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Being and Well-BeingHealth and the Working Bodies of Silicon Valley$

J.A. English-Lueck

Print publication date: 2010

Print ISBN-13: 9780804771573

Published to Stanford Scholarship Online: June 2013

DOI: 10.11126/stanford/9780804771573.001.0001

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In Production

In Production

(p.87) 3 In Production
Being and Well-Being
Stanford University Press

Abstract and Keywords

This chapter focuses on the core workforce in Silicon Valley. This age group, from twenty-five to forty-five, consists of adults who are establishing professional careers and households. Their work lives have been molded by changes in the global economy in the past generation, particularly intensification, individuation, integration with technology, and global distribution of work. More of the work of the region is devoted to the high-end of innovation and service as the manufacturing functions have been relocated. Company policies, practices, and narratives shape the experiences of these workers. The rhythms of their work life are not those of their parents. Work constrains and facilitates their perceptions and management strategies toward time, risk, space, and material culture. It also constrains and facilitates social attitudes toward race, gender, age, and identity. Yet, members of this cohort have grown up with a more intense environment of cultural interaction and borrowing; they are at home with medical diversity. They are the second wave of Silicon Valley workers that have become accustomed to deep diversity and persistent experimentation.

Keywords:   Silicon Valley, workforce, employees, work life, medical diversity

After planting, cutting, threshing, grinding the wheat and baking it into bread, without the help of Pig, Cat and Rat, the little Red Hen asked,

“Who will eat the bread?” All the animals in the barnyard were watching hungrily and smacking their lips in anticipation, and the Pig said, “I will,” the Cat said, “I will,” the Rat said, “I will.” But the Little Red Hen said, “No, you won't. I will.” And she did.

—Williams 2006, “The Little Red Hen,” 24–25

Red hen on her side

flips dust under her wing

the free leg powerful

levering leaves and dirt …

May health, beauty,

Long life and wisdom

come to the barnyard fowl

with humans to serve them:

World made for Red Hens.

—Snyder 1983, untitled poem, 53

Kristal Jacobs and Jeremy Fitzgerald, Second Wave Workers

Second wave workers, such as Kristal Jacobs and Jeremy Fitzgerald, work on their bodies to transform themselves into better workers, superior parents and spouses, and, as they have come to define it, healthier people. Kristal and Jeremy, both in their mid-thirties, occupy that liminal land of highly skilled, self-employed contractors. Jeremy and Kristal are knowledge workers who bring a specialized set of skills to workplaces. Jeremy has been a computer programmer for five years, including a stint at a large CGI animation studio. (p.88) Now he works independently and telecommutes from home. Kristal, his partner, also used to work with him in the East Bay. She is an ergonomics specialist who now contracts to various web 2.0 companies (organizations that specialize in hosted web services, social networking, wikis, blogs, and video sharing, such as eBay or Wikipedia). Their employers relate to them differently, with different obligations, as their status changes. A contract worker is not the same as an employee. Sometimes those distinctions can be happily navigated. Jeremy embraces the freedom his contract status gives him. Kristal is more hesitant; she no longer has access to the networks and resources she had as an employee. Jeremy and Kristal illustrate both the vulnerability that comes with contingent work and the experimental approach that second wave Silicon Valley workers so readily adopt.

For Jeremy, becoming a contingent worker turned his home into his workplace; the shift to telecommuting meant adopting a new set of disciplines. He no longer had the convenience of built in barriers between physically separate work and home spaces, and he needed to construct new ones. Jeremy notes, “You have to just create barriers for yourself. You have to say, ‘Okay. I'm at home.’ And even if you were really in the middle of something … at 7:00, 7:30, you're done with work. You need to eat, and then sort of wind down, and go to bed. You can't eat and then go back to work.” The flip side of his new routine is even more challenging, “You have to get up in the morning, and sort of shower, put clothes on, shave, get in the right mindset. ‘Okay. Now I'm doing work and not playing video games in the middle of the afternoon.’”

The new regime was also liberating. Work-home balance was a challenge at his last job. He reflects, “For a while, I was working sort of from the middle of the afternoon until four in the morning, trying to get this product finished. And it just wreaks havoc on your home life, your mental well-being. You just start to feel just not right…. I felt like I was sort of off-balance all the time.” He found that it was hard to exercise, and yet “exercising is the only thing I found I could really do that at least helps somewhat.”

In his newly redesigned routine, his life is increasingly local; Jeremy is “not really big on vacationing.” He bikes, does a bit of rock climbing, and avidly plays soccer, although an old knee injury still causes him to favor one leg. Jeremy (p.89) is conscious of growing older, but he has a plan. He designs a consistent routine, playing soccer regularly, and experimenting with running and other forms of activity “like … bicycling, lifting weights … various other cardio things…. I certainly need to have an exercise plan when I get older.”

Jeremy knows that whatever he chooses, it must fit easily into the rest of his life, with as few obstacles as possible. In previous workplaces, there were onsite gyms and classes. Utilizing them only worked for him if their practices fit seamlessly into his life. He remembers, “I know that the first company I worked at had yoga classes, and so I went to the yoga classes. That's not something that I would necessarily do, but they had it there…. So I went. It was inexpensive, because the company was subsidizing it. I went, and it was good…. So when it was easy to do, I did it, and then, when it's not easy to do, I seem to not do it.” Without the advantage of easy access, the effort taken to find special exercise sites is simply time spent away from home and work.

Jeremy and Kristal are conscious of the food they eat, the supplements they take, and the consequences of their consumption of liquid stimulants and relaxants. Jeremy cooks, institutes a daily practice of taking multivitamins, making sure that Kristal takes hers too (see Photograph 3). He will make a special effort to find good, fresh cuts of meat and brew good coffee. Stimulants hold a near-sacred place in the pantries of the second wave. Kristal comments, “We have every single coffee thing.” They go out sometimes, and eat at the Indian and Chinese restaurants they favor, but they prefer one neighborhood sports bar just because it's fun. One of Jeremy's central tools for health is a nightly glass of wine at home. His father is a physician, and Jeremy draws on biomedical reasoning to explain his choices. He believes that red wine is good for older men, and yet he drinks it primarily for relaxation. Jeremy comments, “It sort of just relaxes you, and when you're relaxed, I think you feel better, and you're probably happy.” Food and drink have functions, and those functions are consciously articulated as rationales for health practices.

Jeremy still uses his video games, but if he and Kristal play “Rayman Raving Rabbids” using the Wii game console three times a week they can actually move their bodies. In the game, they dash about holding their (p.90) mobile nunchucks and drum for the dancing rabbits. Jeremy has been trying to win Kristal over to the world of gaming with Wii's “Dance Dance Revolution,” claiming that it is really cardio exercise (see Photograph 4). Jeremy, more invested in the technological optimism and fascination that pervades Silicon Valley, tries to convert, or at least rationalize, his desire for digital gaming—a potentially deeply sedentary activity—with his need for exercise. Nintendo's Wii, a gaming system that requires some physical motion to play, helps him navigate this dilemma. Kristal wryly notes, “This is definitely a Silicon Valley solution for things.”

Kristal is much more conscious of health than Jeremy, largely because she has struggled with a chronic condition much of her adult life. Kristal is thirty-four, a slightly overweight Eurasian woman who has hernias, sciatica, kidney stones, and ankle and knee injuries—four surgeries' worth. A car accident has left her in pain much of the time. Kristal has been tired since she was thirteen. This fatigue plagued her and mystified practitioners and only recently has been ameliorated. It was a constant struggle to get energy. Previous diagnoses led to medications that made her problems worse. She experiments with alternative products—“antioxidants, more cranberry, more pomegranate” to add energy. They drink Mango·Xan, a commercial energy tonic made from the Southeast Asian mangosteen fruit. Kristal's friend, Dee, whose husband is a chiropractor, is campaigning to wean her from over-the-counter anti-inflammatory medications.

Kristal has struggled with the amorphous and pervasive problem of fatigue, one that directly undermines her need for productivity. Weaving together diagnoses and practices from biomedicine and alternative medicine, she experiments on herself, much as Jean Sanders does with her psoriasis. To boost their energy, Kristal and Jeremy use a sun lamp, “what they use in Sweden for people who are sunlight deprived to help get their biological clock back…. But seriously, when we have trouble in winter time, we use this in the bedroom and turn it on in the morning to help us wake up.” This appliance is one of the many devices the household members employ in their health ecosystem (see Photograph 5). Kristal reflects on her struggle with fatigue and comments, “I've lived with that all my life. So, we were just trying to get more energy in our days.”

(p.91) First diagnosed as depression and narcolepsy, her sleep apnea was finally pinpointed when she was thirty-two. Sleep apnea is a sleep disorder in which there are pauses in breathing during sleep. The consequences can be profound, ranging from irritability and memory loss to death. For a year and a half Kristal used a CPAP (continuous positive airway pressure) machine to blow air into her throat through a mask that was fitted over her nose. She sounded like Darth Vader and “looked like the thing that jumps out in Alien and grabs onto the guy's face.” She slept as far from Jeremy as possible to keep from disturbing his sleep. Finally she had an operation to treat her obstructive sleep apnea—a maximal mandibular advancement surgically correcting the placement of her jaw. It was a difficult experience, and she gets support from her online sleepnet forum. Already Kristal can see the difference. She can get out of bed in the morning. Jeremy caught the flu and, for once, she did not get it! Her very emotions feel different to her—sharper. After a long series of medical and behavioral experiments, the results of the surgery appear promising to her.

