Coping Mechanisms of Health

Carl Jung argued that sometimes what seems like mental illness is in actuality an effective coping mechanism. He advised against treating the coping mechanism as the problem without understanding what it is a response to. The problem itself could be made worse. Some people have found a careful balance that allows them to function in the world, no matter how dysfunctional it may seem to others, from addiction to dissociation. We need to have respect and compassion for how humans cope with difficulties.

There is something similar in physical health. Consider obesity. Is it always the cause of health problems? Or might it be the body’s way of protecting against other health problems? That is what was explored in a recent study mentioned by Gabor Erdosi. It is Friendly Fat Theory – Explaining the Paradox of Diabetes and Obesity by Rajiv Singla et al. The authors write:

“Obesity has been called the mother of all diseases and, historically, has been strongly linked to diabetes. However, there are still some paradoxes that exist in diabetes epidemiology and obesity and no unifying hypothesis has been proposed to explain these paradoxical phenomena. Despite the ever-increasing prevalence of both obesity and diabetes, differential relationships exist between diabetes and the extent of obesity in various different ethnic groups. In addition, people with a higher body mass index have been shown to have an improved survival advantage in terms of chronic diabetes complications, especially cardiovascular complications. This narrative review attempts to explain these paradoxical and complex relationships with a single unifying theory. We propose that adipocytes are actually friends of the human body to prevent the occurrence of diabetes and also help in mitigating the complications of diabetes. Adipose tissue actually acts as a reservoir of free fatty acids, responsible for insulin resistance, and prevents their overflow into insulin-sensitive tissues and, therefore, friendly fat theory.”

L. Amber O’Hearn responded, “Wait, are you saying the body is actually trying to be healthy and that many symptoms we see in connection with disease are functionally protective coping mechanisms? Yes, indeed.” Following that, someone else mentioned that this perspective was argued by Dr. Jason Fung in an interview with Peter Attia, podcast #59. I’m sure many others have said similar things. It’s not difficult to understand for anyone familiar with some of the science.

For example, inflammation causes many problems, but inflammation itself isn’t the fundamental cause since it is a protective response itself to something else. Or as yet another example, there is the theory that cholesterol plaque in arteries doesn’t cause the problem but is a response to it, as the cholesterol is essentially forming a scab in seeking to heal injury. Pointing at cholesterol would be like making accusations about firefighters being present at fires. One could look to numerous other things, as the basic principal is widely applicable. The body is always seeking the healthiest balance under any conditions, even if less than optimal. So, in seeking greater health, we must realize that the body-mind of an individual is a system that is part of larger systems. To get different results, the totality of the situation needs to be shifted into a new balance. That is why something like ketosis can dramatically improve so many health issues, as it completely alters the functioning of gut health, metabolism, immune response, neurocognition, and on and on. That diet could have that kind of impact should not be hard to understand. Think about the multiple links, direct and indirect, between the gut and the brain — multiply that by hundreds of other major connections within our biology.

The failing of conventional medicine is that it has usually been a symptoms-based approach. Diagnosis is determined by patterns of symptoms. Too often that then is used to choose a medication or surgical intervention to treat those symptoms. Underlying causes are rarely understood or even considered. Partly, that is because of a lack of knowledge and the related low quality of many medical studies. But more problematic is that the dominant paradigm constrains thought, shuts down the ability to imagine other ways of doing medicine. The above study, however, suggests that we should understand what purpose something is serving. Obesity isn’t merely too much fat. Instead of being the problem itself, obesity might be the body’s best possible solution under those conditions.

What if so many of our supposed problems operate in a similar manner? What if instead of constantly fighting against what we deem as bad we sought understanding first about what purpose is being served and then sought some other means of accomplishing that end? Think about the short-term thinking that has been observed under conditions of poverty and high inequality. Instead of judging people as inferior, we could realize that short-term thinking makes perfect sense in evolutionary terms, as extreme stress indicates that immediate problems must be dealt with first. Rather than blaming the symptom or scapegoating the victim, we should look at the entire context of what is going on. If we don’t like the results we are getting as individuals and as a society, we better change the factors that lead to those results. It’s a simple and typically overlooked insight.

We aren’t isolated individuals. We are an inseparable aspect of a larger world. Every system within our bodies and minds, every system in society and the environment is integral to our holistic functioning as human beings. Everything is connected in various ways. Change one thing and it will ripple outward.

