d felt, temporarily, after starting hor-
mones and undergoing surgery—never fully set in.
Her discomfort didn’t go away.
Today, Max identiies as a woman. She believes
that she misinterpreted her sexual orientation, as
well as the efects of the misogyny and trauma she
had experienced as a young person, as being about
gender identity. Because of the hormone therapy,
she still has facial hair and is frequently mistaken for
male as a result, but she has learned to live with this:
“My sense of self isn’t entirely dependent on how
other people see me.”
AX IS ONE of what appears to be a growing
M number of people who believe they were
failed by the therapists and physicians they
went to for help with their gender dysphoria. While
their individual stories difer, they tend to touch on
similar themes. Most began transitioning during ado-
lescence or early adulthood. Many were on hormones
for extended periods of time, causing permanent
changes to their voice, appearance, or both. Some,
like Max, also had surgery.
Many detransitioners feel that during the process
leading up to their transition, well-meaning clini-
cians left unexplored their overlapping mental-health
troubles or past traumas. Though Max’s therapist
had tried to work on other issues with her, Max now
believes she was encouraged to rush into physical
transition by clinicians operating within a framework
that saw it as the only way someone like her could
experience relief. Despite the fact that she was a
minor for much of the process, she says, her doctors
more or less did as she told them.
Over the past couple of years, the detransitioner
movement has become more visible. Last fall, Max
told her story to The Economist’s magazine of cul-
ture and ideas, 1843. Detransitioners who previously
blogged pseudonymously, largely on Tumblr, have
begun writing under their real names, as well as
speaking on camera in YouTube videos.
Cari Stella is the author of a blog called Guide on
Raging Stars. Stella, now 24, socially transitioned
at 15, started hormones at 17, got a double mastec-
tomy at 20, and detransitioned at 22. “I’m a real-live
22-year-old woman with a scarred chest and a broken
voice and a 5 o’clock shadow because I couldn’t face
the idea of growing up to be a woman,” she said in a
video posted in August 2016. “I was not a very emo-
tionally stable teenager,” she told me when we spoke.
Transitioning ofered a “level of control over how I
was being perceived.”
Carey Callahan is a 36-year-old woman living in
Ohio who detransitioned after identifying as trans
for four years and spending nine months on male
hormones. She previously blogged under the pseudo-
nym Maria Catt, but “came out” in a YouTube video in
July 2016. She now serves as something of an older sister
to a network of female, mostly younger detransitioners,
about 70 of whom she has met in person; she told me
she has corresponded online with an additional 300.
(The detransitioners who have spoken out thus far
are mostly people who were assigned female at birth.
Traditionally, most new arrivals at youth gender clinics
were assigned male; today, many clinics are reporting
that new patients are mostly assigned female. There is
no consensus explanation for the change.)
I met Carey in Columbus in March. She told me
that her decision to detransition grew out of her
experience working at a trans clinic in San Francisco
in 2014 and 2015. “People had said often to me that
when you transition, your gender dysphoria gets
worse before it gets better,” she told me. “But I saw
and knew so many people who were cutting them-
selves, starving themselves, never leaving their apart-
ments. That made me doubt the narrative that if you
P H OTO G R A P H S BY M AT T E I C H
make it all the way to medical transition, then it’s Carey Callahan
probably going to work out well for you.” serves as something
Carey said she met people who appeared to be of an older sister to
a group of women
grappling with severe trauma and mental illness,
who, like her, have
but were ixated on their next transition milestone,
detransitioned.
convinced that was the moment when they would
get better. “I knew a lot of people committed to that
narrative who didn’t seem to be doing well,” she
recalled. Carey’s time at the clinic made her real-
ize that testosterone hadn’t made her feel better in a
sustained way either. She detransitioned, moved to
Ohio, and is now calling for a more careful approach
to treating gender dysphoria than what many detran-
sitioners say they experienced themselves.
In part, that would mean clinicians adhering to
guidelines like WPATH’s Standards of Care, which
are nonbinding. “When I look at what the SOC
describes, and then I look at my own experience and
my friends’ experiences of pursuing hormones and
surgery, there’s hardly any overlap between the direc-
tives of the SOC and the reality of care patients get,”
Carey told me. “We didn’t discuss all the implications
of medical intervention—psychological, social, physi-
cal, sexual, occupational, inancial, and legal—which
the SOC directs the mental-health professional to
discuss. What the SOC describes and the care people
get before getting cleared for hormones and surgery
are miles apart.”
Detransitioners, understandably, elicit suspicion
from the trans community. Imagine being a trans
person who endured a bruising ight to prove to your
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 99
 psychiatrist and endocrinologist that you are trans, in
order to gain access to hormones that greatly improve
your quality of life, that relieve sufering. You might
view with skepticism—at the very least—a group
calling for more gatekeeping. Conservative media
outlets, for their part, often seize on detransition
narratives to push the idea that being trans is some
sort of liberal invention. “How Carey Was Set Free
From Transgenderism” was the conservative website
LifeSiteNews’ disingenuous take on Carey’s story.
No one knows how common detransitioning is.
A frequently cited statistic—that only 2.2 percent
of people who physically transition later regret it—
doesn’t paint a complete picture. It comes from a
study, conducted in Sweden, that examined only
those people who had undergone sex-reassignment
surgery and legally changed their gender, then
applied to change their gender back—a standard
that, Carey pointed out, would have excluded her
Laura Edwards- and most of the detransitioners she knows.
Leeper, a clinician at It stands to reason that as any medical procedure
Pacific University
becomes more readily available, a higher number of
and Oregon’s
people will regret having it. Why focus on detran-
Transgender Clinic.
She brought the
sitioners, when no one even knows whether their
puberty-blocking experiences are all that common? One answer is that
transition protocol clinicians who have logged thousands of hours work-
pioneered by the ing with transgender and gender-nonconforming
Dutch to the U.S. young people are raising the same concerns.
100 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
HEN IT C OME S to helping TGNC young
W people gain access to physical inter-
ventions, few American clinicians possess
the bona ides of the psychologist Laura Edwards-
Leeper. A decade ago, when she was working at Bos-
ton Children’s Hospital, she visited the Dutch clinic
to learn the puberty-blocking protocol pioneered
there. She helped bring that protocol back to Boston,
where she worked with the irst-ever group of Ameri-
can kids to go through that process.
Today, Edwards-Leeper oversees a collaboration
between Paciic University and Oregon’s Transgender
Clinic, within the nonproit Legacy Health system. At
Paciic, she is training clinical-psychology doctoral stu-
dents to conduct “readiness assessments” for young
people seeking physical-transition services.
In February, I visited one of her classes at Paciic,
just outside Portland. For an hour, she let me pepper
her students with questions about their experiences
as clinicians-in-training in what is essentially a brand-
new ield. When the subject of detransitioners came
up, Edwards-Leeper chimed in. “I’ve been predict-
ing this for, I don’t know, the last ive or more years,”
she said. “I anticipate there being more and more
and more, because there are so many youth who are
now getting services with very limited mental-health
assessment and sometimes no mental-health assess-
ment. It’s inevitable, I think.”
 Edwards-Leeper believes that comprehensive
assessments are crucial to achieving good outcomes
for TGNC young people, especially those seeking
physical interventions, in part because some kids
who think they are trans at one point in time will not
feel that way later on. This is a controversial subject
in some corners of the trans community. A small
group of studies has been interpreted as showing
that the majority of children who experience gender
dysphoria eventually stop experiencing it and come
to identify as cisgender adults. (In these studies, chil-
dren who sufer intense dysphoria over an extended
period of time, especially into adolescence, are more
likely to identify as trans in the long run.)
This so-called desistance research has been
attacked on various methodological grounds. The
most-credible critiques center on the claim that some
kids who were merely gender nonconforming—that is,
they preferred stereotypically cross-sex activities
or styles of dress—but not dysphoric may have been
counted as desisters because the studies relied on out-
dated diagnostic criteria, artiicially pushing the per-
centage upward. (The terms detransition and desist
are used in diferent ways by diferent people. In this
article, I am drawing this distinction: Detransitioners
are people who undergo social or physical transitions
and later reverse them; desisters are people who stop
experiencing gender dysphoria without having fully
transitioned socially or physically.)
The desistance rate for accurately diagnosed
dysphoric kids is probably lower than some of the
contested studies suggest; a small number of merely
gender-nonconforming kids may indeed have been
wrongly swept into even some of the most recent stud-
ies, which didn’t use the most up-to-date criteria, from
the DSM-5. And there remains a paucity of big, rigor-
ous studies that might deliver a more reliable igure.
Within a subset of trans advocacy, however, desis-
tance isn’t viewed as a phenomenon we’ve yet to fully
understand and quantify but rather as a myth to be dis-
pelled. Those who raise the subject of desistance are
often believed to have nefarious motives—the liberal
outlet ThinkProgress, for example, referred to desis-
tance research as “the pernicious junk science stalking
