I am a childfree woman in her late 20s. I find the idea of pregnancy abhorrent and frightening in almost every way. Everything about it makes me cringe, most intensely if I imagine myself giving birth. I occasionally have nightmares about being pregnant and giving birth.
Ten years ago I used hormonal birth control for a short time and had several unpleasant side effects, including morning sickness, weight gain, and mood swings. Since pregnancy hormones are orders of magnitude stronger than birth control hormones, I am terrified of the changes my body would experience if I were pregnant. I’m afraid I would have hyperemesis gravidarum [severe nausea and vomiting] or some other horrible complication.
Going off the hormonal birth control was ten times worse.
I had depression, insomnia, amenorrhea [no menstruation], gained more weight, and I developed an eating disorder in effort to lose the weight. I believe these issues would repeat themselves—probably in fuller force—after a pregnancy, and that scares me more than anything.
It took a lot of time for me to regain my health, and I wouldn’t like to have to go through that process again. I always feel that my hormones are in a perpetual state of delicate balance. If anything, such as pregnancy, disrupts that balance, I will never regain it. I know it’s irrational.
I have always had extremely painful periods, and without strong painkillers I am unable even to get out of bed. I know that the pain of childbirth would be much worse, and that is not something I ever want to experience.
Several years ago I had exploratory surgery to see if endometriosis was causing my painful periods. It wasn’t the cause, but at that time, something deep inside me had been hoping that it was and that it would render me infertile, just so that I would have no risk of ever becoming pregnant. I still hope I’m infertile and have thought about getting tested, just so I can know for sure.
I’m glad that neither I nor my husband want children. I track my monthly cycle religiously so that I can make sure we have sex at the times that I am least likely to be fertile. I also record and pay close attention to the small changes my body undergoes throughout my cycle, such as PMS symptoms, mood changes, etc. This way, I’ll notice new or intensified symptoms that may indicate pregnancy, if it ever occurs.
I, like Ashley Lauretta, struggle with generalized anxiety, which probably has affected my experiences and predisposes me to tokophobia. Tracking my cycle helps me deal with it by giving me a sense of control and comfort.
From the article that started this whole discussion:
There are not many women who openly discuss having tokophobia, though some have spoken out in media or online in recent years to share their stories or seek help. One woman on Reddit, in a channel devoted to people who don’t want children, notes that her tokophobia was so severe she was afraid of having sex with her significant other for fear of becoming pregnant, even when protection was used. “I know it’s silly that I’m this afraid,” she writes, “but I can’t help it.”
That recent college grad, Eileen Jones, emailed hello@ to elaborate on her experience. In her long and compelling note below, she recalls several events in her life that triggered her tokophobia and how those deep-seated fears derailed her first career goal. Her phobia is so overwhelming that she’s “only had vaginal sex two times.” And her thoughts on self-sterilization raises some interesting questions. Here’s Eileen:
I turned to reddit for advice because for years I had felt like such a freak of nature because not only do I not want children, but I am also terrified of pregnancy. It was such a relief to find an online community that understood how I felt.
I can’t exactly pinpoint what caused my tokophobia. I have always thought that tokophobia/not wanting children might be some sort of evolutionary response to overpopulation. I knew when I was about 4 years old that I did not want children. I think I was maybe around 13 when I realized that I actually had a fear of pregnancy. I remember doing sex education stuff around that age and abstinence was really pushed at my school. I can remember the nurse explaining some of the symptoms of pregnancy and being pretty repulsed.
When I was in high school, I had my heart set on being a doctor.
I attended a National Youth Leadership forum on medicine. During this program, I shadowed a radiologist. She showed me an x-ray of a pregnant woman and you could see the fetus inside of her. Although I did not mean to show any sort of negative reaction, the doctor could tell that I was physically repulsed. She asked if something was wrong, and admitting to her that I didn’t really like “pregnancy stuff” was kind of embarrassing for me. I felt like I was being really rude.
Also, during this medicine program, I remember medical students talking to us about rotational programs where you would intern for a set amount of weeks as an ER doctor, then you would switch for a certain amount of weeks and intern as a pediatrician, etc. I remember thinking that there was no way I would ever become a doctor just because I knew I wouldn’t make it through interning as an OB/GYN. Gastroenterology? Fine. Proctology? Great! But something about working in the OB/GYN field was gross to me. Honestly, gynecology doesn’t bother me one bit, but there is no way I could handle obstetrics.
I really related to the part in Ms. Lauretta’s article when she describes how Helen Mirren felt when she watched a film about childbirth. When I was a senior in high school, my anatomy teacher showed us a film on childbirth. I remember staring down at my desk the entire time. My best friend, who sat in front of me, was turning around periodically to check on me. I remember her asking, “Are you okay? No, really … are you okay… ? Are you sure?”
