Saturday, November 12, 2016

Solidarity in the twilight: how to fight darkness post-election?

Image credit: Pete Linforth via pixabay.com
In the wake of the Trump victory in the US Presidential election, I read a number of confused posts. I see people wondering how they will cope now that forces of darkness have been unleashed, and I read people asking how a campaign built on hatred could do so well. Comparisons with the rise of Hitler and Mussolini, comparisons with Brexit... there is fear all around that, yet again, with a result going the way of those who incite hatred, acts of hatred will follow. A fear that angry white men in particular, but not exclusively, will see the result as legitimising their acts of hatred. Apparently hate crimes against Muslims are already on the rise with only September 11 2001 as a comparable precedent - see this article about just one such incident in Wisconsin, a state in which 300,000 registered voters were turned away without sufficient ID.

I was shown a facebook post today written after an experience in a restaurant that goes like this:
...there's a Muslim family sitting nearby. The woman, wearing a hijab, keeps glancing around warily. Like she's expecting a confrontation any minute. They passed by my table as they left, and I told her that I thought her hijab was beautiful and I loved the color. She smiled and said, 'Thank you,' and I said, 'I hope y'all have a good rest of your night. Stay strong,' to all of them.

It got me thinking - for all the people who are really upset after Trump's victory and wonder what they can do to prevent darkness descending... what have people done in the past? What works and why?

The first thing that came to mind was the trending hashtag after an attack on a Sydney cafe #illridewithyou. The truth of the story at the beginning of the movement is disputed but even if it is a fictionalised account, a fantasy of 'what I should have done' then it fits here. The story goes like this:
and the (presumably) Muslim woman sitting next to me on the train silently removes her hijab.... I ran after her at the train station. I said 'put it back on. I'll walk with u'. She started to cry and hugged me for about a minute - then walked off alone'  and when the story was shared by a journalist, others created the hashtag, with commuters sharing schedules to at least provide company to those who were scared.

I would like to acknowledge an interesting perspective on this kind of helping, which suggests that aiding those who are afraid in this kind of situation actually perpetuates islamophobia, It concerns me, because it is well-argued, and I don't want to suggest that a patronising approach is the best solution under the circumstances. But I don't think that's where I'm going.

So far what I see is the idea that there are people eager to express solidarity but they don't know how. A quick search for explanations of what solidarity actually is led me to a couple of websites quoting from Pope John Paul II.
“Solidarity is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.” 
Pope John Paul II image credit ddouk via pixabay.com


The website I have taken this quote from is thoughtful, giving a reasoned explanation for action.
Solidarity is a radical expression of compassion. Solidarity is rooted not in my distress at the pain of others, but in the objective reality of their distress. Solidarity is rooted not in transient feelings of distress at the pain of others, but in a lifelong commitment to alleviating the pain of others. Solidarity derives not from our sense of generosity but from our sense of justice, from an acknowledgment that we are all united in our common humanity and the pain of others is our responsibility. 


This reminded me of something important, perhaps obvious, but easily forgotten. Feeling distress because of the pain of others is already a step beyond what many adults can manage. Transcending that feeling of distress, recognising that the feeling is best understood as concern for injustice and a desire to act to correct a perceived imbalance... that's even rarer.

This brought to mind the footage of Bernie Sanders being arrested for his involvement in protests against segregation in Chicago schools in 1963. With a history of standing up against injustice, it's no surprise that he's still there to be counted:
Bernie Sanders image credit Max Goldberg via flickr.com


Here are some ideas about what you can do to make it more difficult for people to commit those acts of hate.
1. Start your own conversation with someone who's being verbally assaulted. Your conversation will win.
2. If you're in a position of power/authority/respect, you have the ability to affect whether potential victims feel safe or not. Another post on facebook I saw today was a photograph of a notice on a teacher's classroom door stating that he/she was in support of Mexicans, Muslims, LGBQT... basically saying everyone is welcome. Do you feel like everyone is welcome in your world? Maybe at the moment you need to find a way to say it.
3. The safety pin. Did it work? I suspect it was too subtle.
4. You've got your own social media accounts, right? If you feel bad, why not post about it? This video had popular appeal, probably to people who already weren't racist, but still, why not look and share?
5. If you feel bad, the closest thing there is to a political voice to your feelings is probably Bernie Sanders. Look at his twitter feed and think.
6. Keep your eyes open - more and more messages like this are coming out. Here's Nicola Sturgeon.

7. Follow the advice here:



So where's the link to research?

Empathy. One model of empathy that I have spent some time looking at identifies four components of empathy. While perspective-taking, fantasy and empathic concern increase over time, personal distress goes down. On one hand you could argue that personal distress goes down with the development of a mature detachment from others' distress (Erikson's definition of wisdom), or you might also argue that personal distress decreases when other avenues are found to express concern at injustice. Some of the work from the Berlin approach to measuring wisdom found that many of those nominated as wise in the 1980s had been actively working against the Nazis during World War II (refs. on request).

A situation like this can be a growth experience, for individuals and for society as a whole - it can push you and people like you towards a more active empathic stance. Take the opportunity and at least start to support those who could use it. Think solidarity, not just compassion.


Davis, M. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44 (1), 113-126 DOI: 10.1037//0022-3514.44.1.113
ResearchBlogging.org

Tuesday, November 1, 2016

If depression is biological, does that change how you feel about it?

Last week a story reached my twitter feed that I couldn't resist looking into because the claim in the title looked outrageous.

"Depression isn't a choice, it's a kind of brain damage" on Lifehack.org exists under the same title at themindsjournal.com.

In his bio there, the author describes himself as

an introverted extrovert with a thirst for life. He is a full time web developer and freelance programmer. You can find him online at YourFriendlyWebGuy.com. In his spare time he DJs, loves coffee and practices yoga.

