Why are the poor blamed and shamed for their deaths?

When someone dies, she often suffers a brutal moral autopsy, says Barbara Ehrenreich. Did she smoke? Drink excessively? Eat too much fat?

I watched in dismay as most of my educated, middle-class friends began, at the onset of middle age, to obsess about their health and likely longevity. Even those who were at one point determined to change the world refocused on changing their bodies. They undertook exercise or yoga regimens; they filled their calendars with medical tests and exams; they boasted about their good and bad cholesterol counts, their heart rates and blood pressure.

Mostly they understood the task of ageing to be self-denial, especially in the realm of diet, where one medical fad, one study or another, condemned fat and meat, carbs, gluten, dairy or all animal-derived products. In the health-conscious mindset that has prevailed among the worlds affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are sinfully delicious, while healthful foods may taste good enough to be advertised as guilt-free. Those seeking to compensate for a lapse undertake punitive measures such as hours-long cardio sessions, fasts, purges or diets composed of different juices carefully sequenced throughout the day.

Of course I want to be healthy, too; I just dont want to make the pursuit of health into a major life project. I eat well, meaning I choose foods that taste good and will stave off hunger for as long as possible, such as protein, fibre and fats. But I refuse to overthink the potential hazards of blue cheese on my salad or pepperoni on my pizza. I also exercise not because it will make me live longer but because it feels good when I do. As for medical care, I will seek help for an urgent problem, but I am no longer interested in undergoing tests to uncover problems that remain undetectable to me. When friends berate me for my laxity, my heavy use of butter or habit of puffing (but not inhaling) on cigarettes, I gently remind them that I am, in most cases, older than they are.

So it was with a measure of schadenfreude that I began to record the cases of individuals whose healthy lifestyles failed to produce lasting health. It turns out that many of the people who got caught up in the health craze of the last few decades people who exercised, watched what they ate, abstained from smoking and heavy drinking have nevertheless died. Lucille Roberts, owner of a chain of womens gyms, died incongruously from lung cancer at the age of 59, although she was a self-described exercise nut who, the New York Times reported, wouldnt touch a French fry, much less smoke a cigarette. Jerry Rubin, who devoted his later years to trying every supposedly health-promoting diet fad, therapy and meditation system he could find, jaywalked into Wilshire Boulevard at the age of 56 and died of his injuries two weeks later.

Some of these deaths were genuinely shocking. Jim Fixx, author of the bestselling The Complete Book Of Running, believed he could outwit the cardiac problems that had carried his father off to an early death by running at least 10 miles a day and restricting himself to a diet of pasta, salads and fruit. But he was found dead on the side of a Vermont road in 1984, aged only 52.

Even more disturbing was the untimely demise of John H Knowles, director of the Rockefeller Foundation and promulgator of the doctrine of personal responsibility for ones health. Most illnesses are self-inflicted, he argued the result of gluttony, alcoholic intemperance, reckless driving, sexual frenzy, smoking and other bad choices. The idea of a right to health, he wrote, should be replaced by the idea of an individual moral obligation to preserve ones own health. But he died of pancreatic cancer at 52, prompting one physician commentator to observe, Clearly we cant all be held responsible for our health.

Still, we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: did she smoke? Drink excessively? Eat too much fat and not enough fibre? Can she, in other words, be blamed for her own death? When David Bowie and Alan Rickman both died in early 2016 of what major US newspapers described only as cancer, some readers complained that it is the responsibility of obituaries to reveal what kind of cancer. Ostensibly, this information would help promote awareness of the particular cancers involved, as Betty Fords openness about her breast cancer diagnosis helped to destigmatise that disease. It would also, of course, prompt judgments about the victims lifestyle. Would Bowie have died at the quite respectable age of 69 if he hadnt been a smoker?

Apple co-founder Steve Jobs 2011 death from pancreatic cancer continues to spark debate. He was a food faddist, eating only raw vegan foods, especially fruit, and refusing to deviate from that plan even when doctors recommended a high protein and fat diet to help compensate for his failing pancreas. His office refrigerator was filled with Odwalla juices; he antagonised non-vegan associates by attempting to proselytise among them, as biographer Walter Isaacson has reported: at a meal with Mitch Kapor, the chairman of Lotus software, Jobs was horrified to see Kapor slathering butter on his bread, and asked, Have you ever heard of serum cholesterol? Kapor responded, Ill make you a deal. You stay away from commenting on my dietary habits, and I will stay away from the subject of your personality.

Defenders of veganism argue that his cancer could be attributed to his occasional forays into protein-eating (a meal of eel sushi has been reported) or to exposure to toxic metals as a young man tinkering with computers. But a case could be made that it was the fruitarian diet that killed him: metabolically, a diet of fruit is equivalent to a diet of candy, only with fructose instead of glucose, with the effect that the pancreas is strained to constantly produce more insulin. As for the personality issues the almost manic-depressive mood swings they could be traced to frequent bouts of hypoglycemia. Incidentally, 67-year-old Mitch Kapor is alive and well at the time of this writing.

Similarly, with sufficient ingenuity or malicious intent almost any death can be blamed on some mistake of the deceased. Surely Fixx had failed to listen to his body when he first felt chest pains and tightness while running, and maybe, if he had been less self-absorbed, Rubin would have looked both ways before crossing the street. Maybe its just the way the human mind works, but when bad things happen or someone dies, we seek an explanation, preferably one that features a conscious agent a deity or spirit, an evil-doer or envious acquaintance, even the victim. We dont read detective novels to find out that the universe is meaningless, but that, with sufficient information, it all makes sense. We can, or think we can, understand the causes of disease in cellular and chemical terms, so we should be able to avoid it by following the rules laid down by medical science: avoiding tobacco, exercising, undergoing routine medical screening and eating only foods currently considered healthy. Anyone who fails to do so is inviting an early death. Or, to put it another way, every death can now be understood as suicide.

Liberal commentators countered that this view represented a kind of victim-blaming. In her books Illness As Metaphor and Aids And Its Metaphors, Susan Sontag argued against the oppressive moralising of disease, which was increasingly portrayed as an individual problem. The lesson, she said, was, Watch your appetites. Take care of yourself. Dont let yourself go. Even breast cancer, she noted, which has no clear lifestyle correlates, could be blamed on a cancer personality, sometimes defined in terms of repressed anger which, presumably, one could have sought therapy to cure. Little was said, even by the major breast cancer advocacy groups, about possible environmental carcinogens or carcinogenic medical regimes such as hormone replacement therapy.

