Category Archives: Health

Chronic Stress

Decline of the west, Drugs, Health

 

As Dr. Sajay Gupta pointed out on his HBO documentary, in the United States, the self-proclaimed leader of the Free World,  “we are 4.7% of the world’s population and take 80 to 90% of the world’s OxyContin and hydrocodone. And I’m pretty sure that we don’t have 80-90% of the world’s pain.” Another thing is that epidemic of drugs is mostly affecting whites aged 35 to 55. Stress should be listed as a contributing cause to many deaths. Why whites?

Stress of course is a natural phenomenon.  As Robert Sapolsky, a neuroscientist from Stanford University said,

” When you look at the stress hormones we secrete exactly the same chemicals as a lizard and a fish and a bird. This is ancient, ancient biology. For 99% of the beasts out there what stress is about is 3 minutes of some screaming crisis when somebody is very intent on eating you or you are very intent on eating somebody, and everything your body does at that time makes perfect sense. You increase your heart rate, your blood pressure, your breathing rate, you turn off everything that is not essential and you shut down growth, tissue repair. When a lion is chasing you and you are running for your life and one of the things you are doing is all sorts of metabolic stuff to divert energy to your thigh muscles. Oh my god you think you only have 3 months until your taxes are due and you divert energy to your thigh muscles. That makes no sense whatsoever and that’s where you pay the price.”

 

Robert Sapolsky who wrote a book Why Zebras Don’t Get Ulcers points out that when a lion is chasing a zebra it needs stress to get away. Stress is entirely good in that situation. Yet once the zebra gets away the stress level returns to normal. That also happens quite quickly. Life is good again. The zebra relaxes. The stress was entirely good.  It saved the zebra’s lie.

As Dr. Gupta said, “Stress is not the enemy. It’s the constant never-ending toxic stress–that’s the stress that’ll kill you.” Chronic stress in other words is what we should be stressed out about. Sapolsky says he has learned a lot about stress from the baboon world. What he learned is “What makes psychological stress really corrosive is lack of control, lack of predictability, lack of social support. If you are chronically stressed you will chronically increase your blood pressure and you are going to get more liquid turbulence into your blood vessels and hit the walls. They pound the walls and they cause microscopic bits of scarring, tearing, and inflammation there. And you get plaques and you get the whole cascade there. It’s a fairly straight biological line from chronic stress to your blood pressure that is chronically elevated. It’s a much more indirect route to liver sclerosis.”

Sapolsky was convinced that stress is the common cause of liver sclerosis, suicides, and opioid overdose.  They are all related. Stress is the root problem, he is convinced. “Our lives are more psychologically corroded by stress. Stress: am I valued? Stress: do I have a meaningful place in the community? Stress: is there even a community I can rely upon. Stress: why am I here?” Note all these questions point to social issues.

 

Epidemic of Despair  

Alienation, Health, Loneliness, Social Issues, Substance Abuse

 

When Dr. Sanjay Gupta, who besides being a physician is also a periodic commentator on CNN  first started looking at the deaths in the white middle class that included deaths by opioid overdose, suicide, cirrhosis of the liver, it felt a bit mysterious. He was struck by the numbers but did not really understand the causes. It took some time for him to piece things together.

 

He found an interesting article with an interesting title. This was “The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999-2015” published by Elizabeth Stein, MD. MS, Keith P Gennuso, PhD, […] and Patrick Remington, MD MPH in the medical journal American Journal of Public Health. An epidemic of despair? That is very strong language? Is it justified? Gupta wanted to know. So did I.

Dr. Gupta wanted to know, ‘what causes those deaths of despair?’ That is an important question. He was not satisfied with the medical causes of death. He wanted to know ‘the cause of the cause.’ He, like me, thought that was a much more significant question. But this one is harder to tackle.

Why are people taking so many opioids?  Why are they becoming addicted? Part of it is overprescribing for which physicians are responsible. Why are so many people drinking to excess? Why are so many people dying of suicide. Is there a common cause of the cause?

As Neurosurgery Resident Kumar Vasudevan put it, “We are living in a time in which we are very, very good at treating diseases, we are less good and less proficient at understanding health.”  I would add, that many of us are reluctant to look at social causes, and, believe it or not, political causes. Is that possible?

As Dr. Gupta said, “deaths of despair seem to be a symptom of an underlying problem, rather than the problem itself.” Cyril Wecht believes that the underlying problem is that American society is increasingly stressed. Pressures make lives more and more difficult. Pressures of making a living, depersonalization, families breaking up, and what he calls the “robotization of society.”

But there were also things that happened on the side of medicine. The idea began to flourish that people should not have to suffer. If they suffer that was seen as a failure of medicine. There always seem to be simple solutions–write a prescription. Drugs can take care of any problem. But simple solutions are often the most dangerous. And prescriptions were one of them.