* * *

It’s The Insulin Resistance, Stupid: Part 1 & Part 2
by Timothy Noakes

Most Mainstream Doctors Would Fail Nutrition

To return to the topic at hand, the notion of food as medicine, a premise of the paleo diet, also goes back to the ancient Greeks — in fact, originates with the founder of modern medicine, Hippocrates (he also is ascribed as saying that, “All disease begins in the gut,” a slight exaggeration of a common view about the importance of gut health, a key area of connection between the paleo diet and alternative medicine). What we now call functional medicine, treating people holistically, used to be standard practice of family doctors for centuries and probably millennia, going back to medicine men and women. But this caring attitude and practice went by the wayside because it took time to spend with patients and insurance companies wouldn’t pay for it. Traditional healthcare that we now think of as alternative is maybe not possible with a for-profit model, but I’d say that is more of a criticism of the for-profit model than a criticism of traditional healthcare.

Diets and Systems

Related to diet, Pezeshki does bring up the issue of inflammation. As I originally came around to my present diet from a paleo viewpoint, I became familiar with the approach of functional medicine that puts inflammation as a central factor (Essentialism On the Decline). Inflammation is a bridge between the physiological and the psychological, the individual and the social. Where and how inflammation erupts within the individual determines how a disease condition or rather a confluence of symptoms gets labeled and treated, even if the fundamental cause originated elsewhere, maybe in the ‘external’ world (socioeconomic stress, transgenerational trauma, environmental toxins, parasites because of lack of public sanitation, etc. Inflammation is linked to leaky gut, leaky brain, arthritis, autoimmune disorders, mood disorders, ADHD, autism, schizophrenia, impulsivity, short-term thinking, addiction, aggression, etc — and such problems increase under high inequality.

There are specific examples to point to. Diabetes and mood disorders co-occur. There is the connection of depression and anhedonia, involving the reward circuit and pleasure, which in turn can be affected by inflammation. Also, inflammation can lead to changes in glutamate in depression, similar to the glutamate alterations in autism from diet and microbes, and that is significant considering that glutamate is not only a major neurotransmitter but also a common food additive. Dr. Roger McIntyre writes that, “MRI scans have shown that if you make someone immune activated, the hypervigilance center is activated, activity in the motoric region is reduced, and the person becomes withdrawn and hypervigilant. And that’s what depression is. What’s the classic presentation of depression? People are anxious, agitated, and experience a lack of spontaneous activity and increased emotional withdrawal” (Inflammation, Mood Disorders, and Disease Model Convergence). Inflammation is a serious condition and, in the modern world, quite pervasive. The implications of this are not to be dismissed.

Essentialism On the Decline

In reading about paleolithic diets and traditional foods, a recurring theme is inflammation, specifically as it relates to the health of the gut-brain network and immune system.

The paradigm change this signifies is that seemingly separate diseases with different diagnostic labels often have underlying commonalities. They share overlapping sets of causal and contributing factors, biological processes and symptoms. This is why simple dietary changes can have a profound effect on numerous health conditions. For some, the diseased state expresses as mood disorders and for others as autoimmune disorders and for still others something entirely else, but there are immense commonalities between them all. The differences have more to do with how dysbiosis and dysfunction happens to develop, where it takes hold in the body, and so what symptoms are experienced.

From a paleo diet perspective in treating both patients and her own multiple sclerosis, Terry Wahls gets at this point in a straightforward manner (p. 47): “In a very real sense, we all have the same disease because all disease begins with broken, incorrect biochemistry and disordered communication within and between our cells. […] Inside, the distinction between these autoimmune diseases is, frankly, fairly arbitrary”. In How Emotions Are Made, Lisa Feldman Barrett wrote (Kindle Locations 3834-3850):

“Inflammation has been a game-changer for our understanding of mental illness. For many years, scientists and clinicians held a classical view of mental illnesses like chronic stress, chronic pain, anxiety, and depression. Each ailment was believed to have a biological fingerprint that distinguished it from all others. Researchers would ask essentialist questions that assume each disorder is distinct: “How does depression impact your body? How does emotion influence pain? Why do anxiety and depression frequently co-occur?” 9

“More recently, the dividing lines between these illnesses have been evaporating. People who are diagnosed with the same-named disorder may have greatly diverse symptoms— variation is the norm. At the same time, different disorders overlap: they share symptoms, they cause atrophy in the same brain regions, their sufferers exhibit low emotional granularity, and some of the same medications are prescribed as effective.

“As a result of these findings, researchers are moving away from a classical view of different illnesses with distinct essences. They instead focus on a set of common ingredients that leave people vulnerable to these various disorders, such as genetic factors, insomnia, and damage to the interoceptive network or key hubs in the brain (chapter 6). If these areas become damaged, the brain is in big trouble: depression, panic disorder, schizophrenia, autism, dyslexia, chronic pain, dementia, Parkinson’s disease, and attention deficit hyperactivity disorder are all associated with hub damage. 10

“My view is that some major illnesses considered distinct and “mental” are all rooted in a chronically unbalanced body budget and unbridled inflammation. We categorize and name them as different disorders, based on context, much like we categorize and name the same bodily changes as different emotions. If I’m correct, then questions like, “Why do anxiety and depression frequently co-occur?” are no longer mysteries because, like emotions, these illnesses do not have firm boundaries in nature.”

