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Aeon.com articles

The meanings of life

Happiness is not the same as a sense of meaning. How do

we go about finding a meaningful life, not just a happy

one?

A family party, Italy, 1983.Photo by Leonard Freed/Magnum

Roy F Baumeisteris professor of psychology at Florida State University in Tallahassee. Hislatest book is Willpower(2010), co-authored with John Tierney.

Parents often say: I just want my children to be happy. It is unusual to hear: I just want my

childrens lives to be meaningful, yet thats what most of us seem to want for ourselves. Wefear meaninglessness. We fret about the nihilism of thisor that aspect of our culture. Whenwe lose a sense of meaning, we get depressed. What is this thing we call meaning, and whymight we need it so badly?

Lets start with the last question. To be sure, happiness and meaningfulness frequently

overlap. Perhaps some degree of meaning is a prerequisite for happiness, a necessary butinsufficient condition. If that were the case, people might pursue meaning for purelyinstrumental reasons, as a step on the road towards happiness. But then, is there any reason towant meaning for its own sake? And if there isnt, why would people ever choose lives thatare more meaningful than happy, as they sometimes do?

The difference between meaningfulness and happiness was the focus of an investigation Iworked on with my fellow social psychologists Kathleen Vohs, Jennifer Aaker and EmilyGarbinsky, published in theJournal of Positive Psychologythis August. We carried out a

survey of nearly 400 US citizens, ranging in age from 18 to 78. The survey posed questionsabout the extent to which people thought their lives were happy and the extent to which they
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thought they were meaningful. We did not supply a definition of happiness or meaning, soour subjects responded using their own understanding of those words. By asking a largenumber of other questions, we were able to see which factors went with happiness and whichwent with meaningfulness.

As you might expect, the two states turned out to overlap substantially. Almost half of thevariation in meaningfulness was explained by happiness, and vice versa. Nevertheless, usingstatistical controls we were able to tease two apart, isolating the pure effects of each one

that were not based on the other. We narrowed our search to look for factors that had oppositeeffects on happiness and meaning, or at least, factors that had a positive correlation with oneand not even a hint of a positive correlation with the other (negative or zero correlations werefine). Using this method, we found five sets of major differences between happiness andmeaningfulness, five areas where different versions of the good life parted company.

The first had to do with getting what you want and need. Not surprisingly, satisfaction ofdesires was a reliable source of happiness. But it had nothingmaybe even less than

nothingto add to a sense of meaning. People are happier to the extent that they find theirlives easy rather than difficult. Happy people say they have enough money to buy the thingsthey want and the things they need. Good health is a factor that contributes to happiness butnot to meaningfulness. Healthy people are happier than sick people, but the lives of sick

people do not lack meaning. The more often people feel gooda feeling that can arise fromgetting what one wants or needsthe happier they are. The less often they feel bad, thehappier they are. But the frequency of good and bad feelings turns out to be irrelevant tomeaning, which can flourish even in very forbidding conditions.

The second set of differences involved time frame. Meaning and happiness are apparentlyexperienced quite differently in time. Happiness is about the present; meaning is about thefuture, or, more precisely, about linking past, present and future. The more time people spentthinking about the future or the past, the more meaningful, and less happy, their lives were.Time spent imagining the future was linked especially strongly to higher meaningfulness andlower happiness (as was worry, which Ill come to later). Conversely, the more time people

spent thinking about the here and now, the happier they were. Misery is often focused on thepresent, too, but people are happy more often than they are miserable. If you want tomaximise your happiness, it looks like good advice to focus on the present, especially if yourneeds are being satisfied. Meaning, on the other hand, seems to come from assembling past,

present and future into some kind of coherent story.

This begins to suggest a theory for why it is we care so much about meaning. Perhaps theidea is to make happiness last. Happiness seems present-focused and fleeting, whereasmeaning extends into the future and the past and looks fairly stable. For this reason, peoplemight think that pursuing a meaningful life helps them to stay happy in the long run. Theymight even be rightthough, in empirical fact, happiness is often fairly consistent overtime. Those of us who are happy today are also likely to be happy months or even years fromnow, and those who are unhappy about something today commonly turn out to be unhappyabout other things in the distant future. It feels as though happiness comes from outside, butthe weight of evidence suggests that a big part of it comes from inside. Despite these realities,

people experience happiness as something that is felt here and now, and that cannot becounted on to last. By contrast, meaning is seen as lasting, and so people might think they can

establish a basis for a more lasting kind of happiness by cultivating meaning.


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Social life was the locus of our third set of differences. As you might expect, connections toother people turned out to be important both for meaning and for happiness. Being alone inthe world is linked to low levels of happiness and meaningfulness, as is feeling lonely.

Nevertheless, it was the particular character of ones social connections that determined

which state they helped to bring about. Simply put, meaningfulness comes from contributing

to other people, whereas happiness comes from what they contribute to you. This runscounter to some conventional wisdom: it is widely assumed that helping other people makesyou happy. Well, to the extent that it does, the effect depends entirely on the overlap betweenmeaning and happiness. Helping others had a big positive contribution to meaningfulnessindependent of happiness, but there was no sign that it boosted happiness independently ofmeaning. If anything, the effect was in the opposite direction: once we correct for the boost itgives to meaning, helping others can actually detract from ones own happiness.

We found echoes of this phenomenon when we asked our subjects how much time they spenttaking care of children. For non-parents, childcare contributed nothing to happiness ormeaningfulness. Taking care of other peoples children is apparently neither very pleasant

nor very unpleasant, and it doesnt feel meaningful either. For parents, on the other hand,caring for children was a substantial source of meaning, though it still seemed irrelevant tohappiness, probably because children are sometimes delightful and sometimes stressful andannoying, so it balances out.

Our survey had people rate themselves as givers or as takers. Regarding oneself as agiving person strongly predicted more meaningfulness and less happiness. The effects for

being a taker were weaker, possibly because people are reluctant to admit that they are takers.Even so, it was fairly clear that being a taker (or at least, considering oneself to be one)

boosted happiness but reduced meaning.

The depth of social ties can also make a difference in how social life contributes to happinessand meaning. Spending time with friends was linked to higher happiness but it was irrelevantto meaning. Having a few beers with buddies or enjoying a nice lunch conversation withfriends might be a source of pleasure but, on the whole, it appears not to be very important toa meaningful life. By comparison, spending more time with loved ones was linked to highermeaning and was irrelevant to happiness. The difference, presumably, is in the depth of therelationship. Time with friends is often devoted to simple pleasures, without much at stake,so it may foster good feelings while doing little to increase meaning. If your friends aregrumpy or tiresome, you can just move on. Time with loved ones is not so uniformly

pleasant. Sometimes one has to pay bills, deal with illnesses or repairs, and do other

unsatisfying chores. And of course, loved ones can be difficult too, in which case yougenerally have to work on the relationship and hash it out. It is probably no coincidence thatarguing was itself associated with more meaning and less happiness.

If happiness is about getting what you want, it appears that meaningfulness is about doingthings that express yourself

A fourth category of differences had to do with struggles, problems, stresses and the like. Ingeneral, these went with lower happiness and higher meaningfulness. We asked how many

positive and negative events people had recently experienced. Having lots of good thingshappen turned out to be helpful for both meaning and happiness. No surprise there. But bad

things were a different story. Highly meaningful lives encounter plenty of negative events,which of course reduce happiness. Indeed, stress and negative life events were two powerful


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blows to happiness, despite their significant positive association with a meaningful life. Webegin to get a sense of what the happy but not very meaningful life would be like. Stress,problems, worrying, arguing, reflecting on challenges and strugglesall these are notablylow or absent from the lives of purely happy people, but they seem to be part and parcel of ahighly meaningful life. The transition to retirement illustrates this difference: with the

cessation of work demands and stresses, happiness goes up but meaningfulness drops.

Do people go out looking for stress in order to add meaning to their lives? It seems morelikely that they seek meaning by pursuing projects that are difficult and uncertain. One triesto accomplish things in the world: this brings both ups and downs, so the net gain tohappiness might be small, but the process contributes to meaningfulness either way. To usean example close to home, conducting research adds immensely to the sense of a meaningfullife (what could be meaningful than working to increase the store of human knowledge?), but

projects rarely go exactly as planned, and the many failures and frustrations along the waycan suck some of the joy out of the process.

