Archive for the ‘Books’ Category

The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Well-being is a book by Richard Wilkinson and Kate Pickett.

In the book, the authors make the case that inequality is both bad, and currently rising. It is bad because it degrades our mental and physical health, and increases a whole host of related issues such as addiction, crime, and social isolation.

Importantly, they present evidence to show that it is causative. That is to say that rising inequality is the cause of poorer well-being, and not the other way around. We know it is causative from a host of factors including a dose-response relationship, a plausible theoretical basis, poorer well-being following inquality, and being able to see this both across countries (Denmark is happier than the UK) and longitudinally (people in the UK were happier when equality was higher).

Status anxiety and its problems

Humans, like many animals, are sensitive to status. Many animals live in hierarchies and are constantly anxious about where they are in the pecking order. When equality is high, we all feel on the same level. When equality is low, those at the bottom feel depressed, and those everywhere else experience status anxiety. As a result, everyone’s wellbeing gets worse.

You might think that because it impacts so many animals, hierarchies are natural. But that is not the cause with humans. For most of human history, we lived in egalitarian societies where humans worked together and shared things, particularly big game kills. Hierarchies only came into fashion with the agricultural revolution: a relatively short time period in the course of human history.

In summary, the reason there is so much misery at the moment is that we have so much inequality.

What about meritocracy?

Some might argue that this is a good thing because it motivates people to work hard and that those who are successful are rewarded. The problem with this idea is that it is wrong. As inequality rises, the strongest predictor of where you will end up is your starting point. Class at birth is a better predictor of where you will end up than ability or hard work.

In fact, the causative relationship works the other way around. Rather than ability leading to a higher social class, the privilege of being born into a higher class (and its associated benefits such as private schools, more free time, more money) means people end up with more developed abilities than those born into poverty.

As a result, the greater the inequality, the less motivation there is to work hard and “improve your station” because it simply does not work.

Impact on climate breakdown

Another problem with inequality is that it drives a lot of climate change.

When we experience status anxiety, we are consume more. We buy more things to demonstrate to our peers that we belong in a certain social class. For example, designer clothes, gym membrships andyoga classes, prestige cars, bigger houses, etc.

If we built a more equality society, individuals would experience less status anxiety, and therefore be less concerned with consumption. We would value time with each other more having physical possessions.

Similarly, the need for consumption drives long working hours to earn money. This leads us with little time: our free time is valuable, which makes it more time-expensive to look after the environment. If he we consumed less and worked less, we would worry less about the extra time it takes to walk to work, rather than taking the car.

What do we need to do?

If you are with me so far, you will hopefully now agree we should make a more equality society. If you don’t agree with me, go read the book, which makes a much more convincing case than I can do in a short blog post. But what do we need to do to make such a change?

The authors argue we need economic democracy.

In the west, we often view democracy as one person, one vote. But that ignores the fact that some people spend hundreds of millions changing election results. Or that most of the media is owned by billionaires who can use this to control the narrative. Or that corporations often have more power than governments do.

A clear example of this is trade unions. If a company mistreats you, you can complain, or even sue them. But realistically, what can you do when you are just one person and they are a multinational corporation with a team of lawyers and enough money that all they need to do is stall you in court until you go bankrupt? Trade unions restore this power imbalance and make the situation fairer.

But the authors argue we need to go much further. Companies regularly say they have to focus on generating returns for shareholders. This is a misconception. But speaks to how they act. Anything for a quick profit.

One of the reasons for this is the changing way in which companies are owned. Shares used to be owned by individuals who would hold them for an average of seven years. Now most shares are owned by institutional investors, often engaged in high-frequency trading where they hold shares for minutes at a time. When a shareholder only cares about the performance in the next 10 minutes, and not the next 10 years, it is easy to see why companies struggle to maintain a long-term outlook. This system is shares is not suitable for the 21st century.

The authors propose that all companies could be mandated to have employee representation on company boards. This is already the case in many countries, including Germany. They also suggest that, as a society, we could do more to promote, facilitate and encourage employee-owned companies.

Critically, all of this points to inequality not being an inevitable product of society, but a political choice made by pursuing neoliberalism. We can choose something else, such as the social democracy that brought such improvements to wellbeing in the 20th century.

One-Dimensional Man is a 1964 non-fiction philosophy book by Herbert Marcuse.

