It Is Time to Legalize Cocaine

 The US is gradually moving towards legalizing recreational use of marijuana.  It has taken a long time and there is still a long way to go, but it seems it is going to happen.  And the nation moves on with no dire consequences.  Nevertheless, it was still a bit startling for the relatively conservative magazine, The Economist, to declare the time has come to legalize Cocaine.  A compelling argument is made that the efforts to wipe out the cocaine economy are only making matters worse.  Before considering that perspective, a brief diversion into the history of recreational drugs and the motivations behind their illegalization is useful. 

David F. Musto has written the definitive history of anti-drug legislation in the United States: The American Disease: Origins of Narcotic Control.  Drugs such as opium, morphine, and cocaine were freely available throughout the nineteenth century.  The drugs were regularly used by physicians as medications and were widely available in commercial formulations generically referred to as “patent medicines.”  Cocaine could even be purchased in a syringe for self-injection.  Until 1903, Coca Cola contained cocaine.  Afterward, the cocaine was replaced with a new stimulant: caffeine.  Children were subjected to narcotics as a remedy for crankiness and sleeping difficulties.

“In the United States the exhilarating properties of cocaine made it a favorite ingredient of medicine, soda pop, wines and so on.  The Parke Davis Company, an exceptionally enthusiastic producer of cocaine, even sold coca-leaf cigarettes and coca cheroots to accompany their other products, which provided cocaine in a variety of media and routes such as a liquor-like alcohol mixture called Coca Cordial, tablets, hypodermic injections, ointments, and sprays.”

The addictive properties of these drugs were known and the personal and societal disruption they could cause were recognized.  There were movements to restrict or eliminate their use.   These actions were always countered by those who made money from the drug usage.  All legislative attempts at drug restrictions were ultimately driven by politics rather than science.  Legislation restricting cocaine provided the prime example.

This use of a targeted minority to focus popular disgust in order to obtain desired legislation was effective and became the normal approach with respect to criminalizing drug usage.

“The most passionate support for legal prohibition of narcotics has been associated with fear of a given drug’s effect on a specific minority.  Certain drugs were dreaded because they seemed to undermine essential social restrictions which kept these groups under control: cocaine was supposed to enable blacks to withstand bullets which would kill normal persons and to stimulate sexual assault.  Fear that smoking opium facilitated sexual contact between Chinese and white Americans was also a factor in its total prohibition.  Chicanos in the Southwest were believed to be incited to violence by smoking marijuana.  Heroin was linked in the 1920s with a turbulent age group: adolescents in reckless and promiscuous urban gangs.  Alcohol was associated with immigrants crowding into large and corrupt cities.”

The association of cocaine with blacks was intimately tied to the repressive conditions that the South believed were necessary to keep blacks in their “place.”  First their guns were taken away, then their civil rights, followed by prohibition of alcohol and a call to stop the selling of something called “Coca Cola.”  As usual, the Southern bloc of legislators was needed to get laws passed. To obtain their votes, the fear mongering they engaged in by relating blacks to cocaine became an important part of the political dialogue.

“The fear of the cocainized black coincided with the peak of lynchings, legal segregation, and voting laws all designed to remove political and social power from him.  Fear of cocaine might have contributed to the dread that the black would rise above ‘his place,’ as well as reflecting the extent to which cocaine may have released defiance and retribution.  So far, evidence does not suggest that cocaine caused a crime wave but rather that anticipation of black rebellion inspired white alarm.  Anecdotes often told of superhuman strength, cunning, and efficiency resulting from cocaine.  One of the most terrifying beliefs about cocaine was that it actually improved pistol marksmanship.  Another myth, that cocaine made blacks almost unaffected by mere .32 caliber bullets, is said to have caused southern police departments to switch to .38 caliber revolvers.  These fantasies characterized white fear, not the reality of cocaine’s effects, and gave one more reason for the repression of blacks.”

Cocaine and opiate products would become illegal in 1914, but racial politics did not go dormant.  Fears of black usage of the drug would arise anew during the 1970s and 1980s.  Extremely severe sentences for drug possession or sale came after a period of high crime rate and urban rioting.  In circumstances eerily reminiscent of the post-Reconstruction-era South, whites feared that the blacks, in their segregated urban sectors, might be getting out of control.  Drugs were already prohibited but, nevertheless, were widely available.  The goal of legislation then turned to pouring more resources into crime/drug control.  Can it possibly surprise anyone that the tried-and-true tactic of scaring people with suggestions of cocaine-crazed blacks on a crime spree was resurrected?

Carl Hart has also written a book for a general readership: High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.  In it he provides a perspective on addiction that is counter to conventional wisdom.  He suggests all our favorite addictive drugs, including alcohol and nicotine, can be categorized similarly. 

“…more than 75 percent of drug users—whether they use alcohol, prescription medications, or illegal drugs—do not have this problem [harmful addiction].  Indeed, research shows repeatedly that such issues affect only 10-25 percent of those who try even the most stigmatized drugs, like heroin and crack.”

Even the person who becomes a regular user of the drug continues to maintain the ability to choose to take the drug or not depending on the given circumstances.  The image of the addict being driven mad with desire for his drug just doesn’t happen.  Hart suggests that the desire for the drug is more closely analogous to the desire humans feel for sex and food—both being cravings difficult but possible to control. 

If the more prevalent and more damage-producing drugs such as alcohol, nicotine, and legal psychotropic drugs are not destroying societies, why are we so concerned with cocaine?

In The Economist, the political realities of the failure of “wars on drugs” are detailed to make a case for legalization.  The relevant article is Booming cocaine production suggests the war on drugs has failed. 

“When Richard Nixon, then America’s president, launched his “war on drugs” in 1971, the flow of cocaine into America was a trickle. Despite billions of dollars spent every year on arrests, asset seizures and destroying coca bushes, it has become a flood. About 2% of North Americans—roughly 6m people—are thought to use the stuff. New shipping routes are bringing the drug to consumers in Africa, Asia and Europe…”

The number of people using cocaine thought to have a serious addiction is about 20% or about 0.4% of the population.

The issue is supply and demand.  The supply is in relatively poor South American countries, the demand is in the relatively wealthy countries of the world. 

“According to Jeremy McDermott of InSight Crime, a website that analyses organised crime, Mexican gangs can buy a kilo of cocaine for $3,000 in Colombia. He estimates that a kilo is worth between $8,000 and $12,000 in Central America, $20,000 in the United States, $35,000 in Europe, $50,000 in China and $100,000 in Australia.”

Much of the “warfare” has taken place in the producing countries.  They are beginning to be more aggressive in propagating the notion that the effort has failed and something new must be done.

“Plenty of Latin American presidents have said the war is not working—though as Jonathan Caulkins, a drug expert at Carnegie Mellon University, points out, they tend to do so only once they have safely left office. Now some of those in power are beginning to speak up, too. In an interview with The Economist, Gustavo Petro, Colombia’s new president, talked of leniency for repentant gang members, decriminalising coca-leaf production and creating places where Colombians could consume cocaine in a supervised environment. Felipe Tascón, a member of Mr Petro’s campaign team who had been tipped for a role as his drug ‘tsar’, has flirted with the possibility of outright legalisation, and has talked of collaborating with other Andean countries which produce the drug.”

Even if producing countries legalized production successfully, that would have little impact on demand.  As Carl Hart points out in his book, drug use and addiction are only partly explained by the nature of the drug, they also depend on the needs of the members of the society.  Animals, including humans, are less likely to need to seek satisfaction from drugs if they have stable social and economic standing in their community.

