Thursday, June 27, 2019

Is Day Care Good for Children?

You have heard it over and over again. The solution to a new mother’s problem balancing childcare with work is day care. It’s been around so often that you are probably numb to it. Last week however, Sen. Elizabeth Warren proposed a new bill, called the Universal Child Care and Early Learning Act. It proposed a flood of government funded, government regulated day care centers. 

As with all of these programs, it sounds good. It sounds like day care is the solution for women who want to keep working, even though they have very young children. And yet, as Erica Komisar points out in an important Wall Street Journal op-ed, day care is bad for children. It should not be news. We should know all about it by now. And yet, in our ideologically driven age, we ignore it.

Komisar explains the point clearly:

Day care may be cost effective, but it is unhealthy for the emotional well-being of children under 3. Infants are neurologically fragile, and the first thousand days of life are a critical window of social-emotional right-brain development, which depends on the physical and emotional presence of the primary caregiver, usually the mother.

Mothers are biologically important to regulate children’s emotions from moment to moment by soothing them when they are in distress—and also to buffer them from stress. Only after age 3 do children develop the ability to regulate their own emotions and become resilient to stress.

If the mother can’t be with the child for the first three years, a consistent primary caregiver—ideally a relative—is the next-best alternative. If paid child care is necessary, the ratio of children to caregivers should be no greater than 3 to 1. That’s simply not cost-effective in institutionalized day care. Even the most skilled, well-paid and empathic caregiver can’t give sufficient care to more than three children under 3.

How do advocates of early day care rationalize their policy? They declare that toddlers in day care will learn early socialization. Unfortunately, Komisar notes, very young children cannot deal with socialization:

Some day-care advocates cite the benefits of early socialization. But children under 2 aren’t equipped psychologically or emotionally to be social in a group setting. The day-care environment is stressful and overstimulating to an infant, whose nervous system is still developing, and who depends upon the primary caregiver for emotional security and feeling of safety.

As for the research, a study out of Oxford University has shown that group day care for children under the age of 2 produces psychological damage:

A study by Oxford’s Allan Stein and Kathy Sylva found that participation in group day care before age 2 increases a child’s likelihood of developing behavioral and emotional issues later in childhood as a reaction to coping with the fear of abandonment and loss. This can take the form of aggression, anger and difficulty in establishing intimate relationships.

In today’s Senate Warren’s bill is dead on arrival. If she becomes the presidential candidate or even the president, watch out.

Is She Really an Asshole?

Regrettably, Polly outdoes herself this week. On an average day New York Magazine’s advice columnist counts as the worst of the bunch… filling her column with essence of psychobabble. If you have a problem and you ask Polly for help, you have a bigger problem than you think you have.

In many cases Polly’s ignorance is harmless. After all, it’s like a bunch of young people sitting around sharing the silliness that their therapists have been offering. But, in today’s letter, we see a woman whose problems have little to do with psychology and more to do with neurology. Telling someone with neurological problems that she needs merely to get in touch with her feelings and to lard on a psycho narrative that purports to explain it all is grossly irresponsible. 

The problem, as best the letter writer describes it is: autism. The woman seems to be a high functioning autistic. Perhaps she has Asperger's syndrome. In any event, she blurts out inappropriate comments at the wrong time in the wrong place to the wrong people... often to people she doesn't know. She has no filter and, under such circumstances, she just says what she is thinking. By her reckoning, this makes her an asshole. It is not the same thing as being high functioning autistic. 

We do not know what the woman does for a living. We know that she is married. That is all we know about her life circumstances:

Last night, I went out with my husband to enjoy a big festival in town. We both noticed a sign from a distance, but as we approached, another reveler stood directly in front of the sign to read it. “Wow, I hope no one else wants to read that sign, maybe from another angle,” I commented to my husband loud enough for the reader to hear. My husband quietly chuckled and hugged me, saying “Oh, you.”

Later, a woman with a pram cut across our path, not looking where she was going. “We get it! You’ve spawned! You’re more important than us!” I said to her. Another quiet chuckle from my husband.

