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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 Baumeister is professor of psychology at Florida State University in Tallahassee. His
latest 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. We
fear meaninglessness. We fret about the nihilism of this or that aspect of our culture. When
we lose a sense of meaning, we get depressed. What is this thing we call meaning, and why
might 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 but
insufficient condition. If that were the case, people might pursue meaning for purely
instrumental reasons, as a step on the road towards happiness. But then, is there any reason to
want meaning for its own sake? And if there isnt, why would people ever choose lives that
are more meaningful than happy, as they sometimes do?
The difference between meaningfulness and happiness was the focus of an investigation I
worked on with my fellow social psychologists Kathleen Vohs, Jennifer Aaker and Emily
Garbinsky, published in the Journal of Positive Psychology this August. We carried out a
survey of nearly 400 US citizens, ranging in age from 18 to 78. The survey posed questions
about the extent to which people thought their lives were happy and the extent to which they

thought they were meaningful. We did not supply a definition of happiness or meaning, so
our subjects responded using their own understanding of those words. By asking a large
number of other questions, we were able to see which factors went with happiness and which
went with meaningfulness.
As you might expect, the two states turned out to overlap substantially. Almost half of the
variation in meaningfulness was explained by happiness, and vice versa. Nevertheless, using
statistical 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 opposite
effects on happiness and meaning, or at least, factors that had a positive correlation with one
and not even a hint of a positive correlation with the other (negative or zero correlations were
fine). Using this method, we found five sets of major differences between happiness and
meaningfulness, 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 of
desires was a reliable source of happiness. But it had nothing maybe even less than
nothing to add to a sense of meaning. People are happier to the extent that they find their
lives easy rather than difficult. Happy people say they have enough money to buy the things
they want and the things they need. Good health is a factor that contributes to happiness but
not to meaningfulness. Healthy people are happier than sick people, but the lives of sick
people do not lack meaning. The more often people feel good a feeling that can arise from
getting what one wants or needs the happier they are. The less often they feel bad, the
happier they are. But the frequency of good and bad feelings turns out to be irrelevant to
meaning, which can flourish even in very forbidding conditions.
The second set of differences involved time frame. Meaning and happiness are apparently
experienced quite differently in time. Happiness is about the present; meaning is about the
future, or, more precisely, about linking past, present and future. The more time people spent
thinking 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 and
lower 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 the
present, too, but people are happy more often than they are miserable. If you want to
maximise your happiness, it looks like good advice to focus on the present, especially if your
needs 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 the
idea is to make happiness last. Happiness seems present-focused and fleeting, whereas
meaning extends into the future and the past and looks fairly stable. For this reason, people
might think that pursuing a meaningful life helps them to stay happy in the long run. They
might even be right though, in empirical fact, happiness is often fairly consistent over
time. Those of us who are happy today are also likely to be happy months or even years from
now, and those who are unhappy about something today commonly turn out to be unhappy
about other things in the distant future. It feels as though happiness comes from outside, but
the 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 be
counted 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.

Social life was the locus of our third set of differences. As you might expect, connections to
other people turned out to be important both for meaning and for happiness. Being alone in
the 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 runs
counter to some conventional wisdom: it is widely assumed that helping other people makes
you happy. Well, to the extent that it does, the effect depends entirely on the overlap between
meaning and happiness. Helping others had a big positive contribution to meaningfulness
independent of happiness, but there was no sign that it boosted happiness independently of
meaning. If anything, the effect was in the opposite direction: once we correct for the boost it
gives 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 spent
taking care of children. For non-parents, childcare contributed nothing to happiness or
meaningfulness. 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 to
happiness, probably because children are sometimes delightful and sometimes stressful and
annoying, so it balances out.
Our survey had people rate themselves as givers or as takers. Regarding oneself as a
giving 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 happiness
and meaning. Spending time with friends was linked to higher happiness but it was irrelevant
to meaning. Having a few beers with buddies or enjoying a nice lunch conversation with
friends might be a source of pleasure but, on the whole, it appears not to be very important to
a meaningful life. By comparison, spending more time with loved ones was linked to higher
meaning and was irrelevant to happiness. The difference, presumably, is in the depth of the
relationship. 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 are
grumpy 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 you
generally have to work on the relationship and hash it out. It is probably no coincidence that
arguing was itself associated with more meaning and less happiness.
If happiness is about getting what you want, it appears that meaningfulness is about doing
things that express yourself
A fourth category of differences had to do with struggles, problems, stresses and the like. In
general, these went with lower happiness and higher meaningfulness. We asked how many
positive and negative events people had recently experienced. Having lots of good things
happen 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

