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What to Do When Someone Gives You the Silent Treatment

26 August 2026 at 22:33
—Photo-Illustration by TIME (Source Image: Hans Neleman—Getty Images)

There’s a healthy way to take a break during conflict. Asking for space—and specifying when the conversation will resume—can protect a relationship by giving both people time to calm down. 

The silent treatment does the opposite. Withdrawing without explanation or a plan to reconnect just creates a new conflict, leaving the person on the receiving end scrambling to figure out what went wrong.

Yet not everyone who goes quiet is trying to inflict pain. Some people shut down because they’re overwhelmed and genuinely incapable of having a productive conversation. We asked experts how to figure out what’s behind the silent treatment—and what to do when someone stops speaking to you.

First, figure out what kind of silence you’re dealing with

A healthy cooling-off period and the silent treatment can look identical from the outside, says Rachel Needle, a psychologist in West Palm Beach, Fla. Both involve someone stepping away from a conversation. What changes the meaning of that silence is whether the person explains what's happening and offers some reassurance that the conversation isn't over. Most of all, it's whether they say when they'll be back.

Someone who’s emotionally flooded might say: “I need a little time to calm down before we keep talking. Can we pick this up tonight?” Doing so gives the silence a purpose and an endpoint, Needle says. If the person needs more time when the agreed-upon hour rolls around, they can say so and suggest another time. 

That communication sends an important message, says Enid Wilson, a licensed marriage and family therapist in Sacramento: “I’m still in this relationship. I’m just taking a pause on this conversation because I need to take care of myself.” Walking away or refusing to respond leaves the other person wondering whether the conversation—or even the relationship—is over. The best version also comes with a timeframe.

People withdraw for all kinds of reasons. They might be afraid they’ll say something they regret or have learned to protect themselves by shutting down. Some people simply haven’t learned how to sit with difficult emotions or repair a disagreement, Needle says, so “silence really becomes a way to escape the discomfort, rather than having to deal with it and move through it.”

In other cases, silence is leverage. It creates uncertainty and pressures the recipient to apologize or back down. Sometimes that strategy is conscious, Needle says, and sometimes it isn't. Whatever's motivating the withdrawal, the impact on the other person can be similar. "It creates anxiety, rejection, uncertainty, and a sense of being shut out," she says.

Because it’s impossible to climb inside someone else’s head, focus on what can be observed. Did they say they needed space? Did they give some indication of when they’d return? Did they follow through—or at least check in to ask for more time? Then ask whether this is a rare rupture, or the way every disagreement ends.

Context matters, too. There's no universal number of hours that transforms a delayed response into the silent treatment. If two friends usually exchange a couple emails a month, a week of quiet probably doesn't mean much. If a partner who texts throughout the day suddenly disappears in the middle of a tense conversation, it might. Texting also strips out tone of voice and facial expression, the signals that make intent easier to interpret. "You just miss so many cues when you're not talking either on the phone or in person," Wilson says. That's why she encourages moving difficult conversations out of the text thread.

Send one clear message—and then stop chasing

When someone abruptly goes quiet, the goal is to respond without escalating the conflict while staying grounded in your own needs, Needle says. Start by calmly naming what you've observed: "I noticed that you've gone quiet. I want to understand what's going on, but I also don't want to push you if you need some space."

If the silence is unfolding over text, Wilson suggests a question instead of an accusation: "It seems like now isn't a good time to talk. Can we set a time for later tonight or sometime this week?" That gives the person room to respond while making it clear that disappearing indefinitely doesn't work for you.

Then resist the urge to send six more messages. "One of the biggest mistakes that people make is reacting to the anxiety that the silence is creating, instead of responding to the situation itself," Needle says. That anxiety might inspire repeated calls and demands to talk right now. It might inspire apologies for things you don't believe you did. Some people abandon their own needs simply to get the other person talking again; others retaliate with silence of their own.

Those reactions are understandable, but none are especially useful. Chasing might briefly relieve your distress if the person responds. But “in some cases, it can actually unintentionally reinforce an unhealthy dynamic by teaching both people that silence is what finally gets a response,” Needle says. Returning the silent treatment, meanwhile, only complicates a problem already caused by a lack of communication.

