So is there an epidemic of male suicides? I’ll assume we’re talking about the USA although what I’ll say goes for most other countries. Here are the facts:
In summary, there is no male suicide outbreak. Every suicide is a tragedy and since most suicides are men, it is largely a male tragedy, one that deserves all possible attention – but it is not an epidemic.
Then again, perhaps by “epidemic” Milo does not mean to imply that this was a new phenomenon? Some epidemics last a long time, after all. Surely it’s shocking that males have such high suicide rates, however long this has been true?
Well, yes, but my point is that whatever is driving male suicides, it is not especially modern, and is not confined to the West. So the problem, whatever it is, is unlikely to be due to how we ‘treat boys’, given that boys were treated very differently 100 years ago, in Afghanistan or in Zimbabwe today, and yet the male suicide bias has remained all too constant.
Incidentally, Milo’s is not the first simplistic theory to have come undone when faced with the facts about suicide. For instance, back in 2009 a pop psychologist called Oliver James claimed that British people are ‘twice as unhappy’ as their counterparts in the rest of Europe. However, this does not seem plausible given that British suicide rates are much lower than those in some of the other European countries, such as France and Germany, which James held up as models of well-being.
Similarly, consider the idea that we can measure and compare levels of mental illness in different countries around the world using standardized surveys. These surveys have been carried out, at great expense. The problem is, that these estimates don’t correlate with suicide rates. For instance, Japan’s suicide rate is more than double that of the USA, even though Japan has a rate of mental illness (according to the surveys) three times smaller than the USA.
Overall, suicide statistics are, if you’ll forgive the expression, the graveyard of bad ideas about society.
“Personality differences” between people from different countries may just be a reflection of cultural differences in the use of ‘extreme’ language to describe people.
That’s according to a very important paper just out from an international team led by Estonia’s René Mõttus.
There’s a write up of the study here. In a nutshell, they took 3,000 people from 22 places and asked them to rate the personality of 30 fictional people based on brief descriptions (which were the same, but translated into the local language). Ratings were on a 1 to 5 scale.
It turned out that some populations handed out more of the extreme 1 or 5 responses. Hong Kong, South Korea and Germany tended to give middle of the road 2, 3 and 4 ratings, while Poland, Burkina Faso and people from Changchun in China were much more fond of 1s and 5s.
The characters they were rating were the same in all cases, remember.
Crucially, when the participants rated themselves on the same personality traits, they tended to follow the same pattern. Koreans rated themselves to have more moderate personality traits, compared to Burkinabés who described themselves in stronger tones.
Whether this is a cultural difference or a linguistic one is perhaps debatable; it might be a sign that it is not easy to translate English-language personality words into certain languages without changing how ‘strong’ they sound. However, either way, it’s a serious problem for psychologists interested in cross-cultural studies.
I’ve long suspected that something like this might lie behind the very large differences in reported rates of mental illness across countries. Studies have found that about 3 times as many people in the USA report symptoms of mental illness compared to people in Spain, yet the suicide rate is almost the same, which is odd because mental illness is strongly associated with suicide.
One explanation would be that some cultures are more likely to report ‘higher than normal’ levels of distress, anxiety – a bit like how some make more extreme judgements of personality.
So it would be very interesting to check this by comparing the results of this paper to the international mental illness studies. Unfortunately, the countries sampled don’t overlap enough to do this yet (as far as I can see).
Mõttus R, et al (2012). The Effect of Response Style on Self-Reported Conscientiousness Across 20 Countries. Personality and Social Psychology Bulletin PMID: 22745332
Clinical trials of cognitive behavioural psychotherapy (CBT) for depression are often of poor quality – and are no better than trials of the rival psychodynamic school.
So says a new American Journal of Psychiatry paper that could prove controversial.
CBT is widely perceived as having a better evidence base than other therapies. The “creation myth” of CBT (at least as I was taught it) is that it was invented by a psychoanalyst who got annoyed at the unscientific nature of psychodynamic i.e. Freudian-influenced therapy. CBT has always looked on clinical trials more favorably than the dynamic school.
However, the authors of this meta-analysis found that while there are certainly lots of published CBT trials for depression, they’re actually no better quality than the psychodynamic trials.