Of course there is more to it than this. Let’s look farther.

Is Social Liberalism the problem?

Decline of the west, Health, Liberalism, Social Media

 

I am still looking at the issue of why there are so many youth suicides. What happened?

Ross Douthat of the New York Times thinks Jonathan Haidt, the social psychologist, did not go far enough. He should have looked more at the society into which this new technology fell. Douthat said this:

“One answer is that social media entered into a world that was experiencing the triumph of a certain kind of social liberalism, which the new tech subjected to a stress test that it has conspicuously failed.”

 

We must realize that by “social liberalism” he did not mean exactly what you might think. He is not talking about the woke culture that Republicans are currently constantly criticizing. He does not think anti-racism or diversity equity inclusion (‘DEI’) is the real problem. He thinks it is the liberalism that preceded it—the individualism of the 1960s that included secularization, which replaced the decline of religion in the 2000s. From Douthat’s point of view, which is clearly Christian and conservative, (though not in the Trumpian sense), is that social and sexual permissiveness, widespread and open pre-marital sex, out-of-wedlock child rearing, and marijuana use all contributed to the problem. I would point out that Douthat has not backed up his claims with the rigorous kind of evidence Haidt did, but his ideas have some attraction. All of those factors which might even have been morally justified and rational, might very well have contributed to the moral instability of youth, particularly young girls.

Douthat saw such liberalism this way:

“All of which has made social liberalism look much more unsustainable and self-undermining than it did in 2008. It’s threatened not just by political radicalism and returning disorder, but by a collapse of familial and romantic and even sexual connection, a terrible atomization and existential dread, a chasing after ever stranger gods.

These modern technologies fell on soil that was fertile to growing insecurity and anxiety and thus wrecked havoc on our youth. Freedom can be difficult for anyone, let alone youth and children.  They needed a moral foundation to support these liberal freedoms, which was often absent as parents did not know how to supply them, often relying solely on religious teachings and dogma that were not always adequate for the purpose. This combination of new exciting technologies, exhilarating freedom, and dubious religious instructions did not give youth the solid grounding they needed. Freedom alone can be hell.

Douthat concluded this way:

“If you were comfortable with the world of the early Obama years, it makes a lot of sense to focus on the technological shock that brought us to this place, to lament and attempt to alter its effects.

But those effects should also yield a deeper scrutiny as well — because what looked stable and successful 15 years ago now looks more like a hollowed-out tree standing only because the winds were mild, and waiting for the iPhone to be swung, gleaming, like an ax raised with less family stability and weak attachments to religion, with a strong emphasis on self-creation and a strong hostility to “normativity” — to enter and forge a new social world. And they went forth and created the online world we know today, with its pinball motion between extremes of toxic narcissism and the solidarity of the mob, its therapy-speak unmoored from real community, its conspiracism and ideological crazes, its mimetic misery and despairing catastrophism.”

 

I think Douthat’s analysis provides some helpful supplements to Haidt’s scientific analysis. In other words, in my view, new technologies, new freedoms without a solid moral foundation is what left youth unanchored, and weak religious teachings combined to create the debacle of the 2010s. And sadly, that all started a chain reaction which has fed a steady stream of youth suicides. And we are not over it yet.

Why are North American Teens Miserable?

Decline of the west, Health, Social Media

 

I have already commented on a big problem with youth in North America. In particular, I referred to significant work done by Jonathan Haidt and his team of researchers. Unfortunately, there is more to say on th e issue.  It is time to meander back.

Based on the recent CDC Youth Risk Report Ross Douthat commented as follows in the New York Times:

“American teenagers, and especially American teenage girls, are increasingly miserable: more likely to entertain suicidal thoughts and act on them, more likely to experience depression, more likely to feel beset by “persistent feelings of sadness or hopelessness.”

 

We must remember that every generation worries about and complains about the generation that follows them. My parents did, I did it, and my kids will do it. The next generation is never considered as good as our generation. The only other thing we like to blame as much as the youth is modern technology. Yet now, perhaps surprisingly, at least there is some evidence to support this worry.

 

Jonathan Haidt a leading social psychological researcher has done extensive scientific study on the issue of what is happening to our youth. He has testified about it to the United States Senate. He bases his statements on scientific evidence, not bias. He has shown that based on many indicators there has been a severe darkening of the mental health of youth occurred in the early 2010s. These, of course, in the US were the Obama years. His research lab has actually pinned it down to that time. He saw a worrying change that has continued to the present.