These dynamics can easily become a pursue-withdraw cycle, Wilson says. One person experiences conflict as an urgent threat to the relationship and needs to resolve it immediately. The other copes by detaching or shutting down. The more the first person calls and texts, the more conflict the withdrawer perceives—and the farther away they retreat. "If that person is conflict-avoidant, you're creating more conflict," Wilson says. "So they're going to avoid it."

The way out is to step out of the cycle, at least temporarily. That means tolerating the discomfort of not getting an immediate response, and directing all that nervous energy somewhere else. "The best and healthiest response is usually just the least reactive one," Needle says. After expressing your willingness to talk and asking when the person can reconnect, shift your attention toward what you can control. "Go for a walk, call a friend that you trust, journal, engage in another grounding activity," she suggests, rather than staring at your phone and rehearsing apologies. Doing so helps ensure the other person's silence doesn't determine when you're allowed to feel OK again.

When things are calm, make a plan for next time

When communication resumes, you might be so relieved that you simply pretend nothing happened. But unless the pattern itself is addressed, the next disagreement might end the same way.

Needle suggests leading with curiosity: “Can you help me understand what was happening for you when you needed to step away?” Once you’ve listened, describe the impact without claiming to know the person’s intent: “When I didn’t hear from you and didn’t know whether we would talk again, I felt anxious and disconnected. I’m OK with taking space during conflict, but I need to know we’ll come back to it.”

Then decide together what a future timeout will look like. Avigail Lev, a clinical psychologist in San Francisco, encourages couples to agree in advance on how either person will signal that they need a break, roughly how long it will last, what they’ll do to calm down, and who will restart the conversation. If the person needs longer, they should still check in at the agreed-upon time and provide a new endpoint. Some couples and families even choose a code word that means the conversation is pausing, Wilson says—not that the relationship is disappearing.

It's also a good idea to set a boundary. Wilson likes to think of boundaries not as walls that block people out, but as roads that show them how to stay connected: "You can be here with me, but you can't just go off-roading everywhere." A boundary does more than ask the other person to stop going silent. It clarifies what communication you require in a relationship, and what you'll do if that need repeatedly goes unmet.

One episode of withdrawal isn’t enough to judge an entire relationship, Needle says. What matters is the pattern: Does the behavior change after it’s addressed? Are both people willing to repair the rupture? Or does restoring contact always require one person to get quieter and stop raising concerns? 

If the silence continues despite repeated conversations—or leaves you feeling controlled and perpetually on edge—it might be time to seek professional help or reconsider the relationship. Healthy relationships make room for people to calm down, Needle says. They don’t leave one person indefinitely responsible for managing all the uncertainty that someone else’s silence creates.

What the Lindsay Clancy trial reveals about a broken postpartum mental health system

Lindsay Clancy's murder trial hasn't just dominated headlines for its tragic story and true crime fascination. For many, it has prompted a groundswell of recognition and outrage around the barriers women face when seeking care, the lack of research on postpartum mental health conditions and little education for providers.

Taylor Swift Revealed Her Coping Mantra. Here’s How to Find Yours

26 August 2026 at 20:36
—Matt Winkelmeyer—Getty Images

Taylor Swift already told us she can do it with a broken heart. That might be due to grit, stamina—or a little psychological trick called a coping mantra.

When she feels stressed by her circumstances, “I go through several processes and coping mechanisms,” Swift revealed in August during the Icon Sessions, a conversation presented by the Recording Academy’s Songwriters & Composers Wing. “And one of them is saying, ‘You chose this. You chose this every day. You could have opted out of this any day before it got unmanageably big.’ And I decided not to because I love it that much.”

Even if you don’t have plans to perform in stadiums worldwide, you might recognize the peculiar frustration of being trapped by something you chose—whether that’s the job you once desperately wanted, the committee you volunteered to lead, or the dinner party you insisted on hosting. “Where people tend to get really distressed is when they feel powerless, or like something's being put upon you—you're just sort of stuck in an achy feeling,” says Jill Stoddard, a clinical psychologist in Newburyport, Mass. “But if you remind yourself, ‘Wait a minute, this is actually a choice I made, and choices do come with difficult consequences, but I'm in charge here’—that empowers you to move forward.”