With one problem resolved, Kristal tackles others. She knows she needs to change her overall “fat to lean muscle ratio.” As a contractor, she does not have access to the gyms of her worksite. She will work on building muscle slowly and mindfully, approaching it as she does ergonomics; Kristal does not want just to solve the immediate physical problems, but to support her body for long-term change, including having children. Her goals are modest. Kristal says, “We don't need to be skin conscious, not be the people in the gym everyday. But be healthy, that means being outdoors, exercising, and eating well.” Together, Jeremy and Kristal have experimented with a set of practices that are constantly being modified by trial and rejection, or trial and integration.

Second Wavers, Establishing Work and Family

People like Jeremy and Kristal, from their mid-twenties through their forties, are the cohorts that compose the primary workforce of Silicon Valley. These second wave workers are “in production.” Employees and entrepreneurs juggle career, family, civic consciousness, and health. From their (p.92) quarter-life crises to their midlife crises, they not only form the critical core of the productive workforce but also must imagine and build families, struggle with fading youth, and navigate the public and private bureaucracies that dominate American life. People in this age group must navigate the dual moral imperatives of keeping themselves and their families healthy and applying the work ethic to their careers.

Their immediate elders in the first wave defied conventional wisdom about the life staging of work. Americans imagine a conventional cultural sequencing in which people prepare for work in their youth, become active full-time workers, and then fade gracefully into postwork life. All of these presumptions overstate experienced reality (Moen and Roehling 2005, 15; Pitt-Catsouphes 2005, 3). Members of Kristal's and Jeremy's cohort, and those who immediately follow them, must live within the restaging of adult experiences.

Full-time permanent work, especially in the kind of unstable high-technology and knowledge work of Silicon Valley, is problematic. Instead, people patch together an ecosystem of full-time employment, contract, or temporary work, and unpaid down time that reflects both the specific economy of the Valley and their families' needs. As we saw in the last chapter, the work strategies of the aging first wave required considerable reinvention. Once defined as the generation that followed the people born after World War II, Kristal's and Jeremy's cohort has come to be defined by the economic shifts have that hollowed out the American middle-class (Ortner 1998). People in this age cohort remain unconvinced that the conventional staging of prework, full-time work, and retirement will ever work for them. While flexible work scheduling was a radical invention to the older cohort, for those Jeremy's age and younger it has simply become the way work is done. Workers in this second wave cannot assume that their spouse, friends, or family will have the same work schedule that they do, or that their workplace will necessarily remain a stable source of income (Smola and Sutton 2002, 365). They are more willing than the first wave workers to rethink the personal consequences of work intensification (Benko and Weisberg 2007, 5). Must they settle for less personal satisfaction or the loss of family time?

Family sequencing is no more predictable than work sequencing. Couples (p.93) may have children in their early twenties, or wait until their thirties, or even forties! A forty-year-old mother with young children may have more in common with another who gave birth at twenty-five than with someone her same age with teenagers or no children at all. Specific conditions matter more than age. High rates of divorce, widespread employment of middle-class women, and a fluctuating economy mean that workers who grew up in the last forty years do not expect a classic sit-com family in which men work and women stay at home.

While the second wave cohorts have been called “slackers,” that stereotype reflects the angst of older journalists and pundits rather than the actual behavior of people born between 1961 and 1981. The pundits' anxieties about the larger economic changes of deregulation and employment instability became a moral panic about the death of the work ethic. The “pathologies of the world” were transferred onto that particular cohort (Ortner 1998, 419). Nonetheless, it is a legitimate observation that the subtle social contract that had governed employer-worker relations had changed from that offered to those born before 1960. Organizations and workers knew that economic flexibility might mean that workers, projects, divisions, and whole companies would be subject to elimination. Health and retirement benefits have eroded. Younger workers then chased higher salaries, all too aware of their own ephemeral status as they plot their course through diminished benefits (Smola and Sutton 2002, 365–78; Zemke, Raines, and Filipczak 2000, 124).

Especially in Silicon Valley, people in the second wave cohort spent their teenage years and early adulthood in a world dominated by digital devices. Mobile phones and Nintendo Wii game stations are part of their daily lives. In the United States, half of the workers aged twenty-nine to forty bank online. Like the first wave cohort, they use the Internet to search for health information. Eighty-four percent of second wavers use the Internet for health literacy (Fox 2005, 2–3). While they are not quite the gamers and instant messengers of those born in the late 1980s and the 1990s, this second wave cohort remain sophisticated users of social network and communications technologies. They can use this facility with online networking and mobile telephony to connect to friends, family, and acquaintances to collect (p.94) and discuss specific practices for managing health—what to eat, how to move, and how to interpret medical mandates. They employ these behaviors themselves, and bring these experiments to spouses and children.

Adults from their late twenties to forty are at the age to establish families. These second wave workers are making the tricky transition from a person who is able to focus time and energy on work and play to one who must now accommodate a more complex landscape of responsibilities. Health becomes redefined not as a convenient source of individual productivity but as a moral value that is part of the social contract of adulthood. Taking care of someone else's health—partner, parent, child—is an ethical mandate. A new ecosystem of helpers has evolved to help these younger adults to navigate this set of responsibilities. This age cohort is composed of expert networkers who harness their social connections to help them take care of themselves and others. For the more elite, professional niches have appeared—life coaches, personal trainers, and therapists in company health facilities.

However helpful the network or organization may be, the onus for productivity and for embodied health remains the burden of the individual worker. Workers must discipline their emotions and bodies to work effectively and sustainably—in other words, to stay both healthy and productive. This internalized discipline has counterparts in other cultures. In this chapter, we will examine that discipline and compare it with its analogue in China, suzhi, the pervasive pursuit of personal quality. Yet Silicon Valley is not China, although many Chinese reside there. Fundamental cognitive schema, or orienting cultural frameworks, mold the way health and work are navigated in U.S. culture. People work on their own bodies to make them more productive, energetic, and focused. This discipline serves both the workers' self-interest and the interests of the larger economic system.

Amanda Stewart, Putting Transcendentalism in Place

In her day job Amanda is the director of a nonprofit organization, and her older husband works for a California state bureau. She comments, “Usually I have a lot of plants, because they're kind of healthy, give you (p.95) good air…. I see health not just as my own physical fitness.” She notes that now she is nearly forty, and so “I see … environment as a health issue. So we compost, we recycle, … I wish we had a grass yard that he could run around in.” They don't have a lawn, so her son cannot run around, getting “aerobic exercise … but just getting out in the fresh air and the sun and the green, emotional health, the whole yard is good for that.” We see an indication of a convergence of environmental thinking and health in Amanda Stewart's speculations about how she should reconstruct her Silicon Valley home now that she has a young son. Amanda remembers how she took vitamins, improved her diet, and lived more healthfully during her pregnancy, commenting, “I just wanted to give him the best chance at being healthy and strong.”

Like that of her Transcendental forebears, Amanda's religious practice is eclectic, “cafeteria style. We have The Way of Zen. My husband has read a lot more about Zen and Taoism than I have.” She comments that they live in the San Francisco Bay Area for a reason: more Chinese and Japanese Americans with a different perspective on “what health and wellness are.” She notes that her husband, the household expert in things Asian, “was raised as a Catholic. I was raised as a Protestant and Presbyterian, but I'm not really either one. We're both more spiritual, more than we are religious. But being part of an environment and a community, being aware of yourself and at peace with yourself and doing good deeds, is what it's all about.” Amanda points to her bookshelf; on it are “books related to spiritual things … that would be health related. More the wellness side …”

Transcendentalism, and its twenty-first-century incarnation in New Age beliefs, encompasses practices as diverse as natural healing, spiritualism, and technological optimism. These are not different models but different facets of a deeply imbedded American framework, one that took root especially in California and has a particularly obvious manifestation in the San Francisco Bay Area and Silicon Valley.

Silicon Valley's mixture of technological play and countercultural experimentation goes back to the nineteenth century, well beyond the iconic 1960s. Historically, Californians esteemed the region both as a “natural place” and as a site for nigh-utopian technocratic activity (Starr 2005, xiii). (p.96) People now living in that culture may have a difficult time articulating those values, but often merge these attitudes into an undefined optimism and “open-mindedness.” Valuing nature, experimentation, and open-mindedness harkens back to the Transcendental movement in American cultural history.

In the historiography of American religious practice, intellectuals have usually categorized such experience as evangelical, metaphysical, or institutional—carrying on the traditions of the mainstream churches. Protestant evangelism is often seen as the central expression of American religious history. However, more recent analyses by historians Butler and Albanese suggest, not surprisingly, that the historic religious landscape was more complex. Immigrant and Native American folkloric traditions of magic and spiritualism merged with a new urban, middle-class “catholicity of mind and spirit, signified, especially, by an openness to Asia and an embrace of South and East Asian religious ideas and practices” (Albanese 2007, 2–12). By the mid-nineteenth century a distinctly American form of transcendental philosophy had emerged, which suggested that the natural abundance of the American environment made it a distinctly “noble” society—qualitatively different from other nations. The movement promoted a romantic cultural interpretation of world religion, emphasizing an individualistic spirituality and the belief in the inherent goodness of nature. Thoreau, one of the key proponents of this transcendent worldview commented, “The pure Walden water is mingled with the sacred water of the Ganges,” reaffirming that connection to Eastern philosophies (ibid., 348). In the hybrid transcendental philosophy, nature is powerful, the mind is potent, and people are intimately connected to the environment and have a mandate to experiment on themselves (see Cramer 2004).

