Target practice on the USS Underwood, patrolling international waters near Panama, where U.S. Army troops, Air Force pilots, and Navy ships outfitted with Coast Guard counternarcotics teams are routinely deployed to chase drug smugglers. (Dario Lopez-Mills / AP)

Looking back over a trillion dollars into the war on drugs (since Nixon, 1971), the battle has created more fronts than it has won. Only recently have designer drugs really begun to take hold in forms that effectively mimic the physiologic effects of the substances we've spent decades and lives and fortunes to kill. The target perpetually moves yet faster. Vaughan Bell at The Guardian notes that almost daily day new designer drugs appear in online marketplaces, unregulated. In the last year in the U.K. alone there were 73 new psychoactive synthetic drugs found on the market. 

At this rate demand will always outstretch capacities for detection, much less effective prohibition. Bell writes:

These drugs have hit the headlines under names such as Spice, K2, mephedrone and M-Cat, but there are hundreds more. They are sold euphemistically as "bath salts", "incense" or "research chemicals", and don't get regulated, at least not at first, because they are labeled as "not for human consumption." Unlike previous generations of legal highs that were about as recreational as a slap in the face, they actually work. They get you high.

Feb 11, 2013. Hypodermic syringes in Myanmar. The city of Myitkyina is known for having one of the highest concentrations of drug addicts in the world. The Kachin Baptist Convention, an evangelical group with over 300 churches in the state, says nearly 80 percent of ethnic Kachin youth are addicts. Their drug is heroin. (Gemunu Amarasinghe / AP)

Britain has taken to preemptively banning suspicious substances like Benzo Fury and NBOMe before they've been proven to be harmful (or safe), at least temporarily while they can be tested. In the U.S. they can go unregulated until people start falling over or eating one another.

Bodies inside a morgue truck after drug gang battle in Acapulco, 2012 (Bernandino Hernandez / AP)

Is the militant prohibition of traditional drugs that drives addicts and drug-abuse-prone people into the market of "not for human consumption" chemicals? Sure. The same prohibition is the root of so much gang warfare. Still to condemn the war on drugs as a battle that cannot be won is not a new or useful insight -- though it's nonetheless valid when defining victory in terms of bad guys arrested, bad guys killed, doobies confiscated.

May 19, 2013, the burning body of a man lies next to the shell of a vehicle allegedly belonging to the Knights Templar drug gang, near La Ruana, Mexico, after police and the Mexican army opened fire on a convoy of the Knights Templar when they tried to enter the town. (La Ruana Community Police / AP)

Instead, definitions of progress must reinforce measures that maximize well-being and minimize loss in a world where it is accepted that there will always be drugs.

Carole Farina's grocery cart used to include heads of lettuce, tomatoes, and cucumbers for homemade salads. Not anymore. Shopping at a Family Dollar store in Somerville, Massachusetts, the unemployed 47-year-old recently saw her monthly food stamp benefits reduced from $94 to $68 due to income adjustments from her disability payments. Now, Farina told me, she can only afford to buy "the cheapest stuff," like 5 for $1 instant ramen Cup Noodles -- those dorm-room staples made of refined carbohydrates, fat, sodium, and polysyllabic chemical additives.

Farina still occasionally splurges on cucumbers, but only when they are on sale for 2 for $1 at her local supermarket. Already overweight, she recognizes that her diet is unhealthy, but her diminished food budget portends a future of more Cup Noodles and fewer salads.

Like Farina, millions of food stamp recipients may soon see their monthly benefits trimmed and their nutrition compromised. But unlike Farina, these changes may occur regardless of changes in their personal income. That's because in two weeks the full House floor is slated to vote on the GOP-controlled Agriculture Committee's omnibus farm bill, which includes unprecedented cuts to the food stamp program, now called the Supplemental Nutrition Assistance Program (SNAP). The Agriculture Committee's reductions to SNAP would total $20.5 billion over 10 years and is even more austere than last year's stalled House farm bill, which sought a $16 billion reduction to SNAP. Such draconian cuts to SNAP may exacerbate the obesity epidemic and ultimately raise health care costs associated with treating obesity and related conditions like type 2 diabetes, heart disease, and stroke, particularly among low-income Americans.

There will be even greater disparities in obesity rates across income levels.

According to the CDC, nearly 36 percent of U.S. adults and 17 percent of children are obese. High as these rates are, the proportion of obese Americans has finally plateaued in the last few years after having escalated since 1980. But obesity rates may climb again if the House Agriculture Committee's farm bill passes and results in benefit reductions for the 47.8 million Americans currently on SNAP. (An estimated 2 million households will lose their SNAP benefits altogether.)

SNAP recipients are already means-tested for poverty and scraping by on meager allowances. Under current eligibility guidelines, households qualifying for SNAP can earn no more than 130 percent of the poverty line, or $30,615 for a family of four. (Eighty-three percent of SNAP recipients earn less than 100 percent of the poverty line, or $23,550 for a household of four.) The U.S. Department of Agriculture's figures from 2012 indicate that monthly SNAP benefits average about $133 per person, or $4.43 per day. Had last year's House farm bill been enacted, half a million households would have seen their monthly SNAP benefits slashed by $90 per month, according to the hunger relief organization Feeding America. Given that this year's House farm bill calls for an additional $4 billion in cuts to SNAP, poor Americans would feel even greater hunger pangs if the Agriculture Committee's current farm bill passes.

Households affected by these SNAP cuts will have to contend with desperately tight grocery budgets that will constrain their ability to buy healthy food, making it easier for them to become obese. Having less money to spend on food could prompt SNAP recipients to buy more calorie-dense, nutrient-poor foods that contribute to both weight gain and malnourishment. With the exception of a few items like beans and potatoes, many of the cheapest grocery offerings are highly processed foods packed with health advocates' maligned trinity of salt, sugar and fat.

Calorie for calorie, unhealthy processed foods and sodas are also often significantly more economical than healthier alternatives. In their widely cited survey of supermarket prices in Seattle, University of Washington epidemiologist Adam Drewnowski and his colleague S.E. Specter at UCLA found that one dollar bought 1200 calories worth of cookies or potato chips, but only 250 calories of carrots. For cash-strapped, hungry Americans, the choice seems obvious. And indeed, Drewnowski and Specter's research suggests that consumers on tight budgets decide what foods to buy based not on nutritional considerations, but on the cost and palatability of foods.

In spite of the challenges of eating healthfully on current SNAP allowances, it may still be possible to prepare relatively nutritious meals with scrupulous planning, culinary resourcefulness, and the type of fanatical frugality exhibited by "extreme couponers." The New York Times's Mark Bittman, for example, insists that simple home-prepared meals such as rice and beans are even cheaper than fast food. (Bittman, of course, presumes that working Americans have the time and energy to cook every day, and that they have endless appetites for Spartan dishes like rice and beans.)

A case can also be made that current SNAP funding levels enable recipients to buy a select number of healthy, pricier foods like fresh vegetables, as long as they balance those "luxury" purchases with more cost-efficient processed items like boxed macaroni and cheese. But if SNAP households' benefits are cut, even by a few dollars a week, their food choices may be driven even more by cost and palatability at the expense of nutrition.

This phenomenon was illustrated in 2007, when New York City councilman Eric Gioia attempted to live on a SNAP budget for a week. According to the New York Daily News, Gioia's $28 worth of grocery purchases for that week included a combination of reasonably healthy fare like canned tuna and a "handful" of vegetables, along with inexpensive carbohydrates such as white bread, pasta, and ramen noodles -- items that were filling but not particularly nutritious.

Gioia repeated his week-long SNAP experiment a year later, when food prices had risen about 25 percent and he had effectively six fewer dollars in purchasing power. In order to stretch his food budget this time, Gioia had to eliminate a number of provisions that were within his budget in 2007, but not in 2008. These included "four bananas, three ears of corn, two cucumbers and two packets of pasta." If a highly educated and nutrition-conscious Gioia had to jettison the healthier items from his grocery cart when faced with a shrunken food budget, it is not difficult to imagine that SNAP recipients would have to do the same if Congress approves the House Agriculture Committee's cuts to the program.

Reductions to SNAP may also promote obesity in other ways. Paradoxically, by causing food insecurity (a term used to describe limited or uncertain access to food) reducing SNAP benefits may actually trigger food behaviors associated with obesity, such as binge eating and hoarding. Most SNAP households are unable to stretch their benefits through the month as it is, let alone if their assistance is cut. Feeding America reports that 90 percent of current monthly SNAP benefits are redeemed by the third week. (Gioia's 2007 seven-day food stamp experiment yielded him 5 days' worth of food in 2007 and only 3 days in 2008.)

None of this would not surprise William S. Simon, the chief executive of Walmart's U.S. operations. In a 2010 Goldman Sachs conference, Simon described how SNAP recipients stormed Walmart stores all across the country to load their grocery carts immediately before midnight at the first of every month. Eager to refill their empty cupboards and refrigerators, these midnight shoppers were too hungry to wait until the following day to buy provisions.

Such patterns of food insecurity can lead to lifelong habits of overeating and hoarding. Cornell University nutrition researchers Christine M. Olson, Caron F. Bove, and Emily O. Miller have shown that when food does become available in food-insecure households - such as at the first of every month when SNAP benefits are redeemed - individuals may go on eating binges, overcompensating for the hunger they experienced during periods of privation. The children who grow up in these homes may become obsessed with ensuring that they have enough to eat, and derive emotional comfort from consuming unlimited quantities of food and maintaining fully stocked kitchens. It is no wonder then, that researchers Drewnowski and Specter have also found that women living in food-insecure households are more likely to be overweight than those for which access to foods has never been an issue.

Overall, low-income Americans, particularly if they are white children or women regardless of race, are also considerably more likely to be obese than their higher-income counterparts. Among white women, for example, 39.2 percent of those at or below 130 percent of the poverty line are obese, while only 27.5 percent of those with incomes at or above 350 percent of the poverty line are obese (figures from the CDC, 2010). If SNAP benefits are slashed and the number of low-income obese women and children increases, there will be even greater disparities in obesity rates across income levels.

Apart from raising concerns about health inequities, such an outcome would also undermine Congress's own efforts to combat childhood obesity through the Healthy, Hunger-Free Kids Act of 2010. The law, which imposed new nutrition standards for school lunches, was intended to promote healthy eating at schools. But if Congress passes the House Agriculture Committee's farm bill, many of these same children may soon be eating more poorly at home and obesity rates will rise again.

In response to a spate of teen suicides last year, a number of celebrities (Anne Hathaway, Justin Timberlake, Ellen DeGeneres, among others) used their visibility to castigate people who bully others. When public figures denounce bullying, they draw attention to the power of shame: A victim's experience at the hands of a bully can be so excruciating that life becomes unendurable.

Bullying used to be more or less acceptable behavior, a part of "kids being kids," but in recent years our culture has grown increasingly intolerant of those who shame others for their differences. The recent celebrity crusade against bullying reflects this anti-shame zeitgeist, as does Lady Gaga's "Born This Way." As she often does, Gaga encourages her audience to embrace self-love and self-acceptance, particularly those who might have been bullied due to their sexual orientation or gender identity: "Don't hide yourself in regret; Just love yourself and you're set."

Noted shame-researcher Dr. Brené Brown similarly exhorts her audience to take arms against the shame that shuts them down. Her immense popularity points to the growing power of the anti-shame zeitgeist: her TED lecture "The Power of Vulnerability" has received nearly 10 million views, with hundreds of appreciative comments. Unlike most experts in the field, Brown doesn't address her readers as a distant authority, but rather as a comrades-in-arms: Everyone has shame. I have my own shame and here is how I fight back.

The consensus within our culture is that shame is the enemy. It drives those individuals who are different into the shadows.

John Bradshaw initiated the modern conversation about shame with the publication of his classic Healing the Shame that Binds You in 1988. He viewed shame as a particularly toxic problem: shaming messages from parents, educators, and other important figures can destroy a growing child's sense of self-worth and lead to a host of mental disorders from alcoholism to depression. Bradshaw wanted to help his readers heal their inner child and escape the shackles of toxic shame. Since then, a great many authors have written books about how to heal, overcome, or escape from shame and develop self-esteem.

Everywhere we look, pride is on the march, and shame is on the run.

Andrew Solomon's powerful new book Far From the Tree is the most recent expression of this anti-shame zeitgeist. He details the often heroic efforts of parents to make sure their children don't suffer from the shame usually associated with a disability or sexual difference. He describes gay men and women, little people, deaf and blind people, transgendered individuals, and other groups who insist that their difference is not a disability or defect. Instead, they view their condition as an equal alternative to "normal," and nothing to be ashamed of. Solomon writes with passion and empathy about their struggles to develop feelings of self-worth by rejecting the shame of social stigma and embracing pride.

Gay Pride movements across the country most visibly embody this revolt against shame, but there are many disability pride movements as well. Little People of America, Inc. educates and advocates on behalf of those living with dwarfism, proclaiming their worth and value as members of society. Mainstreaming students with Down syndrome or autism reflects the belief that they should not be marginalized with "their own kind," as if they were defective, but included in the classroom with other children their own age. Emphasis is placed upon diversity -- variation within a broad spectrum -- rather than a shame-laden departure from the norm.

Nicky Loh/Reuters

The consensus within our culture is clear: shame is a uniquely destructive force, and one to be resisted. Movie stars, educators, pop icons, psychologists, and spokespeople for the pride movements will all tell you the same thing -- shame is the enemy. It drives those individuals who are different into the shadows. It causes us to hide our vulnerability, distancing us from those we love. It enforces conformity and stifles the creative or dissident individual. It kills the spirit.

Writing nearly 150 years ago, Charles Darwin observed that shame reactions -- blushing, looking downward, generally averting the gaze, etc. -- were seen among cultures and civilizations the world over. Silvan Tomkins, the father of affect theory, identified shame as one of nine genetically encoded physical responses to expected stimuli. According to Tompkins, every single human being is pre-programmed to experience shame under certain conditions.

If shame is such a bad thing, why did evolution see fit to program it into our genes? Evolutionary psychologists and sociobiologists believe that guilt and shame evolved to promote stable social relationships. According to the Oxford Encyclopedia of Evolution, "conformity to cultural values, beliefs, and practices makes behavior predictable and allows for the advent of complex coordination and cooperation." While the anti-shame zeitgeist views conformity to norms as oppressive, support for a great many of our social norms and the shame that enforces them is virtually unanimous.

For example, many would agree that fathers who walk out on their families, neglect their offspring, and fail to make child support payments should feel ashamed. Shame is the appropriate emotion for those men to feel: if powerful enough, the experience of shame might help them to fulfill their obligations as fathers and members of society.

To take a more extreme example, adults having coercive sex with minor children are universally deplored in Western culture. We agree that acting on pedophilia is a shameful, abhorrent crime. Nobody would think of encouraging child molesters to organize a pride movement and defy the shame which society imposes upon them, even though they can't help their sexual urges. The social stigma attached to pedophilia helps to keep this deviant behavior in check. Shame can't stop it entirely, but does place a brake on behavior destructive to a well-functioning society.