“’The problem is in consumption, not production,’ says Mr Petro. His view is that ‘the competitive society…the ideology of the last few decades…is the one that generates addiction. And it is what generates widespread drug use.’ Mr Petro’s explanation is dubious. But his diagnosis is surely correct. So long as cocaine remains illegal in the rich countries that consume it, then legalising it in the poorer places that produce it will have only a small effect.” 

Is there any hope that legalization could come to a country like the US? 

“Full-on decriminalisation, let alone legalisation, is not about to happen in the West. But attitudes have shifted notably in the past few years. In 2020 the state of Oregon decriminalised the possession of all drugs, cocaine included. Portugal has had a similar policy since 2001. On October 7th Femke Halsema, Amsterdam’s mayor, told a meeting of European justice ministers that she thought that the war on drugs had failed, and that cocaine should be decriminalised. If decriminalisation happens in Latin America, it could put more momentum behind such ideas.”

There is another factor to consider.  It has become common for drug gangs to improve their profit margins by diluting their product with cheaper drugs.

“These days much of the cocaine that is shipped north to the United States comes mixed with fentanyl, a powerful and addictive opioid painkiller. The UNODC reckons that toxic combination is the main reason why cocaine-related deaths in America have risen fivefold since 2010…” 

Many lives could be saved with a regulated and safe source of cocaine.

 

Psychopharmacology and Depression

Twelve years ago, I came across an article that changed my view of the pharmaceutical industry forever.  It appeared in the London Review of Books: Which came first, the condition or the drug?.  In it, Mikkel Borch-Jacobsen wrote a review of a book authored by David Healy titled “Mania: a Short History of Bipolar Disorder”.  The case was made that what was known as bipolar disorder seemed not to exist until a marketing campaign by the pharmaceutical industry produced a high level of diagnoses.  This condition was said to involve individuals who would switch between depressive states and manic states.  The work of Healy in inspecting the history of patient diagnoses over several decades, found that such a finding was extremely rare, but for some reason the diagnosis was now quite common.   Borch-Jacobsen provides this background information.

“…Healy arrives at a figure of ten cases per million each year, that is 0.001 per cent of the general population. This figure is striking, as today the incidence of bipolar disorder is supposed to be much higher. In 1994, for example, the US National Comorbidity Survey estimated that 1.3 per cent of the American population suffered from bipolar disorder. Four years later, the psychiatrist Jules Angst upped the figure to 5 per cent: 5000 times higher than the figure suggested by Healy.”

The implication was that the drug companies had created a new category of illness and proceeded to make it a popular medical diagnosis. 

“Healy tells the story of the launch of bipolar disorder at the end of the 1990s. A specialised journal, Bipolar Disorder, was established, along with the International Society for Bipolar Disorders and the European Bipolar Forum; conferences were inundated with papers commissioned by the industry; a swarm of publications appeared, many of them signed by important names in the psychiatric field but actually ghost-written by PR agencies. Once the medical elites were bought and sold on the new disease, armies of industry representatives descended on clinicians, to ‘educate’ them and teach them how to recognise the symptoms of bipolar disorder. Bipolar patient advocacy groups sprang up, generously supported by pharmaceutical companies; freelance journalists were hired to write magazine articles on the latest advances in psychiatric science; websites were created, such as IsItReallyDepression.com (sponsored by AstraZeneca), where you can fill out a ‘mood assessment questionnaire’ at the end of which you’ll inevitably be dispatched to the nearest doctor. As a British blogger noticed recently, the Wikipedia entries ‘Bipolar Disorder’ and ‘Bipolar Spectrum’ were edited from a computer belonging to AstraZeneca, ensuring that everyone is on the same diagnostic page as the industry.”

Depression is one of the most common features of life, easily recognized and apparently easily treated by medications—more on that later.  That market for antidepressant drugs was large and growing.  Apparently, the goal of establishing bipolar disorder as a common illness was to expand the depression market to allow the sale of stronger and more dangerous antipsychotic drugs—with the collaboration of the psychiatric community.  If one reads the list of symptoms in the psychiatrist created DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition) one finds almost exactly the same set of symptoms as normal depression, a set so broad that every human on Earth could be diagnosed with the condition.

“A series of prominent lawsuits has been brought over the past few years in the United States against the manufacturers of anticonvulsants and atypical antipsychotics for having hidden their side effects and for having marketed them ‘off label’ towards patient populations not approved by the FDA. The sums paid out in fines or settlements by the pharmaceutical companies involved are staggering, and they give an idea of how disastrous the effects of their medications have been: Warner-Lambert/Parke-Davis (now Pfizer) has paid more than $430 million for marketing Neurontin for bipolar disorder; Lilly had to pay a total of $2.6 billion for the illegal marketing of Zyprexa; Pfizer was forced to pay $301 million for the illegal marketing of the atypical antipsychotic Geodon. AstraZeneca has agreed to pay $520 million to settle federal investigations into its marketing of Seroquel and has already spent $593 million in legal fees defending itself against the 10,381 individual lawsuits brought by patients for the side effects caused by the drug. Johnson & Johnson and its subsidiary Janssen have been sued by nine American states for the off-label marketing of Risperdal.”

Recall that the article discussed was published twelve years ago.  Time has not stood still.  The industry now refers to bipolar disorder as bipolar depression.  Perhaps the mania aspect was so rare that they had to change the strategy and focus on bipolar depression being a more serious form of depression requiring more serious medications.  And the drugs continued to fly off the shelves.

If one accumulates evidence that supports the notion that the pharmaceutical industry behaves in the manner described above when mental illness is involved, one is met with incredulous stares.  No one believes that such things can happen in our country.  One is viewed as some weird kind of conspiracy theorist. 

Two of the firmest tenets of psychopharmacology are that depression, and other mental illnesses, are caused by a chemical imbalance in our brains, and that medications act to control that chemical imbalance.  The chemical imbalance assumption began as an hypothesis.  It has never been proved, yet it has become dogma because both psychiatrists and the pharmaceutical companies found it profitable to assume it was true.  Evidence from depression drug trials indicate that almost as many participants who receive a placebo, perhaps a sugar pill, claim improved symptoms as do those who received the actual medication.  This demonstrates that a placebo effect is the dominant cause of most responses.  This fact has been known by both psychiatrists and drug companies for several decades.  Both can claim that the pills they give patients are often helpful at improving their symptoms, so what is the problem?  The problem is that the drugs alter brain function and often produce unpleasant side-effects and addiction. This source provides some perspective.

“The problem is that lots of people who do not need antidepressants are already on them, refilling prescriptions written years or even decades ago. They should be helped to get off the drugs. The side-effects are often life-limiting and, as people age, become life-threatening. They include sexual dysfunction (which sufferers describe as “genital anaesthesia”), lethargy, emotional numbness, increased risk of birth defects when taken during pregnancy, and, in older people, strokes, falls, seizures, heart problems and bleeding after surgery. This is a threat to health-care systems as long-term users age.”

In addition, patients who choose to stop their medications often face severe withdrawal symptoms.  This is yet another of the bizarre realities of the psychopharmacological industry that people find incredible.

A recent article in The Economist finally noticed data that had been around for over a decade and concluded that something should be done about it: How to make better use of antidepressants.  It details what is known about the most common antidepressant drugs: selective serotonin reuptake inhibitors (SSRIs).

“…new drugs called selective serotonin reuptake inhibitors (SSRI), which appeared in the 1980s, specifically block the serotonin transporters, so are much safer—so much so that by the 1990s they had become a lifestyle drug, prescribed widely for normal emotional reactions to events such as bereavement or work burnout.”