blows to happiness, despite their significant positive association with a meaningful life. We
begin to get a sense of what the happy but not very meaningful life would be like. Stress,
problems, worrying, arguing, reflecting on challenges and struggles all these are notably
low or absent from the lives of purely happy people, but they seem to be part and parcel of a
highly 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 more
likely that they seek meaning by pursuing projects that are difficult and uncertain. One tries
to accomplish things in the world: this brings both ups and downs, so the net gain to
happiness might be small, but the process contributes to meaningfulness either way. To use
an example close to home, conducting research adds immensely to the sense of a meaningful
life (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 way
can suck some of the joy out of the process.
The final category of differences had to do with the self and personal identity. Activities that
express the self are an important source of meaning but are mostly irrelevant to happiness. Of
the 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 some
even had a significant negative relationship. The worst was worry: if you think of yourself as
a worrier, that seems to be quite a downer.
If happiness is about getting what you want, it appears that meaningfulness is about doing
things that express yourself. Even just caring about issues of personal identity and selfdefinition was associated with more meaning, though it was irrelevant, if not outright
detrimental, to happiness. This might seem almost paradoxical: happiness is selfish, in the
sense that it is about getting what you want and having other people do things that benefit
you, and yet the self is more tied to meaning than happiness. Expressing yourself, defining
yourself, building a good reputation and other self-oriented activities are more about meaning
than 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 whether
their 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 say
exactly what that meaning is? Recall that my colleagues and I did not give our study
respondents a definition of meaning, and we didnt ask them to define it themselves. We just
asked them to rate their level of agreement with statements such as: In general, I consider
my 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. A
character is stranded in her apartment with nothing to do and starts reading her sisters
Soviet-era medical dictionary. It offers her little in the way of useful or even comprehensible
information except for its definition of life, which she circles in red: Life: a constellation
of vital phenomena organisation, irritability, movement, growth, reproduction,

adaptation. That, in a sense, is what life means. I should add that we now know it is a
special kind of physical process: not atoms or chemicals themselves, but the highly organised
dance 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 entire
dynamic 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 do
lives. Is it the same kind of thing in both cases? In one sense, the meaning of life could be
a simple dictionary definition, something like the one I gave in the previous paragraph. But
thats 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 drivers
licence. One important difference between linguistic meaning and what Ill call the
meaningfulness of a human life is that the second seems to entail a value judgment, or a
cluster of them, which in turn implies a certain kind of emotion. Your mathematics
homework is full of meaning in the sense that it consists entirely of a network of concepts
meanings, 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 reactions
hardly seem conducive to viewing the subject as a source of meaning in life.)
Questions about lifes meaning are really about meaningfulness. We dont simply want to
know the dictionary definition of our lives, if they have such a thing. We want our lives to
have value, to fit into some kind of intelligible context. Yet these existential concerns do
seem to touch on the merely linguistic sense of the word meaning because they invoke
understanding and mental associations. It is remarkable how many synonyms for
meaningfulness also refer to merely verbal content: we talk, for instance, about the point of
life, or its significance, or whether or not it makes sense. If we want to understand the
meaning of life, it seems as though we need to grapple with the nature of meaning in this less
exalted sense.
A bear can walk down the hill and get a drink, as can a person, but only a person thinks the
words Im going to go down and get a drink
Linguistic meaning is a kind of non-physical connection. Two things can be connected
physically, for example when they are nailed together, or when one of them exerts a
gravitational or magnetic pull on the other. But they can also be connected symbolically. The
connection 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 the
planet, making direct physical connection impossible.
The human mind has evolved to use meaning to understand things. This is part of the human
way of being social: we talk about what we do and experience. Most of what we know we
learn from others, not from direct experience. Our very survival depends on learning
language, co-operating with others, following moral and legal rules and so on. Language is
the tool with which humans manipulate meaning. Anthropologists love to find exceptions to
any rule, but so far they have failed to find any culture that dispenses with language. It is a
human universal. But theres an important distinction to make here. Although language as a
whole 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

symbols are arbitrary human inventions, but the idea expressed by 5 x 8 = 43 is inherently
false and thats not something that human beings made up or can change.
The neuroscientist Michael Gazzaniga, professor of psychology at the University of
California 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 happens
to it. The left-brain interpreters account is not always correct, as Gazzaniga has
demonstrated. 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 whether
this 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 what
scientists themselves supposedly do). On the contrary, I suggest that a big part of the purpose
of thinking is to help one talk to other people. Minds make mistakes but, when we talk about
them, other people can spot the errors and correct them. By and large, humankind approaches
the 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 the
human mind seems to prattle on all day. When you try to meditate, your mind overflows with
thoughts, 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 lot
of 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 how
the human creature connects to its group and participates in it and that is how we solve the
eternal biological problems of survival and reproduction. Humans evolved minds that chatter
all day because chattering aloud is how we survive. Talking requires people to take what they
do and put it into words. A bear can walk down the hill and get a drink, as can a person, but
only a person thinks the words Im going to go down and get a drink. In fact, the human
might not just think those words but also say them aloud, and then others can come along for
the trip or perhaps offer a warning not to go after all, because someone saw a bear at the
waterside. By talking, the human being shares information and connects with others, which is
what we as a species are all about.
Studies on children support the idea that the human mind is naturally programmed to put
things into words. Children go through stages of saying aloud the names of everything they
encounter 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 hers
after 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 problems
or any of the familiar pragmatic uses of thinking, but it does help to translate the physical
events of ones life into speech so that they can be shared and discussed with others. The
human mind evolved to join the collective discourse, the social narrative. Our relentless
efforts 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 of
meaning from single words and concepts to simple combinations (sentences), and then on
to 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 emerged
independently in many different places, but the underlying similarities suggest that the idea