Cultures differ in the behaviors they deem shameful; over time, individual cultures may change their minds about what should and should not be subject to shame. Not so long ago, for example, homosexuality largely hid in the shadows within Western culture; today, gay men and women can serve openly in the military, and legally marry in many countries as well as in a growing number of the United States. While the debate over the shamefulness of homosexuality has not been settled, we're clearly in transition.

Nobody would think of encouraging child molesters to organize a pride movement and defy the shame which society imposes upon them.

In recent decades, Western attitudes toward a broad range of physical disabilities have also shifted, lessening the shame stigma they previously carried. Most liberal-minded people view this increasing tolerance for diversity as evidence of progress: Western civilization is becoming more enlightened and humane. This shift in tolerance levels depends upon our relative wealth, however, and upon confidence in our own personal safety. As citizens of a wealthy and powerful country, we have the luxury of deploying vast resources so that those individuals born with a genetic defect, or who are blind, deaf or autistic will suffer as little as possible from the consciousness of their difference.

To understand why I use the word luxury, imagine a less affluent country whose citizens are enduring material shortages and the rationing of food during a border war with its neighbor. Imagine that these people are hungry and frightened for their lives. Under those conditions, they would surely devote scarce resources to training their most able-bodied soldiers and fending off starvation rather than hiring extra teaching assistants in order to mainstream autistic children. Under the psychological pressure of wartime, many would become less tolerant of ambiguity and difference, less inclined to spend money in order to make disabled individuals feel better about themselves.

Today in the West, we have the luxury of supporting those who insist their deafness or dwarfism is a difference rather than a disability. We do what we can to alleviate their shame because we can afford it. In a nomadic culture, no one would pretend that being unable to hear the approach of a predator or enemy was anything other than a grave handicap. Being two or more feet shorter in stature than the average soldier and unable to run quickly puts you at a serious disadvantage during a siege. Except under the most peaceful, advanced conditions, much of what we today consider "diversity" would be viewed as major impediments to survival -- for the individual as well as the group.

In Far From the Tree, Solomon interviewed and wrote about many upper middle-class couples who devoted their lives and resources to making sure their disabled children would thrive. These parents did everything within their financial means to shield their offspring from shame and social stigma, to promote self-esteem, to make it possible for them to fulfill their potential. Emily and Charles Kingsley, for example, devoted their lives to an experimental program of early intervention when their son Jason was born with Down syndrome. This program involved continuous stimulation, especially of his sensory apparatus. "They talked to Jason day and night. They moved his limbs through stretches and exercises to improve his muscle tone." At the end of each exhausting day, Emily would cry herself to sleep.

Jason Kingsley with Mr. Hooper on Sesame Street

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The results of their efforts were impressive. By the age of seven, Jason was able to read, count to ten in twelve languages, distinguish Bach from Mozart and other composers and communicate by Sign with deaf people. Emily, who worked as a writer on Sesame Street, arranged a regular guest spot on the show for Jason, thereby helping to promote tolerance for other disabled children. He appeared in a television special with Jane Pauley. Rather than growing up oppressed by a sense of his inferiority, Jason Kingsley appeared to have escaped the burden of shame.

But about the time he turned 8, his intellectual development came to a halt and his peer group passed him by. He was sent home from sleep-away camp because the other children found his indiscriminate hugs to be off-putting. In soccer, he couldn't keep track of the team on which he played. More and more, he found himself to be an outsider:

One night when Emily was tucking him into bed, he said, "I hate this face. Can you find a store where we can get me a new face, a normal face?" Another night he said, "I'm so sick and tired of this Down syndrome business. When is it going to go away?"

Despite his parents' heroic efforts to stimulate and educate him, despite his appearances on television, Jason had come face to face with shame. He accurately perceived the ways in which he differed from typical children and felt bad about himself as a result.

I'm not suggesting that he should have felt that way; only pointing out that he did.

Solomon's research on dwarfism showed that little people who grow up with average-sized parents have much lower self-esteem than those whose parents are little themselves. He concludes that parents with dwarfism are likely to be more empathic and attuned to the particular challenges their children face. No doubt those children also benefit from a family environment where short stature is the norm. Children with dwarfism who have average-sized parents live with the constant visual reminder of their difference, the ways in which they are "not normal."

For similar reasons, parents of disabled children have found socializing in groups with others who share the condition to be enormously important for building self-esteem. It's easier to feel better about yourself surrounded by people who resemble you than always to be the shortest person in the room by far. In earlier, less tolerant times, homosexuals found relief from shame and social stigma within their own subculture, a society where a different "norm" prevailed. Those whose hearing is impaired have built a thriving community, a separate Deaf culture where signing and not the spoken word is the normal way to communicate.

While the efforts of all the parents in Solomon's book to promote healthy self-esteem in their children are worthy and admirable, here is the unfortunate reality: those afflicted with a major disability will inevitably experience a sense of shame for the ways in which they are different, regardless of whether they have been shunned or actively shamed by their peers. Shame spontaneously arises from the perception of unfavorable difference, whether or not society inflicts it upon the person.

Shame springs from the knowledge that your development didn't unfold as might have been expected under normal conditions.

Shame springs from the knowledge that your development didn't unfold as might have been expected under normal conditions.

The current anti-shame zeitgeist enlarges the boundaries of what is considered normal. Same-sex marriage with children reared by two men or two women -- once unthinkable -- is a mainstream idea for the younger generation. As a society, we're changing our minds and deciding that having sex and building a family with a person of your own gender should carry no shame. A major reason for this change is the growing perception that gay men and women are not so different after all: they want a loving and stable partnership with another person, they want to settle down and raise a family, just as heterosexuals do. As we close the gap, and de-emphasize difference, we remove the source of shame.

With its emphasis on diversity rather than difference, the anti-shame zeitgeist tries to accomplish the same thing for a broad range of people whose disability or difference has traditionally placed them outside the norm. The parents described in Solomon's book do their utmost to bridge the gap between normal and abnormal, to help their children escape the shame of being "other." This is undoubtedly a good thing, but on some important level, no matter what we do, children with achondroplasia (the most common cause of dwarfism) will perceive just how much they are different and feel badly about it to some degree.

I am not saying that people with disabilities ought to feel shame, or that I consider it a good thing that they do. I am saying that they inevitably will. It's more a biological kind of shame than a social one, arising from the awareness that typical, expectable development has gone awry. A secure, affluent society such as ours -- and devoted parents with the means to do so -- can marshal their resources to substantially mitigate that shame, but will never fully erase it.

As a psychotherapist, I've worked with many men and women crippled by shame. Most of them did not have mothers or fathers who shamed, abused, or humiliated them in the ways described by John Bradshaw. Instead, they by and large came from parents who struggled with major depression, alcoholism, or even psychosis, who failed in the most basic ways to provide a safe and loving environment. In other words, my clients did not have the sort of childhood most of us would consider "normal," not even in the very broadest sense of the word.

The British psychoanalyst D.W. Winnicott held that we human beings are born with a set of inbuilt expectations for how the environment should respond to our needs. He called this genetic inheritance a "blueprint for normality." When our parents respond appropriately, in keeping with that blueprint, they instill in us a sense of safety in our world and lay the foundation for strong self-esteem. When they fail in pervasive ways to meet those expectations, we're unable to develop normally; instead of the beginnings of self-esteem, we're left with the conviction that we are damaged. On the most fundamental level, we feel ugly and defective.

Instead of pride, shame takes root at our core.

I believe shame is inevitable. I believe that enormous growth and authentic self-esteem is nonetheless possible.

For those with a major disability, shame inevitably arises when a person's physical development departs dramatically from what is normal for the species. Children damaged by their early environment intuitively understand that their own psychological development hasn't unfolded as might normally have been expected; as a result, they feel core shame. Men and women who don't behave in ways that society expects them to do will (usually) feel shame.

In other words, whether its origins are of a physical, psychological or social nature, shame is the result of disappointed expectations.

My profession promotes the use of cognitive-behavioral techniques and affirmations to combat shame. In keeping with the current zeitgeist, shame is viewed as an enemy; clients in psychotherapy learn ways to fight back, to break the hold of shame, to persuade themselves that they are whole and beautiful. John Bradshaw believes we can heal from shame and recover our "true self," an intact and healthy Inner Child.

I believe shame is inevitable. I believe that individuals afflicted with core shame will never become the people they might have been had their mothers and fathers done a good-enough job of parenting. I believe that enormous growth and authentic self-esteem is nonetheless possible.

One of my clients, Nicole, came from a family background with psychosis on both sides. As a teenager, her sister attempted suicide. Her deeply troubled brother lived at the fringe of society, doing menial jobs, sleeping in his van. When she came to me at the age of 18, Nicole was deeply depressed, with occasional manic flights into grandiosity. She suffered from mild auditory and visual hallucinations; she cut herself with razor blades. She often felt persecuted by songs that would get stuck in her head, endlessly repeating and making sleep almost impossible for days on end. To anyone who met her, she seemed frankly disturbed.

After many, many years of intensive psychotherapy (and without the aid of psychiatric medication), Nicole has grown dramatically. She eventually managed to put herself through college, build a career, marry another professional, and have children. If you met her today, she might strike you as a bit eccentric but not disturbed. By most people's standards, she's an accomplished and successful woman. As long as she respects her limits, Nicole functions at a fairly high level.

But she does have important limits. If she takes on too much or life becomes too stressful, she might begin to see spiders moving at the periphery of her vision. A song might get stuck in her head and keep her up half the night. At very bad moments, she might feel as if she's in danger of falling apart. If she takes care of herself, however -- doesn't pretend that she's superwoman or convince herself she's "just normal" like everyone else -- Nicole can do much, much more than anyone might have expected from that deeply troubled teenager who first came to me.

Nicole lives with core shame, the legacy of dramatically bad parenting. She also feels proud of herself for all the hard work she has done, her bravery in facing psychological pain, and all that she has managed to accomplish. Remaining in touch with shame helps her to make good choices about what she can and cannot do. Shame keeps her humble and prevents her from taking triumphant flight into grandiose denial of who she is. Shame helps her to respect her limitations so that she can undertake the possible and continue building self-esteem.

In the years leading up to her son's eighth birthday, Emily Kingsley believed "that she had licked [Down syndrome]; she lived in triumph." After Jason turned 8 and his intellectual development came to a halt, Emily "began to realize all the things he couldn't do and would never be able to do." In 1987, she wrote a modern fable called "Welcome to Holland," well-known to anyone in the disability world. In this fable, she analogizes the experience of having a disabled child instead of a normal one to the disappointment you might feel if you imagined you were flying on vacation to Italy and landed in Holland instead:

But everyone you know is busy coming and going from Italy ... and they're all bragging about what a wonderful time they had there. And for the rest of your life, you will say, "Yes, that's where I was supposed to go. That's what I had planned."

And the pain of that will never, ever, ever, ever go away ... because the loss of that dream is a very, very significant loss.

But ... if you spend the rest of your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.

I think about living with shame in the same terms. There's a very real and abiding pain that comes from knowing your childhood has damaged you significant ways. Don't pretend otherwise, don't ignore shame; but don't dwell on the pain of it, either. Bearing with shame doesn't mean we can't grow and develop, have satisfying relationships, or find a career that we love. Even with core shame, we can live a meaningful and satisfying life.

In extreme cases, I have patients who feel that their shame is all but a death sentence. It is not; shame is not the enemy. Shame is an often painful fact of life that defines the gap between expectation and reality, but at the same time enables us to make the most of what's actually possible.

PROBLEM: In 1997, a policy reform in Quebec expanded insurance coverage for medications. It was accompanied by a dramatic increase in adolescents' use of Ritalin, one of the stimulant commonly prescribed to treat ADHD, and similar medications, relative to the rest of Canada. In theory, more treatment should be accompanied by improved outcomes in areas like education, where kids with ADHD often struggle. 

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METHODOLOGY: Janet Currie, a professor of economics and public affairs at Princeton, along with colleagues at the University of Toronto and Cornell, took data from a nationally representative sample of over 15,000 children and their families, who were followed for 14 years. They analyzed potential short-term effects like the severity of the children's ADHD, as evaluated by their teacher, their behavior, as evaluated by their parents, their self-assessed emotional health, and their relationship with their teacher and family members. Currie and her team also looked at standardized test scores, whether the children repeated any grades, and whether they eventually graduated high school and went on to higher education.

RESULTS: The more acute a child's ADHD symptoms, the worse they scored for every outcome measured. But despite confirming that Ritalin use increased, especially among children with the worst ADHD, the authors found "little overall improvement in outcomes" in the short-term. After the policy change, children with high ADHD scores were even more likely to be behind in school, to have repeated a grade, and to have lower standardized math scores. The effect was stronger for boys than for girls -- boys were also more likely to eventually drop out of school. Children with average ADHD symptoms, particularly girls in this case, experienced a 24 percent increase in unhappiness once Ritalin became more commonly used.

IMPLICATIONS: How is it possible that an increase in ADHD treatment led to worse academic performance? The authors put forward the possibility that when made less disruptive, children ended up receiving less attention. The medication may have become "a substitute for other types of cognitive and behavioral interventions that might be necessary to help the child learn."

Because this study looked at Ritalin use from a population level, the authors caution that they were unable to determine whether Ritalin was being used correctly -- if children were getting the optimal dosage, for example, or if they were taking the meds consistently. They find it a bit worrying, then, that "in Quebec, as in the U.S., any doctor can prescribe Ritalin, and it is not necessary to have expertise treating ADHD."

The full study, "Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children With ADHD?" is a National Bureau of Economic Research working paper.

I went out with this guy a few times, and then he stopped calling. I thought things had been going really well, and I wanted an explanation, so I called him to ask what had happened. At first he just gave me a line about being too busy with school and work but I wouldn't let it go. He finally told me that is was my smell. MY SMELL. I am a very clean and tidy person so I was hurt and offended by this. He told me that he just has a really strong sense of smell and something about me was off, at least for him. That's bullshit, right?

It sucks when someone doesn't like us back or changes their mind, but for the life of me, I will never understand demanding an explanation out of the person. Like, I know I have an annoying laugh and it's probably caused a few second dates not to turn into thirds but I don't need the dude to tell me that. Why would you want to know the specific reason why someone passed, when you can go on blissfully through your life assuming they either fell off a cliff or were intimidated by your intelligence?

There are plenty of guys who will be into you and your stink. And you won't even have to talk them into it.

It's not bullshit because you called, he gave you a polite answer and you didn't accept it. Did you think that if you pressed the issue, he'd realize that there was nothing wrong with you? As though you can debate someone into a relationship. Sure, I have a scent that affects your delicate sense of smell, but have you seen my record collection? There isn't anything wrong with you. You're probably fine. Just not for him. And I'm sure you smell fine, definitely better than I do right now, that's for sure.

