- It's my pleasure to welcome Dr. Matthew Wolf-Meyer
to our Neuroscience and Public Policy seminar this afternoon.
Dr. Wolf-Meyer is joining us from the Department of
Anthropology at Binghamton University in New York.
Dr. Wolf-Meyer received his bachelor's degree from Oakland
University, acquired two master's degrees,
one from the University of Liverpool,
the other from Bowling Green State University,
both of which involve the study of science fiction.
He then took his PhD from the University of Minnesota
in Anthropology.
Before his position at Binghamton,
he had positions in anthropology at Wayne State University
and the University of California Santa Cruz.
His work focuses on medicine, science, and media
in the United States.
He had a book entitled 'The Slumbering Masses:
Sleep, Medicine, and Modern American Life,'
which won the New Millennium Book Prize in 2013.
In addition to his work on sleep,
he also works on a number of other topics
related to health and brain science.
Dr. Wolf-Meyer's work, I think,
really embodies the essential spirit
of our Neuroscience and Public Policy Program,
which is to take data and clinical and scientific data
out of the pages of strictly academic journals
and find ways to influence society for the better,
to situate these findings
in broader social, cultural, and political contexts.
To this effect, I think it's telling that,
as a visitor to our campus,
Dr. Wolf-Meyer has met with individuals
from our neuroscience department,
from our La Follette School of Public Affairs,
from anthropology, from bioethics, from medical history.
I think it speaks to the interdisciplinary
and cross-disciplinary nature of his work.
And so I think we're all in for a real treat.
Please help me welcome Dr. Wolf-Meyer.
[applause]
- So, thanks to Mike for the introduction,
and to Tara and Maori,
who were my stewards and handlers through all this.
I wouldn't be here without them.
And thanks for spending your Friday afternoon with me.
I'm going to talk about the sleep project primarily because
I think that as it's most reflective of the interests
of the Neuroscience and Public Policy Program.
And so we'll just go through it.
I don't think there's any crazy ideas here, but some of you
have had conversations with me over the last couple days
that you'll see parts of reflected in this.
And my little remote control stopped working.
So, the title of this, and I always have title anxiety, is
'Thinking Through Sleep:
Propositions for a Multi-Biological Society.'
And I'll unpack that neologism.
Don't be afraid.
So, let's start with a case.
And, as many of you know,
this work really developed out of a partnership
between me and sleep researchers and clinicians in Minnesota.
And it's been a couple years in a sleep clinic observing
clinical interactions and diagnosis and went from there to
do a lot of archival research about the history of sleep
and also a lot of observation of patient support groups,
both in Minnesota and Chicago and then nationally.
So part of it meant kind of pretending to be a
neuroscientist and a sleep expert for a while, and part of
it meant acting like a patient and working through the kind of
worlds that they operate in.
And so some of what I'm going to talk about is kind of
case-oriented in a way.
And so let's talk about Ted.
Ted is kind of a typical patient in a lot of ways.
He is awake in the middle of the night.
He falls asleep really easily, but when he does wake up in the
middle of the night he's awake for a few hours.
And so, clinically, the idea is that he has maintenance
insomnia, and the way to treat it is to give him something like
Ambien, Sonata, Lunesta, right?
And the idea there is to produce
eight hours of consolidated sleep.
The problem for Ted, though, is that once he gets put on the
drug, he ends up sleepwalking at night.
So he still gets up, he's just not conscience of being awake,
right?
And so the question is, is Ted an insomniac or is there
something else going on that's a little bit deeper and not
captured by the way that we're thinking about sleep disorders?
So we'll come back to Ted.
The colonel of the slumbering masses is this idea that sleep,
American sleep has changed profoundly over the last 200
years, in that previous to industrialization Americans were
really biphasic sleepers.
And what I mean by that is one of two models.
Either that people go to sleep around sundown for a few hours,
they're awake in the middle of the night, and then they go back
to sleep for a few hours to wake up around dawn.
Or they go to sleep pretty late, they wake up rather early, and
then they take a nap in the middle of the day.
And the evidence to support this, at least related to what
I do, is a bunch of medical monographs and papers
from the 19th century.
So there are a bunch of doctors who get enrolled in the push
towards consolidated work days
who are working to get people to consolidate their sleep.