Apparently he's also a writer... with the same story all over the place on the net. Is it any good?

The first claim is that researchers have definitively shown (finally) that persistent depression causes brain damage, not the other way round.

That's not where I thought this was going. If the claim in the title is correct - that depression is a kind of brain damage, wouldn't you expect researchers to have shown that brain damage causes depression? So I'm already confused after two sentences - what does Erichsen mean by brain damage, and what by depression?

The next two paragraphs take us down a difficult path:

The study, which consisted of 9,000 individual samples, collected from the ENIGMA group, succeeded in definitively proving a causal relationship between persistent depression and brain damage. Magentic resonance images (MRIs) showed evidence of hippocampus shrinkage in 1,728 patients diagnosed with chronic depression compared to the 7,199 healthy individuals partaking in the study.

Specifically, the study found that those patients diagnosed with major depressive disorder, “showed robust reductions in hippocampal volume (1.24%) in MDD patients compared with healthy controls.” You can read the full study here.


Problems in these paragraphs and beyond:
1. It's unlikely that it definitively proved a causal relationship, because science doesn't often do that, but we'll see...
2. Magentic? Not the most persuasive spelling...
3. 1728 + 7199= 8927. Close to 9000 but not the same. Just sayin'. Notice the big difference in sample size between healthy and chronically depressed. We'll see if that matters.
4. I'll forgive the awkwardness of that quote and skip to the problem of the 'here' bit. There's no link. Eventually I found a facebook post by someone else linking to the story and the original article so we can check some of the claims.
5. The diagram is a little unconventional. Is the hippocampus labelled correctly? Compare... Would we say the amygdala is inside it?
6. Most of my concerns are explained by this article - Erichsen's post is mostly a rewrite that introduces inaccuracies.

The original study (Schmaal et al., 2016) is a meta-analysis of other studies. As such it cannot provide definitive proof but it can do what is otherwise difficult: accumulate a sample size big enough to draw some conclusions about brain changes in people with major depression. There are enormous difficulties in bringing together data from different studies with variables like these: criteria for 'depression' vary and there will be differences in samples and techniques used to carry out scans. Their findings included decreased volume in the hippocampus that was more pronounced among those with earlier onset depression but not among those with more severe symptoms. The researchers speculate that their findings may relate to a premorbid vulnerability factor (abnormal hippocampal development) but there is no way to draw conclusions about this from their data.

So let's be absolutely clear: the study associates the size of brain regions with presence of a diagnosis of major depression. As a cross-sectional study, it does not show that size differences represent atrophy, although this seems a likely cause, and it certainly cannot show that depression causes atrophy or that atrophy causes depression.

So why the title in Erichsen's article? Depression is not a choice - that's fine - I'm not sure who says it is. But the validity of that claim does not rest on proof that depression is causing or caused by changes in the size of brain regions. Erichsen's work misrepresents the original article, borrows heavily from someone else's work online, and then goes on to suggest that the choices you make as a depressed person can cure your depression. The epistemological confusion here as well as misinformation is really unhelpful - yet another example of a desperate attempt to find biological evidence for the mechanisms of depression. Of course they can be found and research like the original here is part of an ever-increasing body of literature that finds correlates of depression in the brain.

But what's the point of writing like Erichsen's that trumpets an unsupportable claim that something has been definitively proven? Why is it so important to identify these biological changes? Is it important to you? How does it change your feelings about depression
a) if biological mechanisms are found, and
b) if you see writing like Erichsen's that is factually inaccurate?

Let us know...


This post written by Alan Law

ResearchBlogging.org Schmaal L, Veltman DJ, van Erp TG, Sämann PG, Frodl T, Jahanshad N, Loehrer E, Tiemeier H, Hofman A, Niessen WJ, Vernooij MW, Ikram MA, Wittfeld K, Grabe HJ, Block A, Hegenscheid K, Völzke H, Hoehn D, Czisch M, Lagopoulos J, Hatton SN, Hickie IB, Goya-Maldonado R, Krämer B, Gruber O, Couvy-Duchesne B, Rentería ME, Strike LT, Mills NT, de Zubicaray GI, McMahon KL, Medland SE, Martin NG, Gillespie NA, Wright MJ, Hall GB, MacQueen GM, Frey EM, Carballedo A, van Velzen LS, van Tol MJ, van der Wee NJ, Veer IM, Walter H, Schnell K, Schramm E, Normann C, Schoepf D, Konrad C, Zurowski B, Nickson T, McIntosh AM, Papmeyer M, Whalley HC, Sussmann JE, Godlewska BR, Cowen PJ, Fischer FH, Rose M, Penninx BW, Thompson PM, & Hibar DP (2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular psychiatry, 21 (6), 806-12 PMID: 26122586

Friday, October 14, 2016

New old news about antidepressant side effects

When this story on Psyblog went through my twitter feed because @PsychologyNow shared it this week, I was intrigued and then surprised to find it was a study I knew about... published two years ago. Hardly news, then.

But important nonetheless, and sufficient time has passed that we can look at how the study was received.

The paper reports findings based on online questionnaires completed by 1829 New Zealanders who had been prescribed antidepressants in the five years prior. The side-effects they had experienced were the main focus: although a recipients are usually warned about potential side effects, what they are warned about is not necessarily what is then experienced.
The authors identify some emotional or interpersonal effects and characterize them as 'closing down'

  • feeling emotionally numb
  • feeling not like myself
  • reduction in postive feelings
  • caring less about others 

Importantly, they address the question of whether these are caused by the drugs or by the depression. Because participants were asked to rate their level of depression before they started taking the drugs, the relationship between those levels and adverse effects could be checked: the authors conclude that the simplest explanation is that these adverse effects are caused by the drugs rather than the depression, although the authors also consider the possibility that those who feel the drugs are helpful pay less attention to these adverse effects.