Maybe the smell thing is real, maybe he just wanted to shame you off the phone, but either way, he's not into it. There are plenty of guys who will be into you and your stink. And you won't even have to talk them into it.

My ex-boyfriend of three years and I broke up about six months ago. It wasn't a particularly bad breakup, we just both agreed that it wasn't working. I ran into him a few nights ago and he looked good. Really good. I texted him, and since then we've been sending flirty messages back and forth nonstop. There are no real feelings there on my end, but I do miss having sex with him. I'd like to again. Bad idea?

I am incredibly jealous of you. Having sex with someone after a breakup is all I want to do, and I've never pulled it off. I've tried to passionately kiss a man while he's trying to dump me on several different occasions. Something about a relationship ending that makes me want to squeeze the last bit of life out of it, carnally.

Your situation is obviously a bit less manic. You ran into an ex, you're both still attracted to each other and presumably unattached, go for it. There is nothing wrong with casual sex, and there is nothing more ideal than casual sex with a partner you know and like. But there is some prep before you go down this path.

There's nothing more charming than a naked man in your bed who knows you and knows how to talk to you.

You say in your question that there are no "feelings" there anymore. One, that is not true. You were with this guy for three years and unless you're a robot or heavily medicated you absolutely still feel for this person. I know that you mean that you don't have long-term romantic feelings for him anymore, but I just wanted to point out that there is most likely a deep care and respect for one another and you should try to protect that. Make your intentions very clear from the beginning and make sure that he also doesn't have any "feelings" for you anymore. He will be crushed if you two are on different pages about what this is.

Know the reasons why the relationship didn't work. The thing with having sex is that you have to talk, even if you're trying to be cool or mysterious or leave right after or whatever. You're going to talk and if this happens repeatedly, you're going to bond. In your case, re-bond. Relationships come out of casual arrangements fairly regularly. There's nothing more charming than a naked man in your bed who knows you and knows how to talk to you. I'm assuming a recent ex of three years knows the right things to say. So, if you know this would never work as a relationship, really remind yourself of that. Write it down somewhere you'll see it if you have to, so you don't end up going through the same break up, or in that weird "what are we?" purgatory.

I introduced my girlfriend to my family a few months ago, and my mother hates her. Her reasons (stated or unstated) are superficial, petty things: she doesn't dress well, she makes less money than I do, she didn't go to an Ivy League school like I did. I'm in love with this girl and could see myself with her long-term, but is it worth the fights with the family?

It's really up to you if the pros outweigh the cons, or vice versa. I always try to take the opinions of friends and family very seriously because across the board, they are all smarter than me. Especially when it comes to the people I'm dating because they're not clouded by visions of sex and brunch naps. But reading your question, I do have to say that your mom sounds awful. Are you sure that's what she means? I guess you'd know.

Fred Prouser/Reuters

If your mom had something like, "It doesn't seems like she listens when you talk," or "She seems manipulative," or "I think she's a ghost," and then backed those statements up with examples, maybe there would be some validity to what she's saying. But whatever her motives are but it doesn't seem like she's concerned with your feelings. I have friends with significant others that I can't stand. Can't stand their voices, or their dumb stories, or their weird little faces. But I put up with it like a brave little soldier if they make my friend happy. You should see me trying to smile through a conversation about a craft fair or some other nightmare thing that horrible girlfriends always want to talk about.

The point is, your mom hates your girlfriend. Sorry, that's going to make Thanksgiving hard for you. Your mother will eventually come to terms with it, or get tired of complaining about it. It's just not a sustainable behavior. If you want it to stop sooner, call her up, or better yet, take her to the Cheesecake Factory because moms love that place. Tell her that the insults stop or you'll stop being around.

If you have questions about relationship etiquette, please send them to Ask Alison [at] The Atlantic (.com).

Amid calls for more science in psychiatry, part of the $100 million the U.S. government is spending this year on the BRAIN Initiative will go toward "mapping the human brain" in the interest of more concrete diagnoses. Basing treatments on harder data could cut down on variations from doctor to doctor and get people healthier faster. For example, a recent study at Johns Hopkins found that more than 60 percent of adults who were diagnosed by their doctor as having depression actually did not meet the official diagnostic criteria for the disorder upon re-evaluation by Hopkins psychiatrists. Some of them may have been prescribed antidepressant medications when their real problem was something else entirely.

"It could presage a new era when treating depression depends less on trial and error, less on whether you see a psychiatrist or a psychologist, less on your insurance coverage, and more on science."

Even when diagnosis is accurate, only some depressed people respond well to antidepressants. For others, they don't really help. Dr. Thomas Insel, director of the National Institute of Mental Health, explained to me, "We have reasonably good treatments for depression; both medications and psychotherapies. But we don't know who will respond best to medication and who will respond best to psychotherapy."

We do know about certain interesting factors that predict responses. For example, depressed people with a personal history of child abuse seem to respond better to therapy than to medications. But an empiric test to decide who should receive what type of treatment, instead of relying on possible correlations and likelihoods from the patient's history, could save time and money in effectively getting people what best works for them.

As Insel told me, "We increasingly think of depression as a brain disorder and thus, turning to the brain to predict treatment response seems like a smart thing to do."

Neurologist Helen Mayberg and her team at Emory University published research this week in the Journal of the American Medical Association Psychiatry that used PET imaging of the brain, which lights up to indicate levels of metabolism, in patients with major depressive disorder. Mayberg's group specifically looked at a part of the brain called the insula. They found that patients who had high levels of metabolism in the insula responded well to the commonly prescribed antidepressant escitalopram (Lexapro). People with low levels of metabolism in the insula didn't do well on Lexapro, and were better off with cognitive behavioral therapy.

Since SSRI antidepressants and psychotherapy take time to work, identifying who-needs-what as quickly as possible could save people months of experimenting with ineffective therapies.

This particular study was small, but the concept is promising. In practical terms, as Insel put it, "It's hard to imagine that this form of brain imaging will be of immediate use -- each year 6.7 percent of adults meet criteria for major depression in this country, about 2 percent of adults are disabled by this common disorder (which has the highest rate of disability for all medical disorders for Americans between 15 and 49). Only about half receive any treatment and only half of those receive even minimally adequate care. Against that public health challenge, a high-tech imaging study is probably not going to be widely adopted even if it is useful. That said, this is an exciting proof of concept."

And the concept is getting good attention. Larger studies at multiple medical centers, now well federally-funded, are underway. If they pan out, Insel says, it "could presage a new era when treating depression depends less on trial and error, less on whether you see a psychiatrist or a psychologist, less on your insurance coverage, and more on science. Wouldn't that be enlightened?"

PROBLEM: Giving birth at home, away from the culture of medicine and stockpiles of medical paraphernalia at hospitals, is associated with significantly fewer medical interventions for the mother. Unnecessary interventions can put maternal health at risk. The counterargument, of course, is that should the worst occur and intervention be necessary, the greater risk is not being able to get mother to the hospital -- where that care is available -- in time.

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METHODOLOGY: In the Netherlands, midwife-assisted home births are routine and more common than in any other Western country. Researchers there compared the outcomes for 92,333 women who had a planned home birth to 54,419 who had a planned hospital birth between 2004 and 2006. Crucially, they only included women who were at low risk of complications, and they controlled for maternal age, ethnicity, and socioeconomic class.

RESULTS: Contrary to what the researchers were expecting, the rate of serious complications was lower for women who gave birth at home, provided that this wasn't their first child. 

For women who had previously given birth, the risk of severe outcomes -- admission into an ICU, uterine rupture, eclampsia, or a major obstetric hemorrhage that required a large blood transfusion -- for home births was 1 per 1,000; for hospital births, it was 2.3 per 1,000. This represented a reduction in risk of 58.3 percent. The rate per 1,000 for postpartum hemorrhage was 19.6 for home births, compared to 37.6 for hospitals: a 47.9 percent reduction. The rates per 1,000 for manual removal of the placenta were 8.5 and 19.6, respectively, representing a risk reduction of 56.9 percent.

IMPLICATIONS: There's a big question that the authors, working with their available data, weren't able to answer: what about the infants? After all, the analysis cited above found, in addition to the thing about fewer maternal complications, that the neonatal mortality rate for home births is tripled. The cultural context, here, is important as well: the authors concluded that planned home births for low-risk women don't lead to an increased risk of serious problems for the mother "in a maternity care system with well-trained midwives and a good referral and transportation system."." In the U.S., where our midwife system is nothing like what the Dutch have, the American Academy of Pediatrics recently agreed to go along with some women's desire to give birth at home, while continuing to insist that hospitals are safest.

Our third child was born seven weeks premature with a condition known as intestinal malrotation. The doctor explained it like this: When you're in your mom's uterus, your intestines initially form outside of your body. Then they retreat into your abdomen, twist, and your abdomen seals up around them. If you're unfortunate enough to be born with this condition (5,000-to-1 odds, though more common in premature infants), that crucial twist never occurs, and you can end up with something called a volvulus, which sounds like a kind of Swedish superhero but is actually a dangerous condition in which the intestines get kinked, like a garden hose, and the path of digestion is cut off, restricting blood flow.

Maybe we would get a dog if he passed away, a little dog named Otis or Kirby that would bark and yip and shit all over the place and help us forget about this.

You must have your belly split open so that everything can be put back in the proper order, or else you will die. If you're among the lucky souls born with properly ordered bowels, you should thank those bowels the next time they process a two-pound burrito on your behalf.

They found out that the baby had the condition when he began vomiting thick green fluid after his first feedings. The bile that he secreted to digest his formula was getting clogged in his intestines and was gurgling back up into his stomach, causing him to vomit over and over again. They placed a tube down into his stomach to suck up all the excess fluid and hoped the issue would resolve itself. Nights before the surgery, I stood by his isolette--an enclosed plastic incubator-- in the NICU and stared at the output of that tube, praying that it would turn yellow or clear, hoping to God that he'd be spared the knife and that I'd never see that horrible green shit come out of him again. But I did see it again. I would come to the NICU during the day and ask the nurses if he barfed, my fingers crossed tight enough to break. And they often said yes, he had an "emesis." The first time I heard the word, I asked them if "emesis" meant barf, and when they said that it did, I wished they had just said that he had barfed instead.

He wasn't old enough or awake enough to know that he didn't want to die. We did all that worrying for him.

The vomiting wouldn't stop. His insides weren't going to just naturally fall back into place. He had to be opened. No one makes it through life unscathed, but you usually get a grace period at the start. My son would not be so lucky. At the time, he weighed five pounds--large for a preemie, but still just five itty-bitty pounds. No heavier than a dictionary. I wondered how the surgeons' blades and instruments would fit inside him. Such a large surgery for such a tiny body, I thought.

The surgeon was talking us through the procedure as we all stood by the door to the OR. He had only a few moments to speak with us before our son had to go under. To wait any longer risked killing him.

"Distribution of the Primary Races," Stoddard, 1920  (Wikimedia)

"Have you read The Rise of the Colored Empires by this man Goddard? ... Well, it's a fine book, and everybody ought to read it. The idea is if we don't look out the white race will be -- will be utterly submerged. It's all scientific stuff; it's been proved."

That's Tom Buchanan, a character from Baz Luhrmann's 2013 blockbuster The Great Gatsby. The movie is based on a fine book by this man Fitzgerald. Even in 1925, when it was originally published, painting someone as a white supremacist was effective rhetorical character assassination. Paranoid antagonistic posturing aside, there was prescience in the "proved" numeric analysis. Just-released census estimates say that by approximately 2043, the white majority in the United States will indeed be no longer. 

For the first time in more than 100 years, white deaths in the U.S. over the past year exceeded white births. At the same time, earlier than predicted, the majority of births were to black, Hispanic, and Asian mothers. William H. Frey of the Brookings Institution told this morning's New York Times, "These new census estimates are an early signal alerting us to the impending decline in the white population that will characterize most of the 21st century."

As Hua Hsu wrote for our magazine in 2009's "The End of White America," Fitzgerald's mention of the book by "this man Goddard" was a thinly veiled nod to eugenecist Lothrop Stoddard's The Rising Tide of Color Against White World-Supremacy, which had been published in 1920. The book included a series of foldout maps like the one above, warning that "colored migration is a universal peril, menacing every part of the white world."

Not everyone's identity is as tied to precariously elite social station as is that of the Buchanans. Still at this turning point in statistic history, a good time to revisit Hsu's theses: "What will it mean to be white when whiteness is no longer the norm? And will a post-white America be less racially divided, or more so?"

In the summer of 2008, I moved from Pittsburgh to Chapel Hill to start my new position as a faculty member at the business school at the University of North Carolina. Although I was sad to leave Carnegie Mellon and my colleagues there, I was excited to meet new ones and to move into our new home. A few months earlier, my husband Greg and I had bought a lovely house surrounded by quiet, leafy streets just a few blocks away from the center of town.

Within a few days of moving in, Greg and I received a letter from Chapel Hill's City Hall welcoming us and informing us that new street lighting would be added in the neighborhood in the follow­ing weeks since that part of town had recently experienced a surge in crime. In addition to raising my fears (and not making me feel any safer), the letter also piqued my curiosity, since it highlighted an intriguing assumption: that lighting would reduce crime.

Is it only others' monitoring that prevents us from committing immoral acts?

In a sense, this assumption was consistent with what Ralph Waldo Emerson once wrote: "As gaslight is the best noctur­nal police, so the universe protects itself by pitiless publicity." According to conventional wisdom, darkness conceals identity and also decreases inhibitions; as a result, it may be linked to crime. The idea that darkness promotes unethical behavior dates back to the myth of the "Ring of Gyges," which was recounted by Plato in The Republic (360 BC). In the myth, a shepherd in Lydia named Gyges finds a ring that makes him invisible. He travels to the king's court, seduces the queen, conspires with her to kill the king, and takes control of Lydia. Thus, invisibility corrupted the wearer of the ring. The story leads Plato to ask the following ques­tion: is there anyone alive who could resist taking advantage of the invisibility ring's powers, or is it only others' monitoring that prevents us from committing immoral acts?

From this perspective, by providing anonymity, darkness may facilitate dishonest behavior. When transgressors believe others will not be able to identify them, are they more likely to behave dishonestly? Scholarly work conducted in the 1960s and 1970s found that criminal assaults most frequently occur during hours of darkness and that improving street lighting in urban areas is commonly followed by reductions in crime of between 33 percent and 70 percent -- impressive gains. Although interesting, the sci­entist in me notes that this evidence is inconclusive, as the rela­tionship between darkness and crime suggested by this data could be explained by other factors. I wondered whether there is a direct relationship between darkness and crime rates. Even more inter­estingly, does darkness increase dishonesty?

Soon after Greg and I received our letter from City Hall, Chen-Bo Zhong (a professor at the University of Toronto), Vanessa Bohns (a professor at the University of Waterloo), and I designed a series of experiments to test whether darkness -- or even dim lighting -- would increase dishonesty.

