Dear Dr Ash,

I’m the mother of two children, a boy (16) and a girl (13) – or at least I thought I was, until my son announced about a year ago that he felt himself to be a girl. He has always had longish hair and preferred fantasy games like Dungeons and Dragons to playing sports. Now he wears his hair in a long ponytail, paints his fingernails black and raids his younger sister’s wardrobe for cardigans with a bias cut. My husband and I consider ourselves liberal and relatively woke – and we reacted calmly and, I hope, acceptingly, glad that he was talking to us about it, though we both felt it very likely that this was just a phase and was unlikely to last. Then, about two months ago, our daughter announced that she was in fact a boy – she has cut her hair very short and now raids her older brother’s wardrobe for jeans and shirts. Our patience has become a bit stretched. Why do they feel this need to change gender categories? Surely my daughter is just a tomboy – as I was at her age – and my son just a nerdy boy who happens not to like football?

Befuddled,
Birmingham

After hundreds of hours looking at MRIs, I could never tell which scans belonged to men and which to women

Dear Befuddled,

So often the natural world seems to conform to what we expect: only later do we learn that our expectations have blinded us to the truth. I often think about primatologist Jane Goodall in this context. In the early 1960s, when Goodall went to Africa to study chimpanzee tribes in their native environments, scientific research had established that chimps were vegetarian, unable to use tools and could only exhibit simple social dynamics. Goodall, through the simple but extremely arduous method of careful and constant observation, demonstrated that chimps did eat meat, that they could fashion elaborate tools for foraging, and that their social structures enabled both organised tribal warfare and astonishing examples of love and compassion. As it turns out, until Goodall, no one had really taken the time to look.

When I was in medical school, a similar blindness afflicted the study of gender in neuroscience. Since men were obviously different from women, I was taught, their brains must be different as well. I assumed that endless research studies supported this reasoning, and also it just made sense – foetal exposure to hormones like testosterone and oestrogen changed the body, so they must change the brain too. But after hundreds of hours spent in dark radiology labs looking at MRIs, I could never tell which scans belonged to men and which to women. I figured that maybe I was just bad at it, or that the distinctions were there but too subtle to see on a brain scan.

Then in the early 2000s a series of papers from Daphna Joel and her colleagues at Tel-Aviv University began to challenge the established dogma. Joel looked at scans of thousands of male and female brains, and found that, yes, on average, there were some differences. But zooming in to the level of the individual, Joel found it impossible to characterise any given brain as male or female. What was true of the average was not true of any actual person. Instead, she demonstrated that very small regions of each person’s brain could be classified as more characteristically male or more characteristically female. You might have a typically male hippocampus, for example, but a typically female amygdala. She argued that any individual brain was a composite or “mosaic” of these gendered regions.

And since structure correlates with function, our gendered behaviours are probably mosaics too. I suspect both of your children are simply realising that their emotional and sexual identities are complex and varied, and they don’t feel stereotypical gender patterns describe their experiences. What they may not be aware of, though, is that stereotypical patterns don’t describe anyone’s experiences. The average family in the UK has 1.74 children but I have yet to meet 0.74 of a child in a playground; averages are rarely typical. Your children are experimenting with their identities, and find that the categories they’ve been handed are inadequate. I encourage continued patience; they may be closer to the truth of human nature than you and I have ever been.

Best wishes
Dr Ash

Dear Dr Ash,

My partner and I recently moved from London to a village in Somerset and have been introduced to quite a few couples by friends of friends – which is great, but I’m struggling to make sense of this new social circle. I was warned that it was easier to buy crystals than a toothbrush in Glastonbury (our nearest town) but I hadn’t expected everyone to be quite as into ley lines, druids and dowsing as they are here. I grew up in rural Devon, so I’m not particularly urban in outlook, but it’s hard to take people seriously when they ask if you’ve had your house cleansed of its previous occupants, or consulted with the spirits in your back garden before deciding to plant a new tree. My partner says I’m being closed-minded and overly rational, but isn’t it about just being a grown-up and no longer believing in fairies?

Sceptical,
Somerton

We use stories to help frame our intuitions and guide our actions

Dear Sceptical,

The compulsion to tell stories is an ancient one, and Somerset lends itself to storytelling. Towards the east, Stonehenge shoots up out of the flattest part of the Salisbury plain. The small villages on the border with Dorset were reputedly the site of ancient Camelot, where King Arthur and his knights were beset by witches and dragons with alarming regularity. Glastonbury Tor itself is visible for many, many miles in every direction. It’s hard to get away from talk about fairies and spirits for long.

But as I’ve got older, I have begun to wonder about fairy tales in science too. Many of the truths I thought I knew at the beginning of my career, well-established findings in molecular biology, genetics, and neuroscience, have been brought into question as time has gone on. Some of these findings have been modified as more evidence has accumulated; others have been overturned outright. The cognitive sciences in particular have suffered from a “replication crisis” in which iconic experiments don’t quite work out as they should when new teams with better methods attempt to repeat them.

At the same time, my faith in scientific and medical intuition has grown. As a doctor, I now realise that a lot of what I have learned over the years has become embodied, even pre-conscious. A very specific sound in someone’s cough that can predict pneumonia, a pallor on the eyelid that can happen in anaemia, the barest trace of a shuffle in someone’s footsteps that makes me look for a limp or even for Parkinson’s. After decades of observing signs and symptoms, what was once explicit knowledge has started to feel more like, well, just a gut feeling.

George Box, a British statistician in the early twentieth century, famously wrote that “all models are wrong but some are useful.” He was referring to mathematical models, but his statement could be applied to any theory that simplifies reality into categories, averages and abstract concepts. Scientific models, or spiritual ones about fairies and ley lines, are almost certainly all wrong. But, as Box says, some are useful. If a water dowser is able to find water, it doesn’t really matter what mental model they use to explain their intuitions. If spiritually “cleansing” a house helps you to feel more at peace there, it doesn’t really matter if that involves waving smoking sage leaves around its rooms. We use stories to help frame our intuitions and guide our actions. The material reality behind those stories matters less than the guidance we take from them.

My advice to you is to embrace your new neighbours and listen to what they have to say. Perhaps they are intuiting features of the landscape that you too could tune into, which might even give you a richer connection to your new home. Equally, perhaps they are just nuts. But isn’t it more fun to live in a world with a few fairies than one with absolutely none?

Best wishes
Dr Ash