What jumped out at me was the conventional view of disease as essentialist, and hence the related essentialism in biology and psychology.

On Health or Lack Thereof

Millennials’ health plummets after the age of 27: Study finds the generation has unprecedented rates of diabetes, depression, and digestive disorders
by Natalie Rahhal

  • After age 27, all major measures of health start to decline sharply for millennials, according to a new Blue Cross Blue Shield Report
  • Millennials have higher rates of eight of the top 10 most common health conditions by their mid-30s than generation X-ers did at the same age
  • As their health continues to decline, millennials stand to cost the American health care industry and economy steep sums

It's all downhill from here: A depressing graph shows steep health decline that begins after age 27 and continues until death for millennials
It’s all downhill from here: A depressing graph shows steep health decline that begins after age 27 and continues until death for millennials

Effect of Dietary Lipid on UV Light Carcinogenesis in the Hairless Mouse
by Vivienne E. Reeve, Melissa Matheson, Gavin E. Greenoak, Paul J. Canfield, Christa Boehm‐Wilcox, and Clifford H. Gallagher

Isocaloric feeding of diets varying in lipid content to albino hairless mice has shown that their susceptibility to skin tumorigenesis induced by simulated solar UV light was not affected by the level of polyunsaturated fat, 5% or 20%. However a qualitative effect of dietary lipid was demonstrated. Mice fed 20% saturated fat were almost completely protected from UV tumorigenesis when compared with mice fed 20% polyunsaturated fat. Multiple latent tumours were detected in the saturated fat‐fed mice by subsequent dietary replenishment, suggesting that a requirement for dietary unsaturated fat exists for the promotion stage of UV‐induced skin carcinogenesis.

Therapeutic benefit of combining calorie-restricted ketogenic diet and glutamine targeting in late-stage experimental glioblastoma
by Purna Mukherjee, Zachary M. Augur, Mingyi Li, Collin Hill, Bennett Greenwood, Marek A. Domin, Gramoz Kondakci, Niven R. Narain, Michael A. Kiebish, Roderick T. Bronson, Gabriel Arismendi-Morillo, Christos Chinopoulos, and Thomas N. Seyfried

Glioblastoma (GBM) is an aggressive primary human brain tumour that has resisted effective therapy for decades. Although glucose and glutamine are the major fuels that drive GBM growth and invasion, few studies have targeted these fuels for therapeutic management. The glutamine antagonist, 6-diazo-5-oxo-L-norleucine (DON), was administered together with a calorically restricted ketogenic diet (KD-R) to treat late-stage orthotopic growth in two syngeneic GBM mouse models: VM-M3 and CT-2A. DON targets glutaminolysis, while the KD-R reduces glucose and, simultaneously, elevates neuroprotective and non-fermentable ketone bodies. The diet/drug therapeutic strategy killed tumour cells while reversing disease symptoms, and improving overall mouse survival. The therapeutic strategy also reduces edema, hemorrhage, and inflammation. Moreover, the KD-R diet facilitated DON delivery to the brain and allowed a lower dosage to achieve therapeutic effect. The findings support the importance of glucose and glutamine in driving GBM growth and provide a therapeutic strategy for non-toxic metabolic management.

Writer’s block
by Dr. Malcolm Kendrick

Anyway, to return to the main issue here, which is that medical science may now be incapable of self-correction. Erroneous ideas will be compounded, built on, and can never be overturned. Because of a thing called non-reproducibility.

In most areas of science, there is nothing to stop a researcher going back over old research and trying to replicate it. The correct term is reproducibility. In every branch of science there is currently an acknowledged crisis with reproducibility.

‘Reproducibility is a hot topic in science at the moment, but is there a crisis? Nature asked 1,576 scientists this question as part of an online survey. Most agree that there is a crisis and over 70% said they’d tried and failed to reproduce another group’s experiments.’ 2

This is not good, but in medical research this issue is magnified many times. Because there is another in-built problem. You cannot reproduce research that has been positive. Take clinical trials into statins. You start with middle aged men, split them into two groups, give one a statin and one a placebo. At the end of your five-year trial, you claim that statins had a benefit – stopped heart attacks and strokes and suchlike.

Once this claim has been made, in this group, it becomes unethical/impossible to replicate this study, in this group – ever again. The ethics committee would tell you that statins have been proven to have a benefit, you cannot withhold a drug with a ‘proven’ benefit from patients. Therefore, you cannot have a placebo arm in your trial. Therefore, you cannot attempt to replicate the findings. Ever.

Thus, if a trial was flawed/biased/corrupt or simply done badly. That’s it. You are going to have to believe the results, and you can never, ever, have another go. Ergo, medicine cannot self-correct through non-reproducibility. Stupidity can now last for ever. In fact, it is built in.

