Chapter 12. Sex: Evolutionary, Hormonal, and Neural Bases
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By Jesse Singal On paper, Dr. Kenneth Zucker isn’t the sort of person who gets suddenly and unceremoniously fired. For decades, the 65-year-old psychologist had led the Child Youth and Family Gender Identity Clinic (GIC), in Toronto, one of the most well-known clinics in the world for children and adolescents with gender dysphoria — that is, the feeling that the body they were born with doesn’t fit their true gender identity. Zucker had built up quite a CV during his time leading the clinic: In addition to being one of the most frequently cited names in the research literature on gender dysphoria and gender-identity development, and the editor of the prestigious journal Archives of Sexual Behavior, he took a leading role helping devise diagnostic and treatment guidelines for gender dysphoric and transgender individuals. He headed the group which developed the DSM-5’s criteria for its “gender dysphoria” entry, for example, and also helped write the most recent “standards of care” guidelines for the World Professional Association for Transgender Health — one of the bibles for clinicians who treat transgender and gender-dysphoric patients. An impressive career, yes, but it’s doubtful any of this gave him much comfort on December 15. That was when he was called in from vacation for an 8:30 a.m. meeting with his employer, the Centre for Addiction and Mental Health (CAMH), one of the largest mental health and addiction research hospitals in Canada. Given the long-brewing investigation of his clinic by the hospital, it’s unlikely Zucker was feeling optimistic about what awaited him in downtown Toronto. The GIC, which operates out of CAMH, pronounced “Cam-H,” had been standing firm against a changing tide in the world of psychological treatment for children with gender dysphoria. The “gender-affirmative” approach, which focuses on identifying young transgender children and helping them socially transition — that is, express their gender to others through their everyday clothes, name changes, or other means — has been on the rise in recent years, and has become the favored protocol of many activists and clinicians. GIC clinicians, who saw clients between ages 3 and 18, had a much more cautious stance on social transitioning for their younger clients — they believed that in many cases, it was preferable to first “help children feel comfortable in their own bodies,” as they often put it, since in the GIC’s view gender is quite malleable at a young age and gender dysphoria will likely resolve itself with time. © 2016, New York Media LLC
By Sarah Knapton, Science Editor For women, shedding the pounds can feel like a unending struggle of dieting and exercise with little results. But a new study suggests that there could be a reason why females find it more difficult to lose weight than men. Researchers say hormones responsible for regulating appetite, physical activity and energy expenditure work differently in the sexes. "This could have broad implications for medications used to combat obesity, which at present largely ignore the sex of the individual." Professor Lora Heisler, University of Aberdeen The discovery could change the way obesity is tackled through targeted medication, experts at the University of Aberdeen believe. Working with teams from the University of Cambridge and the University of Michigan, they used a mouse model to study how weight gain differs in each sex depending on physical activity and energy expenditure. During the study, researchers were able to transform obese male into lean, healthy mice, but the same transformation did not occur in the female mice. Current obesity medications stimulate the production of POMC peptides in the brain which regulate appetite, increase energy expenditure through heat and encourage movement. But researchers found in female mice the hormones only regulated appetite - they did not have the extra benefits. © Copyright of Telegraph Media Group Limited 2016
By Laurel Hamers As one person at the dinner table leans back, stretches, and opens their mouth in a gaping yawn, others will soon follow suit. Catching a yawn is more likely to occur between relatives than strangers, and scientists believe it’s sign of empathy. Plus, other social primates like chimps and bonobos do it, too. A new study suggests that women (traditionally branded the more empathetic sex) might be more susceptible to copycat yawning than men. Researchers surreptitiously analyzed more than 4000 real-world yawns on planes and trains, in restaurants, and in offices. They noted when someone yawned, and then whether a nearby acquaintance or friend did the same within a 3-minute period. Men and women spontaneously yawned with about the same frequency. But when someone else yawned first, women were more likely than men to follow suit. Women picked up yawns about 55% of the time, whereas men only did so 40% of the time. Women tend to score higher than men on tests of empathy, and traditional female social roles (like child-rearing) place a higher emphasis on those traits. That might make women more attuned to others’ yawns, the researchers suggest. Gender roles aren’t as rigid in our modern society—but the yawning gap appears to linger. © 2016 American Association for the Advancement of Science