 

Haidt bases his claims on the fact that this is exactly the same time when social media changed significantly.  I have seen the effects of social media on young girls and it is not pretty. Ross Douthat who concurs with Haidt said, “The timing of the mental health trend fits the smartphone’s increasing substitution for in-person socialization.” Douthat also said this:

“Then data aside, having lived through the online revolution as both a participant and a parent, it seems obvious that social media has worsened the coming-of-age experience relative to the halcyon 1990s — creating a “sense of another consciousness that’s welded to your own consciousness and has its own say all the time,” as my fellow teenager-of-the-’90s Freddie DeBoer wrote recently, which makes the general self-consciousness of adolescence feel much more brutal.”

 

It has always been tough being a teen.  But social media has greatly exacerbated the problem. This problem is not confined to the United States. Similar evidence of severe mental health issues have been seen in Canada and throughout the west.  I think this indicates  a severe decline in the west.

Social Cancer

Decline of the west, Drugs, Health, Social Issues

 

Nicholas Kristof and Sheryl WuDunn writing in the New York Times in 2020 said there was “a cancer growing at the heart of the nation.” They meant the USA of course, but really as Jonathan Haidt showed it goes much wider than that. I clearly includes Canada and other countries such as the UK and Australia.

It is that social “cancer” that I want to look at. To do that, I must find it. That may not be easy.

Kristof and WuDunn have a suggestion of where to look:

We have deep structural problems that have been a half century in the making, under both political parties, and that are often transmitted from generation to generation. Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of “deaths of despair.” [They wrote this in 2020]

 

I had heard that expression before. I think it was another physician, Dr. Sanjay Gupta. Dr. Gupta is both a physician and a television medical analyst. He had some very interesting things to say on a fascinating television documentary.

 

The trigger for Dr. Gupta’s documentary  was another startling fact that as far as I was concerned had gone under the radar. As he said, “In the 1960s Americans had among the highest life expectancy in the world. Today [2019] the U.S. ranks at the bottom of major developed nations.”

In that documentary, Dr. Gupta interviewed another physician a forensic pathologist Dr. Cyril Wecht, in Greenburg Pennsylvania, who said “the previous year I did 356 autopsies. Of those more than 300 were drug deaths. And this is what is being experienced throughout the country.” He also said, “this is far greater than what we experienced with AIDs. It is a very significant epidemic of monstrous proportions.” As Dr. Sanjay Gupta said, “what we are dealing with in fentanyl is 50 times stronger than heroin.” Drugs are part of the problem, but I actually think they are more a symptom than the cause. I will post more about this in the future. It is a fascinating issue.

As Dr. Gupta said, “In the United States life expectancy is dropping faster than any other demographic in the world.” According to the Center for Disease Control, “Middle-aged whites are the highest increase in the deaths of despair.” This group also has very high rates of drug overdose. Whites?  Who would have thought that?

What is going on here? That is what we must figure out. What is the cancer at the heart of the United States and Canada?

 

Eye Witness Testimony

Decline of the west, Health, Social Issues, Social Media

Jonathan Haidt also told the Senate that “eyewitness testimony” confirms the academic findings: social media is a culprit. Not necessarily the only culprit.

Their research and others directly asked teens what they think is causing the problem. As we all know, many of them like social media, like heroin users like heroin,  but when teens were asked whether they think social media overall is good or bad for them, according to Haidt, “The answer is consistently “no.”

Added to that, Haidt pointed out to the Senate that

“Facebook’s own internal research, brought out by Frances Haugen in the Wall Street Journal, concluded that “Teens blame Instagram for increases in the rate of anxiety and depression … This reaction was unprompted and consistent across all groups.”

Haidt advised the Senate that in Australia a study showed that “teens believe that social media is the main reason that youth mental health is getting worse.”

This is what Haidt told the Senate committee investing the problem:

“This crisis did not emerge gradually. There was no sign of it before 2010, but by 2015 it was everywhere, overwhelming mental health centers that catered to teens and college students. The crisis emerged in the exact years when American teens were getting smart phones and becoming daily users of social media platforms such as Instagram. Correlational, experimental, and eye-witness testimony points to social media as a major cause of the crisis. I do not believe that social media is the only cause of the crisis, but there is no alternative hypothesis that can explain the suddenness, enormity, and international similarity that I laid out in part 1 of this document. Researchers and spokespeople for the major platforms who tell you that the evidence is “inconclusive” or that the effect sizes are “too small” should be asked directly: “OK, then what do YOU think caused this?”

 

Haidt and his team believe, based on significant evidence, not just grump adults, that social media is part of the reason that in the United States, Canada and elsewhere are suffering from these serious health problems.

It is clear that in the United States and Canada the countries are experiencing what Haidt called “a catastrophic wave of mood disorders (anxiety and depression) and related behaviors (self harm and suicide).”

The crisis is so severe that the U.S. Surgeon General, Vivek Murthy, recently issued an Advisory on Youth Mental Health warning Americans to take this problem seriously.