The manifestation of this "natural religion" in the lives everyday nineteenth-century Americans will seem familiar. If nature is good, healing with nature is best. From Sylvester Graham, of graham cracker fame, to Swedenborgian spiritualist missionary John Chapman, a.k.a. Johnny Appleseed, the linkage of discipline, spirituality, and nature was becoming firmly ingrained. Homeopaths, drawing on the emerging German medical system that used energy healing, and Naturopaths, who used traditional herbal (p.97) approaches, competed with the early pioneers of biomedicine. In this transcendental worldview, the best practice would be to eat natural foods and vegetables, drink natural water, and that those nearest nature “would be in perfect health” (Albanese 1990, 122–23, 30).

Adherents were “preoccupied with mind and its powers,” ranging from self-induced healing to technoscientific invention. They used the beliefs of naturalistic medical systems from India, China, and ancient Greece to consider correspondences—how the microscopic connects to the macroscopic. For example, a part of the body could be diagnostic of the whole person; the tongue or the eyes could be seen to be portals to the patient's state of being and health. Massage therapy in the ancient Hippocratic tradition forms the foundation for its revival in the late nineteenth and early twentieth centuries (Fuller 2005, 24–25).

Transcendental metaphysics holds that each person, in turn, reflects the larger society and environment, just as Chinese feng shui links the well-being of a person to the position of a home or workplace in the energetic landscape. Massage work on one part of the body is amplified to the whole person. Metaphysically, people and nature are composed of movement and energy, and that is more important than mere physicality (ibid., 375). Inherent in this worldview is “a yearning for salvation understood as solace, comfort, therapy and healing” (see Albanese 2007, 13).

Cultural borrowing is rampant in twentieth-century New Age holistic healing. These practices are the great-grandchildren of Transcendental healing; New Age philosophy connects inner emotional states and planetary health to personal well-being. Through time, disciplines as wide-ranging as chiropractic, osteopathy, yoga, Daoist healing, and feng shui have been fused into an aggregate and lumped into the ever-malleable New Age practices that had 10 million American adherents by the mid-nineties (ibid., 402–3, 509–11; see also English-Lueck 1990). The influx of Asian immigrants since 1965 intensified New Age interest in Asian practices (Albanese 2007, 484).

Contemporary transcendentalism is represented by New Age practices. Self-help actualization, and personal and societal transformation, are now mainstream ideas rather than deviations from American values. A study of New Age consumption in Texas demonstrated that the only real predictor (p.98) of who would engage in “alternative” practices was whether someone in the person's network also practiced it. New Age consumption was spread across the demographic categories of age, ethnicity, class, education, and “conventional” religious practice (Mears and Ellison 2000). Another study, conducted out of Atlanta's MARIAL Center, on ritual, noted that among working mothers alternative medical practices spread through their families, media, or networks (LeVeen 2002, 6).

By the turn of the twenty-first century, 40 percent of U.S. adults had purchased complementary and alternative medical products (Eisenberg et al. 1998). In a study in 2002, a team from the National Institutes of Health found that 62 percent of the adult American population used complementary and alternative medicine (CAM) therapies, including prayer. Excluding prayer—although transcendental practices would warrant including it—36 percent of the population use natural products, do yoga or breath-related exercises, meditate, or use massage and chiropractic or diet-based therapies (Barnes et al. 2004, 1). Some 27 percent of all Americans use the Internet to search online for alternative health options, while 33 percent of Californians do so (Fox 2003, 12). In short, a significant portion of the American population engages in the use of alternative healing, enough to suggest it is no longer so alternative after all.

American Transcendentalism was a broad-ranging and free-spirited doctrine that valued experimentation. Novel approaches could be applied to natural conservation, astrology, and even engineering and health. The philosophy emphasized pragmatism and creativity, holding that the human mind is encumbered only by its own self-imposed limits (Albanese 2002, 21–24; Albanese 2007, 13). We see in John Muir (1838–1914) the embodiment of these cultural values (Albanese 2002, 11). He worked hard as a writer and political activist to preserve the wilderness in the United States, especially California's Sierra Nevada mountain range. He was also a naturalist and an engineer/inventor. Since his time, environmental activism has been linked to a romantic spiritualism that continues to view nature as reinvigorating. The invocation of Gaia, a consciousness attributed to the biosphere, is a natural outgrowth of transcendentalism (Albanese 2007, 508).

In the last chapter, we saw the first wave of cultural “revolutionaries” (p.99) engage in social experimentation; they worked on transforming themselves. They brought together diverse cultural influences and wove them into a medically plural ecosystem of beliefs and practices. This older cohort reformed work organizations and the family itself to adapt to the emerging global knowledge economy. The second wave, slightly younger, also experiments on itself, fuses different cultures, and adapts to an economy that stresses individuation. For this cohort, however, the three processes of experimentation, cultural fusion, and adaptation are even less differentiated from each other and more tightly woven into everyday life.

Veeda Ferrazzi and Min Lee, Building an Ecosystem of Support

Veeda Ferrazzi, a native of the San Francisco Bay Area, is a forty-year-old mother of two young children and a researcher. Although frequent travel is part of her job, she can work from home and has created a space to do so. Veeda must also constantly produce to validate her virtual performance to colleagues and superiors who cannot monitor her directly. The work stress is intense. For a time she was falling prey to pathogens every time she traveled. She was constantly getting sinus infections and taking antibiotics. Then she began to reassess what was happening to her. Her husband, Roger, counseled her to nurture her body and let her immune system do the work. Veeda says, “It sounds really stupid, but I really could see the impact of sleep and rest…. So I started taking care of myself better, knowing that there was a real connection, for me at least. It was working for me.”

She recognized that drinking water was a practice that she needed to integrate to keep healthy. Coffee dehydrates her, and wine, while part of living well, also dries her out. She was particularly careful while pregnant, but once she was back in her work routine the old habits started to reemerge. She started drinking green tea. Veeda notes, “I start feeling dried out, my eyes burn. My nose is itchy because I'm dried out. So, drinking the tea—you put the water on and you boil it—reminds me to get hydrated.”

Once she became aware of sleep and fluids, Veeda cultivated other practices to build her health. She chose the place she lives carefully, in order (p.100) to be able to raise a healthy family. Veeda reflects, “We picked a place we knew was a walkable neighborhood, where we could get out every day and be outside—work in the garden or something—be close to public transportation.” Both Veeda and Roger identify commuting as an emotionally and ecologically hazardous practice. She can do much of her project-based work independently on a computer, which gives her the flexibility to telecommute. Veeda also spends time in the new neighborhood with her intensely physically active sister, buffering the negative impact of sedentary work. Her moral commitment to her two daughters keeps her attention on developing a social and environmental infrastructure to keep herself, her family, and friends as healthy as possible. Veeda does not use extraordinary efforts to do so, but builds an ecosystem of incremental practices.

Veeda carefully manages the small details of her life, building in walks with her children and eating fresh vegetables from a local CSA (community supported agriculture) delivery service. Boxes of produce, whose contents vary with the season, are delivered to her doorstep. Exactly which fruits and vegetables she finds in the box is a surprise. Veeda remembers, “We got a flyer and said, ‘Well, we'll try this one.’ We were kind of ready to try it. That comes twice a month and it's great. You make do with what you get. So, I've learned how to do all sorts of things, things I never thought I would have cooked before. It's good! It's fun! There's all sorts of stuff. It's easy because we're not growing it. It is organic and that is something.”

Veeda must also work face-to-face on teams and with clients, which forces her to make the long journey from Berkeley to Palo Alto. At her workplace, discussions of family and health create ties between people. Particularly in knowledge work and other team-based activities, where intangible thoughts are the medium of exchange, trust is a requisite element (Baba 1999, 333; English-Lueck 2002). While arguably the best way to build trust at work is to build a history of doing a job well, there are other tactics that people use to build trusting relationships. One way to build trust is to share details of life that create a sense of mutual vulnerability. Exchanging health-related information and stories about family build bridges between workers that facilitate trusting relationships. This strategy sweeps coworkers into the personal health ecology that family members need to find (p.101) resources, disseminate knowledge, and make sense of complex and sometimes contradictory health information. The stress experienced by juggling work and home can be turned on its head as coworkers become tacit family helpers. Veeda and her fellow workers share their own illness narratives and interventions, building intimacy. Similarly, family members become invisible and indirect coworkers, supporting intense bouts of productivity.

Veeda's health support system includes her sister, husband, and other kin, but also sweeps in coworkers and acquaintances. Her Silicon Valley workplace gives her obvious institutional support—supplying health care benefits and buffering her scheduling quandaries by providing flexible alternatives. It also provides distinct challenges, wearing her down and adding to her stress. Although it is far from her workplace, her neighborhood has tangible resources, such as places to walk safely. Veeda can contract for the delivery of organic produce from local farmers who routinely deliver to her neighborhood. She consciously cultivates this ecosystem of people, institutions, and practices, and in so doing, illustrates the strategies of second wave workers.

Min Lee illustrates this conscious cultivation as well, although she is in a position to command additional support from those under her control. Min is thirty, born in Seoul, South Korea. Recently diagnosed with diabetes, Min reflects that when she was growing up, even though her mother is fanatical about healthful food, she had been discouraged from participating in sports because they were “unfeminine.” She played varsity volleyball in high school, but her parents were uncomfortable watching her display herself quite so publicly. The eating habits she learned as a child are difficult for her to change, especially cutting down on rice, a mainstay of an Asian family diet and an iconic symbol of Korean culture. Min tries, with mixed success, to enlist her family in her new eating and exercise strategies; it would be good for her mother, who also has diabetes.