And I realized this is … common. My outbursts. Maybe too common? Throughout my life, I’ve been told I’m opinionated, brutal, delightfully honest, brave, have balls of steel … a bunch of words presented as flattery and accompanied by laughter, but underneath there may be discomfort from others when I open my mouth — but I don’t feel it.

I have friends who delight in my company, but only when I’m in the right mood. I’ll call out perceived assholes in public, tell men to stop leering at my friends, get impatient and roll my eyes when I am expected to nod and smile. And to be fair, it doesn’t take much for me to be in the right mood. Other friends will only ever take me out to dinner to get my advice. “I know you’ll be honest with me,” they say, and I am. Even more say, “Gosh, I wish I could be honest about my feelings like you.”

What is the problem? It turns out that her family knows what the problem is. Apparently, it has never received any treatment:

I learned my sister once told her friends, in advance of my visit, that I was autistic so they shouldn’t be shocked if I said something blunt or inappropriate. She may not be wrong — I struggle with social interactions, reading emotions, and connecting with people, but I also seem to miss the day-to-day filter that everyone else has, where your mind comes up with the rude thing to say but doesn’t blurt it out for all to hear.

Perhaps she should be a stand-up comedienne? At any event, most of her friends seem to understand her problem. They seem to be willing to tolerate her… up to a point:

And I’m not punished for my bullshit. No one calls me out. At worst, I’ll get a nonresponse, but many people encounter my commentary as some form of entertainment. When I was younger, I thought this was cool. I was witty. I’m starting to realize I might just be a plain old asshole.

The one redeeming quality in my outspokenness, I think, is that I will intervene if I feel someone is being treated poorly. I’ve scared off numerous creepy men from women I don’t know at nightclubs and gotten them home safely, put myself in the middle of stupid fights, and stood up for shopkeepers who were being abused. This kind of assholery seems useful.

But how do I stop being that asshole who punches down? I am, at heart, cynical. I have a deep distrust of others, a shitty upbringing, and worse genes that have stuck me with ongoing depression (treated). I am not that happy-go-lucky girl next door.

So how do I become a nice person who cares what people think and has patience and bites their tongue when someone cuts in line or has no awareness of their surroundings? But more important, how do I do all this without imploding from built-up rage?

Not Witty, Just an Asshole

As for treatment, one would normally suggest that she try some form of cognitive or behavioral therapy. These treatments have been shown to be helpful for children with autistic spectrum disorder. I do not know how well they work with adults, but clearly, some form of reconditioning, to learn some level of self-control would be helpful.

Polly, of course, knows nothing and is proud to regale us with her ignorance. She thinks that the symptoms are meaningful expressions of emotional conflicts. Thus, she offers up the old-line, now-superseded psycho approach to such disorders:

Because your rage is a manifestation of your sadness. Your distrust is a manifestation of the emotional neglect you experienced as a child. Your depression is a manifestation of your melancholy view of the world, your anxiety around intimacy, and your fear of your own insecurities. You can treat your depression, but you might find that it still leaks out no matter what you do. That’s true because some of the nongenetic underlying conditions that cause your depression (and rage and distrust) are still there. You need to address your deep-seated beliefs, your core fears, and your terror at being mistreated and misunderstood by others (who are presumed to be callous) in order to tackle your depression at a deeper level. You need to face your own callousness toward yourself, which lies at the heart of your callousness toward others.

For decades therapists were handing out similar bromides to patients who were suffering from a neurological condition. In France, they probably still do. The result has been that autistic patients were mistreated. In some cases they were denied access to the cognitive and behavioral treatments that might help them.

Normally, Polly just engaged in banal platitudes… worthless nonsense. In this case she did not even bother to research autism. No one would suggest that she ought to know how to diagnose a neurological condition... but the letter writer has offered the diagnosis herself. Polly simply ignored it. As a result Polly has become an obstacle to treatment. She should bow her head in shame for this one.

Will the real asshole please stand up....

Wednesday, June 26, 2019

The New York Blues

We have noted, with little chagrin, that America’s great blue cities are disintegrating. Whether Los Angeles, San Francisco, Chicago or Baltimore… these cities are suffering from homeless encampments, high crime and drug epidemics. In Los Angeles, typhus seems to have made a comeback.