While the affluent struggled dutifully to conform to the latest prescriptions for healthy living adding whole grains and gym time to their daily plans the less affluent remained mired in the old comfortable, unhealthy ways of the past smoking cigarettes and eating foods they found tasty and affordable. There are some obvious reasons why the poor and the working class resisted the health craze: gym memberships can be expensive; health foods usually cost more than junk food. But as the classes diverged, the new stereotype of the lower classes as wilfully unhealthy quickly fused with their old stereotype as semi-literate louts. I confront this in my work as an advocate for a higher minimum wage. Affluent audiences may cluck sympathetically over the miserably low wages offered to blue-collar workers, but they often want to know why these people dont take better care of themselves. Why do they smoke or eat fast food? Concern for the poor usually comes tinged with pity. And contempt.

Photograph: Stephen Voss for the Guardian

In the 00s, British celebrity chef Jamie Oliver took it on himself to reform the eating habits of the masses, starting with school lunches. Pizza and burgers were replaced with menu items one might expect to find in a restaurant fresh greens, for example, and roast chicken. But the experiment was a failure. In the US and UK, schoolchildren dumped out their healthy new lunches or stamped them underfoot. Mothers passed burgers to their children through school fences. Administrators complained that the new meals were vastly over-budget; nutritionists noted that they were cruelly deficient in calories. In Olivers defence, it should be observed that ordinary junk food is chemically engineered to provide an addictive combination of salt, sugar and fat. But it probably matters, too, that he didnt study local eating habits in sufficient depth before challenging them, nor seems to have given enough thought to creatively modifying them. In West Virginia, he alienated parents by bringing a local mother to tears when he publicly announced the food she gave her four children was killing them.

There may well be unfortunate consequences from eating the wrong foods. But what are the wrong foods? In the 80s and 90s, the educated classes turned against fat in all forms, advocating the low-fat and protein diet that, journalist Gary Taubes argues, paved the way for an epidemic of obesity as health-seekers switched from cheese cubes to low-fat desserts. The evidence linking dietary fat to poor health had always been shaky, but class prejudice prevailed: fatty and greasy foods were for the poor and unenlightened; their betters stuck to bone-dry biscotti and fat-free milk. Other nutrients went in and out of style as medical opinion shifted: it turns out high dietary cholesterol, as in oysters, is not a problem after all, and doctors have stopped pushing calcium on women over 40. Increasingly, the main villains appear to be sugar and refined carbohydrates, as in hamburger buns. Eat a pile of fries washed down with a sugary drink and you will probably be hungry again in a couple of hours, when the sugar rush subsides. If the only cure for that is more of the same, your blood sugar levels may permanently rise what we call diabetes.

Special opprobrium is attached to fast food, thought to be the food of the ignorant. Film-maker Morgan Spurlock spent a month eating nothing but McDonalds to create his famous Super Size Me, documenting his 11kg (24lb) weight gain and soaring blood cholesterol. I have also spent many weeks eating fast food because its cheap and filling but, in my case, to no perceptible ill effects. It should be pointed out, though, that I ate selectively, skipping the fries and sugary drinks to double down on the protein. When, at a later point, a notable food writer called to interview me on the subject of fast food, I started by mentioning my favourites (Wendys and Popeyes), but it turned out they were all indistinguishable to him. He wanted a comment on the general category, which was like asking me what I thought about restaurants.

If food choices defined the class gap, smoking provided a firewall between the classes. To be a smoker in almost any modern, industrialised country is to be a pariah and, most likely, a sneak. I grew up in another world, in the 1940s and 50s, when cigarettes served not only as a comfort for the lonely but a powerful social glue. People offered each other cigarettes, and lights, indoors and out, in bars, restaurants, workplaces and living rooms, to the point where tobacco smoke became, for better or worse, the scent of home. My parents smoked; one of my grandfathers could roll a cigarette with one hand; my aunt, who was eventually to die of lung cancer, taught me how to smoke when I was a teenager. And the government seemed to approve. It wasnt till 1975 that the armed forces stopped including cigarettes along with food rations.

As more affluent people gave up the habit, the war on smoking which was always presented as an entirely benevolent effort began to look like a war against the working class. When the break rooms offered by employers banned smoking, workers were forced outdoors, leaning against walls to shelter their cigarettes from the wind. When working-class bars went non-smoking, their clienteles dispersed to drink and smoke in private, leaving few indoor sites for gatherings and conversations. Escalating cigarette taxes hurt the poor and the working class hardest. The way out is to buy single cigarettes on the streets, but strangely enough the sale of these loosies is largely illegal. In 2014 a Staten Island man, Eric Garner, was killed in a chokehold by city police for precisely this crime.

Why do people smoke? I once worked in a restaurant in the era when smoking was still permitted in break rooms, and many workers left their cigarettes burning in the common ashtray so they could catch a puff whenever they had a chance to, without bothering to relight. Everything else they did was done for the boss or the customers; smoking was the only thing they did for themselves. In one of the few studies of why people smoke, a British sociologist found smoking among working-class women was associated with greater responsibilities for the care of family members again suggesting a kind of defiant self-nurturance.

When the notion of stress was crafted in the mid-20th century, the emphasis was on the health of executives, whose anxieties presumably outweighed those of the manual labourer who had no major decisions to make. It turns out, however, that stress measured by blood levels of the stress hormone cortisol increases as you move down the socioeconomic scale, with the most stress inflicted on those who have the least control over their work. In the restaurant industry, stress is concentrated among the people responding to the minute-by-minute demands of customers, not those who sit in offices discussing future menus. Add to these workplace stresses the challenges imposed by poverty and you get a combination that is highly resistant to, for example, anti-smoking propaganda as Linda Tirado reported about her life as a low-wage worker with two jobs and two children: I smoke. Its expensive. Its also the best option. You see, I am always, always exhausted. Its a stimulant. When I am too tired to walk one more step, I can smoke and go for another hour. When I am enraged and beaten down and incapable of accomplishing one more thing, I can smoke and I feel a little better, just for a minute. It is the only relaxation I am allowed.