And so they're actively attacking biphasic sleep
as not healthy, as immoral,
as problematic in one way or another.
And so what comes out of that at the end of the 19th century is
this idea of consolidated sleep being normal sleep.
And the reason why that happens is because people are moving
from agrarian or small-scale work schedules where they can
show up to work late, take a nap if they need, they work with
family or with friends, to working in large, anonymous
factors and cities where they have managers who don't know
them and don't care about them and they can be easily replaced.
So if you're not to work on time or you fall asleep while you're
at work, you're just not going to have a job anymore.
And if you're consolidating all of your work during the day
because these factories are--
They exist before electric light
and they want to get as much labor out of people as they
possibly can, so they start at dawn and they end at dusk.
So you have a consolidated day.
People are totally exhausted, and at the end of the day they
go to sleep in a consolidated way and then they wake up
for the next day of work.
So insomnia, although it's been around for a really long time if
you look at the history of medicine, in the 1860s and 1880s
insomnia becomes something that's not just an elite problem
but a problem of the working classes more generally.
And one form insomnia seems to take is Ted's insomnia,
that people wake up in the middle of the night
and they go back to sleep.
So what was once biphasic sleep
now becomes sleep maintenance insomnia.
And in order for that to happen, the consolidated model of sleep
really needs to be the model of sleep.
And so what happens in the beginning of the 20th century
when sleep science actually kicks off is that the earliest
people who are working on sleep and the emblematic figure here
is a man named Nathaniel Kleitman
at the University of Chicago.
Their model of what sleep is, is consolidated sleep.
So they're not even testing whether or not
other kinds of sleep are possible.
That's just the normative standard that they're using.
And from that standard you have a variety of kinds of
pathologies that are apparent only because that's the norm.
So, there's a few things I want to point to here
as reasons why
we should be thinking about sleep a little bit differently.
So with consolidated sleep is really this expectation that
it's about eight hours a night.
There's very clear evidence, scientifically,
that over the life course sleep changes.
So if you're an adolescent, you probably fall asleep later
and you need longer sleep than you do if you're an adult.
And when you're much older, you probably need less sleep,
and you wake up much earlier than people.
And so the eight-hour average,
and we can talk about this in depth later if you'd like to,
the eight-hour average is really
a normative average.
It's not actually based in the experiential practice of people
throughout their life course.
And babies, if you spend time with babies,
they are not consolidated sleepers.
And so the whole idea of sleep training is that you're going
to make a consolidated sleeper out of this baby
by hook or by crook.
And so all of those things add up, I think, to point to
consolidated sleep not necessarily being natural sleep
for human beings.
Beyond that, humans are the only consolidated sleepers,
if you look cross-species.
So your cat is a polyphasic sleeper.
Your dog is a polyphasic sleeper too.
And I'm going to turn off my phone.
Sorry about that.
And so--
Or I'm just not because that will be even worse.
And so humans are the only consolidated sleepers.
And you can either think that we're exceptional, that somehow
there's been a species break between us and everybody else
and we're destined to be consolidated sleepers
and everybody else is biphasic or polyphasic.
Or you can think, maybe a little suspiciously, that we might not
be consolidated sleepers too, and that consolidated sleep
is a kind of artifact of the way that we organize society.
Along those lines,
sometimes you'll see people argue that
biphasic sleep is an aberration,
and that really we were consolidated sleepers.
We became biphasic sleepers,
and now we're consolidated sleepers again.
The way that I would prefer to think about that is plasticity,
or really capacity around various kinds of sleep.
That some of us can be pretty good consolidated sleepers, and
some of us are maybe better when we're biphasic sleepers.
It's not to say that we can't be consolidated sleepers or that we
can't be biphasic sleepers, but that we have the potential to be
either one of those things.
Some really exhausted people
are pretty good polyphasic sleepers too.
That it's not just at nighttime
that people feel sleepy.
And, finally, and this is the most anthropological
of these points, I think, and
I borrow from a anthropologist named Margaret Lock here
to think about what's referred to
as local biologies.
And so, what Lock is talking about is that in particular
societies what you have are ways of life that reinforce
particular kinds of biological experiences.
So consolidated sleep
might really be a kind of local biology.
That if you look cross-culturally, you see many
different kinds of variations with how people organize sleep.