trans kids,” and a subgenre of articles and blog posts
attempts to debunk “the desistance myth.” But the
evidence that desistance occurs is overwhelming. The
American Psychological Association, the Substance
Abuse and Mental Health Services Administration,
the Endocrine Society, and WPATH all recognize that
desistance occurs. I didn’t speak with a single clinician
who believes otherwise. “I’ve seen it clinically hap-
pen,” Nate Sharon said. “It’s not a myth.”
Despite this general agreement, Edwards-Leeper
worries that treatment practices are trending toward
an interpretation of airming care that entails nodding
along with children and adolescents who say they want
physical interventions rather than evaluating whether
they are likely to beneit from them.
A decade ago, the opposite was true. “I was con-
stantly having to justify why we should be ofering
puberty-blocking medication, why we should be
supporting these trans youth to get the services they
need,” Edwards-Leeper recalled. “People thought this
was just crazy, and thought the four-hour evaluations
I was doing were, too—how could that possibly be
enough to decide whether to go forward with the medi-
cal intervention? That was 2007, and now the ques-
tions I get are ‘Why do you make people go through
any kind of evaluation?’ And ‘Why does mental health
need to be involved in this?’ And ‘We should just listen
to what the kids say and listen to what the adolescents
say and basically just treat them like adults.’ ”
The six trainees on Edwards-Leeper’s Trans-
gender Youth Assessment Team spoke about the
myriad ways mental-health issues and social and
cultural inluences can complicate a child’s concep-
tion of gender. “I would say ‘airming’ isn’t always
doing exactly what the kid says they want in the
moment,” one said. Another
added: “Our role as clinicians
isn’t to conirm or disconirm
someone’s gender identity—
it’s to help them explore it
with a little bit more nuance.”
“I think the
I asked the students whether pendulum has
they had come across the swung so far
idea that conducting in-depth
assessments is insulting or
that now we’re
stigmatizing. They all nodded. maybe not
“Well, they know what reputa- looking as
tion I have,” Edwards-Leeper
said with a laugh. “I told them critically at the
about things almost being issues as we
thrown at me at conferences.”
Those conference troubles
should be,” says
signaled to Edwards-Leeper the psychologist
that her field had shifted in Dianne Berg.
ways she found discomfit-
ing. At one conference a few
years ago, she recalled, a
co-panelist who was a well-
respected clinician in her field said that Edwards-
Leeper’s comprehensive assessments required
kids to “jump through more iery hoops” and were
“retraumatizing.” This prompted a standing ovation
from the audience, mostly families of TGNC young
people. During another panel discussion, at the same
conference with the same clinician, but this time
geared toward fellow clinicians, the same thing hap-
pened: more claims that assessments were traumatiz-
ing, more raucous applause.
Edwards-Leeper isn’t alone in worrying that the
ield is straying from its own established best prac-
tices. “Under the motivation to be supportive and to
be airming and to be nonstigmatizing, I think the
pendulum has swung so far that now we’re maybe
not looking as critically at the issues as we should be,”
the National Center for Gender Spectrum Health’s
Dianne Berg told me. Erica Anderson, the UCSF
clinician, expressed similar concerns: “Some of the
stories we’ve heard about detransitioning, I fear, are
related to people who hastily embarked on medi-
cal interventions and decided that they weren’t for
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 101
 them, and didn’t thoroughly vet their decision either
by themselves or with professional people who could
help them.”
Even some of the clinicians who have emphasized
the need to be deferential to young people acknowl-
edge the complexities at play here. A psychologist
with decades of experience working with TGNC
young people, Diane Ehrensaft is perhaps the most
frequently quoted youth-gender clinician in the
country. She is tireless in her advocacy for trans kids.
“It’s the children who are now leading us,” she told
The Washington Post recently. She sees this as a posi-
tive development: “If you listen to the children, you
will discover their gender,” she wrote in one article.
“It is not for us to tell, but for them to say.”
But when I spoke with Ehrensaft at her home in
Oakland, she described many situations involving
physical interventions in which her work was far
more complicated than simply airming a client’s
self- diagnosis. “This is what I tell kids all the time,
particularly teenagers,” she said. “Often they’re
pushing for fast. I say, ‘Look, I’m old, you’re young.
I go slow, you go fast. We’re going to have to work
that out.’ ” Sometimes, she said, she suspects that a
kid who wants hormones right now is simply recit-
ing something he found on the internet. “It just feels
wooden, is the only thing I can say,” she told me.
At the end of our interview, Ehrensaft showed me
Scott Padberg, a
a slide from a talk she was preparing about what it
16-year-old patient
of Laura Edwards-
means to be an airming clinician: “REALITY: WE
Leeper who went on ARE NEITHER RUBBER STAMPERS NOR PUSH-
cross-sex hormones ERS; WE ARE FACILITATORS.” This isn’t so far of
and recently had a from the deinition of the clinician’s role expressed by
double mastectomy Edwards-Leeper’s students.
102 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
OMPETENT CLINICIANS do occasionally
C challenge their clients’ conception of their
gender identity in order to ensure that they
are approaching the subject in a suiciently sophis-
ticated manner. They want to make sure that a given
patient has gender dysphoria, as defined in the
DSM-5, and that their current gender identity is a con-
sistent part of who they are. If a teenager inds that
his dysphoria lessens signiicantly when he presents
himself in a more feminine way or once his overlap-
ping mental-health problems have been treated, he
may develop a diferent view on the necessity of hor-
mones or surgery.
This is not to say that talk therapy can cure seri-
ous gender dysphoria. Edwards-Leeper worked to
introduce the Dutch protocol of blockers and hor-
mones in the United States precisely because she
believes that it alleviates dysphoria in cases where
there would otherwise be prolonged sufering. But
clinicians like her are also careful, given the upheav-
als of adolescence and the luid conception of gen-
der identity among young people, not to assume that
because a young person has gender dysphoria, they
should automatically go on hormones.
Edwards-Leeper is hoping to promote a concept
of airming care that takes into account the develop-
mental nuances that so often come up in her clinical
work. In this efort, she is joined by Scott Leibowitz, a
psychiatrist who treats children and adolescents. He
is the medical director of behavioral health for the
THRIVE program at Nationwide Children’s Hospital,
in Columbus. Leibowitz has a long history of work-
ing with and supporting TGNC youth—he served as
an expert witness for the Department of Justice in
2016, when President Barack Obama’s administration
challenged state-level “bathroom bills” that sought to
prevent trans people from using the public bathroom
associated with their gender identity. Edwards-Leeper
and Leibowitz met at Boston Children’s, where Leibo-
witz did his psychiatry fellowship, and the two have
been close friends and collaborators ever since.
While it’s understandable, for historical reasons,
why some people associate comprehensive psycho-
logical assessments with denial of access to care, that
isn’t how Leibowitz and Edwards-Leeper view their
approach. Yes, they want to discern whether a patient
actually has gender dysphoria. But comprehensive
assessments and ongoing mental-health work are
also means of ensuring that transitioning—which
can be a physically and emotionally taxing process for
adolescents even under the best of circumstances—
goes smoothly.
Scott Padberg, one of Edwards-Leeper’s patients,
is a good example of how her comprehensive-
assessment process looks for teenagers with a rela-
tively straightforward history of persistent gender
dysphoria and an absence of other factors that might
complicate their diagnosis and transition path. I met
Scott and his grandmother and legal guardian, Nancy,
at a wrap place in Welches, Oregon, not far from where
they live. It was a mild February day, so we sat in one of
the pine booths outside the restaurant. Mount Hood’s
massive snowcapped peak loomed nearby.
Scott, a 16-year-old who radiates calm, explained
that despite having been assigned female at birth,
he simply never felt like a girl. “I guess I kinda felt
diferent since I felt conscious of the fact that I was Orion Foss worked
alive,” he said. For part of his childhood, that was ine with the clinicians
with everyone around him. He was granted all the at Ohio’s THRIVE
freedom he needed to express himself in a gender- clinic on his
mental health, his
nonconforming manner, from getting short haircuts
mother’s concerns,
to playing with stereotypically male toys like dino-
and, eventually,
saurs and Transformers. But the freedom didn’t last. his transition.
When he was 7, his mom married a “super Christian
guy” who tried to impose femininity on him. “It’s
really degrading,” Scott said, to be forced to wear a
dress when you’re a trans boy. (Scott’s mom divorced
her devout husband two years later, and Nancy
eventually took custody of Scott.)
Puberty brought bigger problems. Scott started
developing breasts and got his period. “Everything
just sucked, basically,” he said. “I was pretty miserable
with it.” In 2015, when Scott was 13, Nancy took him
to an assessment appointment with Edwards-Leeper.
“She asked me about how I felt when I was younger—
was I comfortable with my body? What did I tend to
like or be interested in?,” Scott recalled. He said that
getting on testosterone took what felt like a long time.
(He was on puberty blockers for about a year.) But he
said he understood that Edwards-Leeper was making
certain he had considered a range of questions—from
how he would feel about possibly not being able to
have biological kids to whether he was comfortable
with certain hormonal efects, such as a deeper voice.
Scott told Edwards-Leeper that he was pretty certain
about what he wanted.
Scott told me that overall, being on testosterone
made him feel better, though also a bit more into
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 103