Nothing has happened to ease the pressures on low-wage workers. On the contrary, if the old paradigm of a blue-collar job was 40 hours a week, an annual two-week vacation and benefits such as a pension and health insurance, the new expectation is that one will work on demand, as needed, without benefits or guarantees. Some surveys now find a majority of US retail staff working without regular schedules on call for when an employer wants them to come and unable to predict how much they will earn. With the rise in just in time scheduling, it becomes impossible to plan ahead: will you have enough money to pay the rent? Who will take care of the children? The consequences of employee flexibility can be just as damaging as a programme of random electric shocks applied to caged laboratory animals.

Sometime in the early to mid-00s, demographers noticed an unexpected rise in the death rates of poor white Americans. This was not supposed to happen. For almost a century, the comforting American narrative was that better nutrition and medical care would guarantee longer lives for all. It was especially not supposed to happen to whites who, in relation to people of colour, have long had the advantage of higher earnings, better access to healthcare, safer neighbourhoods and freedom from the daily insults and harms inflicted on the darker skinned. But the gap between the life expectancies of blacks and whites has been narrowing. The first response of some researchers themselves likely to be well above the poverty level was to blame the victims: didnt the poor have worse health habits? Didnt they smoke?

In late 2015, the British economist Angus Deaton won the Nobel prize for work he had done with Anne Case, showing that the mortality gap between wealthy white men and poor ones was widening at a rate of one year a year, and slightly less for women. Smoking could account for only one fifth to one third of the excess working-class deaths. The rest were apparently attributable to alcoholism, opioid addiction and actual suicide as opposed to metaphorically killing oneself through unwise lifestyle choices.

Why the excess mortality among poor white Americans? In the last few decades, things have not been going well for working-class people of any colour. I grew up in an America where a man with a strong back and a strong union could reasonably expect to support a family on his own without a college degree. By 2015, those jobs were long gone, leaving only the kind of work once relegated to women and people of colour available in areas such as retail, landscaping and delivery truck driving. This means those in the bottom 20% of the white income distribution face material circumstances like those long familiar to poor blacks, including erratic employment and crowded, hazardous living spaces. Poor whites always had the comfort of knowing that someone was worse off and more despised than they were; racial subjugation was the ground under their feet, the rock they stood upon, even when their own situation was deteriorating. That slender reassurance is shrinking.

There are some practical reasons why whites are likely to be more efficient than blacks at killing themselves. For one thing, they are more likely to be gun owners, and white men favour gunshot as a means of suicide. For another, doctors, undoubtedly acting on stereotypes of non-whites as drug addicts, are more likely to prescribe powerful opioid painkillers to whites. Pain is endemic among the blue-collar working class, from waitresses to construction workers, and few people make it past 50 without palpable damage to their knees, back or shoulders. As opioids became more expensive and closely regulated, users often made the switch to heroin which, being illegal, can vary widely in strength, leading to accidental overdoses.

Affluent reformers are perpetually frustrated by the unhealthy habits of the poor, but it is hard to see how problems arising from poverty and damaging work conditions could be cured by imposing the doctrine of personal responsibility. I have no objections to efforts encouraging people to stop smoking or add more vegetables to their diets. But the class gap in mortality will not be closed by tweaking individual tastes. This is an effort that requires concerted action on a vast scale: a welfare state to alleviate poverty; environmental clean-up of, for example, lead in drinking water; access to medical care including mental health services; occupational health reform to reduce disabilities inflicted by work.

The wealthier classes will also benefit from these measures, but what they need right now is a little humility. We will all die whether we slake our thirst with kombucha or Coca-Cola, whether we run five miles a day or remain confined to our trailer homes, whether we dine on quinoa or KFC. This is the human condition. Its time we began facing it together.

This is an edited extract from Natural Causes, by Barbara Ehrenreich, published by Granta on 12 April at 16.99. To order a copy for 14.44, go to guardianbookshop.com or call 0330 333 6846.

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Read more: https://www.theguardian.com/lifeandstyle/2018/mar/31/why-poor-blamed-shamed-their-deaths-barbara-ehrenreich

The story of one mans pregnancy: It felt joyous, amazing and brilliant

Pregnancy is increasingly common among trans men. For Jason Barker, who has made a film about the experience, it changed his life

Its hard to perform a somersault at 36 weeks pregnant. Towards the end of his debut feature film, Jason Barker is swimming in the London Fields lido in east London, a short walk from the flat he shares with his partner, Tracey. The screen is rinsed blue. Barker dances, makes a star. And then, very slowly, he turns full height in the water, his Hawaiian swim shorts flapping, his stomach a perfect, firm dome.

This is the viewers first sight of Barkers pregnant belly in A Deal With the Universe, which premieres at the BFI Flare festival next week. And after seven years in which he and Tracey tried to conceive, it is a moment of pure levity and joy. That swimming stuff that you see? he says. It felt like the first time I could ever say, Yeah! I actually like this body. Love it. Its brilliant.

Barker was born female. He transitioned roughly 20 years ago, at 26, soon after he met Tracey though, as Barker says, before and after dont really work in this story. The process of transitioning was gradual, without hard edges. The two of them hoped to start a family, but after a few years of Tracey trying to conceive with her own eggs, in 2003 they resorted to plan B. Tracey would be impregnated; Barker, who had undergone chest surgery but kept his ovaries, would supply the eggs. He bought a new camera to document it. Soon they would have a baby and a film.

So Barker stopped taking testosterone. He delayed an appointment to discuss a hysterectomy. Well, it was just a short film. Not too disruptive. But the filming went on and on and Barker ended up telling a very different story to the one he planned. The pregnancy he chronicled was not Traceys, but his own. And it changed his sense of who he was.

Pregnancy among transgender men is increasingly common. Sally Hines, a professor at the University of Leeds who is leading a three-year research project into the subject, says: In the UK, if you look at how many people are accessing blogs and online forums and support groups, asking about healthcare because they are pregnant, or young guys thinking about the future There is lots of anecdotal evidence that more people are doing it. When something becomes visible, more people think its possible.

But 10 years after Thomas Beatie, from Hawaii, made headlines with his combination of beard and baby bump the first publicised case of a legal male, in a traditional marriage to a woman, to give birth the data remains scant. In Australia, 54 people who identified as men gave birth in 2014, according to Medicare statistics. In the UK, the Office for National Statistics collects no information on the gender of the birthing parent; neither does the NHS. Last year, British newspapers including the Sun and the Independent hailed Hayden Cross as Britains first pregnant man. Soon afterwards, they had to hail another man, Scott Parker, after he got in touch to say that he had given birth a few months earlier.

There have been about six first pregnant men, Barker notes wryly. His son turns eight this year.