The final category of differences had to do with the self and personal identity. Activities thatexpress the self are an important source of meaning but are mostly irrelevant to happiness. Ofthe 37 items on our list that asked people to rate whether some activity (such as working,exercising or meditating) was an expression or reflection of the self, 25 yielded significant

positive correlations with a meaningful life and none was negative. Only two of the 37 items(socialising, and partying without alcohol) were positively linked to happiness, and someeven had a significant negative relationship. The worst was worry: if you think of yourself asa worrier, that seems to be quite a downer.

If happiness is about getting what you want, it appears that meaningfulness is about doingthings that express yourself. Even just caring about issues of personal identity and self-definition was associated with more meaning, though it was irrelevant, if not outrightdetrimental, to happiness. This might seem almost paradoxical: happiness is selfish, in thesense that it is about getting what you want and having other people do things that benefityou, and yet the self is more tied to meaning than happiness. Expressing yourself, definingyourself, building a good reputation and other self-oriented activities are more about meaningthan happiness.

Does all of this really tell us anything about the meaning of life? A yes answer depends on

some debatable assumptions, not least the idea that people will tell the truth about whethertheir lives are meaningful. Another assumption is that we are even capable of giving a true

answer. Can we know whether our lives are meaningful? Wouldnt we have to be able to sayexactly what that meaning is? Recall that my colleagues and I did not give our studyrespondents a definition of meaning, and we didnt ask them to define it themselves. We justasked them to rate their level of agreement with statements such as: In general, I considermy life to be meaningful. To look deeper into the meaning of life, it might help to clarify

some basic principles.

First of all, what is life? One answer supplies the title to A Constellation of Vital Phenomena(2013), Anthony Marras moving novel about Chechnya following the two recent wars. Acharacter is stranded in her apartment with nothing to do and starts reading her sistersSoviet-era medical dictionary. It offers her little in the way of useful or even comprehensible

informationexcept for its definition of life, which she circles in red: Life: a constellationof vital phenomenaorganisation, irritability, movement, growth, reproduction,


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adaptation. That, in a sense, is what life means. I should add that we now know it is aspecial kind of physicalprocess:not atoms or chemicals themselves, but the highly organiseddance they perform. The chemicals in a body are pretty much the same from the moment

before death to the moment after. Death doesnt alter this or that substance: the entiredynamic state of the system changes. Nonetheless, life is a purely physical reality.

The meaning of meaning is more complicated. Words and sentences have meaning, as dolives. Is it the same kind of thing in both cases? In one sense, the meaning oflife could bea simple dictionary definition, something like the one I gave in the previous paragraph. Butthats not what people want when they ask about the meaning of life, any more than it would

help someone who was suffering from an identity crisis to read the name on their driverslicence. One important difference between linguistic meaning and what Ill call themeaningfulnessof a human life is that the second seems to entail a value judgment, or acluster of them, which in turn implies a certain kind of emotion. Your mathematicshomework is full of meaning in the sense that it consists entirely of a network of conceptsmeanings, in other words. But in most cases there is not much emotion linked to doing sums,

and so people tend not to regard it as very meaningful in the sense in which we are interested.(In fact, some people loathe doing mathematics, or have anxiety about it, but those reactionshardly seem conducive to viewing the subject as a source of meaning in life.)

Questions about lifesmeaning are really about meaningfulness. We dont simply want toknow the dictionary definition of our lives, if they have such a thing. We want our lives tohave value, to fit into some kind of intelligible context. Yet these existential concerns doseem to touch on the merely linguistic sense of the word meaning because they invokeunderstanding and mental associations. It is remarkable how many synonyms formeaningfulness also refer to merely verbal content: we talk, for instance, about the point oflife, or its significance, or whether or not it makes sense. If we want to understand themeaning of life, it seems as though we need to grapple with the nature of meaning in this lessexalted sense.

A bear can walk down the hill and get a drink, as can a person, but only a person thinks thewords Im going to go down and get a drink

Linguistic meaning is a kind of non-physical connection. Two things can be connectedphysically, for example when they are nailed together, or when one of them exerts agravitational or magnetic pull on the other. But they can also be connected symbolically. Theconnection between a flag and the country it represents is not a physical connection, molecule

to molecule. It remains the same even if the country and the flag are on opposite sides of theplanet, making direct physical connection impossible.

The human mind has evolved to use meaning to understand things. This is part of the humanway of being social: we talk about what we do and experience. Most of what we know welearn from others, not from direct experience. Our very survival depends on learninglanguage, co-operating with others, following moral and legal rules and so on. Language isthe tool with which humans manipulate meaning. Anthropologists love to find exceptions toany rule, but so far they have failed to find any culture that dispenses with language. It is ahuman universal. But theres an important distinction to make here. Although language as awhole is universal, particular languages are invented: they vary by culture. Meaning is

universal, too, but we dont invent it. It is discovered. Think back to the maths homework: the


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symbols are arbitrary human inventions, but the idea expressed by 5 x 8 = 43 is inherentlyfalse and thats not something that human beings made up or can change.

The neuroscientist Michael Gazzaniga, professor of psychology at the University ofCalifornia Santa Barbara, coined the term left-brain interpreter to refer to a section in one

side of the brain that seems almost entirely dedicated to verbalising everything that happensto it. The left-brain interpreters account is not always correct, as Gazzaniga hasdemonstrated. People quickly devise an explanation for whatever they do or experience,fudging the details to fit their story. Their mistakes have led Gazzaniga to question whetherthis process has any value at all, but perhaps his disappointment is coloured by the scientists

natural assumption that the purpose of thinking is to figure out the truth (this, after all, is whatscientists themselves supposedly do). On the contrary, I suggest that a big part of the purposeof thinking is to help one talk to other people. Minds make mistakes but, when we talk aboutthem, other people can spot the errors and correct them. By and large, humankind approachesthe truth collectively, by discussing and arguing, rather than by thinking things through alone.

Many writers, especially those with experience of meditation and Zen, remark on how thehuman mind seems to prattle on all day. When you try to meditate, your mind overflows withthoughts, sometimes called the inner monologue. Why does it do this? William James,author of The Principles of Psychology (1890), said that thinking is for doing, but in fact a lotof thinking seems irrelevant to doing. Putting our thoughts into words is, however, vital

preparation for communicating those thoughts to other people. Talking is important: it is howthe human creature connects to its group and participates in itand that is how we solve theeternal biological problems of survival and reproduction. Humans evolved minds that chatterall day because chattering aloud is how we survive. Talking requires people to take what theydo and put it into words. A bear can walk down the hill and get a drink, as can a person, butonly a person thinks the words Im going to go down and get a drink. In fact, the humanmight not just think those words but also say them aloud, and then others can come along forthe tripor perhaps offer a warning not to go after all, because someone saw a bear at thewaterside. By talking, the human being shares information and connects with others, which iswhat we as a species are all about.

Studies on children support the idea that the human mind is naturally programmed to putthings into words. Children go through stages of saying aloud the names of everything theyencounter and of wanting to bestow names on all sorts of individual things, such as shirts,animals, even their own bowel movements. (For a time, our little daughter was naming hersafter various relatives, seemingly without any animosity or disrespect, though we encouraged

her not to inform the namesakes.) This kind of talk is not directly useful for solving problemsor any of the familiar pragmatic uses of thinking, but it does help to translate the physicalevents of ones life into speech so that they can be shared and discussed with others. Thehuman mind evolved to join the collective discourse, the social narrative. Our relentlessefforts to make sense of things start small, with individual items and events. Very gradually,we work towards bigger, more integrated frameworks. In a sense, we climb the ladder ofmeaningfrom single words and concepts to simple combinations (sentences), and then onto the grand narrative, sweeping visions, or cosmic theories.

Democracy provides a revealing example of how we use meaning. It does not exist in nature.Every year, countless human groups conduct elections, but so far nobody has observed even a

single one in any other species. Was democracy invented or discovered? It probably emergedindependently in many different places, but the underlying similarities suggest that the idea


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was out there, ready to be found. The specific practices for implementing it (how votes aretaken, for example) are invented. All the same, it seems as though the idea of democracy was

just waiting for people to stumble upon it and put it to use.

Wondering about the meaning of life indicates that one has climbed a long way up the ladder.

