The Trouble with Testosterone

by Robert M. Sapolsky

  Scientists have known for decades that people in the developing world are particularly good at retaining salt and water, that they often have hair-trigger metabolisms that are markedly efficient at storing circulating sugars. These highly adaptive, evolved physiologic traits are called “thrifty genes.” This represents a classic case of viewing the world through Western-colored glasses. It’s not that people in the developing world have particularly thrifty metabolisms. They have the same normal metabolisms that our ancestors did, and that nonhuman primates have. The more apt description is that Western surplus allows for the survival of individuals with sloppy genes and wasteful metabolisms.

  Semantics aside, what happens when people in the developing world suddenly get access to Western diets, the newly emerging middle class of the Third World luxuriating in tap water and supermarkets stocked with processed sugars, a chicken in every pot and a saltshaker on every dinner table? Bodies that retain every bit of glucose and every pinch of salt now develop big problems. Throughout Africa, the successful middle class now suffers from a veritable plague of hypertension, hypertension known to be driven by renal water retention rather than by cardiovascular factors as is more often the case. And throughout the developing world, there are astronomically high rates of insulin-resistant, adult-onset diabetes, an archetypal Western disease of nutrient surplus—for example, among some Pacific islanders, Western diets have brought them ten times the diabetes rate found in the United States. There’s a similar, if more complex, story having to do with non-Western patterns of stomach acid secretion as a defense against oral pathogens, with the price of a greatly increased risk of ulcers once you adopt a Western lifestyle. The punch line over and over—you don’t want to receive the gift of a Western diet until you have a Westernized pancreas or kidneys or stomach lining.

  Joseph and his hypertension seemed to fit this picture perfectly. But as I’ve thought more about him, I’ve become convinced that he suffered from an additional feature of partial Westernization. And this is one that I now recognize in a number of my African acquaintances—a lecturer at the university, nearly incapacitated by his stomach ulcer; an assistant warden in the game park, racked with colitis; a handful of other leisure-suited hypertensives. As a common theme, they all take their newly minted Western occupations and responsibilities immensely seriously in a place where nothing much ever works, and they haven’t a clue how to cope.

  Africa is a basket case, to the endless despair of those of us who have lived there and have grown to love it and its people. Find its corners that are still untouched by the maelstroms of this century, and villagers thrive there with wondrous skill and inventiveness. But much of the rest of it is a disaster—AIDS, chloroquine-resistant malaria, and protein malnutrition; deforestation and desertification; fuel shortages and power outages; intertribal bloodbaths, numbing shuffles of military dictatorships, corrupt officials in their Mercedes gliding through seething shantytowns; Western economic manipulation, toxic pesticides dumped there because they’re too dangerous to be legal in the West, decades of homelands turned into battlegrounds for proxy superpower wars. In a setting such as that, who could possibly care that the soufflé has fallen? Yet Joseph did.

  Running a lodge was a hopeless task. During peak tourist season, the front office in Nairobi would sell more rooms than existed and leave Joseph to deal with the irate tourists. The ancient generator on the freezer would expire, a spare part would be weeks away, and all the food would rot, leaving Joseph to negotiate with the local Masai to buy leathery old goats and curry them up beyond recognition for the evening dinner. The weekly petrol truck would be rolled off some bridge on the trip from Nairobi by its drunken driver, stranding all the lodge vehicles as the tourists lined up for their game drives. I’d seen plenty of other managers, before and after Joseph, hide in the curio shop, masquerade as a chef, dodge all responsibility when some major snafu occurred. But Joseph, instead, would patiently wade into the middle of each crisis, take responsibility, issue apologies, and sit worrying in his office late into the night, searching for ways to control the uncontrollable. As would my lecturer friend, trying to do his research amid no funding, the university constantly closed because of antigovernment protests. And as would the assistant warden, actually caring about the well-being of the animals while his boss was busy elephant poaching, the government going months without paying him, or his armed rangers shaking down the local populace for cash. A mountain of findings in health psychology has taught us that the same physical insult is far more likely to produce a stress-related disease if the person feels as if there is no sense of control, and no predictive information as to how long and how bad the stressor will be. And the task of trying to make the unworkable work constitutes a major occupational stressor.