And yet the idea of transmasculine pregnancy as a novelty holds sway. Each birth is greeted as the first. It is perennially surprising, and I wonder if this is because it is conceived by cis people as a double-edged contradiction that undermines both the common conception of pregnancy as inherently female and the sense of a completed transition as if a trans man carrying a child constitutes a sort of U-turn. But, as Hines says, Transition is not a straightforward A to B Pregnancy is not an interruption, just another part of a long and complex journey.

Barker, whose son is now seven. Photograph: David Levene for the Guardian

Barkers film begins with him prizing a state of heightened masculinity. When Tracey cant conceive, he longs for a penis and testicles. He strikes muscular poses while washing the windows of their caravan, and the thought of his eggs entering her makes him feel like cock of the walk. He says it in a way that emphasises the pun. But, as the film progresses, a subtler story emerges.

I had this fantasy picture, he says. I thought, Ill have a baby, and that night Ill go and have a pint, and about two weeks after that Ill start on the testosterone again Job done. Pregnancy was a transient state, a strange bit of my life, after which normality would be restored.

But, pretty quickly, the film begins to transmit more mixed messages. As soon as he is pregnant, Jason appears in a pair of denim dungarees, that classic of 1970s maternitywear. In labour, he looks forlorn in a cerise nightie with a cute animal motif. He laughs when I ask why, in pregnancy, he resorted to these conventional cues for femininity. You just grow so massive and youve got nothing! he says. Retailers of pregnancy clothing arent exactly teeming with options for trans men. Tracey went to New Look and bought a load of maternity trousers, but even the combats were embroidered with flowers. She had to get a needle and unpick them.

In pregnancy, Barker mostly passed as a fat bloke. No one offered him a seat on the bus. No one batted an eyelid when, dressed in jeans and a cardie, he walked along the canal towpath to Nandos two days before giving birth. He was both in plain sight and, owing to the relative rarity of pregnant men, hidden. In an antenatal class, when the teacher instructed all the pregnant folks to feel their hips, and he obeyed, the man beside him gave a nudge and said: I dont think we have to bother, mate!

For as long as he could remember, Barker had had a body that didnt fit. And now youre here, he tells his son in the film, and I cant think like that any more.

It would be easy to imagine pregnancy as a time of heightened gender dysphoria for trans men. I had expected most people to have more dissonance with their body during pregnancy, says Alexis Hoffkling, a researcher and medical student at the University of California, San Francisco who is trans herself. A few years ago, she started interviewing trans men who had been pregnant and found that while some had a lot harder time with their bodies [others] felt empowered. Some found it masculinising. They were more like a fat dude than they had ever felt before. As their body got bigger, they felt stronger.

When Barker began to piece together the 25 hours of tape he had recorded over eight years of trying to start a family, a worry began to form. The proper story, he thought, would be that somebody keeps their gender identity regardless. Im a man and Im pregnant but Im still a man, and this is a mans pregnant tummy. But for me, it felt really different.

Barker says he is naturally a very binary person. Ive been ever so serious about gender in my life. That its this thing you have to be fully committed to. Because my generation of trans people had to be fully committed in order to access treatment. It took a while, but slowly he began to let go of his self-interrogation, what he calls the whole pregnant man thing. He stops to think. The closest comparison, he says, is that being pregnant was like watching Mo Farah run. He is so graceful. Hes not having to go, Im trying to run! like the rest of us. And thats how it felt for me: Wow. Im just doing this. It felt joyous and amazing and brilliant.

In the same way that Barker would always stand up for his friends against transphobic strangers, now he felt compelled to protect his pregnant body against his own sense of incongruence. I would defend that body. That body is a beautiful thing because of what its doing and what its done, he says. The body was all about my kid.

So, in a way, it was a selfless body? It didnt feel right when Barker was its sole occupant, but when it acquired another, an other, it became a better fit? I wonder if Barker felt less male when pregnant. But he says only: Honestly, I had a really lovely time.

Im going to ask you a very personal question, he says, leaning forward. When people talk about getting broody again, its pretty ick, isnt it? Its icky because none of us likes to think we are ruled by our hormones?

Thats true, I say. But, speaking personally, I did get broody again.

Yes, so did I! he exclaims, delighted. He and Tracey knew that they wouldnt try for another child, because it had taken them a decade to conceive and they didnt want to lose their sons infancy in endless rounds of IVF. But for a long time after the birth, Barker lived with a sort of second, shadow baby.

Id have these fantasies that somehow, a few months later, theyd say, Just a minute! We think theres a twin in there! Id think about it all the time, that I was somehow accidentally pregnant and nobody knew. Kangaroos do it, Id think. Would there possibly be a way? Theyd say, We dont know how its happened but its like your body stored it. And Id be, Well, there you go! A miracle!, he says.

He never had the hysterectomy. He hasnt taken testosterone in 15 years, since he and Tracey embarked on their plan B.

Barker and his partner Tracey. Photograph: Sara Davidmann/A Deal With the Universe/BFI

There is, as yet, no guidebook to pregnancy for trans men, though Barkers film will fortify others who wish to follow in his footsteps. There is a memoir, Wheres the Mother? Stories from a Transgender Dad, by Trevor MacDonald, who lives in Manitoba, Canada, and who carried his own children, now three and seven. MacDonald founded a Facebook group on birthing and breast- or chestfeeding for men.

The questions that come up repeatedly are practical ones. What is the impact of testosterone on a trans mans chances of conceiving? (Barker took it for three years.) How does chest surgery affect lactation? (This subject is off-limits for Barker, but MacDonald fed his own children and became the first openly trans volunteer at La Leche League, the breastfeeding support group, after they initially told him it was inappropriate for them to help him. From his own research conversations with trans men, he knows that some found nursing reduced their experience of gender dysphoria around their breasts: It seemed to have to do with those body parts serving a purpose that they otherwise didnt, he says.)

Once, in hospital, the nurses called Barker Mum. But after racking his brains, that is the single misstep he can recall. MacDonald says he is amazed that Barker had such a smooth experience with his healthcare providers. There are plenty of stories of those who dont specimen bottles routinely given to thin female partners instead of the pregnant man, and so on.

Registering the birth was a hurdle, though. Barker had no choice but to officially be his sons mother. As well as his name, he included his birth name under the designation AKA, because he dreaded some kind of clerical error that would make the baby not mine. That sounds completely paranoid, he says, but growing up with section 28 had given him the idea of not thinking that you deserve to be spoken about, do certain jobs or have certain things. And those things included, presumably, a child.