When Evidence Says No, but Doctors Say Yes
by David Epstein

Even if a drug you take was studied in thousands of people and shown truly to save lives, chances are it won’t do that for you. The good news is, it probably won’t harm you, either. Some of the most widely prescribed medications do little of anything meaningful, good or bad, for most people who take them.

In a 2013 study, a dozen doctors from around the country examined all 363 articles published in The New England Journal of Medicine over a decade—2001 through 2010—that tested a current clinical practice, from the use of antibiotics to treat people with persistent Lyme disease symptoms (didn’t help) to the use of specialized sponges for preventing infections in patients having colorectal surgery (caused more infections). Their results, published in the Mayo Clinic Proceedings, found 146 studies that proved or strongly suggested that a current standard practice either had no benefit at all or was inferior to the practice it replaced; 138 articles supported the efficacy of an existing practice, and the remaining 79 were deemed inconclusive. (There was, naturally, plenty of disagreement with the authors’ conclusions.) Some of the contradicted practices possibly affect millions of people daily: Intensive medication to keep blood pressure very low in diabetic patients caused more side effects and was no better at preventing heart attacks or death than more mild treatments that allowed for a somewhat higher blood pressure. Other practices challenged by the study are less common—like the use of a genetic test to determine if a popular blood thinner is right for a particular patient—but gaining in popularity despite mounting contrary evidence. Some examples defy intuition: CPR is no more effective with rescue breathing than if chest compressions are used alone; and breast-cancer survivors who are told not to lift weights with swollen limbs actually should lift weights, because it improves their symptoms.

A separate but similarly themed study in 2012 funded by the Australian Department of Health and Ageing, which sought to reduce spending on needless procedures, looked across the same decade and identified 156 active medical practices that are probably unsafe or ineffective. The list goes on: A brand new review of 48 separate studies—comprising more than 13,000 clinicians—looked at how doctors perceive disease-screening tests and found that they tend to underestimate the potential harms of screening and overestimate the potential benefits; an editorial in American Family Physician, co-written by one of the journal’s editors, noted that a “striking feature” of recent research is how much of it contradicts traditional medical opinion.

That isn’t likely to change any time soon. The 21st Century Cures Act—a rare bipartisan bill, pushed by more than 1,400 lobbyists and signed into law in December—lowers evidentiary standards for new uses of drugs and for marketing and approval of some medical devices. Furthermore, last month President Donald Trump scolded the FDA for what he characterized as withholding drugs from dying patients. He promised to slash regulations “big league. … It could even be up to 80 percent” of current FDA regulations, he said. To that end, one of the president’s top candidates to head the FDA, tech investor Jim O’Neill, has openly advocated for drugs to be approved before they’re shown to work. “Let people start using them at their own risk,” O’Neill has argued.

So, while Americans can expect to see more drugs and devices sped to those who need them, they should also expect the problem of therapies based on flimsy evidence to accelerate. In a recent Stat op-ed, two Johns Hopkins University physician-researchers wrote that the new 21st Century Cures Act will turn the label “FDA approved” into “a shadow of its former self.” In 1962, Congress famously raised the evidentiary bar for drug approvals after thousands of babies were born with malformed limbs to mothers who had taken the sleep aid thalidomide. Steven Galson, a retired rear admiral and former acting surgeon general under both President George W. Bush and President Barack Obama, has called the strengthened approval process created in 1962 the FDA’s “biggest contribution to health.” Before that, he said, “many marketed drugs were ineffective for their labeled uses.”

Striking the right balance between innovation and regulation is incredibly difficult, but once remedies are in use—even in the face of contrary evidence—they tend to persist. A 2007 Journal of the American Medical Association papercoauthored by John Ioannidis—a Stanford University medical researcher and statistician who rose to prominence exposing poor-quality medical science—found that it took 10 years for large swaths of the medical community to stop referencing popular practices after their efficacy was unequivocally vanquished by science.

Science institute that advised EU and UN ‘actually industry lobby group’
by Arthur Nelson

An institute whose experts have occupied key positions on EU and UN regulatory panels is, in reality, an industry lobby group that masquerades as a scientific health charity, according to a peer-reviewed study.

The Washington-based International Life Sciences Institute (ILSI) describes its mission as “pursuing objectivity, clarity and reproducibility” to “benefit the public good”.

But researchers from the University of Cambridge, Bocconi University in Milan, and the US Right to Know campaign assessed over 17,000 pages of documents under US freedom of information laws to present evidence of influence-peddling.

The paper’s lead author, Dr Sarah Steele, a Cambridge university senior research associate, said: “Our findings add to the evidence that this nonprofit organisation has been used by its corporate backers for years to counter public health policies. ILSI should be regarded as an industry group – a private body – and regulated as such, not as a body acting for the greater good.”