To understand the meaning of some newly encountered item, people might ask why it wasmade, how it got there or what it is useful for. When they come to the question of lifesmeaning, similar questions arise: why or for what purpose was life created? How did this lifeget here? What is the right or best way to make use of it? It is natural to expect and assumethat these questions have answers. A child learns what a banana is: it comes from the storeand, before that, from a tree. Its good to eat, which you do by (very important) firstremoving the outer peel to get at the soft, sweet inside. Its natural to assume that life could

be understood in the same way. Just figure out (or learn from others) what its about and what

to do with it. Go to school, get a job, get married, have kids? Sure thing. There is, moreover,a good reason to want to get all this straight. If you had a banana and failed to understand it,you might not get the benefit of eating it. In the same way, if your life had a purpose and you

didnt know it, you might end up wasting it. How sad to miss out on the meaning of life, ifthere is one.

Marriage is a good example of how meaning pins down the world and increases stability

We begin to see how the notion of a meaning of life puts two quite different things together.Life is a physical and chemical process. Meaning is non-physical connection, something thatexists in networks of symbols and contexts. Because it is not purely physical, it can leapacross great distances to connect through space and time. Remember our findings about thedifferent time frames of happiness and meaning. Happiness can be close to physical reality,

because it occurs right here in the present. In an important sense, animals can probably behappy without much in the way of meaning. Meaning, by contrast, links past, present andfuture in ways that go beyond physical connection. When modern Jews celebrate Passover, orwhen Christians celebrate communion by symbolically drinking the blood and eating theflesh of their god, their actions are guided by symbolic connections to events in the distant

past (indeed, events whose very reality is disputed). The link from the past to the present isnot a physical one, the way a row of dominoes falls, but rather a mental connection that leapsacross the centuries.

Questions about lifes meaning are prompted by more than mere idle curiosity or fear ofmissing out. Meaning is a powerful tool in human life. To understand what that tool is used

for, it helps to appreciate something else about life as a process of ongoing change. A livingthing might always be in flux, but life cannot be at peace with endless change. Living thingsyearn for stability, seeking to establish harmonious relationships with their environment.They want to know how to get food, water, shelter and the like. They find or create placeswhere they can rest and be safe. They might keep the same home for years. Life, in otherwords, is change accompanied by a constant striving to slow or stop the process of change,which leads ultimately to death. If only change could stop, especially at some perfect point:that was the theme of the profound story of Fausts bet with the devil. Faust lost his soul

because he could not resist the wish that a wonderful moment would last forever. Suchdreams are futile. Life cannot stop changing until it ends. But living things work hard toestablish some degree of stability, reducing the chaos of constant change to a somewhat

stable status quo.


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By contrast, meaning is largely fixed. Language is possible only insofar as words have thesame meaning for everyone, and the same meaning tomorrow as today. (Languages dochange, but slowly and somewhat reluctantly, relative stability being essential to theirfunction.) Meaning therefore presents itself as an important tool by which the human animalmight impose stability on its world. By recognising the steady rotation of the seasons, people

can plan for future years. By establishing enduring property rights, we can develop farms togrow food.

Crucially, the human being works with others to impose its meanings. Language has to beshared, for private languages are not real languages. By communicating and workingtogether, we create a predictable, reliable, trustworthy world, one in which you can take the

bus or plane to get somewhere, trust that food can be purchased next Tuesday, know youwont have to sleep out in the rain or snow but can count on a warm dry bed, and so forth.

Marriage is a good example of how meaning pins down the world and increases stability.Most animals mate, and some do so for long periods or even for life, but only humans marry.

My colleagues who study close relationships will tell you that relationships continue toevolve and change, even after many years of marriage. However, the fact of marriage isconstant. You are either married or not, and that does not fluctuate from day to day, eventhough your feelings and actions toward your spouse might change considerably. Marriagesmooths out these bumps and helps to stabilise the relationship. Thats one reason that peopleare more likely to stay together if they are married than if not. Tracking all your feelingstoward your romantic partner over time would be difficult, complicated and probably alwaysincomplete. But knowing when you made the transition from not married to married is easy,as it occurred on a precise occasion that was officially recorded. Meaning is more stable thanemotion, and so living things use meaning as part of their never-ending quest to achievestability.

The Austrian psychoanalytic thinker Viktor Frankl, author ofMans Search for Meaning(1946) tried to update Freudian theory by adding a universal desire for meaningfulness toFreuds other drives. He emphasised a sense of purpose, which is undoubtedly one aspect but

perhaps not the full story. My own efforts to understand how people find meaning in lifeeventually settled on a list of four needs for meaning, and in the subsequent years that list

has held up reasonably well.

The point of this list is that you will find life meaningful to the extent that you havesomething that addresses each of these four needs. Conversely, people who fail to satisfy one

or more of these needs are likely to find life less than adequately meaningful. Changes withregard to any of these needs should also affect how meaningful the person finds his or herlife.

The first need is, indeed, for purpose. Frankl was right: without purpose, life lacks meaning.A purpose is a future event or state that lends structure to the present, thus linking differenttimes into a single story. Purposes can be sorted into two broad categories. One might strivetoward a particular goal (to win a championship, become vice president or raise healthychildren) or toward a condition of fulfilment (happiness, spiritual salvation, financial security,wisdom).

People ask what is the meaning of life, as if there is a single answer


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Life goals come from three sources, so in a sense every human life has three basic sources ofpurpose. One is nature. It built you for a particular purpose, which is to sustain life bysurviving and reproducing. Nature doesnt care whether youre happy, much as people wishto be happy. We are descended from people who were good at reproducing and at survivinglong enough to do so. Natures purpose for you is not all-encompassing. It doesnt care what

you do on a Sunday afternoon as long as you manage to survive and, sooner or later,reproduce.

The second source of purpose is culture. Culture tells you what is valuable and important.Some cultures tell you exactly what you are supposed to do: they mark you out for a

particular slot (farmer, soldier, mother etc). Others offer a much wider range of options andput less pressure on you to adopt a particular one, though they certainly reward some choicesmore than others.

That brings us to the third source of goals: your own choices. In modern Western countries inparticular, society presents you with a broad range of paths and you decide which one to take.

For whatever reasoninclination, talent, inertia, high pay, good benefitsyou choose oneset of goals for yourself (your occupation, for example). You create the meaning of your life,fleshing out the sketch that nature and culture provided. You can even choose to defy it:many people choose not to reproduce, and some even choose not to survive. Many othersresist and rebel at what their culture has chosen for them.

The second need for meaning is value. This means having a basis for knowing what is rightand wrong, good and bad. Good and bad areamong the first words children learn. Theyare some of the earliest and most culturally universal concepts, and among the few words thathouse pets sometimes acquire. In terms of brain reactions, the feeling that something is goodor bad comes very fast, almost immediately after you recognise what it is. Solitary creatures

judge good and bad by how they feel upon encountering something (does it reward them orpunish them?). Humans, as social beings, can understand good and bad in loftier ways, suchas their moral quality.

In practice, when it comes to making life meaningful, people need to find values that casttheir lives in positive ways, justifying who they are and what they do. Justification isultimately subject to social, consensual judgment, so one needs to have explanations that willsatisfy other people in the society (especially the people who enforce the laws). Again, naturemakes some values, and culture adds a truckload of additional ones. Its not clear whether

people can invent their own values, but some do originate from inside the self and become

elaborated. People have strong inner desires that shape their reactions.

The third need is for efficacy. Its not very satisfying to have goals and values if you cant doanything about them. People like to feel that they can make a difference. Their values have tofind expression in their life and work. Or, to look at it the other way around, people have to

be able steer events towards positive outcomes (by their lights) and away from negative ones.

The last need is for self-worth. People with meaningful lives typically have some basis forthinking that they are good people, maybe even a little better than certain other people. At aminimum, people want to believe that they are better than they might have been had theychosen or behaved or performed badly. They have earned some degree of respect.


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The meaningful life, then, has four properties. It has purposes that guide actions from presentand past into the future, lending it direction. It has values that enable us to judge what is goodand bad; and, in particular, that allow us to justify our actions and strivings as good. It ismarked by efficacy, in which our actions make a positive contribution towards realising ourgoals and values. And it provides a basis for regarding ourselves in a positive light, as good

and worthy people.

People ask what is the meaning of life, as if there is a single answer. There is no one answer:there are thousands of different ones. A life will be meaningful if it finds responses to thefour questions of purpose, value, efficacy, and self-worth. It is these questions, not theanswers, that endure and unify.

16 September 2013

The self is moral

We tend to think that our memories determine our

identity, but its moral character that really makes us who

we are

'Moral features are the chief dimension by which we judge'; detail from The Conversion ofSaint Paulby Caravaggio 1600-1601.Photo courtesy Wikimedia

Nina Strohmingeris a psychologist at Duke University in North Carolina.