So siesta cultures are biphasic sleepers.
They go to sleep late, they take a nap in the middle of the day.
There are sometimes controversies about how
productive those societies are.
But the idea is that, as a biological experience, it can be
organized in a variety of different ways, and some of
those ways are really shaped by social norms more than
biological hardwiring.
So let's go back to Ted.
And the question is, does Ted have a sleep disorder or is
there some mismatch between the way that he sleeps and the way
that he prefers to sleep and the social obligations that he has?
And another way to ask that question is,
is Ted a pre-industrial sleeper in a post-industrial age?
If what he-- If he's a biphasic sleeper,
it might not really be sleep maintenance insomnia.
It's just a different organization of sleep.
It's just a problem because his family life and his work life
are organized in a way that don't allow him to sleep
the way that he's most inclined to sleep.
At least that's the argument
that I'm subtly trying to make here.
So, to the neologism in the title.
I really argue for this concept, which is multi-biologism.
And the model that I use to get here is really multiculturalism.
That we have this idea that different cultures
should be valued and appreciated and integrated,
and we don't tend to think about variations in human biology
with the same kind of
ecumenical lens.
And so...
So the suggestion in the neologism is a few.
The first is that there's no unitary human nature.
That like when people are compelled to talk about human
nature, they're trying to make some kind of unitary argument.
And, instead, if you think about the variations within
the human population as variations in human nature,
there's no one core human experience
of which everybody else is a pathological variation of.
It's more like there's a spectrum.
That human nature, in some sense,
is this plastic range of possibility.
And what that leads to is me making this argument that when
we conceptualize human difference as variation,
we're moving away from pathology.
So rather than thinking about one biological model as the
natural norm and any variation from it as in need of some kind
of medical intervention, that we can think about a broad spectrum
of human experience that might be adjusted to rather than
trying to get people to adjust through medical intervention to
social norms.
And I'll explain all of this a bit more as we go on.
Which is different than--
So what I'm not trying to say
is that we should do away with medicine all together.
That there are very clearly pathological, biological
experiences of the world, and that some of those actually
require and depend on medical intervention but that there are
a host of what we take to be pathological experiences that
don't necessarily need medical intervention and that it's
really the structure of our society that leads us to think
that medicine is the right way to make these interventions
when we might think differently about how we intervene.
So, like I was saying earlier, one of the critical things here
is that when we think about humans as being plastic, we need
to think about that plasticity itself as being something that
varies between people.
That some people are really good consolidated sleepers and poor
biphasic sleepers and vice versa.
And there's some people who are really good sleepers
no matter what.
That given any kind of circumstance, they're going to
be able to organize their sleep in order to fit those needs.
And so when we think about individuals,
what we're really thinking about
is an individual capacity
to do various kinds of things.
And one of those things would be something like sleep.
And in American society, when we think about someone like Ted,
usually the option is to go to medicine.
That it rather than organize his life differently, a
pharmaceutical is going to be the thing that creates a normal
experience of sleep, and that by giving him that pharmaceutical,
he's going to align with social demands.
In a case like his,
that's not something that's entirely possible.
That, like, if he's on the drug, he has other problems.
And so what recourse does he have?
And I'm going to leave that as an open question for the time
being as we talk through this.
So one of the reasons why I was particularly interested
in having this conversation here
as part of the Neuroscience and Public Policy Program
is that I'm policy adjacent in some sense.
That what this all leads me to think about are societal
interventions that kind of move away from medicalization.
But I'm no policy thinker.
And so maybe you can help me think about the material
consequences of the things that I'm talking about.
The first is this idea that--
And I borrowed this in part from Emily Martin,
who's a medical anthropologist.
That what we've really become wedded to is this idea
of the flexible individual.
That it's your responsibility as an individual
to meet the social demands
of the institutions that you participate in.
So if you're having a hard time being awake in the morning
for work or for school, it's your responsibility
to drink coffee or take a drug.
And if you don't do it, then you're non-compliant.
That you need to be the one that fits into the institution
rather than the other way.
So, instead, I'd really like to start to think about
what it means to have flexible institutions.
So, what does it mean to have a set of institutions,
like school and work and family and recreation,
that are supple enough to be flexible and to meet people
where their plasticity tends to take them.
The second proposition here is thinking about
modular institutions rather than static ones.
