Eleanor Cummins | The Verge

TikTok tics are a symptom of a much bigger problem

2021-11-12T11:00:00-05:00

Reports of teens developing tic-like behaviors after watching TikTok videos highlight something most of us don’t consider about mental health: symptoms can be social.

Since March 2020, specialists in the United States, Australia, Canada, and the United Kingdom have seen a dramatic spike in young patients seeking treatment for tics, according to The Wall Street Journal. Doctors say most of the young people watched content from TikTok creators who say they have Tourette syndrome, one type of tic disorder. Top TikTokers film themselves involuntarily cursing, slapping themselves, making clapping sounds, and more. Cumulatively, #tourettes videos have been viewed more than 5 billion times.

“We learn in different cultural settings, even local settings, how to communicate our suffering.”

Some researchers have claimed the sudden surge in TikTok tics is a “pandemic within a pandemic,” as the teens struggle with schoolwork, feelings of isolation, and even bruises and other physical marks from their tics. But TikTok isn’t creating the distress these teens feel, says pediatric psychologist Allison Libby, an associate clinical professor at the University of California, San Francisco. Instead, the tics are a byproduct of anxiety, depression, and even traumatic stress. Far from dismissing these issues as “all in your head,” acknowledging how symptoms are shaped by a broader social context — and, now, by social media — could help teens find relief for more than just their tics.

“Symptoms are a means of expression,” Rebecca Lester, a professor of sociocultural anthropology at Washington University who studies psychiatry, religion, and gender, told me. “We learn in different cultural settings, even local settings, how to communicate our suffering.” That learning isn’t intentional — or even necessarily conscious. But the consequences can be debilitating.

Mental illness doesn’t work like measles, which manifests the same way wherever it goes. Because emotional experiences can vary dramatically across time and place, so can symptoms.

Take, for example, traumatic stress from war. Psychiatrists tend to treat World War I-era “shell shock” as a precursor to PTSD, a concept that was solidified in the aftermath of the Vietnam War. But the two groups of veterans often exhibited wildly different symptoms. Mutism, seizures, and paralysis were common symptoms of shell shock. PTSD, by contrast, is defined primarily by flashbacks. The further back in history you go, the stranger soldiers’ symptoms seem: in the Civil War, soldiers suffered from “nostalgia,” or homesickness, that made it difficult for them to breathe and unsettled their stomach.

There isn’t a “correct” stress response to war — or any other hardship. In every case, the soldiers’ suffering was very real. But their symptoms changed in part because their culture did. The plight of the TikTok teens suggests we’re in the middle of another revolution in the language of distress today.

Tics, in particular, happen to be very suggestible

Many symptoms have a social component, but tics, in particular, happen to be very suggestible, Libby says. In 2011, for example, as many as 20 teenagers in upstate New York, almost all of them students in the same school, suddenly developed similar tremors. Explanations included environmental pollution and cancer clusters; Erin Brockovich sent a team to test local soil. Ultimately, doctors close to the patients concluded the physical symptoms were the result of psychic distress. Fortunately, by the next spring, many of the afflicted teens were on the road to recovery.

Just 10 years ago, teens were most directly influenced by the handful of kids in their homeroom; today, thanks to platforms like TikTok, the whole world can feel like one big high school. Earlier this year, German psychiatrist Kirsten Müller-Vahl and her colleagues introduced the phrase “mass social media-induced illness” to describe an outbreak of tic-like behaviors among German teens that began in 2019 and is linked to a popular YouTube creator with Tourette syndrome. Add to that the COVID-19 pandemic, which more than 25 percent of American high school students say has worsened their emotional health, and an outbreak of tics seems almost inevitable.

So what happens next? The difference between true tic disorders, which typically emerge in childhood, and tic-like behaviors, which are what these TikTok users seem to be experiencing, doesn’t matter much for treatment, Libby says. Both groups will likely undergo something called comprehensive behavioral intervention for tics, or CBIT, to manage their symptoms. However, if there are other underlying mental health issues, those need to be treated, too. “My guess is that they will absolutely be able to recover,” Libby says, “especially if they are getting treatment for the underlying anxiety or depression.”

When it comes to the current spike in tic-like disorders, “blaming TikTok, it’s a cop-out,” Lester says. For these teens, the distress was probably already there. These symptoms just made it impossible to ignore.