The New Faces of Coke
by Kyle Pfister

Of the 115 individuals Coca-Cola admitted to funding, here’s a breakdown:

By sector, 57% (65) are dietitians, 20% (23) are academics, 7% (8) are medical professionals (mostly Doctors), 6% (7) are fitness experts, 5% (6) are authors, 3% (3) are chefs, and 1% (1) are food representatives. I was not able to identify sectors for two of the funded experts.

Kellogg Paid ‘Independent Experts’ to Promote Its Cereal
by Michael Addady

Kellogg paid council experts an average of $13,000 per year, according to emails and contracts obtained by the Associated Press. The payment was for expert to engage in “nutrition influencer outreach” and refrain from offering their services to products that were “competitive or negative to cereal.”

Outreach usually meant one of two things: Experts would claim Kellogg was their favorite brand on social media, or they would tout the cereal during public appearances. Kellogg’s spokesperson Kris Charles told Fortune in a statement that the experts’ association with the company was disclosed at public appearances.

Additionally, the experts’ connection to the company may have affected some of their published work. For example, an independent expert was involved in publishing an academic paper in the Journal of the Academy of Nutrition and Dietetics that defined a “quality breakfast.” Kellogg had the opportunity to edit the paper and even asked that the author remove a suggestion about limiting added sugar (something the sugar industry has also been accused of doing with heart disease research).

FDA: Sampling finds toxic nonstick compounds in some food
by Ellen Knickmeyer, John Flesher, and Michael Casey

A federal toxicology report last year cited links between high levels of the compounds in people’s blood and health problems, but said it was not certain the nonstick compounds were the cause.

The levels in nearly half of the meat and fish tested were two or more times over the only currently existing federal advisory level for any kind of the widely used manmade compounds, which are called per- and polyfluoroalykyl substances, or PFAS.

The level in the chocolate cake was higher: more than 250 times the only federal guidelines, which are for some PFAS in drinking water.

Food and Drug Administration spokeswoman Tara Rabin said Monday that the agency thought the contamination was “not likely to be a human health concern,” even though the tests exceeded the sole existing federal PFAS recommendations for drinking water.

Why smelling good could come with a cost to health
by Lauren Zanolli

About 4,000 chemicals are currently used to scent products, but you won’t find any of them listed on a label. Fragrance formulations are considered a “trade secret” and therefore protected from disclosure – even to regulators or manufacturers. Instead, one word, fragrance, appears on ingredients lists for countless cosmetics, personal care and cleaning products. A single scent may contain anywhere from 50 to 300 distinct chemicals.

“No state, federal or global authority is regulating the safety of fragrance chemicals,” says Janet Nudelman, policy director for Breast Cancer Prevention Partners (BCPP) and co-founder of the Campaign for Safe Cosmetics. “No state, federal or global authority even knows which fragrance chemicals appear in which products.”

Three-quarters of the toxic chemicals detected in a test of 140 products came from fragrance, reported a 2018 BCPP study of personal care and cleaning brands. The chemicals identified were linked to chronic health issues, including cancer.

Stress and Shittiness

What causes heart disease – Part 63
by Malcolm Kendrick

To keep this simple, and stripping terminology down things down to basics, the concept I am trying to capture, and the word that I am going to use, here to describe the factor that can affect entire populations is ‘psychosocial stress’. By which I mean an environment where there is breakdown of community and support structures, often poverty, with physical threats and suchlike. A place where you would not really want to walk down the road unaccompanied.

This can be a zip code in the US, known as postcode in the UK. It can be a bigger physical area than that, such as a county, a town, or whole community – which could be split across different parts of a country. Such as native Americans living in areas that are called reservations.

On the largest scale it is fully possible for many countries to suffer from major psychosocial stress at the same time. […] Wherever you look, you can see that populations that have been exposed to significant social dislocation, and major psychosocial stressors, have extremely high rate of coronary heart disease/cardiovascular disease.

The bad news is we’re dying early in Britain – and it’s all down to ‘shit-life syndrome’
by Will Hutton

Britain and America are in the midst of a barely reported public health crisis. They are experiencing not merely a slowdown in life expectancy, which in many other rich countries is continuing to lengthen, but the start of an alarming increase in death rates across all our populations, men and women alike. We are needlessly allowing our people to die early.

In Britain, life expectancy, which increased steadily for a century, slowed dramatically between 2010 and 2016. The rate of increase dropped by 90% for women and 76% for men, to 82.8 years and 79.1 years respectively. Now, death rates among older people have so much increased over the last two years – with expectations that this will continue – that two major insurance companies, Aviva and Legal and General, are releasing hundreds of millions of pounds they had been holding as reserves to pay annuities to pay to shareholders instead. Society, once again, affecting the citadels of high finance.