I’ve recently stumbled upon the MTV series 16 and Pregnant. Although I do think it’s a great series, when they show the girls in labor, I can’t watch. I’m seriously like your average person watching a horror movie and shielding their eyes from the screen. I’ve even had to mute it.
Another thing I’ve had to deal with is the repulsion of seeing pregnant stomachs. A friend of mine who is currently pregnant recently posted a video of her stomach on Snapchat. In the video, you can see her baby moving around inside of her. I was so freaked out that I had to exit the video; I couldn’t even watch it.
As far as my sex life goes, I don’t really have much of one. I’ve only had vaginal sex two times. Both times, the guy used a condom, but I still panicked. The last time I engaged in vaginal sex, I sat in my car and cried for a few minutes after. I drove myself to the nearest Walmart and bought some Plan B. I was basically an anxious mess until I had my period. I even took a pregnancy test AFTER I got my period just to make sure I wasn’t pregnant.
I feel that the only way I will ever have a normal sex life is if I get sterilized. Unfortunately, most doctors are not keen on this because they are concerned you will change your mind. However, as I stated earlier, I’ve known since I was about 4 years old that I didn’t want kids and I have only become more sure with age.
I really wish there wasn’t such a negative stigma around women who do not want children. [CB: Readers discussed the contentious subject last year.] I don’t consider myself to be generally selfish. I’m not a child-hating monster. In fact, although I’m not too keen on babies and toddlers, I do enjoy interacting and working with older children, especially teenagers. In college, I volunteered with at the Science Olympiad where I worked with middle and high school kids and really enjoyed it!
One thing I wish people knew about tokophobia, or at least in my case, is that I don’t think less of someone for being pregnant. I don’t hate pregnant people. In fact, I am excited for my friends and family members who are pregnant because I know they’re happy and excited. I will definitely attend their baby showers and get them gifts.
I really wish that I wasn’t mortified by things related to pregnancy, but it’s something that has definitely improved a little in recent years. I can actually look at sonogram images now without being disturbed!
I was so happy when someone told me about Ms. Lauretta’s article. It’s always comforting to me to read about people who feel the same way I do. Thank you so much for taking time to read this. If you have any questions, I would be happy to answer them.
Incredible and timely piece, thank you so much. I actually am writing to ask a question. The article says over and over to get some help if you believe you have this phobia and want to have a baby. That's me, and I want to know how to get help. What are the concrete suggestions from Brian Salmon [a doula and lactation consultant] and his colleagues with regards to getting over this?
My story: I’m a 40-year-old woman, and I’ve only just come to decide that it’s time to be a mom. I don’t have the money to adopt, but I absolutely would if I could. I’m disgusted by being pregnant and terrified of giving birth. I’ve been pregnant before, more than once, and it felt like being invaded by a destructive alien force.
I would say that my phobia comes from the following experiences:
1. I’m a control freak. I’m a lawyer, alpha, eldest child, feminist, political activist, and conservator over my only sibling, who has DD. I fill with anxiety over mere annuals because I cannot STAND the idea of a stranger in my vagina unwantingly, without my guidance and oversight. I avoid them like the plague.
2. Those pregnancies and the subsequent abortions, ONLY with regards to the physical pain, and again, having all these people prod my privates.
3. My parents were open lefties who perhaps shared too much, including horrifying birthing stories that my mother identified (my birth especially) as “the most traumatic experience of her life.” She also showed me videos and books too early, like Our Bodies Ourselves, which depict women screaming in agony with their vaginas gaping in a room full of old white men.
To be fair, my mother’s OB/GYN was an Indian woman, and I have a dear friend who grew up on The Farm with the doulas and midwives who wrote the manuals. And I saw The Business of Being Born, so I know that, rationally, I have options outside the nasty hospitals and their profit-driven approach. And I know that there are oils and exercises to avoid tearing. But this fear isn’t rational, right?
So here I am, ready to do this, and paralyzed with fear. And your article just gave it a name, and the hope of fixing it. Please point me in some direction for fixing it.
When speaking with sources for my piece, I learned a lot about the options available to women who have tokophobia yet wish to have children someday (me being one of them). They recommend finding both a therapist and a midwife, both of whom specialize in tokophobia or have at least worked with it previously. They can not only help you discover the root cause of your phobia but also break it down into smaller related fears and work through each one specifically. They can educate you on the birthing process and your options for it—hospital vs. home, for example, or Cesarean vs. natural—and then advocate for you.