Grief support systems have been wrecked by COVID-19

2020-04-01T11:00:42-04:00

Undertakers rehearse an online funeral in Vienna, Austria. | Photo by Thomas Kronsteiner / Getty Images

Funerals are for the living. They’re an occasion for a community to recognize a loss and gather support for those who remain. But the novel coronavirus pandemic has disrupted these much-needed mourning rituals. To slow the spread of COVID-19, the US Centers for Disease Control and Prevention discourages events of more than 10 people — a guideline that extends from the Irish wake to the Jewish shiva. It’s also created thousands of new mourners, many of whom are grieving alone.

In times of crisis, “it’s even more important to connect,” says Justin Thongsavanh, operations and partnerships manager for The Dinner Party, which has sorted 8,000 grieving 20- and 30-somethings into peer-led support groups around the world. To show people they’re not alone, The Dinner Party has gone digital for the duration of the pandemic. Staff are leading virtual workshops, and some hosts are holding their regular meetings over video. “They’re having a bottle of wine to themselves instead of sharing it around a table,” Thongsavanh says.

But while some startups hope the funeral live stream is here to stay, end-of-life doulas, bereavement group leaders, and grief counselors say these social networking platforms and Zoom meetings are a short-term solution for ongoing grief. Eventually, every mourner needs the human touch.

“Grief is isolating and lonely to begin with.”

“Grief is isolating and lonely to begin with,” Claire Bidwell Smith, a grief coach and the author of Anxiety: The Missing Stage of Grief, says. “To have to be quarantined is making it a lot harder.”

Bidwell Smith has offered digital services for years, including an online course and phone or video consultations. She says death reminds people that their sense of control over the world “is an illusion” — a realization she calls “dizzying.” The pandemic has only exacerbated this sensation. “I’m seeing a lot of people with old grief coming back,” she says. “Those old feelings of anxiety and uncertainty are flaring up again.”

People are also experiencing fresh grief. Whether their losses are directly related to COVID-19, which has killed tens of thousands of people worldwide, or simply occurring against the backdrop of the pandemic, they may not know where to turn. Without support, they may suffer more than they would under normal circumstances. “Grief is not a mental health issue,” says Sarah Shaoul, host of the Grief Gratitude & Greatness podcast, “but if it’s not addressed, it can become one.”

There is little research on the experience of grief in isolation. But one concern is that people mourning alone will be more likely to experience anxiety, depression, and complicated grief, which is when people struggle to integrate their loss into their identity. The condition, which affects about 7 percent of mourners, can manifest in troubling thoughts and behaviors, like the belief that their loved one may come back or that their life is now meaningless. Complicated grief can and does occur even with a robust support network. But without the recognition and reinforcement of others, people may struggle even more to adapt to their new normal. The consequences of seclusion can have other side effects, too. In one study of 200 older adults who experienced the loss of a partner, social isolation was associated with longer-lasting grief and worse mental and physical health.

social isolation was associated with longer-lasting grief

Online support may offer some people a path forward, provided the person grieving has basic tools, like Wi-Fi, a computer, and a video camera. But not all sites are created equal, says Anna Baglione, a PhD student at the University of Virginia researching digital tools for mental health.

In 2018, Baglione published a study on modern bereavement in the context of human-computer interaction. In interviews with 11 support group attendees and facilitators, she found that some people are able to make meaningful friendships in a setting like a Facebook group. These connections were especially important for people in rural communities who may have trouble finding in-person support. But “the biggest turnoff” Baglione found was information overload. People would join an online group and find the resources they needed, only to be overwhelmed by the needs of others. “They were exhausted,” she says.

Some online support networks may struggle to facilitate interpersonal connections and, as a result, suffer from waning commitment. “If they start virtually, [groups] don’t typically work,” says Thongsavanh. Even when they start offline, the connections between group members take time to build. Most of the groups that have successfully transitioned to video meet-ups have been meeting in person for at least six to eight months. To Thongsavanh’s knowledge, none of the newer groups are currently meeting online.

Mourning alone is a unique challenge

Mourning alone is a unique challenge, but there are ways for people to address their grief in isolation, says Francesca Arnoldy, an end-of-life doula who works with terminally ill people and their families to prepare for death.

Even without pandemic-related travel restrictions, “quite a bit of the support we’re offering is remote,” says Arnoldy, the program director of the end-of-life doula training program at the University of Vermont School of Medicine. In recent weeks, she’s spoken with dozens of students, practitioners, and clients about the techniques they’re using to cope with this unique challenge.

For people who are grieving alone, a meditation or visualization practice is important for addressing the anger and anxiety that come with death, Arnoldy says. Even if you don’t have a professional guiding you, dozens of apps offer these services. People may also find meaning in journaling, altar-building, and private rituals, even when public rituals like funerals are off-limits. And though nothing can replicate an in-person interaction, having someone to check in through text messages or phone calls on a regular basis is essential to maintaining a connection with the outside world.

