Amanita muscaria mushrooms, a poisonous variety, are seen at a garden in Poland on October 2, 2022. | Jakub Porzycki/NurPhoto via Getty Images When AI comes for mushroom foragers. Six months ago, I spoke with a man named Elan Trybuch about a problem he was seeing online. He kept coming across different ebooks about mushroom foraging that looked somehow off. Off as in: maybe poisonous. The books were shorter than most foraging guides were, and way, way cheaper, says Trybuch. He’s a software engineer and volunteer secretary for the New York Mycological Society, a nonprofit devoted to “spreading knowledge, love and appreciation of fungi.” He knows mushrooms and he knows AI, and he thought the covers of these books were probably AI-generated. “They had mushroom structures that don’t quite make sense,” says Trybuch. They were the mycological equivalent of a picture of a hot blonde with six fingers and too many teeth. Most disturbing was the information inside the books was totally wrong. “They aren’t even giving you descriptions of real mushrooms. They’re giving you something completely made up,” Trybuch says. Any readers looking to try to use these books to figure out which mushrooms were safe to eat and which weren’t would be out of luck, which to Trybuch was seriously concerning. “It could literally mean life or death” if you eat the wrong mushroom, he says. The problem of very low-quality, very low-priced, probably at least partially AI-generated ebooks is not confined to mushroom foraging. Garbage ebooks have been a problem on Amazon for at least a decade, but — not unlike many strains of fungi — they’ve exploded over the last few years. I spent months investigating the shadowy economy where they’re produced, and what I learned took me by surprise. Inside the scammy world of garbage ebook publishing Garbage ebooks are all over Amazon’s Kindle store, on every topic. Searching for Jonathan Haidt’s bestselling new book The Anxious Generation, I found Jonathan Haidt: The Biography of Jonathan David Haidt, Navigating Morality and Policy; A Joosr Guide to... The Happiness Hypothesis by Jonathan Haidt: Finding Modern Truth in Ancient Wisdom; and The Jonathan Haidt Story: Exploring the Life and Work of a Renowned Social Psychologist, Author, and Advocate. None of these are actually books so much as book-shaped digital files, designed to be picked up in keyword searches and get clicked on in a hurry by someone a tiny bit distracted or not digitally savvy enough to notice what they’re doing. This kind of grift has been around for a while. Now, with the rise of large language models, garbage ebooks have become easier and cheaper than ever to make. Garbage book grifters often don’t use AI to write their books, but they do use it to pick a topic and build an outline. Then they give the outline to a wildly underpaid ghostwriter to flesh it out into something that will pass muster as a real book. The model is a dangerously inviting prospect for anyone who’s ever toyed with the idea of publishing a book but doesn’t want to actually write one. It turns out, though, that the people who make garbage ebooks mostly lose money. The real cash seems to come from the people who teach others the garbage ebook scheme. These teachers claim they’ve shared the key to a life of passive income, but their students say all their courses offer is demands for more and more money, with the ever-deferred promise to teach you the real secrets to easy money once you’ve paid just a few thousand more dollars. Even these grifters are not the real villains. They are often small-time operators working one level of a very big grift industry. The grift is that technology and retail platforms have incentivized a race to the bottom when it comes to selling books. They’ve built an ecosystem where all the incentives are to sell at high volume and low cost. In book production, the biggest cost-saving and time-saving measure you can take is cutting out the labor of writing the actual book. Together, without ever caring enough about the issue to deliberately try to do so, these corporations have built a landscape in which it’s hard to trust what you read and hard to sell what you write. In the end, everyone loses: the would-be writers getting grifted in a fake publishing school, the real writers whose products are getting choked out of the marketplace by floods of cheap garbage, and the readers who just want to be able to buy a book without having to check to make sure the author isn’t a robot. I asked Elan Trybuch if he thought anyone was buying all those fake mushroom foraging guides. “Yeah,” he said. “I mean, there’s a sucker born every minute.” Read the full article here. This version of the story appeared originally in Today, Explained, Vox’s flagship daily newsletter. Sign up here for future editions.

Yuliia Antoshchenko/Getty Images The costly procedure was supposed to give women a new kind of freedom. Is that what it really offers? “For me, it was almost like a message from the universe,” says MeiMei Fox. It was 2009, and Fox was a 36-year-old divorced writer and editor when she sat down to interview a fertility specialist for an upcoming book. He pulled out a chart showing female fertility after age 35 — in her memory, a curve swooping exponentially downward. “I was like, holy moly, this is not a pretty picture,” Fox recalled. She’d always wanted a family, but since her divorce, she hadn’t met the right person to share it with. That’s why she took notice when she and the doctor discussed a technology called egg freezing, still experimental, that could help preserve people’s eggs until they were ready to have kids. At about $10,000, it was expensive, and typically not covered by insurance. She started pulling the money together right away. Fox was an early adopter of a technology that was about to explode in popularity. Initially used primarily by people undergoing chemotherapy or other treatments that can harm fertility, the procedure became more mainstream after the American Society for Reproductive Medicine (ASRM) announced in 2012 that it should no longer be considered “experimental.” Since then, the number of egg-freezing cycles performed each year has skyrocketed, from around 7,600 in 2015 to 29,803 in 2022, the most recent year for which data is available, according to the Society of Assisted Reproductive Technology. In the beginning, expectations were high. Despite the eye-popping cost of the procedure, experts predicted it would usher in a new era of gender equality and career advancement for women. A now-famous 2014 Bloomberg BusinessWeek cover story promised a new option for professional women: “Freeze Your Eggs, Free Your Career.” Big companies such as Facebook and Apple started covering egg-freezing expenses for employees. Startups devoted to the procedure began wooing potential customers with parties and prosecco — and attracting millions in VC funding. Egg freezing was also hailed as the next big step in reproductive health. “It was supposed to revolutionize the whole field just as much as the birth control pill did,” says Janet Takefman, a reproductive health psychologist at McGill University. For Fox and for many, many people who underwent the procedure, however, freezing their eggs was