Thinking critically about Lost Connections 2: The evidencing double standard

Part 2 of my Lost Connections review. Back to part 1

I spent many years of my life in varying levels of depression. Sometimes it was really bad: the ugly, messy shit, the lying in bed too tired to cry, too tired to sleep, subsisting off a diet of Haribo, because it was closest to the bed. Much of the time, it was less bad than that: a nagging numbness, a constant feeling of a dragging weight, a listless lack of enjoyment of things that ought to be fun, problem drinking, problem screwing, problems all over the shop. The usual. I knew the depression was there, and I knew there would be ways of helping myself out if I’d just go and see a fucking doctor.

Once, back when I was at uni, the head of department gently suggested to me, as I was falling very much behind on my workload, a course of citalopram to get myself back on my feet. I pretended I’d consider it as my brain told her to go and stuff herself, because I’d read the research and knew they weren’t something that would magically make me an effective worker (which, it was transparently obvious, was her motivation for the recommendation!). I tried a couple of courses of therapy, and they weren’t particularly helpful, being too short, and not being all that suitable for someone who, it turns out, is physically impaired at visualising.

I never took meds, because I had a low opinion of them, and felt like they’d probably do more harm than good for me.

Meanwhile, my epilepsy also took a turn for the worse, and last year I began finally dealing with that by taking an anticonvulsant medication called lamotrigine. Now, lamotrigine works pretty well at controlling epilepsy. It also has another medical function: treating the depression symptoms side of bipolar.

And would you guess what? An unexpected side effect of my epilepsy medications was that my depression has subsided. I’ve felt this strange sense of energy over the last year, a feeling that I am no longer dragging an ever-increasing weight with me wherever I go. I’m getting out of bed every day, and eating meals. I’m not feeling a crushing insurmountable despair. The drug I was prescribed for different reasons has, it seems, also treated the depression I lived with for years.

Now you’ve read my story, are you planning on popping lamotrigine to deal with your depression?

No?

Then you, my friend, are a sensible person who understands on some level that anecdote isn’t data. That the experience of one person is not the same as others. That, no matter how much a story may resonate with you, it’s something you’d probably want to research a bit more independently and chat to a doctor before seeing if the drug I take (which has a small chance that it might make your skin fall off) is suitable for you.

I opened this section with a personal story because I figured we might as well start on a level playing field of evidence.

Evidencing is important, and doubly important if you were exposed as a fabricator and plagiarist.

When writing about science, there are certain standards of evidence that are better than others, and certain types of reference where you’d be chased out of any research institute with pitchforks if you put them down. The former is stuff that’s published in journals or edited academic books: meta-analyses, experiments, rigorous population research and the like. The latter is stuff like popular science books, blog posts, asking someone who you reckon knows a bit more about the subject than you do, personal anecdotes, and so forth. I’m pleased to report that Lost Connections contains some of the former. It also contains a lot of the latter.

We also talk about levels of evidence, because that’s important too. All evidence is not equal. For example, a single study containing 20 people is less good evidence than a study containing 200 people. A study using 200 monkeys is less good evidence than a study using 200 people, if you want your findings to apply to  humans. A study which finds a correlation between one variable and another is less good evidence than a study where you manipulate one variable and measure its effect on the other. One study finding something is less good evidence than 15 studies that find the same thing. A meta-analysis is great evidence: that’s where you put together findings from lots of studies on the same topic to check if the results still hold up. When you are looking at the evidence, these are all things to bear in mind.

The funny thing is, Hari understands this… to a point. He is very clear on all of these points when presenting the evidence that antidepressants don’t work very well, and explains them reasonably well. Now, I’m not going to get into a point by point analysis of the early sections of the book and why I disagree with his conclusion that the drugs don’t work, because I covered pretty much all of my problems with it in my post about the extract, and every point besides the first remains in place for me as I read the text in its entirety.

In the psychological sciences, we often reference “in-line”, so it makes it easier to pick up on the references.  APA formatting is pretty standard for if you’re publishing a psychology study: when you’re referencing a statement, you’d name the authors and the date they wrote what you’re referencing within the sentence. They’re preferable to footnotes as it makes our jobs a lot easier to look at a reference quickly and check if you’re citing a journal article or whether it’s a forum post by DongSmoker6969.