The concern, anyway, is that over a third of participants were not told about these adverse effects beforehand, a trend that was decreasing over time - which is a challenge to the ideal that patients are given an informed choice over medication use.

There are to date 15 citations of this article in Scopus, 15 in Science Direct, and 29 in Google Scholar, so we stick with the latter for a quick check of how the finding was received.
1. Karanges et al. (2014) , Durisko et al. (2015), Busfield (2014), Demyttenaere et al. (2015)Botella et al. (2015)  (in Spanish), Hughes et al. (2016), Ruby (2016), Kleszcz (n.d.) and Donskoy (2015) simply report the main findings - although Demyttenaere et al. have an interesting argument themselves about what patients vs physicians expect treatment of depression to result in - and Donskoy cites in an article arguing that the lack of informed choice is a violation of human rights.
2. Read, Cartwright or Gibson cite the article  (10 times)
3. Högberg et al. (2014) focus on the idea that empathy is a hindrance to suicidal impulses and medication that causes a closing down ('care less syndrome') may thereby enable suicide.
4.  A book chapter dealing with the validity of the depression diagnosis
5. A biological experiment
5. Some unclear citations in work I can't access or in student theses (5 of these)


In two years' worth of citations then, I can't find a single objection to the findings. On the contrary, there is only more and more support for the idea that doctors who prescribe antidepressants don't tell patients enough about possible adverse effects. Some argue that this is a violation of human rights and others point out this in itself could affect suicide rates.

Does this resonate with you? Did doctors tell you enough? Let us know @hashtagpsych...

ResearchBlogging.org Read, J., Cartwright, C., & Gibson, K. (2014). Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants Psychiatry Research, 216 (1), 67-73 DOI: 10.1016/j.psychres.2014.01.042

Friday, October 7, 2016

Gender pay gap - why the disagreements?

Not long ago I wrote in reference to a suggestion that academic feminism is hurting women. The article that had inspired my post included reference to one of the better known critics of reporting about the gender pay gap. The rather troubling piece seemed to suggest that women have already won the fight for equality and it is only radical feminists and other liberals who perpetuate the myths that, for example, there is a gender wage gap. It's been bothering me that not only did I not address this myth-not myth in my post, but that I keep hearing it again and again.

Christina Hoff-Sommers is frequently cited when people want to argue that the gap is a myth - she works for a conservative thinktank in the States and argues that many feminists are lying to us when they present statistics - so for example,

The bottom line: the 23-cent gender pay gap is simply the difference between the average earnings of all men and women working full-time. It does not account for differences in occupations, positions, education, job tenure or hours worked per week. When such relevant factors are considered, the wage gap narrows to the point of vanishing.


Wage gap comic
Cartoon from leftycartoons.com
In one of her slightly condescending youtube videos, she says that the gap represents only the total difference between all men and women in full-time work without considering differences in occupation, job tenure, positions, education, and hours worked per week. A special example she gives is in medicine, because women are more likely to choose lower paying specialties, like paediatrics rather than cardiology, because they're more likely to choose to work part-time, and because full-time female doctors work 7% fewer hours than males. And women choose to take long periods of absence to start a family. If you account for that, there's no difference. What Hoff Sommers willfully ignores is that just because accounting for these sorts of variables makes the wage gap go away does not mean that those variables themselves are not evidence of some kind of gender wage problem. For example, some questions, why isn't paediatrics paid as much as cardiology? Why are there not more females in cardiology? Is it really the case that female doctors feel the same amount of social pressure to take a break from work to start a family as their husbands? Without a comprehensive answer to these questions, it's merely shifting the blame for the wage gap across from one variable to another and pretending that means there's no problem. I would argue that as long as the statistics show there is a difference, whether the manifestation is at the level of equal pay or at stereotypical patterns of choice does not really matter: there's a problem that needs to be understood. Hoff Sommers prefers to obscure it. At the same time, she claims that only truth will really improve things for women. When she insists that there is freedom of choice, she blames women's free choices for the pay gap. For psychologists it is very hard these days to argue that decisions are made completely freely, in some sort of emotional, social and chronological vacuum; this makes her claim ideological rather than factual. What ideological bent would drive the insistence that the gender pay gap doesn't exist when so many institutions claim it does?

To its credit, the Ministry for Women agree with my assessment of the issue in their recent announcement of the latest figures, which show an increase in the gap. They address the claim made by Hoff Sommers and others, with spectacular use of mocking inverted commas to say that sometimes the gap is 'explained' by other factors. But the Ministry presents those factors as causes of the gap, so there is a difference between explaining the gap and explaining away the gap.



Difference in % between male and female pay, based on data from Ministry of Women

So now that it's been announced that the gender pay gap is up (clearly on the rise since 2012 but with very small increase year on year) - how long before Hoff Sommers gets brought out to argue that it's not a real thing? I'd give it a day or two at most...

Saturday, October 1, 2016

Does The Danish Way Exist and Does it Lead to Happiness?



This week we look at one of the highest ranking stories with the #psychology tag. Tracy Gillett, who runs her own blog, wrote “The Happiest Country on Earth is Proof Positive Parenting Works” about parenting in Denmark. It relates to a book written by Jessica Joelle Alexander and Iben Sandahl that I hadn’t heard of, but according to a one-star review on Amazon, there is not much more in the book than is on the web anyway.

I have three concerns about all of this, and I’ll work through them one by one.


1. What is this Danish way? Can there really be a ‘Danish Way’ of parenting? It’s a smallish country, but I’d be surprised if a distinctive way of parenting could be found that operates independently of other factors.


