University Place

Sleep and Society

[Michael Koenings, Associate Professor, UW-Madison School of Medicine and Public Health]

It’s my pleasure to welcome Dr. Matthew Wolf-Meyer to our Neuroscience and Public Policy seminar this afternoon.

Dr. Wolf-Meyer is joining us from the Department of Anthropology at Binin Bini Binghamton

[laughter]

University in New York.

Dr. Wolf-Meyer received his bachelor’s degree from Oakland University, acquired two master’s degree masters degrees, one from the University of Liverpool, the other from Bowling Green State University, both of which involve the study of science fiction.

He then took his PhD from the University of Minnesota in Anthropology. Before his position at Binghamton, he had positions in anthropology at Wayne State University and the University of California Santa Cruz.

His work focuses on medicine, science, and media in the United States. He had a book entitled “The Slumbering Masses: Sleep, Medicine, and Modern American Life,” which won the New Millennium Book Prize in 2013. In addition to his work on sleep, he also works on a number of other topics related to health and brain science.

Dr. Wolf-Meyer’s work, I think, really embodies the essential spirit of our Neuroscience and Public Policy Program, which is to take data and clinical and scientific data, out of the pages of strictly academic journals and find ways to influence society for the better, to situate these findings in broader social, cultural, and political contexts.

To this effect, I think it’s telling that, as a visitor to our campus, Dr. Wolf-Meyer has met with individuals from our neuroscience department, from our La Follette School of Public Affairs, from anthropology, from bioethics, from medical history. I think it speaks to the interdisciplinary and cross-disciplinary nature of his work. And so, I think we’re all in for a real treat. Please help me welcome Dr. Wolf-Meyer.

[applause]

[Dr. Matthew Wolf-Meyer, Associate Professor, Department of Anthropology, Binghamton University]

So, thanks to Mike for the introduction, and to Tara and Maori, who were my stewards and handlers through all this. I wouldn’t be here without them.

And thanks for spending your Friday afternoon with me.

I’m going to talk about the sleep project primarily because I think that as it’s most reflective of the interests of the Neuroscience and Public Policy Program.

And so, we’ll just go through it.

I don’t think there’s any crazy ideas here, but some of you have had conversations with me over the last couple days that you’ll see parts of reflected in this.

And my little remote control stopped working.

So, the title of this, and I always have title anxiety, is “Thinking Through Sleep: Propositions for a Multi-Biological Society.” And I’ll unpack that neologism.

Don’t be afraid.

So, let’s start with a case.

And, as many of you know, this work really developed out of a partnership between me and sleep researchers and clinicians in Minnesota. And it’s been a couple years in a sleep clinic observing clinical interactions and diagnosis and went from there to do a lot of archival research about the history of sleep and also a lot of observation of patient support groups, both in Minnesota and Chicago and then nationally.

So, part of it meant kind of pretending to be a neuroscientist and a sleep expert for a while, and part of it meant acting like a patient and working through the kind of worlds that they operate in.

And so, some of what I’m going to talk about is kind of case-oriented in a way. And so, let’s talk about Ted.

Ted is kind of a typical patient in a lot of ways. He is awake in the middle of the night. He falls asleep really easily, but when he does wake up in the middle of the night, he’s awake for a few hours.

And so, clinically, the idea is that he has maintenance insomnia, and the way to treat it is to give him something like Ambien, Sonata, Lunesta, right?

And the idea there is to produce eight hours of consolidated sleep.

The problem for Ted, though, is that once he gets put on the drug, he ends up sleepwalking at night. So, he still gets up, he’s just not conscience of being awake, right?

And so, the question is: Is Ted an insomniac?, or is there something else going on that’s a little bit deeper and not captured by the way that we’re thinking about sleep disorders?

So, we’ll come back to Ted.

The kernel of the slumbering masses is this idea that sleep, American sleep, has changed profoundly over the last 200 years, in that previous to industrialization Americans were really biphasic sleepers.

And what I mean by that is one of two models.

Either that people go to sleep around sundown for a few hours, they’re awake in the middle of the night, and then they go back to sleep for a few hours to wake up around dawn.

Or they go to sleep pretty late, they wake up rather early, and then they take a nap in the middle of the day.