Lost Connections uses footnotes. Lots and lots and lots of footnotes. And sometimes the footnote will go to a proper scientific study. Sometimes it will not. It’s a crapshoot, and I will confess that I did not bother checking every footnote, because I value my own sanity. I often just checked the footnote if something seemed a little bit off to me. So, obviously draw healthy scepticism about what I say throughout, because no, I did not check every single reference. I also found Hari’s approach to evidencing particularly irksome as he frequently refers to researchers by their first names, which makes it a little harder to follow who he’s talking about. For example, in Chapter 7, he often alludes to the work of a researcher called John, and so I spent half the chapter thinking “who’s John, and why should I care?”. Flicking back, I finally found it was John Cacioppo, a researcher so well-known they teach his work about loneliness in Psychology A-Level: his work is familiar to many–and I’ll be writing a bit more about that in a later section of this review.

The thing is, though, Hari’s own talk of high standards of evidencing completely collapses as he writes about his own views on the causes of and solutions for depression. There, we suddenly see conclusions drawn from a study involving animals. We see for-profit companies making a profit on selling the idea of a cause of a sickness for which they provide a cure. We see grand conclusions being drawn from one-off studies involving sample sizes of 20, with very non-representative samples.

A substantial portion of what Hari is proposing as “reconnections” to alleviate depression are alternative remedies, be it lifestyle changes, meditation or, indeed, a herbal supplement.

Hari dismisses pharmaceutical interventions for depression, suggesting they’re no better than the placebo, appealing to the authority of Professor Irving Kirsch. Kirsch gives us a suggestion, due to the side effects of antidepressant medication, of an alternative placebo:

“We could be giving people the herb St John’s Wort, Irving says, and we’d have all of the placebo effects and none of these drawbacks. Although–of course–St John’s Wort isn’t patented by the drug companies, so nobody would be making much profit off it.”

I want to focus on this quote because it highlights a lot of problems rather neatly. Firstly, St John’s Wort is not an inert substance. It actually is effective in treating mild-to-moderate depression, and Mind conclude you can use it as an alternative to antidepressant drugs. It affects serotonin levels. However, being not inert, there are also some dangerous problems with St John’s Wort. It has side effects, like any other medicine. And it also interacts with a lot of other medicines to stop them working as well: important drugs such as contraceptives, HIV medications, blood-thinners and heart medicine.

Another problem with herbal remedies is you might get the dose wrong. While pharmaceutical drugs must be tested very rigorously to find the right doses that won’t kill people or make them sicker, this is not the case for herbal medicines. That’s worrying.

You can take St John’s Wort, and it might work for you. However, as with any drug, you should see a doctor so they can make sure you’re doing it safely and you don’t need anything else, to help you.

Of course, St John’s Wort is a herbal remedy that actually works, but we can divide most alternative remedies into two categories: the ones which do work, and therefore, because they’re doing something, can come with side effects and you need medical monitoring; and the ones which do precisely nothing, like homeopathy, which is literally a sugar pill.

Medical professionals’ tendency to avoid alternative remedies is frequently treated as Big Pharma suppressing the secret treatments that really work. And that’s not true. The truth is that they’re often not recommended because they’ll either not do anything, or have an effect that’s wildly unpredictable and possibly dangerous, and therefore, it’s considered better to go with drugs where we know all about safe dosage, side effects and interactions.

The pharmaceutical industry is, of course, not spotless. It’s pretty evil, and I’m eternally grateful to Martin Shkreli for putting a punchable face to everything I hate about it. However, I am highly surprised by the suggestion that nobody is profiting from St John’s Wort; alternative health industry is every bit as lucrative as the pharmaceutical industry, and every bit as evil.

I would imagine the profit margin for the alternative health industry is comparable to, or possibly larger, than that in the pharmaceutical industry. If you’re selling crushed-up flowers or a meditation tape, you don’t have to spend a large amount of money in research and development, testing, and ensuring your remedy is safe. You might sell less of the product, but you’re going to make a killing. It becomes even more unethical when the product is ineffective, as this gives false hope to sick people, which is diabolically cruel.