I followed up with Kirsten Brunner, MA, LPC to find out if there are any specific questions or concerns you should broach in therapy.
“Voicing your fears and reaching out for help is half the battle in overcoming tokophobia,” notes Brunner. “So many women sit in silence and shame with their fears, and that only causes the anxiety to grow.”
“Finding a professional who is familiar with tokophobia and/or reproductive mental health issues is essential.” Brunner suggests that you find a therapist comfortable working with couples, as it may be helpful for your partner to be in the sessions from time to time to better understand your tokophobia and help work through it with you.
When you start looking for a therapist, don’t feel like you need to choose the first one you visit. Brunner notes that having a connection with your therapist is shown by research to be the strongest predictor of a positive outcome. Should you encounter anyone in your search who responds to your fears with judgement or with shaming, they are not the therapist for you.
If you don’t know where to start in your search, Brunner suggests asking your ObGyn for referrals. “Make sure that your therapist, doula, or midwife feels confident that they can help you get to the root of your fears and overcome your phobia,” stresses Brunner. “You want to surround yourself with positive, optimistic energy, as Brian Salmon correctly stated in the original article. Pregnancy and childbirth can be a beautiful and relatively comfortable experience, and aligning yourself with professionals and friends who ascribe to these empowering beliefs is essential.”
Should you not be ready to reach out to a therapist, Herrera recommends having a lifeguard in place. “Have somebody who loves you pay attention to what is happening; if they see that you are having increased tokophobia or symptoms of postpartum depression or anxiety, then they get help,” stresses Herrera. “Have everything lined up, have a therapist lined up with your insurance whom your lifeguard can call.”
I hope this gives Kelly and other readers struggling with tokophobia a sense of where to start as you begin your journey to parenthood. Many of you, like Sacha Zimmerman, had the fear but didn’t know there was a name for it, and I want to remind you that you aren’t alone. You aren’t irrational or broken—you have a legitimate phobia—and asking for help is the best thing you can do to work through your fears.
I always thought I was missing some important maternal chip in my system, some crucial feminine widget in my consciousness that was supposed to look at childbirth as simply beautiful—as the most natural thing in the world. Instead, long into adulthood, my overwhelming feeling toward the act of giving birth was something along the lines of: You want me to push what out of where?!
Ashley Lauretta’s wonderful piece for us this week, “Too Afraid to Have a Baby,” mentions that Helen Mirren was scarred by a childhood viewing of an educational film on the topic. I feared childbirth from the moment I heard how it was done; I don’t remember ever not thinking it sounded ghastly. But I too had my own filmstrip moment that pushed me further over the edge.
In my mid-20s, I saw an episode of Susan “Stop the Insanity” Powter’s short-lived talk show (please do not feel obliged to remember Susan Powter) about nightmare-childbirth scenarios. One guest on the show suffered something so completely horrific, I dare not write it. Suffice it to say, she had to go through several corrective surgeries and receive hundreds of stitches—down there.
Do I sound immature? I felt immature. I also felt rational. That maternal chip I was missing was really a blind spot. Other women could not see the obvious flaws of natural childbirth, but I was cursed with perfect vision.
When I became pregnant at 37, I could feel my due date hurtling toward me like a runaway train. Maybe I could have an elective C-section. I read up on the procedure—too many people have it, hospitals and doctors are too quick to turn to it, it’s driving up health-care costs, it’s selfish, the baby will be bathed in drugs …
As I read, I was not chastened. Instead, I thought, So it’s do-able.
The other women in my mommy pace group would smile at me serenely, beatified by their holy cargo. I’d be fine, they’d assure me. It wouldn’t be bad at all, they promised. I didn’t have the heart to tell them about their childbearing blind spots.
I screwed up my courage and confessed my fears to my doctor. “I’m not sure I can do it,” I cried. “OK, let’s schedule a C-section,” she replied without missing a beat. Yes! She was one of those doctors I’d read about who handed out surgery like candy. She told me that at my age, the chance of ending up with a C-section was already increased because more things go wrong the older the mother is. Given that, she said, she always prefers to schedule procedures than to end up with emergency C-sections—which, obviously, no one plans for. She also said that being in a fevered panic about childbirth was no way to, well, experience childbirth—not to mention it was a pretty poor way to be pregnant; after all, my stress was probably being transmitted to the child inside me.
So as far as my doctor was concerned, it was a no-brainer. Science!
But I still dared not tell a soul. I knew what the world saw: I wasn’t doing it the right way, the best way. I was a selfish, scared, immature crazy person.