Enter the coping mantra: a short, deliberate phrase you can reach for when your brain starts sprinting toward the worst-case scenario. Stress leaves little room for nuance, says Dr. Jasmine Sawhne, a psychiatrist in Los Angeles. When your body is in fight-or-flight mode, you’re not going to reason your way out of it. A mantra gives your overloaded brain something simple to grab onto—and buys you a beat to choose what to do next. Here’s how to find one that actually helps.

Make your brain an offer it can believe

“Everything will be OK” is a lovely thought. It’s also a promise about a future you can’t see—which means your anxious brain might reject it before you finish the sentence.

From a cognitive behavioral therapy perspective, predicting that everything will work out is a form of fortune-telling, says Alison McKleroy, a San Francisco therapist and author of The Self-Compassion Journal. The same goes for affirmations like “I am confident.” If you feel unsure, your brain isn’t going to buy it. You can say it 1,000 times, McKleroy says, and still not believe a word of it.

Instead of predicting a rosy outcome or forcing a new personality, a useful mantra can state a choice that’s within your control. Swift’s is essentially: I’m choosing to keep doing this, difficult parts and all. “It’s a decision you’re making out loud,” McKleroy says.

Stoddard takes a slightly different—but equally reality-based—approach. When she’s crushed by too much to do and too little time, she tells herself, “I’ll get it done. I always do.” It works because in her case, it’s true. “I wouldn’t have a PhD in psychology if I didn’t always get it done,” she says.

If you’re someone who does not, in fact, always get it done, that phrase may not be for you. This isn’t an exercise in “blowing sunshine” at yourself, Stoddard says. The best mantra is simple, specific, memorable—and true.

Figure out what your brain forgets under pressure

Rather than reflecting on which situations stress you out, try a sharper question: “What do I need to remind myself when I get uncomfortable?” suggests Joanna Hardis, a Cleveland-based therapist and author of Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way.

In other words, don’t choose a generic mantra for “stress.” Identify your brain’s favorite way of making stress worse, then find a phrase that interrupts it. If you tend to predict disaster, McKleroy suggests: “I can’t know that yet” or “I don’t have a crystal ball.”

Sawhne’s stress takes a different form: She tries to solve everything at once. She runs a bicoastal psychiatry practice and has two children under 5, and she often catches herself mentally juggling five problems at the same time. Her mantra—“I don’t have to solve everything right now”—reminds her that urgency and importance aren’t the same thing. She doesn’t need the entire day, week, or situation figured out; she needs to identify what requires her attention first.

McKleroy, meanwhile, likes to over-research, add more information, and complicate projects past the point of usefulness. So she tells herself: “Let it be simple.”

“Things are usually naturally simple,” she says. “I just add stuff to it.”

Keep it short enough to say in one breath

Cap a coping mantra at about four words. When stress hits, “we just don’t have a lot of cognitive bandwidth,” Sawhne says, so you need a few words you can pull “out of your back pocket” as soon as your nervous system fires.

Shorter also means fewer words to obsess over. “Perfectionists are going to overthink it,” Hardis says. “You just want something that’s short enough that you can remember that’s going to orient you.” Her own mantra—“Discomfort, not danger”—passes the one-breath test with room to spare.

Use it to keep going while the feeling is still there

Nearly two decades ago, Hardis underwent exposure therapy for an intense fear of flying. When the plane hit turbulence, she would tell herself: “This may suck, but I can handle it.”

She still uses that mantra. During rough turbulence on a recent flight home from visiting her daughter, “I found myself saying it,” she recalls. In the past, she would have stared out the window, listened for every ominous noise, and asked a flight attendant if the plane was OK. This time, she calmly repeated her mantra and kept reading. “It helped me get through the flight and do what I knew I needed to do,” she says.

The fear was still there; it simply didn’t dictate her next move. “The goal in anxiety treatment isn’t to make the feeling go away,” Hardis says. It’s to help you decide what to do while the feeling is still there.

Borrow one—and make it sound like you

There are no bonus points for originality here. Anna Elton, a licensed marriage and family therapist in Palm Beach, Fla., and author of The Formula of Desire, uses “just keep swimming.” She borrowed it from Finding Nemo, which she watched with her kids. “That’s why it’s easy to remember,” she says. She also turns to “If it were easy, everyone would do it” when a project proves harder than expected. Her most exuberant mantra is a call-and-response: “Who is awesome? I’m awesome.” “I do it all the time,” she says. 

