Is this sexism disguised as science?

Women account for two-thirds of all cases of anxiety and depression.  That is a "fact" that has been established for decades.

But "facts" are tricky things.  A "fact" can be something that is happening out in the real world, or at least a proxy measure of something that is happening in the real world.  But a "fact" can also be a problem with the way look at the world.  Maslow once wisely said that "if all you have is a hammer, everything looks like a nail".

So when a group of Pennsylvania fMRI technicians report that higher rates of depression in women are explained by oestrogen causing greater blood flow to the emotional centres of the brain, I am naturally suspicious.  A functional MRI scanner is a very complex and expensive hammer, and the technicians that use it are like Maslow's young boy who - given a hammer - finds that everything needs to be thumped!  

Of course they want to show that their hammer is useful; not least to justify their continuing research funding. But do their findings stack up?  There are several reasons for believing that they do not.  

The least scientific of my objections is that the study was reported in the Daily Mail (famous for inventing "facts" about health).  This does not prove anything, but it should sound a note of caution.  It is sensible never to believe anything that the media in general, and the Daily Mail in particular reports about health.

A more important concern is with the study itself.  The study was not a test of differences between men and women affected and not effected by depression.  Indeed, the study itself had nothing to do with depression.  Rather, it was an examination of brain development in 922 healthy young women aged between 15 and 22.  It did not distinguish men (who were not even studied) from women, or healthy women from those with mental illnesses.

The study found that changes in oestrogen levels correlates with increased blood flow to the emotional centres of the brain as women go through puberty.  But, since the study made no comparison between women with and without mental illnesses like anxiety and depression, there is no way of knowing whether this finding relates to depression at all.  Indeed, since the increase in blood flow occurs in all women (not just the 1 in 10 who are diagnosed with anxiety or depression) there is good reason for believing that this finding has nothing to do with depression whatsoever.

The biggest objection concerns the way we define and measure mental illness.  Psychiatrist and Radiologist Daniel Amen points out that "psychiatry is the only clinical specialism that does not examine the organ it claims to be treating". Conditions like anxiety and depression are not real, objective illnesses that can be measured in the way that we measure an infection, a broken bone or a damaged organ.Where other specialisms use blood tests, x-rays, ultrasound scans and MRI scans to see what is going on, psychiatrists make subjective (educated) guesses based on patients' descriptions of their symptoms.

The patient may be wrong or incomplete in his or her description of the symptoms.  The psychiatrist may misunderstand what the patient is saying when interpreting the symptoms.  This alone gives serious cause for concern about the way mental illnesses are diagnosed.  But even more worrying is the way particular clusters of symptoms come to be defined as "real" illnesses that increasing numbers of psychiatrists and drug companies claim (without evidence) to be disorders of the brain.    As Professor Sami Timimi points out, "most psychiatric diagnoses have been literally voted into existence".  Diagnostic manuals are drawn up by groups of psychiatrists - the majority of whom receive significant funding from the pharmaceutical corporations - who vote upon which symptoms are included (and excluded) from a diagnosis.

So what if the "fact" that depression is much higher in women than men is the product of another of Maslow's hammers - that once a pharmaceutical company has a treatment, then every treatable symptom looks like an illness?  Depression in men would be a lot higher if symptoms such as increased anger and irritability, and increased alcohol and drug use were included in the symptoms clusters used in diagnostic manuals. However, these symptoms are not improved by antidepressants, so they have been excluded.  As such, it may only appear that more women than men have depression.

Throughout the ages, sexism has been based on unsubstantiated claims that because women are biologically different they are inevitably socially, politically and economically different too.  Without care, the use of fMRI scans today to suggest that, for example, women are more prone to mental illness than men, may be little different to Victorian phrenologists feeling the bumps on people's heads to determine who would be a criminal.

There may be real differences between the sexes in predisposition to mental illnesses.  But the difference could just as likely lay in the very poor manner in which mental illness is defined and measured.  Either way, bad science and bad science reporting add nothing to our knowledge but a great deal to our prejudices.

Did Brave Frenchmen Die in Vain? More UKIP incompetence...

If you are going to hijack our shared history to support your narrow-minded xenophobic messages, the very least you could do is make an effort.  

When UKIP decided that it was okay to use the graves of men who died on the Somme under the headline - "They Fought and Died to Keep Britain Free from Foreign Invasion and Control by Foreign Powers" - at the very least, you would expect them to use a photograph of British war graves.

Instead, they used an image from the BBC website:

These are graves from the Australian Imperial Force cemetery just outside Flers...  So not even a British cemetery.  In fairness, the AIF cemetery contains 2,811 British, 402 Australian, 163 French, 84 New Zealand, 68 Canadian, and 27 South African graves.  So it would have been possible to find a photograph of British graves within the AIF cemetery.  But - ironically given their anti-foreigner stance - the picture is of the graves of French solidiers who, whatever else they were fighting for, were assuredly not fighting to keep Britain free from foreigners!