was out there, ready to be found. The specific practices for implementing it (how votes are
taken, 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 was
made, how it got there or what it is useful for. When they come to the question of lifes
meaning, similar questions arise: why or for what purpose was life created? How did this life
get here? What is the right or best way to make use of it? It is natural to expect and assume
that these questions have answers. A child learns what a banana is: it comes from the store
and, before that, from a tree. Its good to eat, which you do by (very important) first
removing 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, if
there 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 that
exists in networks of symbols and contexts. Because it is not purely physical, it can leap
across great distances to connect through space and time. Remember our findings about the
different 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 be
happy without much in the way of meaning. Meaning, by contrast, links past, present and
future in ways that go beyond physical connection. When modern Jews celebrate Passover, or
when Christians celebrate communion by symbolically drinking the blood and eating the
flesh 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 is
not a physical one, the way a row of dominoes falls, but rather a mental connection that leaps
across the centuries.
Questions about lifes meaning are prompted by more than mere idle curiosity or fear of
missing 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 living
thing might always be in flux, but life cannot be at peace with endless change. Living things
yearn 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 places
where they can rest and be safe. They might keep the same home for years. Life, in other
words, 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. Such
dreams are futile. Life cannot stop changing until it ends. But living things work hard to
establish some degree of stability, reducing the chaos of constant change to a somewhat
stable status quo.

By contrast, meaning is largely fixed. Language is possible only insofar as words have the
same meaning for everyone, and the same meaning tomorrow as today. (Languages do
change, but slowly and somewhat reluctantly, relative stability being essential to their
function.) Meaning therefore presents itself as an important tool by which the human animal
might 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 to
grow food.
Crucially, the human being works with others to impose its meanings. Language has to be
shared, for private languages are not real languages. By communicating and working
together, 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 you
wont 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 to
evolve and change, even after many years of marriage. However, the fact of marriage is
constant. You are either married or not, and that does not fluctuate from day to day, even
though your feelings and actions toward your spouse might change considerably. Marriage
smooths out these bumps and helps to stabilise the relationship. Thats one reason that people
are more likely to stay together if they are married than if not. Tracking all your feelings
toward your romantic partner over time would be difficult, complicated and probably always
incomplete. 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 than
emotion, and so living things use meaning as part of their never-ending quest to achieve
stability.
The Austrian psychoanalytic thinker Viktor Frankl, author of Mans Search for Meaning
(1946) tried to update Freudian theory by adding a universal desire for meaningfulness to
Freuds 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 life
eventually 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 have
something 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 with
regard to any of these needs should also affect how meaningful the person finds his or her
life.
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 different
times into a single story. Purposes can be sorted into two broad categories. One might strive
toward a particular goal (to win a championship, become vice president or raise healthy
children) 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

Life goals come from three sources, so in a sense every human life has three basic sources of
purpose. One is nature. It built you for a particular purpose, which is to sustain life by
surviving and reproducing. Nature doesnt care whether youre happy, much as people wish
to be happy. We are descended from people who were good at reproducing and at surviving
long 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 and
put less pressure on you to adopt a particular one, though they certainly reward some choices
more than others.
That brings us to the third source of goals: your own choices. In modern Western countries in
particular, society presents you with a broad range of paths and you decide which one to take.
For whatever reason inclination, talent, inertia, high pay, good benefits you choose one
set 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 others
resist 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 right
and wrong, good and bad. Good and bad are among the first words children learn. They
are some of the earliest and most culturally universal concepts, and among the few words that
house pets sometimes acquire. In terms of brain reactions, the feeling that something is good
or 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 or
punish them?). Humans, as social beings, can understand good and bad in loftier ways, such
as their moral quality.
In practice, when it comes to making life meaningful, people need to find values that cast
their lives in positive ways, justifying who they are and what they do. Justification is
ultimately subject to social, consensual judgment, so one needs to have explanations that will
satisfy other people in the society (especially the people who enforce the laws). Again, nature
makes 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 do
anything about them. People like to feel that they can make a difference. Their values have to
find 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 for
thinking that they are good people, maybe even a little better than certain other people. At a
minimum, people want to believe that they are better than they might have been had they
chosen or behaved or performed badly. They have earned some degree of respect.

The meaningful life, then, has four properties. It has purposes that guide actions from present
and past into the future, lending it direction. It has values that enable us to judge what is good
and bad; and, in particular, that allow us to justify our actions and strivings as good. It is
marked by efficacy, in which our actions make a positive contribution towards realising our
goals 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 the
four questions of purpose, value, efficacy, and self-worth. It is these questions, not the
answers, 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 of
Saint Paul by Caravaggio 1600-1601. Photo courtesy Wikimedia
Nina Strohminger is 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 freckles
dusted 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 little
girl 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 the
last voices in this world she could trust. But as he spoke, her stomach sank with a dreaded
realisation: this man, too, was an impostor.
Kate has Capgras syndrome, the unshakeable belief that someone often a loved one,
sometimes oneself has 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 an
expert disguise. Capgras and Fregoli delusions offer hints about an extraordinary cognitive
mechanism active in the healthy mind, a mechanism so exquisitely tuned that we are hardly
ever 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