Working in a stressful job with a frightening new diagnosis, she sees creating a healthful workplace, one with less emotional strain and more physical activity, as a priority. After her doctor, looking at her “dead-on,” warned her that she must control her weight and her diabetes or risk potential birth defects for her unborn (and at this point only theoretical) child, she knew (p.102) that she had to change her behavior. Min thought, “Oh my God, this is really serious. I've always been pretty conscious about preparing myself for when I do get pregnant…. I don't drink. I don't smoke. I've never done drugs…. Okay, I smoked pot once, but I didn't inhale! I've always been conscious about making sure I get my folic acid … preparing to have kids in the future. That's always been important to me.” Min Lee has very specific reasons for changing her exercise and eating practices that are rooted not only in conventional disease management but also in her plans for childbearing. Central to her motivation is preparing for parenthood, a moral imperative that appears again and again among young workers.

Min needed to create an ecosystem of support that extended beyond her family. Her solution was to use her position as a director to push for a “healthy workplace” and encourage her coworkers to exercise, relax, and take a healthful approach to work. After all, “I want them to take care of themselves and feel good about themselves, and I think you can only do that when you feel healthy.” Her coworkers could then provide support for her to do the same. Alone she might not create these new, healthier practices. Her tactic was to use her position to redirect the goal of the workplace into supporting her efforts at health management. The worksite trainers and her nudged-into-being-supportive colleagues are now fixed in her health management ecosystem. Min uses a workout facility at her workplace, an on-site fitness center, but she has constructed a network of trainers and colleagues to serve her health needs.

Veeda's support lies mainly in her family members and coworkers, occasionally drawing on institutions such as a farmer's cooperative. Min's narrative points to a larger ecosystem of specialists that help workers maintain themselves efficiently. In addition to family members and coworkers, coaches, and trainers, personal assistants and therapists can be found in corporate workplaces, in gyms and spas, as practitioners or as independent consultants. The backgrounds of these specialists are as varied as their destinations. Some are alternative health practitioners, whose holistic healing credentials prepare them for spiritual, emotional, and embodied interventions. Psychology and business credentials can be combined to produce career coaches. Fitness experts—with backgrounds in kinesiology, physical (p.103) therapy, nutrition, and sports—become credentialed as personal trainers. Others may draw on eclectic backgrounds to become personal assistants who manage the business of life for those who need to be totally dedicated to their work for the company. In a different culture and era the people performing many of these functions were called “servants.” However, as bodies are remolded for productivity, the act of taking care of others is recast as therapy. Much of this therapeutic mandate is filtered through a transcendental lens, emphasizing individual agency, experimentation, and crosscultural practices, and invoking a particular version of nature.

Jason, Margot, and Lily, in the Therapeutic Marketplace

Jason has assembled trainers into an independent fitness center, and he illustrates the concerns of those who supply the marketplace for self-improvement. Jason is forty, and his center caters to local companies, providing equipment, trainers, and other, less tangible services. He contacts companies and tells them of the flu shot clinics and blood drives that he runs as promotions. If you “serve the community … it comes back to you.” Jason sits in his office, next to a calendar themed around disasters. One of his clients does failure analysis, and the calendar is a gift. His vitamins sit on his desk; he works long hours and does what he can to avoid getting sick. He goes out on the floor with his clientele, assessing their needs. In the beginning Jason provided a collection of industry magazines, but his clients wanted “an oasis for people to get away from work.” So he now carries Sports Illustrated. He consciously steers conversations away from business, since his clients inevitably talk shop, by asking, “How about those Niners?” Ironically, he does not like sports, or support Oakland's football Raider Nation, but Jason keeps up with such news so that he can talk sports.

Jason's clientele is on the young end, averaging around twenty-eight, mostly male and drawn from an ethnically diverse population. There are tech stars in his clientele, founders of software companies and mentors in the industry, and there are “strong guys … but … mostly we have people that want to stay in shape … not body builders so much.” He has been in the fitness business long enough that he sees a shift from a hard, steroidusing (p.104) clientele to one much more attuned to health, people who “respect their bodies.”

Margot occupies a very different niche in the ecosystem of services. She works directly on clients' bodies as a massage therapist. Margot received an associate of arts degree in massage therapy from a local community college, a “good program” but one completely based on anatomy and physiology. She injects her own brand of spirituality, drawing on the healing power of nature and communicating it to her clients. Margot draws her “energy from nature, however they want to interpret what nature is.” Margot's business plan is simple; she contracts with the health provider of a major computer company, massaging clients at the tech campus itself. Her workspace is a quiet room with dimmed lights and scented oil—for those who are not allergic to the fragrance. She works with the health service nurse and ergonomicist, a person like Kristal. She refers carpal tunnel or other such problems to her colleagues. Margot's client pool, around 150 people, is mostly female. Many come to her directly, while others redeem gift certificates purchased by their managers as rewards for working “really long hours.” Ironically, when project deadlines loom and her “people are so stressed,” they are too involved with the work to come to her. During the most frantic phase of a project, when the workers really need relaxation, Margot rarely sees them.

Most of the time, Margot just massages their heads and shoulders. She likes to begin her massage at the feet, “because all these people are working with their head and that is where all the energy is. So I work at the feet first just doing some points. [I] just try to get some energy to come back down into the body.” Later she moves her massage to the troublesome head and shoulders. Margot reflects, “I have clients who just lie there like a board, who have no concept that they have a body. They just have a head. Until their muscles are screaming at them, then they go, ‘Oh yeah!’”

Lily provides a more indirect service, but one that is ultimately framed as therapeutic. Lily is a designer who has transformed her practice so that she composes interior landscapes according to the principles of feng shui. Lily distinguishes her practice from the faddish generic “diagram” approach and says, “I try to focus more on the classical approach which includes astrology. (p.105) It includes earth sciences, electromagnetic factors, and health factors. I also incorporate my business background into it.” Her clientele “often times are very progressive, very in touch with New Age studies, which of course, isn't new. It's very old. It's … trying to bring these native, spiritual things back.” She began learning years before from a Taiwanese professor who taught students at a local Buddhist temple. Some Americans, like Lily, went to Asia, learned the discipline, and brought it back. Lily notes that her practice has traction, not only among the region's Asian immigrants but also among the “culturally progressive” population of Northern California. Journalist Patricia Brown notes, “In California, feng shui is big business. In communities like Fremont and Cupertino, south of San Francisco, feng shui experts often consult with developers on the layout of subdivisions…. ‘Feng shui is a very major cultural factor,’ said Irene Jhin, publisher of the Chinese New Home Buyer's Guide, based in Burlingame” (Brown 2004).

These “therapies,” ranging from fitness training to spiritual interior design, are examples of the reach of the ever more complex health marketplace. In this book, most health and illness narratives are those of individual consumers of these practices, although they do create practices as well as consume them. Jason, Margot, and Lily provide a different perspective. The traditions and practices themselves, and those who provide them, have subtly changed. Exercise, massage, and feng shui have roots in antiquity, in Hippocratic medicine and traditional Chinese practices, but they are being organized through new institutional frameworks. Jason and Margot are allied with businesses in a subtle contract to keep workers supple. Realtors and local governments sweep in Chinese geomancy, using divination of earth energy, to accommodate both immigrant and transcendental beliefs. They are part of an ecosystem of therapeutic services that makes the transcendental disciplines of healthy living real, and even convenient.

Nikolas Rose, a social theorist who has applied Michel Foucault's notions of governmentality to bioscience and psychiatry, has identified several important themes in biomedicine that can be more broadly applied to the larger suite of practices constituting therapy, including alternative practices. Therapy has become a framework for reshaping “an individual's relations with others” and their “relationship with themselves.” The advent of therapeutic (p.106) governmentality provides a mechanism by which people “experience themselves and their world so that they understand and explain the meaning and nature of life-conduct in fundamentally new ways” (Miller and Rose 2008, 142–47). Therapy transforms the way we control ourselves and each other. Furthermore, the statistical revolution that produced biomedicine created a new objective for therapy, to achieve normalcy. However, the entry of “life enhancing powers of particular activities, foods, thoughts, and the like” shifts the goals of therapy from generic normalcy toward customization (Rose 2007, 20). Therapy is then directed toward the unique needs and desires of the client. The thrust of therapy is not simply bound “by the poles of health and illness,” but directed toward “optimization” (ibid., 17). That optimization, or “self-actualization,” is part of a discipline linked to entrepreneurism, maximizing an individual's capacity for innovation and agency (Miller and Rose 2008, 194).

The pool from which these therapeutic techniques are drawn is deeply diverse, blending nineteenth-century Transcendental concepts, expressions of a colonial global flow of ideas, and twentieth- and twenty-first-century exchanges of concepts, practices, and people. The production of bioscientific knowledge is global, but so are the discourses about alternative forms of therapy (see Photograph 6). In Silicon Valley, practitioners and clients are enacting globalized therapeutic disciplines.

In Silicon Valley, young adults have grown up with increasing cultural diversity, and while not necessarily “born to” deep diversity, they are active participants in encountering, engaging, and creating identities. Workers who have migrated to the Valley have done so to participate in the culture there; they are self-selected to place work as a central value in their lives and to embrace the deep diversity that allows the foreign-born and children of foreign-born to function there. In terms of health, this cultural cosmopolitanism translates into a comfort with medical pluralism. For example, while the widespread practice of yoga contributes to the medical diversity of the region, there is additional complexity below the surface. Northern Californian versions of yoga, practiced by the aging parents of these workers, exist side by side with the yoga practiced by the many varieties of Indian sojourners. Neelima Goti, a native of Bangalore, has a commercial (p.107) yoga video, but her use of yoga and her blend of traditional Indian health practices are not the same as Amanda Stewart's, for whom a more American-adapted yoga simply helps her prepare for pregnancy. There is not one type of Ayurveda, the traditional health system of India, but many forms to choose from. These diverse practices range from an eclectic blending with biomedicine, often practiced by immigrants from India to versions that stress their distinction from biomedicine as practiced by Euro-American alternative healers. The core epistemology, American Transcendentalism, provides a foundation for integrating a host of beliefs that produce alternative health practices, an environment of experimentation and a work culture of invention. This collection of cultural values allows Silicon Valley workers, and many others, to turn their lives into experimental projects in deep medical diversity.