In the book, Marcuse argues that suppression of individuality is presented as rational and efficient in advanced industrial society, but in fact this rationality itself serves domination. That is to say that it becomes logical to drive people to conformity because that scales well in capitalism (literally economies of scale).

New forms of control

This creates what Marcuse describes as “free competition among unequally equipped economic subjects”. For example, if a corporation mistreats you, you can take them to court. But they have millions of pounds and an army of lawyers, so good luck with that. Some of this can be rebalanced with trade unions but both western and eastern countries tend to legislate against this.

Marcuse identifies that we already have the technology to free people from needs and yet we are subject to the grind to survive even more. This is because modern society turns waste into need and we build our identity around commodities. Nobody needs a brand-name shirt. And we have loads of shirts. But we’ve created a world where we work overtime to get the X-branded shirt.

Refusing “to go along” with the system is then pathologised. Too burnt out to work? You have an anxiety disorder.

But why would you even want to rebel? Modern society does not oppress overtly, but rather by offering a life that seems tolerable, rewarding, and comfortable, and then threatening to take that away. By offering us a sense of comfort, it restricts our freedom, because we dare not choose to make our lives harder.

He also encourages to grapple with the concept of freedom itself. Freedom is defined to fit the existing system. You are given a thousand different products to consume but you are not given the choice not to consume.

To me, this brings to mind the question of what is freedom in 21st century society? For example, does freedom include universal healthcare? Libertarians would argue no because then they have to pay tax to fund it. Socialists would argue yes because in what sense are you free if you are too sick to live your life?

Closing of the political universe

Marcuse notes that oppression is hidden behind layers of bureaucracy, management and corporate structures. Workers used to be oppressed by the factory owner themselves, now they themselves answer to a board or shareholders who you will never see.

This is reminiscent of The Grapes of Wrath where the farmers are trying to work out who to shoot. Ultimately, they find there is nobody to rise up against because the system is faceless.

Excess capacity becomes a threat to society because if we do not consume it all, the surplus upsets the capitalist balance and this may impact our “comfortable” lives. Thus the threat of this potential upset becomes greater than the threat of losing our freedom, so we meekly sacrifice freedom for safety.

Chapter three and beyond

I managed to follow the book to here. After that, the philosophy became too dense for me to follow. This was very frustrating and I would love to read a more accessible text on the subject.

Conclusion

If you are a philosopher, you will likely find One-Dimensional Man an excellent critique of technological society. If you are a non-philosopher like myself, I still think you will enjoy the first chapter, but may get lost in the text after that.

The Assertiveness Workbook: How to Express Your Ideas and Stand Up for Yourself at Work and in Relationships is a book by Randy Paterson.

It’s written as a self-help book but makes for an accessible read for clinicians, too. The book begins by describing different types of communication and how they differ from assertiveness communication. It then breaks down specific topics such as giving compliments, giving and receiving feedback, saying no and handling confrontations.

Our current system of understanding mental health is typically based around psychiatric diagnosis. You go to your doctor and your doctor gives you a label like “social anxiety disorder” or “borderline personality disorder”. These labels are, on the whole, stigmatising and unhelpful.

Worse, they are not grounded in evidence-based medicine. After a hundred years of lookng, we cannot find the biomarkers for mental illness. Depressed people do not have lower serotonin, for example. Nor are there genetic markers. As far as we can tell (and research has been well-funded and plentiful), mental health issues are not an “illness” in the traditional medical sense.

So then we say “okay but they are functional”. Something happens to someone which activates underlying vulnerabilities and they develop social anxiety. But this does not hold up, either. There are no clear pathways of things that trigger specific labels (the everything causes everything problem) and the majority of service users meet the criteria for multiple labels (the everyone suffers from everything problem).

As a result, we don’t know what causes any of these labels (no biomarkers or pathways), what they look like (people’s symptoms transcend multiple labels) or what to do about it: most first line treatments like anti-depressants or single-diagnostic CBT seems to make things worse.

Much of psychology already recognises this problem and has suggested dropping the word “disorder” and changing the question from “what is wrong with you?” to “what has happened to you?” Trauma-informed approaches are opening up a much greater scope for what counts as trauma.

The Power Threat Meaning Framework goes beyond that. It asks how power been used in someone’s life (think oppression), what threat that created, what meaning the person made of it and what threat responses were activated. It suggests that all troubling experiences and behaviour, from mild anxiety and depression, to hearing voices, self-harm and eating disorders, can be understood from this perspective.