“For many years drug companies, the main source of research on SSRIs, tended not to publish in scientific journals the results of clinical trials that cast doubt on their products’ utility. That practice biased scientific reviews of the field in the drugs’ favour. But companies are nevertheless required by America’s medicines regulator, the Food and Drug Administration (FDA), to submit to that agency all the data collected during their trials, making them available for others to examine.”

“The most recent such analysis, published in the BMJ in June, combined the results of all trials of antidepressants filed to the FDA between 1979 and 2016. It found that the drugs had a substantial effect on depression beyond that of a placebo for only 15% of patients.”

“A study published in 2010, which examined research on two common SSRIs, estimated that for people with less severe depression the odds of improving by taking the drugs were just 6% higher than they were for taking a placebo. For those with more severe depression they were 25% higher.”

These studies confirm the claim that the majority of those benefiting from antidepressants are merely benefitting from a placebo effect.  More on this placebo effect can be found in Antidepressant Drugs versus Placebos.  The Economist also agrees there has not been any evidence to confirm a relationship between serotonin and depression. 

“Moreover, while all this has been going on the serotonin hypothesis has come crashing down. Researchers have looked from many directions for a relationship between serotonin and depression. They have found little or no evidence to link the two.”

So, if antidepressants provide no benefit other than as a placebo for most users, are the dangers of taking unnecessary brain-altering drugs sufficient to convince users that they are not worth the risk.  The potential side-effects have already been mentioned.  An equally important concern involves the difficulties associated with withdrawal symptoms experienced when quitting the drugs.

“A review of the research published on that topic, carried out in 2019, found that between 27% and 86% of people attempting to come off antidepressants experienced withdrawal symptoms, and that nearly half of them described those symptoms as severe. The variation in these results may have several causes. How long people took the drugs for, and the dose they took, are two.”

Little attention has been paid to the issue of antidepressant drug withdrawal.  Drug companies have no interest in it, and psychiatrists mostly assumed quitting drugs was easy.  It was also convenient to confuse withdrawal symptoms with relapse of the original problem.  This situation seems to be changing, in the UK at least, as healthcare systems ponder the cost effects of aging antidepressant users. 

“Dr Taylor and Mark Horowitz, of University College, London, began the research that led to what has become known as the Horowitz-Taylor method. Drawing on brain images of serotonin-transporter blockage by SSRIs, they proposed a biological explanation for this difference in withdrawal symptoms. Their study found that the effect of the drug on the brain increases steeply at small doses but levels off at higher ones…In other words, reducing SSRIs more slowly at lower doses is needed to produce a gradual decline in their effect—and thus minimise withdrawal symptoms.”

If the requirement is that over time small decreases in the drug level, how does the patient accomplish that?  Pills only come in a few discrete dosage levels.  Liquid drugs could fill the need if they were available.  Some external assistance is needed by most sufferers to ease the transition.

“As things stand, doctors rarely suggest to patients that they should stop taking the drugs. ‘It’s a systems issue. We just don’t have systems to start de-prescribing,’ says Dee Mangin of McMaster University, in Canada. Such cessation is usually initiated by patients who…decide that the side-effects are no longer worth it. The sexual-dysfunction problem is one of the reasons most commonly cited, particularly when people meet a new partner. ‘There is really no way of combating the sexual side-effects other than stopping the drug,’ says Dr Turner. Another is people realising, because of the scary effects on their brain after they have accidentally missed a dose (by forgetting to order a refill, for example), that they have developed a strong physical dependency on them.”

“…the liquid formulations of antidepressants needed for the preparation of small doses are expensive—a month’s worth may cost as much as an annual supply of the pills. And not all antidepressants are available in liquid form, because there are no incentives for drug companies to produce something that will help people stop taking their drugs.”

“’Tapering strips’—prescriptions of pills that contain smaller and smaller amounts of a drug—are available in the Netherlands and have been shown to result in a 70% quit rate. But the Netherlands is an exception, and the strips are too expensive for a lot of those in other countries who try to import the Dutch versions. An alternative is to obtain tapering doses from a compounding pharmacy (a business which can measure out minuscule amounts of the pills). But that, too, is expensive—and not usually covered by health insurance. So patients are stuck.”

Too much short-term thinking has hindered a concerted effort to address antidepressant drug addiction and withdrawal effects.

“Nor do the economic incentives stack in favour of cessation. Most SSRIs are off-patent and therefore cheap. In Britain, a year’s supply of the pills may cost around £40-50 ($35-44). ‘Getting people off them doesn’t save the NHS much in terms of the cost of the drugs,’ says Dr Kendrick. ‘The problem is that when people try to come off if you get only one or two people to have a severe relapse and end up in hospital, that would cost an awful lot,’ he says. This leads to a reluctance to promote quitting.”

“This unwillingness to ante-up is, though, short-sighted. Health-care systems face a risk of there being growing numbers of ageing patients who start to experience the worst side-effects of the long-term use of antidepressants. There will be extra falls, strokes, seizures, heart problems, surgery complications and more. Pay now. Or pay double later.” 

What is startling about depression is the strength of the placebo effect, which is essentially just the power of suggestion.  This suggests that there should be other, less dangerous methods for changing peoples’ view of their lives.  In Treating Depression: It’s Free, It’s Healthy, and It Works, it was pointed out that exercise seems to work better at combating depression than at least one popular antidepressant.  Perhaps therein lies a clue.

 

  

Mental Illness: The Stories We Tell Ourselves and the Stories Psychiatrists Tell Us

 Mental illness seems to be an important and growing concern in our societies.  In the US we are bombarded by advertising on conditions such as depression, anxiety, and bipolar disorder, conditions that are claimed to have pharmaceutical remedies.  Are these categories representative of what people in distress are actually experiencing, or are they merely categories with which psychiatrists and drug companies believe they can deal?  How much of our mental distress is inflicted by cultural or social experiences and how much is due to physical disorder?  What treatments are available, and do they work?  Rachel Aviv discusses the issues associated with what are considered mental illnesses by considering five case histories, including her own, in Strangers to Ourselves: Unsettled Minds and the Stories That Make Us.

Rachel Aviv is best known as a talented staff writer for The New Yorker.  In that role she has covered issues related to mental illness in the past.  In her book she presents several case studies of individuals whose behavior was viewed as stemming from mental illness by doctors and acquaintances, describing their interactions with them as they struggled to understand themselves.  She chose people whose struggle for understanding moved them to keep diaries or write otherwise about their lives.  One of her choices was herself. 

Aviv’s studies have driven her to emphasize that activities that would be considered indicative of mental illness have complex origins.

“…mental illness is caused by an interplay between biological, genetic, psychological, and environmental factors…”

Given the complexity of that interplay, one can likely assume that each individual is unique with a unique set of issues.  When does a person with issues become a person with a mental illness.  Since there are no physical diagnostics that can determine such a state, the characterization is somewhat arbitrary.  A group of psychiatrists gets together every few years and defines what is normal behavior and how much of a deviation from normal can be classified as a specific mental illness.  These conclusions are published in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Sets of symptoms are associated with each disorder.  Since there are many disorders, the symptom sets are not always unique for a specific disorder.  While there are always a few people so out of control that they clearly need help of some kind, it is easy for the rest of us to be captured by a system that views sadness and shyness as symptoms of mental illness.

What emerges from Aviv’s case studies is the ease with which our understanding of ourselves can be corrupted by the act of diagnosis.  A patient’s uniqueness can disappear as a psychiatrist tries to fit her in a specific illness category in order to suggest a treatment.  Conversely, a uniquely troubled person can seek understanding by examining illness categories and conclude that she must fit into one, leading to an imitation of a defined set of symptoms.

“Psychiatrists know remarkably little about why some people with mental illnesses recover and others with the same diagnosis go on to have an illness ‘career.’  Answering the question, I think, requires paying more attention to the distance between the psychiatric models that explain illness and the stories through which people find meaning themselves.”