more than just a medical decision; after an increasingly frantic race against the clock to find a partner, it felt like a way to take back control over their own lives. “Oh my god, I just bought myself years,” Fox remembers thinking. “The stress level went way down.” Many patients report the same sense of relief after making the decision to freeze eggs. Marcia Inhorn, a professor of anthropology and international affairs at Yale, interviewed more than 100 women about their egg-freezing experiences for her 2023 book, Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs. After the procedure, more than 90 percent of women had something positive to say. But in other ways, egg freezing has failed to live up to its early hype. For many years, the effectiveness of the procedure was a bit of a black box: Not enough people had tried to use their frozen eggs for scientists to pull together reliable data. Now, however, a picture is emerging. “It was supposed to revolutionize the whole field just as much as the birth control pill did” In one groundbreaking 2022 study conducted at NYU Langone Fertility Center and looking at 543 patients over 15 years, the chance of a live birth from frozen eggs was 39 percent. “There isn’t a guarantee of having a baby from egg freezing,” says Sarah Druckenmiller Cascante, a reproductive endocrinologist at NYU Langone Fertility Center and one of the study’s authors. The study made a splash because it provided numbers where little comprehensive national data exists, though experts at other clinics tell Vox that its results are in line with what they’ve found. And far from ushering in a new era of gender equality, some experts say, the procedure serves as another way for companies to make money from stoking women’s anxieties. Sales pitches about egg freezing, rather than liberating women from their biological clocks, simply became another way to put pressure on them, says Jody Madeira, a law professor at Indiana University Bloomington and author of the book Taking Baby Steps: How Patients and Fertility Clinics Collaborate in Conception. “In a capitalist society, you’re going to have that incentive to get women’s dollars by piggybacking on this guilt, shame, anxiety, whatever you want to call it, about how we’re supposed to reproduce and we haven’t done so yet.” About a decade after it shed its “experimental” label, the procedure has become ubiquitous in pop culture and ballooned in popularity, with over a million frozen eggs or embryos stored in the United States today. It has done little, however, to materially change women’s lives. The first successful births from frozen eggs were twins, born in Australia in 1986. But the procedure used in this case was difficult to replicate, and egg freezing didn’t begin to take off until the 1990s, starting at a clinic in Bologna, Italy. The Italian government had passed a law, backed by Catholic politicians, that gave embryos the same rights as citizens and restricted freezing them. Freezing eggs instead became a way to circumvent the law and still treat patients with infertility. In the early 2000s, the procedure spread to the US and around the world, gaining more interest after 2012, when the ASRM removed the “experimental” label. For patients, egg freezing can be an arduous process. It starts with 10–14 days of hormone injections, often two or three per day, to stimulate the ovaries to produce large numbers of eggs at once, Cascante said. On top of that, the patient also has to visit a clinic two or three times a week for ultrasounds and bloodwork. Finally, when the eggs are the right size, another injection known as a “trigger shot” gets the eggs ready for collection. “Physically, you go through a lot,” says Fawziah Qadir, a 38-year-old education professor at Barnard College who froze her eggs in 2022. If all goes well, patients under 38 can expect to retrieve between 10 and 20 eggs, which are frozen using liquid nitrogen and stored in a lab until they’re ready to be used. If it doesn’t, more cycles may be necessary — meaning more shots, and more money. When egg freezing first became widely available, there wasn’t a lot of long-term data on its effectiveness. But there was buzz — lots of it — especially around the idea that it would give women more time to focus on their careers. “Imagine a world in which life isn’t dictated by a biological clock,” Emma Rosenblum wrote in the 2014 Bloomberg BusinessWeek story. “If a 25-year-old banks her eggs and, at 35, is up for a huge promotion, she can go for it wholeheartedly without worrying about missing out on having a baby.” In the next few years, new companies sprang up to market the procedure to women, often with a millennial-pink, girlboss sheen. Extend Fertility, launched in 2016 in New York City, offered Instagram influencers reduced rates in exchange for posts. Trellis, a “fertility studio” in Manhattan’s fancy Flatiron district that opened in 2018, offered Turkish-cotton bathrobes and called itself “the Equinox of egg freezing,” a reference to the upscale gym chain. One wall bore the slogan, “It’s up to each of us to invent our own future.” The startup Kindbody, also launched in 2018, hosted parties with drinks and scented candles and peppered its social media ads with taglines like “Plan your path.” “Egg freezing has become like a mantra for how to be an independent woman,” Rebecca Silver, director of marketing for Kindbody, told NBC in 2018. “The people who have frozen their eggs are doing the cool new thing.” That cool new thing, however, was pricey. It took Fox a year to save up the money. Today, with the process still coming in at $10,000 to $15,000 per cycle, several companies offer loans specifically for egg freezing. Qadir’s procedure in 2022 cost about $14,000, which her mom paid as a gift to her, Qadir says. That included storage fees, which are rising rapidly and can run to $800 a year or more. The costs of egg freezing and storage usually aren’t covered by insurance, although more large companies are beginning to offer fertility benefits that include them. The price tag of the procedure limits who can access it; the majority of egg-freezing patients are white women with professional jobs. For Black women like herself, “sometimes it’s unattainable just because it’s so expensive, or we don’t have the jobs that would cover it,” Qadir said. Some experts say stigma and stereotypes, dating back to the history of slavery in America, also contribute to lower rates of fertility treatment among Black women. Startups have attracted enough customers to draw interest from deep-pocketed backers, with fertility companies gaining more than $150 million in investment in 2019, according to the New York Times. “It is an attractive investment for venture capitalists who are looking to make money because it’s an almost unlimited market, potentially, of people who think they need to extend their fertility,” says Karey Harwood, a professor of women’s, gender, and sexuality studies at North Carolina State University and the author of The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies. It’s no surprise that people will pay tens of thousands of dollars, or even go into debt, for the chance to build the family they’ve always imagined. But that key word — chance — can fall by the wayside in an industry built on selling optimism. Getty Images The year after she froze her eggs, Fox got together with her now-husband. After about a year of trying to get pregnant and one miscarriage, the couple had Fox’s frozen eggs shipped from the San Francisco Bay Area, where they were stored, to Los Angeles, where Fox and her husband lived. “Here’s where the story goes rotten,” Fox says. The Bay Area clinic had failed to pack the vials properly, and when they arrived in LA, all the eggs were destroyed. It was “one of the worst days of my life,” Fox recalls. She’s not the only patient to fall victim to storage or transportation mistakes. One 2022 study found at least nine storage tank failures over 15 years, affecting 1,800 patients. Egg-freezing patients also have had to contend with the unpredictable nature of the human body. The process can fail at many points, Cascante said. The ovaries may not produce enough eggs, the eggs may not survive the freezing process, they may not fertilize properly, or the fertilized embryos may not implant in the uterus. One UK-based woman, who asked to remain anonymous because she was concerned about professional ramifications, told Vox she froze 14 eggs, beginning about 10 years ago when she was 36. At the equivalent of about $1,200 per egg, the process wasn’t cheap. But by the end, she says, “I felt really proud that I was doing something proactive, and something that gave me options.” When she decided to use the frozen eggs to conceive on her own at 40, however, none of them fertilized. “I felt really angry at the universe,” she says. She later married and had a child using a donor egg. “In a single cycle of egg collection and fertilization, our donor produced more eggs and created more embryos than I had done in seven cycles.” Despite her experience, “I never felt like I was mis-sold,” the woman says. “I’m a nerd; I did my research.” At the same time, when she was freezing her eggs a decade ago, there wasn’t much research to do. “There weren’t a lot of people who had frozen their eggs, and there were even fewer who had gone back to try and conceive.” Today, there’s more data available, and mainstream fertility clinics are likely to be frank with patients about success rates, says Madeira, the author of Taking Baby Steps. Findings at other clinics have been in line with the NYU study, with another study finding that about a third of patients who returned to use their eggs ended up having a live birth. “Clinics have an actual ethical imperative to give accurate information.” But egg-freezing parties hosted by for-profit companies may be another story. There’s also a difference between listing success rates in fine print and really emphasizing the uncertainty of a procedure. Even Brigitte Adams, the woman featured on the 2014 Bloomberg cover after freezing her eggs, eventually told the Washington Post that she was unable to conceive using her frozen eggs. “They’re going to tell you, in all the paperwork you sign, that this is no guarantee, but you’re still going to have a sense of, oh, this works,” Fox says. Some of that feeling may stem from a kind of relentless optimism in American culture — or, perhaps, a Protestant work ethic — around the idea of having biological children, the message that if people simply try hard enough and long enough, they will eventually be rewarded with a child. This messaging has led some women to open up in recent years about their unsuccessful infertility treatments, to destigmatize their experiences. “For those of us who close our infertility chapters without a baby, we’re often met with unsolicited advice, reinforcing the narrative that we obviously gave up too early,” one woman, Katy Seppi, told CNN. For their part, fertility companies and practices say they work hard to make patients aware of the possibility of failure. At Extend Fertility, every prospective egg-freezing patient gets a free consultation session that includes information on their odds of a live birth from frozen eggs, based on their age and initial test results, says Joshua Klein, the company’s chief clinical officer. After that, “we try to trust women” to make an informed decision, he said. Kindbody also provides every prospective client with “expected outcomes based on their individual hormones and sonograms,” and offers a fertility calculator that estimates a patient’s chance of a live birth based on test results and number of eggs retrieved, Margaret Ryan, the company’s VP of communications, said in an email. “They’re going to tell you, in all the paperwork you sign, that this is no guarantee, but you’re still going to have a sense of, oh, this works” For some people, egg freezing isn’t the only option on the table. Another path is freezing embryos, which are denser and have a lower water content, making them “less sensitive to the freeze-thaw process,” said Amanda Adeleye, a reproductive endocrinologist and the medical director of CCRM Fertility of Chicago. Doctors also are able to screen embryos to help give patients a better sense of how likely they are to have a successful pregnancy. The process has even found its way into the American cultural imagination, with Succession’s Shiv Roy suggesting to her beleaguered husband Tom that they freeze embryos because they “survive way longer than eggs.” Embryos, however, require sperm. The majority of people freezing eggs are single, and they’re often hoping to have biological children with a partner one day. Using donor sperm would defeat that purpose. Fox, for example, was told that freezing embryos might be more effective but “I had zero interest,” she says. “I did not want to be a single mom.” If a patient has a partner or is comfortable using a donor, doctors may recommend embryo freezing. But “if you’re doing all of this to expand your flexibility and time to build your family, to prematurely close the door on part of that by fertilizing the eggs doesn’t necessarily help you,” Adeleye said. Eggs, embryos, freezing, thawing, shots, ultrasounds, thousands of dollars — it’s a lot for patients to navigate, often without much guidance. For example, there’s no single regulatory agency overseeing fertility centers in the US, as NBC has reported. That means no one is ensuring that patients are given a clear picture of the effectiveness of procedures. A lack of oversight also allows companies to use sales pitches that experts say are misleading, like an Instagram ad for Extend Fertility that claimed, “When you freeze your eggs, you #freezetime.” Klein calls that message “oversimplified,” but says it contains a kernel of truth because the procedure gives patients a chance to get pregnant with younger, more viable eggs. Advertising egg freezing is always a difficult balance, he tells Vox. The company doesn’t want to be too aggressive, but at the same time, to keep silent about a technology that can be “life-changingly impactful” risks doing a disservice to all the people who could benefit, Klein says. Others, however, argue that egg-freezing companies are being too aggressive, not just about the effectiveness of the procedure but about its necessity. Companies can “scare women into freezing their own eggs when they might not really need to,” Madeira says. In