And the evidence to support this, at least related to what I do, is a bunch of medical monographs and papers from the 19th century. So, there are a bunch of doctors who get enrolled in the push towards consolidated workdays who are working to get people to consolidate their sleep.

And so, they’re actively attacking biphasic sleep as not healthy, as immoral, as problematic in one way or another.

And so, what comes out of that at the end of the 19th century is this idea of consolidated sleep being normal sleep. And the reason why that happens is because people are moving from agrarian or small-scale work schedules where they can show up to work late, take a nap if they need to, they work with family or with friends, to working in large, anonymous factors and cities where they have managers who don’t know them and don’t care about them and they can be easily replaced. Right?

So, if you’re not to work on time or you fall asleep while you’re at work, you’re just not going to have a job anymore.

And if you’re consolidating all of your work during the day, because these factories are they exist before electric light and they want to get as much labor out of people as they possibly can, so they start at dawn and they end at dusk. So, you have a consolidated day. People are totally exhausted, and at the end of the day they go to sleep in a consolidated way and then they wake up for the next day of work.

So, insomnia, kind of although it’s been around for a really long time if you look at the history of medicine, in the 1860s and 1880s insomnia becomes something that’s not just an elite problem but a problem of the working classes more generally.

And one form insomnia seems to take is Ted’s insomnia, that people wake up in the middle of the night and they go back to sleep. So, what was biphasic sleep now becomes sleep maintenance insomnia. Right?

And in order for that to happen, the consolidated model of sleep need to be the model of sleep. And so what happens in the beginning of the twentieth century, when sleep science actually kicks off, is that the earliest people who are working on sleep and the emblematic figure here is a man named Nathaniel Kleitman at the University of Chicago that their model of what sleep is, is consolidated sleep. So, theyre not even testing whether or not other kinds of sleep are possible. Thats just the normative standard that theyre using. Right?

And from that standard you have a variety of kinds of pathologies that are apparent only because that is the norm. Right?

So, there’s a few things I want to point to here as reasons why we should be thinking about sleep a little bit differently.

The so, with consolidated sleep is really this expectation that it’s about eight hours a night. Right? There’s very clear evidence, scientifically, that over the life course sleep changes. Right?

So, if you’re an adolescent, you probably fall asleep later and you need longer sleep than you do if you’re an adult. And when you’re much older, you probably need less sleep, and you wake up much earlier than people. And so, the eight-hour average, and we can talk about this in depth later if you’d like to, the eight-hour average is really a normative average. Right? It’s not actually based in the experiential practice of people throughout their life course. Right? And babies, if you spend time with babies, they are not consolidated sleepers. Right? And so, the whole idea of sleep training is that you’re going to make a consolidated sleeper out of this baby by hook or by crook. Right?

And so, all of those things add up, I think, to point to consolidated sleep not necessarily being natural sleep for human beings. Right?

Beyond that, humans are the only consolidated sleepers, if you look cross-species. Right?

So, your cat is a polyphasic sleeper. Your dog is a polyphasic sleeper too.

[phone ringing]

And I’m going to turn off my phone. Sorry about that.

And so or I’m just not because that will be even worse.

And so, humans are the only consolidated sleepers. And it it you can either think that we’re exceptional, that somehow there’s been a species break between us and everybody else and we’re destined to be consolidated sleepers and everybody else is biphasic or polyphasic. Or you can think, maybe a little suspiciously, that we might not be consolidated sleepers too, and that consolidated sleep is a kind of artifact, right, of the way that we organize society.

Along those lines, sometimes you’ll see people argue that biphasic sleep is an aberration, and that really, we were consolidated sleepers. We became biphasic sleepers, and now we’re consolidated sleepers again.

The way that I would prefer to think about that is plasticity, or really capacity around various kinds of sleep. Right? That some of us can be pretty good consolidated sleepers, and some of us are maybe better when we’re biphasic sleepers. It’s not to say that we can’t be consolidated sleepers or that we can’t be biphasic sleepers, but that we have the potential to be either one of those things. Right?

Some really exhausted people are pretty good polyphasic sleepers too. Right? That it’s not just at nighttime that people feel sleepy. Right?

And, finally, and this is the most anthropological of these points, I think, and I borrow from a anthropologist named Margaret Lock here to think about what’s referred to as local biologies. And so, what Lock is talking about is that in particular societies what you have are ways of life that reinforce particular kinds of biological experiences.