The internet can’t replace real life

The internet can’t replace real life, but it offers services beyond the support group, says Tamara Kneese, an assistant professor at the University of San Francisco who has studied death in a digital context. People can create easily accessible memorials to the dead, either by taking over an existing Facebook account or starting a virtual altar through a dedicated service. They can also use technology to send material support, whether it’s in the form of a care package delivery or a contribution to a crowdfunding campaign to cover the costs of funerals — which Kneese says is already one of the top crowdfunding categories, after medical expenses. “It’s a way for people to feel like they’re participating,” she says.

Perhaps one upside to the pandemic is that everyone is grieving simultaneously, says Bidwell Smith. Whether it’s a death, a canceled vacation, or a layoff, the whole world has lost something. Though it’s hard to endure, Bidwell Smith believes that grief will ultimately prove to be “really transformative.”

The new coronavirus is not an excuse to be racist

2020-02-04T11:18:18-05:00

An Italian citizen (C) repatriated from the coronavirus hot-zone of Wuhan is directed to a health control zone after landing at the Mario De Bernardi military airport in Pratica di Mare, south of Rome, on February 3, 2020 | Photo by ANSA/AFP via Getty Images

Three weeks ago, Trang Dong, a 21-year-old Vietnamese American, posted a video to TikTok, the short video sharing platform. In the clip, Dong and her cousin are slurping up the leftover broth from pho. The joke is, they’re both holding their spoons with their chopsticks.

In the last few days, Dong’s video has attracted several racist comments. “Where is the bat in your soups???” one TikTok user wrote. “Its corona time,” another posted, referring to the coronavirus, which originated in Wuhan, China, in late 2019, and has since infected more than 19,000 people, mostly in mainland China.

“They’re making a joke out of a pretty serious thing,” Dong says.

“As soon as the news got out that it landed in America, that’s when it started ramping up with the racist comments.”

As officials work to contain the disease, which the World Health Organization (WHO) recently labeled a global public health emergency, anti-Asian racism and xenophobia have continued unabated. On 9gag, the meme- and GIF-sharing site, one user posted an image of a man with his tongue out, ogling a woman. He’s a coronavirus, and she’s “Chinese eating bat soup.” In a viral tweet, an account posted a video of a woman eating bat with the comment, “When you eat bats and bamboo rats and s— and call it a ‘Chinese delicacy,’ why y’all be acting surprised when diseases like #coronavirus appear?” And some restaurants are suffering as people share false warnings that Chinese dishes could somehow harbor the virus.

Kyra Nguyen, a 20-year-old Vietnamese American from Los Angeles, has watched the ethnic slur “chink” ping-pong around Twitter, alongside suggestions to shoot US-bound planes from China out of the sky. “As soon as the news got out that it landed in America, that’s when it started ramping up with the racist comments,” she says. “Prior to that, it was like, ‘Oh, it’s in China,’ so people weren’t as worried about it, I guess.”

Many Twitter and Facebook posts blame Chinese people (or people presumed to be Chinese, like Dong and Nguyen) for creating and spreading the virus. If others challenge their statements, many users, including one who commented on Dong’s video, defend their statements as “jokes.” But Dong, a student at the University of California, Berkeley, says these words and images damage both her sense of identity and her sense of well-being: “[People saying] ‘stay away from your Asian friends’ or ‘stay away from international students’ is really upsetting to see.” She says these posts are a reminder that, as an Asian American, she’s a “perpetual foreigner in the country I was born in, in the country I was raised in.”

“We know that people will look at our black hair and ‘yellow’ skin and target us.”

Chinese people in Asia and Asian people around the world say they’ve been treated with suspicion since the virus made international headlines. Erin Wen Ai Chew, a 37-year-old entrepreneur with Chinese ancestry, told me about a recent experience in an Australian airport. Chew says a white woman eyed every Asian person passing by, especially those wearing face masks, as though searching for signs of disease. Chew purposefully coughed near the woman, who, she says, ran away, eyes wide with terror.

“We’re expecting this type of thing to happen,” Chew says. “We know that people will look at our black hair and ‘yellow’ skin and target us… There’s a lot of anger, a lot of resentment, and also a lot of dread to know that when we go out, we could be subject to racism.”

There are political repercussions, too. Despite little scientific evidence that restricting travel stops the spread of a novel virus, President Trump has banned foreign nationals who have traveled to China in the last 14 days from reentering the United States. This runs counter to WHO’s guidance, which discourages travel and trade bans, as they can make it harder to help nations respond to such outbreaks.