Mostly, though, parenthood has been free of administrative challenges. In fact, Being out and about as a dad with a small baby attracted more attention than being a pregnant man did! he says. Barker is a writer, but he is also his sons prime carer. I remember him crying on a bus and a woman shouted, Not as easy as you thought, was it? Also I once shocked the whole Stay and Play when I told them that my partner had gone back to work two weeks after the baby was born.

Their little boy has grown up with an understanding of his family, how he came about. Ever since he was born, they have told it to him almost like a bedtime story. (He has heard it so often, he sometimes rebukes his dad for boasting about being trans.) Discussing Harry Potter one day, Barkers son wanted to know which of the characters Barker would be if he could choose anyone. Hagrid, Barker replied. In the films, the hirsute, giant gamekeeper is played by Robbie Coltrane. Well, youve already got the beard, his son said, appreciatively.

A film needs an arc, of course to end somewhere other than where it started. Barkers worry about this, when he began to edit the footage last year, was, My God, will somebody think Im cured [of being trans]? Its a horrible thought, he says. Its all right for Tracey, his indomitable partner, whose eyes continue to sparkle even through a mastectomy for breast cancer. She didnt need an arc. She could just be brilliant all the way.

I think my arc, he says, is going from somebody who thinks being an ordinary man is the best thing you can be to somebody who sees a different way of being. To a certain extent its about femininity, he says, tapping the table as if hes put his finger on it. Id pushed [it] away from a really young age, and I think its about bringing some of that back. And you realise how undervalued this work is And it does make you think, What was I pushing away? What was I scared of?

Its about vulnerability, I think, he says, and it is a surprise to hear him say it, because the quality he most wants to surface in the film is resilience. Of course, the two go together, and Barkers story is about both of those things, and the personal regrowth that can come from giving birth. He not only challenged boundaries in the world around him, but in his own understanding of himself.

A Deal with the Universe is at BFI Flare: London LGBTQ+ film festival on 26 March at BFI Southbank

Read more: https://www.theguardian.com/lifeandstyle/2018/mar/22/story-one-mans-pregnancy-trans-jason-barker

Ultra-processed foods may be linked to cancer, says study

Findings suggest increased consumption of ultra-processed foods tied to rise in cancers, but scientists say more research is needed

Ultra-processed foods may be linked to cancer, says study

Findings suggest increased consumption of ultra-processed foods tied to rise in cancers, but scientists say more research is needed

Read more: https://www.theguardian.com/science/2018/feb/14/ultra-processed-foods-may-be-linked-to-cancer-says-study

Cancer I could deal with. Losing my breast I could not

When Joanna Moorhead found out she had breast cancer, a mastectomy seemed the best option. So why did she pull out of the operation at the last minute?

Cancer I could deal with. Losing my breast I could not

When Joanna Moorhead found out she had breast cancer, a mastectomy seemed the best option. So why did she pull out of the operation at the last minute?

Read more: https://www.theguardian.com/society/2018/feb/04/cancer-mastectomy-losing-breast-joanna-moorhead

I have cancer. Don’t tell me you’re sorry | Elizabeth Wurtzel

Everyone else can hate cancer. I dont. Everyone else can be afraid of cancer. I am not, writes Elizabeth Wurtzel

I have cancer. Don’t tell me you’re sorry

Everyone else can hate cancer. I dont. Everyone else can be afraid of cancer. I am not, writes Elizabeth Wurtzel

Read more: https://www.theguardian.com/commentisfree/2018/jan/20/cancer-elizabeth-wurtzel

How the hardest year of my life ended my catastrophic thinking

Worst-case scenario has always been my default setting but complications during pregnancy and an ill mother and partner meant I had to get my anxiety under control

It is March and I am Googling meningitis again. My partner has caught our sons chicken pox and her symptoms are frightening me. Vice-like headache. Aversion to light. Brain fog. Also, I am pregnant and my habit of catastrophising has sprouted horns, and, pumped up on hormones, my heart is working twice as hard as usual. Nausea is now approaching something more cataclysmic. My phone starts autocorrecting morning to meningitis. I become convinced that my partner has developed brain swelling, a rare complication of chicken pox. From here, it is a short step to picturing her dying and me giving birth alone, letting the worst case scenario in like an old friend.

The thing is, this time I am right. Sort of. She does have meningitis. The GP takes one look at her and sends her up to the infectious diseases ward in a taxi. I feel a tiny bit triumphant in the way only catastrophisers can. See? I told you. The worst has happened! But Im also wrong: a tiny wad of catastrophe may have been fired at us, but my partner does not die and I do not give birth alone. She recovers. The baby is born. We are lucky again.

Time and again during the hardest year of my life (to date, the catastrophiser in me would like to qualify), my habit of fearing that the worst will happen got, well, worse. I dont know when it began, so peculiarly subtle is the feeling that the most likely outcome is the really bad one. But last year some of my most calamitous predictionscame true, at least in part. The realisation that I needed to do something about it came when my partner, who is a psychotherapist, arrived home with a book. I saw this and thought of you, she said. It was called Why Does Everything Always Go Wrong?. I laughed a bit too hard. The truth is, there was a lot to catastrophise about last year, on a global, national and personal level.

Just before the meningitis episode I discovered that the baby I was carrying was high risk for Downs syndrome. While we awaited more results, my pregnancy was reduced to a series of statistics one-in-58 chance of Downs, one-in-100 risk of miscarriage with amniocentesis and I grappled with the fact that someone has to be the one. In fact, I already knew what it was to be the one, because my son is autistic and, actually, we are all coping brilliantly; being the one is not a catastrophe once you are living it.

But catastrophising does not give a damn about hard evidence and I remained terrified. A fortnight later, the results came in: the chance of the baby having Downs was vastly reduced, to one in 10,000. It occurred to me that catastrophising is more than just a destructive habit: sometimes it is a reasonable response to what is happening, a kind of mental preparation.

In April, my mother, who is incurably ill with breast cancer, got pneumonia and ended up in A&E. She asked to see my sister and I, so I rushed to London from Edinburgh, five months pregnant, with a daughter (and dread) somersaulting in my belly. I feared the distress would make me lose the baby and I thought my mother was going to die. Catastrophisers have a habit of thinking a person is dead if they are half an hour late, so a situation like this suits our sense of drama perfectly. My mother recovered. We continued to live with the deep uncertainty that comes with scans every three months and the neverending wait for results. Each time, I prepared myself for the worst. Maybe this is not a habit to be broken, but a coping mechanism.