And I'll explain this more with a couple examples.
But the idea is to make institutions more experimental
in the way that they're organizing themselves and the
interactions that they have with individuals.
And the third one is really moving beyond the idea
of the individual at all.
That one of the challenges, especially in the United States,
is that when we think about medical problems,
what we're thinking about is the individual patient.
And the problem there is that individual patients are really
produced by particular kind of social, institutional network.
That thinking about an individual in relationship to
their family and the other institutions that they're a part
of is really necessary in order to figure out what the right
kind of solution is.
So, when I'm thinking about flexible institutions,
the thing that I tend to think about the most or the things
I tend to think about the most
are school start times and the idea of flex time.
And so, like the example that I gave briefly earlier is that
there's mounting evidence that adolescents both have sleep
onset later and need more sleep.
And the problem is that often adolescents are the ones
who start school the earliest.
So if you have to go to school at 7:15 in the morning but
you're not going to sleep until 11 o'clock at night and you need
about 10 hours of sleep in order to be at full operating
capacity, you're always going to be exhausted and you're not
going to get good grades.
And there's decent evidence that supports this.
The challenge has been that-- Well, there are many challenges.
One is that parents really rely on school in order to take care
of their children while they go to work.
And so work time and school time in the United States
are intimately tied together.
And if you're not going to have your kids at school, then you
have to have somewhere else to put them or you need some other
way to organize your work.
That's a challenge.
The other thing, and this was an experiment that happened in
Minnesota, was that one school district started to change their
school start times but the other schools around them that they
competed in athletic events with kept their old times.
And so the times available to student athletes were at odds
with one another, and so they needed to find solutions to that
kind of problem.
In some cases, and I think someone just told me yesterday
that this has happened nearby, one of the things that schools
do is they flip-flop elementary school start times with high
school and middle school start times so that elementary school
tends to start later.
You make those kids wake up a little bit earlier because they
tend to be awake a little bit earlier anyways, and you let the
high schoolers go to school a little bit later.
Usually that's only the difference of 45 minutes or an
hour, and that might be something but it's probably not
enough for most of those students.
One of the--
And so in the workplace probably most of you
are familiar with the idea of flex time, which is that you can
come into work late and you just work late, or you work a few
really long days and then you take a day off.
The challenge has been, and there's mounting evidence here
too, that a lot of people don't use flex time
despite having access to it.
And part of it is that they don't want to be the person
who's coming into work late.
You know, if everybody else is in at nine o'clock, they don't
want to be the person that comes in at 10:15 because it makes
them look like they're lazy or they sleep in
or whatever the case may be.
And people don't necessarily want to take days off work even
when they can, and so the people who tend to use flex time
the most are usually women
in times when they need to care for children.
And so there's stigma around using something like flex time.
But in the clinic where I'd done the sleep research, one of the
things that doctors would do, especially when they were seeing
high school aged students who had a hard time being at school
on time, is rather than medicate those children they would call
the principal of their schools and tell them
that the student wasn't available for school
before 10 o'clock in the morning.
And what they meant was that they may have to be in high
school for five years, they might have to take summer
school, but you can make that institution flexible in order to
meet the needs of those students.
These doctors were actively trying to avoid using a
pharmaceutical in recognition that it probably wasn't the best
thing for these students.
In a few cases, that didn't work, and so what they would do
is they had a list of private schools in the area that had
different school start times.
And so they often recommend students go to a Catholic school
because it started later than the public high school.
That all depends on parents being able to pay for that.
I mean, five years of high school also depends on parents
being willing to house their high schooler for another year.
But, you know, these institutions could be more
flexible than what they tend to be.
Similarly, right, you can think about flex time as being a
possibility in public schools.
That you could have long days and short days,
and that students could organize themselves
much like college students do.
That, like, when you are left to be able to organize your own
schedule people tend to make a schedule that works for them
with some exception for the classes that
you absolutely have to take.
And so this is all to make the argument that what we need to
think about are ways to make institutions more flexible.
So rather than have 9:00 to 5:00 work days and 8:00 to 4:00
school days, that we need to think about the possibilities
that are latent in the organization of these
institutions in the first place and start to work to destabilize them.
Sometimes when I talk about this stuff with people they want to
talk about the agrarian basis of these institutions.
