Assume a spherical frictionless population

So, we've got the government sponsoring a review of sick leave, that essentially recommends that we treat people with acute health conditions in the same way that we now deal with chronic and terminal health conditions.

Latentexistence at Where's the Benefit? has more on the particular problems with this proposal, which I won't try to duplicate here. I want to focus on the last sentence of the article for what it says about government overall:

The DWP spokesman said: "The economy loses £15bn in lost economic output each year due to sickness absence and we cannot continue to foot this bill."

Interesting claim... After quite a bit of searching, I can't find a source for this. I have found:

• Several other unsourced repetitions of the figure, sometimes accompanied by a claim that there are 150 million working days lost annually in the UK due to sickness absence.
• One claim that £12bn (instead) in economic output is lost, but 200 million working days are lost
• Claims in the original press release for the review that the total cost of sickness absence (which is not the same as lost output) is £100bn, £60bn of which is paid by the government.

However, it does seem fairly clear that the main assumption for losses and costs is as compared with an economy where no-one was ever ill.

On that measure, we "waste" about £70 million annually on street lighting, compared with an idealised country which flies around the world on jet engines so that the sun never sets on it, or a country populated entirely by people genetically modified to have sonar.

People are people. They get ill. I'm all in favour of reducing the amount that people get ill through advances in medical science, good¹ public health initiatives, improved safety measures, more efficient treatments, and so on. But anyone seriously basing their government policy essentially on the assumption that people should never be seriously ill has such a bizarre idea² of what humans are that they shouldn't be in charge of the country.

And it leads to policies like this where the sickness absence itself, and by extension the person who is ill, gets treated as the problem - when actually it's a symptom of the facts that we don't have sci-fi medical technology now, that we have unsafe and unhealthy working environments (especially for mental health), that we place toxins into the environment far more than we should be, and so on.

That's what's "costing" us the £15bn in "lost output", not people being ill. Not getting that distinction - and so making a policy based on the belief that people shouldn't be ill (which is not unique to our current central government) - means policies like this, which are likely to make the situation worse, not better, and so cost the economy even more overall - and a lot of ill people a great deal personally.

Footnote

¹ i.e. non-dehumanising

² Admittedly, the ablist idea that "not ill" is normal and "ill" is deviant is so common that finding a member of government who doesn't believe that may take some work - but as with many discriminatory assumptions they just sound silly if you say them explicitly.

Privileged Analogies, and a suggested replacement

One thing I've been seeing happen a lot recently is the use of various mental health conditions being used as analogies in the discussion of political ideas or proposals or strategies.

Or rather, the author's privileged misperception of what a mental health condition is actually like being used as an analogy.

Now obviously there are serious problems with appropriating someone's experience to use as an - invariably negative - analogy for your feelings about a political debate. They're well-documented; a few in summary:

• It adds to the negative general opinions surrounding mental health conditions.
• It alienates people who might have supported your view if you'd used an analogy that wasn't an insult to them.
• It creates an environment generally hostile to people with mental health conditions.

There are also obviously serious problems, purely from a literary standpoint, of using analogies where the thing used for the analogy does not in fact have most of the properties the analogy requires for its effectiveness. Given the widespread misperceptions about mental health, it's not even likely that the default members of the audience have the same misperceptions as the author of the analogy does anyway, so the "I didn't mean X in the mental health way" defence (which was already ridiculous anyway) becomes even more tenuous.

But, of course, neither of these problems actually matter to the people using these analogies. I've seen many an author, confronted with people pointing out both the social and literary problems with their analogising, nevertheless defend the analogy as the right thing to do.

So, if you can't convince them otherwise, why not join them? Not with mental health-based analogies, of course. Use non-harmful analogies instead. Making the uselessness of the analogy even more obvious might even help convince them: if their utterly inaccurate analogy is justifiable, why aren't these less harmful cases? As examples:

The Conservatives are like strawberries.

It works as an analogy because strawberries are red with a green top, and the Conservatives aren't. There are also many other ways, by the reverse logic of mental health analogies, in which this analogy works (strawberries are best in season, while Conservatives are there all year round; etc.)