recent years, fertility startups have reached out to younger and younger groups of women. “We are now targeting women in their 20s and early 30s,” Susan Herzberg, the president of Prelude Fertility, told the New York Times in 2018. “Fertility declines at 22,” Jennifer Lannon, founder of the website Freeze.Health, told the publication. It’s true that egg quality declines with age and that younger patients have better luck with egg freezing. But the American College of Obstetricians and Gynecologists puts the age of significant fertility decline at 32, not 22 (the chance of conceiving drops more precipitously after 37). In the NYU study, the success rate rose to 51 percent for patients who froze their eggs when they were under 38. But the idea that large numbers of people should be freezing eggs in their 20s to guard against future infertility is misguided, some experts say. People in their 20s and early 30s often have time to conceive naturally, without the need for a lengthy, expensive medical procedure. Indeed, only about 12 percent of patients worldwide actually go back for their frozen eggs. Many patients conceive without assistance, Takefman says, while others decide not to become parents. Patients who froze eggs when they were younger than 34 are especially unlikely to use them, Madeira says. Those numbers don’t capture people who froze eggs only a few years ago and might still return, Klein says. And it’s not necessarily a problem that not everyone uses frozen eggs — after all, the process is meant as a “proactive investment,” he says. “You don’t know if you’ll need it.” To some, that investment comes at too high a cost. “More women are freezing eggs, and paying a lot to freeze eggs, than are actually ever going to need [them],” Madeira says. Ten years ago, egg freezing was seen as a path to economic and social empowerment for women. But most people aren’t freezing their eggs so they can work; they’re freezing their eggs so they can date. Eliza Brown, now a sociology professor at the University of California Berkeley, and her team interviewed 52 women who had frozen or were considering freezing their eggs in 2016 and 2017. None of them cited a desire to climb the corporate ladder. Instead, almost all were interested in egg freezing because they lacked a romantic partner. “Most of our participants understood egg freezing as a way to actually temporarily disentangle romantic and reproductive trajectories,” Brown tells Vox. However, in many cases, egg freezing was a bandage on a bigger problem. The women Inhorn interviewed for her book Motherhood on Ice were largely educated professionals who could afford a five-figure elective medical procedure. “They wanted an eligible, educated, equal partner,” Inhorn said, and “they were having trouble finding that.” Both Brown and Inhorn spoke with some egg-freezing patients who were seeking female partners. However, the majority were dating or seeking men, and struggling with the process. Some had tried dating men with less education or career success, but found “there was a lot of intimidation,” Inhorn said. “Men were not comfortable with who they were.” Others were frustrated with “men who will just wine you and dine you, but really have no intention of committing.” MeiMei Fox describes the sense of rush and pressure that can be attached to dating for women in their late 30s: “You go on the first date and you’re like, well, do you want to have kids? No? Okay, bye.” Egg freezing doesn’t change the fact that women are outpacing men in educational attainment, nor that social norms still fetishize the male-breadwinner family, pressuring women and men alike to look for something that may no longer fit them or the times they live in. It also doesn’t change the fact that many women find dating men to be a frustrating and demoralizing experience, as Anna Louie Sussman writes in the New York Times. Daniel Cox, a senior fellow at the American Enterprise Institute who has surveyed more than 5,000 Americans about dating, told the Times that many men were “limited in their ability and willingness to be fully emotionally present and available” and that dating today “requires a level of emotional sensitivity that I think some men probably just lack.” To actually fix straight women’s dating problems, you would need to “fix men,” one of Inhorn’s study participants told her. Until then, Inhorn writes in her book, “egg freezing will remain educated thirty-something women’s single best reproductive option — a techno-medical solution to a fundamental gender inequality that provides them with some hope and allows them to retain their motherhood dreams.” For Fox, freezing her eggs indeed took the feeling of time pressure away. She felt more relaxed and confident. “It was really positive for me,” she says. “Until I tried to use them.” After Fox’s frozen eggs were destroyed, she and her husband went through three rounds of IVF. It cost about $100,000, but she eventually got pregnant and gave birth to twin sons. Today, she’s not against egg freezing but says, “I tell people it is no guarantee.” Fertility centers don’t always “present that to their clients in an honest way,” she adds. Only about 12 percent of patients worldwide actually go back for their frozen eggs Better regulation would help, experts say. Creating a single regulatory agency to oversee fertility centers — as the Human Fertilisation and Embryology Authority does in the UK — could make it easier to require those centers to educate patients on the risks and effectiveness of egg freezing and to follow accuracy guidelines in their advertising, Rachel Strodel argues in an NBC op-ed. “I still certainly respect people’s freedom to make the decision that’s best for them, but they’ve got to be armed with the facts and realize that it’s a gamble,” says Harwood, the Infertility Treadmill author. Federal lawmakers should also require that egg storage facilities follow proper freezing protocol and report any failures, legal scholars Naomi Cahn and Dena Sharp write at the Conversation. Meanwhile, helping women with the relationship problems that push many to freeze eggs in the first place may require bigger social changes. “Maybe men are going to need to get more comfortable marrying women who are more educated than they are and make more money than they do,” Harwood said. “Maybe the change happens there, in our gender ideologies and how we think of family.” Greater support for single parents and other family forms beyond the heterosexual two-parent household could also take the pressure off of women to bank eggs in hopes of meeting a male partner. So, too, could a greater social acceptance of the value of a child-free life, especially since more and more people are choosing not to have children. While many people who freeze eggs have a deep and personal desire for children, it’s also the case that women, especially, experience enormous social and even political pressure to reproduce — and reducing that pressure could free some people to pursue other shapes for their lives. Patients and scholars alike are clear that they don’t want to see egg freezing disappear as an option. “Reproductive choices are being eclipsed in this country,” Inhorn said. “This is a technology that does give women some help with difficult situations they find themselves in.” The process could take on added importance now that an Alabama court ruling has cast doubt on the future of IVF using frozen embryos. Federal oversight of and research into fertility technology and treatment in general have been hampered by opposition to abortion in the US, which has made it difficult to form nationwide policies around reproductive health. Egg freezing also remains an especially important option for people dealing with cancer or other conditions or treatments that can damage ovarian function, and it can be a useful tool for trans people who want to remove their ovaries or who are taking hormones that affect them, Adeleye said. For many patients, however, experts say that the sense of control that egg freezing offers — at a high price — turns out to be illusory. If anything, Fox’s experience with the procedure was an exercise in letting go. “It’s taught me some more patience with life and the universe,” she says. “There are many different pathways to getting what you dream of.”