Once you settle on a potential mantra, say it out loud. Does it sound like something you’d actually tell yourself—or something embroidered on a throw pillow you’d try to hide? McKleroy recommends trying slightly different versions until one lands. “Brave” and “courageous” might look interchangeable on paper, for example, but one could feel much more natural coming out of your mouth.

You’ll know you’re getting close when the words produce even a small shift. The right phrase might bring “a little hit of relief,” McKleroy says, or make a spiral lose some of its momentum. If your brain instantly rejects it, change a word or scale it down. “Let it be simple,” for example, might become “Let it be simpler.”

Once you find one that works, practice it before you need it. Stoddard encourages clients to try new coping tools during low-stakes moments, when their emotions are relatively mellow. Call your mantra to mind when you’re running five minutes late, opening a mildly stressful email, or sitting down to a task you’ve been avoiding. Otherwise, summoning an unfamiliar phrase in the middle of a crisis will be “an uphill battle,” she says.

Put it where the problem lives

Years ago, when McKleroy was trying to stop procrastinating, she hung “Do it now” in big letters above her kitchen sink. “That was my command,” she says. “Just do the dishes.” After enough repetition, “do it now” stopped being a mantra and became a habit, and now she rarely procrastinates.

These days, “Let it be simple” hangs above her desk—prime territory for over-researching and adding just one more thing. McKleroy calls this “keeping it in existence,” or displaying the reminder exactly where you’ll need it.

That might mean taping your mantra to your computer monitor, writing it on the bathroom mirror, turning it into your phone lock screen, or putting it on the front of your journal. “If you’re really anxious, your mind’s not going to remember—it’s going to go blank,” Hardis says. A visual cue ensures the words are waiting for you when you need them.

Your reminder doesn’t even have to be made of words: McKleroy suggests drawing a circle on a stone and carrying it in your pocket or leaving it on the bathroom counter. To her, the circle represents simplicity. “A circle on a rock would be enough,” she says, to remind her to “let it be simple.” You could similarly choose a meaningful color, shape, or object. And—since this entire exercise began with Swift—you could even spell yours out on a friendship bracelet. 

Meta reaches $17 billion settlement with states in landmark trial over teen social media addiction

Meta has agreed to pay $17 billion and add stronger child-safety measures to its Facebook and Instagram platforms to end a landmark trial over teen social media addiction and settle claims filed by 47 states, state attorneys general announced Wednesday.

What’s driving Sweden’s startup boom, from Lovable to Legora 

26 August 2026 at 19:00
Vibe-coding darling Lovable just raised $400 million at a $13.3 billion valuation, roughly doubling its worth in eight months. But Lovable isn’t the only Stockholm startup putting up huge numbers lately — legal AI company Legora and health tech startup Neko Health are right there with it.  On this episode of TechCrunch’s Equity podcast, Dominic-Madori Davis is joined by Sophia Bendz, a partner at Cherry Ventures and longtime fixture of Europe’s startup […]

Is Toilet Paper Bad For You? Here’s What Experts Say

26 August 2026 at 17:41
—Photo-Illustration by TIME (Source Image: Pakin Songmor—Getty Images)

Toilet paper has become a hot topic online. You don’t have to look hard to find videos of health-conscious influencers warning about supposedly harmful ingredients in toilet paper. But how concerned should you be?

Not very, most experts agree. But some also say that TP is worth examining more closely.

Concerning chemicals

Studies have found some concerning chemicals in toilet paper. A 2023 study looking for per- and polyfluoroalkyl substances (PFAS) in toilet paper found them in 21 brands from around the world. Also known as “forever chemicals,” PFAS exposure has been linked to reproductive issues in women, developmental delays in kids, an increased risk of some cancers, and more. A 2019 study in Ghana found “elevated levels” of phthalates, which are endocrine disruptors that may cause developmental and reproductive harm, in toilet paper. That research also found polycyclic aromatic hydrocarbons (PAHs), which are associated with cancer, and semi-volatile chlorinated organic compounds, which have also been connected to cancer and reproductive harm, in toilet paper.

Some research cautions against toilet paper made from recycled paper because it could be made with discarded newspapers or recycled cash-register receipts, which can contaminate the product with BPA, a substance linked to reproductive issues, cardiovascular disease, and more.