SARS created a template for racist fear-mongering in subsequent outbreaks

The current atmosphere echoes a previous outbreak. In 2002, a different coronavirus emerged in China’s Guangdong Province: severe acute respiratory syndrome (SARS). It killed almost 800 people around the world. Public health officials are still not certain how the virus emerged, says Katherine Mason, a medical anthropologist at Brown University. But experts theorize that the zoonotic illness moved from bats to another animal, like civet cats, which are a delicacy in southern China, and then into humans. This genetic baton-pass may have begun in a wet market, which are places where vendors keep many different kinds of live animals and sell them alive or slaughter them on-site. The close proximity of so many species that might not otherwise meet may facilitate the spread of new diseases.

SARS created a template for racist fear-mongering in subsequent outbreaks. Many of the offending coronavirus posts in recent weeks have confidently connected the virus to Chinese people’s purported appetite for bat, which has been labeled disgusting, dangerous, and something people don’t eat “in the normal world.” (Most of the world finds the American appetite for disassembled, plastic-wrapped animal parts equally strange.) The same posts assert that the virus originated in a wet market, which people describe with similar disdain, despite scientific speculation that the coronavirus may have emerged elsewhere.

Only some outbreaks are racialized, says Roger Keil, a professor in the environmental studies department at York University, who studied the impact of SARS on the city of Toronto. Neither H1N1, which emerged in North America, nor mad cow disease, which primarily affected the United Kingdom, generated a racial or ethnic backlash of this magnitude. Yet, diseases that originate in China, like SARS and the new coronavirus, or in Africa — remember the fears about Ebola? — consistently correlate with xenophobia.

“With this new virus, something was triggered that is always latently there.”

“With this new virus, something was triggered that is always latently there, under the surface, which is this fear of the other and the idea that bad things come from elsewhere,” Keil says. It also echoes old prejudices. In the 19th century, Europeans feared a so-called “yellow peril,” brought about by “primitive” people with emerging global power. In the US, there was a specific notion that Asian people carried disease, the Los Angeles Times reported.

To combat racism, people in the public eye, including politicians and media outlets, have to begin by uncoupling the disease from its origin point, Keil says.

Nguyen, the Los Angeleno, thinks coronavirus could be a catalyst for social change. “Growing up, I’ve experienced a lot of microaggressions. Like, ‘Oh are you eating dog?’” she says. “A lot of people don’t view microaggressions as racism. They think it’s a joke.” Now, people are speaking up, online and off.

For now, Keil says, “there are two things to remember every morning when you get up: wash your hands and don’t be racist.”

What Pokémon can teach us about conservation and climate change

2020-01-30T11:59:10-05:00

There’s a moment in the live-action movie Detective Pikachu when the ground beneath our heroes’ feet is crumbling. As they slip and slide, Pikachu, voiced by Ryan Reynolds, yells to no one in particular, “At this point, how can you not believe in climate change?” It’s a good quip — one of a million small jokes that’s easily missed. But it’s also one of the first times that Pokémon, the most lucrative media franchise of all time, addressed the climate crisis. It certainly won’t be the last.

Fans appreciate Pokémon for its camp humor, adorable monsters, and emphasis on the quest for excellence. But for more than two decades, Pokémon has also delivered a crash course in environmental science. Like a professor par excellence, it’s addressed ecological vulnerability and land management, extinction and de-extinction, the plight of endangered species and the dangers of invasive ones, and, most recently, the real costs of climate change. There’s a lot more to Pokémon than just catching ‘em all.

Pokémon was an eco-conscious project from its conception. Nineties kids know the origin story well. Satoshi Tajiri was born in Japan in 1965. He was an avid insect collector — the other kids called him “Dr. Bug.” At the time, Tajiri’s hometown still had rural pockets, but as the Tokyo metropolitan area subsumed outlying villages, plants and animals gave way to concrete and skyscrapers. Decades later, when he first played with a Game Boy, he saw an opportunity to ensure a new generation of urban kids could experience the simulated joys of taxonomy and tromping through the wilderness. In 1996, Tajiri’s company, Game Freak, released the first games in his fantastical universe of Pocket Monsters, better known as Pokémon.

Today, there are eight generations of Pokémon games and, depending on how you count them, about 900 individual monsters. They’ve spawned dozens of video games, 24 movies, and more than 1,000 episodes of television. Along with trading cards, Croc Jibbitz, and other merchandise, the franchise has grossed over $92 billion in total revenue.