One morning after her accident, a woman Ill call Kate awoke in a daze. She looked at the

man next to her in bed. He resembled her husband, with the same coppery beard and frecklesdusted across his shoulders. But this man was definitely not her husband.

Panicked, she packed a small bag and headed to her psychiatrists office. On the bus, there

was a man she had been encountering with increasing frequency over the past several weeks.The man was clever, he was a spy. He always appeared in a different form: one day as a littlegirl in a sundress, another time as a bike courier who smirked at her knowingly. She

explained these bizarre developments to her doctor, who was quickly becoming one of thelast voices in this world she could trust. But as he spoke, her stomach sank with a dreadedrealisation: this man, too, was an impostor.

Kate has Capgras syndrome, the unshakeable belief that someoneoften a loved one,sometimes oneselfhas been replaced with an exact replica. She also has Fregoli syndrome,the delusion that the same person is taking on a variety of shapes, like an actor donning anexpert disguise. Capgras and Fregoli delusions offer hints about an extraordinary cognitivemechanism active in the healthy mind, a mechanism so exquisitely tuned that we are hardlyever aware of it. This mechanism ascribes to each person a unique identity, and then

meticulously tracks and updates it. This mechanism is crucial to virtually every human
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interaction, from navigating a party to navigating a marriage. Without it, we quickly fallapart.

A classic philosophical thought experiment poses the following paradox. Imagine a ship, letscall it theNina, whose planks are replaced, one by one, as they age. Eventually every original

part is changed, resulting in a boat made of entirely new materials. Our intuition that this isthe same ship becomes problematic when the builders reassemble all theNinas original partsinto a second ship. TheNinas identity is tied up inextricably with her physicality.

Personal identity does not work this way. As Nina-the-person ages, almost all the cells of herbody get replaced, in some cases many times over. Yet we have no trouble seeing present-dayNina as the same person. Even radical physical transformationspuberty, surgery, infirmity,some future world where her consciousness is preserved on a hard drivewill not obliteratethe Nina we know. The personal identity detector is not concerned with continuity of matter,

but continuity of mind. As the cognitive scientist Daniel Dennett wryly observed in his essayWhere Am I? (1978), the brain is the only organ where it is preferable to be the donor than

the recipient.

This distinction, between mind and body, begins early in development. In a 2012 study byBruce Hood at the University of Bristol and colleagues, children aged five to six were showna metal contraption, a duplication device that creates perfect replicas of whatever you putinside. When asked to predict what would happen if a hamster were duplicated, the childrensaid the clone would have the same physical traits as the original, but not its memories. Inother words, children were locating the unique essence of the hamster in its mind.

For Nina-the-ship, no part of the vessel is especially Nina-like; her identity is distributedevenly across every atom. We might wonder whether the same applies to peopledoes theircontinued identity depend only on the total number of cognitive planks replaced? Or are some

parts of the mind particularly essential to the self?

The 17th-century philosopher John Locke thought autobiographical memories were the keyto identity, and its easy to see why: memories provide a continuous narrative of the self and

they serve as a record of a persons idiosyncratic history. But evidence in favour of thememory criterion is mixed at best. People who have lost large hunks of memory throughretrograde amnesia tend to report that, while the reel of their life feels blank, their sense ofself remains intact. Nor is memory deterioration from dementia a reliable predictor of feeling

like a different person. Caretakers for these patients often say they can still perceive the same

person persisting beneath radical memory loss. If people have an essence that lends themtheir identity, memory might not be the most promising candidate.

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One day not too long ago, a friend came to me with a problem. His wife of many years hadbegun to change. Once mousy, she was now poised and assertive. Her career had beenimportant to her, now her interests had turned inward, domestic. And while the changes were


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not so dramatic that they fundamentally altered the woman he had fallen in love with, he wasapprehensive about the possibility.

The danger of befriending psychologists is they will use you as their test subjects: I inquiredwhat kind of change would render her unrecognisable. My friend responded without

hesitation: If she stopped being kind. I would leave her immediately. He considered thequestion a few moments more. And I dont mean, if shes in a bad mood or going through arough time. Im saying if she turned into a permanent bitch with no explanation. Her soul

would be different.

This encounter is instructive for a few reasons (not least of which is the intriguing termpermanent bitch) but lets start with my friends invocation of the soul. He is not religious

and, I suspect, does not endorse the existence of a ghost in the machine. But souls are a usefulconstruct, one we can make sense of in fiction and fantasy, and as a shorthand for describingeveryday experience. The soul is an indestructible wisp of ether, present from birth andsurviving our bodies after death. And each soul is one of a kind and unreplicable: it bestows

upon us our unique identity. Souls are, in short, a placeholder notion for the self.

But the soul is something else, too. The soul describes a persons moral sensibility. Aflourishing soul, according to Aristotle, was one in the habit of virtuous acts. When the soulis sick, we feed it chicken soup in the form of bite-sized inspirational stories. Historys great

psychopaths, its serial killers and genocidal maniacs, are seen as soulless. So are the animatecreatures in popular lore: the golems, the Frankensteins, the HALs. The sentient computerwho runs amok is a trope of the genreso much so that, in his short story Runaround(1942), Isaac Asimov felt it necessary to propose Three Laws of Robotics to specify ethicalguidelines for the wayward robot. Why do we assume that a being without a soul will turnagainst us? On some level, we must endorse the idea that, without a soul, moral action is not

possible.

And where does the soul go when we die? In Western religions, either to a place for themorally good (heaven) or the morally bad (hell). There is no afterlife for good or bad

bowlers, the sharp and the dull-witted, the glamorous and the frumpy. Eastern traditions thatsubscribe to a belief in reincarnation specify that the soul is reincarnated according to the

persons moral behaviour (karma). It is our moral selves that survive us in death.

a world filled with more empathy and kindness would be a better place to live, but we areapparently uninterested in swallowing this solution in a pill

Recent studies by the philosopher Shaun Nichols at the University of Arizona and myselfsupport the view that the identity-conferring part of a person is his moral capacities. One ofour experiments pays homage to Lockes thought experiment by asking subjects which of aslew of traits a person would most likely take with him if his soul moved to a new body.Moral traits were considered more likely to survive a body swap than any other type of trait,mental or physical. Interestingly, certain types of memoriesthose involving peopleweredeemed fairly likely to survive the trip. But generic episodic memories, such as onescommute to work, were not. People are not so much concerned with memory as withmemorys ability to connect us to others and our capacity for social action.

In another study, subjects read about a patient who experiences one of a variety of cognitiveimpairments, including amnesia for his past life, losing the ability to recognise objects, his


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desires, and his moral compass. The majority of people responded that the patient was theleast like himself after losing his moral faculties.

This is consistent with some of the more widely discussed case studies from the annals ofneurology. Phineas Gage was a 19th-century US railroad worker who miraculously survived

an explosion that saw an iron rod shoot through his skull. Previously mild-mannered andindustrious, Gage emerged from the accident obstinate, capricious and foul-mouthed. Hisfriends were horrified and said he was no longer Gage.

Other types of brain damage might seem to threaten identity, but are far less potent. In The

Lost Mariner (1984), Oliver Sacks describes Jimmie, a man with near-total memory losscaused by Korsakoffs syndrome, a brain disorder associated with heavy alcohol

consumption. Sacks worries that his patient has become de-souled, but reconsiders when heobserves how Jimmie is transported while singing hymns and taking the sacrament at Mass.He recalls the Soviet psychologist Alexander Lurias insight: A man does not consist of

memory alone. He has feeling, will, sensibility, moral being... It is here... you may touch him,

and see a profound change.

I have limited my discussion here to third-person accounts: what leads us to consider another

personas no longer the same. One might think that a different set of rules applies toassessments of ones own continuity perhaps episodic memory is paramount from this

perspective. However, new research by myself and the psychologists Larisa Heiphetz andLiane Young at Boston College has found that the single most important mental trait in

judging self-identity is ones deeply held moral convictions. We are not only concerned withmoral character when constructing an identity for others, but when doing so for ourselves.

In treating the sick, the use of psychopharmaceuticals is plagued by the persistent worry thatthese drugs will lead to a crisis of authenticity. A 2008 study by Jason Riis, then at New YorkUniversity, and colleagues found that people were least willing to take psychoactive drugsthat threatened their personal identity. And what drugs were those? The ones that enhancedtheir moral traits, of course: kindness, empathy. People were perfectly willing to take drugsthat would enhance memory or wakefulness. Surely a world filled with more empathy andkindness would be a better place to live, but we are apparently uninterested in swallowingthis solution in a pill which seems to threaten our authentic selves.