Chen-Bo, Vanessa, and I tested this possibility by conducting an experiment where we manipulated darkness by varying the level of lighting in rooms. Upon arriving at our laboratory, our eighty-four student participants were randomly assigned to one of two rooms (with about half in each room): one of them was well lit (our control condition); the other one was similar in size but was dimly lit (specifically, lit by four fluorescent lights rather than by twelve). Participants in the dim room could see the materials and one another, but the room was more dimly lit than the aver­age room at a university. Participants completed a problem-solving task: they had five minutes to solve twenty problems (which involved finding two three-digit numbers that add up to ten in a matrix of twelve numbers), and were paid 50 cents for each problem they solved correctly. After the five minutes was up, participants in both conditions were asked to self-report their performance on the problem-solving task. They were able to lie by overstating their performance and thus walk away with undeserved money. As in other experiments concerning dishonesty, we tracked whether participants cheated and, if so, by how much. If you were a participant in this experiment, do you think you would cheat by overstating your performance?

Eight additional fluorescent lights reduced dishonesty by about 37 percent.

Maybe you would stay true to your moral compass. But, as it turns out, many of our participants did not: in fact, on average, about half of them cheated across conditions. More interestingly, the level of darkness in the room dramatically influenced partici­pants' likelihood to lie by overreporting their performance: almost 61 percent of the participants in the dim room cheated, while "only" about 24 percent of participants in the well-lit room cheated. In other words, eight additional fluorescent lights reduced dishonesty by about 37 percent. This is quite a large difference, especially con­sidering that the task Chen-Bo, Vanessa, and I used in the experi­ment was completely anonymous: the only difference between the two rooms was the level of darkness.

These results were consistent with our initial predictions, but we wanted to take them a step further. We reasoned that, beyond simply producing conditions of actual anonymity, darkness may create a sense of what we refer to as illusory anonymity. This type of anonymity is likely to loosen inhibitions surrounding dishon­est behaviors such as lying and cheating. People in a room with slightly dimmed lighting, we reasoned, may feel anonymous not because the relative darkness has reduced others' ability to see or identify them (which it hasn't), but because they are anchored in their own experience of darkness. When people experience impaired vision as a result of darkness, they might unconsciously generalize that experience and expect that others will conversely find it difficult to perceive or see them, even when these others are sitting in a different location (such as another room). Just as small children close their eyes and believe that others can't see them, the experience of darkness, we theorized, would trigger the belief that we are warded from others' attention and inspections. Since peo­ple often have a myopic focus, this reasoning seemed to hold. If it's true, then manipulating darkness in other, more subtle ways than reducing ambient lighting likely would have the same effects on ethical behavior that we observed in our first experiment.

For our next experiment, we invited eighty-three students from the University of North Carolina at Chapel Hill to participate in an experiment for which they would receive a $5 show-up fee and a potential bonus payment of $6. Half of the participants were asked to wear a pair of sunglasses, and the other half were asked to wear glasses with clear lenses. They were then assigned to work with someone they were told was another participant (but was actually the experimenter) in a different room. They would be working with this person by communicating through computers. Participants knew that they would not interact face to face with their partner, nor would they later learn their partner's identity.

Clearly, when you are wearing a pair of sunglasses, no one else's sight is affected, especially when you are not looking at each other. Nonetheless, we expected that the relative darkness caused by wearing sunglasses would trigger a sense of illusory anonymity and influence participants' dishonest behavior. We measured dis­honesty by examining how selfish people were in allocating a sum of money between themselves and their partner.

Each person had $6 to divide between him- or herself and the recipient. The recipient had no choice but to accept the offer, and participants were told they could leave with the money they kept for themselves. Although we told participants that they had been randomly assigned to a role (either initiator or recipient), they all played the initiator against the experimenter. After participants made their choice, they answered a few questions measuring the extent to which they felt anonymous during the experiment.

Participants could offer any amount between $0 and $6. On aver­age, they offered $2.35, a bit less than a 50/50 split. Their offers differed based on whether they wore sunglasses: those who wore sunglasses gave less than $2, on average, while those who wore clear glasses offered an average of almost $3. Participants in the sunglasses condition gave significantly less than an equal division; those in the clear-glasses condition gave significantly more. As we predicted, wearing sunglasses also affected participants' psy­chological state: they felt more anonymous during the study than did those wearing clear glasses. Although darkness had no bear­ing on actual anonymity, it still increased morally questionable behaviors.

Dr. Joshua Landy is envisioning a new way for doctors to learn from one another. A Toronto-based intensive care physician by trade, Landy is the co-founder of Figure 1, a "crowdsourced photo sharing app for health care professionals." Launched just two weeks ago, the iPhone app is already populated with images both clinically significant and arguably beautiful -- without even the benefit of a filter.

"There is a culture among physicians of sharing interesting findings, whether they're classic ones that we learn in medical school but rarely see, or they're just picture-textbook-perfect versions of things that we see day-to-day," Landy explained when I asked about the inspiration behind his idea. His vision is to take these things that are already being passed around via email or photo message -- and then subsequently lost -- and make them available to the wider medical community.

Once uploaded to the app, the images become public content (stringent privacy guidelines ensure that any potential patient identifiers are edited out). Landy envisions a sort of Wikipedia of medical images, "a curated free-access almanac of features of medicine" that anyone can contribute to, edit, or learn from. While the company isn't disclosing any numbers yet, Landy said usership is already "well into the thousands."

What Instagram does for daily life, Figure 1 does for medicine, allowing professionals to see through one another's eyes. Of course, what doctors, nurses, and surgeons see (and choose to share) often approaches what a layperson might think of instead as "horrifically gruesome." This may be in part due to selection bias: there's a lot of gore to be found just by scrolling through the images, from the leg of a pedestrian who had been struck by a car to the hand of someone whose diabetes went untreated. 

*A note of warning: while nothing gratuitous is shown here, the images that follow (and in some cases, their backstories) get very graphic, very quickly.

Medical professionals can't always keep themselves from expressing their excitement over the things they come across. As Landy pointed out, "there's no professional way of saying 'I find this fascinating.'" The phrase users seem to be turning to so far is: "wow." 

While the line might be hard to identify, images that seem to be posted merely for shock value are deleted. But a fascination with things that other people might find gross or funny is, arguably, what most separates those who go into medicine from the rest of us. 

This is how everyone learns.

In the interest of optimizing treatment for people with anorexia nervosa, Anouk Keizer and a team of psychologists at Utrecht University in The Netherlands are working to understand how patients perceive themselves in relation to the physical world. They describe, for example, that people with anorexia seem to vary from the general population in how they perceive certain sensations of touch on their own skin. But, they say, there's not a lot known about "unconscious, action-related, aspects" of perceived body size.

So, to look at this, they asked 39 people (19 diagnosed with anorexia nervosa and 20 without) to walk around a room that included doorways of various sizes. The participants were distracted, asked to do a memory exercise while walking, not knowing that the actual experiment was to look at how they approached the openings.

People without anorexia seemed to regularly begin to rotate themselves, to fit through the smaller doorways, when the width got down to just 25 percent wider than their shoulders. Meanwhile the people with anorexia started rotating when the openings were 40 percent wider than their shoulders.

Keizer and company conclude from observing these approaches that people with anorexia use their perceptions of themselves in reconciling relationships to physical spaces not just consciously, but unconsciously. As they put it, "The disturbed experience of body size in anorexia nervosa is more pervasive than previously assumed."

Of course that depends on what you assumed.

PROBLEM: Extreme endurance athletes, like long-distance runners, bikers, and even cross-country skiers, tend to have enlarged hearts. Also known as "Athlete's Heart," the condition may be associated with an increased risk of heart problems. Within this already elite group, are those who push themselves the hardest even more at risk?

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METHODOLOGY: Researchers based in Uppsala and Stockholm studied almost 53,000 cross-country skiers (mostly men) who managed to complete the Vasaloppet -- the longest cross-country ski race in the world -- between 1989 and 1998, and followed up with them through 2005 using national health registry data. They grouped the participants into quartiles based on the number of races they'd completed and their finishing time, excluded anyone with a history of cardiovascular disease, and controlled for age and other factors.

RESULTS: Those who completed five or more races in a ten-year period, or who placed among the top 25 percent of finishers, increased their risk of developing some form of cardiac arrhythmia -- either an irregular, abnormally fast, or too slow heartbeat -- by 30 percent. 

Between each quartile for the number of races completed (from one to five or more), the risk of arrhythmia increased by 10 percent. A similar trend occurred as finishing time decreased, although this did not reach statistical significance. 

IMPLICATIONS: The Vasaloppet's participants, compared, to "average Swedes," have "lower incidence of physical and mental illness, tobacco consumption, fat intake, and higher fiber consumption." But compared to one another, the top performers were more likely to experience heart irregularities than other, still-extreme-but-less-so athletes.

The researchers didn't find any evidence for the athletes being at an increased risk of the most serious forms of heart failure, like cardiac arrest, and don't necessarily recommend that people cut back on the number of 90 kilometer cross-country megaraces they compete in. Nonetheless, the correlation between increased physical activity and increased heart health may not be as straightforward as we'd like to assume. 

As Seigan Glassing walked down the sterile, white hospital corridor, he thought of a poem written by well-known Zen master Kozan Ichikyo shortly before his death.

Empty handed I entered
The world
Barefoot I leave it
My coming, my going --
Two simple happenings
That got entangled.

Seigan paused outside one of the identical doors of the neurological unit, marked only with a number. He mulled over the words of the poem, letting them mingle, listening to their rhythm, refocusing. He was tired but not exhausted, nearing the end of his hospital shift. He straightened his Buddhist monk uniform and ran his hand over his clean-shaven head before adjusting his glasses.

As he entered the room he met a scent of flowers. The night lights of the city spilled in through the window and 57-year-old Cleo (as she was named in a transcript), her head heavily bandaged, held out her hand to greet him. Her long, dark hair was streaked with grey and she lay propped up in her hospital bed.

"You're the Buddhist chaplain aren't you? I've been waiting for you," she said. "Please sit down. Do you have some time for me?"

"Of course," Seigan said, taking a seat next to her. "Tell me how you're doing, how you're feeling right now."

What the end-of-life process quickly highlights, Seigan says, is that a patient's experience of pain can come in many forms.

Cleo was admitted to the hospital after suffering a major seizure one day while doing her laundry. A brain biopsy a few weeks later revealed a glioblastoma, an aggressive and malignant form of brain cancer. The surgeon laid out the prognosis, cut and dried: she had less than three months to live. He urged her to go ahead with surgery and a chemotherapy follow-up. It would give her perhaps an extra nine months to a year, he said, but ultimately the cancer was terminal. Cleo explained how, despite her initial reaction to let nature take its course, she felt she should go ahead with the surgery for the sake of her 87-year-old mother, who was devastated by the diagnosis.

Seigan listened carefully.

"Can I challenge you for a little bit?" he asked. "What do you really want?"

It's the question that is slowly but steadily refocusing end of life care. As a member of the interdisciplinary palliative care team at one of New York's major teaching hospitals, Seigan is part of a growing push to make health care more holistic -- treating the whole person rather than just focusing on the disease. Trained as a chaplain through the New York Zen Center for Contemplative Care (NYZCCC), he works to champion patients' quality of life and help them prioritize their personal goals and values.

"I encounter people at a vulnerable time, a time of crisis," Seigan explained. "I'm there to walk them through this journey in some way -- not fix them so much as to listen, to offer or reflect back to them their strengths, fears, their own existential support systems and what gives them meaning in their life."

The message that the palliative care team is trying to convey to the world of aggressive medical intervention is a straightforward one: healing people doesn't necessarily mean saving lives. "More and more we are refusing to acknowledge important aspects of what it is to be human, including death," Seigan points out. "People want to talk, they want to be heard and understood. But a lot of the time what we see in health care is a breakdown of communication."

***

Part of the problem, palliative care nurse practitioner Cathy Mondonedo argues, is that doctors have come to see death as failure, prioritizing extension of life over quality and comfort -- a mentality that is then projected onto patients and their families. "Its not that physicians aren't well-meaning, they just don't know how to approach this topic and don't want to look like they are giving up, but aggressive treatment is not always the best option," she said. "It's important that people are given realistic expectations about their illness so that they have time to have these difficult conversations and make plans for the future."

But confronting death is not easy. The Journal of Palliative Medicine reported in 2010 that only around 20 percent of terminally ill elderly patients had their end-of-life wishes documented in their medical records. Much of the painful end-of-life decision-making is then shifted onto family members, who are frequently left feeling isolated and pressured into pursuing invasive treatments. As a result, despite the majority of Americans voicing the desire to die in comfort at home, CAPC statistics show that around 80 percent of deaths still occur in hospitals and intensive care units.

Many doctors fail to call in the palliative care team when patients are terminally ill, fearing that it looks as though they should expect the worst. Yet the resounding response from patients and families who have experienced the interdisciplinary benefits of palliative care, within a hospital or at home via hospice, was that they wished they had known about it sooner.

Terminally ill patients who received early palliative care experienced less depression, had a better quality of life, and survived longer than those who were given "life prolonging" treatments or even just standard care.

When she was diagnosed with pancreatic cancer, Ruth, 83, said it was like receiving a knockout punch. "That blew my mind," she remembered. After the initial shock subsided there was a terrible sense of déjà vu, Ruth's son had died of the same disease five years earlier.

The sun streamed into the front room of their house in the Rockaways as Ruth's husband Joel* helped her to take her pain medication, reading from a neatly typed schedule. She would be allowed another dose in a few hours, he told her. The coffee table was piled high with photo albums, and a bowl of fresh fruit stood next to a huge bouquet of slightly wilting flowers, sent by their son's partner for the anniversary of what would have been his 55th birthday. "I don't want to throw them out," said Ruth with a smile.

She readjusted her slight frame in the large, yellow armchair, her patent, silver shoes catching the sunlight. "There comes a time when you know you're not going to beat nature," she said. "But I want to be comfortable and I don't want to be in pain, that's all I'm asking for. When I have no pain I can get up and get dressed. I don't have to worry." She paused, staring out of the large, white-framed window, "I just want to stay as far away from the hospital as possible," she added.

With the help of the palliative care team, managing the physical pain, nausea, and fatigue has become the focus of Ruth's treatment. Her specialized prescriptions are customized and altered according to her developing symptoms, giving her the freedom to continue with her daily routine as far down the line as possible. "Most doctors can only diagnose and then prescribe, they don't have the time or the expertise to work with you on the trial and error. Palliative care is a wonderful thing." She looked down at her folded hands for a moment. "My son didn't have any of this. He was in terrible pain all the time."

