I said my piece in the 11d thread, basically recounting how my wife and I encountered an extreme advocate of breastfeeding just before our daughter was born and how the intensity of her advocacy wormed its way into our heads even though neither of us cared for it when we heard it. This is one reason why we were slow to move to what turned out to be a totally sensible, pragmatic approach to feeding our child, which was mostly breastmilk (some pumped, some not) combined with a supplemental formula feeding when needed.
Hanna Rosin’s article about breastfeeding, which kicked off the cross-blog discussion, asserts that the positive effects of breastfeeding have been exaggerated. A lot of people reacting to the article (I think in many cases without reading it) leap almost immediately to criticizing Rosin for rejecting breastfeeding (she doesn’t reject it personally; in the article she notes that she breastfed and in the end, is reasonably happy that she did). Those critics also emphasize the expert medical consensus in favor of breastfeeding, asking whether Rosin or any other person who has had doubts has any ground for questioning that consensus.
As a layperson, just looking at the data, I’d say that it is reasonable to say that breastfeeding is better. It’s overwhelmingly better where water supplies are contaminated. It seems to have a range of moderately good effects when that’s not a consideration. On the other hand, as Rosin notes, it’s way harder to do than most first-time parents think. I know we were stunned at how difficult and exhausting it is for both baby and mother to master. It has some costs in terms of scheduling for working women, and bottle-feeding also allows fathers to share the load more equitably from the beginning.
So why is there such an intense commitment from the medical establishment to “breast is best”, a rhetoric that seems to outweigh the modest positives of exclusive breastfeeding? I think this kind of rhetorical overcompensation is typical of a lot of practices that have expert consensus behind them but where their rate of adoption by the general public or their incorporation into policy lags behind that consensus.
When there is such a gap, experts tend to think that the only way to close it is rhetorical overcompensation, to overstate benefits and dangers in order to get attention. Simply saying, “There are modest benefits”, or “All things being equal, it would be better if we did not do this” doesn’t seem to be enough to persuade people to adjust their habits.
Just on this point alone, there’s a risk of blowback: when you oversell a practice or a policy and it doesn’t deliver the overwhelming benefits promised, you often lose the people who tried to change, and foster increased cynicism about all expert authority to boot.
I think this kind of overemphasis also has a corrosive effect on the formation of expert knowledge itself. For one, it underwrites a dangerous sense of inside and outside within an expert community, that you can only talk about proportional benefits and harms when you’re with fellow experts, and when strangers come in the room, you have to switch on the megaphones. For another, this sensibility encourages experts to isolate and amplify the causal force of single variables, which is a basic problem with much social and behavioral science. You get rewarded in various ways for a finding that disaggregates one small aspect of a hugely multivariable outcome because that’s where the feeder streams to public health, policy formation and the like are, it’s what produces findings that can be implemented, encouraged, advocated. You get shunted aside if you firmly insist that the life outcomes for children are a massively complex consequence of income, family stability, physical environment, feeding practices, genetics, influential peers and inspirational models, education, luck, complex-systems interactions between institutions and events, and the mysterious alchemy of the human condition.
And maybe you should be shunted aside if your insistence on that complexity is taken to mean that all more particulate or manageable conclusions are impossible or unwelcome. Breast is best, clearly. Many of the changes to everyday practice which experts argue for are sensible, useful, productive and well-supported by solid evidence.
What I really want is for us to get to a place where modest incremental benefits can be argued for using modest incremental rhetoric, where experts don’t feel the need for overcompensatory alarmism or feel they have to circle the wagons in order to get attention or bludgeon an uncooperative public into change. But the burden of making that change is not all on them. Some of it rests on the mainstream media and the way they report on scientific or expert findings.
Some of it rests on the public themselves. Getting to a place where most of us feel the call to a social politics that rests on modesty, proportionality and pragmatism is really difficult. Partly because there are ethical, social and political questions which shouldn’t be considered in a modest or restrained way, where bipartisan or consensual approaches are the wrong way to go, but also partly because maintaining a measured approach to many questions in a discourse that’s staked out by competing totalizing, will-to-power approaches is a quick road to marginality and irrelevance, a form of unilateral surrender.
I’m not saying that this kind of modest or proportional rhetoric is the be-all and end-all of social and political dispute. I’m sure some of my preference for this kind of rhetoric has as much to do with being a schlumpy mid-life guy who feels increasingly conflict-averse. The one thing that actually still tends to fire me up, really, is overwrought or hackishly partisan argument, when people throw out some messy, ambiguous issue on the table and proceed to lobotomize it down to some one-note slogan, when people seem unwholesomely certain. But I feel pretty certain that life would be better if people (and experts) could learn to playfully knock around a range of ideas about What Is To Be Done with a less fanatical devotion to their own idee fixes, with less fussy tending of their own felt wounds and slights.