By SINDYA N. BHANOO Several studies suggest that men find women more attractive when they are in the ovulatory phase of their menstrual cycle. The thesis takes a strange turn in a new study in which women were questioned: Each subject was asked whether a woman in an image was likely to entice a man that she was dating. Although women do not find images of ovulatory women particularly attractive, scientists found, women with higher estrogen levels did perceive such images to be more threatening. Women with high estrogen, the researchers noted, have a high potential for fertility. “We’re still trying to pinpoint exactly what all is involved in this,” said Janek S. Lobmaier, a psychologist at the University of Bern. © 2016 The New York Times Company
By PAM BELLUCK Women should be screened for depression during pregnancy and after giving birth, an influential government-appointed health panel said Tuesday, the first time it has recommended screening for maternal mental illness. The recommendation, expected to galvanize many more health providers to provide screening, comes in the wake of new evidence that maternal mental illness is more common than previously thought; that many cases of what has been called postpartum depression actually start during pregnancy; and that left untreated, these mood disorders can be detrimental to the well-being of children. It also follows growing efforts by states, medical organizations and health advocates to help women having these symptoms — an estimated one in seven postpartum mothers, some experts say. “There’s better evidence for identifying and treating women with depression” during and after pregnancy, said Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill and an author of the recommendation, which was issued by the United States Preventive Services Task Force. As a result, he said, “we specifically called out the need for screening during this period.” Answers to questions about depression screening and maternal mental illness, following new recommendations saying that women should be screened for depression during pregnancy and after childbirth. The recommendation was part of updated depression screening guidelines issued by the panel, an independent group of experts appointed by the Department of Health and Human Services. In 2009, the group said adults should be screened if clinicians had the staff to provide support and treatment; the new guidelines recommend adult screening even without such staff members, saying mental health support is now more widely available. The 2009 guidelines did not mention depression during or after pregnancy. © 2016 The New York Times Company
Jim Pfaus Self-labeled sex addicts often speak about their identities very clinically, as if they’re paralyzed by a scientific condition that functions the same way as drug and alcohol addiction. But sex and porn “addiction” are NOT the same as alcoholism or a cocaine habit. In fact, hypersexuality and porn obsessions are not addictions at all. They’re not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and by definition, they don’t constitute what most researchers understand to be addiction. Here’s why: addicts withdraw. When you lock a dope fiend in a room without any dope, the lack of drugs will cause an immediate physiological response — some of which is visible, some of which we can only track from within the body. During withdrawal, the brains of addicts create junctions between nerve cells containing the neurotransmitter GABA. This process more or less inhibits the brain systems usually excited by drug-related cues — something we never see in the brains of so-called sex and porn addicts. A sex addict without sex is much more like a teenager without their smartphone. Imagine a kid playing Angry Birds. He seems obsessed, but once the game is off and it’s time for dinner, he unplugs. He might wish he was still playing, but he doesn’t get the shakes at the dinner table. There’s nothing going on in his brain that creates an uncontrollable imbalance.
By Kerry Klein With their suction cup mouths filled with concentric circles of pointy teeth that suck the body fluid of unsuspecting victims, lampreys may seem like the stuff of horror movies. And indeed the 50-centimeter-long, eellike creatures can wreak havoc on freshwater communities when they invade from the sea, with a single sea lamprey able to kill 18 kilograms of fish in its lifetime. Now, the U.S. government has approved of a new way to combat these fearsome fish by using their own sense of smell against them. Sea lampreys are a particular problem in the Great Lakes regions of the United States and Canada. They hitchhiked into the region more than a century ago, likely attaching themselves to ships or fish that traveled along shipping channels from the Atlantic Ocean. Although most lampreys are mere parasites in their native habitats, those in the Great Lakes are far worse, says Nicholas Johnson, a research ecologist at the U.S. Geological Survey’s Hammond Bay Biological Station on Lake Huron in Millersburg, Michigan. “They kill their host, they get too big, they eat too much,” he says. “They’re really more of a predator.” After the toothy invaders proliferated in the mid-20th century, ecosystems all but collapsed, taking prosperous fishing and tourism industries with them. “It’s fair to say that lamprey[s] changed the way of life in the region,” says Marc Gaden of the Great Lakes Fishery Commission, a joint U.S. and Canadian organization based in Ann Arbor, Michigan, that’s tasked with managing the rebounding ecosystems. “Just about every fishery management decision that we make to this day has to take lamprey into consideration.” © 2016 American Association for the Advancement of Science