In many ways, the Pokémon universe still resembles that of Tajiri’s childhood. There are patches of tall grass full of unknown creatures, dark forests, and rushing rivers — all imbued with a sense of aliveness that cultural anthropologist Anne Allison called “techno-animism” in her book Millennial Monsters: Japanese Toys and the Global Imagination. While there are ghost pokémon and sentient ice cream cones, many pocket monsters mimic real-world biodiversity: Caterpie, with its bright orange osmeterium, is clearly the caterpillar form of the eastern tiger swallowtail. Pikachu, an electric mouse, is based on the actual pika, a teeny mammal that’s more closely related to rabbits than rats. Vileplume is a grumpy corpse lily, Sandslash is a superpowered pangolin, and Drowzee is a neon-lit Malayan tapir.

An eco-conscious project from its conception

But where other games like Animal Crossing restrict themselves to a preindustrial idyll, the untamed fantasyland of Pokémon exists side by side with the scientific quagmires of the modern world. Mewtwo, a giant purple alien-cat, was “created by a scientist after years of horrific gene splicing and DNA engineering experiments.” Mewtwo has appeared in numerous installments of the franchise, typically in pursuit of revenge on humanity. In the latest games, Sword and Shield, Koffing “floats into garbage dumps, seeking out the fumes of raw, rotting trash.” Its evolved form, Weezing, which can appear as a two-headed smokestack, reportedly emerged “during a time when droves of factories fouled the air with pollution.” It goes without saying where these garbage dumps and factories came from.

Just as Pokémon has mimicked the real world, it’s influenced it, too. In 2002, researchers reported that more children knew pokémon species than real ones like badgers or oak trees. “[I]t appears that conservationists are doing less well than the creators of Pokémon at inspiring interest in their subjects,” the authors concluded. Some scientists have since risen to the challenge. In 2019, researchers evaluated a Pokémon-style card game called Phylo, which is designed to increase awareness about earthly animals and the challenges they face. The researchers found that people who played Phylo had more fun and remembered a more diverse range of species than those who simply viewed a PowerPoint.

Though Pokémon presents its fans with an opportunity to think through myriad ethical dilemmas and environmental issues, it rarely resolves those challenges in an optimal way. This “tension” between “a yearning for nature and a desire to contain it” has been implicit in the show from the beginning, writes Jason Bainbridge of the University of Canberra. While Pokémon producer Masakazu Kubo has argued the franchise is about the “harmony” between pokémon and people, even the biggest fans know it’s really an unending stream of content based on the adventures of unchaperoned and underaged through-hikers refining their skills in fantastical dog fighting. Even if a pokémon and its trainer truly collaborate, the pokéball — a red, black, and white cage that is used to capture and contain new monsters — gives the humans the upper hand. Without the pokéball, Bainbridge writes, there would be no “pocket” monsters — just a world full of wild magical beings.

“‘Pokémon’ leans toward this worldview that wildlife is there for our exploitation and use.”

These mirror some of the fundamental disagreements of the modern conservation movement, says Leejiah Dorward, a conservation scientist who published an influential paper on Pokémon Go, the AR-enabled smartphone game, in 2016. “Pokémon leans toward this worldview that wildlife is there for our exploitation and use,” he says. “That exploitative view is really in the Western conservationist model.” But, increasingly, conservationists are advocating for biodiversity for the sake of biodiversity. Instead of catching ‘em all (a slogan that applies equally to Pokémon and President Theodore Roosevelt), we should protect wildlife and admire it from a respectful distance — less Ash Ketchum and more Todd in Pokémon Snap.

But for many of these species, time is running out. Recently, the 24-year-old Pokémon franchise has begun to grapple with the very real perils of climate change. In Detective Pikachu, it’s that one-liner from Pikachu. But in Sword and Shield, it’s much more serious. Corsola, a second-generation coral-like Pokémon, has been bleached by rising ocean temperatures. It’s been replaced by a ghost-type descendant, Cursola. Where the original reef was pink and smiling, the creature we have now is shock white with watery red eyes.

If Pokémon has taught us anything about the environment, then we know that the time for action is long overdue.

As women’s running takes off, the shoe industry is racing to keep up

2019-12-23T11:02:01-05:00

Daisy Clark, a 53-year-old ultramarathoner from Seattle, has had her fair share of foot pain: aching joints, toenails peeling off in your socks, and even nerve damage (from tying your laces too tight) are all part of the sport. On one of her first 50-mile races, Clark developed a blister “that was my entire heel — one giant blister with blood.”