There have also been concerns over toilet paper that is bleached, as bleaching can create dioxins, and concerns over toilet paper that includes formaldehyde, a carcinogen.

The ingredients in toilet paper, which manufacturers aren’t required to disclose, are potentially concerning because the skin on the genitalia and anus is thinner and more absorbent than other skin on the body, says Dr. Julia Saylors, an oncologist and integrative medicine physician based in Charleston, South Carolina. 

While skin is known to absorb chemicals, including PFAS, genital and anal areas are made of mucosal surfaces, a type of thin, moist, and more sensitive skin that leads to the interior of the body. This skin is more absorbent than the surfaces on our arms and legs, says Saylors.

“It is well known that applying a medication to the vaginal mucosa results in a substantially higher absorption if the same medication is applied to the skin,” Saylors says. “Therefore, any potentially harmful chemical is best to avoid in that area.”

And while Saylors says that toilet paper probably isn’t a person’s highest exposure to toxins—food packaging, cleaning products, and textiles are more significant sources—she says that any changes we can make to reduce toxin exposure are potentially helpful. 

Toilet paper does not pose a major risk

How toilet paper interacts with people’s skin in these areas and their overall health is not well studied. But the research that has been done suggests that toilet paper does not pose significant health risks, experts agree.

Dr. Amar Rewari, chief of radiation oncology at Luminis Health in Maryland, notes that PFAS and some other industrial chemicals are under study for possible long-term health effects, “but the levels typically found in consumer products like toilet paper are very small and not clearly linked to cancer.”

“Many of these chemicals, including PFAS, phthalates, BPA, and trace dioxins, can be found in small amounts throughout modern life,” he adds. “The highest exposures usually come from what we eat, drink, or breathe over time, not from brief skin contact with toilet paper.”

While BPA may be found in recycled paper, “the levels of BPA detected are generally low, and the clinical significance of these findings remains uncertain,” he says.

Bleaching, likewise, is not a huge concern, and modern processes don’t pose a significant cancer risk, he says.

“The concerns people sometimes hear about chlorine-bleached paper products largely stem from older manufacturing methods that used elemental chlorine. Today, most toilet paper is produced using elemental chlorine-free (ECF) bleaching, which relies on chlorine dioxide instead of chlorine gas. This process dramatically reduces the formation of dioxins and other potentially harmful byproducts and is widely accepted as the standard in modern paper manufacturing,” Rewari says. “The amount of residual chemicals in finished products is extremely low.”

Dr. Alok A. Khorana, professor of medicine in the department of hematology and medical oncology at Case Western Reserve University, agrees that toilet paper probably isn’t a major cause of exposure to toxins. “Exposure to environmental toxins through toilet paper is likely much smaller than those we’re exposed to in food and water, which has a more direct route into our system,” he says. Still, he says exposure to toxins through toilet paper is "worth investigating further.”

“There are several potentially harmful substances present, such as PFAS, and it's worth understanding whether exposure to these is carcinogenic in any way,” Khorana explains. 

He adds that we don’t have many studies yet, likely because concerns over toilet paper are relatively new—plus, Khorana notes it may be difficult for researchers to find people in the U.S. who don’t use toilet paper to compare to those who do. “Studies become challenging to conduct when the candidate risk factor is as prevalent as toilet paper use,” he says.

“I don’t think people need to avoid conventional toilet paper altogether,” Rewari says. “Most people will use conventional toilet paper throughout their lives without any problems.”

Still, he advises patients to choose products with fewer unnecessary additives when possible. “Fragrances, lotions, and dyes don’t improve hygiene, and they may increase the risk of irritation in susceptible individuals. For most people, a simple, unscented, dye-free toilet paper is a reasonable choice.”

An unexpected issue with toilet tissue

Chemicals in toilet paper can present other issues, says Dr. Hannah Kopelman, a dermatologist based in New York City. She says the paper product comes up in her practice more often than one might expect.

“I’ve had patients come in with itching and irritation, which they thought was a yeast infection or eczema flare, only to discover that the culprit was their toilet paper,” Kopelman says. “Most people assume all toilet paper is the same, but the reality is that some formulations can cause problems.”