Scott Leibowitz, “adrenaline-junkie stuff ” than before. (There had
a psychiatrist who been a recent incident involving Scott taking Nancy’s
treats children and car for a spin despite not yet having his learner’s per-
adolescents in
mit.) When I asked him about top surgery, which he
Columbus, Ohio, is a
was hoping to have early in the spring, he got about
proponent of
comprehensive
as animated as I saw him during our lunch. “Oh, it’s
assessments for going to be so freeing,” he said. “I can change in the
young people seeking locker room!” In April I checked in with Nancy, and
to transition. she said in an email that the surgery had gone well:
“He is SO happy not to have to wear a binder!”
Scott’s assessment process centered mostly on
the basic readiness questions Edwards-Leeper and
Leibowitz are convinced should be asked of any
young person considering hormones. But his was a
relatively clear-cut case: He’d had unwavering gen-
der dysphoria since early childhood, a lack of serious
mental-health concerns, and a generally supportive
family. For other gender-dysphoric young people,
mental-health problems and family dynamics can
complicate the transition process, though they are by
no means, on their own, an indication that someone
shouldn’t transition.
I met Orion Foss at a vegetarian café in the Den-
nison Place neighborhood of Columbus. Orion is an
expressive 18-year-old with big eyes who is where
Scott Padberg may be in a couple of years. Orion’s
gender trajectory was a bit different, though. As
a teenager, he identiied as a lesbian and became
involved in the local LGBTQ scene. He says that in
2014, when he was 14 years old and trans narratives
were starting to show up more frequently on social
media, he realized he was trans. He was also sufer-
ing from severe depression and anxiety at the time,
104 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
which had led to self-harm issues, as well
as what may have been an undiagnosed
eating disorder. Orion believed that addi-
tional weight went straight to his hips
and chest, accentuating his feminine
features. At one point, he dipped down
to 70 pounds.
A year or so after he realized he was
trans, he told his mother, an ob-gyn,
who took him to the THRIVE program at
Nationwide, which had recently opened.
(Leibowitz didn’t work there yet.) Orion
met with two clinicians for an eight-hour
assessment. He told me he was “defi-
nitely intimidated,” but if “you want to
do something permanent to your body,
you have to be absolutely positive that
there’s no other way of doing it.”
At the time, Orion was initially upset
that, because he was underage, THRIVE
wouldn’t put him on hormones without
the consent of both parents (his father had
signed of, but his mother had not). He
started sobbing when he found out. But
the THRIVE team made clear that it was
going to help him get where he wanted to
be. In the meantime, a THRIVE therapist,
Lourdes Hill, would work with Orion to
address his anxiety and depression.
Looking back, Orion sees the value of this pro-
cess. “If I had been put on hormone therapy when I
didn’t have my identity settled, and who I was settled,
and my emotions settled, it would have been crazy.
’Cause when I did start hormone therapy, hormones
shoot your mood all around, and it’s not exactly
safe to just shoot hormones into someone that’s not
stable.” He ended up seeing Hill for weekly appoint-
ments, talking about not only his gender-identity and
mental-health issues, but a host of other subjects as
well. “She weeded through every possible issue with
me that she could get to,” he said. “I’m glad she made
me wait. And I’m glad the structure was there so I
couldn’t just throw myself into something that prob-
ably would have made me worse of.”
Eventually, his mother, who was “very hesitant,”
and was refusing to sign the paperwork for him to start
hormones, came around. The THRIVE team helped
her come to grips with the fact that the child she had
always known as her daughter was going to become
her son. “Lourdes was the driving force in that,” Orion
told me in a follow-up email. “Spent a lot of time with
me and my mother in therapy.”
When he was inally able to begin the hormone
treatments, Orion said, he “immediately felt this
weight of my shoulders.” His dosage was gradually
increased and then, in May 2017, he got a double
mastectomy. Orion’s transition has clearly had a
profoundly beneicial efect. It’s changed the way
he carries himself in the world. Before, “I would sit
like this”—he slouched over—“and hide every pos-
sible female thing about me.” Now, he said, he can
sit up straight. He feels like himself.
 OME PARENT S STRUGGLE with the chal-
S lenges of raising a TGNC child, and they can
make gender clinicians’ already compli-
cated jobs that much more complicated. Many, like
Orion Foss’s mother, have trouble accepting the
idea of their child transitioning. She, at least, came
around. In other cases, parents not only refuse to
help their child receive treatment but physically
abuse them or kick them out of the house. (Reliable
numbers for trans young people speciically are hard
to come by, but LGBTQ youth are 120 percent more
likely than their straight or cisgender counterparts
to experience a period of homelessness, according
to a study by Chapin Hall, a research center at the
University of Chicago.)
But progressive-minded parents can sometimes
be a problem for their kids as well. Several of the
clinicians I spoke with, including Nate Sharon, Laura
Edwards-Leeper, and Scott Leibowitz, recounted
new patients’ arriving at their clinics, their parents
having already developed detailed plans for them to
transition. “I’ve actually had patients with parents
pressuring me to recommend their kids start hor-
mones,” Sharon said.
In these cases, the child might be capably navi-
gating a liminal period of gender exploration; it’s the
parents who are having trouble not knowing whether
their kid is a boy or a girl. As Sharon put it: “Every-
thing’s going great, but Mom’s like, ‘My transgender
kid is going to commit suicide as soon as he starts
puberty, and we need to start the hormones now.’
And I’m like, ‘Actually, your kid’s just ine right now.
And we want to leave it open to him, for him to decide
that.’ Don’t put that in stone for this kid, you know?”
Suicide is the dark undercurrent of many discus-
sions among parents of TGNC young people. Sui-
cide and suicidal ideation are tragically common in
the transgender community. An analysis conducted
by the American Foundation for Suicide Prevention
and the Williams Institute, published in 2014, found
that 41 percent of trans respondents had attempted
suicide; 4.6 percent of the overall U.S. population
report having attempted suicide at least once. While
the authors note that for methodological reasons
41 percent is likely an overestimate, it still points to a
scarily high igure, and other research has consistently
shown that trans people have elevated rates of suicidal
ideation and suicide relative to cisgender people.
But the existence of a high suicide rate among
trans people—a population facing high instances of
homelessness, sexual assault, and discrimination—
does not imply that it is common for young people
to become suicidal if they aren’t granted immediate
access to puberty blockers or hormones. Parents and
clinicians do need to make fraught decisions fairly
quickly in certain situations. When severely dys-
phoric kids are approaching puberty, for instance,
blockers can be a crucial tool to buy time, and some-
times there’s a genuine rush to gain access to them,
particularly in light of the waiting lists at many gen-
der clinics. But the clinicians I interviewed said they
rarely encounter situations in which immediate
access to hormones is the difference between
suicide and survival. Leibowitz noted that a relation-
ship with a caring therapist may itself be an impor-
tant prophylactic against suicidal ideation for TGNC
youth: “Often for the irst time having a medical or
mental-health professional tell them that they are
going to take them seriously and really listen to them
and hear their story often helps them feel better than
they’ve ever felt.”
The conversations parents are having about
gender-dysphoric children online aren’t always so
nuanced, however. In many of these conversations,
parents who say they have questions about the pace of
their child’s transition, or whether gender dysphoria is
permanent, are told they are playing games with their
child’s life. “Would you rather have a live daughter or
a dead son?” is a common response to such questions.
“This type of narrative takes an already fearful parent
and makes them even more
afraid, which is hardly the
type of mind-set one would
want a parent to be in when
making a complex lifelong
decision for their adolescent,”
In some cases,
Leibowitz said. a child might
be capably
H E N PA R E N T S
W discuss the reasons
they question their
navigating a
liminal period
children’s desire to transition, of gender
whether in online forums or
in response to a journalist’s exploration;
questions, many mention it’s the parents
“social contagion.” These
parents are worried that their
who are having
kids are influenced by the trouble not
gender-identity exploration knowing whether
they’re seeing online and per-
haps at school or in other social
their kid is
settings, rather than experi- a boy or a girl.
encing gender dysphoria.
Many trans advocates ind
the idea of social contagion
silly or even ofensive given the bullying, violence, and
other abuse this population faces. They also point out
that some parents simply might not want a trans kid—
again, parental skepticism or rejection is a painfully
common experience for trans young people. Michelle
Forcier, a pediatrician who specializes in youth-gender
issues in Rhode Island, said the trans adolescents she
works with frequently tell her things like No one’s tak-
ing me seriously—my parents think this is a phase or a fad.
But some anecdotal evidence suggests that
social forces can play a role in a young person’s gen-
der questioning. “I’ve been seeing this more fre-
quently,” Laura Edwards-Leeper wrote in an email.
Her young clients talk openly about peer inluence,
saying things like Oh, Steve is really trans, but Rachel
is just doing it for attention. Scott Padberg did exactly
this when we met for lunch: He said there are kids in
his school who claim to be trans but who he believes
are not. “They all launt it around, like: ‘I’m trans,
T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 105
 I’m trans, I’m trans,’ ” he said. “They post it on
social media.”
I heard a similar story from a quirky 16-year-old
theater kid who was going by the nickname Delta
when we spoke. She lives outside Portland, Oregon,
with her mother and father. A wave of gender-identity
experimentation hit her social circle in 2013. Suddenly,
it seemed, no one was cisgender anymore. Delta, who
was 13 and homeschooled, soon announced to her
parents that she was genderqueer, then nonbinary,
and inally trans. Then she told them she wanted to
go on testosterone. Her parents were skeptical, both
because of the social inluence they saw at work and
because Delta had anxiety and depression, which
they felt could be contributing to her distress. But
when her mother, Jenny, sought out information, she
found herself in online parenting groups where she
was told that if she dragged her feet about Delta’s
transition, she was poten-
tially endangering her daugh-
ter. “Any questioning brought
down the hammer on you,”
she told me.
One clinician Delta’s parents took her to
said her trans see Edwards-Leeper. The psy-
clients talk chologist didn’t question her
about being trans or close the
openly about door on her eventually start-
peer influence, ing hormones. Rather, she
saying things asked Delta a host of detailed
questions about her life and
like Oh, Steve mental health and family.
is really trans, Edwards-Leeper advised her
but Rachel is to wait until she was a bit older
to take steps toward a physical
just doing transition—as Delta recalled,
it for attention. she said something like “I
acknowledge that you feel a
certain way, but I think we
should work on other stuf irst,
and then if you still feel this way
later on in life, then I will help you with that.”
“Other stuff ” mostly meant her problems with
anxiety and depression. Edwards-Leeper told Jenny
and Delta that while Delta met the clinical threshold
for gender dysphoria, a deliberate approach made
the most sense in light of her mental-health issues.
“At the time I was not happy that she told me that I
should go and deal with mental stuf irst,” Delta said,
“but I’m glad that she said that, because too many
people are so gung ho and just like, ‘You’re trans, just
go ahead,’ even if they aren’t—and then they end
up making mistakes that they can’t redo.” Delta’s
gender dysphoria subsequently dissipated, though
it’s unclear why. She started taking antidepressants
in December, which seem to be working. I asked
Delta whether she thought her mental-health prob-
lems and identity questioning were linked. “They
deinitely were,” she said. “Because once I actually
started working on things, I got better and I didn’t
want anything to do with gender labels—I was ine
with just being me and not being a speciic thing.”
106 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
It’s imperative to remember that Delta’s is a kind
of story that can happen only in a place where trans
people are accepted—and where parents, even skep-
tical ones like Jenny, are open-minded enough to
take their kid to a clinician like Edwards-Leeper. In
vast swaths of the United States, kids coming out as
trans are much more likely to be met with hostility
than with enhanced social status or recognition, and
their parents are more likely to lack the willingness—
or the resources—to ind them care. But to deny the
possibility of a connection between social inluences
and gender-identity exploration among adolescents
would require ignoring a lot of what we know about
the developing teenage brain—which is more suscep-
tible to peer inluence, more impulsive, and less adept
at weighing long-term outcomes and consequences
than fully developed adult brains—as well as indi-
vidual stories like Delta’s.
OT EVERY ONE AGREE S about the impor-
N tance of comprehensive assessments for
transgender and gender-nonconforming
youth. Within the small community of clinicians
who work with TGNC young people, some have a
reputation for being skeptical about the value of
assessments. Johanna Olson-Kennedy, a physician
who specializes in pediatric and adolescent medi-
cine at Children’s Hospital Los Angeles and who is
the medical director of the Center for Transyouth
Health and Development, is one of the most sought-
out voices on these issues, and has signiicant dif-
ferences with Edwards-Leeper and Leibowitz. In
“Mental Health Disparities Among Transgender
Youth: Rethinking the Role of Professionals,” a 2016
JAMA Pediatrics article, she wrote that “establishing
a therapeutic relationship entails honesty and a
sense of safety that can be compromised if young
people believe that what they need and deserve
(potentially blockers, hormones, or surgery) can be
denied them according to the information they pro-
vide to the therapist.”
This view is informed by the fact that Olson-
Kennedy is not convinced that mental-health assess-
ments lead to better outcomes. “We don’t actually
have data on whether psychological assessments
lower regret rates,” she told me. She believes that
therapy can be helpful for many TGNC young people,
but she opposes mandating mental-health assess-
ments for all kids seeking to transition. As she put it
when we talked, “I don’t send someone to a therapist
when I’m going to start them on insulin.” Of course,
gender dysphoria is listed in the DSM-5; juvenile dia-
betes is not.
One recent study co-authored by Olson-Kennedy,
published in the Journal of Adolescent Health, showed
that her clinic is giving cross-sex hormones to kids as
young as 12. This presses against the boundaries of
the Endocrine Society’s guidelines, which state that
while “there may be compelling reasons to initiate
sex hormone treatment prior to age 16 years … there
is minimal published experience treating prior to
13.5 to 14 years of age.”
 If you see gender-dysphoric 13- and
14-year-olds not as young people with a
condition that may or may not indicate
a permanent identity, but as trans kids,
full stop, it makes sense to want to grant
them access to transition resources as
quickly as possible. Olson-Kennedy said
that the majority of the patients she sees
do need that access. She said she sees a
small number of patients who desist or
later regret transitioning; those patients,
in her opinion, shouldn’t dictate the care
of others. She would like to see a radical
reshaping of care for TGNC young peo-
ple. “The way that the care has been orga-
nized is around assuring the certainty and
decreasing the discomfort of the profes-
sionals (usually cisgender) who deter-
mine if the young people are ready or not,”
she told me. “And that’s a broken model.”