interaction, from navigating a party to navigating a marriage. Without it, we quickly fall
apart.
A classic philosophical thought experiment poses the following paradox. Imagine a ship, lets
call it the Nina, 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 is
the same ship becomes problematic when the builders reassemble all the Ninas original parts
into a second ship. The Ninas 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 her
body get replaced, in some cases many times over. Yet we have no trouble seeing present-day
Nina as the same person. Even radical physical transformations puberty, surgery, infirmity,
some future world where her consciousness is preserved on a hard drive will not obliterate
the 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 essay
Where 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 by
Bruce Hood at the University of Bristol and colleagues, children aged five to six were shown
a metal contraption, a duplication device that creates perfect replicas of whatever you put
inside. When asked to predict what would happen if a hamster were duplicated, the children
said the clone would have the same physical traits as the original, but not its memories. In
other 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 distributed
evenly across every atom. We might wonder whether the same applies to people does their
continued 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 key
to 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 the
memory criterion is mixed at best. People who have lost large hunks of memory through
retrograde amnesia tend to report that, while the reel of their life feels blank, their sense of
self remains intact. Nor is memory deterioration from dementia a reliable predictor of feeling
like a dierent 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 them
their 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 had
begun to change. Once mousy, she was now poised and assertive. Her career had been
important to her, now her interests had turned inward, domestic. And while the changes were

not so dramatic that they fundamentally altered the woman he had fallen in love with, he was
apprehensive about the possibility.
The danger of befriending psychologists is they will use you as their test subjects: I inquired
what kind of change would render her unrecognisable. My friend responded without
hesitation: If she stopped being kind. I would leave her immediately. He considered the
question a few moments more. And I dont mean, if shes in a bad mood or going through a
rough time. Im saying if she turned into a permanent bitch with no explanation. Her soul
would be dierent.
This encounter is instructive for a few reasons (not least of which is the intriguing term
permanent 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 useful
construct, one we can make sense of in fiction and fantasy, and as a shorthand for describing
everyday experience. The soul is an indestructible wisp of ether, present from birth and
surviving 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. A
flourishing soul, according to Aristotle, was one in the habit of virtuous acts. When the soul
is 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 animate
creatures in popular lore: the golems, the Frankensteins, the HALs. The sentient computer
who runs amok is a trope of the genre so much so that, in his short story Runaround
(1942), Isaac Asimov felt it necessary to propose Three Laws of Robotics to specify ethical
guidelines for the wayward robot. Why do we assume that a being without a soul will turn
against 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 the
morally 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 that
subscribe 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 are
apparently uninterested in swallowing this solution in a pill
Recent studies by the philosopher Shaun Nichols at the University of Arizona and myself
support the view that the identity-conferring part of a person is his moral capacities. One of
our experiments pays homage to Lockes thought experiment by asking subjects which of a
slew 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 memories those involving people were
deemed fairly likely to survive the trip. But generic episodic memories, such as ones
commute to work, were not. People are not so much concerned with memory as with
memorys 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 cognitive
impairments, including amnesia for his past life, losing the ability to recognise objects, his

desires, and his moral compass. The majority of people responded that the patient was the
least like himself after losing his moral faculties.
This is consistent with some of the more widely discussed case studies from the annals of
neurology. 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 and
industrious, Gage emerged from the accident obstinate, capricious and foul-mouthed. His
friends 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 loss
caused by Korsakoffs syndrome, a brain disorder associated with heavy alcohol
consumption. Sacks worries that his patient has become de-souled, but reconsiders when he
observes 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
person as no longer the same. One might think that a dierent set of rules applies to
assessments of ones own continuity perhaps episodic memory is paramount from this
perspective. However, new research by myself and the psychologists Larisa Heiphetz and
Liane 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 with
moral 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 that
these drugs will lead to a crisis of authenticity. A 2008 study by Jason Riis, then at New York
University, and colleagues found that people were least willing to take psychoactive drugs
that threatened their personal identity. And what drugs were those? The ones that enhanced
their moral traits, of course: kindness, empathy. People were perfectly willing to take drugs
that would enhance memory or wakefulness. Surely a world filled with more empathy and
kindness would be a better place to live, but we are apparently uninterested in swallowing
this solution in a pill which seems to threaten our authentic selves.
Organic transformations can be no less sensational. A notable example from recent memory
takes place in the US TV series Breaking Bad, which tracks Walter White as he morphs from
put-upon suburban chemistry teacher to ruthless tyrant kingpin of a meth empire the
eponymous breaking bad. Under his ominous nerd alter ego Heisenberg, it is all but
impossible to see him as the man he once was. His increasingly distraught wife finds herself
living 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, Whites
accomplice Jesse Pinkman undergoes the reverse transformation the burnout junkie who is
revealed to have a heart of gold. These sorts of twists are endlessly fascinating because they
show personal transformation at its most absolute. Flipping back through the great
metamorphoses 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 our
most distinctive features. Our faces, our fingertips, our quirks, our autobiographies: any of