Ruth explained her new routine with measured precision. She and Joel only plan day to day, nothing in advance. Their focus is now on quality rather than quantity. Life has taken on a more immediate aspect, rooted in the present. They savor daily pleasures like speaking on the phone with friends, listening to music and reading the newspaper. "I want to know that my home is there for me," Ruth said, "that my family is there for me and I'm surrounded by the meaningful things."

g0upil/Flickr

Around her, the living room walls were lined with paintings and prints accumulated from years of vacations and trips abroad. Small ornaments were neatly arranged next to framed photographs and books were stacked in piles around the room. "So many people don't even know about palliative care," said Ruth. "It's an important step forward for medicine. I feel very lucky to have it."

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Over the past six years palliative care has been one of health care's fastest growing practices, becoming ever more widely accepted by patients, by doctors, and by hospitals. The number of teams has doubled, new fellowships have been added and the Center to Advance Palliative Care (CAPC) reports that 63 percent of hospitals with over fifty beds now have a palliative care team. Research has also shown that hospitals could save $6 billion a year in costs by fully integrating palliative care programs across the U.S.

But its use is not universally popular -- there are those who believe that making palliative care a specialty adds confusion to an already baffling health care system. A study conducted this year in The New England Journal of Medicine by Dr. Timothy Quill and Dr. Amy Abernathy voiced concerns that the growing acceptance of palliative care as a specialist field could actually encourage patient care to become further fragmented. The authors suggested that primary care clinicians and specialists may begin to assume that basic psychological and social support for patients with life threatening illnesses is not their responsibility -- a huge problem given that the current number of interdisciplinary palliative care teams won't be able to fully supply demand for years to come.

Educating doctors and specialists about the role of palliative care has also been an ongoing battle in America's hospitals. "One of the most common misconceptions about palliative care and hospice is that they speed up the dying process, but that's just not true," said Dr. Craig Blinderman, a palliative care specialist. "It's about managing symptoms and tailoring a patient's care to their values and goals, whatever those are." Indeed, according to a 2010 study published in The New England Journal of Medicine, terminally ill patients who received early palliative care experienced less depression, had a better quality of life, and survived longer than those who were given "life prolonging" treatments or even just standard care.

"One of the biggest obstacles that we have is in the current lexicon of medicine," said Fran Heller, a senior palliative care social worker, who works closely with patients' families during times of crisis. She argues that physicians, nurses, and social workers need to readdress how they speak about the dying process. "Too often the doctors refer to it as withdrawal of care" she said, shaking her head. "We never withdraw care -- we withdraw treatments."

Seigan suggests that the change in attitude towards end-of-life care needs to start from the roots of medical practice, teaching clinicians a more contemplative approach to health care. "Doctors are currently educated to be clinical and to be detached," he said. "I've heard many young doctors speaking about a patient only in terms of the evolution of the disease, totally forgetting the fact that it's a human being they're discussing."

Buddhist chaplains are taught not to separate the physical and the spiritual well-being of a patient, but to view them as interdependent, co-existing forces.

The convoluted sting of death can be made even more overwhelming for patients and families by the ever-increasing cost pressures that end-of-life scenarios currently present. Around 25 percent of all Medicare spending is funnelled into end-of-life treatments, but a study conducted by Mt. Sinai School of Medicine found that beneficiaries still had to spend an average of $38,688 on medical bills in excess of Medicare during their last five years of life -- frequently crippling amounts at a time already fraught with pain and anxiety.

What the end-of-life process quickly highlights, Seigan says, is that a patient's experience of pain can come in many forms. Buddhist chaplains are taught not to separate the physical and the spiritual well-being of a patient, but to view them as interdependent, co-existing forces. As well as assessing the present moment, preparation for the journey ahead often involves looking back. As Seigan listens to his patients, he works to help them identify the painful issues they wish to heal, leave behind, or simply come to terms with in the time they have left. He draws out thoughts, feelings, and reflections, encouraging the patients to explore and question them.

"Sometimes the most direct way to see something is by looking at it from a different angle," he said. "Illness can bring deprivation in all senses of that word and when we are deprived there can be anxiety, there can be fear, there can be isolation, loneliness, all of these things come up." He points out that the goal of his chaplaincy is not to dictate or prescribe, but instead to help the patient work towards their own sense of spiritual and psychological well-being -- to help them help themselves. "If I can help bring them a sense that they are not alone, that they have been heard, that their pain has been understood by another person, I think I've done my job," he added.

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In the hospital oncology unit, 74-year-old Ursula (as she was named in a transcript) wrapped her grey sweater tightly around herself. Sitting on the white, starched hospital bed, she leafed through a photo album page by page, letting her eyes run over each scene. Her second bout of lung cancer had been further complicated when she contracted pneumonia, but it wasn't the physical pain or shortness of breath she continually experienced which was weighing on her mind. Rounds of chemotherapy had drawn the color from her cheeks and left her frail and delicate, but she spoke with energy and fervor as Seigan sat by her bedside.

"It's always around this time of night that my thinking kicks in and I start ruminating, then it gets hard to sleep" Ursula said.

"Ruminating about what?" Seigan asked, noticing her increasing anxiety.

"I can't forgive myself for not knowing," she stuttered.

Seigan waited for a moment before continuing.

"What do you mean?" he said.

She turned her gaze towards the window. "I didn't know that my children were being abused. Right under my nose. I let them down. I was going through my own hell and I had no idea what was going on."

As the tears streamed down her cheeks she described her rage at the hurt her late husband had caused her family. She was glad he had died in pain, she said, and she could never forgive him. Seigan encouraged her to explore her feelings. "You have every right to feel angry... what frightens you about your anger? ... What happens when you keep it inside?" Her answers came quickly, words, memories, and regrets spilling out. She paused for breath and Seigan drew the conversation back to her children. Her bedside table was covered with cards and flowers from their visit earlier in the day, handwritten notes of love and support, arranged neatly beside her.

"Tell me more about them. What does it feel like to be forgiven?" Seigan asked.

She described her three children and how proud of them she is, two of them are married to "wonderful people" and she adored her grandchildren. "I'm blessed to be loved. I am so grateful to have my children back in my life. I was such a lousy mother and now I'm trying to make up for it," she said, as she wiped away the tears.

She showed Seigan the photo album that her children made for her, filled with photos of a safari holiday the four of them took together. "I love animals of all kinds," she said. "I feel so connected to them."

Seigan continued. "Could you imagine that your feelings, especially your anger, are like wild animals: they're part of you. How do you respond to animals again?"

Ursula thought for a moment, running her hand over the photographs. "By respecting them, not being afraid, accepting them for what they are," she answered slowly.

It's a reflection that Seigan firmly believes about death itself -- that it's part of the natural process of life. "Each one is different; the conclusion of a unique story," he said, sitting in his hospital office. He's seen the patients who felt ready, the ones surrounded by love and support, the unhappy, lonely endings, those in denial, those who fought desperately for their last breath, and those who welcomed it. "I think if we were to ask what is a good death, everyone would answer that question in a different way," he murmured.

Seigan used the analogy of a sunset to illustrate the elusive quality of death. Everything is heightened and intensified, he observed, emotions and thoughts and fears are brought to the surface. "When the sun sets there's a lot more color, there's a lot more drama," he said. "But sometimes it can be minimalist, dark or foggy, obscured by clouds."

Above all, death is something that Seigan believes should be treated with dignity and respect.

Names of patients have been changed. The author had no access to hospital records.

"Syndrome" is derived from Greek roots, meaning "to run together." A syndrome by definition consists of diverse findings that seem at first glance to have nothing to do with each other -- such as severe obesity, low oxygen levels, and a propensity for falling asleep at odd times. The three are indeed related, though; known as Pickwickian syndrome (after a Dickens character).

Uncovering a syndrome is as though we entered a room and found the pieces of a hundred different puzzles scattered all over the floor. To define their relationship is to recognize that a few of the pieces occur together again and again, and then begin piecing them together to form a coherent picture.

What physician wouldn't want to discover a syndrome? After all, the medical textbooks and journals are full of them, and acquiring syndromic status can be a one-way ticket to medical immortality. Some of the great figures in medicine are enshrined in this way, including Herman Boerhaave (Boerhaave syndrome -- a tear in the esophagus from vomiting), Harvey Cushing (weight gain, round face, and thinning of the skin due to excessive steroid levels), and John Down (a grouping of congenital findings associated with having an extra copy of chromosome 21).

This man had in fact visited more than 20 different healthcare facilities with the same set of complaints, though he always identified himself with a different name and address.

Such a brush with immortality happened to a radiologist when he came across the third case of a remarkable grouping of findings in a single year. In the first instance, the patient had been a 60-something year old man with a history of a blow to the head. He had lost touch sensation in his legs, and he was suffering from priapism, a prolonged erection. The emergency room physician caring for him had ordered a head CT scan, which showed a subtle abnormality. The radiologist recommended an MRI, which clearly showed a cyst at the back of the brain.

The radiologist thought the case peculiar, but did not pursue it further. A few weeks later, he received a call from a colleague who reported seeing more or less the same thing: a 60-something year old man with a history of head trauma who presented with a sensory level and priapism. This struck the radiologist as intriguing, but other responsibilities supervened, and soon he forgot about it. Then nearly a year later, he came across a third remarkably similar case, with the same history and physical exam findings. In each case, scans showed a cyst in the back of the brain.

The moment the radiologist encountered the third case, his pulse quickened, and he decided to write up the series of cases for publication. He could almost taste the glory of becoming the first physician ever to recognize the link between these unusual findings. But how in human anatomy and physiology could he connect up such apparently disparate features as head injury, loss of sensation in the lower extremities, priapism, and a brain cyst? What obscure neurologic pathway must tie them together?

Soon after he sat down to review the cases, however, his dreams of medical immortality began to evaporate. All three patients were not only in their 60s -- they were exactly the same age. And as he compared their MRI images, he made an even more unexpected yet disheartening discovery -- the cysts looked not only similar but positively identical. He compared the patients' names -- they were all different. He compared the patient identification numbers -- they were different, too. But how could three different patients have exactly the same rare cyst?

Only one explanation was possible. What he had discovered was not a remarkably similar constellation of findings in three different patients. What he had actually recognized was the very same patient who had presented at three different times at three different hospitals over a period of year. As he dug more deeply, he discovered that this man had in fact visited more than 20 different healthcare facilities with the same set of complaints, though he always identified himself with a different name and address.

What at first had seemed an entirely new neurologic syndrome was probably a manifestation of a rare but venerable psychiatric condition, sometimes referred to as Münchausen syndrome. It is named after Baron Münchausen, an 18th century German-Russian nobleman who attained renown for the remarkable stories he told about himself, later published by Rudolf Raspe under the title The Surprising Adventures of Baron Münchausen. Münchausen's tales of his service in the Russian cavalry were widely recognized by his contemporaries as highly exaggerated, if not unbelievable.

Today Münchausen syndrome is sometimes referred to as "hospital addiction syndrome" or "thick chart syndrome," because patients present again and again to physicians' offices and hospitals. Health professionals are naturally fascinated by unusual complaints and conditions that defy explanation. When this patient showed up in the emergency department, the curiosity of his physicians was inevitably piqued. Like others, he had undergone repeated hospitalizations and extensive diagnostic workups.

The role of patient offers many rewards in addition to attention, including relaxed responsibilities in work and family life, and for some, perverse enjoyment at fooling others.

He had become what physicians and nurses often refer to as a frequent flyer, though he escaped detection by never visiting the same hospital twice. Of course, some of his claims may have been true -- perhaps he really did have some of the problems he claimed. His CT and MRI scans certainly could not have been invented. Yet his objective in seeking care was evidently not to get to the bottom of his condition.

He could have told the physicians in each emergency room that he had been seen elsewhere, that an extensive diagnostic workup including CT and MRI scans had been performed, and that treatments, including psychiatric consultation, had been recommended. He also could have supplied them with his real name and patient identification number. Instead he kept all this information to himself, presenting each time as though he had never been seen before, thereby triggering repetitive and unnecessary hospitalizations and diagnostic workups.

It is highly likely that this deception extended beyond simply withholding his real name and medical records. He had probably exaggerated the history of head trauma. How likely is it that he truly suffered more than 20 separate blows to the head in such a short span of time? His loss of sensation may have been exaggerated as well. And his priapism might be related to the use of medications such as Viagra. The cyst in his brain was certainly real, but it was probably just an "incidental finding," meaning that it was not causing any of the problems he complained of and posed no threat to his health.

Why, then, was he doing it? The short answer is that we don't know. However, it seems likely that at some level he derived satisfaction from each of his visits to the hospital. He liked telling his story over and over to different teams of physicians and nurses. He enjoyed undergoing all the tests. Presenting a puzzle to the staff offered him a level of notoriety and sympathy that he rarely encountered elsewhere. Perhaps no other situation afforded him the opportunity to be the center of attention of so many bright and earnest people.

We usually suppose that no one would ever want to be sick, but this is clearly not the case. Some patients with Münchausen syndrome fake laboratory test results by contaminating blood and urine samples, and others are so desperate that they will actually inject themselves with urine or feces in order to make themselves sick. Such extraordinary acts remind us that the role of patient offers many rewards in addition to attention, including relaxed responsibilities in work and family life, and for some, perverse enjoyment at fooling others.

Ironically, some people are so starved for attention and sympathy that they would rather make themselves sick than carry on feeling so ignored and underappreciated. Regardless what syndrome we call it, there is something deeply sad in the fact that a person's life could be so empty.

A male white Bengal tiger cub ducks as a female Bengal jumps over him. (NancyChan/AP)

"Children should be taught never to roughhouse in water and never to hold another child underwater." So recommends author Jane Brody at The New York Times yesterday, on the importance of teaching kids to swim. Amid that sort of advice, she makes a right turn into the shadows: drowning is the number-two cause of death in children -- and racial disparities in the statistics are important to consider in improving safety. She writes:

According to the USA Swimming Foundation, about 70 percent of African-American children, 60 percent of Latino children and 40 percent of white children are non-swimmers. Lack of access and financial constraints account only partly for these numbers. Fear, cultural factors and even cosmetic issues play a role as well.

"Before the Civil War, more blacks than whites could swim," Lynn Sherr, the author of Swim: Why We Love the Water, said in an interview. "There are many stories of shipwrecks in which black slaves rescued their owners."

But as Ms. Sherr learned from Bruce Wigo of the International Swimming Hall of Fame, segregation destroyed the aquatic culture of the black community. "Once whites discovered swimming, blacks were increasingly excluded from public pools and lifeguarded beaches," Mr. Wigo told her.

As a result, many minority parents never learned how to swim. Adults who can't swim often fear the water and, directly or indirectly, convey that fear to their children.

Cultural difference in the arena are slowly normalizing thanks to the work of people like 29-year-old African-American Olympic gold-medal swimmer Cullen Jones, who works in his spare time as a motivational speaker "dedicated to helping minorities learn how to swim." He was the second black swimmer to ever win gold, after Anthony Ervin in Sydney in 2000. Meanwhile, for better or worse, Ryan Lochte is the one who has a TV show.

