Category Archives: science

Sedated

‘Sedated’ may, at first glance, appear to be a book about the pharmaceutical industry, but it is much more than that – it is well reasoned and passionate attack on the way many of us live, particularly those of us in post-industrial western societies.

There has been a huge rise in anti-depressant use since the 1980s, particularly in countries that have espoused radical right of centre policies: privatisation, deregulation, low taxes, a tightening of government spending, the underfunding of public services.

In ‘Sedated’ James Davies makes a powerful and convincing argument that these policies have led to a mental health crisis. In 2020, for example, seven million people in the UK were using anti-depressants.

Inequality, deprivation, poverty, these, Davies asserts, are the main causes of the mental health epidemic. There is a correlation between marginalisation and poor mental health. So we should not look at the individual as the cause, but at economic and social structures. By blaming the individual and by promoting pharmaceuticals as the solution, we are, Davies writes, promoting ‘the medicalisation of distress’. And this medicalisation furthers the profits of the drug companies.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) was, at one point, number one in Amazon books despite its cost: around $88. It’s a huge book listing 370 mental disorders, these created by a panel of psychiatrists, many linked with big pharmaceutical companies who, in turn, buy the book and distribute, free, to clinicians. These professionals, many overworked and doing what they can, prescribe the pharmaceutical company’s drugs, eg anti-depressants, anti-psychotics. It’s not a huge leap to imagine that some of the disorders have been included so that pharmaceutical companies can devise cures. But do the drugs work? Davies suggests many don’t. What works better, is therapy.

So, when, in 1998, the then Labour Government was presented with a case for using therapy as a cheaper alternative to medication, it did so without considering that for talking therapies to work, practitioners had to be given sufficient resources, and perhaps the most important resource was time. This initiative was not just a cynical means of saving money, there was good evidence to show therapy is more successful than medication at treating certain forms of mental illness. What emerged was IAPT (Improving Access to Psychological Therapies). And the story of what happened in IAPT is the narrative of many public services. The service is introduced with good intentions, but then, when the costs are examined, calls begin for more rigorous assessment and as these systems kick in, practitioners become overloaded, start gaming the system. James Davies compares what happened in IAPT to what has happened in the education system. And as an ex-headteacher, I know he is absolutely right.

The DSM, (see above), anti-depressants, and to some extent even IAPT, have at their core the suggestion that there is something wrong with the individual. What James Davies suggests is the problem is structural, woven into the way we lead our lives, particularly in countries, like the UK and the US, where people experience huge inequalities.

In the UK, for example, the richest fifth own 50% of the wealth, the lowest fifth only 4%.

Pfizer, who makes Sertraline, the biggest selling anti-depressant in the world, have a clear interest in maintaining this status quo.

For example, Pfizer funded the PHQ9 and GAD7 questionnaires, used by clinicians to diagnose depression and anxiety respectively. These questionnaires were devised by a team at Colmbia University with a grant from Pfizer. Pfizer produce, among other things, anti-depressants, including Sertraline, or Zoloft, the most commonly prescribed anti-depressant in the world. (18 million prescriptions in 2021).

The bar set in these questionnaires is very low, for example:

Over the last two weeks how often have you been bothered by any of the following problems:

– little interest or pleasure in doing things? Feeling down, depressed or hopeless?

– trouble falling or staying asleep or sleeping too much?

– feeling tired or having little energy?

If presented with such a questionnaire most of us, perhaps after a particularly bad week, might score highly. But would we want anti-depressants?

The drug companies fund the DSM, fund the questionnaires, and sell their drugs.

Davies writes this: ‘There is nothing scientifically valid or indeed clinically helpful in reclassifying understandable human suffering as mental pathology.’ And then he expands the probable causes of human suffering as marginalisation, disadvantage, abuse, neglect.

Davies asserts that medicalisation depoliticises depression, or its cause, suffering. He suggests the massive rise of anti-depressant use since the 1980s was triggered by radical conservative or neoliberal policies of Reagan and Thatcher – both influenced by the economist Milton Friedman, of economic freedom at the expense of social democracy, privatisation and personal wealth instead of funding of social support structures. It should be remembered that Friedman advised the dictator Pinochet after the military coup in Chile in 1973. Pinochet’s regime murdered hundreds, perhaps thousands of its own people. Despite this, Friedman called what happened there a ‘miracle’.

Neo-liberalism puts individual responsibility and freedom at the core of its belief. Low taxes, for example, at the expense of public services. The individual is responsible for his or her own destiny. Therefore when things go wrong, it isn’t economic conditions, it isn’t the lack of a support network, it’s the individual at fault. (Remember, it was Thatcher who said ‘there is no such thing as society.’) So, instead of challenging the system, we blame the individual, and prescribe them anti-depressants, even though there is growing evidence to suggest that the drugs don’t work.