In the UK, there is a further issue with recommending alternative remedies over what’s available from a doctor: money, dear boy. Here in the UK, the patient doesn’t have to pay full price for medicines, only a prescription fee. Talking therapies are provided free of charge, as are many other services for mental health. Meanwhile, a month’s supply of St John’s Wort would set you back £15, while an SSRI on prescription would be £8.60. Which, by the way, is still revoltingly expensive, and too many chronically ill people are paying through the nose for their prescription medicines. As a patient, it’s probably cheaper for you to stick with the NHS.

I use St John’s Wort as an example here, although perhaps that is unfair, as there is stronger evidence for its efficacy as a treatment for depression than many of the other things presented in the book: for example, I checked the references on “sympathetic joy” meditation. It’s effective. At some things. None of which are treating depression.

Let me provide some concrete examples. I had particular trouble with Hari’s Cause 6: Disconnection From The Natural World. A substantial portion of the evidence presented pertains to bonobos. Now, I hope I don’t have to tell all of you that bonobos aren’t people, and are instead kind of a nicer version of chimpanzees that fuck a lot. We then have a bit of correlational evidence about mental health evidence upon moving from somewhere green to a city, or vice versa. And finally, we have a bit of experimental evidence from a study where people went for a walk in either a natural or a rural setting which found that the walks in nature were superior. A grand claim, so let’s follow that footnote, shall we? It leads us to a 2012 study from Berman and colleagues. The experiment had a sample size of 20 people, which is pretty small, and all of the sample had diagnoses of the same type of depression, which means they’re not very representative of the population.

Had that been a trial for a drug intervention, nobody on this earth would ever be given that drug, and rightly so. Had this been a test of an antidepressant, Johann Hari himself would have noticed that this was not a very good study, and certainly not anything which ought to influence your medical decisions. We see this throughout. For example, we are treated to a dismantling of the serotonin theory of depression, and shown it was a marketing tactic from pharmaceutical companies. This is fair enough. Then, in chapter 7, we are treated to an explanation of how internet addiction is a real thing and very bad, from someone who works at a for-profit internet rehab clinic.

One cannot have it both ways. One cannot take a critical approach to evidence you disagree with, and then turn around and accept evidence–often of a poorer quality–to something that you do agree with. This is called “cherry picking”, and it’s generally frowned upon–indeed, Irving Kirsch, who features heavily in early chapters of the book dismantling evidence of the effectiveness of antidepressant drugs, worked very hard to minimise the cherry picking effect of pharmaceutical companies’ publication of drug trials on the evidence of effectiveness.

Yes, I’m going to take a second to giggle about a man called Kirsch working against cherry picking, because I’ve just read a book I hate and I need a bit of levity in my life.

By all means, be critical of evidence, any evidence. It’s how science thrives and how medical treatments improve. But this rigorous approach needs to be applied to everything you are writing. The high standards of evidencing introduced by Hari at the beginning do not hold up in the slightest when we’re looking at his proposed alternative model, and his remedies.

The evidencing double standard is a vast problem within the text and pollutes everything within. However, the rot is even worse than that: the entire argument presented in the book rests on a strawman, and that’s what we’ll be looking at tomorrow.

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Thinking critically about Lost Connections 1: An introduction, of sorts

I forced myself to read Lost Connections: Uncovering the Real Causes of Depression by Johann Hari so you don’t have to.  Following my look at an extract published online, I was cursed enough to get my hands on a copy, and I have a lot of feelings about it.

I’ve taken it upon myself to review the book, to encourage the critical thinking that’s sorely lacking in the media reception of the text. Unfortunately, I’ve been struggling with this task on a personal level, and this is because there is so much wrong with it. It’s a fundamentally flawed text on almost every level, and it’s been difficult to even work out where to begin.

While I’ve always accepted environmental factors as a depressant and stressor, I feel like the experience of reading the book provides a very neat demonstration of the phenomenon.

How do you begin to criticise a book which claims to be about depression–it’s right there in the title!–when for a substantial portion of the book the author isn’t even writing about depression? How do you evaluate evidencing when you, a rando blogger who has a day job and a bit of a life, can’t click everything and check it says what the author is saying it says? How can you even begin to criticise the politics of the text? How do you point out that the book is telling us nothing new?