Addison Wu and Rupal Patel, Locating Deep Medical Diversity

Addison Wu's problems are not unusual, and she illustrates some of the dilemmas facing young immigrants. Addison is thirty, lives with her parents, and works as a patient care coordinator at a dentist's office. Ethnically Chinese, Addison was born in Southeast Asia but has lived in Silicon Valley since she was two. Her parents wanted her to work in the computer industry, “because we do live in Silicon Valley!” Usually obedient, this time she said she would prefer to go into health care, although she decided against medical school because she disliked studying anatomy.

Addison is four feet, eleven inches tall, and now weighs a 105 pounds. As a teenager Addison was fit. In high school, she was subject to daily enforced physical activity, but that discipline dwindled when she went to college and began to work. Such activities become optional and therefore avoidable. College meant putting on that “freshman fifteen,” and with her short stature, gaining weight is a problem. Addison reflects, “I was thin in high school, but after that, no sports, just munching. And that can get you really fat!” Her weight management had been effortless in high school, but the situation had changed. At 165 pounds she was warned by her doctor that (p.108) “it was beginning to be dangerous.” He scolded, “Be careful. You are still young, so be careful with it.” It “started getting too much for me to handle, so I decided to do something about it and instead of going on diets, I decided I am maybe just going to eat smaller portions and exercise because I love to eat. Eating is part of my life. And if I can't eat what I want to eat that is bad. Bring on the fries! Bring on the ice cream!”

So Addison consciously decides to train to be fit. She began to exercise up to five times daily, aerobic workouts with her hula hoop, jumping rope, and body sculpting with weights—which she calls “her little buddies.” Her stress level intensified when her grandmother died and she had to work more to get her sisters through college, as their tuition costs had shot up. She has to be careful of binge eating, saying, “I eat because the more I eat the less I think about my emotions. It was an emotional thing for me.” Her “aunties” in Asia send her advice and remedies, such as Malaysian wheat grass, but she is content to focus on “eating dutifully” and exercise. She inserts workouts into every unused space in her life—at work, before and after dinner, in the middle of the night, sometimes sleeping only a few hours. She takes stairs instead of the elevator. She doesn't care for the large-scale gym infrastructure, preferring to use lightweight devices that she can use to monitor herself (see Photograph 7). She walks and tracks the calories used and steps taken with her mobile phone. For Addison, entering adulthood meant creating a training regime that matched her aging metabolism. Her workplace supports her new practices; she is allowed to use the waiting room for exercise when it is empty.

Addison, a young immigrant, illustrates some of the most obvious features of medical pluralism, as she joins together mainstream biomedical practices with Asian understandings and remedies. Her sphere of medical interaction, at least around her own care, is limited to her family and friends. Addison consults with her globally based kin and uses devices—designed for the individual—to help her watch and revise the program she has created for herself.

Rupal Patel's immigrant experience illustrates a different set of challenges. The American medical system remains a bit of a mystery to Rupal, although he understands the workaday world of high-technology well. (p.109) Rupal is thirty-one and has been in Silicon Valley for five years. The early years were simple. As an engineer from India, he submerged himself in the work with few distractions. Then his family arranged a marriage, and now he is a husband, the father of a one-month-old infant. Soon Rupal will host his diabetic mother for an extended visit to his small apartment in a gated apartment complex. He carefully manages his own health through diet and exercise, while working at least ten hours a day. The value of his workplace has subtly changed for him. No longer just a site of employment and professional development, his company provides the health insurance that seems essential now that he is a provider. Once a year he discusses his health plan with his company and reviews his coverage. His new family responsibilities bring higher premiums, but most of that is paid for by his employer.

In addition to dentists, doctors, and hospitals, Rupal says that he and his family often go to local Hindu temples as “part of our culture.” Spiritual equilibrium is part of how his family members “maintain” their “health levels.” For biomedical advice he can turn to his brother, who is a physician. They talk every day. If he doesn't feel good he waits for a time, trying to assess if there is really a medical issue. If the problem persists, he asks his brother, then his doctor, and then turns to the computer to do an Internet search.

Unfortunately, since moving to Silicon Valley and working for a large high-tech company, he has been gaining weight. Over at Google they call it the “Google twenty-five,” similar to the “freshman fifteen”; these are pounds earned by a sedentary lifestyle. Gourmet cafeteria food is just too tempting. After his marriage Rupal realized that he now had responsibilities, and keeping his health in order was part of that moral mandate. So Rupal talked to his brother, searched the Internet, and structured a diet plan. He got a personal trainer and started going to the gym. He has had his body finely tuned—to be fit and productive.

Then the baby was born. He can't tell whether his child is normal or unhealthy—the whole experience is too “new.” He talks to his friends and his daughter's doctors and puzzles his way through parenting. His wife is on maternity leave and he helps, saying, “As a father, I do my stuff.” Rupal also monitors his mother's health. She has diabetes, and every week her (p.110) numbers must be assessed. While she talks to her doctor, Rupal scans the web for information. He finds foot creams, and reads about her medications. He discovers a new world of devices and services that he relays to his mother. The responsibilities are beginning to mount. He looks into the future and realizes that forty is not so far away after all, and “we will have to be very careful.”

Generally positive about his adult responsibilities in his home and workplace, he is less sanguine about the American medical system. Having to wait a month to get an appointment seems ludicrous; in India he would just walk into the office of the doctor of his choice and be seen. Why should he end up with a total stranger? He finds it hard to elicit information from the doctor. He doesn't just want to have instructions about what to do; he wants to understand why the illness is happening. He dislikes having to find a pharmacist to query. Shouldn't the doctor be explaining potential side effects and interactions? Rupal wants a thorough explanation. After all, he is an educated man. He admires the technology of the medical system of the United States but not the delivery system itself. Rupal functions well within multiple medical beliefs but has trouble with the system that delivers care that potentially interferes with his ability to be a responsible husband, son, and father.

Both Addison and Rupal draw on a global set of traditions for specific practices and beliefs; even the majority of their activities that could be identified as health-related stem from biomedicine. They have woven together biomedical notions and practices from their distant relatives. However, the imperative of second wave workers remains intact. They must work on themselves, to correct potential problems and to stay fit. That particular agenda, to stay fit, is intertwined with familial obligations and habits of thinking from their respective professions in health care and technoscience.

Luke Brandeis, Staying Well and Better than Well

Practicing complementary and alternative care, as Luke does, adds another dimension to medically diverse self-experimentation. Luke Brandeis embraces a variety of devices and practices just to manage his chronic conditions and uses them to augment his day-to-day functioning. (p.111) A thirty-nine-year-old intellectual, Luke has Type 1 diabetes, poor vision, and Marfan's syndrome, a genetic condition that has resulted in a damaged heart valve. He received an artificial heart valve at eighteen. Luke explains: Marfan's syndrome is “a condition of the ligaments and joints, and Abraham Lincoln had it. In general it makes you tall and it makes your joints elongated. Unfortunately, though, it also expands your aortic heart valve…. I was eighteen, and I felt like my back stiffened up when I was on the way back home from school, and apparently the valve was expanding, so they had to replace it.” When he is quiet, you can hear it beat. He uses his glucometer five or ten times a day to monitor his glucose and charts it on his computer. Luke is adding an insulin pump to the technologies that keep him alive. As his support system grows, Luke meditates on what this means to him:

It comes back to where do you as an individual end and your body begin? That was becoming really blurry with me. The same thing goes back to feeling dependent on devices. Now I have a device implanted within me that I utterly depend on its functioning to work … a second device. So I feel like I'm in this web of devices—devices that I have to carry with me, devices that may be part of me, devices that are already inside of me. I'm always for whatever works, right up to stem cell research, and animal research too…. So the cyborg thing, I think I had that even at age twelve. I was thinking, “Oh, I'm dependent on this device now. This device is a real extension of me now…. The only thing it doesn't give me is superpowers.” And I'm like, damn, you know. What it does give me is an extra sense of my body though…. It gives me that feeling of power that I think not everyone has. So in that sense, it's a psychic shift really.

Yet Luke has many tools at his disposal to enhance his life, in addition to the medical devices that sustain it. The advent of low-carbohydrate diets has made new products available to him, from Diet Coke to high-fiber power bars. “It's like a diabetes paradise.” Luke's brother is “into Tony Robbins,” an entrepreneur who has capitalized on neurolinguistic programming-style self-help seminars. Anthony Robbins has created a global coaching empire. He sells products and seminars, designed as self-actualization tools, to (p.112) guide people to live an “extraordinary life.” Luke's house is decorated with Tony Robbins affirmations that he uses to fine tune his attitude: “You can do it!” “Eat well.” “Today is the time for exercise,” “This is the place to be.” He is sensitive to the power of words.