Then, as I neared the end of my pregnancy, my baby didn’t turn around; he was breech—a common reason to need a C-section. My doctor and I laughed. “So I’m legit?” I said. Since then, if my C-section ever comes up in conversation (which is far less often the more distance from the event I get), I say, “He was breech”—as though I had no choice in the matter. But I did have a choice. And I actively chose.
Now I don’t look back on the day I gave birth as one in which I was tearful and totally terrified, thinking only of the cruel physics of what was about to happen. Now I remember every detail of that happy spectacular day with joy. Because it was all about my son.
Claims about the drug are based on shoddy science—but that science is entirely unremarkable in its shoddiness.
Ivermectin is an antiparasitic drug, and a very good one. If you are infected with the roundworms that cause river blindness or the parasitic mites that cause scabies, it is wonderfully effective. It is cheap; it is accessible; and its discoverers won the Nobel Prize in 2015. It has also been widely promoted as a coronavirus prophylactic and treatment.
This promotion has been broadly criticized as a fever dream conceived in the memetic bowels of the internet and as a convenient buttress for bad arguments against vaccination. This is not entirely fair. Perhaps 70 to 100 studies have been conducted on the use of ivermectin for treating or preventing COVID-19; several dozen of them support the hypothesis that the drug is a plague mitigant. Twometa-analyses, which looked at data aggregated across subsets of these studies, concluded that the drug has value in the fight against the pandemic.
In ways both large and small, American society still assumes that the default adult has a partner and that the default household contains multiple people.
If you were to look under the roofs of American homes at random, it wouldn’t take long to find someone who lives alone. By the Census Bureau’s latest count, there are about 36 million solo dwellers, and together they make up 28 percent of U.S. households.
Even though this percentage has been climbing steadily for decades, these people are still living in a society that is tilted against them. In the domains of work, housing, shopping, and health care, much of American life is a little—and in some cases, a lot—easier if you have a partner or live with family members or housemates. The number of people who are inconvenienced by that fact grows every year.
Those who live alone, to be clear, are not lonely and miserable. Research indicates that, young or old, single people are more social than their partnered peers. Bella DePaulo, the author of How We Live Now: Redefining Home and Family in the 21st Century, reeled off to me some of the pleasures of having your own space: “the privacy, the freedom to arrange your life and your space just the way you want it—you get to decide when to sleep, when to get up, what you eat, when you eat, what you watch on Netflix, how you set the thermostat.”
A brilliant new account upends bedrock assumptions about 30,000 years of change.
Many years ago, when I was a junior professor at Yale, I cold-called a colleague in the anthropology department for assistance with a project I was working on. I didn’t know anything about the guy; I just selected him because he was young, and therefore, I figured, more likely to agree to talk.
Five minutes into our lunch, I realized that I was in the presence of a genius. Not an extremely intelligent person—a genius. There’s a qualitative difference. The individual across the table seemed to belong to a different order of being from me, like a visitor from a higher dimension. I had never experienced anything like it before. I quickly went from trying to keep up with him, to hanging on for dear life, to simply sitting there in wonder.
The U.S. economy is booming, but there’s a mysterious hole in the labor force.
The U.S. economy right now is a little bit like Dune.
Not Frank Herbert’s magisterial sci-fi epic novel, or Denis Villeneuve’s new and reportedly sumptuous film adaptation. I mean David Lynch’s infamously bewildering 1984 movie version, which is remembered mostly for being a semi-glorious mess. Like that space oddity, today’s economy is too strange to neatly categorize as “clearly great” or “obviously terrible.” You keep waiting for it to just be normal. But it stays weird—big economic indicators point in conflicting directions—so you have to accept that nothing is going to make sense for a while, and maybe it’ll be okay.
Americans are buying more stuff than ever before. That’s good. But because of supply constraints, it can feel like there’s a painful shortage of just about everything. That’s bad. Economic growth is booming, but the president’s approval rating on the economy is falling, which is a historically odd juxtaposition. Businesses everywhere are struggling to fill jobs, which sounds bad, but employer pain is workers’ gain, and wages are rising, which is wonderful. But because prices are rising too, inflation-adjusted hourly-wage growth actually declined in September, which is not wonderful.
Female doctors have always dealt with appearance-related confusion and disrespect. That only got worse during the pandemic.
In the spring of 2020, as Boston’s first COVID-19 wave raged, I was the gastroenterologist on call responding to a patient hospitalized with a stomach ulcer. Wearing a layer of yellow personal protective equipment over a pair of baggy scrubs, I spent 30 minutes explaining to him that he needed an endoscopic procedure. We built a rapport, and by the end of our conversation about the pros and cons, he seemed to agree with my recommendation. I told him we would be ready to perform his endoscopy within half an hour.