“There are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which.”

Of all Aviv’s case studies, her own history is perhaps the most relevant.  When she was age six, she suddenly stopped eating.  She doesn’t recall much about her reasoning at the time, but she suggests she may have been influenced by the Jewish Yom Kippur tradition which calls for people to reject food and liquids for a full day as a means of cleansing body and spirit.  She recalls feeling proud of her ability to turn away from food and remembers thinking it was important to her to feel like she had become a better person.  She also remembers being pleased by the reaction of her parents and the attention she received.  Aviv’s parents were recently divorced and were fighting over her custody.  She ended up in a hospital where she and other girls were treated as sufferers of anorexia.  Rachel was the youngest girl anyone could recall suffering from this condition.  During this period the malady was not well understood, and her doctors tried to apply psychanalytic techniques to discover the sources of her problem.

Psychoanalysts led the way in addressing mental illness by focusing on psychological and environmental factors.  Their success was quite limited, and they were mostly superseded by psychiatrists who focused on biological and genetic factors and attempted to treat patients with medications.  Their success has, by many measures, been quite limited as well.  At age six, the influence of the psychiatrist who treated her was small, but the effect of being confined with girls who were deeply in the clutches of anorexia had a dangerously large influence on her.  She was made to feel welcome by the older girls and she, in turn, felt it appropriate to imitate their behaviors and think of them as mentors.  She was taught that in addition to limiting eating, one could lose weight by exercising.  She would try to keep up with the exercises done by the older girls and followed their lead by standing and moving around all day, only stopping at bedtime.

Aviv was lucky to drift into this mode of behavior at such a young age.  It did not manage to capture her because she did not fully possess the consciousness and experiences of the older girls.  She was not allowed to see her parents while confined unless she ate a certain amount of food.  This provided enough motivation to get her eating again and she was soon released.  However, she continued to be affected by the experience.  The need to remain standing all day long followed her as she resumed school.  It would be around a month before she felt comfortable sitting down like the other children.

Imitation is an important factor in determining the manner in which people respond to situations.  Aviv provides a startling example that occurred in Sweden.

“A few years ago, I went to Sweden to report a story about a condition known as ‘resignation syndrome.’  Hundreds of children from former Soviet and Yugoslav states who had been denied asylum in Sweden had taken to their beds.  They refused food.  They stopped talking.  Eventually, they seemed to lose the ability to move.  Many had to be given feeding tubes.  Some gradually slipped into states resembling comas.” 

This only happened in Sweden, not in any other Nordic countries where similar refugees were attempting to settle.  It seemed that in Sweden one child chose the anorexic-like response, probably as an act of protest, and others copied the behavior.  But the behavior, initially voluntary, can become intrinsic and compulsive.  This seems to be the path by which anorexia captures its victims.

“Something about the mute, fasting children in Sweden felt familiar to me.  For a child, solipsistic by nature, there are limits to the ways that despair can be communicated.  Culture shapes the scripts that expressions of distress will follow.  In both anorexia and resignation syndrome, children embody anger and a sense of powerlessness by refusing food, one of the few methods of protest available to them.  Experts tell these children that they are behaving in a recognizable way that has a label.  The children then make adjustments, conscious and unconscious, to the way they’ve been classified.  Over time, a willed pattern of behavior becomes increasingly involuntary and ingrained.”

“The philosopher Ian Hacking uses the term ‘looping effect’ to describe the way that people get caught in self-fulfilling stories about illness.  A new diagnosis can change ‘the space of possibilities for personhood,’ he writes.  ‘We make ourselves in our own scientific image of the kinds of people it is possible to be.’…We find a way to express our distress through imitation until, eventually, we ‘have “learned” or—better—“acquired” a new psychic state’.”

What this describes is mental illness as a fad or as a cultural construct.  People in distress need a way to express their distress that will gather them attention and perhaps sympathy or help.  Embracing a recognizable, well-known mental illness is a surefire way to gain attention.  For centuries female hysteria was considered a form of mental illness.  It has disappeared.  There was no cure, it just went out of style.

Aviv’s personal experience with mental illness would return when she was an adult.  By that time psychiatrists had mainly moved on to focusing on biological explanations for mental problems and the use of medications to treat issues.  This shift created new stories that people could tell about themselves and new stories that psychiatrists could tell their patients.

One of the case studies Aviv included in her book involved a woman named Laura.  She seemed destined for a charmed life, equipped with the characteristics expected of high performers, but she never found satisfaction with the life towards which she was headed.  She was diagnosed initially with bipolar disorder (later renamed bipolar depression).  Aviv uses her “career” in mental illness as an example of a “diagnosis trap” that can emerge when using medications to treat mental illness.  She would ultimately find satisfaction by freeing herself from her dependence on these drugs and spend her time helping others follow her example.  Aviv would provide a description of what she refers to as biological psychiatry and go on to discuss her own attempt to use antidepressants to solve her issues.

Laura, at first, welcomed the diagnosis that her problems were being caused by a chemical imbalance in her brain.  That allowed her to quit questioning her own responsibility and just wait for a medication to correct the imbalance.  She began with moderate doses of Prozac, an antidepressant drug.  That did not help.  Any solution was not going to be simple.

“Her psychiatrist raised her Prozac prescription to 80 milligrams, the maximum dose.  The Prozac made her drowsy, so he prescribed her 400 milligrams of Provigil, a drug for narcolepsy often taken by soldiers and truck drivers to stay awake for long shifts…When the Provigil made it hard for Laura to sleep, her pharmacologist described Ambien [a sedative], which she took every night.  In the course of a year, her doctors had created what’s known as a ‘prescription cascade’: the side effects of one prescription are diagnosed as symptoms of another condition, leading to a succession of new prescriptions.” 

The search for the correct combination of drugs for Laura would go on indefinitely if she allowed it to happen.  The drugs prescribed were psychotropic: they altered her brain function.  Modifying symptoms were all they could claim to do.  It is possible to minimize symptoms and claim an effective treatment, but in the process, the patient may no longer be the same person who began the treatment, and the patient may have become addicted to the drugs.

“In fourteen years, she had taken nineteen different medications.  ‘I never had a baseline sense of myself, of who I am,’ she said.  She wanted to somehow strip away the framework that had been imposed on her identity.”

Laura was influenced by a book by Robert Whitaker: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.

“The book prompted Laura to begin reading about the history of psychiatry.  She hadn’t realized that the idea that depression was caused by a chemical imbalance was just a theory—‘at best a reductionistic oversimplification,’ as Schildkraut, the scientist at the National Institute for Mental Health, had put it…For more than fifty years, scientists have searched for the genetic or neurobiological origins of mental illness, spending billions of dollars on research, but they have not been able to locate a specific biological or genetic marker associated with any diagnosis.  It is still unclear why antidepressants work.  The theory of the chemical imbalance, which had become widespread by the nineties, has survived for so long perhaps because the reality—that mental illness is caused by an interplay between biological, genetic, psychological, and environmental factors—is more difficult to conceptualize, so nothing has taken its place.  In 2022, Thomas Insel, who directed the National Institute for Mental Health for thirteen years, published a book lamenting that, despite great advances in neuroscience, when he left the position in 2015, he realized, ‘Nothing my colleagues and I were doing addressed the ever-increasing urgency or magnitude of the suffering millions of Americans were living through—and dying from’.”