these would be a more reliable way of telling whos who. Somewhat paradoxically, identity
has less to do with what makes us dierent from other people than with our shared humanity.
Consider the reason we keep track of individuals in the first place. Most animals dont have
an identity detector. Those that share our zeal for individual identification have one thing in
common: 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 reciprocal
altruism 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 the
ability to distinguish among the members of a group, an organism cannot recognise who has
co-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 philosopher
Thomas Reid observed that the fundaments of justice rights, duty, responsibility would be
impossible 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 held
responsible 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 of
insanity: for if the person was beside himself or out of his mind when he committed his
crime, 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 partner
is kindness beating out beauty, wealth, health, shared interests, even intelligence. And while
we 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 someone
or not (what social psychologists call impression formation), and predicts the success and
longevity of these bonds. Virtues are mentioned with more frequency in obituaries than
achievements, 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 most
important 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. Its
that morality necessitates the concept of identity, breathes life into it, provides its raison
dtre. 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 maddeningly
empty. It skates the very existential question it pretends to address, the question that obsesses
us: 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 find
a 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

Detachment

How can scientists act ethically when they are studying the
victims of a human tragedy, such as the Romanian
orphans?
Virginia Hughes is a science journalist based in Brooklyn, New York. Her blog, Only
Human, is published by National Geographic.
We drove to the orphanage on a pleasant December morning, under a sky that seemed too
blue. It was a short ride through a residential neighbourhood of Bucharest, littered with
posters of politicians heads for the upcoming elections. Nervous, I mentally recited the two
rules the American professor had given me the night before: no picking up the kids, and no
crying 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 an
empty 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 burned
meatloaf.
Over the next hour or so, the manager of the place a short and affable 24-year-old guy
gave us a tour. He didnt speak much English, but Florin ibu, a Romanian who works with
the professor, translated for us. About 50 children and teenagers lived there, boys and girls
ranging in age from about six to 18, and I saw just six adults: our tour guide, three female
caregivers, 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 always
flock 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 didnt reach my shoulders, so I figured he was eight or nine
years 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 eyes
strabismus, the professor would explain later, a common symptom of children raised in
institutions, possibly because as infants they had nothing to focus their eyes on. A couple of
dozen 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 one
television set. All the TVs were blaring old cartoons, some of the same ones I remember
watching in my own childhood 25 years ago. Kid after kid dragged me proudly to see their
room. Once, we walked in on a cleaning lady frantically sweeping, embarrassed by the
cigarette butts, grey dirt, and insect carcasses all over the floor. One of the rooms held three
or four older boys, still sleeping. They were heroin addicts, I would learn, and sometimes
shot up in front of the younger children.

After about half an hour of holding the sweet boys hand, I suddenly, urgently, needed to let
go. 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 stone
buildings 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 professors
team. We sat in one of them to talk about the morning visit.
The professor is Charles Nelson, a neuroscientist from Harvard University who studies early
brain development. In 1999, he and several other American scientists launched the Bucharest
Early Intervention Project, a now-famous study of Romanian children who were mostly
social orphans, meaning that their biological parents had given them over to the states care.
At the time, despite an international outcry over Romanias orphan problem, many Romanian
officials staunchly believed that the behavioural problems of institutionalised children were
innate the reason their parents had left them there, rather than the result of institutional
life. And because of these inherent deficiencies, the children would fare better in orphanages
than families.
The scientists pitched their study as a way to find out for sure. They enrolled 136
institutionalised 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 have
changed: in 2007, Romania joined the European Union (EU). It has greatly expanded its
state-funded foster-care system. The number of children in institutions or placement
centres, to use the preferred bureaucratic euphemism has dropped dramatically. But other
things havent changed. Romania is still a post-communist country suffering from high levels
of poverty and corruption. It still has a weak medical and scientific infrastructure. It still has
some 9,000 children more than half of all the children in its child protection system
living in orphanages, like the boy who took my hand.
Nelson had warned me several times about the emotional toll of meeting these children. So I
was 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 much
younger 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 get
myself 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 a
neuroscientist. In 1986, he launched his first laboratory at the University of Minnesota, which
specialised in using electroencephalography (EEG) a harmless technique for measuring
brain waves via a soft skullcap of electrodes on babies and toddlers.

His field of developmental neuroscience got a surge of attention in April 1997, when Bill and
Hillary Clinton put on a one-day meeting of researchers called The White House Conference
on Early Childhood Development and Learning: What New Research on the Brain Tells Us
About 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 detached
parents themselves.
The conference was covered widely in the media. In the wake of all the hoopla, the Chicagobased John D and Catherine T MacArthur Foundation asked Nelson to lead a small group of
scientists to dive more deeply into these topics. The resulting Research Network on Early
Experience and Brain Development, fully launched in 1998, included 12 researchers who
shared 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 or
infrequently handled by their human caretakers; baby barn owls whose brain wiring changed
dramatically after wearing prisms over their eyes; and most striking, baby rhesus macaque
monkeys that had been separated from their mothers.
Researchers had isolated monkeys before. In the 1960s, the American psychologist Harry
Harlow famously reared baby monkeys in complete isolation for up to two years. The
animals showed severe and permanent social deficits, bolstering the then-controversial idea
that the maternal-child bond is crucial to healthy development. The Network scientists
wanted to know whether the timing of the maternal separation made any difference.
Monkeys typically become independent around six months old. The Network studies found
that when monkeys are separated very early, at just a week old, they develop severe
symptoms of social withdrawal, just as Harlow had observed: rocking back and forth, hitting
and biting themselves, and running away from any approaching monkey. In contrast, when
the babies are separated at one month old, they show inappropriate attachment, grabbing hold
of any nearby monkey. We concluded from this that the four-week animal had an attachment
with mom and then had that attachment ripped away, Nelson says The one-week animal
never formed an attachment, so it didnt know how to relate socially.
Children were getting adequate food, hygiene and medical care, but had woefully few
interactions with adults, leading to severe behavioural and emotional problems
As the monkey data rolled in, Nelson was hearing about human social deprivation from his
Minnesota colleague Dana Johnson, a neonatologist who had long worked on international
adoptions. Johnson treated orphans from all over the world, but was most disturbed by those
from Romania.
Nelson invited Johnson to talk at a Network meeting in January of 1998. In a conference
room 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 were
all very teary-eyed, Nelson recalls.