“Surprisingly” (their word), they found no difference between the CBT for depression trials, and the psychodynamic trials, on a rating score of trial methodology.
Trials got better over time, but the two groups improved equally (see above). The mean score was 25.5 for CBT and 25.1 for dynamic, on a scale that goes from 0 to 48. Anything over 24 points is deemed acceptable but this is clearly an arbitrary cut-off.
The RCTP-QRS scale is relatively new and it was developed by the people who wrote this paper (albeit with the input of other experts.) There’s 24 items and each gets a score from 0 (bad) to 2 (good). Items are things like “Adaquate sample size”, “Patients randomly assigned to group”, etc.
Worryingly, better CBT trials tended to find smaller benefits of CBT over the comparison treatment. The overall results showed that while CBT was clearly better than doing nothing, it was pretty much the same as antidepressants, and other psychotherapies, in adults with depression:
The article follows one from the same group, Gerber et al, who reviewed the evidence for psychodynamic therapy in more detail. And last year, another team reported evidence of publication bias in psychotherapy trials. In this study, the authors report possible publication bias, but they don’t go into detail.
Overall this is interesting stuff, and a reminder that while CBT has the most evidence of any psychotherapy, this is not the same thing as saying that it has the best evidence…
The first direct evidence of a genetic link to attention-deficit hyperactivity disorder has been found, a study says.
Wow! That’s the headline. What’s the real story?
The research was published in The Lancet, and it’s brought to you by Wilson et al from Cardiff University: Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder.
The authors looked at copy-number variations (CNVs) in 410 children with ADHD, compared to 1156 healthy controls. A CNV is simply a catch-all term for when a large chunk of DNA is either missing (“deletions”) or repeated (“duplications”), compared to normal human DNA. CNVs are extremely common – we all have a handful – and recently there’s been loads of interest in them as possible causes for psychiatric disorders.
What happened? Out of everyone with high quality data available, 15.6% of the ADHD kids had at least one large, rare CNV, compared to 7.5% of the controls. CNVs were especially common in children with ADHD who also suffered mental retardation (defined as having an IQ less than 70) – 36% of this group carried at least one CNV. However, the rate was still elevated in those with normal IQs (11%).
A CNV could occur anywhere in the genome, and obviously what it does depends on where it is – which genes are deleted, or duplicated. Some CNVs don’t cause any problems, presumably because they don’t disrupt any important stuff.
The ADHD variants were very likely to affect genes which had been previously linked to either autism, or schizophrenia. In fact, no less than 6 of the ADHD kids carried the same 16p13.11 duplication, which has been found in schizophrenic patients too.
So…what does this mean? Well, the news has been full of talking heads only too willing to tell us. Pop-psychologist Oliver James was on top form – by his standards – making a comment which was reasonably sensible, and only involved one error:
Only 57 out of the 366 children with ADHD had the genetic variant supposed to be a cause of the illness. That would suggest that other factors are the main cause in the vast majority of cases. Genes hardly explain at all why some kids have ADHD and not others.
Well, there was no single genetic variant, there were lots. Plus, unusual CNVs were also carried by 7% of controls, so the “extra” mutations presumably only account for 7-8%. James also accused The Lancet of “massive spin” in describing the findings. While you can see his point, given that James’s own output nowadays consists mostly of a Guardian column in which he routinely over/misinterprets papers, this is a bit rich.
The authors say that
the findings allow us to refute the hypothesis that ADHD is purely a social construct, which has important clinical and social implications for affected children and their families.
But they’ve actually proven that “ADHD” is a social construct. Yes, they’ve found that certain genetic variants are correlated with certain symptoms. Now we know that, say, 16p13.11-duplication-syndrome is a disease, and that its symptoms include (but aren’t limited to) attention deficit and hyperactivity. But that doesn’t tell us anything about all the other kids who are currently diagnosed with “ADHD”, the ones who don’t have that mutation.
“ADHD” is evidently an umbrella term for many different diseases, of which 16p13.11-duplication-syndrome is one. One day, when we know the causes of all cases of attention deficit and hyperactivity symptoms, the term “ADHD” will become extinct. There’ll just be “X-duplication-syndrome”, “Y-deletion-syndrome” and (because it’s not all about genes) “Z-exposure-syndrome”.