Trends in the US are more serious and foretell what is likely to happen in Britain without an urgent change in course. Death rates of people in midlife(between 25 and 64) are increasing across the racial and ethnic divide. It has long been known that the mortality rates of midlife American black and Hispanic people have been worse than the non-Hispanic white population, but last week the British Medical Journal published an important study re-examining the trends for all racial groups between 1999 and 2016 .

The malaises that have plagued the black population are extending to the non-Hispanic, midlife white population. As the report states: “All cause mortality increased… among non-Hispanic whites.” Why? “Drug overdoses were the leading cause of increased mortality in midlife, but mortality also increased for alcohol-related conditions, suicides and organ diseases involving multiple body systems” (notably liver, heart diseases and cancers).

US doctors coined a phrase for this condition: “shit-life syndrome”. Poor working-age Americans of all races are locked in a cycle of poverty and neglect, amid wider affluence. They are ill educated and ill trained. The jobs available are drudge work paying the minimum wage, with minimal or no job security. They are trapped in poor neighbourhoods where the prospect of owning a home is a distant dream. There is little social housing, scant income support and contingent access to healthcare. Finding meaning in life is close to impossible; the struggle to survive commands all intellectual and emotional resources. Yet turn on the TV or visit a middle-class shopping mall and a very different and unattainable world presents itself. Knowing that you are valueless, you resort to drugs, antidepressants and booze. You eat junk food and watch your ill-treated body balloon. It is not just poverty, but growing relative poverty in an era of rising inequality, with all its psychological side-effects, that is the killer.

The UK is not just suffering shit-life syndrome. We’re also suffering shit-politician syndrome.
by Richard Murphy

Will Hutton has an article in the Guardian in which he argues that the recent decline in the growth of life expectancy in the UK (and its decline in some parts) is down to what he describes as ‘shit-life syndrome’. This is the state where life is reduced to an exercise in mere survival as a result of the economic and social oppression lined up against those suffering the condition. And, as he points out, those suffering are not just those on the economic and social margins of society. In the UK, as in the US, the syndrome is spreading.

The reasons for this can be debated. I engaged in such argument in my book The Courageous State. In that book I argued that we live in a world where those with power do now, when they identify a problem, run as far as they might from it and say the market will find a solution. The market won’t do that. It is designed not to do so. Those suffering shit-life syndrome have, by default, little impact on the market. That’s one of the reasons why they are suffering the syndrome in the first place. That is why so much of current politics has turned a blind eye to this issue.

And they get away with it. That’s because the world of make belief advertising which drives the myths that underpin the media, and in turn out politics, simply pretends such a syndrome does not exist whilst at the same time perpetually reinforcing the sense of dissatisfaction that is at its core.

With Brexit, It’s the Geography, Stupid
by Dawn Foster

One of the major irritations of public discourse after the United Kingdom’s Brexit vote has been the complete poverty of analysis on the reasons behind different demographics’ voting preferences. Endless time, energy, and media attention has been afforded to squabbling over the spending of each campaign for and against continued European Union membership — and now more on the role social media played in influencing the vote — mirroring the arguments in the United States that those who voted to Leave were, like Trump voters, unduly influenced by shady political actors, with little transparency behind political ads and social media tactics.

It’s a handy distraction from the root causes in the UK: widening inequality, but also an increasingly entrenched economic system that is geographically specific, meaning your place of birth and rearing has far more influence over how limited your life is than anything within your control: work, education and life choices.

Across Britain, territorial injustice is growing: for decades, London has boomed in comparison to the rest of the country, with more and more wealth being sucked towards the southeast and other regions being starved of resources, jobs and infrastructure as a result. A lack of secure and well-remunerated work doesn’t just determine whether you can get by each month without relying on social security to make ends meet, but also all aspects of your health, and the health of your children. A recent report by researchers at Cambridge University examined the disproportionate effect of central government cuts on local authorities and services: inner city areas with high rates of poverty, and former industrial areas were hardest hit. Mia Gray, one of the authors of the Cambridge report said: “Ever since vast sums of public money were used to bail out the banks a decade ago, the British people have been told that there is no other choice but austerity imposed at a fierce and relentless rate. We are now seeing austerity policies turn into a downward spiral of disinvestment in certain people and places. This could affect the life chances of entire generations born in the wrong part of the country.”

Life expectancy is perhaps the starkest example. In many other rich countries, life expectancy continues to grow. In the United Kingdom it is not only stalling, but in certain regions falling. The gap between the north and south of England reveals the starkest gap in deaths among young people: in 2015, 29.3 percent more 25-34-year-olds died in the north of England than the south. For those aged 35-44, the number of deaths in the north was 50 percent higher than the south.

