Abstract
‘Gender disappointment’ is the feeling of sadness when a parent’s strong desire for a child of a certain sex is not realised. It is frequently mentioned as a reason behind parents’ pursuit of sex selection for social reasons. It also tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection. Our aim in this paper is to investigate whether ‘gender disappointment’ represents a unique diagnosis. We argue that ‘gender disappointment’ does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy. That said, we recognise that parents’ distress is real and requires psychological treatment. We observe that this distress is rooted in gender essentialism, which can be addressed at both the individual and societal level.
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Notes
In this paper, we limit our discussion of ‘gender disappointment’ and motives for it to the sample of parents’ articulations from sex selection forums, media and empirical study. We recognise that there can be other articulations of ‘gender disappointment’, some that may not be directly grounded in gender essentialism. We are grateful to an anonymous reviewer of this paper for alerting us to the case of parents who might be disappointed when having a child of a particular sex because children of that sex face specific hardship or discrimination in society. As such, this case is not grounded in parental prejudice against the child but reflects on societal attitudes towards children of that sex. Yet, some might still argue that even this case involves some aspects of gender essentialism, such as the assumption that the child will (keep) developing) as a child of a particular gender, who will fit into the gendered group that the particular society will stereotype in a particular way.
A moderator from a sex selection online forum genderdreams.com defines ‘gender disappointment’ as “simply when the sex of your baby is not what you desired. For me, it is having my heart hurt so bad, because I knew that my dreams would never come true. It is the loss of a dream child” (Whittaker 2012, p. 151).
All materials stemming from the Australian study have been collected as part of a Ph.D. project (Hendl 2015). Most citations from this study have not been published (Hendl unpublished data).
While we choose to use the gender neutral term “parents” when referring to procreators with ‘gender disappointment’, it seems important to acknowledge that all participants in the Australian study and parents discussing ‘gender disappointment’ online in studies by Duckett (2008); Whittaker (2012) and Monson and Donaghue (2015) are women.
It is noteworthy that these findings contrast with a study with American procreators desiring sex selection. While parents in the American study express various degrees of ‘gender disappointment’, they nevertheless rarely express unhappiness with their immediate family situation (Sharp et al. 2010). However, this could be caused by the fact that participants in the American study were interviewed during their attempt to gain access to prenatal sex selection and do not want to appear overly gender biased.
Interestingly, Duckett notes that members of online forums distinguish between ‘gender disappointment’ and post partum depression. She cites a participant who says: "I know that GD and PPD are 2 different things, but I have to think that the emotional side of things are somewhat similar" (Duckett 2008, p. 92).
It is worth noting that according to Duckett, most members of online forums analysed by her state that they did not know about the concept of ‘gender disappointment’ before joining the forums. Duckett (2008, p. 86) quotes a participant named Kate: "I did not have a name for this [GD] until I came across the website [GDI] after the birth of my third son. I could not believe that there was an actual term and support for women who experience this." In contrast to this, Monson and Donaghue (2015) who analysed discussions about ‘gender disappointment’ on three Australian parenting websites observe that the term ‘gender disappointment’ is used without further explanation which according to them suggests that it is a “recognisable emotional response” (p. 16).
Furthermore, prenatal sex selection using PGD and IVF is also considered the most ethically acceptable form of sex selection as it does not involve abortion. Although in Australia, sex selection via abortion is allowed whereas sex selection via PGD is not (National Health and Medical Research Council 2017).
This medicalisation of ‘gender disappointment’ could also potentially open the door for demanding access to sex selection on gender grounds for “medical reasons”, i.e. with respect to the parent’s proclaimed ‘medical condition.’ Usually, sex selection for medical reasons is available to prevent the birth of a child with a genetic condition that would significantly limit the child’s wellbeing. However, parents who request sex selection based on their parental gender preferences could use the medicalisation of ‘gender disappointment’ to reframe the understanding of “medical reasons” via shifting the focus from the child’s wellbeing to the “wellbeing” of the parent.
Sex selection does not treat the mind, so it cannot be considered a legitimate treatment for a mental disorder.