Getty Images Here’s how to understand the difference between everyday anxiety and an anxiety disorder. When you run a therapy practice called the Center for Anxiety, as David H. Rosmarin does, you encounter a breadth of anxiety-related experiences. Sometimes, after talking with new patients, Rosmarin will determine their distress may not be related — or solely related — to anxiety at all. Because anxiety intersects with so many other aspects of mental health, like depression and substance abuse, Rosmarin says, many people are quick to attribute their emotional pain to anxiety alone. They may even mistake anxiety for something else entirely. He’s told patients they’re not anxious at all, but stressed. “I’ll say, sleep eight hours a night for the next two weeks,” he says. “Come back and tell me how you’re feeling. I’ve tried that trick many times with stressed-out patients, and they’re at 50 percent of their stress level two weeks later with no therapy at all.” More Americans are seeking professional mental health treatment than ever before. Nearly a quarter of adults visited a psychologist, therapist, psychiatrist, or other mental health professional in 2022, compared to 13 percent who did so in 2004, according to a Gallup poll. No longer stigmatized or discussed in secret, mental health terms — and mental health-adjacent terms — have trickled out of the therapy room and into casual conversation. “Narcissism,” “gaslighting,” “and “boundaries” are just as readily discussed at brunch or online as in clinical settings. Self-diagnosis based on simplified videos and memes on social media can result in pathologizing seemingly mundane behaviors and thought patterns. Normalization of mental health is undoubtedly positive: More people can feel empowered to seek care and to openly discuss their experiences. However, increased awareness has resulted in more people confusing “milder forms of distress as mental health problems,” according to one academic paper. Despite therapy’s wider cultural acceptance, we still don’t have a grasp on what we really feel. Without a nuanced vocabulary to describe these experiences, complex emotions are flattened with blanket terms. “We don’t have a sophisticated lexicon,” Rosmarin says. “We end up labeling everything as anxiety.” When we don’t accurately define our emotions, we don’t know how to properly address them. If we approach our feelings with curiosity, we can improve our emotional intelligence. What is anxiety? Anxiety is both a normal response as well as a pathological experience, says psychiatrist Tracey Marks. People often endure everyday levels of anxiety or nervousness before a first date or if they have to make a presentation at work. You might have physiological effects, like sweating, racing heartbeat, or butterflies in your stomach. Momentary anxiety can be functional, a signal to be on the lookout for potential danger or to prepare for that work presentation. After the nerve-wracking event is over, the feeling usually passes. In an increasingly anxiety-inducing world, where climate change, wars, and a contentious upcoming presidential election instill plenty of anxiety, “it’s normal for us to have some kind of distressing reaction to something that is threatening to us,” Marks says. A sign of an anxiety disorder is when anxiety interferes with your daily life. If the thought of going to a social event elicits physical symptoms like vomiting and/or persistent worried thoughts of how others will perceive you, you may have social anxiety, Marks says. Avoiding people, missing work or school, a baseline level of fear (that may not be logical), and inability to relax are some of the signs of generalized anxiety disorder. “One of the characteristics of generalized anxiety,” she says, “is that you can worry about anything. You can worry about world peace.” Someone with debilitating anxiety might want to work with a therapist to better cope. People may mistake anxiety for stress. Stress is when you have too many demands and not enough resources, like time or money to outsource some responsibilities, Rosmarin says. “Anxiety often happens in the context of an abundance of resources,” he says. You may be getting enough sleep, have a supportive partner, and a job you love, for instance, but still spiral over would-be worst-case scenarios that may never materialize. Even fear can be confused with anxiety. Fear is in response to a concrete threat, whereas anxiety is triggered by an amorphous or future risk. The importance of emotional intelligence The boundaries of anxiety are blurry and subjective, says Nick Haslam, a professor of psychology at the University of Melbourne, so it makes sense that lay people would label all of their upsetting experiences as “anxiety.” But we can stand to improve our emotional intelligence — the ability to accurately identify what we’re feeling, Haslam says. Because many don’t receive emotional education beyond primary school, says Rosmarin, we have a limited emotional vocabulary. Feeling “bad” is a significantly different experience from feeling “distressed,” “frustrated,” “jealous,” “overwhelmed,” or “anxious.” An emotional binary of “good” and “bad” emotions actually makes matters more confusing. “You don’t understand how you should respond to what’s going on,” Haslam says, “whether you should flee or fight, whether you should bite your tongue.” People who struggle to put their emotions into words have more difficulty coping with complex feelings, Haslam says. When we don’t have a deep knowledge of common human emotions, we may pathologize normal experiences. Feeling uncomfortable in a room of new people is incredibly common. It is not, however, social anxiety, Marks says. Online and social media content created by non-professionals may paint anxiety with broad strokes, leading viewers to self-diagnose as having an anxiety disorder. “Even if you do have anxiety, it doesn’t necessarily mean that you have an anxiety disorder,” says psychologist Juli Fraga. What’s often at the root of situational anxiety — like feeling anxious in social scenarios — may be relational trauma dating back to unhealthy social interactions during childhood, Fraga says. What’s