By June, I had to make a major decision that provided an opportunity to see whether I could nix the catastrophising: how to have my baby. My son, who is four, was born by emergency C-section and so I was offered an elective caesarean. I saw a consultant who ran through the risks I faced if I attempted a natural birth without constant foetal monitoring and a cannula in my hand. I decided to laugh or, at least, get off my head on laughing gas in the face of potential catastrophe and attempted a natural birth on my own terms. I hired a doula to support me in hospital and here is a first hoped for the best.

In August, my daughter was born 45 minutes after I arrived in hospital. It was a short, fierce and mind-blowing natural labour. It was not perfect I had an episiotomy and there was a minor Strep B scare that meant we ended up in A&E twice in the first week after her birth but it was one of the best days of my life (to date, the optimist in me would like to qualify).

How am I trying to break my habit of catastrophising? Not by deep breathing, yoga, therapy, drugs or imagining all the catastrophes I fear floating away down a river. Talking and thinking have helped in the daily maintenance of perspective, which is catastrophisings greatest enemy. Has this year been about the worst happening (and I write this a week after my beloved dog has had four tumours removed from her powerful, young body) or about a series of narrow escapes? Is it about bad luck or survival? After all, my partner recovered. The baby is perfect. My mother is still here. The dog is walking off the lead again. We are lucky.

Catastrophising is dependent on you never being in the moment: it constantly shoves you up against an unknowable, uncontrollable future. Once you go there, you are lost. Parenting, so often a source of anxiety, has been the best antidote to this. The hard graft and small, pure joys of looking after a baby and a little boy with autism anchor me to the present. The baby keeps me healthy, makes me feel lucky and gives me a constant dose of perspective. She is also exhausting: I am too tired and busy to catastrophise with as much fervour as the habit demands.

Then there is my brilliantly singular, loving and brave son. Before he was diagnosed with autism (that happened this year, too) I feared this moment: how will we manage? What will we do about school? How will he develop? Is everything going to be OK? The mystery and idiosyncrasy of autism can be frustrating, but it is also a visceral reminder that none of us knows what lies ahead and that compassion is the most powerful weapon against anxiety. So, here I am, living and thriving in the future over which I once catastrophised. And you know what? It is not so scary after all.

Read more: https://www.theguardian.com/lifeandstyle/2017/dec/29/hardest-year-my-life-ended-catastrophic-thinking-anxiety

Warnings over shock dementia revelations from ancestry DNA tests

Companies have been told to accept moral responsibility and provide counselling for people who inadvertently discover health risks

People who use genetic tests to trace their ancestry only to discover that they are at risk of succumbing to an incurable illness are being left to suffer serious psychological problems. Dementia researchers say the problem is particularly acute for those found to be at risk of Alzheimers disease, which has no cure or effective treatment. Yet these people are stumbling upon their status inadvertently after trying to find their Viking, Asian or ancient Greek roots.

These tests have the potential to cause great distress, said Anna Middleton, head of society and ethics research at the Wellcome Genome Campus in Cambridge. Companies should make counselling available, before and after people take tests. The issue is raised in a paper by Middleton and others in the journal Future Medicine.

A similar warning was sounded by Louise Walker, research officer at the Alzheimers Society. Everyone has a right to know about their risk if they want to, but these companies have a moral responsibility to make sure people understand the meaning and consequences of this information. Anyone considering getting genetic test results should do so with their eyes open.

Alzheimers is linked to the build-up in the brain of clumps of a protein called amyloid. This triggers severe memory loss, confusion and disorientation. One gene, known as ApoE, affects this process and exists in three variants: E2, E3 and E4. Those possessing the last of these face an increased chance of getting the disease in late life.

About 3% of the population has two copies of the E4 variant one inherited from each parent, Professor John Hardy, of University College London, said. They have about an 80% chance of getting Alzheimers by the age of 80. The average person has a 10% risk.

The link with ApoE was made in 1996 and Hardy recalled the reaction in his laboratory. We went around testing ourselves to see which variant we possessed. I found I have two low-risk E3 versions on my genome. But if I had found two E4 versions? By now, having reached my 60s, I would be facing the prospect that I had a serious chance of getting Alzheimers disease in 10 years. I would be pretty fed up.

The ability to find a persons ApoE status has become even easier as a result of the development of genetic tests that provide information about a persons ancestry, health risks and general traits. Dozens of companies offer such services and adverts portray happy individuals learning about their roots 43% African or 51% Middle Eastern often to the sound of Julie Andrews singing Getting to Know You or a similarly happy-sounding track. All you have to do is provide a sample of spittle.

The resulting information about predilections to disease is not stressed but it is given. Kelly Boughtflower, from London, took a gene test with the company 23andMe because she wanted to prove her mothers family came from Spain. The results provided no evidence of her Iberian roots but revealed she carried one E4 version of the ApoE gene, which increases her chances of getting Alzheimers, though not as drastically as a double dose.

I didnt think about it at the time, said Boughtflower. Then, when I took up work as an Alzheimers Society support worker, I learned about ApoE4 and the information has come to sit very heavily with me. Did I inherit the ApoE4 from my mother? Is she going to get Alzheimers very soon? Have I passed it on to my daughter? I have tried to get counselling on the NHS but that is not available for a person in my particular predicament, I was told.

Other examples appear on the ApoE4 Info site, a forum for those whose gene tests show an Alzheimers susceptibility. Have stumbled upon my 4/4 ApoE status. Im still in shock, writes one. Another states: I got paid a $50 Amazon gift-card to take part in a genetic study. I was naive and unprepared.

There is no drug or treatment for Alzheimers and although doctors advise that having a healthy lifestyle will help, the baseline risk for E4 carriers remains high. That is a real problem, said Middleton. Genetic test companies say they offer advice about counselling but that usually turns out to be a YouTube video outlining your risks. Affected people needed one-to-one counselling.

For their part, gene test companies say results about Alzheimers and other such as breast cancer and Parkinsons are often hidden behind electronic locks. A person has to answer several questions to show they really want to open these and is informed of potential risks. But Middleton dismissed these precautions. You know there is medical information about you online and so you will go and find it. It is human nature.