Organic transformations can be no less sensational. A notable example from recent memorytakes place in the US TV seriesBreaking Bad, which tracks Walter White as he morphs from

put-upon suburban chemistry teacher to ruthless tyrant kingpin of a meth empiretheeponymous breaking bad. Under his ominous nerd alter ego Heisenberg, it is all butimpossible to see him as the man he once was. His increasingly distraught wife finds herselfliving with a stranger, and Walter confirms what the viewer already realises: If you dont

know who I am, then maybe your best course would be to tread lightly. Meanwhile, Whitesaccomplice Jesse Pinkman undergoes the reverse transformationthe burnout junkie who isrevealed to have a heart of gold. These sorts of twists are endlessly fascinating because theyshow personal transformation at its most absolute. Flipping back through the greatmetamorphoses of fiction and history, we discover they are predominantly moral: think of the

brothers Karamazov, of Scrooge and Schindler, Don Corleone and Darth Vadar.

Why does our identity detector place so much emphasis on moral capacities? These arent ourmost distinctive features. Our faces, our fingertips, our quirks, our autobiographies: any of


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these would be a more reliable way of telling whos who. Somewhat paradoxically, identity

has less to do with what makes us different from other people than with our shared humanity.Consider the reason we keep track of individuals in the first place. Most animals dont havean identity detector. Those that share our zeal for individual identification have one thing incommon: they live in societies, where they must co-operate to survive. Evolutionary

biologists point out that the ability to keep track of individuals is required for reciprocalaltruism and punishment to emerge. If someone breaks the rules, or helps you out of a bind,you need to be able to remember who did this in order return the favour later. Without theability to distinguish among the members of a group, an organism cannot recognise who hasco-operated and who has defected, who has shared and who has been stingey.

Nor can you have formal moral systems without identity. The 18th-century philosopherThomas Reid observed that the fundaments of justicerights, duty, responsibilitywould beimpossible without the ability to ascribe stable identity to persons. If nothing connects a

person from one moment to the next, then the person who acts today cannot be heldresponsible by the person who has replaced him tomorrow. Our identity detector works in

overdrive when reasoning about crimes of passion, crimes under the influence, crimes ofinsanity: for if the person was beside himself or out of his mind when he committed hiscrime, how can we identify who has committed the act, and hold him responsible for it?

If we had no scruples, wed have precious little need for identities

Moral features are the chief dimension by which we judge, sort and choose social partners.For men and women alike, the single most sought-after trait in a long-term romantic partneris kindnessbeating out beauty, wealth, health, shared interests, even intelligence. And whilewe often think of our friends as the people who are uniquely matched to our shared

personality, moral character plays the largest role in determining whether you like someoneor not (what social psychologists call impression formation), and predicts the success andlongevity of these bonds. Virtues are mentioned with more frequency in obituaries thanachievements, abilities or talents. This is even the case for obituaries of notable luminaries,

people who are being written about because of their accomplishments, not their moral fibre.

The identity detector is designed to pick up on moral features because this is the mostimportant type of information we can have about another person. So weve been thinking

about the problem precisely backwards. Its not that identity is centred around morality. Itsthat morality necessitates the concept of identity, breathes life into it, provides its raisondtre. If we had no scruples, wed have precious little need for identities. Humans, with their

engorged and highly complex socio-moral systems, have accordingly inflated egos.

Know thyself is a flimsy bargain-basement platitude, endlessly recycled but maddeninglyempty. It skates the very existential question it pretends to address, the question that obsessesus: what is it to know oneself? The lesson of the identity detector is this: when we dig deep,

beneath our memory traces and career ambitions and favourite authors and small talk, we finda constellation of moral capacities. This is what we should cultivate and burnish, if we want

people to know who we really are.

17 November 2014

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How can scientists act ethically when they are studying the

victims of a human tragedy, such as the Romanian

orphans?

Virginia Hughesis a science journalist based in Brooklyn, New York. Her blog, OnlyHuman, is published byNational Geographic.

We drove to the orphanage on a pleasant December morning, under a sky that seemed tooblue. It was a short ride through a residential neighbourhood of Bucharest, littered withposters of politicians heads for the upcoming elections. Nervous, I mentally recited the tworules the American professor had given me the night before: no picking up the kids, and nocrying in front of them.

We pulled up to a dingy pink building, lined on all sides by tall wire fencing, and parked at

the curb. After passing through the checkpoint of a stoic security guard, we stepped into anempty hallway. It was cleaner than I had expected; old plaster walls and chipped steps, yes,but no obvious filth. There was an overpowering smell of institutional food, like burnedmeatloaf.

Over the next hour or so, the manager of the placea short and affable 24-year-old guygave us a tour. He didnt speak much English, but Florin ibu, a Romanian who works withthe professor, translated for us. About 50 children and teenagers lived there, boys and girlsranging in age from about six to 18, and I saw just six adults: our tour guide, three femalecaregivers, and two cleaning ladies in white coats. The children werent in school because of

the big holiday: Romanias National Day, a celebration of the countrys unification in 1918.

Perhaps a typical day wouldnt have been so chaotic. Then again, ibu said, the kids alwaysflock to new visitors.

And flock they did. A boy in a red T-shirt and sweats skipped up to me, grabbed my hand,and wouldnt let go. His head didntreach my shoulders, so I figured he was eight or nineyears old. He was 13, ibu said. The boy kept looking up at me with an open, sweet face, but

I found it difficult to return his gaze. Like most of the other kids, he had crossed eyesstrabismus, the professor would explain later, a common symptom of children raised ininstitutions, possibly because as infants they had nothing to focus their eyes on. A couple ofdozen kids gathered around us in a tight circle, chirping and giggling loudly as children do.At one point they broke into a laughing fit, and I asked ibu what happened. They were

gawking at the whiteness of my teeth, he said. Two of the girls, somewhere in that gaggle,were pregnant.

We saw the kids bedrooms. Each had half a dozen mattresses lying on the floor and onetelevision set. All the TVs were blaring old cartoons, some of the same ones I rememberwatching in my own childhood 25 years ago. Kid after kid dragged me proudly to see theirroom. Once, we walked in on a cleaning lady frantically sweeping, embarrassed by thecigarette butts, grey dirt, and insect carcasses all over the floor. One of the rooms held threeor four older boys, still sleeping. They were heroin addicts, I would learn, and sometimesshot up in front of the younger children.
http://aeon.co/magazine/author/virginia-hughes/http://aeon.co/magazine/author/virginia-hughes/http://aeon.co/magazine/author/virginia-hughes/


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After about half an hour of holding the sweet boys hand, I suddenly, urgently, needed to letgo. I wriggled my fingers free, only to have him clutch them again.

St Catherines was once the largest orphanage in Bucharest.Photo courtesy Dr Charles

Nelson

We Americans drove back to St Catherines, a sprawling complex of late 19th-century stonebuildings and desolate courtyards that was once the largest orphanage in Bucharest. Today,its mostly office space, with rooms along one long hallway occupied by the professorsteam. We sat in one of them to talk about the morning visit.

The professor is Charles Nelson, a neuroscientist from Harvard University who studies earlybrain development. In 1999, he and several other American scientists launched the BucharestEarly Intervention Project, a now-famous study of Romanian children who were mostlysocial orphans, meaning that their biological parents had given them over to the states care.

At the time, despite an international outcry over Romanias orphanproblem, many Romanian

officials staunchly believed that the behavioural problems of institutionalised children wereinnatethe reason their parents had left them there, rather than the result of institutionallife. And because of these inherent deficiencies, the children would fare better in orphanagesthan families.

The scientists pitched their study as a way to find out for sure. They enrolled 136institutionalised children, placed half of them in foster care, and tracked the physical,

psychological, and neurological development of both groups for many years. They found,predictably, that kids are much better off in foster care than in orphanages.

Nelson has visited Bucharest 30 to 40 times since his first trip in 1999. Some things havechanged: in 2007, Romania joined the European Union (EU). It has greatly expanded itsstate-funded foster-care system. The number of children in institutionsor placementcentres, to use the preferred bureaucratic euphemism has dropped dramatically. But otherthings havent changed. Romania is still a post-communist country suffering from high levelsof poverty and corruption. It still has a weak medical and scientific infrastructure. It still hassome 9,000 childrenmore than half of all the children in its child protection systemliving in orphanages, like the boy who took my hand.