lost when every experience is “anxiety” Labeling yourself as an anxious person, even if you do have a diagnosis, can make it more difficult to overcome your emotions. If anxiety is so baked into how you see yourself, you could use it as a crutch or an excuse to avoid social situations, new experiences, or other potentially enriching events. “As soon as you attribute some sort of noun label to yourself — I’m an anxious person or anxiety is who I am,” Haslam says, “people tend to infer that they’ve got something deep-seated and lasting and a reason not to engage with the world.” Avoidance is generally the wrong way to address anxiety, Haslam says. Believing you have social anxiety, for example, may lead you to isolate, which only entrenches the anxiety. Avoidance may offer temporary relief, but doesn’t offer a long-term solution. When we don’t have the appropriate vocabulary to describe our emotions, we lose the ability to effectively intervene, Rosmarin says. “Imagine going into a board meeting with a sophisticated company that has a lot of different projects,” he says, “and you have one word to describe anything negative that’s going on in any of those projects.” Determining whether we’re stressed or anxious greatly impacts how we move forward: It’s the difference between getting a good night’s sleep and moving your body (effective ways to manage stress) and working with a therapist to confront what makes you anxious. How to get a little better at defining anxiety Getting to the root of emotions takes some thought. When it comes to anxiety, Marks says to consider how much disruption it causes. Do you feel anxious in certain situations or does it significantly impair your ability to perform day-to-day tasks? For example, if you experience such intense, constant distress about the safety of your loved ones — even if there is no present threat to their safety — that it actually damages your relationships, you may feel inspired to seek professional help for your anxiety. If you have trouble sleeping and feel nervous during exam time, you may be stressed. “Maybe [try] exercising more, or making sure that you’re trying to get the best sleep you can,” Marks says, “things that you can do to help you cope better as these situations come.” Whenever feelings of anxiety do arise, get curious about its causes, Fraga suggests. Think about what it is about parties that deters you from social gatherings. Maybe you don’t like talking to strangers. Again, ask yourself why. Perhaps you had an embarrassing rebuff in the past. Anxiety isn’t a truth-teller. Just because you had a negative previous experience doesn’t mean you’re doomed to repeat the same patterns or should feel afraid of repeating those patterns. Rather than relying on labels to describe our emotions, we owe it to ourselves to use a vocabulary as vast and complex as our experiences. Accurately describing the causes of anxiety, how it physically manifests, and when and how often it occurs, allows us to pinpoint the exact form of support we need, too, whether it’s therapy or just talking to a loved one. That’s how we move forward. It can be helpful to depersonalize anxiety. Try reminding yourself, “Yes, I’m anxious but that’s a temporary thing which I can do something about, and I’m actually pretty courageous to be able to deal with it,” Haslam says. “I’m not just a damaged individual.”

Jared Bartman for Vox Dangerous, polluting SUVs and pickups took over America. Lawmakers are partly to blame. Cars, you might have noticed, have grown enormous. Low-slung station wagons are all but extinct on American roads, and even sedans have become an endangered species. (Ford, producer of the iconic Model T a century ago, no longer sells any sedans in its home market.) Bulky SUVs and pickup trucks — which have themselves steadily added pounds and inches — now comprise more than four out of every five new cars sold in the US, up from just over half in 2013, even as national household size steadily declines. The expanding size of automobiles — a phenomenon I call car bloat — has deepened a slew of national problems. Take road safety: Unlike peer nations, the US has endured a steep rise in traffic deaths, with fatalities among pedestrians and cyclists, who are at elevated risk in a crash with a huge car, recently hitting 40-year highs. Vehicle occupants face danger as well. A 2019 study concluded that compared to a smaller vehicle, an SUV or a pickup colliding with a smaller car was 28 percent and 159 percent, respectively, more likely to kill that car’s driver. Car bloat also threatens the planet. Because heavier vehicles require more energy to move, they tend to gulp rather than sip the gasoline or electricity that powers them, increasing greenhouse gas emissions. Extra weight also accelerates the erosion of roadways and tires, straining highway maintenance budgets and releasing microplastics that damage ecosystems. Al Seib/Los Angeles Times via Getty Images SUVs and pickup trucks make up more than 80 percent of new car sales in the US. Their height and weight make them significantly more likely to injure pedestrians, cyclists, and other road users, and they also make it harder to see pedestrians crossing the street. Here, a pickup truck crashed into and seriously injured a pedestrian before smashing into a storefront in Los Angeles in 2014. What lies behind this shift? Some Americans prefer bigger cars, especially when gas prices are low, for their ample storage space, ability to see over other vehicles on the road, and perceived safety benefits (more on that later). But shifting consumer demands tell only part of the story. For half a century, a litany of federal policies has favored large SUVs and trucks, pushing automakers and American buyers toward larger models. Instead of counteracting car bloat through regulation, policymakers have subtly encouraged it. That has been a boon for car companies, but a disaster for everyone else. Here are some of the most egregious examples. Why we let bigger cars pollute more After the 1970s OPEC oil embargo triggered a spike in gas prices, the federal government adopted an array of policies intended to reduce energy demand. One of Congress’s most consequential moves was creating the Corporate Average Fuel Economy (CAFE) standards, which require that the average fuel economy (miles per gallon, or MPG) of a carmaker’s vehicles remain below a set threshold. Pressed by auto lobbyists, Congress made a fateful decision when it established CAFE. Instead of setting a single fuel economy standard that applies to all cars, CAFE has two of them: one for passenger cars, such as sedans and station wagons, and a separate, more lenient standard for “light trucks,” including pickups and SUVs. In 1982, for instance, the CAFE standard for passenger cars was 24 mph and only 17.5 mpg for light trucks. That dual structure didn’t initially seem like a big deal, because in the 1970s SUVs and trucks together accounted for less than a quarter of new cars sold. But as gas prices fell in the 1980s, the “light truck loophole” encouraged automakers to shift away from sedans and churn out more pickups and SUVs (which were also more profitable). Car ads of the 1980s and 1990s frequently featured owners of SUVs and trucks