French Olympian Therese Blondeau dives during a competition in the 1930s. (CharlesPlatiau/Reuters)

It wasn't until August 25, 1981, that Charles "Tuna" Chapman became the first black person to swim the English Channel -- 106 years after the first white person did it. He was the 220th person overall.

Tuna said at the time, "Black people haven't been exposed to swimming, and they believe they're going to drown ... the majority of the population is gripped in fear of water."

Lee Pitts corroborates the history for the International Swimming Hall of Fame:

The African American experience of exclusion from the opportunity to swim in Fort Lauderdale [home of the National Swimming Hall of Fame] was commonplace throughout America in the first half of the twentieth century, leading to what has been described as a cultural disconnect between the Black community and swimming. One of the tragic consequences of this disconnect is that African Americans drown at a significantly higher rate than Whites.

While it is true that most African Americans do not connect with swimming, African Americans have an amazingly rich swimming history that dates back to pre-slavery days in Africa and the impact of swimming on the Civil Rights Movement toward the demise of the Jim Crow laws of the south was enormous. Before the slave trade began, Africans living in coastal communities were observed by early European explorers to be excellent swimmers. But as the slave traders invaded Africa, swimming became a dangerous pastime.

In his memoirs, Boyrereau Brinch, known by his slave name, Jeffrey Brace, told of a festive afternoon in the 1740s, when he and thirteen of his friends went swimming in a river. When they got out of the water, they were surrounded by white men with dogs who succeeded in capturing 11 of them. One moment he and his friends were engaged in what Brinch described as a "delightful sport;" moments later he was bound, gagged, and "fastened down in the boat," surrounded by the "horrid stench" of his captors.

Meanwhile there are still occasionally overt sorts of pre-civil right discrimination across the U.S., like this sign on a Cincinnati pool in ... 2011.

The Ohio Civil Rights Commission ruled that in posting the sign, landlord Jamie Hein had indeed violated the Ohio Civil Rights Act. The sign is a replica of one dated 1931 from a Selma, Alabama pool.

Hein contested, "I don't have any problem with race at all. It's a historical sign."

So yes, children should be taught never to roughhouse in water and never to hold another child underwater.

PROBLEM: If you haven't consulted with the CDC's official guide to handwashing recently, you might be surprised to learn, as I was, that they don't distinguish between using warm or cold water. What is important, they say, is that you use soap, that you scrub well (including the backs of your hands, between your fingers, and under your nails) for at least 20 seconds, and that you dry your hands afterwards. The CDC also officially recommends humming the "Happy Birthday" song twice through for an accurate measure of time.

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METHODOLOGY: Since "research has established that people generally overstate the degree to which they wash their hands," researchers at Michigan State hid out in four different bathrooms to see what was really happening. More specifically, they deputized their research assistants to do so. The assistants, who were instructed not to draw attention to themselves (they entered data into their phones so it would look like they were just texting), categorized people as not washing their hands at all, as wetting their hands but not using soap, or as washing with soap. In addition, they timed how long each person spent scrubbing.

RESULTS: Of 3,749 people observed leaving the bathrooms, 66.9 percent used soap, while 10.3 percent didn't wash their hands at all. The other 23 percent of people stopped at wetting their hands, in what the researchers, for some reason, call "attempted washing" (as if maybe those people just weren't sure how to follow through). Although the researchers generously counted the combined time spent washing, rubbing, and rinsing, only 5.3 percent of people spent 15 seconds or longer doing so, thus fulfilling the requirements of proper handwashing. They average time spent was 6 seconds.

Other findings include: people were less likely to wash their hands in the evening and significantly more likely to use soap in the morning; women, at 77.9 percent, were much more likely to use soap than men (50.3 percent), as were people perceived to be older than college aged, and soap was used more frequently when the sinks were clean.

IMPLICATIONS: Two separate surveys that relied on self-reports found that 96 percent of people claim to wash their hands consistently. If what's going on around Michigan State is any indication, the opposite is in fact true. Handwashing, again according to the CDC, "is the most effective thing one can do to reduce the spread of infectious disease."

We have been hearing a lot recently about a revolution in the way we think about human health -- how it is inextricably linked to the health of microbes in our gut, mouth, nasal passages, and other "habitats" in and on us. With the release last summer of the results of the five-year National Institutes of Health's Human Microbiome Project, we are told we should think of ourselves as a "superorganism," a residence for microbes with whom we have coevolved, who perform critical functions and provide services to us, and who outnumber our own human cells ten to one. For the first time, thanks to our ability to conduct highly efficient and low cost genetic sequencing, we now have a map of the normal microbial make-up of a healthy human, a collection of bacteria, fungi, one-celled archaea, and viruses. Collectively they weigh about three pounds -- the same as our brain.

Now that we have this map of what microorganisms are vital to our health, many believe that the future of healthcare will focus less on traditional illnesses and more on treating disorders of the human microbiome by introducing targeted microbial species (a "probiotic") and therapeutic foods (a "prebiotic" -- food for microbes) into the gut "community." Scientists in the Human Microbiome Project set as a core outcome the development of "a twenty-first century pharmacopoeia that includes members of the human microbiota and the chemical messengers they produce." In short, the drugs of the future that we ingest will be full of friendly germs and the food they like to eat.

The single greatest leverage point for a sustainable and healthy future for the seven billion people on the planet is arguably immediately underfoot: the living soil, where we grow our food.

But there is another major revolution in human health also just beginning based on an understanding of tiny organisms. It is driven by the same technological advances and allows us to understand and restore our collaborative relationship with microbiota not in the human gut but in another dark place: the soil.

Just as we have unwittingly destroyed vital microbes in the human gut through overuse of antibiotics and highly processed foods, we have recklessly devastated soil microbiota essential to plant health through overuse of certain chemical fertilizers, fungicides, herbicides, pesticides, failure to add sufficient organic matter (upon which they feed), and heavy tillage. These soil microorganisms -- particularly bacteria and fungi -- cycle nutrients and water to plants, to our crops, the source of our food, and ultimately our health. Soil bacteria and fungi serve as the "stomachs" of plants. They form symbiotic relationships with plant roots and "digest" nutrients, providing nitrogen, phosphorus, and many other nutrients in a form that plant cells can assimilate. Reintroducing the right bacteria and fungi to facilitate the dark fermentation process in depleted and sterile soils is analogous to eating yogurt (or taking those targeted probiotic "drugs of the future") to restore the right microbiota deep in your digestive tract.

The good news is that the same technological advances that allow us to map the human microbiome now enable us to understand, isolate, and reintroduce microbial species into the soil to repair the damage and restore healthy microbial communities that sustain our crops and provide nutritious food. It is now much easier for us to map genetic sequences of soil microorganisms, understand what they actually do and how to grow them, and reintroduce them back to the soil.

Since the 1970s, there have been soil microbes for sale in garden shops, but most products were hit-or-miss in terms of actual effectiveness, were expensive, and were largely limited to horticulture and hydroponics. Due to new genetic sequencing and production technologies, we have now come to a point where we can effectively and at low cost identify and grow key bacteria and the right species of fungi and apply them in large-scale agriculture. We can produce these "bio fertilizers" and add them to soybean, corn, vegetables, or other crop seeds to grow with and nourish the plant. We can sow the "seeds" of microorganisms with our crop seeds and, as hundreds of independent studies confirm, increase our crop yields and reduce the need for irrigation and chemical fertilizers.

A mycorrhiza or fungus root in cross section. The stained-blue tissue is fungal.

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These soil microorganisms do much more than nourish plants. Just as the microbes in the human body both aid digestion and maintain our immune system, soil microorganisms both digest nutrients and protect plants against pathogens and other threats. For over four hundred million years, plants have been forming a symbiotic association with fungi that colonize their roots, creating mycorrhizae (my-cor-rhi-zee), literally "fungus roots," which extend the reach of plant roots a hundred-fold. These fungal filaments not only channel nutrients and water back to the plant cells, they connect plants and actually enable them to communicate with one another and set up defense systems. A recent experiment in the U.K. showed that mycorrhizal filaments act as a conduit for signaling between plants, strengthening their natural defenses against pests. When attacked by aphids, a broad bean plant transmitted a signal through the mycorrhizal filaments to other bean plants nearby, acting as an early warning system, enabling those plants to begin to produce their defensive chemical that repels aphids and attracts wasps, a natural aphid predator. Another study showed that diseased tomato plants also use the underground network of mycorrhizal filaments to warn healthy tomato plants, which then activate their defenses before being attacked themselves.

Thus the microbial community in the soil, like in the human biome, provides "invasion resistance" services to its symbiotic partner. We disturb this association at our peril. As Michael Pollan recently noted, "Some researchers believe that the alarming increase in autoimmune diseases in the West may owe to a disruption in the ancient relationship between our bodies and their 'old friends' -- the microbial symbionts with whom we coevolved."

Not only do soil microorganisms nourish and protect plants, they play a crucial role in providing many "ecosystem services" that are absolutely critical to human survival. By many calculations, the living soil is the Earth's most valuable ecosystem, providing ecological services such as climate regulation, mitigation of drought and floods, soil erosion prevention, and water filtration, worth trillions of dollars each year. Those who study the human microbiome have now begun to borrow the term "ecosystem services" to describe critical functions played by microorganisms in human health.

Important species of microorganisms may have already gone extinct, some which might play a key role in our health.

With regard to stabilizing our increasingly unruly climate, soil microorganisms have been sequestering carbon for hundreds of millions of years through the mycorrizal filaments, which are coated in a sticky protein called "glomalin." Microbiologists are now working to gain a fuller understanding of its chemical nature and mapping its gene sequence. As much as 30 to 40 percent of the glomalin molecule is carbon. Glomalin may account for as much as one-third of the world's soil carbon -- and the soil contains more carbon than all plants and the atmosphere combined.

We are now at a point where microbes that thrive in healthy soil have been largely rendered inactive or eliminated in most commercial agricultural lands; they are unable to do what they have done for hundreds of millions of years, to access, conserve, and cycle nutrients and water for plants and regulate the climate. Half of the earth's habitable lands are farmed and we are losing soil and organic matter at an alarming rate. Studies show steady global soil depletion over time, and a serious stagnation in crop yields.

So, not only have we hindered natural processes that nourish crops and sequester carbon in cultivated land, but modern agriculture has become one of the biggest causes of climate instability. Our current global food system, from clearing forests to growing food, to fertilizer manufacturing, to food storage and packaging, is responsible for up to one-third of all human-caused greenhouse-gas emissions. This is more than all the cars and trucks in the transportation sector, which accounts for about one-fifth of all green house gases globally.

The single greatest leverage point for a sustainable and healthy future for the seven billion people on the planet is thus arguably immediately underfoot: the living soil, where we grow our food. Overall soil ecology still holds many mysteries. What Leonardo Da Vinci said five hundred years ago is probably still true today: "We know more about the movement of celestial bodies than about the soil underfoot." Though you never see them, ninety percent of all organisms on the seven continents live underground. In addition to bacteria and fungi, the soil is also filled with protozoa, nematodes, mites, and microarthropods. There can be 10,000 to 50,000 species in less than a teaspoon of soil. In that same teaspoon of soil, there are more microbes than there are people on the earth. In a handful of healthy soil, there is more biodiversity in just the bacterial community than you will find in all the animals of the Amazon basin.

We hear about many endangered animals in the Amazon and now all around the world. We all know about the chainsaw-wielding workers cutting trees in the rainforest. But we hear relatively little about the destruction of the habitat of kingdoms of life beyond plant and animal -- that of bacteria and fungi. Some microbiologists are now warning us that we must stop the destruction of the human microbiome, and that important species of microorganisms may have already gone extinct, some which might possibly play a key role in our health.

We are making good progress in mapping the soil microbiome, hopefully in time to identify those species vital to soil and plant health, so they can be reintroduced as necessary. There is now an Earth Microbiome Project dedicated to analyzing and mapping microbial communities in soils and waters across the globe. We do not want to find ourselves in the position we have been with regard to many animal species that have gone extinct. We have already decimated or eliminated known vital soil microorganisms in certain soils and now need to reintroduce them. But it is very different from an effort, let us say, to reintroduce the once massive herds of buffalo to the American plains. We need these tiny partners to help build a sustainable agricultural system, to stabilize our climate in an era of increasing drought and severe weather, and to maintain our very health and well-being.

The mass destruction of soil microorganisms began with technological advances in the early twentieth century. The number of tractors in the U.S. went from zero to three million by 1950. Farmers increased the size of their fields and made cropping more specialized. Advances in the manufacture of nitrogen fertilizers made them abundant and affordable. Ammonium nitrate produced in WWII for munitions was then used for agriculture (we recently saw the explosive power contained in one such fertilizer factory in the town of West Texas). The "Green Revolution" was driven by a fear of how to feed massive population growth. It did produce more food, but it was at the cost of the long-term health of the soil. And many would argue that the food it did produce was progressively less nutritious as the soil became depleted of organic matter, minerals, and microorganisms. Arden Andersen, a soil scientist and agricultural consultant turned physician, has long argued that human health is directly correlated to soil health.

During this same period, we saw the rise of the "biological agriculture" movement, largely in reaction to these technological developments and the mechanization of agriculture. In the first part of the twentieth century, the British botanist Sir Albert Howard and his wife Gabrielle documented traditional Indian farming practices, the beginning of the biological farming movement in the West. Austrian writer, educator, and activist Rudolf Steiner advanced a concept of "biodynamic" agriculture. In 1930, the Soil Society was established in London. Shortly thereafter, Masanobu Fukuoka, a Japanese microbiologist working in soil science and plant pathology, developed a radical no-till organic method for growing grain and other crops that has been practiced effectively on a small scale.

Fortunately, there is now a strong business case for the reintroduction of soil microorganisms in both small farms and large-scale agribusiness. Scientific advances have now allowed us to take soil organisms from an eco-farming niche to mainstream agribusiness. We can replenish the soil and save billions of dollars. Many field tests, including a recent one at the University of North Dakota, show that application of a commercial mycorrhizal fungi product to the soybean root or seeds increased soybean yields from 5 to 15 percent. The U.S. market for soybeans is currently worth about $43 billion annually, so adding healthy microbes to the crop will save billions (the value of increased yields is three to five times greater than the cost of application at current prices). Studies show that there will also be major savings from reduced need for chemical fertilizers and irrigation due to more efficient up-take of minerals and water. This also means fewer toxins and pollutants, particularly nitrogen fertilizers, leaching from agricultural lands into our public water system and rivers, which has contributed to massive "dead zones" like that in the Mississippi Delta.

For all these reasons, bio fertility products are now a $500 million industry and growing fast. The major agricultural chemical companies, like Bayer, BASF, Novozymes, Pioneer, and Syngenta are now actively selling, acquiring or developing these products.