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 crisis began in 1965, when the
communist Nicolae Ceauescu took over as the countrys leader. Over the course of his 24year rule, Ceauescu deliberately cultivated the orphan population in hopes of creating
loyalty to and dependency on the state. In 1966, he made abortion illegal for the vast
majority of women. He later imposed taxes on families with fewer than five children and
even sent out medically trained government agents The Menstrual Police to examine
women who werent producing their quota. But Ceauescus draconian economic policies
meant that most families were too poor to support multiple children. So, without other
options, thousands of parents left their babies in government-run orphanages.
By Christmas day in 1989, when revolutionaries executed Ceauescu and his wife by firing
squad, 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 were
getting adequate food, hygiene and medical care, but had woefully few interactions with
adults, leading to severe behavioural and emotional problems. A handful of orphanages were
utterly abhorrent, depriving children of their basic needs. Soon photos of dirty, handicapped
orphans lying in their own excrement were showing up in newspapers across the world. I
was 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 been
raised 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 countrys
institutions. After seeing the movies, Network scientist Charles Zeanah, a child psychiatrist
from Tulane University who specialised in infant-parent relationships, was gung-ho about
meeting Tabacaru and setting up a humanitarian project.
Nelson was touched by the videos, too. And he couldnt help but think of the scientific
possibilities 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 clinical
psychologist, 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 child
reached out to comfort them, saying: Its OK, its OK.
The Zeanahs also met with Tabacaru. He was eager to work with the MacArthur group
because he thought that a rigorous scientific study could help his cause. If there was
scientific evidence to support the idea that foster care was better for kids, he thought hed
have 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 green
building 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 of
human research.

All reputable scientific institutions follow a few ethical principles to guide their human
experiments: participants must give informed and unambiguous consent; researchers must
thoroughly consider possible risks and benefits; the gains and burdens of research must be
equally distributed to participants and society at large. These rules are largely unheard of in
Romania, let alone enforced.
In a packed auditorium, Nelson began his lecture by describing the fundamental moral
dilemma facing all clinical studies. The real goal of research is to generate useful knowledge
about health and illness, not necessarily to benefit those who participate in the research, he
said. 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. There
was Josef Mengele, the Nazi physician who performed medical experiments radiating,
sterilising, infecting, and freezing identical twins, among other atrocities on Auschwitz
prisoners. Mengele escaped capture after the war, but 20 other Nazi doctors were tried in a
US 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 voluntary
consent, avoidance of suffering, and the right of the subject to end the experiment at any
time.
The Nuremberg Code provided the intellectual basis for the 1964 Declaration of Helsinki, the
first ethics text created by the medical community and one thats still updated frequently. Its
not legally binding, but thousands of research institutions use the declaration to guide their
formal regulations and ethical review committees.
Could there be a more vulnerable study population, after all, than orphans with physical and
psychological disabilities living in an economically feeble and politically unstable country
Today the importance of these rules is obvious, but it was decades before they were
systematically enforced and many ethically dubious experiments happened in the interim.
In the 1950s and 60s, for example, researchers from New York University fed mixtures of
fecal matter infected with hepatitis to mentally retarded children living at the Willowbrook
State 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 was
rampant in the institution anyway, they werent exposing the children to any additional
harm.)
Meanwhile, 1,000 miles south, other researchers were testing the natural history of untreated
syphilis on hundreds of poor black men in Tuskegee, Alabama. The men were not only
denied treatment for the disease, but had no idea they were sick. In 1972, the studys 40th
year, a whistle-blower scientist finally told the press about the effort, which had been
sanctioned by the US Centers for Disease Control and Prevention.
The Tuskegee syphilis experiment triggered a public uproar and a US Congressional
investigation that ultimately shut down the research. It became the standard bearer of
unethical research, Nelson told the room of Romanian students.
These were the ugly precedents confronting Nelson and his colleagues in 1999, when they
began discussions of how to set up the early intervention project in Bucharest. They knew