So, consolidated sleep might really be a kind of local biology. That if you look cross-culturally, you see many different kinds of variations with how people organize sleep. So, siesta cultures are biphasic sleepers. They go to sleep late, they take a nap in the middle of the day. There are sometimes controversies about how productive those societies are. Right? But the idea is that, as a biological experience, it can be organized in a variety of different ways, and some of those ways are really shaped by social norms more than biological hardwiring. Right?

So, let’s go back to Ted. And the question is, does Ted have a sleep disorder or is there some mismatch between his the way that he sleeps and the way that he prefers to sleep and the social obligations that he has? Right?

And another way to ask that question is, is Ted a pre-industrial sleeper in a post-industrial age? Right?

If what he if he’s a biphasic sleeper, it might not really be sleep maintenance insomnia. Right? It’s just a different organization of sleep. It’s just a problem because his family life and his work life are organized in a way that don’t allow him to sleep the way that he’s most inclined to sleep. Right?

At least that’s the argument that I’m subtly trying to make here.

So, to the neologism in the title. I really argue for this concept, which is multi-biologism. And the model that I use to get here is really multiculturalism. That we have this idea that different cultures should be valued and appreciated and integrated, and we don’t tend to think about variations in human biology with the same kind of ecumenical lens.

And so so the suggestion in the neologism is a few. The first is that there’s no unitary human nature. Right? That, like, when people are compelled to talk about human nature, they’re trying to make some kind of unitary argument. And, instead, if you think about the variations within the human population as variations in human nature, right, there’s no one core human experience of which everybody else is a pathological variation of. Right? It’s more like there’s a spectrum. That human nature, in some sense, is this plastic range of possibility. Right?

And what that leads to is me making this argument that when we conceptualize human difference as variation, we’re moving away from pathology. So rather than thinking about one biological model as the natural norm and any variation from it as in need of some kind of medical intervention, that we can think about a broad spectrum of human experience that might be adjusted to rather than trying to get people to adjust through medical intervention to social norms.

And I’ll explain all of this a bit more as we go on.

Which is different than so what I’m not trying to say is that we should do away with medicine all together. Right?

That there are very clearly pathological, biological experiences of the world, and that some of those actually require and depend on medical intervention but that there are a host of what we take to be pathological experiences that don’t necessarily need medical intervention and that it’s really the structure of our society that leads us to think that medicine is the right way to make these interventions when we might think differently about how we intervene.

So, like I was saying earlier, one of the critical things here is that when we think about humans as being plastic, we need to think about that plasticity itself as being something that varies between people. Right?

That some people are really good consolidated sleepers and poor biphasic sleepers and vice versa. And there’s some people who are really good sleepers no matter what. Right? That given any kind of circumstance, they’re going to be able to organize their sleep in order to fit those needs. Right?

And so when we think about individuals, what we’re really thinking about is an individual capacity to do various kinds of things. And one of those things would be something like sleep.

And in American society, when we think about someone like Ted, usually the option is to go to medicine. Right? That it rather than organize his life differently, a pharmaceutical is going to be the thing that creates a normal experience of sleep. Right? And that by giving him that pharmaceutical, he’s going to align with social demands. In a case like his, that’s not something that’s entirely possible. Right? That, like, if he’s on the drug, he has other problems. And so, what recourse does he have?

And I’m going to leave that as an open question for the time being as we talk through this.

So, one of one of the reasons why I was particularly interested in having this conversation here as part of the Neuroscience and Public Policy Program is that I I I’m policy adjacent in some sense. That what this all leads me to think about are societal interventions that kind of move away from medicalization. And but I’m no policy thinker. And so maybe you can help me think about the material consequences of the things that I’m talking about.

The first and is this idea that and I borrowed this in part from Emily Martin, who’s a medical anthropologist that what we’ve really become wedded to is this idea of the flexible individual. That it’s your responsibility as an individual to meet the social demands of the institutions that you participate in. So, if you’re having a hard time being awake in the morning for work or for school, it’s your responsibility to drink coffee or take a drug. Right? And if you don’t do it, then you’re non-compliant. Right? That you need to be the one that fits into the institution rather than the other way.