It also suggests that all behaviour is on a continuum, from “normal” to “clinical”. This is important because while some critics might agree mild anxiety is part of normal human experience, they often bawk at the idea that hearing voices or dissociation is typical. Even though most people regularly “zone out” (dissociate) on a regular basis.

The PTM Framework offers what it calls a general foundational pattern and seven provisional general patterns. These allow us to explore useful patterns without detracting from an individual’s personal narrative.

• Identities
• Surviving rejection, entrapment, and invalidation
• Surviving disrupted attachments and adversities in care
• Surviving separation and identity confusion
• Surviving defeat, entrapment, disconnection and loss
• Surviving social exclusion, shame, and coercive power
• Surviving single threats

The PTM Framework is a contribution to the movement away from psychiatric diagnosis which still has much work to do, and the document acknowledges this.

But we are already seeing improvements. Many services, such as educational support and some NHS mental health services, look at individual need rather than labels and many have switched away from using disorder-specific measures to general outcome measures.

I don’t claim to have done justice to this document in any way in this blog post. You should go read it; it’s fantastic, if quite a technical read.

Sedated: How Modern Capitalism Created our Mental Health Crisis is a book by James Davies discussing the rise in use of psychiatric diagnosis and antidepressant prescribing.

Davies charts the rise of the DSM, Diagnostic and Statistical Manual of Mental Disorders, which is the standard textbook for psychiatric diagnosis. Now on the revision of its fifth edition, the DSM has massively expanded over the decades to include ever more labels. These labels have no biological basis and are generally the consensus of small committees many of whom have financial links to the pharmaceutical industry.

The author then goes on to connect this to the rise of neoliberalism. As Thatcher dismantled trade unions, increased inequality and reduced working-class people’s quality of life, something was needed to explain this suffering that depoliticised and managed that suffering. The answer was labelling people as mentally ill.

Today, if you are sad because your zero-hours contract means you both have a job and still need to rely on food banks, it is not because of inequality it is because you have an anxiety disorder, or a depressive disorder. It is you, the individual, that is broken, and not that you are living in an unfair society, or so the biomedical model of mental illness would have us believe. And wouldn’t you know it, uber-capitalism can sell us the solution in the form of some antidepressants or a course of CBT.

Some people do find labels helpful. But currently, this is the only lens we are using. And often, the only solution is antidepressants, or if you are lucky some non-trauma-informed CBT.

Thus, mental health has been redefined to conform to the needs of uber-capitalism. Someone who is “mentally well” is someone who can work. IAPT was explicitly set up with the idea of getting people back to work. And programmes like mental health at work initiatives or Mental Health First Aid try to teach us that we should find new ways to handle the suffering caused by low wages, lack of job security and 24/7 work stress.

Work can be meaningful and promote self-esteem. But many jobs today do not provide any dignity. 10% of nurses are using food banks. People are being forced into the gig economy never sure if they will get a pay cheque. People work in warehouses that are gutting their local high street while their bathroom breaks are timed.

Crucially, everybody suffers. Even those with well-paid jobs find themselves lacking meaning and social connectedness. So we try to fix it by buying more stuff. This creates a cycle of consumerism, and then having to invest in security systems and increased policing to protect our stuff, and that in turn divides communities further.

So, what do we do about all of this?

First, we need a model of mental health that targets the root causes: inequality and social isolation. Putting more money into training counsellors will not help because individual distress is a symptom of wider social problems and not something that can be fixed in itself.

Second, we need a wellbeing economy. We need a form of capitalism that works for the benefits of individuals, not for the benefit of capitalism itself. A good start would be undoing the harms of deregulation and rebuilding trade unions to move away from uber-capitalism to more balanced social democracy. This is the exact model that operates in Nordic countries who have the highest quality of life.

Bartleby, the Scrivener is a short story by Herman Melville. It tells the story of a lawyer who hires a new member of staff, Bartleby. At first Bartleby works hard but gradually refuses to do any work or even leave the office, answering each request with “I would prefer not do”.

It’s well worth a read. For me, the exploration of the psychological processes the lawyer goes through in responding to such a situation are both relatable and fascinating.

The Burnout Society is an essay by Byung-Chul Han.