By SINDYA N. BHANOO Male zebra finches learn their courtship songs from their fathers. Now, a new study details the precise changes in brain circuitry that occur during that process. As a young male listens to his father’s song, networks of brain cells are activated that the younger bird will use later to sing the song himself, researchers have found. As the learning process occurs, inhibitory cells suppress further activity in the area and help sculpt the song into a permanent memory. “These inhibitory cells are really smart — once you’ve gotten a part of the song down, the area gets locked,” said Michael Long, a neuroscientist at NYU Langone Medical Center and an author of the new study, which appears in the journal Science. Zebra finches learn their courtship song from their fathers and reach sexual maturity in about 100 days. At this point, they ignore their fathers’ tutoring altogether, Dr. Long said. In their study, he and his colleagues played recorded courtship songs to young and old birds and monitored neural activity in their brains. In sexually mature birds, the courtship song did not elicit any neural response. Understanding the role of the inhibitory cells in the brain could help researchers develop ways to manipulate this network, Dr. Long said. “Maybe we could teach old birds new tricks,” he said. “And extrapolating widely, maybe we could even do this in mammals, maybe even humans, and enrich learning.” © 2016 The New York Times Company
By Emily Underwood The boisterous songs a male zebra finch sings to his mate might not sound all that melodious to humans—some have compared them to squeaky dog toys—but the courtship tunes are stunningly complex, with thousands of variations. Now, a new study helps explain how the birds master such an impressive repertoire. As they learn from a tutor, usually their father, their brains tune out phrases they’ve already studied, allowing them to focus on unfamiliar sections bit by bit. The mechanism could help explain how other animals, including humans, learn complex skills, scientists say. The study is a “technical tour de force,” and “an important advance in our understanding of mechanisms of vocal learning and of motor learning generally,” says Erich Jarvis, a neuroscientist at Duke University in Durham, North Carolina. Many species—including humans, chimpanzees, crows, dolphins, and even octopuses—learn complex behaviors by imitating their peers and parents, but little is known about how that process works on a neuronal level. In the case of zebra finches, young males spend the whole of their teenage lives trying to copy their fathers, says Michael Long, a neuroscientist at New York University in New York City. It comes out “all wrong” at first, but after practicing hundreds of times, the birds “sound a lot like dad.” In the new study, Long’s graduate student Daniela Vallentin used a tiny electrode implant to record the activity of neurons in a region of the finch brain called the HVC, which is essential for birdsong learning and production. Weighing less than a penny, the implant can be affixed to a bird’s head and record activity in the brains of freely moving and singing birds, Long says. The researchers also used a powerful light microscope to visualize the activity of individual neurons as the birds listened to a fake “tutor” bird that taught young finches only one “syllable” of a song at a time. © 2016 American Association for the Advancement of Science.
David Cox In the spring of 1930, Danish artist Einar Wegener arrived in Berlin for a consultation that he hoped would both save and change his life. Wegener had spent the previous twenty years dressing as a woman, Lili Elbe. In public, his wife, painter Gerda Gottlieb, introduced Elbe as Wegener’s sister . But by 1930 he could not bear his double life any longer. He resolved to commit suicide, even naming a date – May 1. Instead, Wegener made a different choice, electing to undergo a series of pioneering gender reassignment operations, transitioning into Lili Ilse Elvenes, better known as Lili Elbe. Elbe’s extraordinary story remains controversial; indeed, the film The Danish Girl, starring Eddie Redmayne and based on Elbe’s life was this week banned from Qatari cinemas after protests about its “depravity”. Elbe’s revolutionary transition would not have been possible without the contribution of the sexologist Magnus Hirschfeld, a man who had become both renowned and notorious across Europe for his groundbreaking research into human gender and sexuality. While Elbe’s posthumous 1933 biography, “Man into Woman: The First Sex Change”, made her story internationally famous, Hirschfeld is a less well-known figure today. As both a Jew and gay activist, much of his legacy was burnt to ashes when his Institute for Sexual Research was targeted by a Nazi attack in 1933. But through colleagues and pupils, his work has gone on to transform the way we view sexual minorities and has helped make gender reassignment surgery the widely accepted procedure it is today. © 2016 Guardian News and Media Limited o