In areas left behind economically, such as the ex-mining towns in the Welsh valleys, the post-industrial north of England, and former seaside holiday destinations that have been abandoned as people plump for cheap European breaks, doctors informally describe the myriad tangle of health, social and economic problems besieging people as “Shit Life Syndrome”. The term, brought to public attention by the Financial Times, sounds flippant, but it attempts to tease out the cumulative impact of strict and diminished life chances, poor health worsened by economic circumstances, and the effects of low paid work and unemployment on mental health, and lifestyle issues such as smoking, heavy drinking, and lack of exercise, factors worsened by a lack of agency in the lives of people in the most deprived areas. Similar to “deaths of despair” in the United States, Shit Life Syndrome leads to stark upticks in avoidable deaths due to suicide, accidents, and overdoses: several former classmates who remained in the depressed Welsh city I grew up in have taken their own lives, overdosed, or died as a result of accidents caused by alcohol or drugs. Their lives prior to death were predictably unhappy, but the opportunity to turn things around simply didn’t exist. To move away, you need money and therefore a job. The only vacancies that appear pay minimum wage, and usually you’re turned away without interview.

Simply put, it’s a waste of lives on an industrial scale, but few people notice or care. One of the effects of austerity is the death of public spaces people can gather without being forced to spend money. Youth clubs no longer exist, and public health officials blame their demise on the rise in teenagers becoming involved in gangs and drug dealing in inner cities. Libraries are closing at a rate of knots, despite the government requiring all benefits claims to be submitted via computers. More and more public spaces and playgrounds are being sold off to land-hungry developers, forcing more and more people to shoulder their misery alone, depriving them of spaces and opportunities to meet people and socialise. Shame is key in perpetuating the sense that poverty is deserved, but isolation and loneliness help exacerbate the self-hatred that stops you fighting back against your circumstances.

“Shit-Life Syndrome” (Oxycontin Blues)
by Curtis Price

In narrowing drug use to a legal or public health problem, as many genuinely concerned about the legal and social consequences of addiction will argue, I believe a larger politics and political critique gets lost (This myopia is not confined to drug issues. From what I’ve seen, much of the “social justice” perspective in the professional care industry is deeply conservative; what gets argued for amounts to little more than increased funding for their own services and endless expansion of non-profits). Drug use, broadly speaking, doesn’t take place in a vacuum. It is a thermometer for social misery and the more social misery, the greater the use. In other words, it’s not just a matter of the properties of the drug or the psychological states of the individual user, but also of the social context in which such actions play out.

If we accept this as a yardstick, then it’s no accident then that the loss of the 1984-1985 U.K. Miners’ Strike, with the follow-on closure of the pits and destruction of pit communities’ tight-knit ways of life, triggered widespread heroin use (2). What followed the defeat of the Miners’ Strike only telescoped into a few years the same social processes that in much of the U.S. were drawn out, more prolonged, insidious, and harder to detect. Until, that is, the mortality rates – that canary in the epidemiological coalmine -sharply rose to everyone’s shock.

US doctors have coined a phrase for the underlying condition of which drug use and alcoholism is just part: “shit-life syndrome.” As Will Hutton in the Guardian describes it,

“Poor working-age Americans of all races are locked in a cycle of poverty and neglect, amid wider affluence. They are ill educated and ill trained. The jobs available are drudge work paying the minimum wage, with minimal or no job security. They are trapped in poor neighborhoods where the prospect of owning a home is a distant dream. There is little social housing, scant income support and contingent access to healthcare. Finding meaning in life is close to impossible; the struggle to survive commands all intellectual and emotional resources. Yet turn on the TV or visit a middle-class shopping mall and a very different and unattainable world presents itself. Knowing that you are valueless, you resort to drugs, antidepressants and booze. You eat junk food and watch your ill-treated body balloon. It is not just poverty, but growing relative poverty in an era of rising inequality, with all its psychological side-effects, that is the killer”(3).

This accurately sums up “shit-life syndrome.” So, by all means, end locking up non-violent drug offenders and increase drug treatment options. But as worthwhile as these steps may be, they will do nothing to alter “shit-life syndrome.” “Shit-life syndrome” is just one more expression of the never-ending cruelty of capitalism, an underlying cruelty inherent in the way the system operates, that can’t be reformed out, and won’t disappear until new ways of living and social organization come into place.

The Human Kind, A Doctor’s Stories From The Heart Of Medicine
Peter Dorward
p. 155-157

It’s not like this for all kinds of illness, of course. Illness, by and large, is as solid and real as the chair I’m sitting on: and nothing I say or believe about it will change its nature. That’s what people mean when they describe an illness as ‘real’. You can see it and touch it, and if you can’t do that, then at least you can measure it. You can weigh a tumour; you can see on the screen the ragged outline of the plaque of atheroma in your coronary artery which is occluded and crushing the life out of you, and you would be mad to question the legitimacy of this condition that prompts the wiry cardiologist to feed the catheter down the long forks and bends of your clogged arterial tree in order to feed an expanding metal stent into the blocked artery and save you.