Nelson had warned me several times about the emotional toll of meeting these children. So Iwas surprised, during our debrief, to hear him say that our visit had upset him. Turns out it

was the first time that he had been to an orphanage with older teenagers, not all that muchyounger than his own son. Im used to being really distressed when I see all the little babies,or the three- and four-year-olds, he said. But here, I almost had to leave at one point, to getmyself some air. Just the thought of these kids living like this, it was really depressing.

How does he do this?I wondered.

Nelson never expected to be an advocate for orphans, or for anybody really: hes aneuroscientist. In 1986, he launched his first laboratory at the University of Minnesota, whichspecialised in using electroencephalography (EEG)a harmless technique for measuring

brain waves via a soft skullcap of electrodeson babies and toddlers.


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His field of developmental neuroscience got a surge of attention in April 1997, when Bill andHillary Clinton put on a one-day meeting of researchers called The White House Conferenceon Early Childhood Development and Learning: What New Research on the Brain Tells UsAbout Our Youngest Children. The First Lady gave the gist of the meeting in her opening

remarks: the first three years of life, she said, can determine whether children will grow up

to be peaceful or violent citizens, focused or undisciplined workers, attentive or detachedparents themselves.

The conference was covered widely in the media. In the wake of all the hoopla, the Chicago-based John D and Catherine T MacArthur Foundation asked Nelson to lead a small group ofscientists to dive more deeply into these topics. The resulting Research Network on EarlyExperience and Brain Development, fully launched in 1998, included 12 researchers whoshared a plush budget of about $1.3 million a year. Nelson held the purse strings.

The Networks first studies used animals: baby mice that were either frequently orinfrequently handled by their human caretakers; baby barn owls whose brain wiring changed

dramatically after wearing prisms over their eyes; and most striking, baby rhesus macaquemonkeys that had been separated from their mothers.

Researchers had isolated monkeys before. In the 1960s, the American psychologist HarryHarlow famously reared baby monkeys in complete isolation for up to two years. Theanimals showed severe and permanent social deficits, bolstering the then-controversial ideathat the maternal-child bond is crucial to healthy development. The Network scientistswanted to know whether the timing of the maternal separation made any difference.

Monkeys typically become independent around six months old. The Network studies foundthat when monkeys are separated very early, at just a week old, they develop severesymptoms of social withdrawal, just as Harlow had observed: rocking back and forth, hittingand biting themselves, and running away from any approaching monkey. In contrast, whenthe babies are separated at one month old, they show inappropriate attachment, grabbing holdof any nearby monkey. We concluded from this that the four-week animal had an attachmentwith mom and then had that attachment ripped away, Nelson says The one-week animalnever formed an attachment, so it didnt know how to relate socially.

Children were getting adequate food, hygiene and medical care, but had woefully fewinteractions with adults, leading to severe behavioural and emotional problems

As the monkey data rolled in, Nelson was hearing about human social deprivation from hisMinnesota colleague Dana Johnson, a neonatologist who had long worked on internationaladoptions. Johnson treated orphans from all over the world, but was most disturbed by thosefrom Romania.

Nelson invited Johnson to talk at a Network meeting in January of 1998. In a conferenceroom of the Claremont Hotel in Oakland, California, Johnson switched off the lights and

played the Network scientists a few disturbing movies of children in Romanian orphanages.Some kids were rocking and flailing and socially withdrawn; others were clingy. We wereall very teary-eyed, Nelson recalls.


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Immediately following Johnsons presentation, Judy Cameron, leader of the monkey project,gave the group an update of her findings. She starts showing videos of these monkeys, and

they look just like the videos of Danas kids, Nelson told me. It really freaked us all out.

Romania has had orphanages for centuries. But its orphan crisisbegan in 1965, when the

communist Nicolae Ceauescu took over as the countrys leader. Over the course of his 24-year rule, Ceauescu deliberately cultivated the orphan population in hopes of creatingloyalty toand dependency onthe state. In 1966, he made abortion illegal for the vastmajority of women. He later imposed taxes on families with fewer than five children andeven sent out medically trained government agentsThe Menstrual Police to examinewomen who werentproducing their quota. But Ceauescus draconian economic policiesmeant that most families were too poor to support multiple children. So, without otheroptions, thousands of parents left their babies in government-run orphanages.

By Christmas day in 1989, when revolutionaries executed Ceauescu and his wife by firingsquad, an estimated 170,000 children were living in more than 700 state orphanages. As the

regime crumbled, journalists and humanitarians swept in. In most institutions, children weregetting adequate food, hygiene and medical care, but had woefully few interactions withadults, leading to severe behavioural and emotional problems. A handful of orphanages wereutterly abhorrent, depriving children of their basic needs. Soon photos of dirty, handicappedorphans lying in their own excrement were showing up in newspapers across the world. Iwas very taken with the kids in orphanages, Johnson says. Their condition was a stunning

contrast to most of the kids we were seeing come for international adoption who had beenraised in foster homes.

In his presentation, Johnson had mentioned that the head of Romanias newly formed

Department for Child Protection, Cristian Tabacaru, was keen on closing down his countrysinstitutions. After seeing the movies, Network scientist Charles Zeanah, a child psychiatristfrom Tulane University who specialised in infant-parent relationships, was gung-ho aboutmeeting Tabacaru and setting up a humanitarian project.

Nelson was touched by the videos, too. And he couldnt help but think of the scientificpossibilities of studying these children. The animal model could allow us to dig into brain

biology and all of that but, at the same time, wed be running a parallel human study.

Eleven months after that emotional hotel meeting, Zeanah and his wife, a nurse and clinicalpsychologist, travelled to Romania and saw the orphans for themselves. During their first

orphanage visit, the couple couldnt help but start bawling in front of the kids. One childreached out to comfort them, saying: Its OK, its OK.

The Zeanahs also met with Tabacaru. He was eager to work with the MacArthur groupbecause he thought that a rigorous scientific study could help his cause. If there wasscientific evidence to support the idea that foster care was better for kids, he thought hedhave more leverage with his political colleagues, Nelson told me. The data, in other words,could speak for the children.

Two days before our visit to the orphanage, I accompanied Nelson to a homely greenbuilding that houses the psychology department of the University of Bucharest, where he

holds an honorary doctorate. He had been invited by the Dean to give a talk on the ethics ofhuman research.


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All reputable scientific institutions follow a few ethical principles to guide their humanexperiments: participants must give informed and unambiguous consent; researchers mustthoroughly consider possible risks and benefits; the gains and burdens of research must beequally distributed to participants and society at large. These rules are largely unheard of inRomania, let alone enforced.

In a packed auditorium, Nelson began his lecture by describing the fundamental moraldilemma facing all clinical studies. The real goal of research is to generate useful knowledgeabout health and illness, not necessarily to benefit those who participate in the research, hesaid. That means, he added, that participants are at risk of being exploited.

Nelson outlined the sad history of human rights violations done in the name of science. Therewas Josef Mengele, the Nazi physician who performed medical experimentsradiating,sterilising, infecting, and freezing identical twins, among other atrocitieson Auschwitz

prisoners. Mengele escaped capture after the war, but 20 other Nazi doctors were tried in aUS military tribunal in Nuremberg, Germany. The judges at these trials created a list of 10

ethical tenets for human research, known as the Nuremberg Code. These included voluntaryconsent, avoidance of suffering, and the right of the subject to end the experiment at anytime.

The Nuremberg Code provided the intellectual basis for the 1964 Declaration of Helsinki, thefirst ethics text created by the medical community and one thats still updated frequently. Itsnot legally binding, but thousands of research institutions use the declaration to guide theirformal regulations and ethical review committees.

Could there be a more vulnerable study population, after all, than orphans with physical andpsychological disabilities living in an economically feeble and politically unstable country

Today the importance of these rules is obvious, but it was decades before they weresystematically enforcedand many ethically dubious experiments happened in the interim.In the 1950s and 60s, for example, researchers from New York University fed mixtures offecal matter infected with hepatitis to mentally retarded children living at the WillowbrookState School in Staten Island. The researchers intent, as they would publish in the prestigious

New England Journal of Medicine in 1958 and 59, was to track the course of the disease and

the effect of new antibody treatments. (The researchers argued that since hepatitis wasrampant in the institution anyway, they werent exposing the children to any additionalharm.)