“When they switch to plain, unbleached, fragrance-free options, the irritation usually clears quickly,” she says.

Dr. Meagan W. Shepherd, an allergist and immunologist based in Barboursville, West Virginia, says people are often surprised to learn how commonly allergens are found in toilet paper, noting that both traditional paper and flushable wipes can cause irritation.

“Wet varieties such as flushable wipes often have preservatives like methylchloroisothiazolinone and methylisothiozolinone, which together account for about 10% of contact allergen sensitizations in North America,” says Shepherd. Dry varieties, on the other hand, are more likely to include added fragrances or dyes, which can act as irritants or allergic triggers, she says.

“I frequently see patients with severe vulvar rashes caused by hidden chemicals,” she adds.

Shepherd also says that if people are struggling to find toilet paper they can tolerate, she recommends skipping recycled paper. “It can be rougher than regular varieties, leading to irritation,” she says. “Plus, trace amounts of various allergens found in the original paper product sources could still be present and potentially cause a reaction in those who are sensitized.”

Shepherd also cautions against recycled toilet paper—as well as anything marketed as “ultra soft.” “While meant to soothe, these products may contain softening agents such as lanolin, as well as fragrances, dyes, preservatives, and adhesives,” she says. “These can be irritating for some people and can cause unpleasant symptoms like itching, redness, and contact dermatitis.”

Kopelman adds that looking for words including “unscented,” “dye-free,” or “chlorine-free” on the packaging is more important than the base material.

“On its own, toilet paper is unlikely to be a major source of chemical exposure,” says Kopelman. “But for those with sensitive skin, choosing products without unnecessary chemicals in toilet paper is a simple way to avoid skin irritation.”

Is the food at the farmers market safer?

26 August 2026 at 16:00
Still image from a video showing produce in containers, with a caption reading "Local farms = safer food?"

What we eat and where it comes from is a critical part of human health. According to a 2025 survey, 59 percent of Americans think it’s important to know where their food comes from, and 54 percent prioritize food that is consistently available locally. And one of the best places to get that locally sourced food? Farmers markets. 

The US has more than 8,700 farmers markets, where roughly 40,000 farmers sell their products. Recently, the markets have been getting a bit more attention thanks to a series of high-profile food recalls. Americans’ confidence in the safety of their food is being tested, and buying direct from your local farm could be the answer. 

Some produce travels hundreds or thousands of miles from where it’s grown to where it’s sold, passing through processing, storage, and distribution facilities. One advantage of a small local farm is the direct journey the produce takes from the field to the customer. But how does a small family farm business compete with major grocery stores for customers, and what’s behind their sales pitch for safer and fresher food? We drove out to Camarillo, California, to a small family farm to find out. 

Read more about food sources and food safety:

This video is presented by Verizon Business. Verizon Business doesn’t have a say in our editorial decisions, but they help make videos like this one possible.

The lifesaving case for CPR dummies with breasts

26 August 2026 at 14:30

Every once in a while, I feel the urge to shout “women are not small men!” at inanimate objects. Today, that object is the flat-chested plastic torso typically used for CPR training. 

Breasts, it turns out, are really the bane of every woman’s existence — the back pain, the boob jail, the running. But here’s a new one: In a public cardiac arrest, they may be the reason nobody helps you.

Two years ago, an analysis of over 300,000 cardiac arrests showed that women are 14 percent less likely than men to receive CPR from a stranger if they have a cardiac arrest in public. Bystanders tend to be more hesitant and feel less comfortable providing CPR or using external defibrillator paddles, called AEDs, on people with breasts. Experts have time and again pointed, in part, to the fact that nearly everyone learns to perform CPR using the traditional, flat-chested dummies called “manikins,” which overwhelmingly represent the male anatomy. If the first time a stranger has to perform CPR on someone with breasts is in the middle of a high-stakes emergency — what else would you expect? 

For the last 20 years, not only has the survival rate for out-of-hospital cardiac arrests been around 10 percent, but also the chances of the victim surviving decrease by 10 percent every minute that interventions like CPR are not performed. It makes it all the more harrowing that women are not receiving the care they need when they experience cardiac arrests — especially in places where they are surrounded by people. 

Whether it is manikins used for CPR training, crash tests or medical care in combat, the default stand-in for what is “human” has long been male. 