Laura attempted to gradually eliminate the medications she was taking.  Her body responded in difficult, unpleasant ways.  There is much money spent on producing pills in large quantities, and producing new ones to generate additional prescriptions, but little or no effort is being made to help people shed the burden of these drugs.  Laura connected with an online forum of people who were in exactly the same situation as her as she eventually managed the transition.  Laura’s exit from her drug-induced state does not mean she has become “normal,” whatever that might mean.  She still endures the emotional highs and lows, the anxieties and doubts that might make others seek a pill for assistance.  But she endures them and has a life she found satisfying.  Having spent many years in that drug-induced state has become part of the story she tells about herself, one that does not require psychotropic drugs.  Interestingly, Aviv, would also be introduced to a drug that proved beneficial for her, and she would ultimately choose to continue to take the drug in spite of the lessons that might have been learned from Laura’s experience. 

Aviv has written: “It is still unclear why antidepressants work.”  That is not true.  Pharmaceutical companies and psychiatrists have known for years that antidepressants work mostly, if not entirely, via a placebo effect.  If one tells a person that she might receive a pill that will make them feel better, they will most likely feel better if they believe that they actually received the pill containing the drug.  When a double-blind clinical trial is run, about the same number of people given a placebo (perhaps a sugar pill) claim to have benefited from the pill as those that have received the antidepressant.  The arguments have gone on for decades as to whether or not antidepressants actually provide a benefit.  This issue is discussed in Antidepressant Drugs versus Placebos.  Most popular antidepressants are SSRIs (Selective Serotonin Reuptake Inhibitors) designed to increase the level of serotonin in the brain.  The hypothesis that the serotonin might control depression was the basis for the chemical imbalance hypothesis.  Every several years researchers look for proof that serotonin has an effect on depression.  No connection has ever been found.  A recent study confirming the lack of any relationship is discussed in Depressing News About Depression and Antidepressants.  Many people who hear such news refuse to believe it.  How could such a situation exist?  People are being helped; it can’t be true.  But it is.  What is sad is that the strength of the placebo effect should be an incentive to devise more effective, simpler, and less dangerous treatments.  Instead, there is more money to be made ignoring the issue and searching for ever more expensive drugs.  And people should note that pharmaceutical companies have been fined billions of dollars for telling lies about their psychotropic drugs.

Aviv does understand how the system works.  Psychotropic drugs are intended to alter symptoms, not cure an ailment.  Aviv was prescribed what she referred to as an antidepressant.  Her symptoms did not seem to be consistent with depression.  She suffered anxiety over her performance as a writer and as an individual member of society.  She was prescribed Lexapro, an SSRI antidepressant that is said to be effective also in countering anxiety.  She was thrilled with the result.

“My first six months on Lexapro were probably the best half year of my life.  I was what psychiatrists call a ‘good responder.’  My brain suddenly felt like a fun, fresh place to be.  ‘Today: nothing I’m feeling shame for,’ I wrote in my journal.  I began writing jokey emails to people for no other reason than that I was briming with warmth for them.”

Aviv became the person she wanted to be.  Soon she was recommending Lexapro to friends who would then also be satisfied with the results.  Eventually she began to worry about the possible consequences of long-term use and discovered that she couldn’t stop taking the drug, or at least did not want to badly enough.  She had withdrawal symptoms and feared that the medication might have changed her intrinsically such that she would not get back to her original self and might end up in even worse shape without the drug.  So, she has continued using it.

Aviv made an interesting observation.

“Helen and I kept discovering new Lexapro users, both colleagues and friends.  We became unnerved by how many of us—mostly white women—were taking the same drug.  ‘These more and more seem like Make the Ambitious Ladies More Tolerable Pills,’ Helen wrote me…I told Dr Hall that nearly all my female friends were on Lexapro and thriving, a fact that made me think we were swept up in a cultural phenomenon, rather than suffering from the same disease…”

Does our patriarchal heritage produce women who are anxious about their place in society or do psychiatrists assume women need chemical assistance in managing their ambitions.  This is an issue that arises several times in Aviv’s book.

“In rejecting the authority of psychoanalysis, psychiatrists hoped to rid themselves of the sway of culture and the fundamental subjectivity it implied.  But the history of biological psychiatry has been marked by biases about gender and race just as psychoanalysis had been.  The benzodiazepines, a class of tranquilizer celebrated as a replacement for psychoanalysis, was marketed in the seventies especially to women, to give them personalities congenial to husbands.  In ads called ’35 and single’ in the Archives of General Psychiatry in 1970, the pharmaceutical company Roche encouraged doctors to give Valium to the kind of highly strung patient who ‘realizes she is in a losing pattern—and that she may never marry.’  Between 1969 and 1982, Valium was the most widely prescribed medication in America, and roughly three-quarters of its users were women.  In an editorial in the French journal L’Encéphale, two psychiatrists from the largest psychiatric hospital in Paris warned, ‘Benzodiazepines have lost their status as medications…and become simple domestic helpers’.”

“Serotonin reuptake inhibitors, or SSRIs—most prominently Prozac and Zoloft—were created in the eighties, filling a gap in the market opened by concerns that benzodiazepines were addictive.  They were soon prescribed for not just depression but the anxieties that benzodiazepines had previously addressed.  Now more than one in five white women in America take antidepressants.  Peter Kramer, the author of Listening to Prozac, told me that the SSRIs were ‘eerily consonant with what the culture required of women: less fragility, more juggling outside of the home.’  An early advertisement for Zoloft showed a white woman in a pantsuit, holding the hands of her two children, and the phrase ‘Power that speaks softly.’  An ad for Prozac, which ran for two and a half years, showed another white woman, her wedding ring visible, and the slogan ‘For both restful nights and productive days’.”

“While black women tend to be undermedicated for depression, white women, especially ambitious ones, are often overmedicated, in order to ‘have it all’: a family and a thriving career.  And yet, a common side effect of the drugs is loss of sexuality, an experience perhaps more compatible with contemporary gender roles than we would like to imagine.” 

Is it that our patriarchal traditions are more easily preserved in a society where female sexual drive is inhibited a bit?  Do men feel more comfortable in such a situation?

“Allen Frances, an emeritus professor of psychiatry at Duke who chaired the task force for the fourth edition of the DSM, in 1994, told me, ‘It was very apparent early on that the SSRIs have a fairly dramatic impact on sexual interest and performance.  It has always puzzled me that this was not more of a disqualifying aspect of their wide popularity’.”

“Audrey Bahrick, a psychologist at the University of Iowa Counseling service who has published papers on the way that SSRIs affect sexuality, says she sees thousands of college students each year, many of whom have been taking SSRIs since adolescence.  She told me, ‘I seem to have the expectation that young people would be quite distressed about the sexual side effects, but my observation clinically is that these young people don’t yet know what sexuality really means or why it is such a driving force.  They start to look a little behind their peers with regard to having crushes or being sexually motivated’.”

The stories we tell ourselves….. and the stories psychiatrists tell us…..

 

The Emptiness of Conservatism

 Jan-Werner Müller produced a discussion for the London Review of Books of the degree of unity within the European Union (EU) in the context of the war in Ukraine: United Europe?.  In it, he discussed the near universal rise of far-right populist activism and how it relates to traditional conservatism and the center-right political parties.  He provided an interesting perspective.

“While election results for far-right populist parties have improved over the last two decades, only in Italy have these parties come to power without the collaboration of mainstream conservative forces. What has made the difference is conservative defeatism. Partly because the self-designated centre-right is so bereft of ideas – witness Truss’s zombie Thatcherism – it has defaulted to embracing far-right positions or joining hands with previously ostracised parties.”

In other words, a center-right party “bereft of ideas” must have some means of attracting voters so it can strive for political power, and it has no option but to move to the far-right where there is at least some excitement.  The US Republican Party fits this scenario exactly.  It cannot even claim to have a platform on which it runs.  Instead, it limps on grasping the remnants of an ideology that was formulated and established sixty years ago. 