2. If there is, is it right that Gillett refers to it as ‘positive parenting’ or is that something different?


3. The word ‘proof’ suggests evidence of a solid causal link between the two ideas. In this case we can check for evidence of a solid causal link between positive parenting (or maybe Danish parenting) and being the happiest country on Earth. That’s quite a big causal claim.


4. Denmark is often referred to as the happiest country on Earth and that claim needs some attention.


1. The Danish Way

As I understand it, the book is organised round an acronym PARENT, which is remarkably English for what are supposed to be Danish ideas, and reminds us that it is written for an American audience (see playeatlove.com for a quote from the introduction). For information about the six ideas represented by the letters PARENT, look at The Danish Way website, but be prepared to settle for ARENT on that page. The P is missing. Regardless, the six are Play, authenticity, reframing, empathy, no ultimatums, togetherness (hygge). Here’s the kind of claim I’m looking for:

Danes, on the other hand, follow a philosophy called “proximal development,” which basically states that kids need space to learn and grow (with a little help, if necessary).


I dispute most of that sentence. Although there is a researcher named Danish who has some work on proximal development, and some research on proximal development has certainly been done in Denmark, I can’t find evidence for such claim. But the claim doesn’t make much sense anyway. I’m not aware of a philosophy called proximal development and I believe the authors actually refer to Vygotsky’s “Zone of Proximal Development” (ZPD) – not a philosophy, but an incompletely explained developmental psychology concept that has implications close to the reverse of the authors’ claims. Vygotsky’s point was to emphasise the social aspect of learning: we learn how to deal with new challenges not only by ourselves, but with the presence and presumably mentorship or assistance of more competent others. Thus the suggestion that Danish parents do not intervene unless it is absolutely necessary sounds both false and anyway irrelevant to the spirit of what Vygotsky was trying to emphasise. The book supports some of its claims with studies carried out in the US and with reference to the Danish play patrol system, which does indeed seem to carry some elements of ZPD.

So I can only give a mixed answer without reading more of the book. Is there a Danish way? I’m not sure. Where there are differences, like a later starting age for primary school children than is typical in Anglo-Saxon countries, is that a difference in parenting, or is it just better to bring kids up in Denmark ? A life-swap article from The Guardian relating to this is a compelling read – and I’m inclined to agree with this review that if a country’s happiness is to be improved, it will take political upheaval before the kind of parenting suggested in this book is able to occur.

What I can say is that what little I have read of the book does not convince me that there is a Danish way (as opposed, for example, to a continental European or Scandinavian way) worthy of this kind of treatment, even if the ideas presented are in themselves quite intuitively appealing.

2. Positive parenting?

Back to Gillett. Actually her article is mostly a summary of the messages in The Danish Way, and she doesn’t really get to this point, except at the end in the final lament that there is not enough support for the choices that Gillett and friends make. What is positive parenting? Another page on Gillett’s own site is quite useful in explaining it, and she’s right, it’s not that dissimilar to what The Danish Way authors seem to suggest. So The Danish Way is mostly just ‘positive parenting’ – not especially, uniquely, or exclusively Danish.

3. Positive parenting as a cause of something

Gillett has a page dedicated to a defence of positive parenting decisions. There’s evidence that punishment causes problems, but I don’t see evidence of benefits. I understand the logic and I like it. But I’m a step further from being able to say the title claim is valid. The problem I see now is that Gillett’s claim seems to be based on a claim made in The Danish Way. So here’s the summary of the evidence so far:

Denmark is consistently the happiest country. The Danish Way suggests it could be because of parenting. I’m suggesting the book has only a weak connection to any genuinely Danish parenting or one that is not clearly demonstrated on The Danish Way’s website. I am inclined to think that what has been described is probably more representative of positive parenting as explained by Gillett, which means that positive parenting makes Denmark the happiest country, not Danish parenting.

4. Is Denmark really the happiest country?

Gillett refers us to a BBC article about the World Happiness Report 2016, which put Denmark on top and Burundi at the bottom. The article begins to explain happiness through the way people interact with each other and unhappiness through civil unrest. I wonder if The Danish Way would help the Danes stay happy in equally troublesome civil conditions as are faced in Burundi. Isn’t it a little insulting to the people of Burundi?


Have a look at a couple of images copied from the Report (pages 16-22). First, here’s the top 20 countries. Notice that there’s not actually a big difference in scores among these countries.














And the bottom 20 countries are here. Overall there is clearly a difference between the top and the bottom, but is it worth trying to explain differences between individual countries, especially if you clutch at ‘parenting’ as an explanation. If you look at the key below, you’ll notice what factors contributed to the overall index.




The Report uses these individual factors in an OLS regression to show the importance of each of them in contributing overall to happiness. Social support, freedom to make life choices, and generosity all seem to make important contributions to positive affect. Look at the orange and green bars. Much smaller for the bottom 20 countries than the top 20 countries, right? What does that tell you?





My impression, regardless for the moment of whether I think the measures used were sufficient, is that comparisons within the top 20 are silly. Comparisons across time within a country, comparisons between regions… these things are ok.

But I just can’t see that it makes any sense to tell any of the countries on top that they can do anything to compete with Denmark: it’s all so close at the top.

Summary

Positive parenting deserves more attention and I agree with many of the fundamental principles but I haven’t yet seen enough to make a comment about it that has any scientific basis.

In the meantime, I am very sceptical about The Danish Way because a) I don’t believe a specific set of parenting strategies can be labelled as Danish and b) it appears that any evidence for effect belongs to the strategies themselves rather than to an overall strategy and c) its popularity seems to be linked to the distinctly unproven claim that this parenting has a causal connection to Danish happiness. For Gillett, the book itself was proof. It isn’t.