UKIP seems to be picking up where the BNP left off - presumably in an attempt to woo former BNP supporters.  In the 2009 European election, the BNP used an image of a Battle of Britain spitfire to attack Polish immigrants, but failed to notice that the spitfire had Polish insignia.  It is worth noting that in the dark days of 1940, Britain owed her survival to the Commonwealth, French and Eastern European pilots who volunteered to fight for her cause.  Moreover, Britain only ended up on the winning side because millions of foreigners joined the allied armies.

The way UKIP stirs up racism and xenophobia while pretending their views are reasonable is objectionable. I am disturbed that they legitimate the racist views of a highly unpleasant minority of my fellow citizens.  And I am appalled that UKIP refuse to condemn racism and xenophobia among their supporters.  But most of all, I object to the fact that they are incompetent in their xenophobia.  

At the very least, when you are trying to employ the imagery of the two World Wars, try to choose an image that doesn't remind everyone that were it not for the sacrifices of millions of men and women from more than 100 countries around the world, Germany would have won!

Is Mindfulness the New Prozac?

Mahatma Gandhi once said, “First they ignore you, then they ridicule you, then they fight you, and then you win”.  This sentiment might well be applied to the recent popularity of mindfulness as a means of treating common mental illnesses and as a method for stress reduction.

The practice of mindfulness – of stilling your thoughts, relaxing your body, and becoming focused on the here and now – has been around for several millennia.  Popularised in the west by the hippy generation, mindfulness aka meditation was largely ignored as a somewhat obscure practice that could have little useful impact for most people.  It was only when professor of medicine, Jon Kabat Zinn brought the meditation practices learned from yoga and Zen Buddhism into medicine that the potential benefits of mindfulness for people experiencing stress and mental health problems began to be realised.

The modern forms of Mindfulness-Based Stress Reduction and Mindful Cognitive Behavioural Therapy have only proven themselves in the last 20 years, and were largely ignored (and occasionally ridiculed) until about 5 years ago.  However, in the last 5 years, we have witnessed a growing interest in the application of mindfulness practice not just as a mental health therapy, but as an aid to educational and business success.

There is no doubt that the practice of mindfulness can be very helpful for thousands of people affected by common mental health problems.  But it isn’t a miracle cure.  Nor is it an entirely benign and peaceful practice – while the aim of meditation is to switch off your thought processes in order to become fully present, the practice often involves wading through traumatic memories, fears and worries.  Both Buddhist and yoga meditation teachers warn that your mind (like an unruly monkey) will fight hard every time you set out to tame it.  So mindfulness is a life-long practice, not a 6-week quick-fix for the often profound psychological and social causes of mental illness.

Like Prozac and Cognitive Behavioural Therapy (CBT) before it, Mindfulness has followed a path to popularity that will inevitably lead to mass disappointment.  This disappointment will come not from mindfulness itself – Prozac and CBT continue to help millions of people every year, and there is no reason why mindfulness should be any different.  Rather, the problems come when politicians and public health systems seek to use these approaches as one-size-fits-all mass treatments.

Prozac didn’t fail because it didn’t work.  It failed because it didn’t work for everyone.  CBT has not failed because it didn’t work.  It failed because it didn’t work for everyone.  Mindfulness won’t work for everyone either.

Antidepressants like Prozac failed in part because the pharmaceutical companies’ marketing departments grossly over-stated their impact on people with depression.  But a larger part of their failure lay with the millions of people who believed that all they had to do was to take Prozac. Similar failures are now emerging in relation to CBT.  Whatever its initial promise, the attempt to deliver it to a mass of patients through the English Improving Access to Psychological Therapies (IAPT) programme has resulted in a 58 percent failure rate.  And just like Prozac, far too many people have been led to believe that attending CBT sessions was all they had to do.

One thing Prozac, CBT and mindfulness have in common is that those using them to reduce their stress or treat their mental illness must also take action.  If they work for you, drugs like Prozac may lift your mood and increase your energy levels so that taking action will be easier.  Talking therapies like CBT can help you to work out what actions you need to take. Mindfulness can also help you to unlock the very core of your being, enabling you to develop core skills and realise your deepest dreams and wishes: But only if you take action.

The problem is that most of us either do not want to, or do not know how to take action.  So with mindfulness now emerging to eclipse CBT (just as it eclipsed Prozac) as the most popular treatment for common mental health problems, it looks set to follow the same trajectory from miracle cure to disappointment.