Place also matters to Luke. He is conscious of place and knows the value of each spot: particular places to meditate, the neighborhood streets where he walks, and the grocery stores that carry the products he can eat. He tests his blood in specific locations, where he also goes to meditate on his life. In the main hallway he has a spot where he tests after he comes back from his morning constitutional. He has other places in his home as well, “like a medical workstation … a meditation area too. It's a place where I can check in with my body.” Luke takes a “poll” of his body, tracking whether his blood sugar is in range, but also looking at the bigger picture. He meditates on, “Am I doing okay? What could I be doing better? Do I need to do more exercise? Do I need to eat less? I can always check in to see what my body chemistry is, and I love that.”

Luke's in-laws work for Whole Foods and have influenced his wife to explore the holistic approach of Andrew Weil—a leader in integrative medicine from the University of Arizona. Luke began to experiment with adding new practices, especially around food, and rethinking his health management. He says, “It just got me more mindful. I think it was that development of mindfulness of health that was really important … really thinking about the mind/body connection … again, checking in with my body made me feel better about myself.” Beyond the consciousness his “cyborg” status gave him, he “re-evaluated the way I was testing my blood … thinking that there were different ways to approach medicine than from a Western point of view.” He began to practice meditation and does yoga and taiji. He visits acupuncturists and yet is still perfectly comfortable at his health maintenance organization. Luke is, after all, “an HMO baby.” He divides his life into the cyborg phase, the holistic phase, and then wonders, “What's next? It's like, now I'm ready for the cure. I'm ready for the genetic phase where they just cure it!” Luke is not just maintaining his health, but using global alternative remedies, organic food, and nutraceutical food supplements to augment it. For Luke, the world of transhuman augmentation—being better (p.113) than well—blends seamlessly into the medically plural realm of transcendental natural healing.

Luke's practices hint at more than simply staying well, but being better than well. There is a subtle distinction. Being healthy is part of an older discipline of self, one that suggests maintenance and repair. To be augmented is to be improved, through health practices or technologies, making a person “transhuman.” A highly debated philosophical term, “transhumanism” is an “intellectual and cultural movement that affirms the possibility and desirability of fundamentally improving the human condition through applied reason, especially by developing and making widely available technologies to eliminate aging and to greatly enhance human intellectual, physical, and psychological capacities” (Bostrom 2008).

In Silicon Valley, transhumanism takes on many forms: including active meet-up groups that identify with the movement and those who simply accept the notion that augmentation is an appropriate metaphor for humanity. Silicon Valley's role in promoting the concept of augmentation is deeply rooted in its development. Early in the development of computing, the dominant model for technological development was replacement, aiming toward functional artificial intelligence. Computing pioneers such as Doug Engelbart posited a new direction, using technology to augment human intelligence (Markoff 2006, 45–47, 66–67). Before such substances earned notorious reputations, in the early 1960s, experiments with LSD sensitized Bay Area intellectuals to the notion of cognitive augmentation. Some participants in these psychological experiments founded the computer science Augmentation Research Center, where the ideas behind the mouse, the typewriter-derived QWERTY keyboard, and the CRT terminal were developed (Turner 2006, 61, 107–8). Technology would augment human intelligence, helping people produce, communicate, and be more efficient. The metaphor of augmentation changed the way technology was conceived, invented, designed, and implemented.

In a tone reminiscent of Addison, feminist sociologist Gimlin's ethnographic study of an aerobics class in New York revealed that the women have a nostalgic memory of their bodies, and talk about having somehow “lost” their ideal bodies. They turn to exercise and, as they age, sometimes (p.114) cosmetic surgical intervention (Gimlin 2002). Such interventions are well used in Silicon Valley by those who can afford them. Appearance, as Giddens notes, is part of the project of self-actualization (1991). In a culture that celebrates youthful innovation, appearing aged or looking tired is a liability. Dr. Cheng, a Los Gatos cosmetic surgeon, comments that his patients prefer incremental changes to radical ones. Starting in their thirties and forties, they want to “keep what they have.” They also do not want to lose work time. He comments, “In Silicon Valley in particular, people want quick fixes with little to no downtime because they're too busy to wait out a long healing process.” So they pursue the small corrections of collagen tissue fillers and blepharoplasty to de-puff lower eyelids. Older clients opt for more expensive and consequential augmentation. Another surgeon, Dr. Weston, comments that more people, women and men, are trying to “stay vital in a precarious workplace…. There is a premium placed on youth here” (Kato 2004). Cosmetic practices that are used to pursue the appearance of vitality become augmentation.

Cosmetic surgery, once a technology of repair, has become something to enhance existing experience. In a similar way, medical technologies originally designed to treat cognitive and affective disorders are expanding to augment attention, memory, and learning in healthy people. The field of cosmetic neurology is beginning to emerge (Chatterjee 2007, 130–31), as people begin to tinker with their neurochemical selves (Miller and Rose 2008, 104–5). There is a whole suite of prescription medications to help people focus or be more productive in school or work. Often in pill form, nutraceuticals—food or herb derivatives that are marketed to have an impact on human health—range from well-known vitamins to specific plant or animal derivatives. Well-made “gourmet” coffee, such as that favored by Veeda, Kristal, and Jeremy, provides a caffeine boost. In the words of Paul Erdős, “A mathematician is a machine for turning coffee into theorems” (Reid 2005, 16). Kristal's Mango∙Xan is an example of an “energy inducing drink” that is also supposed to be able to reduce inflammations. Functional foods, which provide a health benefit beyond nutrition, are also examples of augmented nutrition. Examples range from breakfast cereals with oats to enhance heart health to organic eggs with omega-3, produced (p.115) by feeding flaxseed to hens (see Nestle 2002, 333–34). Dairies add vitamin D to milk, and Coca Cola adds vitamins to its Diet Coke Plus. People in this younger second wave cohort are comfortable with these functional foods (Belasco 2006, 251).

Janelle and David Smith, Adult Onset

The second wave cohort, whether they are just beginning career and family at twenty-five or forty, is coming into the full impact of adult responsibilities. Young parents and parents-to-be, such as Luke, Rupal, Jeremy, and Kristal, consciously prepare themselves for their new duties. Self-care becomes family-care, an inherently moral endeavor. The family occupies a special position in the American social structure. It is the site of accommodation for other institutions. The family is the visible arena “where problems are expressed, even if causes lie elsewhere” (Darrah 2005, 12). The family home is the first and last bastion of health care. Symptoms are felt by family members, and their kin help them understand whether an embodied feeling is an illness or simply one of the normal miseries of life. Heath care decisions are based on the resources collectively harnessed in the home from employer-based insurance or network-based expertise. Religiosity and cultural values are embedded, disseminated, and debated within the confines of the family. The busyness of life, referenced earlier—managing the many activities that fall to an individual worker, student, patient—is navigated within the family. That navigation means making particular decisions within an ecosystem of choices, many of which are constrained or benefited by specific work circumstances.

Parenting becomes the navigation of risk, trading one potential danger for another in the moral quest to take care of the next generation (Beck 1992, 22–27). Risk, as Rose points out, is a function of thinking and acting after potential futures have been considered (2007, 70). Public health discourses have been the medium through which health risks for families and workers have been translated. There is a long-standing structural connection between work and family through modern public health strategies. In the nineteenth century, from sewer gas to germs, the home was seen as (p.116) a place of lurking dangers. Food was distributed in the home. Sanitation in the home—private hygiene—was seen as an essential element of public health. Cleaning the home was the domain of women in the cult of domesticity; it was also a critical health practice and gave rise to a whole industry (Tomes 1997, 506–7). In the twenty-first century, the linkage between hygiene and moral parenting is less oriented toward pathogens, although that connection is still there. Rather, families now struggle to protect themselves from pollutants, toxins, and environmental degradation (ibid., 521).

The tension between work and family in U.S. culture is so poignant precisely because both are such powerful centers of moral action. Being a good parent means expending considerable effort to take care of the well-being of the next generation. That may mean making sure that the children are educated and prepared for the workforce, and that they haven't been unduly exposed to industrial toxins in their school or agricultural toxins in their food. Moral action in the family can be manifest in making breakfast, or in taking civic action to monitor superfund sites. Workplaces can be allies in this pursuit through “family-friendly” and “wellness” policies, and certainly coworkers can be confederates in making family life satisfactory. However, both workplaces and colleagues can also be barriers to health as well, by emphasizing the morality inherent in the work ethic at the expense of the workers and their families. Devotion to work is a central tenant of the productivity ethic, and not to be easily set aside.

Janelle and David Smith both work in education. They embody the complexity of juggling dual knowledge service-based careers and a young middle-class family. They also illustrate the diverse cultural alternatives from which they must consciously choose. As parents and educators, they must make decisions that reach beyond themselves to influence the next generation. Experimental, deeply diverse, and intensely productive, Janelle and David model the challenges faced by their age cohort. Janelle is a speech pathologist; her family is from Panama, and she bilingual in Spanish. David Smith is a residence director (RD) at a Silicon Valley University, a young African-American professional with jurisdiction over “student life” on campus. Because of his work, they reside on campus in a tiny two-bedroom apartment inside a residence hall, the only young family in a sea of (p.117) eighteen-year-olds. Mirella Smith is only a few weeks old. Her older sister, Mardi, is not yet three. They carefully planned both Mardi's and Mirella's births to fall during academic breaks. Mirella has her mother for an eight-week maternity leave, including the Christmas holiday, before Janelle returns to her rounds in San Jose's elementary schools. Mardi is thoroughly integrated into her parents' working lives. Another RD, Toni, has been adopted as an “auntie” and helps them with the logistics of their “revolving door” childcare strategy. One parent goes to work as the other returns. They meet for breakfast, hand off the children, then meet for dinner and switch. This particular weekend David is on a twenty-four hour shift, on-call at any time of day for crises that can range from quarreling roommates to serious infringements of university regulations. He is particularly good with “judicial” issues, knowing when to transform the infringement into a life lesson, and when to deem it a legal matter for the campus police. It's the end of the holidays, and they have returning students and visiting relatives from the Midwest, all wanting to see the new baby. David gets up first, his PDA beeping to remind him to pick up the cloth diapers that have been delivered. He checks the digital monitor that allows him to hear what is going on in his daughters' room, although the apartment is small enough that such electronic eavesdropping is a bit redundant.