O W B E S T T O support TGNC
H kids is a whiplash-inducing
subject. To understand even
just the small set of stories I encoun-
tered in my reporting—stories involving
relatively privileged white kids with car-
ing, involved families, none of which is
necessarily the case for all TGNC young
people in the United States—requires
keeping several seemingly conflict-
ing claims in mind. Some teenagers, in
the years ahead, are going to rush into
physically transitioning and may regret
it. Other teens will be prevented from
accessing hormones and will suffer
great anguish as a result. Along the way,
a heartbreaking number of trans and
gender- nonconforming teens will be
bullied and ostracized and will even end
their own lives.
Some LGBTQ advocates have called for gender relieve immense sufering. We recognize that there Delta, a patient of
dysphoria to be removed from the DSM-5, arguing is no one-size-its-all approach to treating anxiety Laura Edwards-Leeper
that its inclusion pathologizes being trans. But gen- or depression, and a strong case can be made that who wanted to
der dysphoria, as science currently understands it, the same logic should prevail with gender dysphoria. transition. Edwards-
Leeper counseled
is a painful condition that requires treatment to be Perhaps a irst step is to recognize detransitioners
her to take things
alleviated. Given the diversity of outcomes among and desisters as being on the same “side” as happily
slowly and to work
kids who experience dysphoria at one time or another, transitioned trans people. Members of each of these on her co-occurring
it’s hard to imagine a system without a standardized, groups have experienced gender dysphoria at some mental-health issues.
comprehensive diagnostic protocol, one designed to point, and all have a right to compassionate, compre- Her gender dysphoria
maximize good outcomes. hensive care, whether or not that includes hormones eventually lifted.
Experiencing gender dysphoria isn’t the same as or surgery. “The detransitioner is probably just as
experiencing anxiety or depression or psychological scarred by the system as the transitioner who didn’t
ailments, of course. But in certain ways it is similar: have access to transition,” Leibowitz told me. The
As with other psychiatric conditions, some people best way to build a system that fails fewer people is
experience dysphoria more acutely than others; to acknowledge the staggering complexity of gender
its severity can wax and wane within an individual dysphoria—and to acknowledge just how early we are
based on a variety of factors; it is in many cases inti- in the process of understanding it.
mately tied to an individual’s social and familial life.
For some people, it will pass; for others, it can be Jesse Singal is a contributing writer at New York
resolved without medical interventions; for still oth- magazine. His book about why bad behavioral science
ers, only the most thorough treatment available will goes viral will be published next year.