Meanwhile, 1,000 miles south, other researchers were testing the natural history of untreatedsyphilis on hundreds of poor black men in Tuskegee, Alabama. The men were not onlydenied treatment for the disease, but had no idea they were sick. In 1972, the studys 40thyear, a whistle-blower scientist finally told the press about the effort, which had beensanctioned by the US Centers for Disease Control and Prevention.

The Tuskegee syphilis experiment triggered a public uproar and a US Congressionalinvestigation that ultimately shut down the research. It became the standard bearer ofunethical research, Nelson told the room of Romanian students.

These were the ugly precedents confronting Nelson and his colleagues in 1999, when theybegan discussions of how to set up the early intervention project in Bucharest. They knew


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from the outset that the project would be ethically precarious: could there be a morevulnerable study population, after all, than orphans with physical and psychologicaldisabilities living in an economically feeble and politically unstable country? As the

bioethicist Stuart Rennie later wrote of the Romanian orphans: Researchers who choose

them as study participantsin this age of intensified ethical scrutinywould seem to have

a career death-wish.

The MacArthur Network scientists spent the better part of a year hammering out the ethicalparameters and experimental design of the project. They wanted to use the gold standard ofclinical research design: a randomised controlled trial. This would allow them to objectivelycompare children given one intervention (foster care) with those given another (institutionalcare). For most randomised controlled trials, if one intervention proves to be better toward the

beginning of the trial, researchers will call off the study and put all participants on thattreatment.

But that wouldnt be an option for this study. The problem was that, with a few exceptions,

foster care didnt exist in Romania. That meant the scientists would have to create their ownsystem, leading to a slew of sticky complications. How would they choose families andadequately train them? What was appropriate payment? What if a particular foster-carefamily was abusive, or otherwise didnt work out? Was it fairto leave half of the childrenlanguishing in orphanages? What would happen to the children if the study (and its funding)ended?

The team answered these questions with the help of non-governmental organisations (NGOs)in Romania that specialised in orphan care. They would recruit foster families throughnewspaper advertisements and put them through a rigorous training programme for parentingskills. They would pay the families well250 Romanian Lei per month (about $96 at thetime), which was almost twice the minimum wage in Romania. And after that initial

placement, the Department for Child Protection would be in charge of the childrenswhereabouts, just as they were before. So, for example, if a biological mother came forwardand wanted her child back, the department could opt to reintegrate the child. Or if morefoster homes were to become available, then the department could move children from theinstitutions into families. And if the project were to stop for any reason, the Romaniangovernment had agreed to take over the payment of the foster-care families.

Three of the MacArthur scientistsNelson, Zeanah, and the psychologist Nathan Fox of theUniversity of Marylandstepped up as leaders of the project. After getting approval from

ethics committees at each of their universities, the study launched a feasibility phase inNovember of 2000, and officially began collecting data in April 2001. The plan was to endthe study after 42 months.

The researchers set up a satellite lab in St Catherines, which at the time was still operating asa placement centre for about 500 children. The researchers hired half a dozen Romanians tofollow the participants personal cases and collect data on physical growth, IQ,

psychological development, and later, EEG and brain scansevery few months.

These Romanian researchers, many of whom are still part of the project, were intimatelyfamiliar with their countrys orphan problem. Take Anca Radulescu, who is now the projects

manager in Bucharest and the teams mother hen. Radulescu was born in 1968, two yearsafter Ceauescus abortion ban, Decree 770. People born around this time are known as


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Decreei: children of the decree. As a young girl, Radulescu remembers, her mother told herthat despite her birth year, she was not one of theDecreeishe was wanted.

In 1997 Radulescu had begun working at St Catherines as a psychologist. She was hired

thanks to new legislationpassed because Romania was trying to get into the EU that

moved the administration of orphans from the Ministry of Health to the newly createdDepartment for Child Protection. The law marked the beginning of a philosophical change inthe governments treatment of orphans, with a new focus on nurture over nature.

The transition was a nightmare, Radulescu says, because of the doctors who managed theinstitutions. They were dismissive of psychology and social work, both of which had been

banned during Ceauescus reign, and believed that the orphans problems were medical.

They gave the children a physical exam nearly every day, and prescribed them sedatives atnight. Meanwhile, the children werent getting the social interaction they desperately needed.They lived in units of 40 or 50 kids, each with about six adult caretakers who were kept busy

preparing food and doing laundry. The kids were left in big rooms to play by themselves.

In late 2000, Radulescu started working for the brand-new Bucharest Early InterventionProject, in offices just a few corridors away from those residential units. She and the rest ofthe team, working closely with Romanian NGOs, used newspaper advertisements to findfoster-care families and never-institutionalised children (who would serve as communitycontrols). The team screened 187 orphans from six Bucharest institutions, eventuallychoosing 136 who did not have major medical problems. The children ranged from six to 31months old. They were randomly assigned to either foster care or the orphanage, with siblingskept together. In the end, 69 children went into foster care and 67 stayed in institutions.

For its first couple of years, the Bucharest project rolled along smoothly and quietly. Thiswas remarkable given the constant political turnovers (including one in which Tabacaru, theresearchers government ally, was booted out).

Then, in June of 2002, a crisis. The Bucharest lab had an unannounced, and unwelcome,visitor: Baroness Emma Nicholson.

The children who grew up in institutions have less white matter, the tissue that links updifferent brain regions, compared with those in foster care

Nicholson, hailing from the village of Winterbourne in England, was a member of the

European Parliament and had been appointed to represent Romanias application into the EU.This made her a powerful figure in Romania, which had been trying to join the EU since1993. She also happened to be an outspoken opponent of international adoptions, which shefelt were avenues for child trafficking. Thanks to her influence, in 2001 Romania placed amoratorium on international adoptions.

After Nicholsons visit to the lab, she was quoted in several Romanian newspapers makingdamning accusations against the Bucharest project. She goes to the press and says that were

doing a study, using high-tech American measures, to identify the smartest orphans so we cansell them on the black market, Nelson told me one night, practically sputtering.

Nicholson would deny that she ever accused the scientists of trafficking, but she continued todescribe the MacArthur project as illegal and unethical. Although the claims were patently


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false, and no formal charges were ever made, the story was quickly picked up byinternational newspapers, includingLe Mondeand The New York Times.

The scandal died down quickly after Nelson called Michael Guest, then US ambassador toRomania, who ran interference with the Romanian government. But the team learnt an

important lesson about their public profile. We never, ever took a position on internationaladoptionsit would have been suicide, Nelson said. We took the model of, look, werescientists. Our job is to collect the data and give it to others who know how to do policy, notto take sides on an issue.

The BEIP project stayed under the radar until 8 June 2004, when Nelsons team held a pressconference to announce some exciting data. In the Hilton Hotel in Bucharest, withrepresentatives from several Romanian ministries and the US ambassador in attendance, theresearchers reported that, as expected, the 136 children who started in institutions tended tohave diminished growth and intellectual ability compared with controls who had never livedoutside of a family. But there was a surprising silver lining. Children who had been placed in

foster care before the age of two years showed significant gains in IQ, motor skills, andpsychological development compared with those who stayed in the orphanages.

The scientists published these findings in 2007, in the prestigious journal Science. That paperis the most famous to come out of project, but its just one of nearly 60. Others have shown,

for example, that toddlers who never left institutions have more repetitive behaviours thanthose who went into foster care. Long-institutionalised toddlers also show different EEG

brainwave patterns when looking at emotional faces.

As the children got older, the researchers gave them brain scans (renting out time with aprivate clinics MRI machine, one of only a handful in the country). These scans showed that,at around the age of eight, the children who grew up in institutions have less white matter, thetissue that links up different brain regions, compared with those in foster care. Theresearchers looked at the childrens genomes, too, and found that those who lived the longest

in orphanages tend to have the shortest telomeres, the caps on the end of chromosomes thatare related to lifespan.

The project is now funded not only by the MacArthur Foundation, but by grants from the USNational Institutes of Health (NIH) and the Binder Family Foundation. After 14 years, theBucharest project is well-known and well-respected in the scientific community. At first,though, many scientists had concerns about its ethical design.

For example, when the researchers first submitted their data to Science, the journals editordidnt know what to make of its ethics. So she sent it to bioethicists at the NIH for a thoroughreview. Even if you study ethics all the time, it turns out this is a very interesting ethicalcase, said Joseph Millum, one of the NIH bioethicists who reviewed it. As Millum and hiscolleague Ezekiel Emanuel would explain in a commentary published in the same issue ofScience, they did not find the work to be exploitative or unethical.