There is no agrarian basis to these institutions.
That, like, waking up at dawn and going to work all day is not
something that's been founded historically.
People took naps.
We can take naps again.
And so just because we traditionally do it isn't a good
enough reason to keep doing it.
So, point two is thinking about modularity
in relationship to institutions.
And the two examples I'll give you
are the workplace nap and the staggered day.
And what I mean by this is that
there were some experiments with
introducing napping to the workplace.
And this was mostly in the early 2000s and late 1990s.
And the idea was that you would increase worker productivity by
letting people take a nap after lunch or whenever they needed to
take a nap throughout the day.
And so there were a couple companies who would make, like,
desk pillows, and they would make curtains to put across your
cubicle so that you could take a private nap.
And they'll come to your business and proselytize why the
workplace nap was a great idea.
The problem was that nobody would ever take those naps.
In part, again, because they don't want to be the person
who's taking a nap at work.
And so, often when people are tired
they just go out to their car and take a nap.
That they have some privacy in doing it.
Because of all the stigma around it, it wasn't something that
people would happily integrate.
And so there were a couple places that I tracked for a
while who eventually did away with the workplace nap
all together.
They had a cubicle set aside for people to take a nap in,
and nobody would ever take a nap in it.
And so they were just done with the possibility.
The other idea to think about is what I think about
as the staggered day.
And what I mean by that is--
This is pure fantasy on my part,
so bear with me.
That variation that you see in high schoolers or any school
aged student probably matches variation that you see in adults
in terms of wakefulness and when people want to be working.
And so you could have some students who start
the school day at eight o'clock in the morning and end at 4:00,
and you could have some--
And they have faculty to support that.
And you have some students who start the school day
at 11:00 and end at 6:00.
And faculty to match those needs too.
That you can match faculty interests and abilities to be
awake and coherent at various times with student desires
to learn and be awake at various times
and stagger the institution appropriately.
In big schools and big school districts, that's probably
more of a possibility than in a small school
and a small school district.
But thinking about the variation in individuals should allow us
to think about the variations in a way that an institution might
be organized too.
And this is all predicated on my assumption that the institutions
that make up our everyday life should really meet our
biological needs as much as our social obligations.
That if we are best workers at certain times of day, we're best
students at certain times of day, that we should try and find
ways to organize those institutions in order to meet
those best times.
And the other thing alongside that is thinking about the
individual who changes over the life course.
That what works for one individual in one year and one
institution isn't necessarily going to work for the same
individual the next year.
And so institutions and their relationships with individuals
need to be supple enough in order to address
those changing demands on the part of the people that those
institutions are meant to serve.
So the last proposition here is really to stop thinking about
the individual and to think instead about what I refer to
as the facilitated individual.
And so part of this is recognizing that when we think
about the individual what we're thinking about is
a kind of ideological artifact.
That when we think about the individual, there's a lot of
history here that's preconditioning us to think
about you alone as a patient in need of an intervention.
And there's often very little attention to the situation that
the individual is coming out of and why they might look the way
that they do, which is to say
that individuals are really
entrenched in society.
That they're entrenched in the network that they're a part of.
And we can't really extricate them for intervention.
We need to think about the network that they're a part of
in order to figure out the right kind of intervention.
And that in order to care for individuals, we need to address
the whole network.
So that might be a family, it might be beyond the family, but
we need to be more attentive to the situation in which people
are coming out of.
So, part of this
is thinking about how we move
away from pathologization and pharmaceuticalization
as individual focused.
And so this goes back to the idea of the flexible individual
versus the flexible institution.
That when we think about the need of an individual to meet
the demands of an institution that they're a part of, often
that's through medicalization.
It's through the categorization of a certain experience of the
world as aligning with a diagnostic category and
identifying a treatment in order to normalize that individual.
And, at least in the United States, this is through the
market of medicine that people need medical insurance or
medical care in order to become normalized.
And, like I was saying before,
that's not necessarily a problem,
but it is a problem when we're not thinking
about how institutions might be organized differently
to address the same demand.
Alongside that is thinking about providing equal access to
institutions that have
these kinds of support mechanisms to them.
That when we think about something like flex time, it has
almost only been available to white collar workers.
I mean, university professors are ultimate flex time workers.