  It seems to me that these individuals festered in their stress-related diseases in part because their jobs, if taken seriously instead of as window dressing, were inordinately more stressful than are the equivalent ones in the West. But in addition, the truly damaging feature of their partial Westernization was that they lacked some critical means of coping. The keys to stress management involve not only gaining some sense of control or predictability in difficult situations, but also having outlets for frustration, social support, and affiliation. The frequent chaos around these men like Joseph often guaranteed little or no sense of control or predictability. And the other features were missing as well. There was no resorting to the stress-reducing outlets we take for granted.

  Imagine an ambitious young turk on the fast track of some high-powered, competitive profession, working the corridors of power in the company’s headquarters in New York or L.A., someone finding the job to be increasingly stressful and abusive. What advice would you give? Go talk to the boss about the problems that need to be corrected; if need be, go over the incompetent superior’s head or make an anonymous suggestion about the changes needed. Drop out of the rat race and go back to the carpentry you’ve always been good at, or maybe answer that headhunter’s phone call and interview with some other company in the business. Get a hobby, do some regular exercise to let the steam out. Make sure you have someone to talk to—a spouse, a significant other, a friend, a therapist, a circle of people in the same business who’d understand; just make sure you’re not carrying this burden alone.

  It’s an obvious list that comes to mind readily for most of us, as if we learned it in some Type A’s Outward Bound course for surviving in the canyons of the urban outback. And for the stressed white-collar professional in a place like Kenya, few of these coping mechanisms are ever considered, or would work if they were tried. Repeatedly, in conversations with Joseph and my other friends and acquaintances in his position, I would try to import some of those ideas, and slowly learned how inapplicable they were.

  Businesses are run in a strictly hierarchical fashion owing much to the elder systems in many villages. (I once had a wonderfully silly conversation with a young bank officer with endless who’s-on-first-what’s-on-second confusion—Now let me get this straight, it’s your village chief who has picked out a wife for you and who tells you when is the best time for the wedding, but it’s your bank chief who tells you what you should feed the guests at the wedding, but it’s your village chief who . . .). One does not tell the boss how to run his business, one does not go over someone’s head; this is a work world without suggestion boxes. Exercise for its own stress-reducing sake is unheard of; Africa, a century behind us in the trappings of conspicuous consumption, demands that its successful men look like bloated nineteenth-century robber barons, instead of like our lean, mean sharks cutting deals on the racquetball court. Hobbies are unheard of as well; no hotel chain, worrying about its stressed executives, encourages them to take up watercolors or classical guitar.

  The nouveau Westerner in the developing world also often lacks the stress relief that we feel in knowing that there are alternatives. You don’t decide to drop out, accept the smaller paycheck but at least be happy—there’s t
ypically a village of relatives depending on your singular access to the cash economy. Furthermore, you can rarely pick up and work for the opposition—there’s only a handful of hotel chains, only one university, only one game park service; the infrastructure is still too new and small to afford many alternatives to a bad situation. And intrinsic in this is another drawback—there is less likely to be a peer group to bitch and moan with after work as an outlet, as people often have situations that are one of a kind.

