Sunday, May 04, 2014

Are pills or psychology best for treating mental illness?

JAMA, a major medical journal, has just published a review of reviews which tries to answer that question.  They found a slight edge in favour of psychology, somewhat surprisingly.  Excerpt of results  below:

Efficacy of Pharmacotherapy and Psychotherapy for Adult Psychiatric Disorders:  A Systematic Overview of Meta-analyses

By Maximilian Huhn et al


The search yielded 45 233 results. We included 61 meta-analyses on 21 psychiatric disorders, which contained 852 individual trials and 137 126 participants. The mean effect size of the meta-analyses was medium (mean, 0.50; 95% CI, 0.41-0.59). Effect sizes of psychotherapies vs placebo tended to be higher than those of medication, but direct comparisons, albeit usually based on few trials, did not reveal consistent differences. Individual pharmacotherapy trials were more likely to have large sample sizes, blinding, control groups, and intention-to-treat analyses. In contrast, psychotherapy trials had lower dropout rates and provided follow-up data. In psychotherapy studies, wait-list designs showed larger effects than did comparisons with placebo.

JAMA Psychiatry. Published online April 30, 2014.


Inequality isn't a problem: it's a driver of progress

Is there a genuine "issue of inequality"? I say no. There are (or at least may be) genuine issues of poverty, market and regulatory failure in the financial sector, or how best to raise taxes to fund public services. Very often discussions of "inequality" are either disguised discussions of one of these things or else inequality is seen a symptom of problems elsewhere (e.g. bonuses in the banking sector seen as a symptom of poor regulatory risk management oversight).

But once we strip out these other potential issues all that is left of the "inequality" discussion is this: is it bad if some folk are rich? And in truth, almost no-one claims that it is.

Try this thought experiment. Suppose each of us lived on our own desert island, like Robinson Crusoe, with identical resources and skills – so we're all perfectly equal  - and get our food in the form of fish from the teeming oceans (there is no scarcity of fish). Then suppose one of us works out a way to fish better, so inequality increases. Is everyone else somehow worse off? Clearly the answer is that everyone else is not worse off unless the better fisherman makes fish scarcer for them. The one person's riches do not come at others' expense.

Obviously this is a rather abstract thought experiment, but it points at something simple and important: almost all inequality in developed economies does not arise by the wealth of almost anyone else declining. (That does happen in less socially and politically developed societies, in which wealth arises from political control of resources or access to corruption.) In modern developed economies inequality arises when someone – a Gates or Zuckerberg or Cowell or Ronaldo or Rowling or just an ordinary businessman or professional – finds some way (some skill or invention or investment) that adds considerable value, and that value is not then shared equally.

In our modern globalised economy, the gains from a new idea or skill can now be leveraged over enormously more people. Instead of your new and better mousetrap being sold just to the fair folk of Wolverhampton, the whole world beats a path to your door. In such a world, improved added value creates large inequalities. But that is precisely because the added value of a Windows or Facebook or awesome evening's football skill benefits so enormously many people – even if each only benefits a little compared with the huge aggregate benefits benefits taken by the value-creator.

Many of those preaching the evils of inequality will at this point start to deny that this is actually how high inequality arises. They might claim that remuneration of executives or in the financial sector do not come from added value but, rather, from market failure. I would probably disagree, but at least they would then be talking about something interesting – the alleged market failure – rather than something of no intrinsic policy concern (the fact that some folk are rich).

Others will start telling you of the terrible social problems associated with inequality – the depression, violence, low life expectancy and so on. Well, insofar as these arise from poverty, we can debate how much to alleviate poverty. But then poverty is the issue, not inequality.

"Ah," say the evils-of-inequality purists, "but you miss the point that some of these social problems are psychologically connected to the fact that there are very rich people, not simply the result of the poverty itself." If that is the case offered, then my response is that you are either talking of aspiration or of envy.

Aspiration – being discontent in your current circumstances and hoping to improve your lot and that of those you love – is a driver of progress. Obviously some will fail in their aspiration, and may suffer psychological consequences. But are we really saying it would be better if no-one aspired at all, than for some to aspire and not succeed?

Others may not simply aspire, but may instead envy the success of those that have done better or who were luckier to begin with. It's hardly controversial that envy exists or that it may have negative consequences – that is, after all, presumably why it's one of the Seven Deadly Sins?