Sunday, September 18, 2016

Post-natal depression - not just about mothers

Photo by Steven Van Loy @mafalou from unsplash.com
Post-natal depression in dads?
When I started writing this, I thought I was going to write about one thing: men feeling extreme and sometimes debilitating sadness, irritability and/or worthlessness after the birth of a child. I thought I was going to write about how sceptical host Mike Hosking looked in the Seven Sharp piece on television about post-natal depression in men, and I would write about how real it actually is.

On second review of that television piece, though, I was spectacularly unimpressed. I forgave Mike his scepticism for two reasons: firstly, I think he accepts that big life changes can make people feel bad – but it requires real disruption and self-examination of the kind that many working dads don’t go through because, despite a lot of social change, dads’ lives are still less disrupted than mums’ lives. Perhaps he was sceptical because he didn't face the kind of upheaval others do.

Secondly, the story implied that post-natal depression in women and men is caused by hormonal changes, which arouses my suspicions. Too often we reach for biological explanations for human suffering, and I think paternal post-natal depression is almost so self-explanatory that it defies a need for biological explanation.

A lot of fathers have a really hard time after the birth of a child and I don't think there's a need for me to attempt to prove that. However, aware that there is a lot of misinformation and rumour around, I reviewed some websites, some recent research and some news stories and found a few things I think it’s important to talk about: what is post-natal depression; how is it different in men; what factors make it more likely to happen and is there evidence that it is caused by hormone changes; and does it need to be treated? My answers are below, but first, my overall impression.

The societies I have lived in and the cultures in which I became a father are not well-equipped to deal with a problem like this. Fathers can experience powerful and difficult emotions while feeling isolated, worthless when they can’t find their place in the new relationship and responsibilities structure, and overwhelmed with responsibility when they can. They may not have anyone to talk to about it even if they can overcome the expectation that they solve it themselves. We still tend to socialise boys in a way that suppresses or denies emotion rather than acknowledging it, and I suspect this is at the heart of the condition discussed here, and it is liberation from this socialisation that is at the heart of treating it: there is almost universal acknowledgement that troubled fathers need to talk more and be heard.

I was told many times over that I needed to provide support for my wife as a new mother but seldom advised to ensure that I had the same – and I got the impression that there is competition for rare sympathetic resources that should really be unlimited: the needs of the mother deserve no less attention when we pay attention to her partner. After reading more about paternal post-natal depression, I urge readers to give more support to dads. Ask how they are and listen to the answer. Share your stories - being a parent is hard work and we need to hear more about the rough side of being a dad. In addition, I'm struck that for all my concern about the lack of information about the paternal version of post-natal depression, it's blatantly obvious that  partners of mothers who are not fathers are even more ignored. At the bottom of this piece I invite your stories, and I would encourage everyone who can relate to this as the partner of a mother to respond.

1. What is post-natal depression (PND)?
One of the striking differences about this particular phenomenon is that the trigger of the emotions is identified in the name of the condition. You don’t get ‘post-spousal death depression’ etc. and I wonder if people more readily accept a diagnosis like this when it includes a specific reference to an understandable cause. My first step was to look at formal diagnosis. The American Psychiatric Association produce a Diagnostic and Statistical Manual that is now in its 5th major edition, which, although eternally controversial, contains up-to-date psychiatric thinking on symptoms for a very big range of conditions. In the latest edition, for example, a bereavement exclusion was removed from the diagnosis of major depression. Previously, it was not recommended to diagnosis depression in a person suffering from grief for up to two months after the death of a loved one. Some viewed this as a move to further medicalise human experience and encourage the unnecessary prescription of medication, and others viewed it as more liberating. It was not until the previous major edition of the DSM that post-partum was introduced as a specifier, in a sense establishing it as a type of depression. Now it is possible to diagnose major depression with peripartum (i.e. around the time of giving birth, not just after) onset, and up to 4 weeks after birth. So the basic story is that depression following childbirth is not considered different in terms of symptoms, but giving birth is recognised as a specific trigger. After 4 weeks, though, it’s regular major depression. None of that seems to have any bearing on the situation in New Zealand and in the UK, though, where any number of websites alert parents to the problems of PND and PPND (the paternal version) and dispense advice and warnings. Estimates in my quick sampling of websites dealing with the topic range from 10 to 20% of women and 3 to 10% of fathers to 26% at the peak time for this condition at 3-6 months after delivery.

2. What does PPND look like?
This is clearly a tough question because most of the available information available is about mothers. Some information is rather weak – inviting any reader to panic instantly as Babycenter.com defines PPD as, well… having a baby:

a woman with PPD may be:
sleep-deprived
transitioning to motherhood and dealing with the psychological adjustment
hormonally unsteady
breastfeeding or weaning
experiencing worrisome thoughts about her baby or her ability to be a good mother

consumed with guilt and disappointment about what's supposed to be the "best time of her life."

Some of the New Zealand websites are better. The Ministry of Health offers a sometimes gender-neutral set of symptoms:

always feel tired
cry a lot
feel that you are a bad mother
have aches and pains
think bad thoughts
do not sleep well, even when your baby is asleep
feel that you can’t cope with anything, such as housework
feel anxious or uncertain all of the time
don’t care about how you or things around you look
get angry with other people around you, such as your partner, other children or your whānau.


Four sites I looked at, the Mental Health Foundation, Plunket, the Health Promotion Agency’s depression site and Kiwi Families, don’t mention that men or partners can suffer from it, and there is only passing mention at The Postnatal Distress Centre. It takes quite some time before I get to a specific explanation of what the paternal version looks like. Parents.com’s Sad Dads post mentions some specifics, including irritability, anxiety, feelings of worthlessness, and engaging in risky behaviour, particularly related to alcohol and other drugs, gambling, or infidelity. And then there’s losing your sense of humour and being miserable a lot of the time. Everything is much clearer after I find an expert on the topic: Lloyd Philpott. With an already substantial body of work on PPND, he offers most of the answers I’m seeking and this guide for primary healthcare professionals is, in contrast to everything else I’ve seen, remarkably clear and focused. Two additions to the list of male symptoms worth noting here are excessive self-criticism and increased escapist behaviours, such as television watching and work. In sum, it seems like a lot of common addictive and risky behaviour tendencies are exacerbated with the arrival of a new baby and a possible deterioration in their relationship with the mother. The importance of PPND is also clarified: it is a major health risk for men, and may have long-term impact on relationships in the family, with knock-on effects for the child’s development.