At the time, Clark was still running in Hoka One One sneakers, a popular brand among ultramarathoners. But the mega-blister taught her a lesson. She began to lubricate her feet, wear toe socks, and “the next time I did a 50-miler, I’d gone to Altras,” Clark said. “I’ve tried almost every brand you can think of and I always come back to them,” she said. “Their women’s shoes are actually built around a woman’s foot.”

Clark’s experience isn’t unusual among endurance athletes — or women. “At the beginning, shoes were built for the people who were running, which were men,” said Benno Nigg, one of the first biomechanists to systematically study athletic shoes. But times are changing: the sneaker industry is now worth $100 billion globally, and the women’s share of the market is growing faster than men’s. This shift is driven by pure athleticism — female runners now outnumber male runners — and by fashion: the rise of athleisure means many Americans wear sneakers around the clock, not just in the gym.

Still, “women are a lot more dissatisfied with their shoes than men are” even though they also tend to have lower expectations for their footwear’s comfort, said Geoffrey Gray of Heeluxe, an independent shoe research laboratory. Heeluxe’s data suggests that, in general, women’s shoes are up to 18 percent tighter around the toes, 70 percent tighter around the big toe joint, and 68.4 percent looser in the heel than men’s shoes. And we’re not just talking stilettos — women are suffering in sandals, casual sneakers, even athletic performance shoes.

What gives?

shrink it and pink it

Many brands, researchers, and individual runners like Daisy Clark, attribute at least some of this discomfort to a long history of unisex shoe design. Factories construct shoes around a last — a foot-shaped mold of steel, copper, or durable plastic. Historically, they built men’s, women’s, and even children’s sneakers on lasts based on an adult male foot. The colors changed, but the relative dimensions did not. A size 9 men’s last could make a size 10 ½ women’s shoe. That’s how this practice earned its name: shrink it and pink it.

This technique might have evaded scrutiny if male and female feet were identical. But as a 2009 study in the Journal of the American Podiatric Medical Association concluded, “female feet … are not algebraically scaled, smaller versions of male feet, as is often assumed.” Instead, evidence suggests female feet tend to have a higher instep and narrower heel relative to the ball of their foot, while male feet are longer and broader overall. Forcing women into shoes designed for male feet can have serious side effects, Gray said, including dropped arches, bunions, ankle bone soreness (typically when a shoe collar is too high), and blistering.

many athletic and outdoor brands are now building gender-specific shoes

That’s why many athletic and outdoor brands are now building gender-specific shoes. Altra, Reebok, and Asics design all of their women’s sneakers on women’s-specific lasts. Nike manufactures its performance shoes on gendered lasts, though many lifestyle shoes, like Air Force 1s, are still made on a unisex mold. And Keen, Adidas, and New Balance currently sell at least one women’s-specific shoe. Only one company — Brooks — confirmed it still engineers all of its sneakers on a unisex last. (Hoka declined to comment.)

The companies that have invested in engineering and marketing women’s-specific shoes have found remarkable success. Keen’s Terradora boot, which debuted in 2016, is the second bestselling shoe in its trailhead category, according to a company spokesperson. The boot has a more padded (and therefore narrower) heel, a smaller toe box, and higher arch support compared to one of Keen’s more traditional, unisex fits.

“One of the things that sold me when I tried them on is there’s a lot of padding around the Achilles — around the ankle — and that’s something I’ve never experienced before,” said Jamie Wearne, a recreational hiker in Adelaide, Australia, who posts about her Terradoras on Instagram. “It’s something you don’t realize you need before you experience it.”

But the problem seems to run much deeper than a gendered last. Even as brands put more women’s-specific shoes on the market, female foot pain persists.

The problem, it turns out, is that we aren’t sure how to design a safe, comfortable shoe in the first place. And, regardless of their gender, “we don’t know how we can connect a shoe to a person,” said Nigg.

Runners still get injured as often as they did in the 1980s

The Nike Zoom Vaporfly 4%, which debuted in 2018, showed engineers can make a faster shoe : the sneaker speeds runners up so significantly, it’s caused an existential crisis in the running community. But how exactly the Vaporfly’s carbon fiber midsole plate and proprietary new foam, ZoomX, lead to faster marathon times is hotly contested.

When it comes to safety, things are even murkier. Decades of research haven’t determined how (or if) shoes contribute to athletic injury or what we can do to prevent it. Runners still get injured as often as they did in the 1980s, when the first shoes advertised with “motion control” and “stability” features began to hit the market. And, as customer feedback shows, sneaker manufacturers can’t even guarantee every customer a proper, pain-free fit.