taking family trips or going out with friends, activities that could also be done in a sedan or station wagon. The messaging seemed to resonate: By 2002, light trucks comprised more than half of new car sales. In the early 2000s, the federal government made these distortions even worse. During the George W. Bush administration, CAFE was revised to further loosen rules for the biggest cars by tying a car model’s efficiency standard to its physical footprint (which is basically the shadow cast by the vehicle when the sun is directly above it). President Obama then incorporated similar footprint rules into new greenhouse gas emissions standards that are overseen by the Environmental Protection Agency (EPA). Dan Becker, who led the Sierra Club’s global warming program from 1989 to 2007, told me that he and others warned federal lawmakers that adopting footprint-based standards was a mistake. “People like me were saying, ‘give carmakers another loophole and they’ll use it,’” he said. “But we lost.” Those concerns proved justified. The average vehicle footprint expanded 6 percent between 2008 and 2023, a “historic high,” according to an EPA report, which also found that some carmakers, such as General Motors, actually had lower average fuel economy and higher average carbon emissions in 2022 than in 2017. To its credit, the EPA recently announced revisions to its vehicle GHG rules that would narrow (but not close) the gaps between standards for large and small cars. But the shift toward electric vehicles may further entrench car bloat. The EPA’s rules assume that all EVs, regardless of their design, generate no emissions — a questionable assumption, because EVs create emissions indirectly through the production and transmission of power that flows into their batteries. A huge or inefficient battery requires more electricity, which can lead to significant pollution (especially in regions where fossil fuels dominate the energy mix). The EPA’s policy of treating all EVs equally makes a monstrously wasteful vehicle like the Hummer EV seem cleaner than it is, encouraging carmakers to manufacture more of them. To counteract EV bloat, Peter Huether, a senior research associate at the American Council for an Energy-Efficient Economy, would like to see the EPA revise its GHG rules to consider emissions from power generation and transmission: “If these standards look at upstream emissions, it could have a downstream effect on shape and size of EVs.” Blocking smaller cars from abroad What does a 60-year-old trade dispute have to do with car bloat? More than you might imagine. In the early 1960s, Europe raised the ire of American officials by slapping a 50 percent tariff on chicken exported from the United States. In retaliation, the US enacted a 25 percent tax on pickup trucks imported from abroad. The dispute is long forgotten, but the “Chicken Tax” lives on. Although the tariff was initially aimed at Germany’s immense auto industry (Volkswagen in particular), it also applies to pickups imported from newer automaking powers such as Japan and South Korea, where carmakers are often adept at building vehicles much smaller than those available to Americans. Toyota’s Hilux Double Cab pickup, for instance, weighs several hundred pounds less than a 2024 Ford F-150 Tremor or Lariat and is about half a foot shorter. But Americans who might want it are out of luck. Toyota does not sell the Hilux in the US (but does in countries like India and Britain); the 25 percent tariff would make it prohibitively expensive. “The Chicken Tax has prevented competitive Asian or European truck makers from entering the US market,” said Jason Torchinsky, a co-founder of the Autopian, a media outlet focused on the auto industry. “American manufacturers have really never had to compete.” John Krafcik, who previously led Hyundai, has called the Chicken Tax “one of the most important determinants of how the [auto] industry looks today and how it operates today in the US.” The tariff has been condemned by everyone from the Libertarian Cato Institute, the center-right American Enterprise Institute, and the left-leaning Tax Policy Center. “Tariffs in general hurt consumers, and the Chicken Tax is no exception,” wrote Robert McClelland of the Tax Policy Center. There are other protectionist rules blocking smaller vehicles from abroad: Carmakers from China, an emerging automaking behemoth, face a 25 percent tariff enacted by Donald Trump. As a result, Americans cannot buy small Chinese EV sedans like the BYD Seagull that cost around $10,000, barely a fifth the price of an average American car. VCG/VCG via Getty Images The Seagull, a small, low-cost electric sedan from Chinese automaker BYD Nicolas Datiche/AFP via Getty Images Refrigerators are transported on a Japanese mini truck, also known as a kei truck. These often have bed lengths comparable to American-style pickup trucks but are much shorter in height, lighter, and safer for other road users — yet they’re exceedingly hard to obtain in the US. And those hoping to import a kei truck, a miniature pickup common in Japan, must navigate a labyrinth of federal and state rules. (Even Afghanistan seems ahead of the US in minitruck offerings, as the Wichita Eagle’s Dion Lefler noted in a tongue-in-cheek 2023 column: “In the land of the free, why can’t we have mini-pickup trucks like the Taliban?”) These policies have established a regulatory moat protecting US automakers whose profits disproportionately come from pricey, hulking SUVs and trucks. The Hummer Tax Loophole In 1984, Congress stopped allowing small business owners to take a tax deduction for the purchase price of cars used for work. But the bill included a giant loophole: To protect those who need a heavy-duty vehicle (think farmers or construction workers), Congress made an exception, known as Section 179, for cars that weigh over 6,000 pounds when fully loaded with passengers and cargo. Today such behemoths are eligible for a tax deduction of up to $30,500, while business owners who opt for a smaller car can claim nothing at all. Few car models were heavy enough to qualify for the tax break 40 years ago, but that is no longer the case: A Hummer 1, for instance, weighs about 10,300 pounds (leading Section 179 to be dubbed the “Hummer Tax Loophole”). Other huge cars, such as a Chevrolet Suburban or an F-250 Ford Super Duty truck can qualify, too. “Few folks at EPA know about Section 179,” said Becker, the former Sierra Club executive. “But every auto dealer does.” Some car dealerships even offer handy Section 179 guides on their websites. The tax advantage of buying a behemoth may be powerful enough to tilt the vehicle purchase decisions of individuals like real estate agents, who use their vehicles for both professional and personal use. And as cars electrify, the added tonnage from batteries will allow more models to qualify for favorable tax treatment. If Section 179 sounds crazy, consider another federal loophole that has endured for decades. In 1978, Congress established the “Gas Guzzler Tax,” requiring automakers to pay between $1,000 and $7,700 for every car produced that gets less than 22.5 miles per gallon. But the tax only applies to passenger vehicles like sedans and station wagons. SUVs and