 I think we should all do that. If we don’t the west will continue to decline and many more American and Canadian young people will suffer immeasurably.

A World-Wide Problem

Decline of the west, Health, Social democracy, Social Issues, Social Media

 

Jonathan Haidt made another important point to the Senators that he has often made in print, namely, that this is not just an American problem. The same crisis has hit “many countries” not only the United States. That means that it cannot be blamed solely on problems unique to the US such as gun violence, particularly in schools. The cause must be broader than that. He then made a statement that should concern Canadians, namely that

 “The patterns are nearly identical in the UK and Canada, and the trends are similar though not identical in Australia and New Zealand. We do not yet see signs of similar epidemics in continental Europe or in East Asia, although I have not yet found good data from those regions.”

 

Together with His associate researcher Jean Twenge, they had discovered

“a sudden increase between 2012 and 2015 in all regions of the world. These patterns indicate that whatever happened to American teens was not uniquely caused by trends and events in the USA (e.g., a sudden fear of school shootings after the Newtown massacre of 2012). The cause is likely to be something that affected teens in many or all regions of the world at the same time.”

 

This is a world wide problem, partly because social media is a world wide phenomenon.

Note in particular the sharp rise for Girls after 2020. In particular, between 2012 and 2020 The rates of major depression for girls more than doubled during this time. The increase for boys was not as high.

Most of the research is confined to the west, but by no means exclusively.

One must always bear in mind the scientific point often made, that correlation does not prove causation.  For example, just because 80% of sex assaults are perpetrated by men who ate potatoes that day does not prove potatoes are a cause of sexual assaults.

First, Jonathan Haidt explained to the Senate Select Committee that “Correlational studies consistently show a link between heavy social media use and mood disorders, but the size of the relationship is disputed.”

Haidt then drilled down:

“Nearly all studies find a correlation, and it is usually curvilinear. That is, moving from no social media use to one or two hours a day is often not associated with an increase in poor mental health, but as usage rises to 3 or 4 hours a day, the increases in mental illness often become quite sharp.”

 

The graphs are quite explicit. To see them go to the reports. The message is loud and clear.  The more young people use social media the more they suffer from serious depression and anxiety and the more likely they are to attempt to commit suicide. Haidt puts it this, contrary to what some of his critics have said,  “The correlation is much larger than for “eating potatoes” or “wearing glasses.”

This is a big deal. We should all take note but particularly our political leaders who have the capacity to respond. This is not something that should be swept under the rug.

Serious and Sudden Stuff

Decline of the west, Health, Social Media

 

 

When Jonathan Haidt testified before the American Senate, he presented specific data from the Center for Disease Control and Prevention (‘CDC’) that showed how sharp and sudden the increase had been for hospital admissions for teen girls who had intentionally harmed themselves, mostly by cutting themselves. This was serious and sudden stuff in other words. The numbers were stunning, particularly for young girls and serious, though not as drastic for young boys.

He noted that “emergency room visits for self harm increased very rapidly among teen girls beginning in 2010.”

One of the most interesting things about all of this data was how fast it rose. As he said, “The crisis came on suddenly, in the early 2010s.” In other words, things were fine before 2010 and then incidents shot up! What happened after 2010 was not just a continuation of what had started before then.  Something caused this rapid rise that could not be explained on the basis of prior conditions! As he said to the Senate,

 The curves you can see in the Adolescent Mood Disorders Google Doc are not just the continuation of trends already in evidence for the Millennial generation (born 1982 through 2016). They are more like “hockey sticks,” with a long relatively flat period before the early 2010s, and then a sharp upturn or elbow. This is rare in mental health data. It suggests that something changed in the lives of American teens around 2010

The next thing Jonathan Haidt explained to the Senators was that these numbers were big. As he said,

 

“The increases in mental illness are very large. When you compare rates in 2009 –before most teens were daily users of social media––to 2019––the last full year before Covid made things even worse––the increases are generally between 50% and 150%, depending on the disorder, gender, and subgroup.”

 After that he testified that “The crisis is gendered. He explained to the Senators what this meant:

The collapse of mental health has hit both sexes, and on many measures, boys and girls are up by roughly similar percentages. However there are two important caveats: A) the base rate for mood disorders is always higher for girls than boys, particularly after puberty, which means that a doubling of the rate produces far more additional sick girls than boys, as you can see in Figure 2 below, and B) there are some disorders and age groups for which girls are up far more, especially for self-harm, which is a much more common way of manifesting anxiety in girls than in boys.

 In specific terms, “rates of major depression roughly doubled, for boys and for girls, from 2010 to 2020”.  I must repeat this with emphasis. The rates for major depression doubled for boys and girls in 10 years! This is serious stuff! Serious and sudden.