New short story: Raw Water

I wrote a short story, it contains gay Victoriana and my hatred of current health fads.

Read RAW WATER.

It’s available on patreon, where you can patronise me for just $1USD a month and you get cool stuff. Along with Raw Water, I’m posting other forays into fiction writing, such as The Voice of Mathey Trewella (lesbian mermaids and a Cornish legend), status updates and excerpts from other fiction projects, recipes without an interminable story section, and the selfies I take that contain slightly more traceable data than my public ones. I really do love all patrons, even the dollar ones.

So, start with a read of Raw Water, and let’s take our monetised relationship from there… 😉

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

Update 22/1/18: I’ve read the whole fucking book now. It’s changed the view I’ve expressed here, very slightly, to “it was a bit worse than I thought”. Read more.

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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Some doomful predictions for 2018

2017 has been a hell of a year, hasn’t it? A year of doom, gloom and misery. And, sadly, emerging from this shit, I can’t see much good coming of the year that will follow it.

Now, I hate being right. I don’t want any of these predictions to happen. Unfortunately, I fear that they will.

The Tories will escalate vicious cuts

The government is in a bit of an awkward position at present. They know that, we know that, and if an election is called, they are more stuffed than a Christmas turkey. The party hates Theresa May, and thus, she must do all she can to appeal to them. The Tory right has little manoeuvring space, because they got everything they wanted with Brexit, but that’s always just been a wedge issue. So, what do they need to be appeased, to maintain a minority government? And what do the DUP want for propping up a minority government? Why, death and poverty, of course! As a cynical gesture of pandering, I suspect that the ideology-driven Tory “austerity” agenda is going to get even worse. And your fave “liberal” Tories like dear old Soubz are just going to vote it right through, because they’re fucking Tories.

Let’s face it, there’s not going to be a snap election next year. Tories are primarily creatures of self-preservation, and they always have been.

TERF and Nazi collaboration

I’ve included TERFs and Nazis under the same heading because tactically, they are identical, and I strongly suspect there’s more overlap between the groups than either would care to admit. These groups thrive on pretending they’re under attack, and now they’re facing small consequences like not being invited to so many lucrative speaking gigs, or people being a little bit rude to them on Twitter. Like petulant children, they lash out.

They are inherently unreasonable, and utterly dangerous. They will play the victim harder than ever while punching down. TERFs and Nazis alike will escalate their “free speech is under attack” lines, with their more respectable faces photographed wearing duck tape on their gobs. Jo Johnson is already making noises about forcing universities to platform the far right. Changes to a law about gender recognition that would bring Britain into line with countries like Ireland and Malta are already being kicked into the long grass. There’s a lot of sympathisers in politics, and many more in the media. They’re probably going to side with these hateful bigots.

Trump will be deposed or die

Why have I listed this as a bad thing? Surely it’s good that Badwig von Orange will no longer be president?

Only if you’ve failed to notice who’s waiting in the wings behind him. Get your red gown and wings, because under Mike Pence things will likely get a lot worse. He’s quietly, competently evil, and under him, the USA will move further in the direction of The Handmaid’s Tale. There’ll be less fightback to this than is needed, because everyone will be talking (or debunking) conspiracy theories surrounding Trump no longer being president. Meanwhile, access to reproductive healthcare will be quietly stripped away, LGBT rights and access to healthcare will be rolled back, and it’ll all be done with silent, ruthless efficiency.

Trump’s on some thin ice, and I can see an impeachment happening when his position finally becomes too corrupt and untenable. I can also see him dying, because that much cocaine and anger isn’t good for anyone’s heart.

The robot uprising won’t happen, they’ll just be spying on us

I, for one, would welcome our new robot overlords. Unfortunately, they’re not coming to save us. Instead, something more frightening lurks. Already, people are gladly welcoming devices that are always listening into their handbags and homes. Concurrently, many governments are looking at ways of increasing surveillance–take, for example, Amber Rudd’s crusade to end encryption. It’s not a far leap to be worried that these little doohickeys that make life marginally easier will be used against us.

There is an unprecedented amount of personal data already being processed, which could be accessible to those who would use this data to sell us shit we don’t need or to incarcerate us.

A little bit of advice: don’t pay with your face, and be careful.

Nothing will change

This is, perhaps, the scariest thing of all: that literally nothing will change. That the positive developments over the last year–such as abusers facing accountability–have no impact whatsoever.

It’s possible. We’re up against a lot, and systems are slow to change and highly resistant.

Can anything get better?

Possibly. I’ve written some more hopeful predictions to accompany this over on Patreon. I suspect these will happen alongside the gloomy forecast I’ve presented here, but I think they might happen. And if they do, at least the “nothing will change” prediction is moot.

As I said, I hate being right. I hope none of this comes to pass. I just fear that it will.

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Dear suffering Mail journalists: get another job

This is a message for all the suffering journalists out there, writing hate speech or misogynistic fluff and feeling bad about it, like poor Sophie Brown or Thea de Gallier’s pals: just, don’t.