The issues start with data collection. Shoe scientists tend to “cast a very, very, very wide net,” said Max Paquette, a biomechanist at the University of Memphis. To get as many people in their studies as possible, researchers have tended to include any athlete doing any activity, as long as it’s all in the same shoe. Now, Paquette said, he and other academics are starting to do more controlled experiments that organize participants by factors like gender, age, foot type, experience, strike pattern, and even exercise goals. In doing so, they hope to exorcise the noise and narrow in on the connection between a body and a shoe.

“The bias is so much stronger than we even realized.”

For women, these mysteries are only magnified. When it comes to elite athletes, researchers have traditionally only studied high-performing men, because it’s easier to control for variables like the force of their stride or the length of their foot. And, Paquette added, “historically scientists have, in a lazy way, avoided studies on women because there’s a confounder of the menstrual cycle.”

This data gap exists in more basic fit research, too. Gray, who has been fighting for women’s-specific shoe design for a decade, found that Heeluxe has tested seven times as many men’s running shoes as women’s. In basketball and hiking, the ratio was three to one. Sandals, high heels, and lifestyle shoes were the only categories where they’ve tested more women’s products than men’s. “The bias is so much stronger than we even realized,” Gray said. “I was like, ‘Oh my god, this is terrible.’”

Data, when it does exist, may also be misconstrued. Take pronation — the degree to which the foot rolls downward or inward when landing. “Initially, people just started to create shoes with the theoretical idea … that if we create a shoe that prevents these excessive motions of the foot … it might actually help us not get injured,” said Paquette. “But it wasn’t based on any real science.”

Today, Paquette said, “we have a ton of evidence, it’s just that it’s all over the place.” In 2013, Danish researchers published the results of a year-long effort to track beginning runners in a neutral shoe. They found that foot posture wasn’t correlated with an increased risk of injury. If anything, people whose feet pronated had fewer injuries than those with a neutral foot posture. But that hasn’t stopped many companies — and doctors — from using earlier research to encourage people who over- or under-pronate to wear shoes to correct these tendencies.

“we have a ton of evidence, it’s just that it’s all over the place.”

Anxiety about over-pronation has disproportionately affected female athletes, said Casey Kerrigan, founder of the shoe startup Oesh. Because female bodies tend to have wider hips, they have a higher Q angle — the gradient at which your tibia aligns with your kneecap — which is tied to increased pronation. As a result, women are more likely to have stability and motion control features marketed to them. The marketing sends a weird message. “It’s almost as if women are designed all wrong, and we need to order something” to fix it, Kerrigan said.

In the absence of strong evidence, customers must rely on their intuition. If the shoe fits comfortably, biomechanists like Paquette and Nigg say, wear it. Then again, even our intuition could be compromised: “I could go to Target and get a pair of neutral shoes and probably be fine,” Paquette says. “But I don’t, right? Because the marketing is so strong.”

In the absence of strong evidence, customers must rely on their intuition

The future of sneaker science could lie in personalization. In 2016, Nike began 3D printing customized shoes for elite athletes, like Olympian Allyson Felix. Brooks, the Seattle-based running shoe company, hopes to bring this technology to the masses by 3D printing perfectly complementary soles for every customer.

Custom kicks sounds like the solution to all our footwear issues — no gendered lasts, no questionable categories like one-size-fits-all motion control — but we aren’t likely to transcend these problems anytime soon.

Nikhil Jain, a senior manager with Brooks, said its Genesys beta project, which launched in 2018, was the first step in creating fully personalized running shoes. The company collected 3D scans from the feet of 300 participants and delivered each of them sneakers with soles personalized for their specific needs. But the shoes weren’t ready for prime time — and won’t be for years to come.

It’s not because manufacturers lack the technology: 3D printers are widely available, and scientists have been successfully scanning feet for decades. It’s that the problem they’re designing for is unclear. “Nothing on the customization end right now outperforms traditional shoes,” Gray says. To make them a truly viable product, “the cost has to be similar, and the experience has to be elevated.”

Until then, we’re just 3D printing the same old problems.

Correction 1/7 5:45PM ET: An earlier version of this article referred to Geoffrey Gray of Heeluxe as Gregory Gray. We regret the error.

Correction 12/23 10:40PM ET: An earlier version of this article stated that soles in the Genesys beta project were 3D-printed. While the shoes were customized, they were not 3D-printed.