There is a plethora of studies, which show how gender differences are created and entrenched by society. Stereotype threat, for instance, is a phenomenon whereby people who are members of a stereotyped group underperform at certain tasks simply because they are aware of their membership of that group. For instance, in a study by Cadinu et al. (2005) showing the effect of stereotype threat on math performance, 60 women were divided into two groups. One group was told that research shows clear differences between men and women in their math performance (the stereotype threat condition), and the other group was told that there are no such differences (the no-threat condition). The women were instructed to note their thoughts during the course of the test. Women in the stereotype threat group noted twice as many negative thoughts about maths and the test compared with the no-threat group. There was also a marked difference in scores. In the first half of the test, both groups achieved a 70% average of correct answers. However, in the second half the score dropped to a 56% average for those in the stereotype threat group, whereas the average score rose to 81% in the no-threat group. As Fine explains, “the deadly combination of ‘knowing-and-being’ (women are bad at maths and I am a woman) can lower performance expectations, as well as trigger performance anxiety and other negative emotions” (Fine 2010, p. 32).
Richards et al. (2016) list a number of recent studies, which map the prevalence of gender variant identities in Western countries. For example, a study (Kuyper and Wijsen 2014) with a large sample of the Dutch population found out that 6% of individuals assigned male gender and 3.2% of individuals assigned female gender at birth reported an ‘ambivalent gender identity’ (they identified equally as male and female) and 1.1% of individuals assigned male and 0.8% of individuals assigned female at birth reported an ‘incongruent gender identity’ (they identified more strongly with the ‘other’ gender than the one assigned to them at birth). Furthermore, Van Caenegem et al. (2015) conducted surveys with 1832 Flemish individuals and 2472 with ‘sexual minority individuals’ in Flanders, Belgium, with ‘gender ambivalence’ or non-binary gender reported by 1.8% of male assigned individuals and 4.1% female assigned individuals. With regard to LGBTQ population more specifically, a recent UK study (METRO Youth Chances 2014) with LGBTQ youth found that 5% identified as neither male nor female and a US study (Harrison et al. 2011) found that 13% of trans people in the sample identified with a gender not listed in the survey and a Scottish study (Mcneil et al. 2012) exploring trans mental health reported that over a quarter of participants identified as gender non-binary.
Some of those affected by the rigid two-sex model are people with intersex variations, who tend to be diagnosed with ‘disorders of sex development’ (Parliament of Australia 2013; United Nations 2015a; Human Rights Council 2013; Australian Human Rights Commission 2009) and are often subject to irreversible clinical interventions (Blackless et al. 2000).
Recent studies in neuroscience (Fine 2010; Rippon et al. 2014) show that gender variables are characterized by at least four aspects. The first aspect is overlap because all humans tend to express traits and behaviours stereotypically framed as ‘feminine’ and ‘masculine.’ Hence, there are no two distinctive, mutually exclusive male and female personalities. The second aspect is mosaicism, which means that human psychological characteristics differ in continuous rather than categorical dimorphic ‘sex specific’ ways. The third aspect is contingency, as gendered behavior is created by complex factors, such as time, place, affiliation with a specific social or ethnic group etc. The fourth aspect is entanglement, owing to the fact that behaviour is modified by the environment.
Vincent and Manzano (2017) argue that the Western notion of a gender binary is relatively new and only one of a wide range of perspectives. According to them the dichotomous conceptualisation of gender was not so distinct only a 100 years ago. They show that there has been a long history of gender variance around the world, offering examples from Eastern Europe, Asia, South America and Indigenous communities in the US and Canada as well as pointing to known examples from Africa and the Middle East. They emphasise that particular socio-historical contexts can generate “highly varied articulations of gender” (p. 25) and reflect on the systemic suppression of gender diversity in non-Western societies under Western colonialism.
We acknowledge that not all queer visibility is empowering or voluntary. For example, Stella (2015) shows how the ‘new’ visibility of queer people in post-Soviet Russia is perceived by many as a threat to ‘tradition’, which leads to the targeting of ‘visibly’ queer people with oppressive state politics and violence.
In consequence, the real existing diversity calls into question the ability of sex selective technologies to deliver a child gendered according to parents’ preferences (Ryan 1990; Mudde 2010; Seavilleklein and Sherwin 2007). This is a significant issue regarding sex selection, nevertheless, we do not have the space to explore it in depth in this paper.