Reintroducing microorganisms into the soil, together with the organic matter they feed upon, has the potential to be a key part of the next big revolution in human health -- the development of sustainable agriculture and food security based on restored soil health. Just as in the case of the human microbiome, the soil drugs of the future are ones full of friendly germs, and the foods they like to eat.

As the iconic Tim "The Tool Man" Taylor would say, "[guttural grunt], more power."

If I'm properly remembering Home Improvement, things rarely went awry for Taylor and his wife Jill. His North Star was the simple, relentless pursuit of the twentieth-century American "more is more" ethos. Taylor owned a multi-story house, had three stylish boys, a happy marriage, and a career that afforded him both celebrity and pursuit of his passion. Meanwhile the family's painfully levelheaded neighbor, Wilson, squandered most of his time clinging to eccentric cultural anachronisms alone in his backyard. It was strongly implied that he had lost the bottom half of his face in some sort of terrible accident.

The moderate Al Borland was also perpetually drab, surpassed by Taylor in every quantifiable metric of success.

Taylor is not America's Doctor today, though. (America's Doctor is of course Dr. Mehmet "A Revolutionary New Way to Live Years Longer: It's Red Palm Oil" Oz.) On the whole, twenty-first century medicine is ushering in a revival of moderation. This weekend, Dr. Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia, wrote a fact-heavy piece in the Opinion section of The New York Times, "Don't Take Your Vitamins." It was the most popular article on the Times' site.

@KatyPerry shows off bags of supplements and vitamins, labeled "Upon Rising," "Breakfast," and "Dinner."

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I know what it's like to be reduced to a headline. People sometimes put articles on their Facebook walls without reading past the headlines, I hear. Offit's actual point is more nuanced, if no less reactionary: Multivitamins are not a panacea; more is not always better; more is sometimes quite bad. Some of the anti-supplement data he cites is compelling:

In a study published in The New England Journal of Medicine in 1994, 29,000 Finnish men, all smokers, had been given daily vitamin E, beta-carotene, both or a placebo. The study found that those who had taken beta-carotene for five to eight years were more likely to die from lung cancer or heart disease.

Two years later the same journal published another study on vitamin supplements. In it, 18,000 people who were at an increased risk of lung cancer because of asbestos exposure or smoking received a combination of vitamin A and beta-carotene, or a placebo. Investigators stopped the study when they found that the risk of death from lung cancer for those who took the vitamins was 46 percent higher.

Then, in 2004, a review of 14 randomized trials for the Cochrane Database found that the supplemental vitamins A, C, E and beta-carotene, and a mineral, selenium, taken to prevent intestinal cancers, actually increased mortality.

Another review, published in 2005 in the Annals of Internal Medicine, found that in 19 trials of nearly 136,000 people, supplemental vitamin E increased mortality. Also that year, a study of people with vascular disease or diabetes found that vitamin E increased the risk of heart failure. And in 2011, a study published in the Journal of the American Medical Association tied vitamin E supplements to an increased risk of prostate cancer.

Finally, last year, a Cochrane review found that "beta-carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A."

When you put it that way, vitamins look bad. Beta-carotene, very bad. The fat soluble vitamins (A, D, E, K), as a rule of thumb, are the easiest to get too much of. Still reductive notions swaying perception too far against nebulous notions of vitamins is also bad. Everything we knew is not wrong.

First, talking in aggregate about all vitamins (which is like lumping "medications" as one thing) in binary good-or-bad terms misses all the points. We still don't know the exact ideal amounts of many vitamins, though we know more about some than others. For example, just three months ago, the U.S. Preventive Services Task Force reversed its position on vitamin D and calcium supplements for postmenopausal women. Michael LeFevre, chair of the task force that made the statement, said, "What we're saying is that a practice that we have commonly used for years -- literally, years -- routinely in postmenopausal women just doesn't work."

Similarly while vitamin A supplementation is not recommended in industrialized countries -- and can be outright dangerous to pregnant women -- the World Health Organization does recommend it in resource-poor places. Vegans may need to be on B12, but it is not recommended for most people. Vitamin C supplements, too, which are commonly taken in hopes of warding off impending colds, are not recommended as they have not actually been shown to work.

There is also the concern that deficiencies don't just manifest as overt syndromes like scurvy, but sometimes as more insidious pathologies. They have been tied in limited research to cancers, high blood pressure, and atherosclerosis. (Likewise vitamin excess has been tied to many of the same things.) Still the USPTF maintains that there's "not enough evidence" to blanket-recommend that we take (or that we do not take) vitamins A, C, E, or multivitamins, folic acid, or antioxidant supplements for purposes of preventing cancer or heart disease. Expect more research on all of that, particularly in high-risk patients.

One of the most important points to note where supplementation is very recommended is folic acid in pregnancy, which is necessary for normal cell division, as a supplement to all women trying to conceive -- sometimes to all women of childbearing age. (True you can get pregnant at 60 now with IVF, but the point is to address cases of unplanned pregnancy, where neural tube defects like spina bifida can result from insufficient folate before the woman even knows she's pregnant and thinks to start taking prenatal vitamins).

Bottom line, we understand the majority of people to be best off without any vitamin supplements. Just because they are non-prescription and still live inside a "health halo," vitamins are not harmless. They could shorten or extend your life; at this point, taking vitamins randomly is metabolic roulette. So, not to sound like the caveat at the end of a pill commercial, talk to your doctor about vitamins -- just like you would about prescription medications -- before waving any sort of pro or anti-vitamin flag. Not everyone needs the same things, and more doesn't mean better. Be the Al Borland of nutritional supplements.

On a whirlwind tour across the globe to document sustainable food, the team from Perennial Plate stops in Spain to meet one family dedicated to reversing the stigma surrounding a certain European delicacy. Creators Daniel Klein and Mirra Fine speak with the people behind Pateria de Sousa, a picturesque farm in the business of producing ethical, sustainable foie gras.

One of the most controversial foods around today, foie gras has been condemned in animal rights campaigns for the industry’s gruesome practice of force-feeding ducks and geese. At Pateria de Sousa, animals roam free and the farmers "recreate the natural instincts," they say, so that "the animal generates the necessary fat." When they "sacrifice" geese, they use a method of hypnosis that they believe is more humane. 

While industrial producers from France and elsewhere have journeyed to the farm to see its methods for themselves, some question the family’s limited production rate. The father responds, “Everything is not about making money. Our system isn’t just a business. It’s a way of life.”

For more from the Perennial Plate, visit their site.

PROBLEM: While there are recognized factors that put some people more at risk of suicide than others, it's extremely difficult to predict who will end up taking their own life. Over one million people do each year. Knowing specifically as possible what to look out for -- and in whom -- can help us concentrate prevention efforts.

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• Foreign-Born Kids in the U.S. Develop Fewer Allergies
• Men's Biceps Predict Their Political Ideologies
• Daily Sunscreen for 24% Fewer Wrinkles

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METHODOLOGY: Researchers at Lund University in Sweden and Stanford University collaborated on a population-wide study of over seven million Swedish adults, through the use of census data, out- and in-patient registries, and the national death registry. Between the years of 2001 and 2008, 8,721 members of the cohort committed suicide.

RESULTS: Depression was the highest overall factor associated with suicide, representing a 32-fold increased risk, and suicide was most common within 13 weeks of a first diagnosis. In fact, the chances of committing suicide were highest for those with any psychiatric diagnosis. For the entire population, having a poor social network -- for example, being divorced or unmarried -- increased the risk of suicide, albeit to a much lesser extent, as well. 

After accounting for all other variables, men were nearly three times as likely as women to commit suicide, and there were striking differences in risk factors between genders. Being young, single, and having a low level of education put men at a higher risk of suicide than women, while mental illness was a stronger risk factor for women than for men. Among social risk factors for suicide, women were most impacted by unemployment; for men, it was being single.

Physical ailments, too, heightened risk of suicide. Risk was increased between 1.4 to 2.1 times for people with chronic obstructive pulmonary disease, cancer, spine disorders, asthma, and stroke.

IMPLICATIONS: This is one of the largest population-wide studies to look at a large spectrum of suicide risk factors. Perhaps unsurprisingly, given the association between physical and mental illness and suicide, those who committed suicide sought out health-care more frequently than the general population. Approximately half of the people studied -- 57 percent of the women and 45 percent of the men -- had visited a doctor within three months of committing suicide; 29.5 percent of women and 21.7 percent of men had visited a doctor as recently as two weeks prior.

"Does this... look right?" I asked, cupping one of 10 flexible, vaguely boob-shaped plastic bowls against one naked breast, while the other dangled there.

"Whichever one feels comfortable and covers you," the sales associate, Whitney, reassured me. "But yeah," she said, pointing under my arm, "you wanna get that in there."

"Right. Yikes." And I reached for a bigger bowl.

For my entire adult life, I've been a chronic in-public bra adjuster.

You've likely seen women like me before, restlessly digging around inside their shirts to fix what's gone wrong below deck, or jamming their thumbs in just below the armpits for a quick everything-back-in-place shakedown. The habitual tugger of underwires, the indiscreet scooper-and-tucker of stray underboob. My mother calls this habit "unbecoming." 

An expert would probably call it evidence that I, like an oft-reported 8 out of 10 American women, wear a bra that doesn't fit. But as an annually fitted, routine buyer of D-cup bras, I've always called it the small karmic price I pay for being able to wear strapless dresses, or for having a surefire strategy to catch a lazy bartender's attention in a pinch.

When I saw a story in The New York Times recently, though -- "A New Step in Wrestling With the Bra" -- I couldn't help but feel a little wistful. Undergarment emperor Jockey, according to the story, was reinventing the bra with the goal of creating the ultimate comfortable garment that could perfectly fit and support a woman of any shape. 

Jockey

After screening hundreds of women and listening to women's complaints about their bras -- about their uncomfortable or unsupportive fit; their inconsistent sizing; their jabby, constricting underwires; even their favorite manufacturers' habit of discontinuing their favorite styles -- Jockey spent eight years engineering a new product called, creatively, the Jockey Bra. Now available for purchase, the it looks identical to a conventional bra, but it aims (and claims) to be much more: According to Jockey, the "reinvented" bra solves these assorted problems by offering consistent sizing in styles that won't be discontinued, plus a flexible resin "3-D contour" piece instead of an underwire ("Because we're not flat," as Whitney explained). And perhaps most radically, the Jockey Bra has thrown out the traditional sizing system in favor of "volumetric sizing" -- that is, a larger variety of cup sizes and shapes designed to more securely accommodate a larger variety of breasts, which could keep women comfier and even potentially healthier.

And that's how I ended up naked in front of Whitney, clutching what looked like a warped Frisbee to my chest. The promise of a no-fuss, strap-it-on-and-forget-about-it bra beckoned.

Was it too good to be true?

Well, yes and no.

The ill-fitting bra problem, by Jockey's logic, results from a time-honored tradition of bra manufacturers failing to take into consideration the actual shape and weight of a breast.

Traditionally, bra cup sizes are based on two measurements: the distance around the breasts at their fullest point (the "nipple line," it's sometimes called) minus the circumference of the ribcage just below the breast tissue (or "under-bust"). A one-inch difference corresponds to an A-cup; two inches, a B-cup, et cetera.

But as Jockey's slogan goes, "You wouldn't measure a pitcher of water in inches." In other words, because a breast -- especially a larger breast -- is malleable and often somewhat round, measuring a garment to support it is a little more complicated than the alphanumeric system of bust-circumference-minus-chest-wall-circumference accounts for.

Hence the 10 different sizes of jellyfish-esque "volumetric fit cups" that were lined up in a row before me. As Whitney explained to me while I boob-tested one "fit cup" after another, each larger size is shaped more like a rounder, fuller breast to ensure that the closest possible measurement of actual breast tissue gets taken. (For more on how that works, watch Jessica, whose breasts are made of glass, get fitted in the Jockey promotional video)

The women who might benefit the most from the Jockey Bra, Whitney explained, are those women with what she calls "pendulous" breasts, or larger breasts that hang down onto the chest wall. If a woman has pendulous breasts (and many women do), the traditional nipple-line-minus-ribcage measurement doesn't account for any breast tissue that hangs below the nipple line. A bra, of course, lifts the breasts upward. A cup that's the purported "right" size for a woman with pendulous breasts, then, can leave some overspill on the sides or over the top of the cup, which can weigh down the front of the bra and cause it to ride up in the back or dig uncomfortably into the shoulders.

Other negative health effects of wearing an insufficiently supportive bra have been well-documented over the years. Breast pain and back pain are well-known side effects of poor bra fit, and very concerned osteopath Jon-Morton Bell even warned British news outlet The Independent:

If a woman is bending forward because of insufficient breast support, the trapezius overstretches and causes headaches. All nerve roots come from the back; stomach upsets and fatigue are common by-products of bad back health.

So a new method for finding precisely the right cup size and shape could be immensely helpful for women -- especially those women with pendulous breasts -- who find their postures affected by bras that don't adequately support them.

"Pendulous," I repeated. "Is that what I have?"

Whitney laughed politely. Not as pendulous as some she'd seen.

The Jockey Bra comes in 55 sizes -- based on combinations of 10 different cup sizes and seven under-bust measurements -- and five different styles. In the spirit of finding the garment that truly best conformed to and supported my natural shape, I chose, quite literally, the bra of least resistance: the un-padded, full-coverage Double Lined Contour model in the weirdly foreign size "7-34." Then my brand-new, "closest thing to custom" Jockey Bra was placed in my hands in what looked like a light-blue shoebox, like a glass boob-slipper that promised to transform me from a maternally embarrassing underwire yanker to an effortlessly well-supported princess.

The next day at work, I was dismayed to find that I was not any more of a princess than I had been the day before. I felt, as per usual, like a person wearing a bra.

But I did find that I had less fidgety hands.

In the Jockey Bra, the following everyday activities could be completed without the obligatory re-shuffle afterward:

• Running to catch a waiting elevator before the doors closed.
• Bending over to get a yogurt from the bottom shelf of the office fridge.
• A midday finally-outta-the-desk-chair overhead stretch.
• Scampering down an escalator in time to hop aboard a subway train.
• Resuming normal upright evening activities after an accidental couch nap.
• Ashtanga yoga in a zero-gravity chamber.*
• Jumping rope on a trampoline while driving 60 miles per hour over speed bumps.*

*Not actually tested

Now, make no mistake: The Jockey Bra I chose, though fabulously un-frustrating, was also terrifically, terrifyingly unsexy. Perhaps that's because I picked a model with a "natural" fit, which does the opposite of what a pushup bra might do. (Rather than lifting and smushing together, it just sort of... cradles, like a couple of hammocks.) Or perhaps that's simply because it's a bra made by Jockey -- and bras made by Jockey aren't generally the kind you wear under an anniversary dinner-date ensemble anyway.

But for pattering around my office on a Thursday, comfortably un-voluptuous was a perfectly acceptable option -- and the hands-free, low-maintenance nature of a bra that fit snugly and firmly was a productivity-boosting surprise.