2019 was the year climate change charted

2019-12-19T09:30:00-05:00

Billie Eilish performs at the Radio 1 Big Weekend at Stewart Park on May 25, 2019 in Middlesbrough, England. | Photo by Jo Hale/Redferns

Billie Eilish, the 18-year-old singer-songwriter redefining pop stardom, recently spoke with the the LA Times about her climate anxiety. It’s taken the form of bad dreams, spooky lyrics, and high fashion: a week earlier, Eilish wore a characteristically oversized “No Music on a Dead Planet” tee to the American Music Awards.

“We’re about to die if we don’t change,” she told the paper.

A year ago, such a blunt message from one of the biggest acts in the world would have seemed like an aberration. In April, Ryan Bassil at Vice argued that musicians weren’t ready to tackle the climate crisis — and wouldn’t be for the foreseeable future. Combining climate activism with a music career isn’t a lucrative stance, especially at its extremes: Coldplay, which announced it will not tour until concerts are “actively beneficial” to the environment, stands to lose hundreds of millions in ticket sales. Activism isn’t always aesthetically pleasing, either. As Bassil noted, artists like Bono have made songs about collective action seem chronically “corny and overly sincere.” Or, as Grist put it back in 2009, the Venn diagram of “songs that suck” and “songs that are green” is basically a circle.

back in 2009, the Venn diagram of “songs that suck” and “songs that are green” is basically a circle

But it has since become clear that this was the year that the changing climate began changing music, with many major recording artists streaming their interpretations of the eco-apocalypse. It was, at times, extremely corny. In April, YouTube rapper Lil Dicky released “Earth,” a star-studded and totally unlistenable call to action. In July, The 1975 made an eponymous “song” that’s just a Greta Thunberg speech set to a tinkling piano. More often, though, musicians have found their own unique way to give voice to the experience of living at the end of days — to living, in other words, in 2019.

Eilish is arguably the most famous and outspoken artist on the climate crisis so far. In September, Darkroom / Interscope Records released the music video for “All the Good Girls Go to Hell.” For a haunting three minutes, Eilish dons the perspective — and wings — of a fallen angel who lands in the goopy darkness of a La Brea-like tar pit. As the creature stalks the seared streets of Los Angeles, Eilish whispers her refrain, “Hills burn in California / my turn to ignore ya / don’t say I didn’t warn ya.”

“Hills burn in California / my turn to ignore ya / don’t say I didn’t warn ya.”

In case the foreboding lyrics or fiery visuals don’t do the trick, the YouTube video description shares Eilish’s message in clear-cut prose: “A note from Billie,” it proclaims. “The clock is ticking… take it to the streets. #climatestrike.”

Grimes, the experimental recording artist, has also been writing hymns for a horsewoman of the apocalypse. She described her forthcoming album, Miss Anthropocene, as the tale of an “anthropomorphic Goddess of climate change.” The first singles dropped in November. On “My Name is Dark,” Grimes sings about how “imminent annihilation sounds so dope,” while still asking God to “un-fuck the world.”

Not everyone is so high-concept. In August, Lana Del Rey released her long-awaited album, Norman Fucking Rockwell. On “The Greatest,” Del Rey put a joyfully nihilistic spin on our current catastrophe. She spends the majority of the song mixing the personal and the universal with lyrics like, “the culture is lit and if this is it, I’ve had a ball / I guess I’m burned out after all.” But at the end of the track, the former New Yorker gets explicit about her new Southern California surroundings: “LA is in flames, it’s getting hot” — an idea reinforced by the cover art, which depicts Del Rey on a boat just off a smoldering shore.

At this point, it feels like you can find climate change in everything. Fans retrospectively assign apocalyptic meaning to their favorite songs all the time. Take “Year 3000” by the Jonas Brothers (a Disney-fied cover of an earlier hit by the British band Busted) which can be understood as a message of climate optimism: your descendants will “live underwater,” but the time-traveling brothers assure you that “your great-great-great granddaughter is doing fine.”

Sometimes, it’s the artists who add new meaning to their own music. At the Global Climate Strike in New York City, thousands watched Jaden Smith perform a short musical set. He introduced his 2017 song “Icon,” which is about gold teeth and owning your own record label, as something that “really goes to show what we all have to be in this world — and in the environmental community — in order to make a difference.”

This may have been the year that climate change had a musical moment all its own, but the message has been emanating from our speakers for decades: What is “All Star” if not a reminder of just how long we’ve known about climate change? As Smash Mouth sang in 1999, “The ice we skate is getting pretty thin / The water’s getting warm so you might as well swim / My world’s on fire, how about yours? / That’s the way I like it and I never get bored.”

As musicians develop new ways to address the climate crisis, listeners won’t get bored, either. And maybe, at Eilish’s behest, some will continue to take their climate anthems to the streets.