So, instead, I’d really like to start to think about what it means to have flexible institutions. Right? So, what does it mean to have a set of institutions, like school and work and family and recreation, that are supple enough to be flexible and to meet people where their plasticity tends to take them?

The second proposition here is thinking about modular institutions rather than static ones. And I’ll explain this more with a couple examples. But the idea is to make institutions more experimental in the way that they’re organizing themselves and the interactions that they have with individuals.

And the third one is really moving beyond the idea of the individual at all. That one of the challenges, especially in the United States, is that when we think about medical problems, what we’re thinking about is the individual patient. Right? And the problem there is that individual patients are really produced by particular kind of social, institutional network. Right? That thinking about an individual in relationship to their family and the other institutions that they’re a part of is really necessary in order to figure out what the right kind of solution is.

So, when I’m thinking about flexible institutions, the thing that I tend to think about the most or the things I tend to think about the most are school start times and the idea of flex time. And so, like the example that I I gave briefly earlier is that there’s mounting evidence that adolescents both have sleep onset later and need more sleep. Right? And the problem is that often adolescents are the ones who start school the earliest. So if you have to go to school at 7:15 in the morning but you’re not going to sleep until 11 o’clock at night and you need about 10 hours of sleep in order to be at full operating capacity, you’re always going to be exhausted and you’re not going to get good grades. Right? And there’s decent evidence that supports this.

The challenge has been that well, there are many challenges. One is that parents really rely on school in order to take care of their children while they go to work. Right? And so, work time and school time in the United States are intimately tied together. Right? And if you’re not going to have your kids at school, then you have to have somewhere else to put them or you need some other way to organize your work. That’s a challenge.

The other thing, and this was an experiment that happened in Minnesota, was that one school district started to change their school start times but the other schools around them that they competed in athletic events with kept their old times. And so, the times available to student athletes were at odds with one another, and so they needed to find solutions to that kind of problem.

In some cases, what and I think someone just told me yesterday that this has happened nearby one of the things that schools do is they flip-flop elementary school start times with high school and middle school start times so that elementary school tends to start later. You make those kids wake up a little bit earlier because they tend to be awake a little bit earlier anyways, and you let the high schoolers go to school a little bit later. Usually that’s only the difference of 45 minutes or an hour, and that might be something but it’s probably not enough for most of those students.

One of the and so in the workplace probably most of you are familiar with the idea of flex time, which is that you can come into work late and you just work late, or you work a few really long days and then you take a day off. Right? The challenge has been, and there’s mounting evidence here too, that a lot of people don’t use flex time despite having access to it. And part of it is that they don’t want to be the person who’s coming into work late. You know, if everybody else is in at nine o’clock, they don’t want to be the person that comes in at 10:15 because it makes them look like they’re lazy or they sleep in or whatever the case may be. Right? And people don’t necessarily want to take days off work even when they can, and so the people who tend to use flex time the most are usually women in times when they need to care for children. And so, there’s stigma around using something like flex time.

But in the clinic that where I’d done the sleep research, one of the things that doctors would do, especially when they were seeing high school aged students who had a hard time being at school on time, is rather than medicate those children they would call the principal of their schools and tell them that the student wasn’t available for school before 10 o’clock in the morning. Right? And what they meant was that they may have to be in high school for five years, they might have to take summer school, but you can make that institution flexible in order to meet the needs of those students.

These doctors were actively trying to avoid using a pharmaceutical in recognition that it probably wasn’t the best thing for these students. In a few cases, that didn’t work, and so what they would do is they had a list of private schools in the area that had different school start times. And so, they would often recommend students go to a Catholic school because it started later than the public high school. Right? That all depends on parents being able to pay for that. I mean, five years of high school also depends on parents being willing to house their high schooler for another year. But, you know, these institutions could be more flexible than what they tend to be. Right?

Similarly, right, you can think about flex time as being a possibility in public schools. Right? That you could have long days and short days, and that students could organize themselves much like college students do. Right? That, like, when you are left to be able to organize your own schedule people tend to make a schedule that works for them with some exception for the classes that you absolutely have to take. Right?

And so, this is all to make the argument that what we need to think about are ways to make institutions more flexible. Right? So rather than have 9:00 to 5:00 workdays and 8:00 to 4:00 school days, that we need to think about the possibilities that are latent in the organization of these institutions in the first place and start to work to destabilize them.