T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 107
 FOR
SEARCHING

JEAN-MICHEL

an art star,
ESSAY

Was he an artist,

or just a celebrity?

By Stephen Metcalf

EDO BERTOGLIO, JEAN-MICHEL BASQUIAT WEARING AN AMERICAN FOOTBALL HELMET (1981).

PHOTOGRAPH: © EDO BERTOGLIO; COURTESY OF MARIPOL. ARTWORK: © VG BILD-KUNST BONN,
T H E E STAT E O F J E A N - M I C H E L B A S Q U I AT; L I C E N S E D BY A R T E STA R , N E W YO R K .
T H E AT L A N T I C J U LY/AU G U ST 20 1 8 109
 N M AY 2 0 1 6 , a painting by Jean-
I
Michel Basquiat sold for $57.3 mil-
lion. One year later, another
painting of his from 1982, Untitled,
sold for $110.5 million, making it
the sixth-most-expensive work of art
ever purchased at auction, and setting a
record for an American artist. Basquiat is
not the irst painter to have a canvas sell
for a price that strikes ordinary people
as obscene. But when Jeffrey Deitch, a
prominent curator and dealer, said after
the sale, “He’s now in the same league as
Francis Bacon and Pablo Picasso,” it was
hard to pin down the precise meaning of
the word league. Was Basquiat now con-
sidered as great an artist as Picasso? Or
was he merely as expensive to own?
Basquiat became famous in the early
1980s, when the idea that artists were
supposed to be commercial innocents
fell apart for good, and when the idea
of the “art star”—a funnily
abbreviated inversion, if you
think about it, of starving
artist—irst came into vogue.
In 1985, The New York Times
Magazine ran a cover story
on Basquiat, titled “New Art,
New Money.” Its tone was
both awed and suspicious,
with constant references
to a hot, possibly gullible,
market in contemporary art.
His work was said to be sell-
ing “at a brisk pace—so brisk,
some observers joked, that
the paint was barely dry,” and
Basquiat himself was quoted
as worrying he had become a
“gallery mascot.” Whatever
else was true, as the art histo-
By 1982, Basquiat’s use of color, surface, and line had grown more confident.
rian Jordana Moore Saggese
has said since, “this was not
the starving artist the public was accus-
tomed to seeing.”
In the 30 years since Basquiat died
of a drug overdose, in 1988, at the age of
27, the prices of his work have climbed
steadily upward, taking some astonishing
leaps along the way. Everyone remains
fascinated by him—the life is compelling,
the person bewitching, the canvases im-
possible to turn away from—but nobody
agrees on why. His work seems to elicit
one of two reactions from people. The
first, as the writer bell hooks noticed
when she attended a 1992 retrospective
of his work at the Whitney Museum, in
New York, is avoidance:
110 J U LY/AU G U ST 2 0 1 8 T H E
I wandered through the crowd talking
to the folks about the art. I had just
one question. It was about emotional
responses to the work. I asked, what
did people feel looking at Basquiat’s
paintings? No one I talked with
answered the question. They went
of on tangents, said what they liked
about him, recalled meetings, gener-
ally talked about the show, but some-
thing seemed to stand in the way,
preventing them from spontaneously
articulating feelings the work evoked.
Standing before Jef Koons’s Balloon
Dog, you take a selfie. Before Untitled,
which its owner is now exhibiting on a
global tour, you … do what, exactly? A com-
mon initial response—that the art is slap-
dash, tender, true—feels wrong somehow,
as if we haven’t gotten it. Unwilling to play
the part of the rearguard philistine any-
more, we stay quiet, stranded in a vaguely
shameful silence. In front of the painting,
we fear we have seen or felt too little, espe-
cially given the $110.5 million price tag.
Basquiat’s works can also elicit the
opposite response, very much in evidence
in commentary on a recent retrospective
mounted at the Barbican, in London, and
then at the Schirn Kunsthalle, in Frank-
furt. Anxious to stake a claim for the paint-
ings’ place in art history, critics load them
up with extra signiication. I’ve seen the
following cited as inluences on, or analo-
gies to, Basquiat’s work: action painting,
art brut, surrealist automatism, William
Burroughs’s cut-ups, the schizoanalysis
AT L A N T I C
of Gilles Deleuze and Félix Guattari, Leo-
nardo da Vinci, punk, postpunk, no wave,
hip-hop, bebop, Lee “Scratch” Perry, Ein-
stein on the Beach, Herman Melville, and
Jack Kerouac. The convergence of mul-
tiple lines of inluence is apparent in Bas-
quiat’s work, and has been called a form of
“creolization,” and fair enough. But there’s
creole, and then there’s the kitchen sink. If
all of his creations were lost, and you had
to reconstruct them going only on the
criticism, you would end up with some
abominable artwork.
What critics seem to be striving for on
behalf of Basquiat isn’t understanding
but respectability, which anyone looking
at the paintings can immediately see Bas-
quiat was uninterested in. These canvases
were made by a young man, barely out of
his teens, who never lost a teenager’s con-
tempt for respectability. Trying to assert
art-historical importance on the paint-
U N T I T L E D ( 1 9 8 2 ) , AC RY L I C A N D O I L O N L I N E N . © VG B I L D - K U N ST B O N N , T H E E STAT E O F J E A N - M I C H E L B A S Q U I AT;
ings’ behalf, a critic comes up
LICENSED BY ARTESTAR, NEW YORK; COURTESY OF THE MUSEUM BOIJMANS VAN BEUNINGEN. PHOTOGRAPH BY
against their obvious lack of
self-importance. Next to their
louche irreverence, the lan-
guage surrounding them has
felt clumsy and overwrought
from the beginning. What
little we know for sure about
Basquiat can be said simply:
An extraordinary painterly
sensitivity expressed itself in
the person of a young black
male, the locus of terror and
misgiving in a racist society.
That, and rich people love to
collect his work. We have had a
hard time making these two go
together easily. But so did he.
For many years, the photos
accompanying the Times piece
supplied the public with its
image of the artist. Basquiat
is dressed in an Armani suit, barefoot,
dreadlocked, paint-spattered. He looks—
it’s hard to tell, he stares so blankly into
the camera. With the beneit of hindsight
and some good reporting, we now know
that Basquiat was being crushed under
money and publicity. At the very same
S T U D I O T R O M P, R O T T E R D A M .
time, he was being asked to reinvest paint-
ing with its foregone aura of authenticity,
even saintliness, because he was black. No
human being could have survived that,
and he didn’t. The irony of his work’s ever-
rising prices is that, far from clarifying his
stature, they keep alive the question he
repeatedly asked himself: Am I an artist,
an art star, or just another celebrity?
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 A S Q U I AT ’ S M O T H E R , Matilde, a friend, born of an impulse universal a slim volume that accompanied the irst

B was a Brooklynite of Puerto Rican

descent. In some accounts she is a
loving and nurturing igure, taking him
to the Museum of Modern Art to see
Picasso’s Guernica and to the theater to
see West Side Story, giving him a copy
of Gray’s Anatomy. (All of these appear
as touchstones in his work.) In other
accounts she is erratic, beating him
for wearing his underwear backwards,
threatening to kill her entire family with
a jerk of the steering wheel. Basquiat
once said his mother carried “a worry
line on her forehead from worrying too
much.” He called her a bruja, a “sorcer-
ess.” She was in and out of mental hospi-
tals. He told one interviewer: “She went
crazy as a result of a bad marriage.”
His father, Gerard, was a Haitian
immigrant. He was upwardly mobile,
middle class, and professional, and he
wanted to instill middle-class values in
his oldest child. His oldest child wanted
none of it. Gerard Basquiat reportedly
once beat his son so severely that Jean-
among teenage boys. As 17-year-old “Jean”
explained to The Village Voice, Samo was
designed as “a tool for mocking bogus-
ness.” He kvelled at how the SoHo types
had fallen for it. “They’re doing exactly
what we thought they’d do,” he told the
reporter. “We tried to make it sound pro-
found and they think it actually is!” It’s
hard, reading the piece now, not to hear
him talking back to the blue blazer:
This city is crawling with uptight,
middle-class pseudos trying to look
like the money they don’t have. Sta-
tus symbols. It cracks me up. It’s like
they’re walking around with price
tags stapled to their heads. People
should live more spiritually, man. But
we can’t stand on the sidewalk all day
screaming at people to clean up their
acts, so we write on walls.
In 1979, he gained “his first stable
home,” says Alexis Adler, his roommate
from the time, “the irst place he had a key
public exhibition, in 2017, of the surviving
materials from that East 12th Street squat.
His terrain included “the walls and loor
of the apartment and the building’s hall-
ways, which were strewn with discarded
appliances.” Their apartment is described
as a heavenly cocoon, overlooking the
“shooting galleries,” the drug dens of Ave-
nue B. They went dancing every night.
“Art was life and life was art,” Adler wrote.
A new documentary, Boom For Real:
The Late Teenage Years of Jean-Michel
Basquiat, made with the cooperation of
Adler, expands on a now-familiar story.
“One week ago New York City tottered on
the brink of inancial default,” President
Gerald Ford intones over the opening
montage of a busted-up and burning city.
During this period, we’re told, a tiny sub-
set of young people, leeing boring lives
elsewhere, gravitated to the lawlessness
and decay and created their own urban
village. The streets may have been dan-
gerous, but that encouraged a sociable
and intimate scene.

© VG B I L D - K U N ST B O N N , T H E E STAT E O F J E A N - M I C H E L B A S Q U I AT; L I C E N S E D BY A R T E STA R , N E W YO R K .