The book is divided into three sections: poking holes in the current model of depression and its treatment; Hari’s proposed real causes of depression; and remedies (“reconnections”) to alleviate the problem. The central thesis is that depression is a symptom of a sick society, and it’s a message that shouldn’t be damped down, but should instead be addressed using Hari’s proposed remedies.

And, sadly, the case isn’t made very well at all.

Of course, the very logic, that depression is a symptom, much like nausea, is flawed. It can be a symptom, much like nausea. That does not mean that one ought never to take a medicine to alleviate it. It also does not mean that it’d go away under the right circumstances. Indeed, something like nausea often needs treatment, because it’s often unhelpful.

The evidence presented in the first section is reasonably strong, although highly biased and by no means holistic. It also sets up a huge strawman: that the only way that doctors think about depression is pure chemistry. That simply isn’t true. Parts 2 and 3 have a different set of problems, being largely horribly-evidenced, with the bits that aren’t being things which we’ve all already known about a thousand times over.

What the book is is this: a self-help book for a well-off Guardian reader who fancies themselves as clever and educated about science. It’s badly-evidenced, largely inapplicable for the people who need societal interventions the most, and is nowhere near as groundbreaking as it thinks it is. It’s an unhelpful text, which is highly annoying to read if you’re someone who has a background in psychology; if I’d been marking it as a submitted paper, I’d probably fail it.

So I suppose what I’ll start with doing is warn you that this review is going to be five blogs long (including this one). I spent a bit of time dividing the methodological and political flaws into broad themes, and these were the things which seemed most egregious to me. These things are:

  • The approach to evidencing and the double standard
  • Conflation of depression with other mental health issues, and emotions.
  • A false dichotomy as to how depression is thought about: science vs the real problem
  • How we’re not actually learning much new from the text

I will also be questioning the largely-positive critical reception of the book, because it’s kind of annoying to me, but mostly because I want to ask questions about why it’s been so universally popular, and that I suspect there’s more at play than merely a well-oiled PR machine. My thoughts on this are circular, with problems feeding into one another: for example, bad evidencing means that bad solutions are presented, but this couldn’t happen if a false dichotomy strawman weren’t set up to present treatment as either drugs or meditation.

I won’t be delving into any point-by-point takedowns, because I am only human, and it would take approximately a million years for me to pick apart every incorrect reference, every misleading claim, every moment where he seems to have fundamentally misunderstood what he’s supposed to be talking about.

I’ll be posting a blog a day this week to cover the whats and whys of this book, so get yourselves comfortable, kids. Before we get started, I’d like to recommend a bit of reading for you, if you haven’t done it already. I don’t want to retread ground that’s already been trodden, and so here are some things which have already been covered:

Why does this matter? It matters because there is a very real risk that people might stop taking their medicine–something which may well be happening. It matters because it might deter people from seeking help from a qualified professional altogether. It matters because we need solutions that work for the people who need them most, not the people who enjoy moralising.

Please do not use Lost Connections to influence your personal health decisions. Speak to a doctor. The care available to you is better than you think. 

If this were some random internet person’s blog with 40 views, I wouldn’t be spending my time writing a takedown. But it isn’t. It’s a widely-promoted book, and with great reach comes great responsibility. I’d have loved to have not written this series, that someone else would have done this instead. But they haven’t, and so, here I go.

Part 2: The Evidencing Double Standard >

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Five things wrong with Johann Hari’s comeback book that I spotted from the extract alone

Noted plagiarist and wikipedia editor Johann Hari is back, with a book about depression. Yesterday, the Observer published an extract from the book, Lost Connections, which I presume is an early chapter setting the scene for Hari’s main thesis.

As far as I can discern from the extract, Hari is arguing that the environment is the cause of depression, with neurochemical imbalances not being particularly important, and therefore antidepressants not being very good. Now, I’m pretty critical of psychiatry, and very critical of the tendency towards prescribing antidepressants because waiting lists for talking therapies are so interminably long. However, we can’t have these conversations while we’re spending endless hours clearing the Augean stables of awful science, with nary a river to reroute.