Sometimes when I talk about this stuff with people they want to talk about the agrarian basis of these institutions. Right? There is no agrarian basis to these institutions. That, like, waking up at dawn and going to work all day is not something that’s been founded historically. Right? People took naps. We can take naps again.

And so just because we traditionally do it isn’t a good enough reason to keep doing it.

So, point two is thinking about modularity in relationship to institutions. And the two examples I’ll give you are the workplace nap and the staggered day.

And what I mean by this is that there were some experiments with introducing napping to the workplace. And this was mostly in the early 2000s and late 1990s. And the idea was that you would increase worker productivity by letting people take a nap after lunch or whenever they needed to take a nap throughout the day. And so, there were a couple companies who would make, like, desk pillows, and so they would make curtains to put across your cubicle so that you could take a private nap. And they’ll come to your business and proselytize why the workplace nap was a great idea.

The problem was that nobody would ever take those naps. In part, again, because they don’t want to be the person who’s taking a nap at work. And so, often when people are tired, they just go out to their car and take a nap. That they have some privacy in doing it. Because of all the stigma around it right? it wasn’t something that people would happily integrate. And so, there were a couple places that I tracked for a while who eventually did away with the workplace nap all together. They had a cubicle set aside for people to take a nap in, and nobody would ever take a nap in it. And so, they were just done with the possibility.

The other idea to think about is what I think about as the staggered day. And what I mean by that is this is pure fantasy on my part, so bear with me that variation that you see in high schoolers or any school aged student probably matches variation that you see in adults in terms of wakefulness and when people want to be working. And so, you could have some students who start the school day at eight o’clock in the morning and end at 4:00, and you could have some and they have faculty to support that. And you have some students who start the school day at 11:00 and end at 6:00. Right? That you could have and faculty to match those needs too. Right? That you can match faculty interests and abilities to be awake and coherent at various times with student desires to learn and be awake at various times and stagger the institution appropriately.

In big schools and big school districts, that’s probably more of a possibility than in a small school and a small school district. But thinking about the variation in individuals should allow us to think about the variations in a way that an institution might be organized too.

And this is all predicated on my assumption that the institutions that make up our everyday life should really meet our biological needs as much as our social obligations. Right? That if we are best workers at certain times of day, we’re best students at certain times of day, that we should try and find ways to organize those institutions in order to meet those best times. Right?

And the the other thing alongside that is thinking about the individual who changes over the life course. Right? That what works for one individual in one year and one institution isn’t necessarily going to work for the same individual the next year. Right? And so, institutions and their relationships with individuals need to be supple enough in order to address those changing demands on the part of the people that those institutions are meant to serve. Right?

So, the last proposition here is really to stop thinking about the individual and to think instead about what I refer to as the facilitated individual. And so, part of this is recognizing that when we think about the individual what we’re thinking about is a kind of ideological artifact. Right?

That when we think about the individual, there’s a lot of history here that’s preconditioning us to think about you alone as a patient in need of an intervention. And there’s often very little attention to the situation that the individual is coming out of and why they might look the way that they do, which is to say that individuals are really entrenched in society. Right? That they’re entrenched in the network that they’re a part of. And we can’t really extricate them for intervention. We need to think about the network that they’re a part of in order to figure out the right kind of intervention. And that in order to care for individuals, we need to address the whole network. Right? So that might be a family, it might be beyond the family right? but we need to be more attentive to the situation in which people are coming out of. Right?

So so, part of this is thinking about how we move away from pathologization and pharmaceuticalization as individual focused. Right? And so this goes back to the idea of the flexible individual versus the flexible institution. That when we think about the need of an individual to meet the demands of an institution that they’re a part of, often that’s through medicalization. Right? It’s through the categorization of a certain experience of the world as aligning with a diagnostic category and identifying a treatment in order to normalize that individual. And, at least in the United States, this is through the market of medicine right? that people need medical insurance or medical care in order to become normalized.

And, like I was saying before, that’s not necessarily a problem, but it is a problem when we’re not thinking about how institutions might be organized differently to address the same demand. Right?

