Sense and Sensibility

Some more thinking about journalism, the public sphere and policy formation. There was a spirited discussion of breastfeeding last week at a number of blogs, particularly 11d and Crooked Timber.

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.

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13 Responses to Sense and Sensibility

  1. Mary says:

    This argument (with which I agree, despite not being a schlumpy mid-life guy) that experts feel the need to overstate their position when fighting social trends reminds me a little of the similar one about ‘risky’ pregnancy behaviours: for example, the insistence on a “we can’t recommend any alcohol intake in pregnancy or breastfeeding” message rather than a more subtle and arguably truthful message, on the assumption that either women or juries or both will want the simple message. (note however that the author is a strong exclusive breastmilk advocate)

  2. Daniel says:

    I agree almost entirely with your case about experts’ exhortations, but I’m not sure that breast feeding is the best illustrative case for those arguments – because of who the “experts” are and the history of breastfeeding in this country.

    There are 2 sets of breastfeeding ‘experts’ with very different approaches. In my experience, the traditional medical establishment (doctors, nurses, etc.) all say “breast is best” but are pretty quick to offer formula as a back-up. This can be read as either the more pragmatic approach that you’re advocating, or as evidence of a secret preference for/OK-ness with non-breast-feeding, but either way we didn’t encounter any dogmatic “breast-is-best” from the medical establishment around my daughter’s birth, despite the fact that my partner had a pretty difficult time breastfeeding and the baby lost weight on a few occasions.

    The other set of “experts” on breast feeding is exemplified by La Leche League. I’m not an expert on the history of the breastfeeding movement, but these folks are by far the most extreme and dogmatic about breastfeeding. These are largely activists, not professional experts. The dogmatism probably comes from having to combat a medical establishment and culture that saw breastfeeding (and childbirth and most other aspects of reproduction & female sexuality) as messy, animal-like, and generally something to be hidden away or made as clinical and tidy as possible. And despite a medical establishment that’s mostly acquiesced, at least on a formal/surface level, to their demands, the rhetoric has stayed combative and extreme.

    (That said, we also worked with a great lactation consultant, arguably from the advocacy/La Leche League set of experts, who supported us in working to breast feed exclusively – which we were able to do – but also assured us that, should it be necessary, supplementing with formula was not at all the end of the world.)

    And I’d venture that it’s at least in part due to pressure from these advocates – combined with, you know, actual scientific evidence – that medical experts, at least at first, spout the absolutist rhetoric about breastfeeding. But it’s also, if I have my history right, at least in part because of these advocates that they advocate breast feeding at all, and have (mostly?) stopped sending new mothers home with bottles of formula and no support around breastfeeding. I guess my point is that there’s some reason for advocates to be excessive/absolutist that may not apply to experts, and I think in some cases that’s reasonable & justified.

    Still, I think your complaints about expert culture fit perfectly with another expert exhortation which has clearly not worked – anti-drug messages. Now, there’s an example where a public health message was so extreme (I’m thinking of the “brain on drugs” stuff from my kid- and teenager-hood, but I don’t see that it’s gotten much better) that, if anything, it probably backfired.

  3. Timothy Burke says:

    Anti-drug messages are a great example. Another would be the touchiness of a lot of public health experts in reporting findings about the positive effects of moderate alcohol consumption. In both cases, the driving idea seems to be that if you put forward a nuanced message, the public will somehow fail to listen or see that as licensing extreme or unsafe behavior.

    I agree there’s a complex intellectual and social history around breastfeeding that adds some nuance to my comments. Our encounter through our childbirth class was with a lactation consultant who in retrospect I think was a La Leche activist, given the intensity of her views. But in her case, she presented those views as having expert authority, and she was operating from within a medically sanctioned program. (Though notably the nurse who normally led the class was not there, and when we spoke to her later about our frustrations with the intensity of the lactation consultant’s advice, seemed pretty irritated with the lactation consultant, so this may have been the by-product of some complex relationships between the pregnancy specialists at the hospital and local breastfeeding advocates.)

  4. back40 says:

    “here???? some reason for advocates to be excessive/absolutist that may not apply to experts, and I think in some cases that???? reasonable & justified.”

    I think this is false. Improvement doesn’t happen because some folks act out. It can seem that way when you don’t have full information from all perspectives, but it’s an artifact of asymmetrical information. Degradation is far more likely and common – overshoot, dead ends, misdirection – the list is very long. When improvement does result from monomania, it’s an accident, luck at best. We do ourselves harm by promulgating the myth that this is useful behavior. At best it can be exhilarating, primates do love to tussle, but it’s a harmful way to get a buzz.