Yes, I am calling Hari’s extract horseshit. The ideas, I might be convinced to agree with in part, but there are serious, fundamental flaws with his methodology which mean that it’s impossible to take anything seriously. I am going to assume his extract is representative of the book as a whole, and highlight some of these major flaws, expanding a thread I made on Twitter. Let’s start with a guided example of how Johann Hari is flat-out making shit up. Talking about changing DSM criteria of depression, Hari says:

So, they responded in a simple way – by whittling away the grief exception. With each new edition of the manual they reduced the period of grief that you were allowed before being labelled mentally ill – down to a few months and then, finally, to nothing at all. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.

The bolded part is a complete, total falsehood, which is easily refuted by 10 seconds on google. Search “DSM depression criteria”. Click the first link. Or the second, or any, they all take you to the criteria. Now look at the first fucking line of the criteria: “Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.” Hari has made up a fact about maternal grief and the teams who work with those who have lost children, to make an imaginary point.

This research methodology seems prevalent throughout the extract, and there’s five key things I can see from reading a few thousand words.

1. [citation needed]

Footnotes and citations are necessary when writing a book based on presenting an evidence-based argument. This goes for anyone, but is particularly important if you’re a disgraced writer who has a history of fabricating things. Citations are completely absent from the published extract of Lost Connections, despite confidently-asserted statistics, for example: “It turns out that between 65 and 80% of people on antidepressants are depressed again within a year.” Where is this from? Who found it? Is it from an Irving Kirsch study, since Kirsch is mentioned in the paragraph above? If so, which Kirsch study? Where can we read it so we can get context for the figure?

When a number is presented, you link to where it’s found. And you make it clear where you found it. Otherwise, you might be misrepresenting it. Or you could have made it up completely. Where there’s no referencing, take any information presented with an ocean of salt.

2. Reliance on a single piece of research

Hari’s argument that antidepressants don’t work relies heavily on the work of a single researcher, Irving Kirsch. Now, due to the lack of citations, I can’t be completely certain that the research Hari outlines is Kirsch and colleague’s 2008 meta-analysis, but I’m going to guess it was because this is the most famous research into the topic.

Kirsch’s meta-analysis is decent, although it is not as definitively presenting that antidepressants don’t work for most people as Hari presents the research. Firstly, Kirsch and colleagues didn’t find that antidepressants don’t work on the majority of people: they found that effectiveness of antidepressants are more effective for severe depression and less effective for mild or moderate depression. That’s a nuanced difference, and it’s unfortunate that it led to so many “drugs don’t work” headlines from a screechy media, and Hari has lapped it right up.

Secondly, other researchers analysed the same dataset and drew different conclusions. Using different statistical modelling, Fountoulakis and colleagues found antidepressants were better than placebo, at all levels of depression severity. Turner and Rosenthal’s interpretation of the data is different to Kirsch’s, suggesting that certain measures can be more important than disappearance of depression, such as quality of life, which has been overlooked in Kirsch’s study, and to be “circumspect but not dismissive” in considering the benefits of antidepressants.

And one more issue is present in Kirsch’s research: it’s not a look at all antidepressants. It examines four drugs, all of the same type: selective serotonin reuptake inhibitors (SSRIs).

3. There’s lots of different antidepressant drugs

“Antidepressant” is a wide category of types of drug, which do different things: Mind’s information lists the drugs, and what they do. Some drugs act on serotonin receptors–the SSRIs which Kirsch studied. Others act on different receptors, or prolong the activity of neurotransmitters, or perhaps make it harder for the body to break the neurotransmitters down: most of these will regulate levels of serotonin, noradrenaline, or both. Then there’s the weirdo drugs which don’t act on serotonin or noradrenaline: the atypical antidepressants, which include drugs like mirtazipine, which doesn’t do any of that, or variants on ketamine, which are increasing in popularity.

Basically, the drugs work differently, and it’s not exactly a secret that different drugs work better for different people: this is one of the first things the NHS tells you in their information for patients.

Hari fails to make the distinction throughout his article, referring only to “antidepressants”, the umbrella term for a diverse range of drugs which act in different ways on the body’s neurochemistry, and which are well-known to affect different people differently. There is no effort whatsoever made to acknowledge that not all antidepressants are the same, and the study he’s citing refers only to one class. This nuance is important. Really, really important.