But, now, for those of us, like your humble blogger, who live in New York City, the bell seems to be tolling. New York City and New York State have gone deep blue, and the attendant social pathologies are beginning to make their presence known. 

For many years the city was well-enough led, by Rudy Giuliani and Michael Bloomberg. Now, under the aegis of Comrade Bill de Blasio, things are beginning to take a turn toward the worst.

Kristin Tate has the story for The Hill:

Dragging business practices, skyrocketing taxes, telecommuting, and loss of special status is a toxic mix for New York. Among young people, New York is becoming passe. During recent years, both the city and the state of New York have lost residents, as waves of educated and high earning millennials have fled. In fact, more than 46 percent of New Yorkers of all ages moving out of the state are in the bracket earning at least $150,000.

The Empire State budget is in near freefall, in no small part due to lower revenue from middle class and upper class workers, while growing states like Texas and Florida are in surplus. Governor Andrew Cuomo noted a $2.3 billion hole in the state budget earlier this year, caused largely by oppressive policies that have gutted the local population and economy. More than 450,000 people moved out of New York in the last year alone.

New York is filled with rich people, says Mayor de Blasio. They can afford to be taxed. Apparently, not so much any more:

In the Big Apple, the tax burden on high earners is onerous. The local government is reliant on the top 10 percent for over 70 percent of taxes paid, with the top 1 percent paying more than the bottom 90 percent combined. Any efforts to help the most needy citizens are heavily dependent on the city keeping its reputation as a driver of the national economy. The accelerating outflow of middle class and upper class residents will no doubt tarnish that. As steep declines in revenue hit, spending cuts will burden the urban poor rather than the bureaucrats.

The current spending levels are likely unsustainable for the Big Apple in the long term. The New York City Council passed a $93 billion budget, which includes spending hikes of 6 percent for salaries, 9 percent for other employee benefits, 9 percent for debt service, 11 percent for health insurance, 12 percent for public assistance funding, and more. This local budget also set aside a new line item for taxpayer funded abortions, an army of new social workers, and even a package for the Green New Deal.

If New York continues to lose taxpayers in droves, the city will not be able to fund its current initiatives, let alone new spending increases. As the exodus further dwindles local revenue, public programs will eventually require massive cuts. Meanwhile, increased pension spending will eat up any slack the city has left. The pension plans are already underfunded to the tune of tens of billions of dollars. Retirement spending comprises nearly a quarter of the annual budget and will only continue growing.

We have seen this picture before:

Whenever push came to shove in the past, cities like Chicago and Detroit prioritized bureaucratic spending and honoring pensions over funding public programs and infrastructure. If New York takes a similar route, the people most dependent on campaign promises will be left behind. The Big Apple has been down this path before with the struggling economy and massive spending hikes of the 1970s. New York leaders overpromised and underdelivered, while moderate mayors like Fiorello LaGuardia were unfortunately replaced by increasingly radical or incompetent politicians.

Democratic politicians talk about taxing the rich as though their wealth were a bottomless punch bowl. Apparently, such is not the case:

Those very same wealthy people that politicians have demonized to gain votes are the actual linchpins for the spending largesse of progressives. Once high earners are gone, soon followed by middle class taxpayers, the promises of democratic socialism by Mayor Bill de Blasio will also vanish. Many of those who remain in New York will be those without the means to leave.

Now that Bernie Sanders imagines that he is going to tax Wall Street trading, how long will it be before Wall Street banks move their trading operations off shore? I will conclude with a recent proposal: if we want to eliminate student loan debt why not tax university endowments? 

The Apps That Read Minds

It’s intriguing, to say the least. We now have created machines that can read your mind. They need but take a brief glance at your texts or your Instagram posts and they can tell whether you are depressed or suicidal. 

When it comes to diagnosing mental health problems, physicians, David Brooks remarks, are fallible:

Primary care physicians can be mediocre at recognizing if a patient is depressed, or at predicting who is about to become depressed. Many people contemplate suicide, but it is very hard to tell who is really serious about it. Most people don’t seek treatment until their illness is well advanced.