The early 1960s were years of great political activity with the left and right both forming views of the ideal national government.  The conservatives gathered at William F. Buckley’s estate in Sharon, Connecticut in 1960, while the liberals congregated at a United Auto Workers camp at Port Huron Michigan in 1962.  Both groups would issue documents describing the political directions in which they wished to move.  The liberals wanted an activist federal government, but one that was driven by the wishes of the voters expressed through democratic processes.  The conservatives wished for an inactive federal government that only protected property and defended the homeland: low taxes, free markets, and little regulation.  The liberals saw a world filled with problems that required solutions.  Sixty-four pages of details were required.  The conservatives saw only one problem: the government.  The Sharon document only required a single page. 

Has anything changed politically in the past 60 years?  Liberal Democrats are still pinpointing problems and trying to figure out how to address them.  Conservative Republicans are still preaching the same dogma they preached 60 years ago.  Their philosophy had its day in the sun and heightened economic and social inequalities.  But problems keep coming while growing in number and complexity, requiring new approaches.  However, the rigid conservative dogma constrains Republicans to inactivity other than lower taxes, deregulation, and smaller government.  That no longer sells.  The only way to attract voters is to embrace the far-right conspiracy theorists, religious nationalists, racists, and antisemites. 

The midterm 2022 election has happened.  It suggests a change has occurred.  Election deniers and other extremists have not fared well.  Political scientists like to claim that many voters worry little about party policies and tend to vote based on their personal economic feelings at the time of the election.  If things seem bad, throw out those in charge.  This time it appears the voters blended some national issues like threats to personal autonomy and democracy in with their economic issues and surprised everyone.  Hopefully, this is a practice that will be renewed for each election.

Perhaps we can one day achieve a state where political parties actually debate policy solutions to our problems in front of the voters. And the voters are listening.

 

Reuniting the Disunited States of America

 The formation of the United States is usually viewed as an experiment in forming a union of diverse states into a single entity with combined central and local governance.  A more accurate way of understanding the issues that determined the future evolution of the United States would be to view it as an experiment in forming a union between two vastly different cultures.  These different societies have been at odds for the entire existence of the nation.  The Civil War broke out between them, but the winning side only temporarily reined in the political power of the losers.  The cultural differences remained with the losers of the Civil War now striving to win another war which currently is waged on judicial and political fronts.  Nevertheless, the threat of physical violence is rapidly growing and contributing to a situation reminiscent of the years preceding the Civil War.  Each culture wishes to impose its views on the other.  Given this scenario, what does the future hold? 

Steven Simon and Jonathan Stevenson considered these issues and provided an interesting perspective in These Disunited States, an article for the New York Review of Books.

“America is already virtually a binational state, with two sharply opposed national communities comparable in size and political strength that effectively operate as confederations under a single federal government.”

“At the core of the US binational character is a deep and durable tension between a Christian white-supremacist ideology that evolved to justify slavery and a broad-based multiethnic resistance to it. Reinforcing this tension are cultural divisions between the rural and urban populations, including divergent values on education and immigration.”

“The splits between the two halves of the nation—red and blue, right and left—increasingly appear irreconcilable. Today, new state legislation on abortion, LGBTQ rights, gun rights, free speech, and public health is making red and blue states radically different.”

“Many Americans have relegated their political adversaries to the category of ‘the other,’ an ominous prelude to the dehumanization that facilitates violence in civil conflict.” 

If one worries that the contention between the two cultures will continue to escalate, what can one do about it?  The authors provide an interesting suggestion: redefining the existing concept of federalization.

“…partial defederalization, in which a national legislature would pass laws relating to the funding and maintenance of the armed forces and other national assets, mainly infrastructure, and otherwise leave the states to govern themselves. This would bear a passing resemblance to the EU [European Union].”

Using the EU as an example of how the US states might negotiate what would have to be a highly modified Constitution that all can live with sounds reasonable at first.  However, even after many centuries of brutal warfare between the nations of Europe, they are now more uniform in their social goals than are the US states.  They federalized because they saw advantages to working together.  The authors make the defederalizing suggestion for the US and then move on to convince themselves and their readers that it would be too complex and require many unlikely compromises.  They end with this comment which seems somewhere between a warning and a prayer.

“The reality is that the states are no longer united—if, other than during the world wars and the cold war, they ever really were. The sooner some process of matching political form to political substance gets underway, the less likely the transition is to be violent. Many Americans—conservative as well as liberal—would see defederalization as tantamount to an admission that the US can no longer boast of an enlightened and ideologically cohesive citizenry, and is no longer a large and powerful unitary democracy, a political exemplar to the world, and a potential global force for good. Sadly, it may come to that.”

It is sometimes thought that a catastrophe might bring the two cultures together in a common cause.  World War II did provide a unified approach to conducting the war, but that was at a time when the cultures were distributed across the two political parties.  At present, each culture owns its own political party and there is little interest in compromise. The Democrats believe they deserve to be the leaders of the nation; the Republicans believe they are winning a battle for permanent leadership.  An extremely challenging pandemic has only served to increase the political polarization.  The potential for armed conflict in Europe is beginning to do the same.  Why negotiate and compromise if you don’t think you have to?  Why negotiate and compromise with people you despise?

It is possible that the political leaders of one culture may overplay their hand and drive their people away.  It hasn’t happened yet, but that may be the only way out of our current situation.

 

World War III: The Gathering Storm

 A few months ago, the Russian invasion of Ukraine seemed to be moving in a dangerous direction in which nations might be choosing sides in the conflict.  The wealthy democracies were organizing support for Ukraine while autocracies were either professing neutrality or supporting Russia’s claim that the invasion was an act of self-defense.  The most troubling alliance seemed to be between Russia and China as they declared an unlimited friendship just prior to the invasion.  Both nations were determined to exercise power over their neighboring countries: Russia with military might, China with economic and political might.  The same nations supporting Ukraine were organizing for what might be called an economic war with China.  An alliance between Russia and China against a common enemy alliance would be a frightful situation.  In World War III: Alliances Are Forming; Weaponizing Food, Energy this situation was discussed in terms of a possible prelude to worldwide conflict.

Much has changed since then—and not for the better.  The United States, along with its NATO allies, have been able to provide Ukraine with superior armaments to those available to the Russian forces, and in sufficient supply to turn the tide and begin recapturing large sections of the territory lost in the initial invasion.  Russia embarrassed itself by picking a fight with a better-trained, better-led, and more-highly-motivated army.  However, Putin is not willing to endure defeat.  His only option is to play for time hoping that his enemies will lack the will to continue indefinitely.  Against Ukraine, he has mobilized a large number of new soldiers and began immediately rushing them to the front to provide poorly trained reinforcements.  Observers do not see that as a strategy likely to make much difference, but it may slow the Ukrainian advance. 

Putin’s mobilization strategy seems more like another attempt to extend the fighting through winter when he hopes his enemies will have their will broken by a long, cold, dark winter.  He is also trying to break states away from the NATO alliance and bring into the mix military assistance from his allies.  There appears to be more emphasis on destroying Ukraine’s civilian infrastructure, particularly energy, than in holding occupied territory.  He attempted to create a natural gas shortage in Europe when the main pipeline from Russia was put out of commission by an explosion caused by an “unknown” terrorist nation.  He then offered Turkey the opportunity to become a hub for gas flow to Europe by building a new pipeline to its shoreline.  That seems a blatant attempt to further separate Turkey, not enthusiastic about NATO’s policy against Russia, from the other members of the alliance.  The most disturbing reason why Putin will follow a biding-time policy is the upcoming election in the United States.  He knows that Trump is an avowed admirer and wishes to rule the US in the same way he rules Russia.  There is a wing of the Republican Party that supports Trump and a move in that direction.  If the Republicans win either or both legislative branches, he knows he will be a step closer to seeing the end of support for Ukraine and the NATO alliance.