When I say that “ADHD” is a social construct, I don’t mean that people with ADHD aren’t ill. “Cancer” is also a social construct, a catch-all term for hundreds of diseases. The diseases are all too real, but the concept “cancer” is not necessarily a helpful one. It leads people to talk about Finding The Cure for Cancer, for example, which will never happen. A lot of cancers are already curable. One day, they might all be curable. But they’ll be different cures.
So the fact that some cases of “ADHD” are caused by large rare genetic mutations, doesn’t prove that the other cases are genetic. They might or might not be – for one thing, this study only looked at large mutations, affecting at least 500,000 bases. Given that even a deletion or insertion of just one base in the wrong place could completely screw up a gene, these could be just the tip of the iceberg.
But the other problem with claiming that this study shows “a genetic basis for ADHD” is that the variants overlapped with the ones that have recently been linked to autism, and schizophrenia. In other words, these genes don’t so much cause ADHD, as protect against all kinds of problems, if you have the right variants.
If you don’t, you might get ADHD, but you might get something else, or nothing, depending on… we don’t know. Other genes and the environment, presumably. But “7% of cases of ADHD associated with mutations that also cause other stuff” wouldn’t be a very good headline…
British pop psychologist Oliver James says Avoid putting the under-threes in daycare if you can.
The story starts with cortisol, the hormone we secrete when faced with threat, leading to “fight or flight”. Its levels were measured in 70 15-month-old children at home before they had ever been to daycare. Compared with this, the levels had doubled within an hour of the mother leaving them in daycare on the first, fifth and ninth days. Measured again five months later, while no longer double, they were still significantly elevated compared with the home baseline…
Here’s the study, “Transition to child care: associations with infant-mother attachment, infant negative emotion, and cortisol elevations.” James’s summary is actually not too bad, at least by Jamesian standards, but it omits a number of important points…
Freudian psychoanalysis is the key to treating depression, especially the post-natal kind (depression after childbirth). That’s according to a Guardian article by popular British psychologist and author Oliver James. He says that recent research has proven Freud right about the mind, and that psychoanalysis works better than other treatments, like cognitive-behavioural therapy (CBT).
Neuroskeptic readers have encountered James before. He’s the person who thinks that Britain is the most mentally-ill country in Europe. I disagree, but that’s at least a debatable point. This time around, James’s claims are just plain wrong.
So, some corrections. We’ve got a lot to cover, so I’ll keep it brief:
“10% [of new mothers] develop a full-blown depression…which therapy should you opt for? [antidepressants] rule out breastfeeding“ – No, they don’t. Breast-feeding mothers are able to use antidepressants when necessary, according to the British medical guidelines and others:
Limited data on effects of SSRI exposure via breast milk on weight gain and infant development are encouraging. If a woman has been successfully treated with a SSRI in pregnancy and needs to continue therapy after delivery, there is no need to change the drug, provided the infant is full term, healthy and can be adequately monitored…
James’s statement is a dangerous mistake, which could lead to new mothers worrying unduly, or even stopping their medication.
“People given chalk pills but told they are antidepressants are almost as likely to claim to feel better as people given the real thing.” – This is true in many cases, although it’s a little bit more complicated than that, but this refers to trials on general adult clinical depression, not post-natal depression, which might be completely different.
There’s actually only one trial comparing an antidepressant to chalk placebo pills in post-natal depression. The antidepressant, Prozac, worked remarkably well, much better than in most general adult trials. This was a small study, and we really need more research, but it’s encouraging.
“Regarding the talking therapies, in one study depressed new mothers were randomly assigned to eight sessions of CBT, counselling, or to psychodynamic psychotherapy. Eighteen weeks later, the ones given dynamic therapy were most likely to have recovered (71%, versus 57% for CBT, 54% counselling).”