Yes, you have to make rent. So do we all, but of course, your job is to demonise any of the rest of us doing things to keep roofs over our heads like being on benefits, doing sex work, working service jobs, or working in the public sector. Have you considered that there are better uses to your skills?

For example, the skills you have as a journalist can be used in a comms role. Or a copywriting role. Or writing books. Don’t you think that’s a better use of your time than, say, discussing a celebrity’s visible c-section scar in a derogatory fashion?

I understand that being a journalist was your dream job. It sounds romantic, doesn’t it? The taste of noir, the plucky intrepid journalist getting to the bottom of the story and exposing the bad guys. But let’s be honest here, shall we? That’s not what the industry is any more, and it hasn’t been for a long time. You’re unlikely to ever be doing the cool investigative stuff.

Once you start down the road of combing through a teenager’s old tweets so you can smear all trans women on the basis of it, that’s going to be the rest of your career for the rest of your life.

It might hurt your feelings when people criticise what you’re doing, but you’re doing material damage to marginalised people. That’s worse. Sorry. It sounds harsh but it’s true. You want to not feel like an arsehole, but you are.

If your dream job involves inciting hate against marginalised people, get a new dream.

Stop crying, because nobody has any sympathy for you. You are accountable. You are complicit. Your feelings are absolutely trivial compared to the active harm you’re doing.

At one point in my life, I considered moving in the direction of journalism. See, I was changing careers, and there were two options that sprang out to me immediately, because they were two things I’m reasonably competent at and quite enjoy doing: sex work and journalism. I had a think to myself. I decided against sex work, because there’s an amount of personal grooming involved which, frankly, I cannot be bothered with. I decided against journalism because the thing one sells in journalism is utterly repugnant to me: one sells ones opinions and makes them marketable to a bigoted public, and in doing so, one also sells one’s principles. In the end, I chose neither course, and I’m all the happier for it.

I have no sympathy for those who choose to incite hatred.

The job market is appalling, but anything, anything is better than working for the Daily Mail or the Sun, being assigned to write 500 words of poison.

And here’s the thing: if you conscientiously object, publicly, more will follow you. If you refuse an assignment and get sacked, you’ll be supported. Take a stand, like the tube workers or the teachers. Take that loss of income for the benefit of yourself or others.

I am, of course, assuming that you are the good person you think you are. That you don’t really believe the racist, disablist, misogynistic, transphobic, homophobic drivel you’re writing. There’s a chance that you are, in fact, the piece of shit that believes that stuff.

Either way, you’re not immune to criticism or accountability.

Fuck your feelings. Take a stand, or be the abominable prepuce that we all think you are anyway.

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OK, Matt Damon, let’s talk about the Hollywood men who aren’t abusers… and their role in enabling abuse.

Content note: this post discusses sexual abuse and sexual harassment

Latest in the string of awful opinions about Hollywood’s structural problems with sexual abuse and sexual harassment comes Matt Damon, who first spouted off about “degrees of abuse”, before being heroically taken down by Minnie Driver, and then continued talking, because nobody loves him enough to stop him, this time saying that we need to talk more about all those oh-so-lovely men who aren’t sexual predators.

Now, I’m not in the business of giving out cookies, but all right then, Matt, you want a conversation about the men who are not sexual predators? Here goes.

Any Hollywood man who is not personally an abuser, but remains silent, is complicit in sexual violence. He is enabling sexual violence. He is also, probably, benefitting from it.

Silence is violence, and what men need to be doing right now is nailing their colours to the mast in support of victims and survivors speaking out. They need to unequivocally side with those who have named their abusers. Those who do not are making it easier for abusers. The only words one of these lovely Hollywood non-predatory men need to say is “I believe her. I stand with her.” No more, and no less. We do not want to hear about your opinions of the accused. We do not need to hear about your opinion of what counts as sexual violence. And finally, we don’t want your silence.

The path to dismantling rape culture needs everyone to explicitly reject it. To stay silent is allowing the problem to continue: it allows abusers to feel like they will not be challenged, and discourages survivors from speaking out.

While we’re talking about the men in Hollywood who are not, personally, sexual predators, we might as well also talk about how all men benefit from a culture of sexual violence. Yes, all men.

Let’s take Hollywood as an example, since that’s what Matt Damon wants to talk about. Sexual harassment is rife there, and many women have found themselves party to sexual coercion. This affects women in numerous ways. Firstly, it tells women that they must make themselves sexually available in order to work, and that they must not reject men, or they will face serious consequences. This benefits abusers, but this mindset forced upon women benefits all men who seek sexual access to women. Outside of sex, the threat of sexual violence also seeps into women’s general attitudes towards everything, and they are less willing to rock the boat in any way, lest it damages them–which means Hollywood remains horribly unequal. Relationally, many heterosexual women think a man who is not a complete piece of shit rapist is therefore a good man. It lowers the bar. “He treats me well” translates to “he isn’t physically or sexually violent towards me”. Professionally “this is a good job” translates to “well, he didn’t sexually harass me, even if I am being paid significantly less than my male co-star.”

So yes. Let us talk about the men in Hollywood who are not predators. They shoulder guilt and complicity, too.

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Congratulations to the anti-trans bigots who got reproductive healthcare defunded

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