The development that most motivated the “Gathering Storm” theme was the entry of Iran into the fray by providing aid to Russia in the form of long-range weaponized drones.  The NATO countries benefited from the war by being able to judge the performance of their armaments in actual warfare without risking their own personnel.  This has been extremely useful.  The Iranians seem to wish the same opportunity.  They possess a large number of rockets and drones, enough to wage war against someone, and they are interested in seeing how they perform and if there are improvements needed.  Thus far, the drones have been effective in causing the desired damage, but countermeasures are also effective and may become even more so.

The assistance provided Russia by Iran is not yet a game-changer in Ukraine.  However, Israel, the likely target for Iran’s armaments buildup, must be watching closely.  The more effective Iran’s weapons appear in Ukraine, the more likely the Israelis must consider some sort of response.  Iran has already targeted Saudi energy infrastructure.  The Saudis would be even more vulnerable.  An Iran with a credible conventional armament threat against nations in the Middle East might be more upsetting to political stability than an Iran with a nuclear weapon.  Effectively, Putin’s war in Ukraine has spread to a highly unstable region.

In terms of potential worldwide conflict, China’s actions are critical.  Thus far, China’s support for Putin follows the initial assertion that Russia was under threat when it began the invasion.  There is no claim of direct support other than taking advantage of discounted prices for Russian oil.  The fear is that China could begin to provide direct military assistance to Russia in Ukraine, and/or take advantage of the Ukraine distraction to make an aggressive move in Asia.  If either move is made, it is not sure what would happen next, but the world would become a different place.

Meanwhile, worldwide problems that require worldwide attention will not be addressed.  While climate change grows unabated, more climate refugees will be created; increased levels and areas of conflict will create more war refugees; an already stumbling world economy will not benefit from conflicts, generating more economic refugees.

Stay tuned…

Get worried…

Vote for Democrats…

 

 

 

 

 

 

 

 

The Worldwide Surge in Myopia

 In 2014 an article was encountered which discussed a dramatic increase in nearsightedness in school age children in Asia.  It indicated that this phenomenon was the result of high-intensity educational practices that left too little time for play outside in the sunlight.  It was the lack of sunlight that disturbed the normal growth of the eyes.  Recently, another article appeared stating that this phenomenon had spread throughout the developed world, its cause was more complicated than merely too much studying, and it was producing a significant rise in dangerous eye conditions.  Sarah Zhang produced The Myopia Generation: Why do so many kids need glasses now? for The Atlantic.

Zhang provides this perspective.

“In East and Southeast Asia, where this shift is most dramatic, the proportion of teenagers and young adults with myopia has jumped from roughly a quarter to more than 80 percent in just over half a century. In China, myopia is so prevalent that it has become a national-security concern: The military is worried about recruiting enough sharp-eyed pilots from among the country’s 1.4 billion people. Recent pandemic lockdowns seem to have made eyesight among Chinese children even worse.”

For years it was assumed this effect was somehow specific to Asian populations.  Now the worldwide nature has become apparent.

“In the U.S., 42 percent of 12-to-54-year-olds were nearsighted in the early 2000s—the last time a national survey of myopia was conducted—up from a quarter in the 1970s. Though more recent large-scale surveys are not available, when I asked eye doctors around the U.S. if they were seeing more nearsighted kids, the answers were: ‘Absolutely.’ ‘Yes.’ ‘No question about it’.”

“In Europe as well, young adults are more likely to need glasses for distance vision than their parents or grandparents are now. Some of the lowest rates of myopia are in developing countries in Africa and South America. But where Asia was once seen as an outlier, it’s now considered a harbinger. If current trends continue, one study estimates, half of the world’s population will be myopic by 2050.”

Experts continue to argue about precise details, but there is general agreement that the condition is caused by too much time inside focusing on near objects like books, phones, videogames and such, and too little time in the sunlight scanning distant objects. 

“In humans, the majority of babies are born farsighted. Our eyes start slightly too short, and they grow in childhood to the right length, then stop. This process has been finely calibrated over millions of years of evolution. But when the environmental signals don’t match what the eye has evolved to expect—whether that’s due to too much near work, not enough outdoor time, some combination of the two, or another factor—the eye just keeps growing. This process is irreversible.”

This phenomenon is more than a curiosity.  Myopia can lead to unhealthy eyes and even blindness.

“Nearsighted eyes become prone to serious problems like glaucoma and retinal detachment in middle age, conditions that can in turn cause permanent blindness. The risks start small but rise exponentially with higher prescriptions. The younger myopia starts, the worse the outlook. In 2019, the American Academy of Ophthalmology convened a task force to recognize myopia as an urgent global-health problem. As Michael Repka, an ophthalmology professor at Johns Hopkins University and the AAO’s medical director for government affairs, told me, ‘You’re trying to head off an epidemic of blindness that’s decades down the road’.”

For those interested in more information, try a National Institutes of Health publication: Myopia: a growing global problem with sight-threatening complications. 

Since the problem has been severe for the longest in Asia, that is where research has indicated that the problem can be alleviated by specific treatments to limit the elongation of the eyeball.

“Over the past two decades, eye doctors—mostly in Asia—have discovered that special lenses and eye drops can slow the progression of nearsightedness in children.”

These treatments seem to limit myopia development but not eliminate it.  And none have been approved by the FDA for use in myopia control.  However, if the trend continues, parents will demand them.

Children are already subject to competition between parents striving to provide the best for their offspring.  It is such competition in education and recreational pursuits that contributes to this surge in myopia.  Myopia will become another arena in which the well-off will seek to separate themselves from the masses by investing in these treatments.  And the cost of raising a child will again escalate.

Or, we could just demand that our children spend more time outdoors.

 

Are Females Better at Learning than Males?

 I have recently come across several books that provide detailed accounts of the lives, cultures, and idiosyncrasies of various animal species.  Several of these explicitly seek to promote the notion that we can learn something about ourselves by studying animals and their societies.  That is not such a wild hypothesis, especially if we limit comparisons to mammals.  We are all species with a shared evolutionary history, having the same body parts, and the same body chemistry.  The comparison can be refined by restricting comparison to just primates, or even to apes, or perhaps just to chimpanzees and bonobos, our evolutionary cousins.  If common traits appear in a number of related species, then those traits are likely to have a biological component. This has been a productive pursuit leading to interesting insights.  The most recent is the subject of this article.

Carl Safina produced the book Becoming Wild: How Animal Cultures Raise Families, Create Beauty, and Achieve Peace.  His intent is to imprint in the readers’ brains the realization that complex animals, including humans, require a long maturation period before they learn how to exist as a member of their species.  Each must learn how and what to eat, who is a danger and who isn’t, how to get along with members of their own sex, how to get along with members of the opposite sex, and what are the cultural rules of their society.  Learning about how animals learn is obviously a highly relevant pursuit.  In discussing this topic Safina provided the following intriguing observation.

“…there was a pattern: juvenile females were twice as likely to acquire the new skill as juvenile males or mature females.  Least likely of all to learn the new trick: adult males.  Across a wide swath of animals, the young, especially young females, appear to be the best learners (probably because young females generally divert less time to squabbling for dominance).