Michel went to school the next day walk-
ing with a cane. (Gerard has denied this.)
Other times, the story goes, he was so
badly beaten that he called the police.
His parents separated permanently when
he was 7, and his father later moved him
and his two younger sisters from East
Flatbush to a townhouse in Boerum
to.” He was 18; she was 22. In their sixth-
loor walk-up, Basquiat began to make the
transition from street tagger to gallery art-
ist. “He wrote and drew on any surface,”
Adler recalled in Basquiat Before Basquiat,
The streets were as much Basquiat’s
home, apparently, as the squat, and
the work he made reflects this fact. He
scrawled on detritus fished from the
neighborhood, on discarded scraps of

G L E N N ( 1 9 8 4 ) , A C R Y L I C , O I L S T I C K , A N D P H O T O C O P Y, C O L L A G E O N C A N V A S .
Hill. Gerard, who always insisted that
the Basquiats had been an elite family in
Haiti, obtained a night-school degree in
accounting and eventually became the
comptroller for the Macmillan publish-
ing company.
In their new neighborhood, Gerard
played the happy divorcé, in a blue blazer
with brass buttons, driving a Mercedes-
Benz. Jean-Michel disappeared into the
crawl space beneath the staircase, cover-
ing it in his drawings. What art Basquiat
made, and how he made it, remained
closely bound up in his own unsettled
relationship to real estate. He ran away at
least twice before leaving home for good
at 17. That meant—and here something of
a mythical fog descends—living in Wash-
ington Square Park and leabag hotels, and
rotating through the sofas and beds of vari-
ous friends and lovers.
He began his life as an artist spray-
painting tantalizing koans on the walls in
and around SoHo under the pseudonym
Samo, short for “same old shit.” His work Basquiat’s early streetscapes gave way to collage-based work featuring the human figure.
as Samo was a collaborative project with

112 J U LY/AU G U ST 2 0 1 8 T H E AT L A N T I C
 “A fascinating account of one of our
canvas or a torn-of apartment door, illus-
trating them with street action: car acci- country’s great historical mysteries.”
dents, ambulances, skylines. These works
are very crude—they scarcely even count
NATHANIEL PHILBRICK,
as juvenilia—but they are also very sweet, bestselling author of Valiant Ambition and Mayflower
and contain hints of what was coming. He
began crossing out words as a way to draw
attention to them. He was also developing

Basquiat became famous

in the early 1980s,
when the idea that artists
were supposed to be
commercial innocents
fell apart for good.
a set of symbols that remained important
throughout his career—among them the
copyright symbol. It was meant ironically,
given that Samo’s work was very much in
the public domain. Once he started work-
ing indoors, the symbols began to take on
a diferent irony, at once darker and more
fragile. Is this work mine? Should I use my
given name instead of the Samo tag? If so, will
it make me money?
As Basquiat moved toward more con-
ventional painting, he transitioned from
streetscapes to human figures. These “Andrew Lawler turns Roanoke into one of
are shown frontally, with little or no
depth of ield, and nerves and organs are our history’s best stories, recounting not only the
exposed, as in an anatomy textbook. Are fascinating, little-known history of the colony itself but
these creatures dead and being clinically
that of the incredible swirl of historians, archaeologists,
dissected, one wonders, or alive and in
immense pain? hoaxers, and experts on arcane subjects who have been
caught up in the quest to find it.”
D L E R A N D B A S Q U I A T lived

A together on East 12th Street from

the fall of 1979 to the summer of
1980. That June, he exhibited his work for
—Charles Mann, bestselling author of 1491

“The most enduring riddle of American history,

the irst time: He painted a mural inside reveals more about who we are today than
the “Times Square Show,” the legendary
the actual fate of the doomed expedition of 1587.”
event held in a former massage parlor
of Seventh Avenue. The show featured —Rinker Buck, author of The Oregon Trail and Flight of Passage
performance art, graiti, ilm, and a car-
nival atmosphere. But it was Basquiat’s
contribution that was singled out in Art “Riveting and carefully researched….
in America. (“A patch of wall painted by Lawler takes us inside one of the oldest and most
SAMO, the omnipresent graiti sloganeer,
intoxicating mysteries in American history.”
was a knockout combination of de Koon-
ing and subway paint scribbles.”) The fol- —Candice Millard, bestselling author of Hero of the Empire
lowing February, Basquiat was included
in the “New York/New Wave” show at
PS1, the nonproit arts space housed in a
— Illustrated throughout with maps and photographs —
defunct elementary school in Long Island Available wherever books are sold
Doubleday Also available in audio and eBook formats www.andrewlawler.com
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114
City. Of more than 100 artists, he was the
only one to be given a prominent space
for paintings. He showed more than 20
works on their own wall in the inal room
of the show.
His paintings, the art dealer Annina
Nosei later said, “had a quality you don’t
find on the walls of the street, a qual-
ity of poetry and a universal message of
the sign. It was a bit immature, but very
beautiful.” Nosei’s background in the
art world was deep—she had worked for
the eminent dealer Ileana Sonnabend,
toured the country with John Cage, met
her husband through Robert Rauschen-
berg. Her connection to Basquiat’s work
was instantaneous and serious. She was
frantic to represent him, but there was a
hitch. Other than what he’d exhibited, he
had no paintings. Visiting Basquiat (dif-
ferent apartment, new girlfriend), Nosei
was floored to discover that he had no
inventory to show her. “You don’t have
anything?” she asked him, as she recalls in
a 2010 documentary called The Radiant
Child. And so, in September 1981, Nosei
put him to work producing canvases in
her Prince Street gallery’s basement.
The arrangement understandably
makes commentators squirm: a white
taskmistress keeping a black ward in her
basement to turn out paintings on com-
mand. Basquiat himself said, “That has
a nasty edge to it, you know? I was never
locked anywhere. If I was white, they
would just say ‘artist in residence.’ ” With
its large, oblong skylight, the space was
neither gloomy nor cramped, and it was
continuously restocked with supplies
by fawning assistants. Basquiat treated
the arrangement like a job. Nosei recalls
him showing up early in the morning
with croissants from Dean & DeLuca
and apologizing if he was late. Once in
the basement, he would put on music,
often Ravel’s Boléro, incurring the bang
of Nosei’s umbrella from the loor above.
And then he would paint.
Here his work begins to mature so
quickly, so decisively, one can scarcely
process it. At the same time, race
enters his work more explicitly. In Irony
of Negro Police man, Basquiat offers
his own excruciatingly personal take on
what W. E. B. Du Bois famously called
“double-consciousness.” Elsewhere,
black men for him are at once virtuosos
and martyrs, Dizzy Gillespie and Sugar
Ray Robinson featured prominently
among them. His favored symbol, the
crown, appears more often, but what is it,
exactly? An Apollonian laurel wreath, the
ultimate symbol of victory and honor? Or
a crown of thorns, which, along with the
cross, is Christendom’s ultimate symbol
of humiliation and mockery?
Basquiat worked several canvases at
once, dancing from surface to surface
like “Ali in his prime,” according to an
assistant. He could finish two or three
in a day. Sometimes he would paint in
pajamas and slippers. At intervals, one of
Nosei’s assistants would walk him over to
a Citibank to provide him with cash.
A I N T I NG S H AV E BE E N tradable
P commodities since at least the 16th
century, and by the middle of the
17th century, something like an inter-
national market in art was up and run-
ning. It dealt mostly in antiquities and
old masters, and was small and illiquid.
When a trade in modern art irst arose, in
the late 19th century, it was deined by an
absence of heat or velocity. An art dealer
discovered unknown artists, then sup-
ported them through years, even decades,
of obscurity. “We would have died of hun-
ger without [Paul] Durand-Ruel, all we
Impressionists,” Claude Monet famously
said of the renowned dealer.
Modern art was once deemed serious
because it derived from an avant-garde,
and what the garde was in avant of was
the market. This much is plain if you read
the memoirs of Durand-Ruel, and of his
successors Ambroise Vollard and Daniel-
Henry Kahnweiler, the original dealers
in modern art. All three acknowledge
the market, and Durand-Ruel and Vol-
lard make constant reference to prices.
Kahnweiler invoked Picasso’s dictum:
“For paintings to be worth a lot of money,
they must at some point have been sold
cheaply.” Artistic validation was a pro-
cess, a struggle that entailed trial and con-
demnation by the market, then triumphs
in the market, which over time revealed
the “true” value of the work in high, and
inally exorbitant, sale prices.
The appearance of the art market as
we now know it has been traced to the
early 1970s, and to one auction in par-
ticular. In 1973, Robert Scull, a New York
taxi tycoon, sold of 50 works of contem-
porary art. At the auction, Double White
Map, an encaustic collage by Jasper
Johns, sold for $240,000. For Scull, this
represented a 2,250 percent return on his
money in eight years. As the sociologist
 The Skeptic’s Guide
to American History
E D TIME OF Taught by Professor Mark A. Stoler
IT THE UNIVERSITY OF VERMONT

FE
LIM
LECTURE TITLES

R
70% 1. Religious Toleration in Colonial America?