from the outset that the project would be ethically precarious: could there be a more
vulnerable study population, after all, than orphans with physical and psychological
disabilities 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 participants in this age of intensified ethical scrutiny would seem to have
a career death-wish.
The MacArthur Network scientists spent the better part of a year hammering out the ethical
parameters and experimental design of the project. They wanted to use the gold standard of
clinical research design: a randomised controlled trial. This would allow them to objectively
compare children given one intervention (foster care) with those given another (institutional
care). 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 that
treatment.
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 own
system, leading to a slew of sticky complications. How would they choose families and
adequately train them? What was appropriate payment? What if a particular foster-care
family was abusive, or otherwise didnt work out? Was it fair to leave half of the children
languishing 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 through
newspaper advertisements and put them through a rigorous training programme for parenting
skills. They would pay the families well 250 Romanian Lei per month (about $96 at the
time), 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 childrens
whereabouts, just as they were before. So, for example, if a biological mother came forward
and wanted her child back, the department could opt to reintegrate the child. Or if more
foster homes were to become available, then the department could move children from the
institutions into families. And if the project were to stop for any reason, the Romanian
government had agreed to take over the payment of the foster-care families.
Three of the MacArthur scientists Nelson, Zeanah, and the psychologist Nathan Fox of the
University of Maryland stepped up as leaders of the project. After getting approval from
ethics committees at each of their universities, the study launched a feasibility phase in
November of 2000, and officially began collecting data in April 2001. The plan was to end
the study after 42 months.
The researchers set up a satellite lab in St Catherines, which at the time was still operating as
a placement centre for about 500 children. The researchers hired half a dozen Romanians to
follow the participants personal cases and collect data on physical growth, IQ,
psychological development, and later, EEG and brain scans every few months.
These Romanian researchers, many of whom are still part of the project, were intimately
familiar 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 years
after Ceauescus abortion ban, Decree 770. People born around this time are known as

Decreei: children of the decree. As a young girl, Radulescu remembers, her mother told her
that despite her birth year, she was not one of the Decreei she was wanted.
In 1997 Radulescu had begun working at St Catherines as a psychologist. She was hired
thanks to new legislation passed because Romania was trying to get into the EU that
moved the administration of orphans from the Ministry of Health to the newly created
Department for Child Protection. The law marked the beginning of a philosophical change in
the 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 the
institutions. 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 at
night. 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 Intervention
Project, in offices just a few corridors away from those residential units. She and the rest of
the team, working closely with Romanian NGOs, used newspaper advertisements to find
foster-care families and never-institutionalised children (who would serve as community
controls). The team screened 187 orphans from six Bucharest institutions, eventually
choosing 136 who did not have major medical problems. The children ranged from six to 31
months old. They were randomly assigned to either foster care or the orphanage, with siblings
kept 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. This
was remarkable given the constant political turnovers (including one in which Tabacaru, the
researchers 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 up
different 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 since
1993. She also happened to be an outspoken opponent of international adoptions, which she
felt were avenues for child trafficking. Thanks to her influence, in 2001 Romania placed a
moratorium on international adoptions.
After Nicholsons visit to the lab, she was quoted in several Romanian newspapers making
damning 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 can
sell 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 to
describe the MacArthur project as illegal and unethical. Although the claims were patently

false, and no formal charges were ever made, the story was quickly picked up by
international newspapers, including Le Monde and The New York Times.
The scandal died down quickly after Nelson called Michael Guest, then US ambassador to
Romania, 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 international
adoptions it would have been suicide, Nelson said. We took the model of, look, were
scientists. Our job is to collect the data and give it to others who know how to do policy, not
to take sides on an issue.
The BEIP project stayed under the radar until 8 June 2004, when Nelsons team held a press
conference to announce some exciting data. In the Hilton Hotel in Bucharest, with
representatives from several Romanian ministries and the US ambassador in attendance, the
researchers reported that, as expected, the 136 children who started in institutions tended to
have diminished growth and intellectual ability compared with controls who had never lived
outside 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, and
psychological development compared with those who stayed in the orphanages.
The scientists published these findings in 2007, in the prestigious journal Science. That paper
is 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 than
those 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 a
private 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, the
tissue that links up different brain regions, compared with those in foster care. The
researchers 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 that
are related to lifespan.
The project is now funded not only by the MacArthur Foundation, but by grants from the US
National Institutes of Health (NIH) and the Binder Family Foundation. After 14 years, the
Bucharest 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 editor
didnt know what to make of its ethics. So she sent it to bioethicists at the NIH for a thorough
review. Even if you study ethics all the time, it turns out this is a very interesting ethical
case, said Joseph Millum, one of the NIH bioethicists who reviewed it. As Millum and his
colleague Ezekiel Emanuel would explain in a commentary published in the same issue of
Science, they did not find the work to be exploitative or unethical.
The Bucharest project study differs from most randomised control trials done in
disadvantaged countries, Millum explained. Those tend to be studies of a new treatment an
antiretroviral 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

that the new knowledge you get out of the study is then going to be useful in informing
practice, 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 so few institutions. So although the study could
potentially answer lots of new, open questions, the one that justified its existence had already
been answered.
Still, that older research had not influenced Romanian social policy; many government
officials did not trust the idea of foster parents, and believed that institutions provided
adequate 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. The
answers 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 is
taking place in Western Europe, for example, where there is a relatively robust health care
system, 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, the
researchers might share more of the burden.
These are not easy waters to navigate. And there are limits, of course, to what even the most
motivated 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 in
Boston 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 Romanias
most destructive policies regarding orphans are still in place. The international adoption
moratorium was made permanent in 2005. Domestic adoption exists, but comes with onerous
regulations. 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 all
of 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 and
institutionalisation. On 23 June 2004, 15 days after the Bucharest projects first big press
conference, Romania passed Law 272/2004, stating that children younger than two are not
allowed to be placed into residential facilities. The law has loopholes children with severe
handicaps can still be institutionalised, and young babies can still be left in maternity
hospitals for their first few years but it signifies a major change in attitude, and seems to
have reduced the overall number of institutionalised children.