This is cherry-picking. In the trial in question the dynamic (psychoanalytic) therapy was slightly better than the other two when depression was assessed in one way, which is what James quotes. The difference was not statistically significant. And using another depression measurement scale, it was no better at all. Take a look, it’s hardly impressive:
“Studies done in the last 15 years have largely confirmed Freud’s basic theories. Dreams have been proven to contain meaning.” – Nope. Freud believed that dreams exist to fulfil our fantasies, often although not always sexual ones. We dream about what we’d like to do. Except we don’t actually dream about it, because we’d find much of it shameful, so our minds hide the true meaning behind layers of metaphor and so forth. “Steep inclines, ladders and stairs, and going up or down them, are symbolic representations of the sexual act…”
If you believe that, good for you, and some people still do, but there has been no research over the past 15 years supporting this (although this is quite interesting). There was never any research really, just anecdotes
“Early childhood experience has been shown to be a major determinant of adult character.” Nope. The big story over the past decade is that contra Freud, “shared environment”, i.e. family life and child rearing make almost no contribution to adult personality, which is determined by a combination of genes and “individual environment” unrelated to family background. One could argue about the merits of this research but to say that modern psychology is moving towards a Freudian view is absurd. The opposite is true.
“And it is now accepted by almost all psychologists that we do have an unconscious and that it can contain material that has been repressed because it is unacceptable to the conscious mind.” Nope. Some psychologists do still believe in “repressed memory” theory, but it’s highly controversial. Many consider it a dangerous myth associated with “recovered memory therapy” which has led to false accusations of sexual abuse, Satanic rituals, etc. Again, they may be wrong, but to assert that “almost all” psychologists accept it is bizarre.
“Although slow to be tested, the clinical technique [of Freudian psychoanalysis] has now also been demonstrated to work. The strongest evidence for its superiority over cognitive, short-term treatments was published last year…”
First off, the trial referred to was not about post-natal depression, and it didn’t test cognitive therapy at all. It compared long-term psychodynamic therapy, vs. short-term psychodynamic therapy, vs. “solution-focused therapy” in the treatment of various chronic emotional problems. No CBT was harmed in the making of this study.
After 1 year, long-term dynamic therapy was the worst of the three. At 2 years, they were the same. At 3 years, long-term dynamic therapy was the best. Although all these differences were small. Short-term dynamic therapy was no better than solution-focused therapy, which is rather a point against psychoanalysis since solution-focused therapy is firmly non-Freudian. And amusingly, the “short-term” dynamic therapy was actually twice as long as the dynamic therapy in the first study discussed above, which James praised! (20 weekly sessions vs 10). (Edit 23.10.09)
James ends by slagging off CBT and its practitioners, and suggesting that we need a “Campaign for Real Therapy”, i.e. not CBT, something he has suggested before. This is the key to understanding why James wrote his muddled piece.
The British government is currently pouring hundreds of millions into the IAPT campaign which aims to “implement National Institute for Health and Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders”. NICE guidelines essentially only recommend CBT, so this is effectively a campaign to massively expand CBT services. CBT is widely seen as the only psychotherapy which has been proven to work, in Britain and increasingly elsewhere too.
Oliver James, like quite a lot of people, doesn’t like this. And in that, he has a point. There are serious debates to be had over whether CBT is really better than other therapies, and whether we really need lots more of it. There are also serious debates to be had over whether antidepressants are really effective and whether they are over-used. But these are all extremely complex questions. There are no easy answers, no short cuts, no panaceas, and James’s brand of sectarian polemic is exactly what we don’t need.
In the Guardian, Oliver James gets his hands on some mental health statistics. As I have explained before, this rarely ends well. Zarathustra of the really wonderful Mental Nurse blog takes James to to task. Hilarity ensues.
Or so says Oliver James(*) on this BBC radio show in which he also says things like “I absolutely embrace the credit crunch with both arms”.
Oliver James is a British psychologist best known for his theory of “Affluenza”. This is his term for unhappiness and mental illness caused, he thinks, by an obsession with money, status and possessions. Affluenza, James says, is especially prevanlent in English-speaking countries, because we’re more into free-market capitalism than the people of mainland Europe.
In fact, James regularly makes the claim that we in Britain, the U.S., Australia etc. are today twice as likely to be mentally ill as “the Europeans”. This is because rates of mental illness supposedly surged in the English-speaking world due to 1980s Reagan/Thatcher free market policies. Hence why he welcomes the current economic unpleasantness.