R 7
off 2. Neither American nor Revolutionary?

OR

BE
3. The Constitution Did Not Create a Democracy
ER

D
M
BY S E P T E 4. Washington—Failures and Real Accomplishments
5. Confusions about Jeferson and Hamilton
6. Andrew Jackson—An Odd Symbol of Democracy
7. The Second Great Awakening—Enduring Impacts
8. Did Slavery Really Cause the Civil War?
9. The Civil War’s Actual Turning Points
10. The Myth of Laissez-Faire
11. Misconceptions about the Original Populists
12. Labor in America—A Strange History
13. Myths about American Isolation and Empire
14. Early Progressives Were Not Liberals
15. Woodrow Wilson and the Rating of Presidents
16. The Roaring Twenties Reconsidered
17. Hoover and the Great Depression Revisited
18. What Did Roosevelt’s New Deal Really Do?
19. World War II Misconceptions and Myths
20. Was the Cold War Inevitable?
21. The Real Blunders of the Vietnam War
22. Myths about American Wars

What Really Happened 23. Who Matters in American History?

24. History Did Not Begin with Us

in Our Nation’s Past? The Skeptic’s Guide to American History

Course no. 8588 | 24 lectures (30 minutes/lecture)

Our knowledge of American history is built on a set of long-accepted

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the whole story? What we believe to be history is the lens through SAVE UP TO $195
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 Olav Velthuis discovered through exten-
sive interviewing, dealers and artists
point to this as the moment when the “art
market proper [turned] into a commodity
or investment market.”
And then, in September 1980, the Jas-
per Johns painting Three Flags was sold to
Darwin Panama the Whitney Museum for $1 million. This
A warm weather hat with Australian was a record price for a work by a living
styling, handwoven in Ecuador from artist, though it wasn’t only the money
toquilla iber. Braided kangaroo leather that made the sale notable. A Connecticut
band. Reinforced 4½" crown, 3" brim. couple, the Tremaines, had acquired Three
Finished in USA. Flags in 1959, for $900, from the legendary
art dealer Leo Castelli. Selling it, they had
S (6¾-6⅞) M (7-7⅛) L (7¼-7⅜)
bypassed him completely; and this, Cas-
XL (7½-7⅝) XXL (7¾)
telli felt, violated the established courte-
#1649 Darwin Panama $139 delivered sies of his profession.
Shop online or request a catalog Castelli had presided over a market that
#KBE-13-FH was not a free market at all. It was a ield
of action dense with personal meaning—
#1622 #1648
handshake agreements, favoritism (in the
form of a waiting list and some genteel
price discrimination), and, most crucial,
a blacklist of collectors who resold works.
^
800-324-4934 davidmorgan.com
Together these customs restricted supply,
protecting collectors from a looded mar-
ket while keeping ultimate jurisdiction
11812 N Creek Pkwy N, Ste 103•Bothell, WA 98011
over a painter’s career in the hands of his
dealer. “It was bucolic,” Castelli said of the
period. “Money was not so important.”
Autobiography of a Yogi The sale of Three Flags made the front
page of The New York Times. It heralded,
Velthuis has argued, the arrival of “super-
“A timeless
star prices” in contemporary art. By late
classic 1982, thanks in part to the onset of the
in spiritual Reagan-era economic boom, a period
literature.” of reckless, almost spastic, buying had
-DEEPAK CHOPRA begun in earnest. Whatever else was true,
the garde was no longer avant, and prices
The life story of were rising fast. In 1983, Julian Schnabel’s
Paramahansa Notre Dame was auctioned at Sotheby’s
Yogananda for a winning bid of $93,000—a three-
year return on investment of more than
SRFbooks.org 2,500 percent. Relationships between
artists and dealers were becoming more
nakedly transactional. When the painter
Roll-up Panama $110 and sculptor Donald Judd left the presti-
Handwoven straw. Made in Ecuador.
Sizes: S - 2XL. Ideal traveling sun hat. gious dealer Paula Cooper for the Pace
Colors: dark natural or light natural. Gallery, Cooper said, “Artists today are
Check or credit card w/ exp. date.
Add $15 S/H. www.johnhelmer.com like baseball stars.”
John Helmer • Est. 1921 • (503) 223-4976
969 S.W. Broadway, Dept. T078 • Portland, OR 97205 N O C T O BE R 1 9 8 1 , Nosei included
work for him, supplies, and, waiting at the
end of this pipeline, collectors to buy his
art. Basquiat had arrived, but he, at least,
didn’t seem sure where.
The Crosby Street loft was on the sec-
ond floor, and visitors would either hit
the buzzer, which Basquiat had labeled
TAR in trademark Samo handwriting, or
call up from the street. Collectors would
drop in, and if they wondered aloud
whether a painting might blend in with
their decor, Basquiat would chase them
away, often hurling abuse, or sometimes
food—cereal, rice, milk—from the win-
dow down on their heads. Graffiti kids,
groupies, celebrities, and, not least, drug
buddies—people came day and night
and found a space strewed with art, gar-
bage, toys, magazines, books. A Haitian
voodoo statue stood in a corner. The bed
had a polyester Superman comforter and
a cocaine mirror on the headboard shelf.
Reports from this period converge on two
details: The television was always on, and
the fridge was always illed with gourmet
sundries—chocolates, pastries, Russian
caviar—slowly going bad.
Basquiat’s girlfriend at the time,
Suzanne Mallouk, remembers him cover-
ing the windows with black paper, banish-
ing daytime from the living space and the
internal clock from their bodies. They did
more and more coke, and Basquiat began
freebasing. Along with drugs, renown,
hangers-on, and paranoia, money was
now a force in his life, and large bills were
stufed in books and under the carpet, or
left to drift where they may. Basquiat
once binged on expensive electronics,
then sat on the loor surrounded by his
latest gadgets and cried.
In March of 1982, he exhibited work
he had made in Nosei’s basement—Arroz
con Pollo, Crowns (Peso Neto), Untitled (Per
Capita)—in the upstairs of her gallery.
This was his irst solo show in the United
States, and his irst solo show as Basquiat.
(He had recently shown as Samo in Italy.)
It sold out in one night. He was 21 years
old. He followed up his debut in New York
City with a mob-scene opening in Los
Angeles, and a solo show at the Galerie

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 live in, a studio to paint in, assistants to
I Basquiat in a group show. She gave his
six paintings the entire back room of
her gallery, and after his work sold, she
was ready to make another proposal.
She ofered, in a stroke, to put the entire
apparatus of the working artist in place
around him. She would give him a loft to
Bruno Bischoberger, in Switzerland.
Shortly after his triumph, he was lown
back to Italy, and in an airplane hangar in
the industrial outskirts of Modena, Bas-
quiat was deposited in front of massive
25-by-15-foot canvases, stretched and
ready, and was given just days to pro-
duce fresh material for a second Italian

116
opening. He was attended by his Italian
dealer, as well as by Nosei and Bischof-
berger. “They set it up for me so I’d have
to make eight paintings in a week,” he
later told The New York Times Magazine. “I
WhiteWalls
Steel Whiteboard Wall Panels
®

made them in this big warehouse … It was

like a factory, a sick factory.”
Two months later, he snuck into
Nosei’s basement and destroyed 10 of his
canvases. Using a box cutter, he slashed
them down to rags, and then, as if to
make sure that they could never be resur-
rected as salable art, he doused them with
a bucket of white paint.

HEN I SAW “Basquiat: Boom For

W Real,” the major retrospective of

his work that recently closed
in Frankfurt, the exhibit was not only
well, but reverentially, attended. View-
ers paused over items as if they were
holy relics. (Someone knew to save this, I "You wouldn’t believe how much creativity is sparked when
thought over and over.) The presentation
you have the entire room as your writing surface"
lowed gracefully from Samo to the East
12th Street material through to the danse Office Manager, Label Manufacturer, Brea CA
macabre of his last major works. Mostly
glossed over in the catalog commentary WhiteWalls.com 800-624-4154
and exhibit photographs was the fact

He slashed his canvases

down to rags, and then,
as if to make sure
they could never be
resurrected as salable
art, he doused them with LOVE
a bucket of white paint.
that, after he became famous, Basquiat THE
ATLANTIC?
went, in quick and ghastly succession,
from sweet East Village magpie to café-
society boor to dead. The artist who pre-
sided at the show instead is the pre-boom
Basquiat, the marvel of a crumbling yet
vibrantly creative New York City. What is
he being made innocent of here if not the Get more from us on Facebook,
market, the 1980s art market in particu-
lar? Yet to make him innocent of the mar- Instagram, and Twitter.
ket is to cleave him in two, and discard the
struggle that deined him as an artist.
By early 1982, Basquiat had plainly
entered a new phase. He started replacing
, H  @TheAtlantic
the incidental crud of his surfaces—torn
bits of paper aixed with glue, sneaker
prints—with something more calcu-
lated, deploying techniques of collaging