Note: after writing this post, I found a champion website that somehow nailed it. Look at Well Women Franklin for good info. Not only do they recognise the male form of PND, they do their best to describe it and provide links to the limited services available.

3. What factors predict the occurrence of PPND?
Although a history of depression is frequently identified as a very important predictor, for women, being single or unemployed at the time of birth, and bottle-feeding are identified as increasing risk in an Irish study. A meta-analysis considering more than 80 studies adds self esteem, social support, infant temperament and socioeconomic status to the list along with the pregnancy being unplanned – but note that these are all predictors, not necessarily causes. Such social and psychosocial factors, along with personality, have been found to be more important than any birth complications in predicting symptoms at 8 weeks after delivery in an Australian study. Likewise, the Growing Up in New Zealand study has yielded some important results, and is one of few studies explicitly attempting to address the problem for men: the key predictors for fathers are stress and relationship troubles. If relationship troubles seem to be so important, you have to wonder to what extent it makes sense to look at post-natal depression as an individual phenomenon; perhaps it’s more sensible to look at it as a feature of the transition to parenthood (the title of a book by Jay Belsky) experienced by several people together, as seen in this more dynamic model that looks at the partnership as both a possible cause of distress and a possible target for improvement.

4. What about hormones?
The theme of hormone change is certainly quite prevalent through the various websites I’ve been looking at. At parents.com there are unreferenced claims that women’s PPD is triggered by hormonal fluctuations and unnamed ‘studies show’ that men’s hormones also shift, with testosterone and prolactin levels going down and cortisol going up. The same page also mentions that it is probably no coincidence that the typical onset of PPND at 3-6 months after birth is around the time that maternity leave typically ends and women return to work, and that the current generation of fathers might be experiencing more PPPD as they are more likely to be involved in household tasks than previously. With such a weight of evidence that psychosocial factors are the key to understanding this, is there a need to talk about hormones at all?

Another site, run by psychologist Christina Hibbert, claims that hormones are one of the causes, specifying decreasing testosterone and increasing estrogen as the culprits, with a reference to a USA Today article in which Dr William Courtenay says that men’s hormone levels change and that testosterone changes are linked to depression in men. Curiously, there is no direct link mentioned between these two ideas: Courtenay did not say that reduced testosterone has been found in PPND dads. He has referred interested readers to a study by Kim and Swain (2007) for a discussion of hormones, but those authors explicitly conjecture that there might be a relationship that needs to be tested. Their suggestion is based on a study of older men with depressed mood and low testosterone and studies that suggest testosterone levels decrease in men after the birth of a child with the effect of making them more sensitive and attached fathers. They also suggest that maybe increased estrogen has a role because more involved dads have been found to have higher levels of estrogen (even among rats), but offers no link to depression. They go on to speculate about four other possible hormonal explanations. However, I did not find any evidence of a link, even among articles that have cited it.

The California Psychologist published a piece by Daniel Singley, PhD, which cites the same references for the same purposes but explicitly states no clear link has been found. It does refer to another study mentioned by Courtenay – by Ramchandani et al. (2005), which apparently offered early evidence for a link. I tried and tried, but I can’t find any reference to hormones at all in that paper.

So the rather underwhelming conclusion I have to make is that everything I’ve read about hormones as a cause of paternal post-natal depression is simply conjecture or bad referencing. At worst, it’s an idea that’s made up. Why would a hormonal explanation for male depression be necessary? That’s a question for another time.

5. Does it need to treated? Does it go away?
By now I’m a fan of the ‘family’ approach to understanding PPD. So as I look through treatment advice, that’s on my mind. So advice like this:
Depression isn’t something a guy can simply “get over.” It’s a health condition that needs to be treated – just like a bad heart or injured knee.
just doesn’t sound right. Fair enough, without treatment, it can last for months or years. And it’s true one place to start is your GP or the Plunket nurse. But remember the Plunket website didn’t address men or partners. Lots of sites suggest you should talk to someone as soon as possible. The Father and Child Trust, featured in the Seven Sharp piece mentioned above goes a step further by running drop-in groups and offering telephone numbers without focusing on ‘treatment’. Christina Hibbert’s site is quite helpful with a number of options but the focus on men disappears in this section. Aside from this, there seems to be almost universal agreement that the interventions necessary for men are intimately bound with the likely cause. This article by Anna Whyte in the BOP Times appears to be the most informative and least judgmental and I recommend it.

Collecting stories of PPND
You don’t need to have been diagnosed or treated. Do the emotions mentioned above sound familiar to you? If so, please send an email to editor@hashtagpsychology.com with a brief version of your story if you are willing to feature anonymously in a bank of stories that will help better inform our understanding of paternal feelings after the birth of a child.


Notes

Post-natal is a more generally used term. Because it refers to birth it could be used in reference to the baby, the mother, or anyone around. Postpartum specifically refers to after giving birth and as such tends to be narrowly focused towards the mother. In practice, they are used interchangeably.