But beyond that, it's really the creative class and white collar
elites who have access to flex time, and it's very difficult to
think about what flex time would look like for someone who works
at McDonald's when there's very recognizable shifts and people
need to be there at certain times and it's all managed by
participate people in order to meet very specific demands.
And so one of the challenges here is thinking about what flex
time looks like for blue collar or service workers.
How might we export flex time as a policy concept to other kinds
of context in order to address the same kinds of needs.
And, finally, one of the things that we need to think about
is incentivizing experimentations
with modularity and institutions.
That it's fine for me to kind of come up with these fantastical
ideas about how we might organize society and social
institutions differently, but we need to think as a society about
how we incentivize experimenting with something like
school start times.
Because there are deeply entrenched feelings and
organizations of society around work and childcare that makes
school start time need to occur within a certain window,
what can we do in order to support
experimental reorganizations of that?
So it might mean childcare that's available to people
at various times of the day.
It might mean staggered work time as much as it means
staggered school time.
These propositions for how we reorganize things are kind of
interpenetrating and need to be thought about across different
kinds of institutions simultaneously.
And moreover, like we need to think about institutions as
ongoing experiments in a way.
That we need to conceptualize how things might change over
time to allow for new solutions to emerging problems
as we move forward.
So the sleep, to me at this point,
has become a kind of easy
example for thinking about all of this stuff.
But you might see resonance in other situations that are
similarly, you know, focused on human biological experience
of the world.
And one of the challenges, or maybe it's a challenge, maybe
it's an analogy, is thinking about the human diet.
That over time one of the things
that people have become much more attentive to
are variations in the capacity of humans
to digest certain kinds of things.
So, celiac disease is an emergent awareness
on the part of most people.
And so the existence of gluten-free options on most
menus has really been something
that's happened over the last decade.
The challenges there--
Well, and so I also suggest things
like school lunch experiments where, in San Francisco,
at least for a while, they were experimenting
with introducing kids to things
that aren't just pizza and hamburgers and nuggets.
That they would have sushi day and stuff like that.
And that by doing that, what you're doing is
you're allowing for the possibility
that children recognize something that they like.
And so in both cases what I want to think about is how when you
offer a breadth of options, that people are going to find where
they fit within those options.
And so rather than thinking about certain kinds of
organizational forms as being normative,
that we need to think
about institutional forms as falling along
a spectrum of possibilities.
So, you know,
one of the other examples that you might think
is reproductive normativity, which is something
that's changed significantly over time.
So the providing equal access to things like IVF
and egg freezing
is something that shouldn't just be market based, but something
that other people can apply for too.
And, in doing so, what we're doing is allowing for various
other experiences of the world for people who might
not normally have those means.
So this is all a suggestion to
get us to consider that when we
think about any kind of reformation in institutional
organization that we're making sure that those reorganizations
are broadly accessible.
So, finally, and we can have a discussion about this stuff,
there's sort of the specter of human nature in all of this.
And one of the challenges, I think, in a lot of contemporary
science is this push towards kind of laboratory purification
and reductivism and the removal of social influence.
That, like, when people are talking about sleep, often what
they're talking about is sleep as it's known
through laboratory experiments.
And to really know what sleep looks like means that we need to
think about sleep in its social contexts.
And what I think this means is really taking the laboratory out
of the lab.
That thinking about biological phenomena in their lived
realities is really important to getting at
what human biology actually looks like
because it's always being shaped by social forces.
That there's no human biology that's outside of society.
Which is to say, maybe, that,
you know, when we talk about
something like human nature, and I mean that in a big way but
also in smaller ways too, that we're always recognizing that
it's something that's socially constructed
and socially influenced.
That there's no one unitary human nature but biological
experiences that are being influenced by social demands
and obligations.
And, finally, I think it's worth thinking about taking
experiments out of the laboratory too.
That if we start to think about the institutions that make up
our everyday lives as experimental institutions in
their modularity, that we can start to think about society as
a place where experimental possibilities arise.
That we can think about organizing school differently in
order to see what the produces in students.
That if we organize it differently, we might have very
different outcomes than what we have now.
And so I am really happy to talk about that with all of you now.
If you'd like me to,
I can also talk a bit about methods.
I can give you some other examples, but I'm going to turn
it over to your questions.
So, thanks.
[applause]