Margaret McCartney, a GP and author of The Patient Paradox, agreed. What worries me is the aggressive way these tests are marketed. People are told all the benefits but there is no mention of the downsides. The NHS is expected to mop these up.

Meanwhile, the gene test company has made its profit and walks away from the mess they have created. I think that is immoral. They should be made to pay for counselling for their customers.

Read more: https://www.theguardian.com/science/2017/aug/26/alzheimers-disease-shock-for-genetic-ancestry-hunters

HRT and vaginal moisturisers? Here’s what really helps menopausal women

Products claiming to fix the menopause are now a multibillion-dollar global industry. We asked the experts for their advice on what works and what doesnt

Even though 80% of women going through the menopause will get symptoms, such as hot flushes and night sweats (and in 25% of cases they will be severe enough to affect quality of life), few are confident talking about it. A global industry worth about US$4bn (3.4bn) flogs books and products, but reliable information is hard to come by. So how can women distinguish fact from marketing hype and what helps?

Managing the symptoms

Kathy Abernethy, chair of the British Menopause Society, says: Hormone replacement therapy (HRT) is absolutely the best treatment for hot flushes and sweats that affect daily life. It can also help sleep disturbance caused by night sweats and is one of several strategies to keep bones strong. Dr Mark Vanderpump, an endocrinologist (hormone specialist), agrees: If men got hot flushes, theyd be screaming for HRT, he says. Other options include the non-hormonal drugs clonidine, venlafaxine and gabapentin, or lifestyle measures such as avoiding spicy foods, alcohol and hot places.

HRT and cancer risks

The risk of cancer from HRT is overstated, says Vanderpump. Cancer Research UK puts it in perspective; if 1,000 women start HRT at the age of 50 and take it for five years, there will be two extra cases of breast cancer and one extra case of ovarian cancer compared with among non-HRT users. There will also be some extra cases of heart attack and stroke, but the overall negative effects are small. Avoiding HRT could prevent 1,700 cancer cases a year, but staying a healthy weight could prevent 18,000 cancer cases and not smoking would prevent 64,500 in a year. Women need to be given information and choices, says Vanderpump. Abernethy recommends the Womens Health Concern factsheets and the website Manage My Menopause, which offers tailored advice.

Natural supplements

Campaigner and author Maryon Stewart advocates a diet rich in plants such as soy that contain oestrogen-like chemicals called phytoestrogens. But Abernethy says we dont know how much soy you need to eat to get the same effect as HRT. And if phytoestrogens have similar benefits to synthetic oestrogens in HRT, they may share the risks: an increased chance of blood clots and a possible increase in breast cancer.

Dietary supplements containing isoflavones (the active chemicals in phytoestrogens), herbal remedies such as black cohosh and vitamin E are all available over the counter, but there is little evidence about their effectiveness or otherwise, according to the North American Menopause Society.

Eating a varied, Mediterranean-style diet, avoiding obesity, and doing regular weight-bearing exercise will help to minimise the risk of osteoporosis, heart disease, depression and osteoarthritis. Most women dont need calcium supplements, but those at particular risk of osteoporosis should get specialist advice.

Preventing heart disease and strokes

June Davison of the British Heart Foundation says women need to be aware that their risk of heart disease and stroke increases dramatically after the menopause. Oestrogen, which has a protective effect on artery linings, falls and other factors, such as high blood pressure, raised cholesterol and the ageing process kick in. Davison says: Heart disease kills three times as many women as breast cancer does; its common and certainly not a male disease. The best approach is to get a health check at your GP, optimise blood pressure, cholesterol and weight, dont smoke, eat well and exercise. We dont advise HRT to protect against heart disease; it may increase the risk of thrombosis (blood clots) if you are at increased risk and there is some evidence that heart disease is increased in the first year of HRT use. Women who want to take HRT for other reasons, such as hot flushes, and are at low risk of heart disease, can be reassured that the increased risk will be very low.

Sex drive and dry vagina

Loss of sex drive is common around the time of the menopause. Low mood, tiredness, hormonal changes and relationship problems may all play a part. It doesnt help that sex can be painful as the fall in oestrogen levels makes the vagina dry and sore. Non-hormonal vaginal moisturisers such as Replens, lubricants, and oestrogen pessaries (on prescription only) can restore vaginal moistness; the other factors may be more complex to fix.

Supplements for skin and hair

Vanderpump says women and men in midlife often experience thinning hair, rougher skin and various other age-related changes to their looks. But these are more likely to be due to genetics and environmental factors, such as sun exposure and smoking. If you eat a normal, varied diet, there is no reason to think that nutritional supplements will help hair, nails or skin. HRT doesnt turn the clock back and isnt recommended for these factors.

How can my employer help?

A government review examined 104 studies and found that the years around the menopause can have a big, usually negative, impact on womens working lives. Study co-author Professor Jo Brewis of the University of Leicester school of business says: We need to talk about the nitty gritty of menopause without embarrassment or fear being judged. Brewis says the analogy is with pregnancy 20 years ago when women feared telling employers that they were pregnant and needed certain reasonable adjustments in the workplace. For menopausal symptoms such as hot flushes, that might include fans, open windows, adjustable air conditioning, non-synthetic uniforms and flexible working hours.

We need to normalise the menopause, understand that it affects women differently and that many of the problems are relatively short-lived, says Brewis.

What are bioidentical hormones?

This form of HRT marketed in the private sector claims to offer hormones derived from plants that are chemically closer to the ones that occur naturally in the body. But the US Food and Drug Administration (FDA) is clear that they are no safer or more effective than standard HRT. Vanderpump says that if you find HRT helps symptoms, the exact preparation can be tailored to your specific needs; adding low-dose testosterone (Testim) gel, for instance, may help libido even though it is only licensed for men.

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Read more: https://www.theguardian.com/lifeandstyle/2017/aug/07/hrt-and-vaginal-moisturisers-heres-what-really-helps-menopausal-women

Feminism, politics and death: my mum died the night Hillary Clinton lost

They may seem like unrelated events but the end of Clintons campaign and my mothers life made me reflect differently on my own political career

My mother died the night Hillary Clinton lost. These might seem like two very unrelated events and youd be right about that. But for me, and my somewhat particular circumstances, Ive found a plethora of meaning about life and death, feminism and politics.

See, it was also the night I was due to be sworn in as a councillor for my local city council. It was my first political foray and Ive reflected on the start of my own political journey while on the other side of the world a smart and skilled female politician saw the end of hers, with our whole gender brutalised by a despicable Trump. And though Mum doesnt know it, all my political guts I got from her.