  The isolation and lack of social support has an even more dramatic manifestation. In a place like Kenya, the individuals who have been successes and have entered the cash economy—typically men—usually work in the capital or in one of the cities or, for some specialized job, in some distant outpost like a game park. And their wives and kids are back farming the family land in their tribal area (this pattern is so extreme that it has been remarked that Africa has evolved a form of gender-specific classism, with men forming the urban proletariat, and women, the rural peasantry). The average man in the workforce sees his family perhaps one month a year on home leave. You’ll meet men who, when asked where they live, will say the name of their tribal village, at the other end of the country, and add as an afterthought, “But I’m working now in Nairobi,” the capital—something they’ve been doing for twenty years. They just happen to spend eleven months a year temporarily sleeping near their workplace—far from their loved ones, far from the members of their tribe (a point of identification that has no remote equivalent for even the most ethnocentric of us in the West), in a country with few telephones to phone home and no such thing as quick weekend shuttle flights. And to my knowledge, there is no Westernized institution in all of Kenya that would say, “Well, given that you are such a success in the stressful position we have put you in, we’re going to come up with some bonus money for someone to farm your family land so that your wife and kids can live here with you.” There simply isn’t the mind-set for considering that solution.

  Perhaps the most unsettling lack of a coping mechanism is that there is little that can be done when something bad and unfair happens, and that could happen at any moment. It was often sheer luck that launched someone successful into this new world in the first place—in a lodge, the brightest individual around might be some pot washer stuck back in the kitchen, a man with a frustrated brilliance whose poor family couldn’t pay school fees past the first few years, while the manager wound up where he was because he was the nephew of the subchief of the right tribe; no one’s heard of Horatio Alger yet. And many of the nouveau Westerners I’ve gotten to know—catapulted into the new world by luck—are diligent, capable, and meritorious. Nevertheless, those traits still won’t prevent it from all being yanked away at a moment’s notice—a superior develops a grudge, there’s another shuffle in the government and a new tribe emerges ascendant, and the job is suddenly gone. And there are few unions to defend you, few grievance boards to appeal to, no unemployment insurance. There is never the solace of knowing that there is redress, and the ground is never solid. And so, with a table filled with food each meal, with a king’s ransom of salt always available, and with worries that never subside and tomorrow always seeming uncertain, a price is eventually paid.

  Strong and pragmatic words have been written about the malaise of the developing world. Some of the most trenchant and unsparing have been written about Africa by one of its own, the political scientist Ali Mazrui. He views the economic, societal-wide problems of Africa as one of partial Westernization: “We borrowed the profit motive [of the West] but not the entrepreneurial spirit. We borrowed the acquisitive appetites of capitalism but not the creative risk-taking. We are at home with Western gadgets but are bewildered by Western workshops. We wear the wristwatch but refuse to watch it for the culture of punctuality. We have learnt to parade in display, but not to drill in discipline. The West’s consumption patterns have arrived, but not necessarily the West’s technique of production.”

  An author like V. S. Naipaul, another jaundiced son of the developing world, has written of the same process of partial Westernization on the individual level, his characters often lost in limbo between the new world they have not quite yet joined and the traditional one they can never return to.

  And the scientists concerned with thrifty genes merely describe a more reductive version of the price of partial Westernization. To which I add my observation that you don’t want a Western lifestyle until, along with your Westernized physiology, you have Westernized techniques of stress management as well.

  I once listened to a group of musicians playing in the lowest level of the labyrinthine Times Square subway station in New York, Peruvian Indians in traditional clothes, playing gorgeous Andean music with their hats out for change. Maybe these guys had already become slick New Yorkers with a good street act, but it was impossible to hear their music and not to think of the wispy memories of mountains they must have had in their heads, down there in the bowels of the urban earth.

  Many of us in this country are only a few generations removed from the immigrant ancestors who made the long journey to this new world. Most who made that move would term it a success—they survived, even thrived, or at least their kids did, and they were now free of the persecution that had caused them to flee their homes. But regardless of the successes and benefits, the immigrant experience often exacted a considerable price for that first generation, the ones with only partially acculturated minds and bodies, the ones who forever carried those wispy memories of their world left behind.

  After that summer of our blood pressure luncheons, Joseph was transferred to managing a different hotel, and we lost track of each other. I recently received word that his hypertension had indeed killed him, at age forty-eight. I am sorry that he is gone, as he was a good man. I hope his children will be able to experience the Western world that he gained for them more healthfully than he could. Before him, I only knew about immigrants who weathered long boat journeys in steerage in order to arrive, dislocated, in a new world. But now I realize the extent to which it is possible to be an immigrant in a dislocating new world that has journeyed to you.

