When New Yorker writer Larissa MacFarquhar set out to write about the lives of extreme altruists in her first book, Strangers Drowning: Grappling with Impossible Idealism, Drastic Choices, and the Overpowering Urge to Help, she imagined that her impulse was to document the lives of living saints.

“Originally I had been using the word ‘saint,’ but it turned out that the word is too weighted with religious and literary connotations and it was too ambiguous,” she explains. “I wanted to use a word that showed people what I was talking about while simultaneously pushing back against their skepticism.”

The author ultimately landed on the word “do-gooder,” a concept that is laden with inherent incredulity and mistrust. In the book, she chronicles the strange, somewhat chaotic lives of people who give until it hurts, including a couple in Philadelphia that adopted 22 children, the founder of a leper colony in India, and a woman who donated one of her kidneys to a stranger.

“I thought it was a very useful word,” she says. “The word ‘do-gooder’ encompasses one of the basic problems I wanted to confront with this book, which is to explore why it’s often a pejorative word. Why are we hostile toward do-gooders?”

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The project’s origins came with MacFarquhar’s reading of philosopher Susan Wolf’s 1984 text Moral Saints. That book posits the question whether we would even like a person who lived a perfectly moral life.

“I thought that was an incredibly interesting question because I do think there is a resistance that most of us feel towards the idea of moral perfection,” says the author. “We don’t like the idea of being friends with a person like that or even becoming that sort of person ourselves. I wanted to write not about people who consider themselves perfect but instead about people who hold themselves to incredibly high moral standards and then see what their actual lives look like. I wanted to see in the context of these very moral lives whether our collective ambivalence is justified or not. My instinct was that it was not.”

MacFarquhar found that not only do the life choices of do-gooders often undermine their lives but also that they face extremely harsh criticism from friends, peers, and even family members.

“I was very surprised by the hostility,” she says. “The more I read about the phenomenon, the more sense it made to me—not in the sense that I thought it was sensible to confront do-gooders with suspicion and hostility—but in the sense that there is a long cultural history behind it. It’s not a random personal quirk that leads people to believe that people leading a very moral life are mentally ill or estranged from their family. There’s a long cultural history that feeds into it.”

Putting the lives of extreme altruists into historical context helped establish one of the book’s main tenets: for do-gooders, it is always wartime.

“In different cultures, there are very different expectations for what a good and decent life requires of a person,” MacFarquhar explains. “It struck me that it’s been a good long time since there was a draft in this country for a war that the majority of people agreed was a ‘good war.’ When there is a draft for what most people feel is a good war, people feel the need to rise to the occasion. They believe that more is expected of them. During that kind oStrangersDrowning_Macfarquharf wartime, not just soldiers but civilians feel that they need to give more of themselves to uphold the collective effort.”

There’s the rub: do-gooders, in effect, feel like they are always at war. This does not mean, as MacFarquhar clearly elucidates in Strangers Drowning, that they are mad or even damaged in any way. They’re just different. But they also have their own ways of coping with the world in all its fractured glory.

“One of the things these people have done that is very difficult is that not only have they decided to push back against their own love of comfort and security but they have also figured out a mental system by which they wall off enough of the world’s suffering so they can focus on the one thing they are able to do, and then do it to the utmost,” MacFarquhar says. “If you hold yourself responsible for strangers, the need becomes infinite. This is a very difficult thing. They feel responsible for the world but simultaneously they have to narrow down what they can do. They are not some different species of aliens or freaks. They’re just people who have decided it is incumbent upon them to do more to help strangers. It’s inspiring but it’s also overwhelming to see that impulse in action.”

While her subjects haven’t read the book yet, MacFarquhar believes these unusual individuals will find the experience valuable in the end.

“First of all, these people are very tough,” says MacFarquhar. “They’ve spent their entire lives doing the extreme work that they do so they are perfectly used to people finding them bizarre. In most cases, though, they have something they want to promote. They think the world would be better if more people did more. They saw this book as a chance to show people that you can do more without living a life of misery and suffering. I hope and would like to think that the process may be helpful for them in that it’s a chance to think carefully about why they are doing the things that they are doing. In the ordinary course of life, very few people sit down to think about why they live the way they do. It’s a chance to examine the foundation of their lives.”

Clayton Moore is a freelance writer, journalist, book critic, and prolific interviewer of other writers. His work appears in numerous newspapers, magazines, websites and other media. He is based near San Francisco, California.