Jockey's radical "reinvention" of the bra didn't reinvent my life, but a better-fitting bra certainly made me a less squirmy human -- and more shape-conscious sizing systems could make an even bigger difference for women whose musculoskeletal health is adversely affected by an ill-fitting bra. If Jockey's new undergarment sizing system signals the future of the bra, we could look forward to less aggressive underwires, fewer over-burdened shoulder straps, and a generally less fidgety tomorrow.

Michael, an autistic boy living in New York City, started scratching and picking at his face when he was about seven years old. Before long, he was gnawing on the side of his thumb. Along the bottom of his stomach, he tore cuts so deep that they scarred.

Over the next five years, a series of psychiatrists prescribed psychotropic medications to correct the self-mutilation. But nothing seemed to help. By age 12, he'd been taken out of school because he was a constant disruption. Though his parents wanted him to live at home, they decided he could be better cared for in a residential facility.

"These kids just live in a very fine balance. And when anything is off, they regress."

As they prepared to move Michael to the group home, his family was referred to Dr. Kara Margolis. Margolis, 36, is a pediatric gastroenterologist at New York Presbyterian Hospital and a researcher at Columbia University Medical Center. She speaks with contagious enthusiasm and the slightest hint of a Brooklyn accent. By the time she met Michael, bloody scabs dotted his face, from the tender skin below his eyes to the tips of his ears. He'd chewed his thumb down nearly to the bone. There was blood everywhere, Margolis recalls as she describes their first visit. He screamed and paced the room throughout the brief exam.

Until recently, psychiatrists have mainly been handling these kinds of behavioral changes. "A lot of these kids, before they see me, have been trialed on many different psychotropic drugs to try to relax them, to calm them down," Margolis explained on a Wednesday morning in April, as she sat at her cluttered desk in the gastroenterology research lab at Columbia. "Sometimes they work and sometimes they don't."

Dr. Kent Williams, a pediatric gastroenterologist at Nationwide Children's Hospital in Columbus, Ohio, agrees that many doctors are reluctant to consider other possibilities. "My heart goes out to the parents, because this is a daily struggle," he said. "Some physicians don't know what to do, so they give up."

Margolis, Williams and a handful of doctors across the country take a different approach. Instead of concentrating on the brain, they treat the gut.

Dr. Kara Margolis examines a patient. [Danielle Elliot]

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"Many doctors don't recognize that aggressive behavior is not part of autism," Margolis said. "This is really a new field." Research is showing that a common cause of autistic children acting out is simply because they're constipated -- which, from there, can mean they stop sleeping and eating well. They may become aggressive and frustrated because they have no other way of saying that their stomachs hurt.

Approximately one in 88 children in the U.S. has an autistic spectrum disorder. Up to 70 percent of them have gastrointestinal (GI) abnormalities at some point during childhood or adolescence. They are 3.5 times more likely to have constipation or chronic diarrhea than children who are not autistic. For years, parents have tried altering their children's diets to alleviate the issues, often restricting or completely eliminating gluten and dairy. But there is little scientific evidence supporting these dietary changes. Still signs keep pointing back to an underlying biological link between autism and GI issues.

A study published last year in the Journal of Abnormal Child Psychology linked the GI issues with behavior, showing that autistic children who have GI issues often experience extreme anxiety as well as regressions in behavior and communication skills. What's worse, the side effects of the psychotropic drugs that are prescribed to many autistic children may be intensifying the digestive issues. Once the GI issues are treated, aggressive and problematic behaviors sometimes subside.

At her first visit with Michael, Margolis suspected that he was nauseous and constipated, conditions that generally manifest in the area of the stomach where he was scratching. The nausea would explain why he often gagged and salivated during meals. She couldn't take x-rays because he was so hyperactive, but Margolis followed her instincts and treated him for constipation and reflux (gastritis).

When Michael came in for his follow-up one month later, the scabs on his face were healing. He'd stopped biting and scratching; he sat through the exam. His mother cried in the exam room, seemingly amazed that over the five years that his behavior deteriorated, no other doctors had recognized the GI issues.

Today, he is back in school and living with his family. He is still very sensitive to the slightest bit of constipation, but as long as his GI issues remain in control, so do his behaviors.

"These are kids who, their whole lives turned around when we treated the GI issues," Margolis said. "They're not miracles. They seem like miracles, but really all it takes is a recognition that GI things happen in these kids and they manifest in very different ways than in kids who are not autistic." Understanding how GI issues manifest differently in autistic children could lead to new treatments and pharmaceuticals targeted specifically to the autistic community.

There are several theories behind the link between GI issues and autism, and whether abnormal gut development precedes or contributes to abnormal neurological development. There is no evidence to say that GI issues and autism have a causal relationship in either direction. The first step to improving treatments is to understand the underlying link between the two conditions.

Scientists at U.C. Davis, supported by a $770,000 grant from Autism Speaks, are concentrating on bacterial overgrowth in the gut and potential antibiotic treatments that would help the gut function more normally. At the University of Toronto, neuroscientist Derrick MacFabe is researching the relationship between gut bacteria and brain development.

Margolis is also investigating the role of gut bacterial overgrowth -- as well as that of serotonin.

Serotonin is best known for its role in the central nervous system. It regulates mood, appetite, and sleep -- yet more than 90 percent of the body's serotonin is actually in the gut. Dr. Michael Gershon, author of the The Second Brain: Your gut has a mind of its own and head of the gastroenterology lab at Columbia, was one of the first to study the role of serotonin in the gut -- or, as he calls it, the enteric nerve system. His research shows that serotonin regulates movement within the intestines, which is critical to healthy digestion.

A 2009 study found that about 30 percent of autistic children have too much serotonin. In medical terms, this is called hyperserotonemia. In the gut, serotonin is produced by two different enzymes. Once it is released, digestion kicks into action, and the serotonin needs to be reabsorbed for the gut to return to the normal resting state. Reabsorption is carried out mainly by the serotonin re-uptake transporter (SERT), which is carried in gene 17q11.2. If sufficient serotonin isn't produced, or it isn't reabsorbed, GI issues ensue.

In a 2012 study, researchers at Vanderbilt University identified the most common genetic SERT mutation (SERT Ala56) in the genomes of hyperserotonemic autistic children. After pinpointing SERT Ala56, they created autistic-like mice by manipulating their SERT. These mice exhibited communication delays and repetitive behaviors similar to those observed in children with autistic spectrum disorders. When the Columbia researchers joined the study last year, they started to investigate gut development in the SERT Ala56 mice.

"Do these kids respond in the same way? Do we need additional interventions?"

"So far we found that these mice do have huge differences in the way that their guts develop," Margolis said. "They're constipated, like a large number of kids with autism; they have bacterial overgrowth in their guts, which we think also happens in a lot of kids with autism; and we'll be looking at other aspects of these mice with gut function as well."

At this stage of the study, they're looking at tissue samples to see if similar abnormalities occur in human development. If they do, it will tell the researchers one of two things: either they are right that the serotonin imbalance affects gut development, or that the serotonin imbalance is a coping mechanism for something else.

In both cases, it would mean that treatments for GI issues should be different for autistic patients than they are for non-autistic patients. "The idea would be to target treatments to figure out what's going on in the serotonin system in the gut," Margolis said. "And to be able to treat these kids more effectively based on the defect that's causing the hyperserotonemia."

Williams is also investigating the role of serotonin in GI dysfunction among autistic patients. He is in the early stages of comparing tissue and blood samples from autistic and non-autistic children with GI issues. Like Margolis, he hopes the research will lead to new treatments for autistic patients. "Do these kids respond in the same way? Do we need additional interventions?"

One of the biggest challenges is dealing with the children's sensory issues. Once autistic children start to recognize the taste or texture of medications, Williams said, many of them start refusing to take them. Margolis regularly treats a 10-year-old boy who spots the prescription pills that his mom mixes into his trail mix. He picks them out and throws them across the room. Autism-specific treatments would address these sensory issues in the medication plan.

"There's not a lot out there on how to approach and treat these kids," Williams concluded. "So, I think there's a lot to be done." He stressed that educating physicians, especially those who don't often treat autistic patients, is key to helping diagnose and mitigate GI issues.

This year Margolis is also collaborating with Drs. Harland Winter, Tim Buie of Massachusetts General, and Dr. Agnes Whitaker from Columbia on a separate study supported by the Autism Treatment Network. Through a questionnaire, they are pinpointing the most common GI problems in autistic children, as well as confirming the link between these conditions and problematic behaviors.

The preliminary results of the study support something Margolis has already seen in her clinical practice: not all autistic patients respond to GI issues aggressively, but their behaviors and reactions can be severe in other ways. If an autistic child's behavior suddenly shifts, doctors should consider GI issues as a potential cause.

Last year, Margolis treated an 8-year-old boy for constipation. Six months before coming in, the boy was developing well. He was reading, speaking, and doing math with home-school tutors. Then, after a family vacation, he became nearly catatonic and obsessive compulsive to the point of dysfunction. He drank water so excessively that his sodium dropped, causing him to have several seizures. Margolis says he was severely constipated. Once treated, he started to improve. Within months, he was back to his old self.

Margolis and Williams can share many stories like these, stories of patients whom they've seen transform once they are treated for conditions as basic as constipation and reflux.

"You would say it was a miraculous recovery," Margolis said during a rare five-minute respite between patients at New York Presbyterian. "But I think these kids just live in a very fine balance. And when anything is off, they regress, because they compensate."

"There are many other causes for these things, so I don't think that everyone that has these behaviors has a GI problem," she added. "I certainly don't solve every case. But I think for sure that a GI evaluation is warranted in the majority of these kids."

I haven't seen this question asked yet, and I'm not entirely sure how to say it. Anyway, I was lucky enough to get a great job right out of college, but my boyfriend was not. I've stuck it out for two years now, but he's going to be 27 this fall and still is unemployed and lives with his parents. We're both ready to be full-time adults but it's pretty impossible in his situation. When is it time for me to move on? I know it's not his fault, but I'm tired of it being my problem. Too harsh?

Usually when young people start dating young people, for the most part, you are equals at least in some way, you know? You both go to the same college, or you're equally attractive, or you live in the same apartment building or whatever. As time goes on, that slides around until you might be three years in, staring at a stranger. A good relationship feels like both people are growing and improving because of each other. In your case it sounds like you're thriving in spite of, not because of, your boyfriend.

It sucks when our lives move us away from the people we used to be closest to. But your life is clearly pulling you away from this guy. We all fall on hard times and sometimes need to lean on our significant others emotionally, financially, or both. 

So maybe it is harsh to end a relationship because things aren't going according to plan, or because the other person doesn't make as much money as you, etc. But it is also unrealistic for him to ask a grown woman to have a conversation with his parents every time she comes over. Imagine if you two had your first date today. Would there be a second one? That doesn't make you petty or shallow, it means you want an equal, which you deserve.

I don't know what your boyfriend's career aspirations are and I understand that the economy is still bad, but most people out of college suck it up and take a low paying job and a live in a gross apartment and struggle while they work out lives for themselves. Two years in, it kind of sounds like this guy is waiting for the perfect opportunity before he leaves home. Maybe some tough love would do him good. He's got free rent and a girlfriend who is willing to put up with it. Ending the relationship might be what wakes him up; good for you both.

I'm a 31 year old guy, recently divorced, pretty chill, and I just started dating a 23-year-old woman. She's an angel. I know what love is, and this is love. We've gone out a few times. She's just kind of like "oh well, we'll see what happens," but I know this is marriage material. Last weekend her roommates had a keg party, and I wanted to sweep her off into a carriage and propose to her on the spot. She only wanted to dance, though, and not even just with me. When I watched her dancing with other guys it made my blood boil. I wanted to yell out, you know, "THIS IS NOT COOL." But all I did was tap my foot and nod to the music. I guess I'm just a romantic. She'd be such a good mom to my son, they even look alike. How do I play it cool?

I was back home visiting my parents a few weeks ago and stopped by a local coffee shop. I fell in love with the barista that took my order. Right there. He was in his early twenties, had the stubble of a community college poly sci major and was just such a babe in a way that really spoke to me. We joked around while he made my coffee and all the while I was thinking, "I could take you away from all of this." Because I could. I could take him back to my little house on the east side of Los Angeles and show him my record collection and my framed posters and sleep with him and we would be happy forever, or maybe a few weeks. So when you tell me you're in love with this girl, please know that holds little or no weight with me. I fall in love like three times a month at least.

You don't say how recently divorced you are but I'm guessing that whatever the timeline; if you're still using the word "recently," you may need time to process the change. We all do that differently. Some of us watch sad YouTube videos of blind kittens and sob into a salad bowl filled with cereal. Some people do "healthier" things like channel that energy into a creative project. Some people try to ignore the pain completely and transfer all of their feelings onto a young unsuspecting co-ed.

However strong your feelings may be for this girl, or whatever they're really for, take time to really consider the possibility that you are just trying to navigate your way out of a painful chapter. It doesn't work that way. You will have to feel what you're trying not to feel right now. This girl isn't going to save you or replace what you lost.

I went out several times with a guy going through a divorce so recent I'm not even sure he had finished moving all of his stuff out of their house. When I wasn't listening to him complain about his ex-wife or having some of the worst sex of my life, I was busy debating him on how he wasn't ready to be out in the world, "dating." In my defense he was very handsome and I had a rough idea of what I was in for. I promise you that you are not fooling anyone right now. 

For one, the woman is 23 years old. When we're young, we sometimes read train wreck as romantic; delusions as compliments. Please don't attach much to this young thing. It sounds like you see something new and full of hope, and maybe she's the only real bright spot in your life right now (aside from your kid, I guess) which is never good. Even if she is ready to settle down (she's not) into your imaginary world of domestic bliss, she is almost certainly equipped to help you.

Finally, to answer your actual question on tips for how to play it cool: sit this girl down, tell her you're not emotionally ready for this and then leave her alone. It's the coolest thing you can do.

I just started seeing this guy and I'm crazy about him. I also just found out that I'm moving for work to a city six hours away. I don't leave for a few months, should we stop seeing each other? I can't stress to you enough how crazy I am about him.

The easy answer is yes, of course. Cut it off before you're too deeply attached and spare yourself a tearful airport goodbye or doing a big speech about what life could be like, Family Man style. 

But if you're like most people, when you like someone in those early infatuation stages, no rhyme or reason is going to keep you apart. It's really the reason most people end up together at all: the total suspension of disbelief. You probably know that the logical thing to do would be to end this, but we both know that's not going to happen. So keep seeing each other as long as you can, be realistic about the situation you two have found yourself in, have a lot of sex while you can, and be prepared to cry at the airport asking, "Why did I do this to myself?" Hey, if this is the guy, who knows, maybe he'll eventually make the move with you. If not, you'll be single in a new city. There are worse things.

If you have questions about relationship etiquette, please send them to Ask Alison [at] The Atlantic (.com).