4. The serotonin hypothesis isn’t as important as you think

Poking holes in the serotonin hypothesis is treated by Hari as debunking the neurochemical basis of depression. That’s a pity, because it doesn’t. There are dozens of theories of depression, both biological and cognitive, and the serotonin hypothesis is but one. It’s also acknowledged it may be caused differently in different people. Genetics, neurochemistry including but not limited to serotonin, interpersonal factors, the environment, the immune system… all of these things and more are believed to contribute to depression.

The dominance of the serotonin hypothesis in the public consciousness is mirrored by Hari’s writing, and presents a grotesquely oversimplified perspective of something which is a lot more complicated than that. The way you’d think it if you were listening to Hari was that science has two cards on the table: a deficiency in serotonin, or the environment, which is a brand-new discovery made by Hari, and definitely not something widely-acknowledged in the scientific literature. This is simply not the case, and never has been. Christ, even a basic A Level in Psychology will teach you that.

Doubt about the serotonin hypothesis does not mean that there’s a vast conspiracy to put people on drugs when really we should be making the world a nicer place. It’s a hell of a lot more nuanced than Hari would have it.

5. Stress and depression aren’t the same thing

Towards the latter end of the extract, Hari discusses environmental factors, and places a lot of emphasis on stress. While stress is acknowledged to be a contributor to depression, it’s a different kettle of fish entirely and isn’t thought to be the root cause of all depression by anyone. Stress is physical changes to the body caused by your “fight-or-flight” responses going on the alert in response to an external stimulus and just keeping on going. Stress isn’t a medical condition, per se, and it’s often advised that it’s managed by relaxation or just taking a break once in a while. There’s different neurotransmitters involved: depression itself doesn’t tend to have increased levels of cortisol, which is the dangerous thing about stress, and the killer. Because it’s different, stress has different symptoms to depression, though there may be some overlap.

Hari conflates stress and depression repeatedly throughout the latter half of his article. This is an enormous problem, because it becomes difficult to follow, and therefore critically appraise, exactly what he’s talking about, and also, to acknowledge that these are different problems, with different solutions, and it seems as though Hari favours the treatments recommended for stress–which may be why he conflates depression and stress so readily.

tl;dr

If this extract is representative for Johann Hari’s comeback book, don’t believe a word he says. The methodology is awful, given how much I spotted just from a few thousand words and a quick read.

It’s a huge shame there’s so much ill-informed nonsense out there, because there are real conversations we need to have about psychiatry and medicalisation, which we can’t have when we’re fighting this crap.

Update 13/1/18: Johann Hari has written a response to criticisms of his extract and research methodology on his blog. He also responds to fact-checks from Dean Burnett, who wrote a very good critical article questioning the conclusions and implications, and Stuart Ritchie, who presented meta-analytical evidence for the efficacy of antidepressants and identified the source of Hari’s “65-80%” figure, which I pulled up in the “citation needed” section of this blog. Stuart’s thread is good and spoiler: the figure came from a self-help book. Stuart has responded to Hari’s response over on Twitter, which, along with his original thread and Dean’s article, are well worth a read.

I’d like to respond to Hari’s response too. Hari neglects to respond to four of the five points I’ve made in this article, opting only to answer point 2: relying heavily on the research of Professor Irving Kirsh. To refute this, Hari got Professor Irving Kirsch to reply. Throughout Hari’s response to Dean, Stuart and I, Kirsch is mentioned or quoted more than 20 times. I don’t think I need to say why this is not a good way of refuting my concerns! I acknowledge that Kirsch thinks his own research is the most solid, and that Johann Hari favours the work of a researcher who unequivocally supports his conclusions. I will say that the criticisms of Kirsch’s meta-analyses still stand, as well as the bulk of meta-analyses conducted by other researchers. I’ll also say that even if a hole had been poked in my concerns about over-reliance on the work of a single researcher, there’s still four other reasons to be worried about the methodology Hari has deployed.

I’m also pretty concerned that there’s only three of us raising criticisms of Hari’s book, and one of us is just some rando blogger (that’d be me!). It’s very telling that media outlets have not been proactively commissioning experts to review the book, as opposed to other journalists. This isn’t just some journalistic circlejerk. There are real-life consequences, and at least one quote from someone considering stopping their meds off the back of the book has been found. To anyone who is thinking of coming off meds I say this: do it under medical supervision. For many antidepressants, you mustn’t just stop taking them, but need to titrate off. You should also be checking in with a medical professional regularly to ensure you are doing it safely, and to see if it’s working for you. This is very important and for pity’s sake DON’T JUST STOP TAKING YOUR MEDICATION.