Keyword: Sexual Behavior
Link ID: 21786 - Posted: 01.14.2016
Eva Emerson Chronic stress takes its toll on everyone. But it may hit women harder (or at least differently) than men, much research finds. New studies in rodents show that females remain sensitive to ongoing stress longer than males do, as Susan Gaidos reports. It remains to be seen whether such results can explain the differences in rates of depression and anxiety disorders in men and women. (Perhaps women are more likely to discuss their symptoms and be diagnosed. Men, on the other hand, are more likely to abuse drugs and alcohol, disorders which may also be related to stress.) Still, the new work offers an intriguing idea: If stress induces distinct biochemical signaling in men and women, perhaps therapies should also be tailored to each sex. Another fascinating line of research mentioned in Gaidos’ story involves altering female mice’s response to chronic stress (making it more like a male’s) by targeting DNA modifications known as epigenetic tags. Consisting of chemicals such as methyl groups, these tags are attached to DNA and influence gene activity. They seem like a perfect target for drugs. Epigenetic tags don’t change the underlying genes, just the instructions for turning those genes on or off, up or down. In the mice, scientists used enzymes to alter the chemical tags on genes involved in the response to chronic stress. It’s an exciting approach, one I’m sure many scientists will try in efforts to modulate the body’s response, not just to stress, but also to other threats to health. Maybe even to fat. A woman’s extra fat can trigger metabolic changes in a developing fetus, Laura Beil reports. Beil describes the latest research about the risks faced by children of obese moms or moms who have gained too much weight while pregnant. Neurological effects are the new twist, and a scary one, given the prevalence of obesity among women of childbearing age. © Society for Science & the Public 2000 - 2015
By Virginia Morell When you hear a bird warbling, you probably think the crooner is a male. And chances are if you’re in the Northern Hemisphere, you would be right. But females also evolved to sing, and many still do—although generally less than the males. One reason may be that it’s more dangerous for them to sing especially when nesting, scientists report today. At least, that’s the case for female fairywrens, the most vocal of which are the most likely to have their eggs and chicks eaten. The study “provides some of the first field evidence indicating why females of so many songbird species might have lost song,” says Karan Odom, a Ph.D. candidate at the University of Maryland, Baltimore, and the lead author of a 2014 study on the evolution of birdsong. Female superb fairywrens (Malarus cyaneus)—a small Australian species—aren’t the only female songbirds that sing. In fact, females sing in 71% of songbird species, often for territorial defense. In species like the superb fairywren, some females even sing when they’re on their nests, a place where, at least theoretically, they should pipe down so as not to attract predators. Rodents, birds, cats, and foxes have all been seen preying on the fairywrens’ nests. “People had observed [this singing in the nest behavior], but they hadn’t investigated it,” says Sonia Kleindorfer, a behavioral ecologist at Flinders University in Adelaide, Australia. “It struck me as odd, and very risky.” © 2016 American Association for the Advancement of Science
Susan Gaidos Muscles tighten, the heart pounds and nausea takes hold: In the face of sudden stress, men and women respond alike. But when threats, scares or frustrations continue for days or months, differences between the sexes emerge. Scientists have long known that women are more likely than men to suffer depression, post-traumatic stress disorder and other anxiety disorders, all of which have been linked to chronic stress, says Temple University psychologist Debra Bangasser. But until recently, studies of people’s responses to such stress have focused primarily on men. Now, a growing number of scientists are studying what happens at the cellular and genetic levels in the brains of stressed-out rodents — male and female — to gain insight into the human brain. The studies are beginning to reveal differences between the sexes that may help explain the variability in their reactions and perhaps even provide much-needed insight into why stress-related disorders are more common in women than men. Recent findings reported at the annual meeting of the Society for Neuroscience, held in Chicago in October, show that a common stress hormone triggers different responses in specific brain cells of male and female animals. The differences make females less able than males to adapt to chronic stress. Other studies are exploring how exposure to the same hormone influences gene expression in a part of the brain that controls mood and behavior. Still other research suggests that a different hormone, associated with trust, could render females more susceptible than males to depression, anxiety and PTSD. © Society for Science & the Public 2000 - 2015.