A middle-aged human teacher, sandwiched between a generation of boys and girls and a generation of aging parents, might read that statement and conclude it is generally consistent with their experience.  Safina’s claim raises a number of questions.  Is there a reason why quicker learning for females provides an evolutionary advantage?  Is there a reason why slower learning for males is not an evolutionary disadvantage?  Can this learning pattern be recognized in human societies?

Safina’s parenthetic comment provides a clue as to why young males and females are different: they generally have different roles in their societies, each with different learning requirements.  The most fundamental evolutionary demand is that of reproduction.  The nurturance of offspring is almost always the responsibility of the female.  The male’s most fundamental responsibility is merely to provide sperm.  In Of Chimps and Men: Males—What Are They Good For?, this quote from the female anthropologist Sarah Blaffer Hrdy was collected.

“To put men in perspective....across all 5,400 or so species of mammals in the world.  In the majority of them fathers do remarkably little beyond stake out territories, compete with other males, and mate with females.  With outlandish auditory and visual displays which often entail specially evolved weaponry, bellowing, barking, or roaring, males engage in fierce contests to route their competitors. Then ‘slam bam thank you ma’am’ and the inseminator is off.  Male caretaking is found in only a fraction of mammals.  By comparison, males in the order Primates stand out as paragons of nurturing, unusual for how much protection and even direct care of young they provide.”

The distribution of sperm to a female is not a simple task for a male.  There is a competition with other sperm-carrying males for access to any female, and then there is often the need to convince the female to be receptive to their approach.  These tasks produce cognitive demands on males, but ones different from those of the females.  Given that males are capable of disseminating sperm to a number of females, the individual female is more important to evolution than the individual male.  Nature wishes the female to learn all that it is necessary to nurture offspring by the time they become fertile.  If the male takes a little longer to learn what is necessary for it to compete for females there are plenty of other males around.  That consideration and the greater responsibilities of females for continuation of the species suggests that it would not be surprising if females evolved a more efficient learning capability

Safina suggests that male competition is a factor in their ability to learn, not necessarily in their ultimate cognitive capabilities.  Hrdy suggests that primates have evolved into species where males have the capability and, at least occasionally, the interest in assisting in caring for infants.  Does this aspect of primates tell us something about ourselves.  Safina claims that human evolution has produced a species that most closely resembles that of the chimpanzee.

“We aren’t ‘like apes.’  We are like chimpanzees.  Chimpanzees are obsessed with dominance and status within their group; we are obsessed with dominance and status within our group.  Chimpanzees oppress within their group; we oppress within our group.  Chimpanzee males may turn on their friends and beat their mates; human males may turn on their friends and beat their mates.  Chimpanzees and males are the only two ape species stuck dealing with familiar males as dangerous.  A gender that frequently creates lethal violence within our own communities makes chimpanzees and humans simply bizarre among group-living animals.  Chimpanzees don’t create a safe space; they create a stressful, tension-bound, politically encumbered social world for themselves to inhabit.  Which is what we do.  This behavioral package exists only in chimpanzees and humans.” 

Frans de Waal provides insight into primate characteristics in his book Different: Gender Through the Eyes of a Primatologist.  He warns us that discerning differences in cognitive functioning between males and females is complicated because there are brain differences that come from genetics and there are brain differences that come from lived experience.  Nevertheless, there are clear differences in males and females from birth, with each tending towards activities, playing modes, that are part of preparing for their future responsibilities.  Male chimps seem immediately to anticipate competing with other males, both physically and mentally.

“I am always astonished at the inexhaustible energy with which young male apes romp around, jump up and down things, and go at each other, rolling over the ground with big laughing faces while they rip each other apart.  Known as rough and tumble play, it’s mostly fake assaults, wrestling, pushing, shoving, slapping, and gnawing on each other’s limbs while laughing.”

Male chimps are infamous for their fiercely competitive male hierarchies.  Females will form hierarchies as well, but they do it more efficiently without the continuous tension, leaving them to concentrate on their main function.

“Among primates, the orientation to vulnerable newborns and their substitutes, such as dolls or logs, is undoubtedly part of biology and more typical of females than males.”

“Young primate females are besotted with infants…Young females surround a new mother and try to get close to her infant.  They groom the mother and—if they are lucky—get to touch and inspect the infant…Females follow the mother wherever she goes.  They may play with the newborn and carry it if the mother lets them, which serves as a preparation for the moment when they get their own progeny.”

Male primates, including chimpanzees have demonstrated the tendency to nurture infants, but usually only when a mother is no longer available.  Otherwise, competition with other males is the constant concern.  Similarly for females, raising offspring is a constant, lifelong task.  Both biology and culture suggest that there are likely differences in the capabilities and interests in learning between males and females.

Do these tendencies translate to humans.  Richard V. Reeves provides an interesting perspective on male/female differences in an article for The Atlantic: Redshirt the Boys: Why boys should start school a year later than girls.  The term “redshirting” refers to the practice of having a young athlete, usually a freshman at a college, sit out a year so he/she can gain another year of physical maturation before competing.  This is normally for sports that demand considerable physical strength.

The basis for Reeves claim is the now well-known fact that males’ brain development occurs more slowly than that of females.  At the age of five or six, girls are more ready to sit and listen to a teacher than a boy who will soon start looking out the window wishing he was outside playing (mostly some form of competition with other boys).  This sounds a lot like Safina’s claim for male animals in general.  And as we shall see, Reeves claims that males don’t seem to ever catch up, at least not through tertiary formal schooling.

“…the fact that boys mature later than girls is one known to every parent, and certainly to every teacher. According to a Rand survey, teachers are three times more likely to delay entry for their own sons than their own daughters. The maturity gap is now demonstrated conclusively by neuroscience: Brain development follows a different trajectory for boys than it does for girls. But this fact is entirely ignored in broader education policy, even as boys fall further behind girls in the classroom.”

“On almost every measure of educational success from pre-K to postgrad, boys and young men now lag well behind their female classmates. The trend is so pronounced that it can result only from structural problems. Affluent parents and elite schools are tackling the issue by giving boys more time. But in fact it is boys from poorer backgrounds who struggle the most in the classroom, and these boys, who could benefit most from the gift of time, are the ones least likely to receive it. Public schools usually follow an industrial model, enrolling children automatically based on their birth date. Administrators in the public system rarely have the luxury of conversations with parents about school readiness.”

Reeves points to noncognitive factors such as diminished social and emotional controls in boys compared to girls to explain the difference in performance.  In short, girls are better able to focus on the task at hand rather than having their minds wander off topic 

“The problem of self-regulation is much more severe for boys than for girls. Flooded with testosterone, which drives up dopamine activity, teenage boys are more inclined to take risks and seek short-term rewards than girls are. Meanwhile, the parts of the brain associated with impulse control, planning, and future orientation are mostly in the prefrontal cortex—the so-called CEO of the brain—which matures about two years later in boys than in girls.”

“Other relevant centers of the brain follow suit. The cerebellum, for example, plays a role in ‘emotional, cognitive, and regulatory capacities,’ according to Gokcen Akyurek, an expert on executive functioning at Hacettepe University, in Turkey. It reaches full size at the age of 11 for girls, but not until age 15 for boys.” 

The subject here is not the problems of school bias that haunt boys.  The goal was to evaluate whether humans and other animals are all subject to similar biological factors that affect their development.  As far as evolution is concerned, females are the gender that has the most responsibility for the continuation of a species and natural selection made sure they had the attributes necessary to perform that critical function. 

Humans, for very good reasons, are trying to arrive at societies in which males and females can be considered essentially equal.  For thousands of years men had convinced themselves that women were less capable and should be denied academic opportunities.  The elimination of bias against females seems to be demonstrating that females are the better learners, and it is the males who may need some form of affirmative action.  Society will just have to learn how to deal with this.