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Shockingly bad science journalism in the Guardian

Content note: this post discusses mental illness, mentions self harm, suicide and sexual violence

It’s been a while since I’ve considered the Guardian a decent source of news, but sometimes things get egregious. Yesterday, an article entitled “Mental illness soars among young women in England – survey” was put out, and their reporting… wasn’t very good.

A study was released finding that young women aged 16-24 are at very high risk for mental illness, with more than a quarter of the group experiencing a condition, and almost 20% screening positive for PTSD symptoms. This has all risen since 2007: not just for young women, but across genders and age groups. What, according to the Guardian’s heavy focus of the article, is to blame?

Social media, apparently.

The Guardian’s reporting focuses heavily on how social media is to blame, selectively quoting researchers mentioning social media to the extent that I would love to see what questions they were asked (my personal favourite: “There are some studies that have found those who spend time on the internet or using social media are more likely to [experience] depression, but correlation doesn’t imply causality.”)

Then there’s the case study telling her story of her experience with PTSD and triggers. She talks a lot about film and TV, and the stress of university, and yet somehow her case study is titled “Social media makes it harder to tune out things that are traumatic”. She mentions it briefly in the last paragraph–while still mostly focusing on film and TV!

Now, the reason the Guardian’s twisting of this survey for their own ends is so particularly problematic is the importance of the research. You can download the whole report here, or read a summary here.

It’s quite a well-done survey, a very robust look at mental illness in England, and laying groups who are most at risk. You know me, and how quibbly I can get about published research. This one is actually good. However, it’s worth noting something they didn’t measure in the survey: social media use. This means, of course, it’s absolutely impossible to draw conclusions from the data about social media and mental illness from this research. The survey authors mention that their young cohort is the first to come of age in the social media age, which is true to a certain extent, although I am in an older cohort and came of age in a world where I constantly chatted to friends online, whether I knew them in the meatspace or not. Again, it would be nice if they’d consistently measured online behaviour across studies.

I’ll quote one of the other key research findings here, because again it’s crucial and if you read the Guardian you’d never know about them.

Most mental disorders were more common in people living alone, in poor physical health, and not employed. Claimants of Employment and Support Allowance (ESA), a benefit aimed at those unable to work due to poor health or disability, experienced particularly high rates of all the disorders assessed.

So. Let’s speculate with the results then. What else happened between 2007 and 2014 that might have had a negative impact on people, especially those who are on disability benefits.

I’ll give you a clue. It happened quite soon after 2007, and the young cohort would have come of age into this, as well as more people using Facebook.

One more clue: it rhymes with wobal winancial wisis wand wausterity.

These are young people who have grown into a world with no prospects, with a hugely gendered impact. Of course, once again, it’s just speculation, but it’s slightly more robust speculation than the Guardian’s because they measured benefit receipt and employment status.

As women, a lot of us would have chorused “no shit, Sherlock” upon seeing the results, and seeing how gendered the results are. We deal with more, and it’s even worse if we’re poor.

The Guardian has a bit of a hateboner for social media, and, unfortunately, this has completely blurred its analysis and reporting of what is an important survey that actually found some interesting trends over time, as well as a bleak snapshot of the current realities.

A twitter rant about sleep, capitalism and Jeremy Corbyn

Today, I am mostly furious about a particular capitalist value: lack of sleep. So I made some twitter threads.

Firstly, about Jeremy Corbyn and leaders. Worth noting, as an addendum, that Margaret Thatcher bragged about sleeping 4 hours a night and Definitely Never Made A Bad Decision Ever. Also, Hitler, who used stimulants to stay awake.

Secondly, about disability and accessibility.

The public health double standard: smoking, drinking, eating sugar, etc are frowned upon, and people who do some of these things are deprived medical treatment. Why is it, then, that an equally dangerous health behaviour–willing sleep deprivation–is considered all right… if not actively valued and encouraged? (and, certainly, medical professionals are subjected to hugely dangerous sleep disruption)

Gender and getting up early

What do I envisage? As a transitional demand, I’d like “That’s too early for me” to be a valid and accepted reason not to attend work engagements. I’d like for homeworking and flexible hours to be the norm, and if sleep disruption is necessary for a job, for “danger money” to be paid: we are, after all, ruining our health. And, ultimately, I’d like for work as we understand it under capitalism to be abolished, but I get that that one’s a big ask, and I’d be all right with the other two demands being implemented within my lifetime.