T H E AT L A N T I C J U LY/AU G U ST 2 0 1 8 117
reminiscent of Rauschenberg’s. His use
of color, surface, and line to achieve
expression istic affect showed a new-
found conidence. At the same time, he
was suddenly making paintings for the
market, and making a lot of them quickly
and under pressure.
The result was a heroic mastery
combined with the randomness of trash
buoyed in the wind. Basquiat became
frenetic in his inclusion of materials he
found ready to hand, illing his canvases
with yet more symbols: renditions of dol-
lar signs, coins, Federal Reserve notes,
Japanese yen, Afro-Cuban ideograms,
logos, cars, airplanes, feathers, feet,
skulls. To do this, he grabbed at anything
that might serve as raw material—from
Henry Dreyfuss’s Symbol Sourcebook:
An Authoritative Guide to International
Graphic Symbols to the 1980 catalog of
the Met’s permanent collection. By 1984,
his collaging technique had become more
sophisticated. He’d sometimes layer the
canvas densely with color photocopies,
which he would then paint over. He even
began using Andy Warhol’s trick of silk-
screening to repeat images both within
and between canvases.
Warhol reported in his diaries that
when Bischoberger irst saw these works
he gave them a “sour look.” The approach
had “ruined [Basquiat’s] ‘intuitive primi-
tivism.’ ” There is a kernel of truth even to
this casual racism. Inevitably, words like
primitive, unschooled, undisciplined are per-
ilous, given how carefully vetted Basquiat
criticism is for ofensiveness. Yet if you are
afraid, you will never understand who he
was or what he was getting at. The curators
and critics of “Basquiat: Boom For Real”
tried running in the opposite direction,
describing him as a maestro in all things,
with one contributor to the catalog go-
ing so far as to call him an “extraordinary
painter and draughtsman.” But Basquiat
wasn’t even a good draughtsman, and he
cheerfully admitted it. It is useless to pre-
tend otherwise: Unlike Jean Dubufet, he
made unschooled images because he was
unschooled. Unlike Picasso’s, his igures
were crude because he could barely draw.
To insist that Basquiat was a virtuoso
is to turn away from the paintings all over
again, to miss their ultimate dare. The
search for authenticity of form and feel-
ing that led white artists toward naive
(even childish) techniques and human
primitives—what does that quest mean
when a black artist pursues it? It’s a good
question, a biting one, and we’ve become
accustomed to asking it of Basquiat while
leaving the follow-up hanging in the air:
What does it mean when a black artist
vaults altogether beyond technique, or
formal training, or deep study? On his
canvases, Basquiat turned to the black ath-
letes and musicians he venerated, to Hank
Aaron and Charlie Parker. They were the
What does it mean when
a black artist vaults
altogether beyond
technique, or formal
training, or deep study?
consummate virtuosos, yet Aaron was
viliied when he displaced Babe Ruth, the
greatest of white American athletes, as
the home-run king in the sport that is a
stand-in for national innocence. Parker,
as one of the pioneers of postwar bebop,
took “Negro genius” to abstruse places it
was never supposed to go.
What does it mean to have depicted
them in paintings that are easily mis-
read as lazy, among the most loaded of
racist terms? Black American genius has
long been forced into music and sports,
where it has been asked to further vindi-
cate itself by displaying a total virtuosity,
only to be martyred when that genius
breaks out of the mold that respectability
and conformity has made for it. Basquiat
refused to play that game. First, he
rejected the role of ingratiating virtuoso,
placing himself instead within the lin-
eage of the (white) modernist genius,
of “Twombly, Rauschenberg, Warhol,
Johns,” as he said. Then he made the
martyrdom of the black virtuoso the sub-
ject of his work. To be the irst black artist
who was not a black artist, while never
not being a black artist: This is to make
of yourself a holy singularity.
H E N E W O W N E R of Untitled,
T Yusa ku Maezawa, has indicated
that the proper fate of the paint-
ing is not to be hoarded, but to be seen.
I went to see the single-painting show
“One Basquiat” in March, at the irst stop
on its global tour, the Brooklyn Museum.
The viewing room was chapel-like. At
the near end, a glass case held Basquiat’s
junior museum membership card. On
the far wall hung the most expensive (for
now) artwork by an American.
Viewers feel stared at by Basquiat’s
paintings, one commentator has said, and
I agree. But in their presence, I also have
the feeling of happening upon something
I was never supposed to see. Basquiat’s
art was made under conditions that, one
has to believe, are anomalous in the his-
tory of art, and yet we would apply to it the
traditional standards and vocabularies of
art history. On the one hand, Basquiat
was a heroic master like Picasso, even
though he was rushed to market before
he could fully develop his mastery. On
the other hand, we need him to be one of
the ultimate authentics, à la Vincent van
Gogh, even though he interacted directly
and on a continuous basis with the mar-
ket. To this day, he is asked to restore the
symbolic capital of the starving artist to a
system that otherwise does everything in
its power to destroy it. And so he remains,
to this day, a perpetually uncertain thing.
Untitled, an agonized skull from the
Crosby Street period, was irst purchased
in 1984 for $19,000. At its recent sale price,
it had increased in value by 581,479 per-
cent. One shakes one’s head in disbelief
and thinks: Whatever the market will bear.
At the same time, one bows one’s head in
awe and thinks: Worth every penny.
Stephen Metcalf, the host of Slate’s
Culture Gabfest podcast, is at work on a
book about the 1980s.

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Q:
What book or article
would you make
required reading for
everyone on Earth?
Carey Cranston,
president, American
Writers Museum
Narrative of the Life of
Frederick Douglass, an
American Slave illustrates
the greatest heights and
the lowest depths of Ameri-
ca’s history and potential,
while, better than any other
work, showing the power of
literacy—that when a person
can read and write, he gains
the ability to create his own
narrative, and to shape his life
and the surrounding world.
Michiko Kakutani,
literary critic
Shakespeare’s collected
plays. Four hundred years
after the playwright’s death,
his inluence spans the
planet. He was uncannily
modern in his inventive-
ness and gift for engaging
the popular imagination;
in his depiction of spirited,
independent women; and in
his appreciation of the con-
tingencies of life in a chaotic
world reeling from accelerat-
ing change and loss.
Imbolo Mbue, author,
Behold the Dreamers
Don Miguel Ruiz’s The
Four Agreements. Imagine
120 J U LY/AU G U ST 2 0 1 8
THE BIG QUESTION
a world where we all live by
this covenant: Be impeccable
with your word; don’t take
anything personally; don’t
make assumptions; always
do your best.
Susanna Fogel, director
and co-writer, The Spy
Who Dumped Me
The Frog and Toad series,
by Arnold Lobel. Though
ostensibly children’s books,
they frame depression and
anxiety in the most relat-
able way possible. The two
amphibians—one an intro-
verted cynic who can’t
stay present, the other an
emotional-novelty addict—
have a sweet, enduring
friendship. Both worldviews
are valid!
Kevin Kwan, author,
Crazy Rich Asians
Brave New World, by
Aldous Huxley, is an
T H E AT L A N T I C
astoundingly visionary satire
published in 1932 that fore-
saw not just what’s happen-
ing today, but where we’re
possibly heading next.
Marley Dias, founder,
#1000BlackGirlBooks
Dr. Seuss’s Yertle the Tur-
tle shows the consequences
of abusing power. Yertle the
Turtle yelled and screamed
at those who supported him,
and his lack of gratitude led
to his fall from power. The
book can teach all of us that
as we rise, we need to thank
and uplift those who help us.
Esmeralda Santiago,
author, Conquistadora
Men speak about peace but
prefer war. Men head the
majority of governments
and control the increas-
ingly lethal weapons, using
women and gods as moral
shields. Unsparing in its
portrayal of men’s nature,
The Iliad should be read
by everyone who hopes to
understand mankind.
READER RESPONSES
Gary Kohl,
Toronto, Canada
Dr. Seuss’s commentary on
industry and the environment,
The Lorax—because unless
each of us “cares a whole
awful lot, nothing is going to
get better. It’s not.”
Illustrations by GRAHAM ROUMIEU
Don Marine,
Sun City West, Ariz.
Maya Angelou’s poem
“Human Family.” Her
signature plea, “We are more
alike, my friends, / than
unalike,” is truly universal.
Nancy Hawley,
Spokane, Wash.
I suggest The World
According to Mister Rogers,
by Fred Rogers, because we
all need to practice kindness,
tolerance, and respect.
Robert Murphy,
Tarpon Springs, Fla.
The Book of Exodus
should be required reading
in an era of refugees, climate
change, and failed leader-
ship. Pharaoh was paranoid
about homeland security,
and he didn’t like pluralism.
Something went wrong in
the environment, and the
government collapsed.
Want to see your name on this page?
Email bigquestion@theatlantic.com
with your response to the question for
our October issue: What would you
designate as the eighth wonder of
the world?
www.grand-seiko.us.com