Alongside that is thinking about providing equal access to institutions that have these kinds of support mechanisms to them. Right? That when we think about something like flex time, it has almost only been available to white collar workers. I mean, university professors are ultimate flex time workers. But beyond that, it’s really the creative class and white collar elites who have access to flex time, and it’s very difficult to think about what flex time would look like for someone who works at McDonald’s when there’s very recognizable shifts and people need to be there at certain times -right? and it’s all managed by participate people in order to meet very specific demands.

And so, one of the challenges here is thinking about what flex time looks like for blue collar or service workers. How might we export flex time as a policy concept to other kinds of context in order to address the same kinds of needs.

And and and, finally, one of the things that we need to think about is incentivizing experimentations with modularity and institutions. Right? That it’s fine for me to kind of come up with these fantastical ideas about how we might organize society and social institutions differently, but we need to think as a society about how we incentivize experimenting with something like school start times. Right?

Because there are deeply entrenched feelings and organizations of society around work and childcare that makes school start time need to occur within a certain window, what can we do in order to support experimental reorganizations of that? Right?

So, it might mean childcare that’s available to people at various times of the day. It might mean staggered work time as much as it means staggered school time. Right? That these propositions for how we reorganize things are kind of interpenetrating and need to be thought about across different kinds of institutions simultaneously.

And moreover, like, that we need to think about institutions as ongoing experiments in a way. That we need to conceptualize how things might change over time to allow for new solutions to emerging problems as we move forward.

So, the sleep to me at this point has become a kind of easy example for thinking about all of this stuff. But you might see resonance in other situations that are similarly, you know, focused on human biological experience of the world. And one of the challenges or maybe one of the it’s a challenge, maybe it’s an analogy is thinking about the human diet. Right?

That over time one of the things that people have become much more attentive to are variations in the capacity of humans to digest certain kinds of things. So, celiac disease is an emergent awareness on the part of most people. And so, the existence of gluten-free options on most menus has really been something that’s happened over the last decade. Right?

It the challenges there, it well, and so I also suggest things like school lunch experiments where, in San Francisco, at least for a while, they were experimenting with introducing kids to things that aren’t just pizza and hamburgers and nuggets. Right? That they would have sushi day and stuff like that. And that by doing that, what you’re doing is you’re allowing for the possibility that children recognize something that they like. Right? And so, in in both cases what I want to think about is how when you offer a breadth of options right? that people are going to find where they fit within those options. Right?

And so rather than thinking about certain kinds of organizational forms as being normative -right? that we need to think about institutional forms as falling along a spectrum of possibilities. Right?

So, you know, one of the other examples that you might think is reproductive normativity, which is something that’s changed significantly over time. So, the providing equal access to things like IVF and egg freezing right? is something that shouldn’t just be market based, but something that other people can apply for too. And, in doing so right? what we’re doing is allowing for various other experiences of the world for people who might not normally have those means. So, this is all a suggestion to get us to consider that when we think about any kind of reformation in institutional organization that we’re making sure that those reorganizations are broadly accessible. Right?

So, finally, and we can have a discussion about this stuff, there- there’s sort of the specter of human nature in all of this. Right?

And one of the challenges, I think, in a lot of contemporary science is this push towards kind of laboratory purification and reductivism and the removal of social influence. Right?

That, like, when people are talking about sleep, often what they’re talking about are is sleep as it’s known through laboratory experiments. Right? And to really know what sleep looks like means that we need to think about sleep in its social contexts.

And what I think this means is really taking the laboratory out of the lab. Right? That thinking about biological phenomena in their lived realities is really important to getting at what human biology actually looks like because it’s always being shaped by social forces. Right? That there’s no human biology that’s outside of society.

Which is to say, maybe, that, you know, when we talk about something like human nature, and I mean that in a big way but also in smaller ways too, that we’re always recognizing that it’s something that’s socially constructed and socially influenced. Right? That there’s no one unitary human nature but biological experiences that are being influenced by social demands and obligations.

And, finally, I think it’s worth thinking about taking experiments out of the laboratory too. Right? That if we start to think about the institutions that make up our everyday lives as experimental institutions in their modularity, that we can start to think about society as a place where experimental possibilities arise. Right? That we can think about organizing school differently in order to see what the produces in students. Right? That if we organize it differently, we might have very different outcomes than what we have now.

And so, I am really happy to talk about that with all of you now. If you’d like me to, I can also talk a bit about methods. I can give you some other examples, but I’m going to turn it over to your questions. So, thanks.

[applause]