There is a clear link between poverty and the prescribing of anti-depressants. Or, perhaps more subtly, it is a link between inequality and medication. Here Davies cites ‘The Spirit Level’, the 2009 book by Richard Wilkinson and Kate Pickett. The book asserts that in every major aspect of life, health, education, justice, individuals in societies with less inequality fare better. It’s an astonishing book, one that sits alongside ‘Sedated’ as a quietly measured, yet explosive demolition of radical right wing economics.

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The Georgian Star

The Hershel Museum sits in a quiet street of terraced houses just outside the centre of Bath. I’ve passed it many times, seen the modest plate that marks it. In the back garden of this house, in 1781, William Hershel, musician, church organist, composer of symphonies and amateur astronomer, discovered the planet Uranus. Hershel was from Hanover, but left his home to escape conscription and was soon joined in England by his sister Caroline. The reigning monarch, King George III, was also from Hanover, so Hershel wanted to name his new planet George, or ‘the Georgian Star’. Despite not succeeding in this, the king appointed Hershel his court astronomer, and in the years to come, Hershel was to build a telescope, in Slough, so huge that it remained the biggest in the world for fifty years.

The discovery of Neptune, in 1846 has, to some extent, obscured Hershel’s achievement, and minimised the profound effect it must have had on contemporary thinking. Uranus was the first planet to be discovered in modern times. Each of those already discovered is visible to the naked eye and were known even to the Babylonians. Neptune’s discovery doubled the size of the solar system, and, at the same time, made Earth, and thus all the achievements of humanity, shrink down to tiny speck, just one more, orbiting our Sun. Furthermore Hershel recognised that some of what were thought of as nebulae, clouds of cosmic dust, were other galaxies, and the recognition of this could only serve to reduce the sense of humanity’s importance, and maybe question belief in a deity.

Hershel’s first obsession was cataloguing double stars – pairs of stars which appear to be close; some of these he recognised as being binary stars, a term and distinction which is still in use today. Meanwhile his sister, who at first accepted the role of his assistant, noting down his observations in the light of the kitchen while he sat at his telescope in the garden, began her own quest, and today is celebrated for her work on comets, one of which bears her name.

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Octopus Consciousness

Consider this: an octopus has one central brain and possibly eight smaller brains, each for the independent control of its limbs. It also has skin that reacts to colour changes in the environment even though the octopus cannot see colour itself. How? Its skin can see. Therefore it’s possible that the octopus has several forms of consciousness operating independently. Maybe the limbs communicate with each other, and thus the octopus has three levels of awareness: the central brain, the limbs and the skin. All this is explored in Peter Godfrey-Smith’s  dazzling ‘Metazoa’, a book which blew both my minds, particularly when Godfrey-Smith considers the consciousness of the octopus in light of experiments on split brain patients. Then things get very weird. If, after surgery, or damage, a patient’s brain has weak communication between its two halves, then the patient may recognise objects, but not be able to name them. Such patients live in a world that is separated into things and their names, and somehow the two never quite hold together. It is only by what Godfrey-Smith calls ‘switching’ that the patient can function – the patient must learn to switch perception from one side of the brain to the other: the vigilant right brain flips to the more forensic left. ‘In a wide range of animals, the left side of the brain specialises in identifying food, the right has an aptitude for social relations and threats.’ Maybe all humans use ‘switching’, one moment concentrating, focusing, the next, vigilant, open to new impressions. (Iain McGilchrist’s The Master and His Emissary‘  explores this subject in great depth).  Could the octopus do something similar – switch its focus from central brain to its limbs, or even to its skin? ‘Metazoa’ is a book about consciousness, or perhaps subjectivities. Bees ‘are masters of logical abstraction’, insects and slugs have emotions, fish can count and even discriminate different genres of music, cuttlefish dream, rats hatch plans. With such intelligence in life forms we may have assumed were lacking in complexity, maybe its time to reconsider our attitude to all other beings, and accept that although humans may be more destructive, we aren’t so special after all.

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The Mouse that Roared

Are we influenced by the fears, and maybe the loves of our ancestors?  This story – http://www.nature.com/news/fearful-memories-haunt-mouse-descendants-1.14272 – took my breath away.  A mouse was trained to react negatively to a particular smell, and this reaction was passed on to its grandchildren.  The experiment asks as many questions as it answers – for politicians, teachers, artists, for all of us.  Just as we’ve got used to the idea that we may be the product more of our genes than of our nurture, this blows the whole argument open again.

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