Although it is of course possible for men to be disappointed with the sex of their child, those who talk about ‘gender disappointment’ appear to be almost exclusively women. This could be due to the internalisation of societal stereotypes of what can be expected from sons and daughters combined with an adherence to the belief that “unconditional love” is a trait that mothers, but not necessarily fathers, should have. It could also be that the men who are disappointed with the sex of their child are reluctant to talk about it due to a sexist perception that it is not masculine for a man to talk about his feelings.
Having said this, the individual still has some responsibility in the matter. Although the root of the problem lies in society’s beliefs about gender, that fact does not give a parent license to force their child not to conform to those beliefs. For example, a parent should not force their son to wear a pink tutu if he does not wish to (or force him to wear trousers if he does not wish to) and claim that it is society’s fault, not the parent’s, if the child is upset. (Thanks to Edmund Horowicz for this point.).
One of the authors of this paper argues that perhaps we should. See Browne (2018).
There may be causes of a parent’s disappointment with the sex of their child, which may not be strongly related to gender essentialism. More studies may reveal such causes. Our paper can only address what we know from studies, forums and the media thus far, and the reasons articulated by parents for their ‘gender disappointment’ thus far have centred on gender essentialist beliefs.
References
Ahmed, S. 2006. ORIENTATIONS: Toward a queer phenomenology. GLQ: A Journal of Lesbian and Gay Studies 12 (4): 543–574.
Ainsworth, Claire. 2015. Sex redefined. Nature 518 (7539): 288–291.
Ali, Alisha, Paula J. Caplan, and Rachel Fagnant. 2010. Gender stereotypes in diagnostic criteria. In Handbook of gender research in psychology, vol. 2: Gender research in social and applied psychology, ed. Joan C. Chrisler and Donald R. McCreary, 91–109. New York: Springer.
American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders: DSM-5, 5th ed. Arlington, VA: American Psychiatric Association.
Australian Human Rights Commission. 2009. Surgery on Intersex Infants and Human Rights. https://www.humanrights.gov.au/surgery-intersex-infants-and-human-rights-2009. Accessed 13 Jan 2019.
Belle, Deborah, and Joanne Doucet. 2003. Poverty, inequality, and discrimination as sources of depression among U.S. women. Psychology of Women Quarterly 27 (2): 101–113.
Berta, Philippe, J. Boss Hawkins, Andrew H. Sinclair, Anne Taylor, Beatrice L. Griffiths, Peter N. Goodfellow, and Marc Fellous. 1990. Genetic evidence equating SRY and the testis-determining factor. Nature 348 (6300): 448–450.
Bhatia R (2018) Gender before birth: sex selection in a transnational context. University of Washington Press, Seattle
Blackless, Melanie, Anthony Charuvastra, Amanda Derryck, Anne Fausto-Sterling, Karl Lauzanne, and Ellen Lee. 2000. How sexually dimorphic are we? Review and synthesis. American Journal of Human Biology 12 (2): 151–166.
Boorse, Christopher. 1997. A rebuttal on health. In What is disease?, ed. James M. Humber and Robert F. Almeder, 1–134. Totowa, NJ: Humana Press.
Browne TK (2018) Depression and the self: meaning, control and authenticity. Cambridge University Press, Cambridge
Butler, Judith. 2008. Gender trouble: Feminism and the subversion of identity. New York, London: Routlege.
Cabral, Meena, and Jill Astbury. 2000. Women’s mental health: an evidence based review. Geneva. https://www.who.int/mental_health/media/en/67.pdf. Accessed 15 Feb 2019.
Cadinu, Mara, Anne Maass, Alessandra Rosabianca, and Jeff Kiesner. 2005. Why do women underperform under stereotype threat? Evidence for the role of negative thinking. Psychological Science 16 (7): 572–578.
Daily Mail. 2014. Mother so depressed by having three boys she spent $50,000 to make sure fourth child was a girl. http://www.dailymail.co.uk/news/article-2841999/When-having-boy-wasn-t-sure-Meet-mother-three-boys-spent-50-000-went-ensure-girl.html. Accessed 16 May 2018.