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Blocking fat people and smokers from accessing healthcare hits our most scapegoated punchbags

Content note: this post discusses gatekeeping healthcare, and structural oppressions

Various NHS commissioning groups have decided to cut costs by blocking access to surgery for people deemed to be obese, and smokers. To the terminally naive, this can be considered an intuitive, common-sense solution, which would encourage people to make better healthcare choices. To the rest of us, we know that choice is, for the most part, an illusion, and that such bans to healthcare access affect certain groups disproportionately–coincidentally, the same groups who make for convenient scapegoats.

First, let’s look at who’s more likely to smoke. LGBT people are much more likely to smoke than straights, and less likely to try to quit. People with mental illness are also far more likely to smoke–up to 2 in 5 cigarettes smoked will be by a mentally ill person. And of course, these groups are not mutually exclusive, with LGBT people at a higher risk of mental illness. Also, poor people are more likely to smoke, and deprivation makes it harder to stop.

When it comes to obesity, let’s first have a look at what’s deemed obese: some CCGs are using the BMI of 30 as a cut-off, which is an absolutely terrible idea. BMI is a nonsense statistic, particularly when applied to how calculating fat an individual is. A substantial portion of Olympic athletes, upon returning after their heroes’ welcome and perhaps needing an operation on injuries, would be turned away by the NHS, because their body weight is too “obese” for surgery–among other issues, BMI does not distinguish between muscle and fat. It’s also particularly statistically dodgy when someone is particularly tall or short, so Usain Bolt and Simone Biles should be glad they’re not going to find themselves at the mercy of the NHS.

As well as the muscular and the all-round encouraged under usual circumstances, who else is likely to be considered obese? Certain minority ethnic groups are more likely to have BMIs over 30–in the UK, particularly Black Caribbean, Black African, Bangladeshi, Pakistani, Indian and Irish people. Again, mentally ill people are more likely to be at risk, both as a result of their illness itself, or as a result of medication side effects. And once again, poor people are more likely to be considered obese. People with physical disabilities are also more likely to be obese. Incidentally, one of the surgeries “obese” people are blocked from accessing is hip or knee replacements–exactly how the NHS expects them to exercise to lose weight while unable to move, they have not yet explained.

So, NHS trusts with these policies will be disproportionately picking on groups who have been historically and currently disproportionately picked on and blamed for their own misfortune. It is yet another manifestation of the general state approach to behaviour change, which goes like this:

Step 1: Deprive marginalised people of a basic need
Step 2: ??????
Step 3: BEHAVIOUR CHANGE!

Unsurprisingly, there’s no evidence that this works, but it’s a nice little bedtime story for fascists-in-denial to tell themselves, that people are being refused healthcare because they made poor life choices.

At this point, the terminally naive might pipe up that obese people and smokers are at a greater risk of surgical complications than non-smokers or thin people. Yes. That’s true. However, there are also lots of other groups who are at greater risk of surgical complications. Like the elderly. Or the very young. Or malnutrition. Or even drinking moderate amounts of alcohol. Or being a bit cold around the time of your operation. Think of the billions that could be saved if they stopped operating on moderate drinkers: suddenly, there’d be barely any operations, especially if they also stopped operating on kids!

Of course that would be absurd: another myth in play here is that healthcare needs to be rationed at all. The NHS is in crisis, but this crisis isn’t caused by obese people, or smokers, or immigrants, or striking junior doctors, or whichever scapegoat you want to pick. This crisis has been manufactured by years of butchering the NHS. Hospitals are not given enough money to function, and given unrealistic targets to meet on these shoestring budgets, along with a hefty dose of bloated private sector provider inefficiency. In truth, with adequate money, the NHS could happily accommodate everyone who needed treatment.

Given that the government would be perfectly happy for the NHS to go tits-up so the private sector could further cannibalise it, that’s unlikely to happen–that harm comes to the most marginalised people is simply a welcome bonus.

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