By Darryl Fears Flushed down toilets, poured down sinks and excreted in urine, a chemical component in the pill wafts into sewage systems and ends up in various waterways where it collects in fairly heavy doses. That's where fish soak it up. A recent survey by the U.S. Geological Survey found that fish exposed to a synthetic hormone called 17a-ethinylestradiol, or EE2, produced offspring that struggled to fertilize eggs. The grandchildren of the originally exposed fish suffered a 30 percent decrease in their fertilization rate. The authors mulled the impact of what they discovered and decided it wasn't good. "If those trends continued, the potential for declines in overall population numbers might be expected in future generations," said Ramji Bhandari, a University of Missouri assistant research professor and a visiting scientist at USGS. "These adverse outcomes, if shown in natural populations, could have negative impacts on fish inhabiting contaminated aquatic environments." The study, with Bhandari as lead author, also determined that the chemical BPA, used widely in plastics, had a similar effect on the small Japanese medaka fish used for the research. The medaka was chosen because it reproduces quickly so that scientists can see results of subsequent generations faster than slow reproducing species such as smallmouth bass.
Katherine Hobson Pregnant women worry about all kinds of things. Can I drink alcohol? (No.) Can I take antidepressants? (Maybe.) Can I do the downward dog? (Yes.) Now there's one less thing to fret about: harm to the baby when the mother takes birth control pill right before conceiving, or during the first few months of pregnancy. According to a study covering more than 880,000 births in Denmark, the overall rate of birth defects was consistent for women who had never taken the pill at all, for those who had used it before getting pregnant and for those who continued on the pill in early pregnancy. (There were about 25 birth defects per 1,000 births for all groups.) The study is important because so many women take the pill – about 16 percent of women of childbearing age in the U.S. When used perfectly, the failure rate of the pill is less than 1 percent, but that jumps to 9 percent under typical use because of missed pills, drug interactions or illness. That means a lot of embryos are exposed to the hormones used in the pill, which can linger for a few months after a woman stops taking it. "Our findings are really reassuring," says Brittany Charlton, an author of the study and a researcher in the Harvard T.H. Chan School of Public Health's epidemiology department. The results also confirm most of the previous research, which has pointed to no overall increase in major birth defects, she says. This study, published in the medical journal BMJ, used national birth, patient and prescription registry data to track contraceptive prescriptions among women who gave birth, then looked at whether birth defects were associated with pill use. © 2016 npr
By Debra W. Soh What should parents do if their little boy professes an intense desire to be a girl? Or if their daughter comes home from kindergarten and says she wants to be a boy? In recent years the dominant thinking has changed dramatically regarding children’s gender dysphoria. Previously, parents might hope that it would be a passing phase, as it usually is. But now they are under pressure from gender-identity politics, which asserts that children as young as 5 should be supported in wanting to live as the opposite sex. Any attempts to challenge this approach are deemed intolerant and oppressive. I myself was a gender-dysphoric child who preferred trucks and Meccano sets to Easy-Bake Ovens. I detested being female and all of its trappings. Yet when I was growing up in the 1980s, the concept of helping children transition to another sex was completely unheard of. My parents allowed me to wear boys’ clothing and shave my head, to live as a girl who otherwise looked and behaved like a boy. I outgrew my dysphoria by my late teens. Looking back, I am grateful for my parents’ support, which helped me work things out. Since then, research has established best-treatment practices for adolescents and adults with gender dysphoria: full transitioning, which includes treatment with hormones to suppress puberty and help the individual develop breasts or facial hair, as well as gender-reassignment surgery. But prepubescent children who identify with the opposite sex are another matter entirely. How best to deal with them has become so politicized that sexologists, who presumably would be able to determine the healthiest approach, are extremely reluctant to get involved. They have seen what happens when they deviate from orthodoxy. ©2016 Dow Jones & Company, Inc
By Darryl Fears For male smallmouth bass, sex change is increasingly not an option. In the chemical-laced Chesapeake Bay watershed and in rivers up through New England, it comes with the territory. Based on the latest U.S. Geological Survey on intersex fish, 85 percent of male smallmouth bass in waters in and around national wildlife refuges in the Northeast have developed "characteristics of the opposite sex." That's in addition to 90 percent of the species in some West Virginia waters and 50 percent to 100 percent in the southern stretch of the Potomac River. All of the affected fish had eggs where their testes should be, according to previous studies. Why this is happening remains a mystery, says the lead author of a new study, despite the problem being detected more than a decade ago. “It is not clear what the specific cause of intersex is in these fish,” said Luke Iwanowicz, a USGS research biologist. “This study was designed to identify locations that may warrant further investigation." The strongest suspicion focuses on what is poured down the drains of homes, businesses and farms every day. Scientists are worried that prescription drugs such as birth control and mood-control pharmaceuticals, flushed down toilets, and chemical pesticides such as atrazine, washed off farms by rain, have turned creeks, streams and rivers into chemical soups that disrupt the endocrines of marine life.