The Bucharest project study differs from most randomised control trials done indisadvantaged countries, Millum explained. Those tend to be studies of a new treatmentanantiretroviral drug to treat HIV in Africans, say. Its ethical to put people through those trials

because the researchers dont know from the outset whether the drug will work. The hope is


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that the new knowledge you get out of the study is then going to be useful in informingpractice, Millum said.

However, in the Bucharest projects case, the researchers already knew from a multitude of

studies in Western countries that foster care is better for children than institutionalised care

thats why Western countries have sofew institutions. So although the study couldpotentially answer lots of new, open questions, the one that justified its existence had alreadybeen answered.

Still, that older research had not influenced Romanian social policy; many governmentofficials did not trust the idea of foster parents, and believed that institutions providedadequate care. That, plus the fact that the project had close connections with the government,lent credence to the argument that the study could change policy, Millum explained. Theanswers to the question the study asked could have changed practice.

But realistically, how likely was it that the study would change anything? And once the study

was over, were the scientists supposed to then become advocates for those policy changes?

Its complicated, Millum said. People have different views about whether there is an

obligation to provide successful interventions after a study is complete. If a medical study istaking place in Western Europe, for example, where there is a relatively robust health caresystem, then those health institutions will probably be the ones integrating the new data into

policy, he says. But in an African country, for example, with no health care to speak of, theresearchers might share more of the burden.

These are not easy waters to navigate. And there are limits, of course, to what even the mostmotivated scientists can do. The idea that there is a single experiment that leads to a

breakthrough, and then we solve the problem is, sadly, naive, Millum said. They cant

control what happens in Romania.

In late May this year, exactly six months after my Bucharest trip, I had lunch with Nelson inBoston to catch up. I asked him whether he thought Romanias orphan situation had changed

much since he first learnt about it 14 years ago. After all, I pointed out, some of Romaniasmost destructive policies regarding orphans are still in place. The international adoptionmoratorium was made permanent in 2005. Domestic adoption exists, but comes with onerousregulations. A taxi driver in Bucharest told me a story about friends of his, native Romanians,who have been trying to adopt a Romanian orphan for years. The regulations seem ridiculous;

for example, children cant be adopted until the state has attempted to make contact with allof their fourth-degree relatives.

There are two things that have changed, Nelson said: one good and one bad.

The good: Romania has seen a significant drop in the rate of child abandonment andinstitutionalisation. On 23 June 2004, 15 days after the Bucharest projects first big pressconference, Romania passed Law 272/2004, stating that children younger than two are notallowed to be placed into residential facilities. The law has loopholeschildren with severehandicaps can still be institutionalised, and young babies can still be left in maternityhospitals for their first few yearsbut it signifies a major change in attitude, and seems to

have reduced the overall number of institutionalised children.


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Its impossible to know how much credit the Bucharest project deserves for that law. Theproject was by then well known among Romanian officials. But there was another powerfulforce at work: Romania badly wanted to get into the EU, and the EU (thanks in large part toBaroness Nicholson) had demanded that Romania deal with its orphan problem. TheBucharest project data and the EU pressure were like a perfect storm, Nelson said.

The more depressing change that Nelson has noticed since 1999 is the global recession,which hit eastern Europe hard. A study last year by the European Commission found thatRomania still has the continents highest rate of babies abandoned in maternity hospitals peryear, at 8.6 per 1,000 live births. Since the recession hit, Romania has cut back on fostercare, Nelson said, and parents with kids in foster care are putting the kids back in

institutions.

For all that they hope to change in Romanias social policy, the researchers are moreimmediately concerned with the children in their study. These kids have known some of theseresearchers for as long as they can remember. Relationships have formed.

Of the original 136 children the researchers recruited from institutions, 62 are now livingwith foster or adopted families, 31 were reintegrated with their biological parents, and just 17are still living in institutions (of the rest, 10 live in social apartments, which are similar togroup homes, and 16 dropped out of the study). All evidence suggests that these kids are noworse off today than they would have been had the study never existed. But that doesntmean theyre doing well.

In the Bucharest lab, I met a 12-year-old project participant named Simona and her biologicalmother. Simona was the youngest of four children; when she was eight months old, hermother could no longer afford to keep her. So she dropped her off at St Catherines, whereher older sister, an epileptic, had already been living for several years. Simonas mother told

me how difficult it was to give up her babies. She visited them every week, and was sad tosee that they were often sick with a cold or a rash. When Simona was five years old, hermother was receiving enough financial assistance from the government to bring her backhome. But those years in the institution took a toll: Simona has a sweet disposition, like hermother, but shes very thin, and her IQ is 70.

I next met 13-year-old Raluca, a strikingly pretty girl who went into foster care at 21 monthsold and has lived with the same family ever since. Raluca is stylish and intellectually sharp;her big eyes, unlike Simonas, made frequent contact with mine. At first, I thought of Raluca

as one of the lucky ones; she escaped the hell of the orphanage. But she has differentproblems. Shes defiant to her teachers and parents, and has started smoking and seeing olderboys. Her foster mother has threatened to give her up.

These two girls are doing relatively well. The Bucharest projects staff is dealing with ahandful of participants in more dire situations. While sitting in on a lab meeting, I heard afew examples: a girl who at age 10 was sexually attacked by her neighbour; a Roma girl who,at age 12, was returned to an orphanage because her foster-care mother said she was stealing,lying, and had a gipsy smell; another 12-year-old girl who was reintegrated with hergrandparents and then, with their blessing, married a 12-year-old boy. The scientists worrythat these sorts of horror stories will become more common as the children ride the

rollercoaster of adolescence.


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And then there are the 17 participants who still live in orphanages. Theyre slightly better offthan the average institutionalised child, in that they get regular medical assessments andconstant check-ins from the researchers. After doing a brain scan of one boy, for example, theresearchers discovered a nasty infection hidden in the space behind his ear. These mastoidinfections can be fatal, but the boy was fine after a round of antibiotics.

Well, you couldnt do what I do if you got upset all the time.

Still, institutional life is undeniably miserable. During my visit to the orphanage, I chattedwith a 14-year-old Bucharest project participant named Maria. Maria was abandoned at birthand spent her first four months in two different maternity hospitals. Shesbeen in orphanagesever since, moving every few years. She has a normal IQ, which means shes far more

resilient than others with her history. She was shy when we talked, and didnt make much eyecontact, but otherwise seemed like a normal girl.

I asked Maria what she thought was the worst thing about living in the placement centre. She

said it was the older boys who take drugs.

And what about the best thing? I asked. She paused for about half a minute, looking down ather purple Crocs. The times we get to leave for a little while, when we can take the bus to the

park, she said.

When Nelsons team first set up the Bucharest Early Intervention Project, the MacArthurFoundation gave them a separate pot of money to create a humanitarian institute inBucharest. The goal of the so-called Institute of Child Development was to work with localofficials and non-profits on orphan issues, as well as to train a new generation of Romanianresearchers. The institute has put on several scientific and policy workshops, invitinghundreds of researchers from across the world. The last of these will probably take place in

November. Then in December 2013, the MacArthur funding runs out, and its unclearwhether the institute will continue under local direction.

Were limited inour resources, says Elizabeth Furtado, who has been the Bucharestprojects manager since 2006 and visits the Bucharest lab about twice a year. Furtado has afour-year-old son. She copes with the job by compartmentalising; for example, she has veryintentionally not read the full life histories of any of the participants. But sometimes the painis unavoidable. She was with Nelson and me the day we visited the orphanageher firsttime in an institution since becoming a mother. It took me almost a month after coming back

to get to a [point] where I could kind of let it go and focus on my relationship with my son,she told me.

The last two years on the project have been somewhat defeating, Furtado says, because theadolescents behaviours are becoming more difficult to manage, and the foster-care parentsare getting less and less supportfinancial, educational, emotionalfrom the government.On the one hand, I know that we are doing a lot of good for a lot of these kids, she says.But it makes me sad that legislation isnt keeping up with enough of what were finding.

Nelson, too, has felt his share of emotional tension over this project, though he tends todownplay it (he often refers to being sad, for example, as having an activated amygdala).

Like the Zeanahs, he wept on his first visit to St Catherines, in 1999, where he saw a roomfull of babies lying in cribs and sta

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