“Well, before we do anything, I’m going to need to discuss it with the doctor.”
When I entered the room, I had introduced myself as the doctor. I had also just explained, in great detail, a highly specialized procedure.
Lately, news stories about the supply chain tend to start in similar ways. The reader is dropped into an American container port, maybe in Long Beach, California, or Savannah, Georgia, full to bursting with trailer-size steel boxes loaded with toilet paper and exercise bikes and future Christmas presents. Some of the containers have gone untouched for weeks or months, waiting for their contents to be trucked to distribution centers. On the horizon, dozens of additional vessels are anchored and idle, waiting for their turn in the port. More ships keep arriving. Everyone involved—sailors, longshoremen, customs clerks, truckers—works as fast and hard as they possibly can. It’s not fast or hard enough.
Four Hours at the Capitol, a new HBO documentary, is a vivid, terrifying picture of violent insurrection.
In the days and weeks after the storming of the U.S. Capitol on January 6, 2021, commentators and media outlets grappled with the question of what to call that event. Language is sticky; it clarifies and obfuscates the truth depending on who’s wielding it. January 6 was described as or likened to a “riot,” a “tourist visit,” an “insurrection,” a “peaceful protest,” and a “coup attempt.” And yet, watching Four Hours at the Capitol, Jamie Roberts’s tight, unsettling new HBO documentary about that day, another word seemed more appropriate to me, one that most of the participants interviewed in the film might agree on. More than anything else, January 6 was war.
There have been a number of incisive breakdowns of that day, including “Day of Rage,” TheNew York Times’ 40-minute film detailing how the attack was strategized and executed, and how President Donald Trump and his allies fomented mass anger and even seemed to encourage the violence. Four Hours at the Capitol isn’t as analytical, or as thorough in its parsing of all the information that’s emerged. But its immersiveness offers something else. With his rigidly chronological framing and his interviews with people who were present at the Capitol that day, Roberts captures the extent to which both sides were engaging in combat. This dynamic emerges over and over again throughout different accounts and video clips. One clash between Capitol Police officers and pro-Trump extremists is referred to by a participant as “the battle for the tunnel.” Different interviewees describe fighting on “the front line,” engaging in “hand-to-hand combat,” and, in the case of one police officer, the strangeness of walking through his own colleagues’ blood. In a scene that seems ripped right out of a Bruce Willis movie, a police commander shouts, “We are not losing the U.S. Capitol today, do you hear me?”
Breaking up social-media companies is one way to fix them. Shutting their users up is a better one.
Your social life has a biological limit: 150. That’s the number—Dunbar’s number, proposed by the British psychologist Robin Dunbar three decades ago—of people with whom you can have meaningful relationships.
What makes a relationship meaningful? Dunbar gave TheNew York Times a shorthand answer: “those people you know well enough to greet without feeling awkward if you ran into them in an airport lounge”—a take that may accidentally reveal the substantial spoils of having produced a predominant psychological theory. The construct encompasses multiple “layers” of intimacy in relationships. We can reasonably expect to develop up to 150 productive bonds, but we have our most intimate, and therefore most connected, relationships with only about five to 15 closest friends. We can maintain much larger networks, but only by compromising the quality or sincerity of those connections; most people operate in much smaller social circles.
The field’s future lies in reclaiming parts of its past that it willingly abandoned.
There was a time, at the start of the 20th century, when the field of public health was stronger and more ambitious. A mixed group of physicians, scientists, industrialists, and social activists all saw themselves “as part of this giant social-reform effort that was going to transform the health of the nation,” David Rosner, a public-health historian at Columbia University, told me. They were united by a simple yet radical notion: that some people were more susceptible to disease because of social problems. And they worked to address those foundational ills—dilapidated neighborhoods, crowded housing, unsafe working conditions, poor sanitation—with a “moral certainty regarding the need to act,” Rosner and his colleagues wrote in a 2010 paper.
Different chemically than it was a decade ago, the drug is creating a wave of severe mental illness and worsening America’s homelessness problem.
In the fall of 2006, law enforcement on the southwest border of the United States seized some crystal methamphetamine. In due course, a five-gram sample of that seizure landed on the desk of a 31-year-old chemist named Joe Bozenko, at the Drug Enforcement Administration lab outside Washington, D.C.
Organic chemistry can be endlessly manipulated, with compounds that, like Lego bricks, can be used to build almost anything. The field seems to breed folks whose every waking minute is spent puzzling over chemical reactions. Bozenko, a garrulous man with a wide smile, worked in the DEA lab during the day and taught chemistry at a local university in the evenings. “Chemist by day, chemist by night,” his Twitter bio once read.