By Gary Stix A lingering question asked by neuroscientists has to do with what, if anything, makes the male and female brain distinctive, whether in mice or (wo)men. There is still no concise answer. The best evidence from the most recent research suggests that both males and females share the same neural circuitry, but use it differently. Catherine Dulac, a professor of molecular and cellular biology at Harvard, and investigator at the Howard Hughes medical Institute, is a pioneer in exploring these questions. I talked to her briefly about her research, which also extends far beyond just the neurobiology of gender. Can you tell me in broad overview about what you study? I'm interested in understanding how the brain engages in instinctive social behaviors. There are a lot of instinctive behaviors such as eating and sleeping that are essential in animals and humans, but social behavior is a very distinctive and particularly interesting set of instinctive behaviors that we would like to understand at the neuronal level. What we would like to understand in mechanistic terms is how does an individual recognize other animals of its own species, for example how does an animal identifies a male, a female, or an infant, how does the brain processes these signals in order to trigger appropriate social behaviors such as mating, aggression or parenting. Can you tell me a little bit about your work of the last few years that relates to gender identification? © 2015 Scientific American
By Katrina Schwartz It has become a cultural cliché that raising adolescents is the most difficult part of parenting. It’s common to joke that when kids are in their teens they are sullen, uncommunicative, more interested in their phones than in their parents and generally hard to take. But this negative trope about adolescents misses the incredible opportunity to positively shape a kid’s brain and future life course during this period of development. “[Adolescence is] a stage of life when we can really thrive, but we need to take advantage of the opportunity,” said Temple University neuroscientist Laurence Steinberg at a Learning and the Brain conference in Boston. Steinberg has spent his career studying how the adolescent brain develops and believes there is a fundamental disconnect between the popular characterizations of adolescents and what’s really going on in their brains. Because the brain is still developing during adolescence, it has incredible plasticity. It’s akin to the first five years of life, when a child’s brain is growing and developing new pathways all the time in response to experiences. Adult brains are somewhat plastic as well — otherwise they wouldn’t be able to learn new things — but “brain plasticity in adulthood involves minor changes to existing circuits, not the wholesale development of new ones or elimination of others,” Steinberg said. Adolescence is the last time in a person’s life that the brain can be so dramatically overhauled. © 2015 KQED Inc.
By BENEDICT CAREY Dr. Robert L. Spitzer, who gave psychiatry its first set of rigorous standards to describe mental disorders, providing a framework for diagnosis, research and legal judgments, as well as a lingua franca for the endless social debate over where to draw the line between normal and abnormal behavior, died on Friday. He was 83. From Our Advertisers Dr. Spitzer died from complications of heart disease at the assisted living facility where he lived in Seattle, his wife, Janet Williams, said. The couple had moved to Seattle from Princeton, N.J., this year. Dr. Spitzer’s remaking of psychiatry began with an early interest in one of the least glamorous and, historically, most ignored corners of the field: measurement. In the early 1960s, the field was fighting to sustain its credibility, in large part because diagnoses varied widely from doctor to doctor. For instance, a patient told he was depressed by one doctor might be called anxious or neurotic by another. The field’s diagnostic manual, at the time a pamphlet-like document rooted in Freudian ideas, left wide latitude for the therapist’s judgment. Dr. Spitzer, a rising star at Columbia University, was himself looking for direction, increasingly frustrated with Freudian analysis. A chance meeting with a colleague working on a new edition of the manual — the Diagnostic and Statistical Manual of Mental Disorders, or the D.S.M. for short — led to a job taking notes for the committee debating revisions. There, he became fascinated with reliable means for measuring symptoms and behavior — i.e., assessment. “At the time, there was zero interest in assessment,” said Dr. Michael First, a professor of clinical psychiatry at Columbia. “He saw how important it was, and his whole career led to assessment being taken seriously.” © 2015 The New York Times Company