In the essay, the author argues that there is too much positivity in the world. We now live in an “achievement society” and a “can do” culture, but we are the poor saps that have to do the doing. We find ourselves in a perpetual state of hyperactivity, unable to say no.

Traditional models of psychotherapy stem from Freud. But Han argues these are based on the repressive values of the Victorian era. Today everything is permissible and there are no rules, except that we must achieve and the potential to achieve more is endless, leading to burnout. We never reach the ultimate goal or achieve closure.

Traditionally, capitalism has achieved oppression by directly oppressing the working class. But in this new world, we are victims of self-oppression, believing that we are free and simply striving for better, which is supposedly good somehow, but are actually still mere slaves to the capitalist machine. Reduced to the essence of life, health becomes the new goddess. All focus is on keeping the body alive to serve the machine of capitalism.

It’s a hard read. It’s like reading Marx; I felt like I had been dropped into the middle of conversation at times and, again like Marx, he flips between a few different languages. Worth trying to get your head around, though.

Industrial Society and Its Future, perhaps better known as the Unabomber Manifesto, is an anti-technology essay by Ted Kaczynski. It was published in 1995 in The Washington Post. I watched the Netflix documentary on Kaczynski and thought I would give the essay a read.

Kaczynski argues that technology is the source of most of our problems. Industrial society is a system and human autonomy (which he calls the power progress) has to be limited in service of the system. If you are going to have a factory production line, you have to have workers there, at a time that suits the factory, working on the line.

Technology then becomes pervasive. For example, when cars were invented, you could live just fine and have a car or not have a car. It was good. But now, owning a car involves a driving licence, insurance, MOTs. And because people have cars, cities spread out and so now you have to have a car. Or rely on public transport, which limits your freedom even further.

It’s not correct that humans did not have an affect on the world before the Industrial Revolution. Yuval Noah Harari talks about how early humans eliminated most of the large mammals in Sapiens. But we are doing exponentially more damage now, as well as increasingly making ourselves miserable.

So it is arguably a good critique of the problems of our technological society.

He is wrong about everything else, though. Starting with the fact that he killed a bunch of people to get the thing published, which, it goes without saying, is morally wrong. Maybe things would have been different if social media had existed back then, allowing him to spread his message without violence.

Kaczynski would have hated me. The work starts and ends with an attack of “leftism” which is ill-defined but generally the political left including socialists, communists, and any group gammons would call “woke” these days such as LGBTQ advocacy groups or feminists. He argues that a lot of the people complaining are well educated white people. Which is true, because we are the people who have a voice. That’s how oppression theory works and I don’t see any understanding of oppression theory in the text.

Finally, he doesn’t offer any real solution. His solution is “nature”. But what does this look like? How does it work? Even if we wanted to live without all of our modern technology (such as a antibiotics, for example), how would we stop people just reinventing technology?

The Female Profile of Autism: A Guide to Clinical Assessment is a book by Isabelle Hénault and Annyck?Martin. It suggests its intended audience is both clinical professionals and autistic women looking to understand how autism presents in women and what the assessment process looks like.

It has three parts. The first talks about autistic experience in the third person. The second is a narrative written by Martin about her experience of discovering she is autistic. Part three is some guidelines for clinical assessment.

I wasn’t too sure what to make of the book. There is clearly a lot of relevant clinical experience here. But is it neuroaffirmative? I’m not sure. It’s not medical model but it’s not the language I would expect to see in a new book. However, it was written in French and then translated to English, so it is fair to say some of the language may have got off point in translation.

It also leverages the work of Tony Attwood a lot. Now, Tony Attwood is a legitimate bigwig with his own Wikipedia page. But some of the language is like “and the magnificant Tony Attwood says…” as if he is the Wizard of Oz. Maybe he is; I’ve not met him. But I would like a clinical book to reference research and integrate ideas a little more. And again, maybe some of this is the translation.

The assessment guide provides a lot of useful questions. I would tweak the language to pathologise a little less, but the questions hit on the relevant issues. Overall, I would say this is a useful book for clinicians working with autistic women and girls.

Under the Radar: An Essential Guide to Autism and Girls is a book by Dr Emilia Misheva.

It’s a short book at arounf 140 pages which makes it a nice easy read. There are not enough short books in the world. It is written for a general audience and would be a good read for anyone looking to understand a lot of the key issues for autistic girls. Clinicians might want something a little more technical but it would still be a good overview.