Davis, Georgiann, Jodie M. Dewey, and Erin L. Murphy. 2016. Giving sex: Deconstructing intersex and trans medicalization practices. Gender & Society 30 (3): 490–514.
Duckett, Alison J. 2008. Gender dreams: The social constructions of gender disappointment as an affliction in online communities. Guelph: The University of Guelph.
Eliot, Lise. 2012. Pink brain, blue brain: How small differences grow into troublesome gaps-and what we can do about it. Oxford: Oneworld.
Fausto-Sterling, Anne. 1993. The five sexes. The Sciences 33 (2): 20–25.
Fausto-Sterling, Anne. 1995. How to build a man. In Constructing masculinity, ed. Maurice Berger, Brian Wallace, and Simon Watson, 127–135. New York: Routledge.
Fausto-Sterling, Anne. 2000. Sexing the body: Gender politics and the construction of sexuality. New York: Basic Books.
Fine, Cordelia. 2010. Delusions of gender: The real science behind sex differences. London: Icon Books.
Fine, Cordelia, Rebecca Jordan-Young, Anelis Kaiser, and Gina Rippon. 2013. Plasticity, plasticity, plasticity… and the rigid problem of sex. Trends in Cognitive Sciences 17 (11): 550–551.
Gender Selection Australia. 2014. About gender selection australia. http://www.genderselectionaustralia.com.au/about-us/. Accessed 17 May 2018.
GenderDreaming. 2019a. Community stats. https://www.genderdreaming.com/. Accessed 28 Mar 2019.
GenderDreaming. 2019b. Gender disappointment. https://genderdreaming.com/forum/. Accessed 28 Mar 2019.
Germon, Jennifer. 2014. Norrie’s gender win brings us closer to knowing who we are. The Conversation. http://theconversation.com/norries-gender-win-brings-us-closer-to-knowing-who-we-are-25250. Accessed 14 Oct 2018.
Gilbert, Miqqi Alicia. 2009. Defeating bigenderism: Changing gender assumptions in the twenty-first century. Hypatia 24 (3): 93–112.
Harrison, Jack, Jaime Grant, and Jody L. Herman. 2011. A gender not listed here: Genderqueers, gender rebels, and otherwise in the national transgender discrimination survey. LGBTQ Policy Journal at the Harvard Kennedy School 2: 13–24.
Hausman, Bernice L. 2000. Do boys have to be boys? Narrativity, and the John/Joan Case. NWSA Journal 12 (3): 114–138.
Hendl, Tereza. 2015. The ethical aspects of gender selection for non-medical reasons. Macquarie Park: Macquarie University.
Hendl, Tereza. 2017. Queering the odds: The case against ‘family balancing’. IJFAB 10 (2): 4–30.
Horwitz, Allan V., and Jerome C. Wakefield. 2007. The loss of sadness how psychiatry transformed normal sorrow into depressive disorder. Oxford: Oxford University Press.
Human Rights Council. 2013. Report of the special rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. Geneva. http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf. Accessed 22 Nov 2018.
Jordan, Brian K., Mansoor Mohammed, Saunders T. Ching, Emmanuèle Délot, Xiao-Ning Chen, Phoebe Dewing, P. Amanda Swain, B. Nagesh Rao, Rafael Elejalde, and Eric Vilain. 2001. Up-regulation of WNT-4 signaling and dosage-sensitive sex reversal in humans. The American Journal of Human Genetics 68 (5): 1102–1109.
Kane, Emily W. 2009. ‘I Wanted a soul mate’: Gendered anticipation and frameworks of accountability in parents’ preferences for sons and daughters. Symbolic Interaction 32 (4): 372–389.
Kuyper, Lisette, and Ciel Wijsen. 2014. Gender identities and gender dysphoria in the Netherlands. Archives of Sexual Behavior 43 (2): 377–378.
Lal, Rachna, and Dean F. Mackinnon. 2017. Adjustment disorder. Johns Hopkins Psychiatry Guide. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787068/all/Adjustment_Disorder. Accessed 29 Mar 2019.