If someone said: "Women with beautiful eyes should cover them up to avoid inciting lust in others" we would say that's silly or oppressive. It's the luster's problem, not the person lusted after. Yet in the case of envy, somehow we're supposed to believe it's the envied person that's the bad one, not the envier? No. Envy may be harmful, but to the very limited extent it's a policy concern the correct response is to teach people not to envy.

Others say "In studies, unequal societies have lower social mobility". But that wouldn't be surprising if either low social mobility were a cause of high and persistent inequality (which it might be) or if the same forces that drove low social mobility also drive high returns (e.g. if societies are already highly meritocratic, social mobility is likely to be low, because children are likely to be similar in innate talent to their parents, and returns are likely to be high, because meritocracy is efficient).

The intellectual case that inequality is a concern in itself collapses fairly rapidly under probing, and always has done. Yet the political concern is remarkably durable. I suspect that is because an important element in the inequality discussion is actually a disguised and somewhat incoherent discussion about something else – namely, unearned income.

Truly unearned income can be an issue for Right-wingers as well as the left. Right-wing thinkers tend to subscribe to the Lockean theory of property, according to which property (as opposed to mere possession) arises from combining work with the "common treasury". For example, if you find a stick in the road, the stick is part of the common treasury and thus far your possession but not your property. But if you sharpen the end of the stick to make it a spear, that spear is your property.

Now, think about investment income. According to the Capitalist theory of lending at interest, the return on investment arises from two forms of work (risk-taking and investment project analysis) and one of sacrifice (giving up other opportunities to use the money). That means no investment income is strictly "unearned".

But now suppose, instead, that the way things worked were this: the wealthy lend money at interest, which grows systematically faster than wages, and the money lent is at no risk of loss, because if there is any risk of loss the State will intervene to bail the project out (e.g. by bailing out failed banks). Under that sort of system, it would be difficult to provide a justification for that element of wealth growth that was then truly unearned. Under the Lockean theory it isn't even the property of the wealthy person – who has done no work to produce it! It's mere possession and control of riches, not property at all.

Now 19th-century radicals, and radicals such as Thomas Piketty today, appear to me to have a rather pessimistic and fatalistic conception of politics. They believe it is inevitable that the wealthy will use their political influence to defend their wealth in this way. Consequently, the recommendation is that the wealthy be charged by the state in the form of wealth taxes – which we can see as a kind of payment to the state for defending their riches. Furthermore, it seems pretty obvious that once one started to charge the wealthy such wealth taxes, the political and moral pressure to bail them out to defend their position would be overwhelming – otherwise, what are the wealth taxes being paid for?

I would prefer a system in which the wealthy were allowed to lose their money if their investments go bad, in which the state does not intervene in the economy to keep the rich rich.  I grant that we do not have such a political system now – the bank bailouts of 2008 and since have made that clear to everyone, and things like deposit insurance have become even more extensive in recent years. But I am optimistic that one day we can achieve a politics, society and economy in which investment capital is always genuinely at risk and the state does not think it is its job to keep the rich rich. It's nice to dream that, anyway…



Churchill, Hitler and Islam

The English patriot Paul Weston, chairman of the party Liberty GB, was arrested by the police on April 26 2014 in his native Britain… for the crime of quoting Winston Churchill, Britain’s Prime Minister during the Second World War. Yes, it has come to that.

The passage quoted by Weston was published in 1899. It focuses on Churchill’s negative observations about Islam while serving during the Anglo-Egyptian reconquest of the Sudan. The young man commented on the repressive and warlike nature of Islam and concluded that “ No stronger retrograde force exists in the world.”

As the commentator Daniel Hannan noted: You may or may not agree with these comments, which Mr. Weston cited. That does not change the fact that this was a political arrest. A British political candidate running for elections was arrested in mid-speech simply for publicly addressing potential voters by quoting a former Prime Minister.

For this, Paul Weston was arrested and put in a cell for some hours. He was suspected of having committed a “racially aggravated crime under Section 4 of the Public Order Act.” I’m not quite sure what that is, but it sounds very much like something George Orwell might have invented in one of his novels.

Reality has moved beyond parody. Britain, once a champion of political liberty, is no longer a free country. It is now a Monty Python sketch — except it’s not funny — or a banana republic without the bananas.

Sadly, it’s not the only European country that could be classified as such these days. From Hamburg to Helsinki, from Marseille to Stockholm and from Barcelona to Brussels, the natives have to endure seeing their heritage being dismantled and being turned into strangers in their own cities.