Using A.I., researchers can make better predictions about who is going to get depressed next week, and who is going to try to kill themselves.

And then what? Did anyone ask whether these patients want AI to read their intentions and behaviors? Will they be happy to hear that an app has invaded their privacy and has consigned them to psychiatric treatment? And besides, what treatments are currently on offer?

To state the obvious, depressed patients commonly feel disconnected from other human beings. The cure for disconnection is obviously connection. I am not saying this to insult your intelligence, but because the thought has never crossed the minds of most of the therapy world. After all, connection involves conversational exchange, person to person, preferably in person or at least over Skype or the telephone. Talking to a recording advice is hardly an adequate substitute. 

When our new techno gadgets can read your mind by analyzing the grammatical structure of your sentences you are relieved of the need to communicate and to connect. The more you talk with another person the more you might see that you do not need to be depressed. The more you talk the more you might discover ways to solve your problems. The apps only know that you have problems. They do not know how to help you to solve them.

If so, one of the lifelines to mental health has been eliminated. Is it not depressing to have an app read your mind?

It might be a good idea for psychiatrists to learn how to make diagnoses through conversation, rather than by running down a check list. As for primary care physicians they are barely qualified to diagnose depression or suicidal tendencies. 

Consider this:

On its website, the Crisis Text Line posts the words that people who are seriously considering suicide frequently use in their texts. A lot of them seem to be all-or-nothing words: “never,” “everything,” “anymore,” “always.”

This is not news. The mental health profession, especially its cognitive therapists, have long known about this. But, what will happen when prospective patients learn the cues. If they want to hide their intentions they might very well learn how to manipulate the machine.

And, among other obvious thoughts, when people learn that their communications to help lines are being monitored and analyzed by AI apps… will this make it more or less likely that they will call these help lines?

If they are suffering from disconnection, won’t they think that the prevalence of mind reading apps says that they need not communicate with anyone.

Or else, consider these observations, which are very likely true:

When people suffering from depression speak, the range and pitch of their voice tends to be lower. There are more pauses, starts and stops between words. People whose voice has a breathy quality are more likely to reattempt suicide. Machines can detect this stuff better than humans.

There are also visual patterns. Depressed people move their heads less often. Their smiles don’t last as long. One research team led by Andrew Reece and Christopher Danforth analyzed 43,950 Instagram photos from 166 people and recognized who was depressed with 70 percent accuracy, which is better than general practice doctors.

Not to be any more churlish than usual, we should how much of these conversational changes derive from the way an interviewer is conducting the interview. If a psychoanalyst is sitting back and saying nothing, that might well induce the patient to indulge more depressive speech patterns. If a therapist is more adept at engaging with a patient, such patterns might diminish.

Brooks finds this hopeful. But Brooks knows nothing about mental health issues, and ought, in the end, not to opine about them. Yes, I understand that writing a regular op-ed column for the Times makes you think that you are qualified to write about things you know nothing about. It's an occupational hazard.

But, AI is coming. It is coming to the mental health field. And not just to the mental health field. The chances for abuse are legion.

Brooks writes:

The upshot is that we are entering a world in which people we don’t know will be able to understand the most intimate details of our emotional life by observing the ways we communicate. You can imagine how problematic this could be if the information gets used by employers or the state.

But if it’s a matter of life and death, I suspect we’re going to go there. At some level we’re all strangers to ourselves. We’re all about to know ourselves a lot more deeply. You tell me if that’s good or bad.

Isn’t it depressing to think that people we don’t know will be able to read our minds, to discern facts that we might choose not to share? If you think that the AI developers will stop after they discover ways to see whether you are depressed or suicidal, you are hopelessly naive. Why would they not want to delve into some of your other secrets?

If it’s just about downloading an app, whatever makes you think that the state or your employer will not be rushing out to buy one? The more pervasive these apps become, the less inclined will people become to communicate... with anyone.

Of course, we can pretend that it’s a matter of life and death. It’s the all-or-nothing argument that people trot out when they want to persuade you to buy something you shouldn’t be buying.