If you are seeking advice or support, please use the following contacts as supplied by the Mental Health Foundation:

  • Depression helpline. freephone 0800 111 757 
  • Healthline: 0800 611 116. (Available 24 hours, 7 days a week and free to callers throughout New Zealand, including from a mobile phone).
  • Lifeline 0800 543 35
  • Samaritans – 0800 726 666 (for callers from the Lower North Island, Christchurch and West Coast) or 04 473 9739 (for callers from all other regions)


This article was written by Alan Law for Hashtagpsychology.com

Friday, September 9, 2016

What's going on? Chiefs, Phantom patriarchy, Rape culture

A couple of days ago I was bothered by some assertions I found in a Psychology Today post and a Time post suggesting between them that there is too much liberal bias in social psychology, that it is infantalizing and inaccurate to warn women about a rape culture sustained by men, that women have taken over psychology, that many academic feminists cherrypick data and dismiss that which doesn't agree with what they think about a patriarchy that is in fact just phantom. Eek.

Today I was encouraged by the swift admission from Steve Tew that New Zealand Rugby (note capital letters) has a culture problem - swift in the face of a tide of fury as New Zealanders rejected the organization's attempt to quietly investigate some allegations of quite foul behaviour by players from one of the top teams towards a stripper. This was a public relations disaster that may have been successfully turned around because of the love so many New Zealanders have for rugby - check #loverugbyrespectwomen. I heard some callers on talkback radio who clearly think that if a woman takes her clothes off then everything she says must be a lie. Others believe her allegations but thought she deserved it because she blurred the lines - and therefore it wasn't a problem. Steve Tew has proper PR people, and that explains his quick turnaround. Watch All Blacks captain Kieran Read struggle to walk the line between 'the boys' and the indignant public and you can see how difficult it is to step out of the culture that Rachel Smalley describes as 'booze and birds' - and you can understand that all the PR in the world whispering in their ears can only tell these guys what to say after the fact - now they have to bring in specialists to help them treat women better. A final note on this story - a winner and some losers. Well played, Susan Devoy, New Zealand's former world champion squash player and now Race Relations Commissioner, who spoke so well on the radio - she clearly gets what the problem is and has an authentic reaction to it. The loser - and this is really tragic - the Minister for Women, Louise Upton, who refused to comment on the issue. Prime Minister John Key says she doesn't need to because it's basically not the government's job to have an opinion about it - this despite the Ministry's website indicating that keeping women free from violence is one of four priorities and that can be done through promoting a safe society. But John Key also says that Louise might have thought John had already said enough so, even as Minister for Women, she didn't need to find her own voice. Could have been a career moment. In addition, Sam Cane and Aaron Cruden, co-captains of the Chiefs - bad form not standing up and saying something. Don't be surprised if the public passion for justice turns its face your way soon. Probably not too late to find a voice - redemption is always possible. It does remind me of one thing: the same culture that disrespects women also imprisons men and there's a lot of work to be done with young men before they are able to recognise the harm and speak out against it.

So is redemption possible? In despair I cast an eye over other news. A Canadian judge asks a 19 year old (alleged?) rape victim why she didn't keep her legs together and tells her sex and pain often go together. He gets investigated for making inappropriate comments (result pending... check @carolyndunncbc) and now he's been through sensitivity training. He and his trainers think he has something useful to offer because of the experience. Regardless, how did that training not already happen? Like Steve Tew with his initial reaction, how much of a mess is that so much power is in the hands of people who can't recognise inappropriate behaviour towards women?

Back to the claims at the top - is it a myth that men are sustaining rape culture? When judges need re-education to find out why it's wrong to refer to victims as the accused, when rugby bosses need a Human Rights Commissioner to intervene before they can admit that maybe an in-house investigation wasn't the right way to go... it's not a myth - it's right here in front of us. We don't need to imply that men are intentionally sustaining a culture because 'all men are rapists' - I think that's how some people hear it - but we need to see that there are quite obvious elements of rape culture all around us and that men and women all need to work on changing it.

p.s.
At The Villainesse, you can read an open letter sent to the Minister for Women regarding her decision to make no comment on the Chiefs scandal. Louise Upston's response was that this was a matter entirely for the RFU (does it exist ? does she mean NZRU?) and blandly comments that when it is proven that sportspeople don't uphold high standards of behaviour, that is "obviously disappointing" - DISAPPOINTING? It's true, rape culture is disappointing. And 'frustrating' too. Poor Minister for Women is frustrated at continued violence. For goodness sake, take a freaking stand!









Note: Photo by Mpho Mojapelo 

Monday, September 5, 2016

Reflecting misogyny: Academic feminism is harming women?!



A surprising story from Clay Routledge, PhD in Psychology Today: "Is modern academic feminism harming women?" - The article is number 1 on Psychology Today as I write.

My gut reaction is that it's probably not harming women as much as he's going to tell me it is, and that means I need to read on. I don't know Clay Routledge but I will look into his work later.

Here's a few quotes from the first few paragraphs.

"There are fields in which men still outnumber women, but at the same time women have pretty much taken over a number of disciplines such as psychology and veterinary medicine. Women can now freely choose whatever career path they want and are making their choices based on personal preferences and priorities."


"...many feminist scholars and some journalists are not celebrating. Instead, they continue to advance a narrative in which women are perpetually victimized by men. They tend to ignore or dismiss data that challenge their narrative."



Well, that's curious. I wasn't aware that women had pretty much taken over psychology. I know most of my colleagues are female, but have they taken it over? What would that look like? Of the last 10 American Psychological Association Presidents, 6 were female. The next is male. Of the top 5 social psychology journals (ranked by impact factor), I find four males and four females listed as editors. The APA noted in 2011 that female PhD candidates outnumbered males and wondered if it was because males were scared off by stagnant salaries. In another piece in 2014, the figure below displays a change in proportion over time, but strangely enough, males still outnumber females at the top. More recently, this piece details other problems, noting that for every practicing male psychologist, there are 2.1 female psychologists, and that the gap is even wider among minorities.