Its impossible to know how much credit the Bucharest project deserves for that law. The
project was by then well known among Romanian officials. But there was another powerful
force at work: Romania badly wanted to get into the EU, and the EU (thanks in large part to
Baroness Nicholson) had demanded that Romania deal with its orphan problem. The
Bucharest 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 that
Romania still has the continents highest rate of babies abandoned in maternity hospitals per
year, at 8.6 per 1,000 live births. Since the recession hit, Romania has cut back on foster
care, 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 more
immediately concerned with the children in their study. These kids have known some of these
researchers for as long as they can remember. Relationships have formed.
Of the original 136 children the researchers recruited from institutions, 62 are now living
with foster or adopted families, 31 were reintegrated with their biological parents, and just 17
are still living in institutions (of the rest, 10 live in social apartments, which are similar to
group homes, and 16 dropped out of the study). All evidence suggests that these kids are no
worse off today than they would have been had the study never existed. But that doesnt
mean theyre doing well.
In the Bucharest lab, I met a 12-year-old project participant named Simona and her biological
mother. Simona was the youngest of four children; when she was eight months old, her
mother could no longer afford to keep her. So she dropped her off at St Catherines, where
her 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 to
see that they were often sick with a cold or a rash. When Simona was five years old, her
mother was receiving enough financial assistance from the government to bring her back
home. But those years in the institution took a toll: Simona has a sweet disposition, like her
mother, 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 months
old 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 different
problems. Shes defiant to her teachers and parents, and has started smoking and seeing older
boys. Her foster mother has threatened to give her up.
These two girls are doing relatively well. The Bucharest projects staff is dealing with a
handful of participants in more dire situations. While sitting in on a lab meeting, I heard a
few 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 her
grandparents and then, with their blessing, married a 12-year-old boy. The scientists worry
that these sorts of horror stories will become more common as the children ride the
rollercoaster of adolescence.

And then there are the 17 participants who still live in orphanages. Theyre slightly better off
than the average institutionalised child, in that they get regular medical assessments and
constant check-ins from the researchers. After doing a brain scan of one boy, for example, the
researchers discovered a nasty infection hidden in the space behind his ear. These mastoid
infections 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 chatted
with a 14-year-old Bucharest project participant named Maria. Maria was abandoned at birth
and spent her first four months in two different maternity hospitals. Shes been in orphanages
ever 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 eye
contact, 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 at
her 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 MacArthur
Foundation gave them a separate pot of money to create a humanitarian institute in
Bucharest. The goal of the so-called Institute of Child Development was to work with local
officials and non-profits on orphan issues, as well as to train a new generation of Romanian
researchers. The institute has put on several scientific and policy workshops, inviting
hundreds 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 unclear
whether the institute will continue under local direction.
Were limited in our resources, says Elizabeth Furtado, who has been the Bucharest
projects manager since 2006 and visits the Bucharest lab about twice a year. Furtado has a
four-year-old son. She copes with the job by compartmentalising; for example, she has very
intentionally not read the full life histories of any of the participants. But sometimes the pain
is unavoidable. She was with Nelson and me the day we visited the orphanage her first
time 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 the
adolescents behaviours are becoming more difficult to manage, and the foster-care parents
are getting less and less support financial, educational, emotional from 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 to
downplay 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 room
full of babies lying in cribs and staring at white ceilings while their adult caretakers chatted

and smoked cigarettes in the corner. He remembers staring out the plane window for most of
the long flight back. When he arrived at his house, he rushed to hug his bewildered teenage
son. You just feel grateful, he told me at our recent lunch.
Over time, though, Nelson has become desensitised, holding on to the idea that scientific data
will eventually pave the road for better social policy.
This June, the researchers learnt that a grant they received from the NIH was renewed for
another five years (a coup given recent cuts to the US federal budget). With that money, the
team can track the childrens brain structures, cognitive skills, and emotional maturity from
age 12 to 16 a period that, despite major brain reorganisation, doesnt get much attention
in policy circles. And Nelson is in the process of setting up similar child intervention projects
in other parts of the world, including Brazil and Chile.
Nelsons last trip to Bucharest was in April. Soon after he got home to Boston, his mother
came to visit. She asked him how he could go over there all the time without being constantly
upset. He told her, Well, you couldnt do what I do if you got upset all the time.
But how do you avoid it? I pressed. You just sort of learn to deal with it, he said. You put
on your scientist hat and detach.
Some names have been changed to protect the identities of those mentioned in the article.
29 July 2013