Besides, the argument assumes that we know how to treat depression. By and large we are not very good at it. As noted on recent blog posts, SSRIs comport a significant suicide risk. And psychiatrists seem to diagnose and prescribe willy nilly.

Brooks ignores the issue. As for the notion that the app can teach us about ourselves, our interactions with other human beings teaches us as much, within the context of human relationships. The notion that an app is seeing inside your mind, thus that you have no more privacy, is likely to produce more, not less depression. 

Tuesday, June 25, 2019

The Dangers of SSRIs

This ought to be well enough known by now, but apparently it isn’t. Every time a high profile individual commits suicide the media issues some well intended advice, to the effect that we need to have a national conversation about depression. And it always adds, wistfully, that if only the victim could have received proper treatment.

And yet, many of these suicide victims were receiving mental health treatment. As I noted in my post about Lauren Slater, psychiatric treatment seems to be doled out haphazardly. It produces some very unpleasant side effects. And besides, we ought to emphasize, yet again, a simple fact, known to all physicians and psychopharmacologists: namely, that antidepressant medication, especially SSRIs, comport a suicide risk.

The Daily Mail has the story:

Taking antidepressants raises the risk of suicide, a study suggests.

Experts last night warned that patients should be told of the dangers before they start taking the pills.

The research found depressed people on the drugs were more than twice as likely to attempt suicide as similar patients who were not taking them.

Study leader Dr Michael Hengartner, of Zurich University in Switzerland, said: ‘We can be confident that these drugs are producing an excess rate of suicides, beyond the depression itself.

‘There is no doubt that this must be a response to the pharmacological effect of the drugs themselves.’ 

Although the increased risk appears stark, in real terms the researchers calculated only 77 extra suicides per 100,000 patients taking the pills.

Scientists acknowledge that for many people, antidepressants are a lifeline.

Given that the Daily Mail is a British publication, it emphasizes how these medications are being prescribed in Great Britain:

But with more patients in Britain taking them than those in almost every other Western country, many doctors believe millions are being put at risk. 

Some seven million adults in England took the drugs in 2016/17. The researchers believe that for some, the chemicals in the pills can trigger severe agitation, restlessness and even psychotic episodes.

Dr Hengartner added: ‘I’m not saying no one should be given antidepressants, but doctors should be much more conservative about how they use them. One in six adults being given antidepressants like in the UK – that is alarming.

How bad is the risk?

The study found that people prescribed antidepressants were 2.5 times more likely to attempt suicide than depressed people taking placebo pills.

The research, published in the journal Psychotherapy and Psychosomatics, combined the results of 14 studies involving nearly 32,000 people taking a variety of antidepressants.

The authors stressed that the real-terms rise in risk was small, calculating that for every 100,000 taking the pills, there would be an extra 413 suicide attempts and an extra 77 suicides. But in England, this could add up to thousands of extra suicides.
The highest risk was found to occur in the first four weeks after the treatment begins.

And yet, the data for the study comes from the United States, of all places:

Professor Wendy Burn, president of the Royal College of Psychiatrists, pointed out that the study was based on US data, and four of the 14 drugs assessed are not available in the UK.

But she added: ‘This is an important issue, which we need to understand better. As with all medications, we need to balance the potential benefits and risks of harm from starting, continuing and stopping their use.

‘It is vital that people prescribed antidepressants are monitored closely, made aware of possible side effects and know how to seek help if they experience them.’

This ought not to be news. Strange to say, it is. And suicide is not the only risk factor, to being on or coming off the drugs:

Last month, the Royal College of Psychiatrists acknowledged for the first time that coming off the pills can cause severe side effects lasting months – with the worst-hit suffering nausea, anxiety and insomnia.

And two weeks ago, the European Medicines Agency issued guidance suggesting the most common pills – selective serotonin reuptake inhibitors or SSRIs – can cause long-term loss of sexual function.

Aside from teaching us that these pills are not a panacea, we all need to be far more aware of the potential bad side effects. Let’s accept that they are beneficial on balance. But, it is strange to see, thirty years after SSRIs were introduced, people coming to a belated awareness that those who take them need to be monitored and warned.