Janelle wakes next and talks to David about buying groceries; she wants the ingredients for Panamanian rice—peas, coconut oil, and bakala as well, a salty dried cod fish. Her mom pipes up that she didn't take the train from the Midwest to cook for them. David mentions that he is an excellent cook and makes a mean stir-fry. Janelle playfully asks him if he wants a stir-fry cookoff, but he says he would need a wok. Janelle scoffs, “You don't need a wok. You're not the iron chef!” Ultimately they settle on red snapper. They have a tiny kitchen, and it bursts with cooking supplies. They also have the option of eating in the dining commons with the residential students, which they do when work ramps up and they struggle to find the time and energy to cook and clean.

Exercise becomes another casualty of working parenthood. David, a near-professional basketball player, continues to practice through injury and distraction. His games can be family events. Janelle, however, finds it (p.118) hard to make time for her own exercise. Walking strollers is not the same workout as rollerblading with age-mates. Televised Tae Bo is hard to do in a one-meter-square space in a cramped apartment.

While Janelle and Mardi are playing, David goes into his office and prepares an event for the hall, related to a couple of cases of substance abuse in the previous year. Roofies, Roche's Rohypnot, the insomnia treatment turned “date rape drug,” and Ecstasy, methylenedioxymethamphetamine (MDMA), “the rave drug,” are intimated. He plans to do some serious education on substance abuse before student infractions become real criminal activities.

A few weeks later, the temporary reprieve of parental leave draws to a close. The whole family goes to the doctor for Mirella's well-baby visit. They are covered by Blue Shield, but this visit is a no-co-payment, long wait sojourn. They settle in the pediatrician's office. Janelle picks up a Working Woman magazine, to see if her career remains among the twenty hottest. When Mirella gets fussy, Janelle walks her around, greeting the other babies happily until another mother comes in with her sick nine-month-old. He has had the flu since Monday and she has to work. The mother wonders, “Why isn't he getting better?” Her husband and she both work, and she needs this taken care of before the weekend. Her family is in Mexico and Nebraska, and her sister didn't come to help until a couple of months ago. She tells Janelle that she doesn't think she will have another; she just did not realize how time consuming babies could be.

Mirella's well-baby check goes mostly well; she is gaining an appropriate amount of weight and is thriving on breast milk, “the good stuff.” She does have an umbilical hernia that may resolve in the next few months. David is a little concerned, especially when the word “surgery” is used. Shot time. The range of required vaccinations is available in only three shots, which are done deftly. As long as Janelle holds her, Mirella is fine.

As the next year unfolds, the Smiths discover what Janelle had already experienced, as a speech pathologist, that “all life revolves around sick kids.” Mardi is generally healthy but has “poop issues.” She is chronically constipated, with discomfort and medical response escalating over the course of five months. It takes a year to find the right specialist and begin to address (p.119) the underlying causes, a year that takes a toll on the whole family (see Darrah, Freeman, and English-Lueck 2007, 61–62). Janelle and David are juggling working across several sites and accommodating complex work-related social demands. A sick child “speeds up the treadmill of quality parenting” and requires that much more effort (Jarvis and Pratt 2006, 338).

The Smiths form a dual-career family, one that illustrates that children are part of an ecosystem that includes adult work, food choices, exercise patterns, identity play, and attitudes toward life. Mirella and Mardi are reflective of their own identities, learning Spanish, playing with multicultural sticker books. When Mardi gets eighteen Barbie dolls for her birthday from family, friends, and parents' coworkers, the majority of them are “African-American,” embodying a particular cultural identity. Children are socialized into this world, but also act as anchors for parental agency. Children are transformed by their parents and revolutionize the options of those around them, opening some windows for reflective self-conscious work and health management among the adults, and closing others. Parental health attitudes and behaviors define the routines that shape children's health practices (Tinsley 1992, 1046–48).

Debate on the navigation of work and family life can be framed in many ways. Workplaces and families can be seen as organizational units. The impact of the interaction of work and family can be analyzed through its individual workers and family members. However, recalling that both work and family are embodied processes recasts the discussion of their interaction. Both work and family life are being redesigned for productivity. People struggle to make their bodies well, or even better than well, to serve the adult obligations of family and work.

Policies meant to “improve” work and family balance can themselves have unanticipated implications if “bodies” are left out of the program. In her study of lactation-friendly workplaces in the Bay Area, sociologist Bentovim notes that women curiously ignore the reality of bodies in the workplace. Nursing mothers are expected to breast pump milk in seclusion—yet another task to be worked into a hectic day. The real business of lactation is messy—breasts leak—and requires a relaxation hard to achieve in the corporate ladies' room. Bentovim found that women developed strategies and (p.120) stories to maximize their productivity both in making milk and reaching project milestones. Women pumped while multitasking, reading email, or in the car. Breast-feeding became another project to be managed. Leslie, a self-employed consultant, noted, “In my mind, the distance from Fremont to Mountain View is three ounces” (Bentovim 2002, 10–12).

Janelle Smith, a speech pathologist, owned a pump, but her infant daughter, Mirella, was “truly offended by the bottle.” Janelle then had to create tiny windows of opportunity to feed Mirella. She could quickly drive home after the end of her school day, nurse Mirella, and then quickly return to conduct meetings with teachers and parents about her speech pathology clients. If Mirella did not wake up during that critical window, the remainder of the day's routine would be in jeopardy. Mothers are fully aware that nursing is an embodied experience; employers, even those who are “lactation-friendly,” treat workers as ideally disembodied. Working mothers have to accommodate the assumptions that steal away their bodies. While devotion to the family is clearly a moral mandate, so is commitment to work.

Working on Bodies, Working on Self

The larger infrastructure of employer-based health care is being transformed. The pool on which risk is assessed is becoming more and more fragmented, making it difficult to keep costs down for the employers who contribute to worker benefits. Premiums to third-party payers are skyrocketing, and the relative contribution of the employee is increasing. Even the category employee is problematic, as expert and unskilled labor alike become contingent workers, differing from direct employees entitled to health benefits (Barley and Kunda 2004). We will explore this situation in more detail in Chapter 5, but the consequences of this change are clear—a greater burden for individual workers and their families, as they must work harder and longer to meet their responsibilities. Employers are caught in the middle, trying to keep benefits that traditionally helped retain workers, offering new services that help their employees stay healthy, while still maintaining their bottom line.

Workplaces like Cisco are experimenting with a new model of care, deemphasizing (p.121) sick care, which is the most expensive, and augmenting preventative wellness programs. Wellness programs are notoriously difficult to manage, and long-term benefits to individual companies are difficult to defend when there is high employee turnover (Galvin and Delbanco 2006, 1550). Nonetheless, particularly when employees are “high value,” there is sufficient motivation for corporate experimentation. For example, in Cisco's pilot program employees are given a cash incentive to participate in health risk assessments, and additional rewards for behaviorally implementing health advice. Workers with health problems are given coaching to help them understand and materialize behavioral changes that should reduce the chance of developing expensive advanced chronic conditions. By 2007 more than half of the employees had taken such assessments, and 65 percent of those eligible for coaching were using the service (Moos 2007).

Essential to this wellness approach is the use of a broad definition of health, such as the World Health Organization's assessment of a healthy workforce as one that is healthy, productive, ready, and resilient (Hymel 2006a, S6). Employee-based wellness programs are part of a larger ecosystem of changes designed to reduce health care cost by increasing efficiency. Some of those changes are directed at employees' lifestyles and personal habits. Such a broad definition penetrates the daily lives of workers, going well beyond workplace concerns into the family and community. In principal, American workers support such efforts, although they are more skeptical of wellness programs in their own particular workplaces when their personal privacy is at stake (Helman, Greenwald, and Fronstein 2007, 4–5). Implicit in this organizational experiment is the necessity that the workers take on a new project for their company—themselves. Employees must compete for organizational resources, guard against stress, and work to prevent chronic illness; at the same time they must demonstrate their dedication to job productivity.

The competitive self-management and the tactical promotion of health practices converge to create a health ethic that harnesses the discipline of the work ethic and applies it to the crafting of self. This convergence of values and practices is similar to those actions that swirl around narratives of the word suzhi in the People's Republic of China. Increasingly, over the past (p.122) few decades, Chinese citizens are described as having low or high suzhi—that is, as people of poor or good quality.

Over the last fifteen years, sinologists have been increasingly fascinated by the way the government, the media, and everyday folk in China talk about suzhi. Most frequently translated as “quality,” suzhi is an expression whose meaning is morphing, expanding, and being adapted. The use of this concept by the Chinese state became associated with Deng Xiaoping's market socialism. For this reason, most of the analyses of the term are overtly Foucauldian, relating the discipline of everyday behavior to the power of governmentality (see Murphy 2004; Yan 2003; Anagnost 2004). High quality was explicitly associated with being educated, urban, cosmopolitan, innovative, and competent in the market. Just as the “socialist man” embodied characteristics desired by the Chinese Communist Party generations before, the new citizen-consumer supported a vision of a wealth-generating and thoroughly modern China. Those who enacted these values had a high level of suzhi, to be contrasted with rural peasants whose attachment to folk religion, clan consciousness, and gambling marked them as having low suzhi (Yan 2003, 498). Suzhi would be “taught and tested” in the educational system, tacitly marking separate tracks for the menial and mental workers of the future. A well-educated urban innovator with only one child who has a strong, but not strident, nationalism has profoundly high suzhi. Since the term emphasizes individual quality by validating a “personal moral code,” it could shift the burden of responsibility for productivity, education, family management, and even health to the individual and away from the government (ibid., 510). Does this shifting of responsibility sound familiar?