  FURTHER READING

  The subject of thrifty genes can be found in a piece by the originator of the concept: J. Neel, “The Thrifty Genotype Revisited,” in J. Kobberling and R. Tattersall, eds., The Genetics of Diabetes Mellitus (London: Academic Press, 1982), 283. For a discussion of the hypertensive consequences of plentiful salt in the developing world, see J. Diamond, “The Saltshaker’s Curse,” Natural History, October 1991, 20.

  An overview of the building blocks of coping and stress management can be found in chapters 10 and 13 of my book Why Zebras Don’t Get Ulcers: A Guide to Stress, Stress-Related Diseases, and Coping (New York: W. H. Freeman, 1994).

  The Ali Mazrui quote is from a BBC special called The Africans. Similar sentiments occur in his book by the same title (Boston: Little, Brown, 1986).

  The Dissolution of Ego Boundaries and the Fit of My Father’s Shirt

  Alfredo Castañeda, El Puerto de Vera Cruz, 1993; courtesy Mary-Anne Martin/Fine Art, New York

  I’ve been wondering lately how many bodies a person needs, not a question that would normally interest me as a scientist. Yet this question has crept in, and I’m no longer sure of the answer.

  In retrospect, I realize that I once watched someone inhabit two bodies. It was Stephen Hawking, the astrophysicist as much famed for his Lou Gehrig’s disease as for his work. He came to my graduate school to lecture on the beginning and end of time. Or perhaps the point, which I could barely catch with my rudimentary physics, was that time had no beginning or end. It was a dozen years ago and he could still move his mouth a bit, generating a gargly, novocainized, incomprehensible voice.

  We packed the auditorium, biochemists and physiologists and geneticists, attending a lecture we would not understand to bear witness to Hawking’s body melted by disease and his mind knowing whether time began. The door at the rear of the stage opened t
o reveal the university’s four physics professors carrying Hawking, facing backward in his wheelchair. None were young men, they panted visibly, but it seemed as if only they could carry out this task, that if you did not understand special relativity or the mathematics of time’s arrow and touched his wheelchair, you would be vaporized.

  His chair was placed center stage, still facing backward. The professors fled, never turning their backs on him. A stillness descended, followed by a whirring sound. His electric wheelchair rotated toward us, and we were confronted with a shriveled, mummified husk staring from behind horn-rim glasses. We inhaled as one, as if to chant ritualistically in some dead language.

  So we sat there, paralyzed by this mummy brain from the crypts, when a young guy in jeans and corduroy jacket and tousled blond mane entered the stage. He had an offhanded, rolling gait. He was sauntering on the same stage as Stephen Hawking. He looked like he had just rolled out of bed and was still preoccupied with whomever he had left there. He walked up behind Hawking, readjusted his hair, and shoved the wheelchair forward.

  Jesus, Hawking is rolling to the edge of the stage. We’re dumbstruck, watching this rock star assassin murder Stephen Hawking. As the mummy brain approaches his doom, at the last second, the kid stops him. He roughly positions Hawking toward the audience, turns to us, and in an arrogant English public school voice says, “You know, you’re not in church.”

  The kid seats himself next to Hawking, gripping the microphone like he’s doing Vegas. This, apparently, is to be Hawking’s voice, the person who will interpret the strangulated raspings for us.

  Hawking begins and is indeed incomprehensible. Muffled garglings, pauses suggesting sentence structure, and the arrogant voice translating. “Today, I will discuss some theories of mine concerning the beginning and end of time. In some cases, these theories have been experimentally confirmed. In others, there has not yet been sufficient time for their confirmation.” We chuckle—cocky bastard—before we catch ourselves, How could you think that about Stephen Hawking?