No one questions the reality and medical legitimacy of those things in the world that can be seen, felt, weighed, touched. That creates a deep bias in the patient; it creates a profound preference among us, the healers.

But a person is interactive . Minds can’t exist independently of other minds: that’s the nature of our kind. The names we have for things in the world and the way that we choose to talk about them affect how we experience them. Our minds are made of language, and grammar, intentions, emotions, perceptions and memory. We can only experience the world through the agency of our minds, and how our minds interact with others. Science is a great tool for talking about the external world: the world that is indifferent to what we think. Science doesn’t begin to touch the other, inner, social stuff. And that’s a challenge in medicine. You need other tools for that.

‘Shit-life syndrome,’ offers Becky, whose skin is so pale it looks translucent, who wears white blouses with little ruffs buttoned to the top and her blonde hair in plaits, whose voice is vicarage English and in whose mouth shit life sounds anomalous. Medicine can have this coarsening effect. ‘Shit-life syndrome provides the raw material. We doctors do all the rest.’

‘Go on…’

‘That’s all I ever seem to see in GP. People whose lives are non-specifically crap. Women single parenting too many children, doing three jobs which they hate, with kids on Ritalin, heads wrecked by smartphone and tablet parenting. Women who hate their bodies and have a new diagnosis of diabetes because they’re too fat. No wonder they want a better diagnosis! What am I meant to do?’

I like to keep this tutorial upbeat. I don’t like it to become a moan-fest, which is pointless and damaging. Yet, I don’t want to censor.

‘… Sometimes I feel like a big stone, dropped into a river of pain. I create a few eddies around me, the odd wave or ripple, but the torrent just goes on…’

‘… I see it different. It’s worse! I think half the time we actually cause the problems. Or at least we create our own little side channels in the torrent. Build dams. Deep pools of misery of our own creation!’

That’s Nadja. She’s my trainee. And I recognise something familiar in what she is saying – the echo of something that I have said to her. It’s flattering, and depressing.

‘For example, take the issuing of sick notes. They’re the worst. We have all of these people who say they’re depressed, or addicted, or stressed, who stay awake all night because they can’t sleep for worry, and sleep all day so they can’t work, and they say they’re depressed or anxious, or have backache or work-related stress, and we drug them up and sign them off, but what they’re really suffering from are the symptoms of chronic unemployment and the misery of poverty, which are the worst illnesses that there are! And every time I sign one of these sick notes, I feel another little flake chipped off my integrity. You’re asking about vectors for social illness? Sick notes! It’s like we’re … shitting in the river, and worrying about the cholera!’

Strong words. I need to speak to Nadja about her intemperate opinions…

‘At least, that’s what he keeps saying,’ says Nadja, nodding at me.

Nadja’s father was a Croatian doctor, who fled the war there. Brought up as she was, at her father’s knee, on his stories of war and torture, of driving his motorbike between Kiseljac and Sarajevo and all the villages in between with his medical bag perched on the back to do his house calls, she can never quite believe the sorts of things that pass for ‘suffering’ here. It doesn’t make Nadja a more compassionate doctor. She sips her coffee, with a smile.

Aly, the one training to be an anaesthetist-traumatologist, says, ‘We shouldn’t do it. Simple as that. It’s just not medicine. We should confine ourselves to the physical, and send the rest to a social worker, or a counsellor or a priest. No more sick notes, no more doing the dirty work of governments. If society has a problem with unemployment, that’s society’s problem, not mine. No more convincing people that they’re sick. No more prescriptions for crap drugs that don’t work. If you can’t see it or measure it, it isn’t real. We’re encouraging all this pseudo-­illness with our sick notes and our crap drugs. What’s our first duty? Do no harm! End of.’

She’ll be a great trauma doctor, no doubt about it.

* * *

From Bad to Worse: Trends Across Generations
Rate And Duration of Despair
Trauma, Embodied and Extended
Facing Shared Trauma and Seeking Hope
Society: Precarious or Persistent?
Union Membership, Free Labor, and the Legacy of Slavery
The Desperate Acting Desperately
Social Disorder, Mental Disorder
Social Conditions of an Individual’s Condition
Society and Dysfunction
It’s All Your Fault, You Fat Loser!
To Grow Up Fast
Individualism and Isolation
To Put the Rat Back in the Rat Park
Rationalizing the Rat Race, Imagining the Rat Park
The Unimagined: Capitalism and Crappiness
Stress Is Real, As Are The Symptoms
On Conflict and Stupidity
Connecting the Dots of Violence
Inequality in the Anthropocene
Morality-Punishment Link