Farmer is born in North Adams, Massachusetts, as the second of six children to his mother, Ginny, and father, Paul Sr., a stern and restless man the family nicknames “the Warden.” During Farmer’s childhood, his family moves to Birmingham, Alabama, and then the outskirts of Tampa, Florida. The family’s Florida homes include the Blue Bird Inn, a retrofitted tuberculosis van, and The Lady Gin, a makeshift boat that requires constant maintenance. The young Farmer excels in school and enjoys complex novels like The Lord of the Rings and War and Peace. At one point, Paul Sr. works at a citrus farm, where Farmer learns about the plight of the Haitian workers.

Farmer goes to Duke University and, after a rough first semester, earns excellent grades, wins over many friends, becomes a fraternity leader, and seemingly falls in love with the wealthy lifestyle of his peers. He spends two terms in Paris, learning the language fluently, and focuses his studies on medical anthropology. However, he quits his fraternity over its whites-only policies and develops respect for his father, who avoids pretenses and throws himself into activities even if he doesn’t excel in them.

Farmer’s primary inspiration is German polymath Rudolf Virchow, who codified self-reproducing cells as the basic units of life and advocated for social change as a means of curing the poor.