But recently, researchers, advocates and governing bodies like the American Heart Association and European Resuscitation Council are pushing for better representation in CPR training and education. Increases in simulation-based research on the use of representative manikins, like ones that accurately represent female anatomy, are changing how people train to respond to cardiac arrest — and simultaneously exposing bigger gender gaps in design that systematically exclude women from experiencing the same level of safety and care as men. 

One size doesn’t fit all

The first CPR manikin was developed in 1960 by the Norwegian toy manufacturer Laerdal. The manikin, called Resusci Anne, which had the anatomy of a prepubescent teen, was ironically modeled off an unnamed girl who was thought to have drowned in the river Seine in Paris. Laerdal famously wanted a female face on the manikin since he thought men might hesitate to practice mouth-to-mouth resuscitation on a male manikin. It’s not surprising that women trainees didn’t factor into the equation at all back in the 1960s — they weren’t even included in clinical trials yet — but the norm of designing with the comfort of men at the forefront continues to this day. 

Since then, Resusci Anne has been reengineered many times over, and today’s manikins are surprisingly high-tech and interactive. However, as of 2022, about 95 percent of manikins on the market from mainstream manufacturers were still flat-chested and androgynous. 

Key takeaways

  • Women are less likely than men to receive CPR from a stranger in the event of a public cardiac arrest. 
  • Research indicates that this is because people feel uncomfortable and hesitant to touch or expose women in order to perform CPR, in case it is misconstrued as inappropriate. They also worry about injuring them in the process. 
  • Experts believe that such dangerous hesitation could be reduced by using resuscitation manikins that have female secondary sex characteristics, like breasts, during CPR training.
  • This is difficult to execute because anatomically accurate female manikins are not widely available for purchase or widely adopted; 95 percent of manikins on the market are flat-chested and androgynous.
  • The conversation surrounding the design disparity in CPR training is also exposing similar flaws in other fields like vehicular crash-testing or combat medicine, where female dummies are largely excluded from mainstream testing and training protocols.  

So why does this matter?

In the past, research has hinted at three main reasons why bystanders don’t immediately rush to the aid of a woman in cardiac arrest. One, they are hesitant to expose or touch her in any way that could be misconstrued as inappropriate and are worried about sexual assault allegations after the fact. Two, they don’t want to accidentally hurt them, perceiving them as generally more fragile than the average man. And three — perhaps saddest of all: bystanders often don’t recognize that a woman is in cardiac arrest if, say, she collapses in public, misattributing it as overreacting, simply fainting or faking it. 

CPR training with female manikins would go a long way in teaching people to be comfortable with the female form.  

In one study, people at MassCPR — the free CPR certification program offered by Massachusetts Institute of Technology for the MIT community — were trained using standard manikins,  as well as a few which were retrofitted with a mold resembling breasts. At the end of the certification, participants who practiced on the manikin with breasts reported greater comfort performing CPR on women. 

If there was widespread adoption of manikins that looked and felt different, this could ultimately become the norm. 

It’s really only in the past five years or so that research on this disparity has sped up, offering some evidence for the need for more representative manikins. Even then, widespread adoption of female manikins is hindered by commercial availability of anatomically correct models and the cost of switching existing CPR training programs over to using them.   

Closing the design (gender) gap

There are two main ways to go about increasing the availability of female manikins: Either you retrofit existing standard manikins with breasts or you design completely new ones. 

When Christoph Veigl and colleagues at the Medical University of Vienna surveyed 133 training organizations across 43 countries from six continents, they found that of more than 5,000 manikins in use, only a fifth of organizations owned a female one. While that number is still low, adoption is triple what it was four years ago. The researchers acknowledge that just the availability of female manikins is not necessarily an indication of how much they are used in training — about a quarter of the organizations were also employing makeshift adaptations, like placing a bra on standard manikins, to simulate training on women. 

Dr. Pooja Nawathe, a resuscitation science researcher and pediatric critical care clinician at Cedars-Sinai Hospital, chose to focus her research on gender disparity in resuscitation for a specific reason. 

“Skin color is about implicit biases, but female breast tissue, which is a normal physical characteristic, is about the actual science of this,” she said, speaking about variations in care during cardiac arrests. “Are we teaching how to place the pads on the breast tissue?”  