In this atmosphere, saying negative things about Christianity is not merely allowed, but in certain quarters actively encouraged. At the same time, saying negative things about Islam may end your career, trigger violent threats and maybe even get you arrested by the police.

The supreme irony in all of this is that if Paul Weston had quoted Adolf Hitler’s favorable views on Islam instead of Winston Churchill’s unfavorable views, he would presumably have encountered no problems. That’s because Hitler’s positive view of Islam is more in line with that of today’s ruling Multiculturalists.

There is a tendency in the mass media to portray opposition to Islamization as something “far-Right,” at the same time as they portray Nazis as far-Right. This is questionable. The political terms “Left” and “Right” date back to a random seating arrangement in France in the late eighteenth century.

Perhaps we need a new political vocabulary, more in tune with the realities of the twenty-first century. For example, some of the established so-called “right-wing” parties are every bit as much in favor of mass immigration and open borders as the “left-wing” parties are, if not always for the same reasons. That fact now undermines the very fabric of the Western democratic system. Many Western citizens do not want mass immigration to their countries, but they get it, anyway.

Nevertheless, to the extent that you talk about Left vs. Right, you could argue that the national Socialists (Nazis) formed a part of the political Left, just like other Socialist parties and movements. It was Vladimir Lenin and his followers, not Adolf Hitler, who founded the first major totalitarian state of the twentieth century. The Nazis copied tools of propaganda and methods of repression pioneered by the Communists. People are often led to forget that today.

There is arguably a direct line from the revolutionary terror of the Jacobins during the French Revolution to the revolutionary terror of the Bolsheviks during the Russian Revolution, from the political mass murders under Robespierre in the 1790s to the political mass murders under Lenin after 1917. Most (some might even claim all) of the mass-murdering totalitarian movements in the modern world have come from the political Left. It is therefore strange that to be “left-wing” is now seen as something neutral or positive, whereas to be “right-wing” is seen as suspect. Viewed in the light of history, it should be the other way around.

The Dutch politician Geert Wilders has been criticized and branded an “extremist” for comparing the Koran to the Nazi leader Adolf Hitler’s autobiography Mein Kampf (“My Struggle”). Yet as Wilders notes in his book Marked for Death, no lesser man than Winston Churchill, who led the fight against Hitler and the Nazis, did the same.

Churchill did this in his six-volume history The Second World War, which partly earned him the 1953 Nobel Prize for Literature. In it, the conservative British statesman called Mein Kampf “the new Koran of faith and war: turgid, verbose, shapeless, but pregnant with its message.” [Original quote by Winston S. Churchill in The Second World War, vol. 1, The Gathering Storm, page 50.]

Hitler openly lamented the fact that the Franks had defeated the invading Arabs in AD 732. “Had Charles Martel not been victorious at Poitiers,” Hitler told his inner circle, “then we should in all probability have been converted to Mohammedanism, that cult which glorifies the heroism and which opens up the seventh Heaven to the bold warrior alone.” [Original statement by Adolf Hitler, 28 August 1942. Quoted in page 667 of Hitler’s Table Talk; 1941-1944, translated by N. Cameron and R.H. Stevens, Enigma Books (1953)]

Albert Speer wrote in his diary that Hitler regretted that Islam had not conquered Germany, as it was much more compatible with Nazism. “It’s been our misfortune to have the wrong religion,” he told Speer. “Why did it have to be Christianity with its meekness and flabbiness?” [A quote from Albert Speer, Inside the Third Reich, chapter 6]

Hitler repeatedly expressed his great respect and admiration for Islam and his contempt for silly Christian notions of compassion. Similarly, Heinrich Himmler, the leader of the SS and the Gestapo and by extension one of the most feared men in Germany and Europe, was full of admiration for Islam. He was sad that the combined Polish, German and Austrian troops of King Sobieski of Poland had halted the invading Turks at the gates of Vienna in 1683.

Himmler told Felix Kersten, his personal masseur and confidant, that Islam with its concept of Jihad and promises of beautiful women and instant rewards in the afterlife if you fall in battle was a wise religion, well-suited as a male warrior creed. [Source: Felix Kersten’s memoirs, Totenkopf und Treue, page 203.] The SS leadership for the same reason considered Islam to be a practical religion for soldiers.

The admiration between Islam and Nazis was often mutual, and sometimes still is. Scholars such as Andrew G. Bostom have meticulously documented this fact.



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