Hijab Wars in Iran

Calling Jacinda Ardern. You recall that the dimwitted virtue signalling prime minister of New Zealand was widely praised for donning a hijab after a terrorist opened fire in a Christchurch mosque, killing 51 and injuring dozens more.

But then, Iranian feminists rejected Ardern’s virtue signalling. After all, they have no right to remove their hijab, lest they be arrested, imprisoned and tortured. They see the hijab as an instrument of female oppression. They are having none of it.

Now, the Daily Mail reports on what happened to Iranian women who were caught not wearing the hijab:

This is the shocking moment a woman without a hijab is savagely dragged away by security forces in Iran after she and her friends were caught playing with a water pistol.

Footage posted by Iranian journalist Masih Alinejad, which was shot at an unknown location in the country, shows a confrontation between several officers and a group of girls.

In the footage uniformed officers can be seen standing around a police car as they attempt to detain a woman.

And also:

The country's morality police have frequently made headlines for arresting women who decline to wear Islamic headdress. 

Only last month, clashes broke out at Tehran University amid anger over the enforcement of Islamic laws which force female students to wear a headscarf. 

Students claimed that Iran's religious police and security forces had entered the campus to warn female students that they had to obey the hijab laws. 

There’s an ongoing struggle in Iran over the hijab. One would think that Western female leaders would take it into account before they indulged in virtue signalling.

Tehran University students protest Iran’s mandatory hijab law

Mob Rule at Harvard

In today’s New York Times Ronald Sullivan responds to Harvard University. He opens by reminding us of why he was dismissed as faculty dean of Winthrop House:

In May, Harvard College announced that it would not renew the appointment of me and my wife, Stephanie Robinson, as faculty deans of Winthrop House, one of Harvard’s undergraduate residential houses, because I am one of the lawyers who represented the Hollywood producer Harvey Weinstein in advance of his coming sexual assault trial. The administration’s decision followed reports by some students that they felt “unsafe” in an institution led by a lawyer who would take on Mr. Weinstein as a client.

Why did the administration do it? Because they thought that dismissing Sullivan and his wife would be therapeutic.

To which Sullivan responds:

I am willing to believe that some students felt unsafe. But feelings alone should not drive university policy. Administrators must help students distinguish between feelings that have a rational basis and those that do not. In my case, Harvard missed an opportunity to help students do that.

In a culture where therapy rules, students must be protected and coddled. We must suppress any stimulus that might hurt their delicate feelings. We have not been told, because the current cultural climate makes it impossible, that children who are protected from the least triggering stimulus will become hypersensitive. Having no experience processing potentially traumatizing stimuli, they will be prey to almost any stimulus whatever.

Sullivan recommends that hurt feelings be submitted to rational examination:

I would hope that any student who felt unsafe as a result of my representation of Mr. Weinstein might, after a reasoned discussion of the relevant facts, question whether his or her feelings were warranted. But Harvard was not interested in having that discussion. Nor was Harvard interested in facilitating conversations about the appropriate role of its faculty in addressing sexual violence and the tension between protecting the rights of the criminally accused and treating survivors of sexual violence with respect.

Evidently, the administration simply capitulated. The mob is in charge. Academic officials, at Harvard and elsewhere have attained a level of cowardice that speaks ill of their own ability to process emotion:

Instead, the administration capitulated to protesters. Given that universities are supposed to be places of considered and civil discourse, where people are forced to wrestle with difficult, controversial and unfamiliar ideas, this is disappointing.

Sullivan continues:

But I am profoundly troubled by the reaction of university administrators who are in charge of student growth and development. The job of a teacher is to help students think through what constitutes a reasonable argument. It is a dereliction of duty for administrators to allow themselves to be bullied into unprincipled positions.

Unchecked emotion has replaced thoughtful reasoning on campus. Feelings are no longer subjected to evidence, analysis or empirical defense. Angry demands, rather than rigorous arguments, now appear to guide university policy.

It’s not just that universities have redefined their purpose in terms of therapy, not education. More importantly, they are offering up bad therapy, therapy that will make students more, not less likely to suffer emotional distress.