pickups, which often have much worse gas mileage, are exempt. That omission makes no sense from a policy perspective, but it is good news for carmakers producing inefficient behemoths. Freezing the gas tax Every time a car owner fills her gas tank, a portion of the bill goes into the federal Highway Trust Fund, a central source of funding for roads and mass transit. That tax rate is set at $0.184 per gallon, a level that has been frozen since 1993, when Bill Clinton was less than a year into his presidency. Congressional proposals to increase the gas tax to close a yawning highway budget gap, or at least tie it to inflation, have gone nowhere. Over the last 31 years, consumer prices have risen 113 percent, making the real value of the gas tax less than half what it was in 1993. That decline has reduced the cost of powering a huge SUV or truck with abysmal gas mileage, like the 6,270-lb 2024 Cadillac Escalade that gets around 16 mpg. A 2018 OECD study found that the US had the lowest average gas tax (including both federal and state taxes) among rich nations, which averaged $2.24 per gallon — four times the typical US rate. “Why are European cars so small?” said McClelland, of the Tax Policy Center. “One reason has got to be the much higher gasoline tax.” Federal policy ignores crash risk for anyone outside a car A vehicle’s design affects not just the safety of its occupants, but also people walking, biking, or inside other cars. Although seemingly obvious, this basic truth has eluded federal regulators for decades. Car safety rules are laid out in the encyclopedic Federal Motor Vehicle Safety Standards (FMVSS), which touches on everything from power windows to seat belts. But the FMVSS revolves around protecting a vehicle’s occupants; nothing within its 562 pages limits a car’s physical design to protect someone who might come into contact with it in a collision. That omission invites an arms race of vehicle size — precisely what the US is experiencing. Nor does the National Highway Traffic Safety Administration (NHTSA) consider pedestrians, cyclists, or other car occupants when calculating its safety ratings from crash tests. Unlike safety ratings in Europe and elsewhere, the American crash ratings program also ignores the danger that vehicle designs pose to those walking and biking. NHTSA’s myopic focus on car occupants is a boon for the heaviest and tallest cars, which pose disproportionate risk to those outside of them. Weightier vehicles exert more force in a crash, and they require additional time to come to a halt when a driver slams on the brakes. A 2023 study by the Insurance Institute for Highway Safety (IIHS) found that vehicles with tall, flat front ends (common on big pickups and SUVs) are significantly more likely to kill pedestrians in crashes. An earlier IIHS study found that large cars also make it harder to see pedestrians at intersections. Mindy Schauer/Digital First Media/Orange County Register via Getty Images The US is in the midst of a car fatality crisis, exacerbated by the risks large cars pose to pedestrians. Here, a pickup truck driver in Santa Ana, California, quickly applies brakes as two pedestrians cross in front. One is not visible. With pedestrian and cyclist deaths now soaring, NHTSA last year took its first, tentative step toward protecting so-called vulnerable road users by proposing that its vehicle safety ratings be revised to include an evaluation of automatic pedestrian braking technology, which can force a vehicle to halt before striking someone on foot. But even if adopted, it would not affect NCAP’s 5-star safety rating, the hallmark of the program. And NHTSA’s focus on automatic pedestrian braking, an imperfect tech fix, ignores car bloat, a root cause of America’s traffic safety crisis. Earlier this year, a paper co-authored by former NHTSA executive Missy Cummings gave an ominous assessment of automatic braking systems, concluding that they did not work consistently. By contrast, the potential safety benefits of constraining vehicles’ weight and height have been well established. Why can’t we fix things? All of these policies have distorted the US car market, leading the 278 million vehicles plying American roads to become ever bigger, more dangerous, and more destructive. So why have they remained on the books after the growing societal costs of car bloat became impossible to miss? To find an answer, consider who benefits from oversized vehicles. American carmakers like Ford and GM (which are headquartered in Michigan, a crucial swing state) rely on juicy margins from big SUVs and pickups, which are more expensive and profitable than smaller models. They enjoy protection from foreign competition through tariffs like the Chicken Tax, as well as favorable policies like CAFE’s light-truck loophole. The regulatory status quo suits domestic automakers just fine — and they act as a roadblock to even modest attempts to change it. In 2022, for example, the largest auto industry association lobbied District of Columbia council members against a proposal to charge owners of the most egregiously oversized cars $500 per year, seven times more than a light sedan (the District adopted the policy anyway). Daniel Acker/Bloomberg via Getty Images SUVs and trucks now overwhelmingly dominate the offerings of US carmakers. Here, a Cadillac SUV is on display at the 2019 North American International Auto Show in Detroit. As American sales of big SUVs and trucks have surged, their owners are likely to resist policy moves they see as penalizing them. Many are likely to be unaware of the federal loopholes and policy oversights that have distorted their vehicle choices. The negative externalities of supersized cars — in emissions, crash deaths, and the erosion of tires and pavement — are what economists call a market failure, since their costs are borne by society writ large, not the people who buy big pickups and SUVs. Left unaddressed, those societal costs will grow as more people replace their modest-sized cars with big SUVs or trucks. After all, everyone else seems to be doing it — why not do the same, if only for self-preservation? Regulation can end such a cycle toward enormity. Countries including France and Norway have enacted weight-based taxes to counteract car bloat’s collective costs and avoid giving huge vehicles implicit subsidies. But American policymakers have done the exact opposite, and they rarely even acknowledge the problem. Asked explicitly about ways that the Department of Transportation could address car bloat, Secretary Pete Buttigieg ducked, calling merely for “further research.” With the feds refusing to lead, it has fallen on state and local leaders to try and address car bloat themselves. Colorado and California, for instance, have proposed weight-based vehicle registration fees, following the District of Columbia’s lead. But such moves are an imperfect solution to a national problem (vehicles can, after all, be driven across state lines). A true policy fix will require action from Congress, NHTSA, and the EPA. It need not begin with new regulations or taxes. Federal leaders could do a world of good if they simply unwind the ill-advised policies already on the books. Kendra Levine contributed research assistance.