Mum was diagnosed with breast cancer 10 days before the 2016 Australian federal election. Dad called me from Canberra to say he had taken Mum to hospital and she had acute pneumonia. I was going through the processes of my Labor nomination for council elections. With days to the federal election, every spare moment I wasnt working I was door-knocking and pre-polling.

I dont remember that first conversation with Dad. I do remember the call the next day when Dad told me Mum had terminal cancer (as well as acute pneumonia) and the cancer had spread through her ribs, spine and pelvis. I was at my desk so I booked a flight home and, as I headed out the door, asked a colleague to cancel me out of every election activity I was signed up for.

Breast cancer is a disease that inflicts itself predominantly on women. Its also one of the most misdiagnosed cancers around. Mum had her last mammogram only months earlier and it hadnt appeared. I grew bitter quickly.

At the same time this was a federal election where it was one bloke versus another bloke versus another bloke, and women barely seemed to get a mention. I had volunteered the bulk of my time on campaigns to support female candidates in tough Victorian seats, none who won. I sat bedside my mother who taught me everything and watched women largely erased out of public life.

On Sunday 3 July, a day after the federal election Mum was only in the second week of a disastrous five week stint in hospital my journal shows compassion draining out of me:

I suspect I will grow rough and battle hardened and unforgiving from this. A part of me hopes I will. Perhaps I will grow ruthless and mean and brutal like life and that might make me powerful like men. I dont think Mum will like the new me. Ill have an excuse to be mean now, finally.

I thought at length about quitting the council race. We didnt know the timeline Mums cancer was working to, although wed been told up to 24 months for stage four breast cancer. I was enjoying caring for her and all her needs. But quality of life for Mum was also about quality of life for her daughters and, honestly, I just always thought shed make it a little longer.

So I ran my council campaign in between working full time and flying back home to care for Mum, alternating every second weekend with my sister. Offering a parallel world to my campaigning life, my life with Mum gave me such relief. I loved the quiet nights I shared with her. From the carers bed in her room, I would lie facing her and would listen for her breathing as her lungs drew in air from her oxygen tank.

In late October, I won the third and final spot at the council ward elections; Mum went back into hospital and I flew home again.

While nothing can prepare you for the death of a parent I did everything I could to prepare myself. I read memoir and non-fiction (by women) and I talked with women who had experience, both personal and professional.

In the final days, as Mum slept sedated, I read A Very Easy Death by Simone de Beauvoir. It was the 50th anniversary of the translation of the French feminists account of her mothers death. The months of that death also mirrored my mothers own: a few long weeks over October and November.

De Beauvoirs mothers death was frightening to me because it was everything her maman didnt want. She wasnt ready for death and her medical wishes were not respected: the doctors operated on her even though she had begged de Beauvoir that she wouldnt let them touch her body. Her final moments were full of pain and distress. De Beauvoir wasnt even there as she had slept through the panicked phone calls from her sister.

I was not watching the US election results that afternoon and evening in November. Mum was at Canberras public hospice set amongst beautiful gardens and overlooking Lake Burley Griffin. For the last few days she had been heavily sedated. Mums breathing changed late in the afternoon and we knew, not long now.

In academia, philosopher Michel Foucault called it a heterotopia, but most of us might think of it as a bit of a headfuck, a space or place in time that has more meaning or relationship to another space than it might first appear. As my mum lay dying, I was in a room full of strong women with her. My cousin brought in the bad news from the US and I slumped in my chair beside Mum, overwhelmed by yet more insurmountable grief. I thought if I was back in Melbourne, if my mum wasnt dying, Id be at my council ceremony right now and Hillary might even have been winning but here I was in this awful parallel universe that happened to be real.

Mum died that night. A little after midnight, I woke from a light doze and Mum was turned slightly in her bed, facing me and she had stopped breathing. I leaned in close and checked for a pulse on her wrist. Her skin was so perfectly warm. The family all woke and we said our goodbyes.

I stayed with Mums body till morning. I picked out clothes for her as the nurses cleaned and dressed her. Then finally watched on as they are you ready for this? put Mums body into the transport bag. I followed the nurses as they pushed her bed down the hallway to the cold room, where I thanked them and having already said my goodbyes, left for my car and for my first day without my mum in a bleak, bleak new world.

In the months after, it was through the company of women, and particularly women who have lost their mothers, that I have found my feet again. I havent turned bitter and mean as I once thought or hoped I would. My feminism is softer with new compassion but also bolder with new militancy.

Im still finding my political feet, but Ive been elected to a council with majority women membership plus we have a female mayor and CEO too. At every council meeting I reflect deeply on the values, learnt from my mother, that drive my decision-making even if at times they wont make me popular.

I dont see much of Hillary in the news these days, which Im thankful for. It reminds me of Mum each time and when I do, bystanders watch me dab at my eyes and think she must really have liked Hillary. Little do they know that was the night my mum died.

Read more: https://www.theguardian.com/lifeandstyle/2017/jun/18/feminism-politics-and-death-my-mum-died-the-night-hillary-clinton-lost

The dos and don’ts of being a first lady: from Jackie Kennedy to Melania Trump

Now she has officially left New York to follow her husband to Washington, how will Mrs Trump navigate life in the White House?

Ever since her husband was elected president of the United States, theres been speculation about how much Melania Trump really wants to 1) be The Donalds wife; 2) take on the duties of first lady. Not least because it has taken the former model more than a month to move into the White House, which she and her son Barron finally did this week. Barron marked the occasion by wearing a T-Shirt reading The Expert, already now sold out.

Im no expert but, Id wager that despite this move, recent events suggest the answer to question one might still be: very little. During the Trumps first official international trip, to the Middle East and Europe, much was made of Melania twice batting away Trumps outstretched hand (also very little). But while Melania appeared unwilling to hold her husbands hand, it looked like she was finally getting a handle on the whole first lady thing. She has spent much of Trumps presidency shunning the spotlight, leading many to wonder whether Ivanka might be assuming the role of a surrogate first lady. On this first foreign foray, however, Melania seemed to come out of her shell. She bantered with the Pope and visited sick children; Anita McBride, who was chief of staff to first lady Laura Bush, told CNN that when she saw Melania step off Air Force Once with Trump, she looked fully prepared for her role.

Read more: https://www.theguardian.com/us-news/2017/jun/13/melania-trump-ready-first-lady-donald-united-states