Yet the Chinese government, despite its one-party system, is not a uniform entity, and messages coming from one bureau in Beijing may differ from the understanding of another, or of a municipality. It is not a simple matter of governmental hegemony. Moreover, now that the term is in the popular imagination, it can be applied to a wide variety of circumstances to mean a variety of desirable characteristics. The term suzhi can signify many different things, and individuals can play with the definition to position themselves favorably. Urban teenagers use suzhi to denigrate rural or ethnic migrants. Otherwise top students who test poorly can be painted as having (p.123) poor psychological suzhi. Students who test well can claim suzhi by studying assiduously, showing that they have developed inner discipline (Fong 2007).

Embodied disciplines include not only studying and urbanity but also well-being. Medical anthropologist Judith Farquhar has done decades of research on the role of Chinese medicine in everyday life. Food, pleasure, and medicine converge to create the Chinese version of the “good life” (Farquhar 2002; see Farquhar 2007). As she wryly notes, all food is political, embedded in notions of nationalism, farm policy, and of course, suzhi discourses. Along with Zhang Qicheng, Farquhar closely examines yangsheng, “life-cultivation arts,” in Beijing, which promote health, well-being, and suzhi. Taijiquan and Qigong are classical examples of such individual practices, but so are photography, dancing, or taking walks to “soak up the sunshine and air, that is, in theory, fresh” (Farquhar and Zhang 2005, 306). With the dismantling of socialist health care access, Chinese citizens increasing “realize that they are on their own” (ibid., 319–20). Building their quality through life-cultivation arts is an adaptation to this reality. Suzhi is a deeply malleable qualifier with no English counterpart, yet it helps us understand how culturally shaped internal discipline can embrace a range of domains, from improving health to redefining work practice.

Specific moral actors—daughters, sons, parents, coworkers, physicians—are the agents of this discipline. The word discipline conjures up an image of social theorist Michel Foucault. He suggested that diffuse, pervasive, but passive conventions—nonagentic power—shape the discourses and actions of people. An anthropologist might call those ambiguous tropes “culture,” or point out that the beliefs can bind individuals fast into structures of power. The work ethic, for example, deeply benefits the generic structures of capitalism by intensifying productivity. The work ethic encourages disciplines that profit industry. A health ethic shapes the morality of consumption—of health products or services—which also benefits productivity (see Miller and Rose 2008, 116). Tracking that embodied “socially constituted agent” of discipline through specific situations can tell us how power is navigated and experienced (see Sangren 1995, 5–13). For the embodied workers of Silicon Valley, it is useful to ask: who are the agents of discipline, (p.124) how do they rationalize their actions, and what factors enhance and constrain this “ethic”? The actual experience of disciplining oneself may serve the structures of power and at the same time create alternatives to subvert that power.

Rachel Cohen, Getting a Game Face

Rachel is a journalist, and she reflects on how important it has been to be conscious of how her embodied emotions will be read. When she was growing up, in Berkeley, she thought she was “not a terribly complicated person.” She cried when she was sad and laughed when she was happy. She had observed that “there are people in the world [for whom] those equations aren't necessarily true.” When she went into the working world she realized, “It's usually pretty easy to read what's going on in my face. A friend of mine from work once said, ‘You don't have a game face. You need to get a game face.’” She thought about whether that discipline applied to her and concluded it did not. She lived in a truly diverse place, where people “are not like you,” and while it might be useful to have such discipline, it would also be problematic.

Rachel, while she works with ideas and people, does not work in a high-tech environment. There, a different ethic may prevail. Sharone and Melton, in their various ethnographies of high-tech workplaces, emphasize the requirement of “competitive self-management.” Individuals engaged in project work must manage themselves so that they make their companies competitive. They are also rivals to others in their own project team, and those on other projects within their companies. Individual workers must compete as well as cooperate. Hence while engineers may work long hours, because that “is up to the individual,” they are making that choice within a context of competitive self-management (Sharone 2002, 1–6). Performance metrics reinforce this competition. Getting a 3.5 score on a performance review means that doing better than average really is just keeping up with the pack (ibid., 12). Self-selected high achievers are catapulted into a competitive self-management spiral as high goals are reset to even higher ones. These workplaces set a culture of “time-demands” that value working long (p.125) hours and reward the virtuous who are willing to meet them (Mennino, Falter, Rubin, and Brayfield 2007, 488).

Along with this pervasive and intense sense of competition comes a form of emotional self-management quite different from Rachel's. Emotion work, especially in science and technology work, is an important mechanism for communicating rationality and control. In project teamwork optimism and enthusiasm are rewarded, but anger, fear, and frustration are not. These embodied moderations are learned in engineering schools, and favor those who tone down their emotional expression. For those who are not comfortable with such introversion, particularly women, this is a challenge (Melton 2003, 104–7). People learn when to keep their “game faces” and when to groan and make faces in frustration—inside the safety of a cubicle or with trusted coworkers. However, expressing frustration about too much work, tales of overwork, is allowable. Such grousing reveals that a person is working hard, and that sentiment reinforces that work is serious business (ibid., 110).

Aaron, a software engineer, says that his workgroup has a “Timex award” given to the person who has generated the most stress-related illnesses. That person can “take a licking but keep on ticking” (English-Lueck 2002, 68). This ritual demonstrates, with irony, dedication to the ethic of competitive discipline. This phenomenon is particularly acute in technology rich workplaces where time is “compressed and accelerated,” and information overload is accompanied by heightened pace of work. Financial journalist Jill Andresky Fraser (2007, 143–44) calls this experience “technostress.” The intangibility of knowledge work makes being seen working all that more important. One aspect of the need to be seen working can be measured in the unintended consequence of “presenteeism,” dragging oneself to work even when ill, fearing the social and economic consequences of being absent (Middaugh 2006, 103–5).

Manipulating and enhancing one's body in the service of productivity is a moral act. The individuation of work—in which workers have become more responsible for their own productivity—is clearly one force that influences workers' lives. It is not the only moral force in play. Work is valued, given primacy, and embodies an ethic of mastery and discipline. Yet, when (p.126) the burden of productivity is given to the individual, there is a potential for that ethic to sweep in all aspects of life into the service of work. What are the moral safeguards for preventing that restructuring of life?

Here again, health is important. As people are enhancing themselves to be better than well, and forcing ill bodies to continue to produce, health may still be invoked to buffer the demands of work. Even in Silicon Valley, our social conventions consider illness to be a mitigating circumstance for continued productivity. We do have “sick days” as a cultural category that can be called upon to manage the demands of work. Veeda's continued sinus infections and Min's diabetes allowed them to push back on work's demands by using a competing virtue. In that formula, health is a collective, not an individual, enterprise, and to abandon sick coworkers to their fate is an immoral act. There are socially defined moral limits of what can be asked of unhealthy people. Illness is a clear refuge against the demands of work intensification, as well as a probable consequence. People have agency in recognizing and invoking the collective moral stance to protect the ill and to buffer themselves from what they consider to be unreasonable demands.

Although Silicon Valley has no specific word for it, such as suzhi, there is a comparable disciplining of self. Disciplining the body is intimately linked to self-actualization, making self a project that embraces “appearance, demeanor, sensuality” and “regimes” (Giddens 1991, 99). Part of that discipline is what is commonly identified as a work ethic, a value set that is alive and well in a region whose main purpose is work. Few people come to Silicon Valley just to enjoy the climate and scenery. Another facet of that discipline is emotional control, which is linked to the self-discipline of teamwork and work in a multicultural setting. Working in deep diversity requires the emotional control to refrain from reacting to inadvertent cultural faux pas (English-Lueck 2002, 131–33). While education is valued, particularly by immigrants, creativity is the intellectual attribute most celebrated in local discourse. Creativity is the key to innovation, which is the raison d'être of the region. Finally, organizations are shifting to employee wellness programs, focusing on behavior as the root of chronic disease. This innovation merges training for health into other work disciplines. In order (p.127) to be a “good worker,” the scope of life to be managed broadens to include health management. As Valerie O'Hara writes in her self-help book on wellness in the workplace, “[T]he key to wellness is your own firm resolve to do what it takes!” (O'Hara 1995, 191).

Kristal, Jeremy, Addison, Luke, and the other second wave workers you have met in this chapter have molded a distinctive discipline from the legacy of American Transcendentalism and immigrant-based medical pluralism. As fully fledged adults, Veeda, Rupal, Janelle, and David are starting careers and families; they bear a weighty moral burden to work on themselves and to be productive. In part, this health culture can be used to buffer the demands of work and expand the potential of other spheres of life. However, it can also be used to augment them so that they can perform better than well—at work, in play, and for their families. This group of productive adults may not have invented this health culture—much of that distinction goes to the older cohort in the first wave—but they have embodied it more thoroughly. The next generation, the cohort I will call the “third wave,” was born into deep medical diversity; they grew up with the expectation of augmented productivity. Their story constitutes the next chapter.