She also stresses the importance of gathering good, granular data on how CPR performance changes when people are exposed to diverse populations.     

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men.

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men. But that’s starting to change, too. Last year, the National Highway Traffic Safety Administration (NHTSA) released the design details for THOR-05F, the first detailed female crash-test dummy.

Before this, the standard female crash-test dummy was a model called the Hybrid III 5th percentile female dummy — literally just a scaled-down version of the Hybrid III 50th percentile male dummy that represents the average male body dimensions. But the THOR-05F — every woman’s dream name, I’m sure — is a much more anatomically accurate female dummy, and includes a female pelvis, breasts, and a flexible spine. 

THOR-05F has arrived just as new research by the NHTSA affirmed the need for better crash-testing on women. Although the gap in vehicular accident fatality rates between the sexes has narrowed significantly in newer car models, women continue to experience a higher injury rate compared to men in multiple different types of vehicular accidents. The hope is that testing with the THOR-05F will provide a better understanding of this trend and help engineer safer vehicles and regulations for women.

Women are not small men!

Women are often referred to as the “invisible sex,” and the lack of female manikins really brings that to the forefront. It’s not like the manufacturers or policymakers intentionally excluded women from this area — they simply ignored them, accepting an androgynous body as the standard with an unchallenged assumption that what applies to it will undoubtedly apply to women too. 

In 2019, Joan Creative, the New York-based ad agency, launched the Womanikin, a universal attachment for CPR manikins, in partnership with United State of Women, a now-shuttered organization focused on gender equity. Launched during National CPR Week, the Womanikin is a neoprene vest with silicone breasts that can be zipped onto any standard manikin. Built as an awareness campaign, they open-sourced the design for the breasted vest and helped spark a broader conversation about the CPR gender gap. But we don’t have any detailed information about its success or adoption. 

More recently, other manufacturers like Prestan have come out with newly designed female manikins that can be purchased as is. They also sell “replacement female skin” that retrofits any existing Prestan adult manikins. Notably, these are now available on the American Red Cross store, increasing visibility for female manikins.

The fact that women account for 50 percent of the world’s population and yet have to mold themselves to standards not designed for them in the first place is atrocious. Not only is it frustrating to live in a world not built for you, but in cases like CPR training, the gender gap can quite literally be fatal. This is true whether it is for motor vehicle crash-test dummies or those used to train battlefield medics — another field where women injured in battle have a higher fatality rate than their counterparts.

The basic idea is that repeated exposure to female bodily characteristics during training or testing can significantly alleviate discomfort that causes dangerous hesitation. If people had more practice administering CPR to models that looked more feminine, they wouldn’t be thrown off by breasts, would understand how to cut away clothing like bras if needed, and learn how to efficiently place the pads of the external defibrillator on a female body. 

CPR techniques remain largely the same irrespective of sex. Chest compressions are performed on the sternum, which is the flat bone running down the center of your chest. For women, it lies between the breasts, so there are some additional considerations. That is what representation in training manikins is meant to address — not new skills, but familiarity. 

Ultimately, it really comes down to not feeling awkward about putting your hand in between two breasts, if it means you save a life.

Mpox is back – and in new countries. How can this outbreak be contained?

The public health emergencies in 2022 and 2024 saw the virus reported in 145 countries, but in the new cases children appear particularly affected

A fresh outbreak of mpox in Guinea Bissau – the country’s first – means the virus formerly known as monkey pox is back in the headlines. So what has changed?

Since 2022, there have been almost 190,000 lab-confirmed cases of mpox reported worldwide in 145 countries. Before then, outbreaks of mpox tended to be relatively small and in a handful of African countries, where the viral infection was known to be endemic.

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© Photograph: Tchandrou Nitanga/AFP/Getty Images

© Photograph: Tchandrou Nitanga/AFP/Getty Images

© Photograph: Tchandrou Nitanga/AFP/Getty Images

A look at the devastating impact of USAID cuts in rural Afghanistan

It's been 18 months since the Trump administration made cuts to foreign aid. One of the countries hardest-hit is Afghanistan. The five years since the U.S. withdrawal have been grim for the people there, and Refugees International attributes over 160 deaths during the last 18 months to cuts in aid. Special correspondent Leila Molana-Allen and videographer Eric O'Connor report.

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