Losty, Mairéad, and John O’Connor. 2018. Falling outside of the ‘nice little binary box’: A psychoanalytic exploration of the non-binary gender identity. Psychoanalytic Psychotherapy 32 (1): 40–60.
Mcneil, Jay, Louis Bailey, Sonja Ellis, James Morton, and Maeve Regan. 2012. Trans mental health study 2012. https://www.gires.org.uk/wp-content/uploads/2014/08/trans_mh_study.pdf. Accessed 25 Mar 2019.
METRO Youth Chances. 2014. Youth chances summary of first findings: The experiences of LGBTQ young people in England. London: METRO Youth Chances.
Monson, Olivia, and Ngaire Donaghue. 2015. ‘You get the baby you need’: Negotiating the use of assisted reproductive technology for social sex selection in online discussion forums. Qualitative Research in Psychology 12 (3): 298–313.
Mudde, Anna. 2010. ‘Before you formed in the womb i knew you’: Sex selection and spaces of ambiguity. Hypatia 25 (3): 553–576.
National Health and Medical Research Council. 2017. Ethical guidelines on the use of assisted reproductive technology in clinical practice and research. www.nhmrc.gov.au/guidelines/publications/e79. Accessed 28 Mar 2018.
News. 2015. Mum Jayne Cornwill’s dream of a daughter realised through gender selection via IVF in the USA. http://www.news.com.au/lifestyle/parenting/babies/mum-jayne-cornwills-dream-of-a-daughter-realised-through-gender-selection-via-ivf-. Accessed 17 Aug 2018.
Offord, Baden, and Leon Cantrell. 1999. Unfixed in a fixated world. Journal of Homosexuality 36 (3–4): 207–220.
Parekh, Ranna. 2017. What is depression. https://www.psychiatry.org/patients-families/depression/what-is-depression. Accessed 23 Mar 2019.
Parliament of Australia. 2013. Involuntary or coerced sterilization of people with disabilities. Canberra: Community Affairs References Committee. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index. Accessed 17 Feb 2019.
Pies, Ronald. 2009. Should DSM-V designate “Internet Addiction” a mental disorder? Psychiatry (Edgemont) 6 (2): 31–37.
Powell, Russell, and Eric Scarffe. 2019. Rethinking ‘disease’: A fresh diagnosis and a new philosophical treatment. Journal of Medical Ethics. https://doi.org/10.1136/medethics-2019-105465.
Richards, Christina, Walter Pierre Bouman, Leighton Seal, Meg John Barker, Timo O. Nieder, and Guy T’Sjoen. 2016. Non-binary or genderqueer genders. International Review of Psychiatry 28 (1): 95–102.
Rippon, Gina. 2019. The gendered brain: The new neuroscience that shatters the myth of the female brain. London: The Bodley Head.
Rippon, Gina, Rebecca Jordan-Young, Anelis Kaiser, and Cordelia Fine. 2014. Recommendations for sex/gender neuroimaging research: Key principles and implications for research design, analysis, and interpretation. Frontiers in Human Neuroscience 8: 1–13.
Romao, Rodrigo L.P., Joao L.Pippi Salle, and Diane K. Wherett. 2012. Update on the management of disorders of sex development. The Pediatric Clinics of North America 59 (4): 853–869.
Rupp, Leila J. 2002. A desired past: A short history of same-sex love in America. Chicago: University of Chicago Press.
Ryan, Maura. 1990. The argument for unlimited procreative liberty: A feminist critique. Hastings Center Report 20 (4): 6–12.
Scott, S., and M. Dawson. 2015. Rethinking asexuality: A symbolic interactionist account. Sexualities 18 (1–2): 3–19.
Seavilleklein, Victoria, and Susan Sherwin. 2007. The myth of the gendered chromosome: Sex selection and the social interest. Cambridge Quarterly of Healthcare Ethics 16 (1): 7–19.
Sharp, Richard R., Michelle L. Mcgowan, Jonathan A. Verma, David C. Landy, Sallie Mcadoo, Sandra A. Carson, Joe Leigh, and Laurence B. Mccullough. 2010. Moral attitudes and beliefs among couples pursuing PGD for sex selection. Reproductive BioMedicine Online 21 (7): 838–847.