Proportion of Male and Female Faculty at each Academic Rank, 1985 and 2013
Source" http://www.apa.org/monitor/2014/10/datapoint.aspx
So there are a lot of women in psychology, but I'd hardly say women have taken over. I'm also not a fan of free choice as an explanation of how we choose our careers. Worse than that, though, is the assertion that many feminist scholars ignore or dismiss data that challenge their narrative. Dude, didn't the data in my previous paragraph cross your mind when you wrote that sentence about women taking over psychology? At this point I don't know where your narrative is going, but it looks to me like you're dismissing several examples of males retaining power at the top of journals (alongside women) and outnumbering women at the highest levels of university in order to run with a narrative that intends to portray feminists as persisting with a fight that's already been won.  Let's see.

And then I feel quite conflicted. We are led to an article in Time by Christina Hoff Sommers that focuses on dispelling myths that some feminist scholars keep reciting. It's interesting stuff. She pushes for us to drop the myths and focus on the facts. I believe that very few people actually deal in factual information here and many will have used numbers that are inaccurate, but Hoff Sommers doesn't seem heavy on providing the real numbers here, which leaves the impression that she's saying if the numbers are wrong then the information isn't true. Which leads her to suggest that men are not sustaining a rape culture, for example. The problem is that even if she's right about the inaccuracies, I'm not sure how this approach will help - she says it will. I suspect The Factual Feminist will explain things better but I'm not going there for now. Back to Clay.

Oh. Next he's interviewing Hoff Sommers. And here things get better. Below are some key points that help me understand what Hoff Sommers is saying. There's probably something to it, but it's somewhat diluted by the paragraph-long questions that Routledge is asking.

  • Modern feminism tends towards benevolent sexism. Trigger warnings and safe spaces are infantilizing.
  • Female college students are some of the most privileged members of society but are coddled against a phantom patriarchy.
  • Too many gender scholars subscribe to a 'women-as-victims' narrative and try to 'knock down open doors'
And here's another quote from Clay Routledge:

"The concern is that since most social psychologists are liberals, when they study topics such as prejudice or intolerance they tend to focus on domains most likely to capture bias and discrimination among conservatives. If this can be a problem even in empirical fields, should we be especially concerned about this in more qualitative fields such as gender studies? Is there any debate going on in fields like gender studies about a lack of viewpoint diversity and liberal bias and how to combat these issues?"

Whose concern is that?

My own concern is that Routledge is pushing an agenda that is not supportive of genuine diversity. He therefore reasserts his opinion that women have it pretty good now and should stop feeling oppressed, using Hoff Sommers as a form of evidence. This while expressing a concern that there are too many liberals in social psychology.

So how do we best describe this piece? It has anti-feminist undertones, and appears to use the opinions of Hoff Sommers to advance the author's own concerns, which seem to be to do with combat against liberal bias. Is it actually calling for misogyny but disguising it as a less coddling version of feminism? I'm still puzzled about the title - it's not entirely clear who is harming women and how.

Read with caution.

Note: Christina Hoff Sommers is Resident Scholar at the American Enterprise Institute, a conservative thinktank.

Saturday, September 3, 2016

Satisfaction in later life

The second story this week is from Psyblog ‘People are happiest at this unexpected time of life’ – unsurprisingly, it reports that people get happier with age.

Alarm bells…. What kind of happiness are we talking about? There are some important distinctions to consider...

Anxiety and depression peak in our 20s and 30s. So it’s not happiness; it’s absence of mental health problems? Yes: Professor Dilip Jeste says young adulthood has worse levels of psychological well-being than other adult time periods. It’s a study from a survey of 1546 randomly selected adults in San Diego County. Random? Really? The post says this is the first link between better mental health and getting older. Again, I very much doubt it…. And it could be that 

older people tend not to ‘sweat the small stuff’, are more wise, regulate their emotions more effectively, retain fewer negative emotions and memories, and make better social decisions.”

Well, there’s loads of research on that. Was this just imprecise writing, or was the study awful? As it happens, a link to the study itself also arrived in my inbox this week because it cited one of the few wisdom researchers out there, Igor Grossmann, and I follow his work. So do we have any questions for the original work? Of course.

1.       What’s your main conclusion and are you sure it’s the first time it’s been drawn?

The study was only published this month so I haven’t been able to access the full text yet. However the abstract is out there, and there’s a press release from Jeste’s University, so we know that the sample wasn’t randomly selected, but used random digit dialling to find participants with telephones. Minor detail? Perhaps. The conclusion is warped by the writing. It seems to be that Jeste is not claiming to have discovered a new link between aging and better mental health, because this ‘paradox’ is already quite well known (see, for example, Kunzmann, Little and Smith, 2000). Rather, the finding is that in this study, improvement in mental health showed a steady, linear trend from young adulthood. The importance of this is in the absence of a decline in mental health in mid-life. So the conclusion isn’t really about happiness in later life; it’s about fewer mental health problems than expected in mid-life. More information would be great now – the issue of whether questions to participants were about happiness or satisfaction or absence of mental health symptoms is really not trivial.

2.       Is there an explanation of the possible mechanisms for this? For example, do we actually get happier as we age, or do we just feel less?
No, and there shouldn’t be. For a start, the study is cross-sectional, meaning it’s not about trends in the lives of individuals. It could just represent differences in groups at the present time.

Take home message? When we get a closer look at the measures used, I suspect there’s a really interesting story in the data and it’s being completely overlooked in the media, with lazy reporting of the now unsurprising finding that some aspects of mental health are at their healthy peak in later life. I see no reason to think the study itself was awful – it actually looks very promising and quite measured in its claims. Is this what happens when writers don’t read the research for themselves and the researcher's voice is lost...?