  5. Timothy Burke says:

    I think what Daniel is suggesting is that there was one form of expertise that dominated “common sense” as well as medical knowledge that was by and large hostile to breastfeeding, and that advocates who wanted to reverse that found themselves marginalized and laughed at every time they tried to make headway. In a way, possibly analogous to the situation of climate skeptics? But that may demonstrate exactly what back40 suggests, that when one group with some knowledge gets frustrated by an expert consensus that marginalizes them, it tends to drive them towards their own dead ends and degraded understandings. La Leche League is a great example of that–the hostility they battled against drove them towards being more and more zealous and exclusive in their own views of breastfeeding.

    Still, it’s an interesting question: when you’re part of a group that has a legitimate idea that questions a stifling expert consensus, how to go about pluralizing public knowledge without being zealots or having that monomania?

  6. sibyl says:

    To my mind the exemplary practitioners of the expert exaggeration exhortation are the authors of the “What To Expect When You’re Expecting” book. Their diet advice is so strict as to be counterproductive. Yes, prenatal nutrition is important, but if you eat one dish of ice cream you are not thereby condemning your child to hyperactivity, dropping out of high school, juvenile delinquency, diabetes, and an early death.

    I also think that anytime anyone compares anything to Hitler and/or the Holocaust I can stop paying attention to them, because there’s nowhere to take the discussion after that.

    The problem is that in the modern-day echo chamber that passes for public discourse, only yelling gets you anywhere. Modest stillness and humility doesn’t bring in the blog traffic (present company excepted, of course).

  7. David Chudzicki says:

    I just walked by a poster on campus here (U of C) that reminded me of this post: The Midwest Workers Association was claiming that in Chicago, a ‘living wage’ is $18/hour. This is 36k/year, which is a lot more than I’ve needed for what I consider a decent standard of living here

    So maybe another example of out-of-proportion rhetoric, unless I’m missing something? One can see the appeal, of course– with lots of people making $8/hour, maybe the rhetoric is supposed to lead someone to do something about it, so they end up doing a bit better, but still not $18.

    (There was a volunteer for the group recruiting in the same building, so I decided to see if he could point to anything I’m missing. He said “We’re talking about the general, not one particular case,” and “It’s not so much about the particular amount as it is about having enough to shop and be able to give back to the local economy and community.”)

  8. Timothy Burke says:

    A lot of living wage advocates calculate what they consider the living wage quite deliberately against any specific local labor market or living standard; it’s actually pretty expressly a quasi-utopian calculation of what life should be like, so it often encompasses health, education, savings, etc. I actually get what they’re thinking, which is that if you calculate “living wage” against labor markets and local living standards, you introduce two problems: 1) relative standards about what’s ‘adequate living’, where one person who is willing to live a monastic, minimalist lifestyle and incur exposure to risk with health, etc., can be used as a standard, with everyone else appearing profligate; 2) letting the local labor market determine what’s a living wage keeps us from having to ask whether that provides anything like a decent life (this is what Barbara Ehrenreich was writing about in Nickle-and-Dimed).

    But yeah, if this is what one is about, then don’t set a specific $$$ figure. Ask about the general case, talk about what it is that we aspire to as a basic bottom floor of material, economic and social decency, etc.

  9. On the other hand, as Rosin notes, it???? 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.

    By the way, isn’t this fact awfully weird? Maybe I’m missing something, but I don’t see any other animals that routinely have such troubles feeding their young.

  10. Timothy Burke says:

    It’s hard to judge from this particular sample, maybe, but I know that captive primates in general have difficulties. I don’t know if that’s been observed in the wild as well. A lot of other mammals skew infant development very powerfully towards immediate ability to function, but social primates have long periods of relative helplessness as infants–a cost of intelligence? sociality? I’m sure some research comparing learning and breastfeeding among mammals has been done.

  11. Well, it’s not just your sample, it’s people in my family, and it’s all the many books, articles, groups, consultants, etc., centered around teaching people the mysterious art of breastfeeding. What other animal needs that degree of help with something so basic to survival? Just seems odd, that’s all.

  12. Timothy Burke says:

    I think it’s the tricky bargain we struck when our brains started getting bigger: we had to be born earlier and earlier in our development. There’s a balancing point: where does the intellect of the mother and other adults allow for them to manage breastfeeding when the infant is born so early in its development that feeding is a struggle for it to master?

  13. Rana says:

    There are a fair number of the higher mammals that need assistance learning parenting tasks – or surviving as infants, even – it’s the trade-off for not being hard-wired with a limited slate of instinctual responses.

    Perhaps the reason breastfeeding is challenging today is that few of us have grown up watching women breast feed – I know I didn’t have a conscious memory of seeing it up close until a friend of mine had her child in her late 20s, and I was a breastfed baby with a younger sibling – nor do we have chances to practice these skills (like young nonhuman primates do) with others’ infants. So the learning curve is perforce steep.

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