Sinclair, Andrew H., Philippe Berta, Mark S. Palmer, J. Ross Hawkins, Beatrice L. Griffiths, Matthijs J. Smith, Jamie W. Foster, Anna-Maria Frischauf, Robin Lovell-Badge, and Peter N. Goodfellow. 1990. A gene from the human sex-determining region encodes a protein with homology to a conserved DNA-binding motif. Nature 346 (6281): 240–244.
Stella, Francesca. 2015. Lesbian lives in Soviet and post-soviet Russia: Post/socialism and gendered sexualities. New York: Palgrave Macmillan.
Stone, Amy L. 2013. Flexible queers, serious bodies: Transgender inclusion in queer spaces. Journal of Homosexuality 60 (12): 1647–1665.
Stoppard, J.M., and L.M. McMullen. 2003. Situating sadness: Women and depression in social context. New York: New York University Press.
Stoppard, Janet. 2000. Understanding depression: Feminist social constructionist approaches. Oxfordshire: Routledge.
Stryker, Susan, and Stephen Whittle. 2006. The transgender studies reader. New York: Routledge.
Sunday Express. 2010. Parenting: For mothers of sons, ‘gender disappointment’ is a guilty secret. http://www.express.co.uk/expressyourself/195625/Parenting-For-mothers-of-sons-gender-disappointment-is-a-guilty-secret. Accessed 25 May 2018.
The Guardian. 2014. Gender selection: Australian couple spent $50,000 and travelled to US to have baby girl. http://www.theguardian.com/australia-news/2014/dec/01/australian-couple-spent-50000-travelled-us-baby-girl. Accessed 30 Jan 2018.
The Telegraph. 2010. ‘Gender Disappointment’: coping with the ‘wrong’ baby. http://www.telegraph.co.uk/lifestyle/wellbeing/7714755/Gender-disappointment-Coping-with-the-wrong-bay.html. Accessed 18 Mar 2018.
Tomaselli, Sara, Francesca Megiorni, Lin Lin, Maria Cristina Mazzilli, Dianne Gerrelli, Silvia Majore, Paola Grammatico, and John C. Achermann. 2011. Human RSPO1/R-spondin1 is expressed during early ovary development and augments β-catenin signaling. PLoS ONE 6 (1): e16366.
United Nations. 2015a. Ending violence and discrimination against lesbian, gay, bisexual, transgender and intersex people. http://www.ohchr.org/Documents/Issues/Discrimination/Joint_LGBTI_Statement_ENG.PDF. Accessed 27 Oct 2018.
United Nations. 2015b. Intersex: Fact Sheet. www.ohchr.org. Accessed 16 Feb 2019.
Van Caenegem E, Wierckx K, Elaut E, Buysse A, Dewaele A, Van Nieuwerburgh F, De Cuypere G, T’Sjoen G (2015) Prevalence of gender nonconformity in Flanders, Belgium. Arch Sex Behav 44(5):1281–1287.
Vincent, Ben, and Ana Manzano. 2017. History and cultural diversity. In Genderqueer and non-binary genders, ed. Christina Richards, Walter Pierre Bouman, and Meg-John Barker, 11–30. London: Palgrave Macmillan.
Wakefield, Jerome C. 2007. The concept of mental disorder: Diagnostic implications of the harmful dysfunction analysis. World Psychiatry 6: 149–156.
Walsh, Fintan. 2016. Queer performance and contemporary ireland: Dissent and disorientation. London: Palgrave Macmillan UK.
Whittaker, Andrea. 2012. Gender disappointment and cross-border high-tech sex selection a new global sex trade. In Technologies of sexuality, identity and sexual health, ed. Lenore Manderson, 143–164. London: Routledge.
World Health Organization. 2011. Gender, equity and human rights: Glossary of terms and tools. WHO. https://www.who.int/gender-equity-rights/knowledge/glossary/en/. Accessed 26 Feb 2019.
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Hendl, T., Browne, T.K. Is ‘gender disappointment’ a unique mental illness?. Med Health Care and Philos 23, 281–294 (2020). https://doi.org/10.1007/s11019-019-09933-3
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DOI: https://doi.org/10.1007/s11019-019-09933-3