The government's policy is like a plug hole.

Water doesn't actually swirl in opposite directions in opposite hemispheres, but enough people think that it does for the analogy to work. If commonplace misperceptions are a vital part of analogy making, then they can be used without ableism.

Coalition continues not taking rape seriously

[trigger warning]

The government has shelved a study into police handling of rape cases, to "save money". The total expected cost of the study was £441,000.

Meanwhile, Essex Police have been strongly reprimanded by the Independent Police Complaints Commission for, essentially, doing absolutely everything wrong when investigating a rape case. In summary: a woman reported twice - several months apart - that someone had broken into her house and raped her. On both occasions, the police reported that "no offence had occurred", without checking for actual evidence, because they were sexist ablist bigots (or as the IPCC puts it were "adversely influenced by the woman's mental health history"). When the suspect was finally arrested he admitted to the crime.

But I'm sure there's no need for an actual investigation into police handling of rape cases and consequent steps to get them to consistently do it properly. Baroness Stern's report pointed out that actually following the existing guidance would be a very good start, of course, but I doubt that £441,000 - a tiny amount in the context of government spending - will be going towards that either.

Meanwhile, the report the government was promising on "why anonymity for suspects is a good idea" has been delayed yet again, until October. This is hardly surprising, of course, given the lack of evidence there actually is for this claim, and the fact that - when I asked in August - the ministry had no evidence at all regarding the number of suspects their current proposal would affect or the likely effect on media reporting their proposals would have.

It was fairly clear right from the start that they didn't actually have any evidence backing up their proposal, but it's always useful to have more official confirmation of this.

Harming fat people: why the government thinks it's okay.

After asking for some more details about the research behind the National Child Measurement Programme (NCMP), I got back some research papers.

Here's the papers I got. Full-text availability is variable.

1. Parents often do not recognize overweight in their child, regardless of their socio-demographic background (full text free)
2. Telling Parents Their Child's Weight Status: Psychological Impact of a Weight-Screening Program (full text free)
3. Recognition and management of childhood overweight and obesity by clinicians (full text requires subscription)
4. Can we recognise obesity clinically? (full text requires subscription)
5. Health consequences of obesity (full text requires subscription)

The second paper essentially describes the pilot study of the NCMP, and is an interesting read. One of the points made in the abstract, of course, is that "However, a minority of participants found it distressing, which highlights the importance of managing the process sensitively, particularly for families with overweight children.", and it's fairly clear from the news reports that the process has not been managed sensitively.

The first, third and fourth papers are all various ways of saying "Oh no! Not everyone is panicking enough about the obesity crisis! Even some doctors are relaxed!".

The fifth paper is the only one that attempts to show that "childhood obesity" is actually a problem - the other four proceed from the assumption that it is - and it's not a good paper (by which I mean it meets the internal standards of the field perfectly, but those standards are so bad that the paper is still terrible).

It shows a lot of correlation, but doesn't then go on to even consider the question of causation. The best example of this is probably the first area it looks at - psychological problems.

[...] We can conclude that obese children are more likely to experience psychological or psychiatric problems than non-obese children, that girls are at greater risk than boys, and that risk of psychological morbidity increases with age. Low self-esteem and behavioural problems were particularly commonly associated with obesity. [...]

Further on, in a section on long-term socio-economic effects of childhood weight:

[...] that obesity in adolescence/young adulthood has adverse effects on social and economic outcomes in young adulthood [...] For example, British girls born in 1958 who had BMI >90th centile when studied at age 16 had significantly lower income than girls with BMI <90th centile (by 7% on average) at age 23 [...]

Well, there's a surprise. It turns out that bullying and harassment, exacerbated in girls by the intersectionality with gender of appearance policing, and relentless social messages about the inferiority of fat people, will give fat people low self-esteem, with increasing likelihood as they get older and so live through and internalise more of this. When they get to adulthood, widespread discrimination in society then creates a noticeable pay gap.

Their solution is not to try to end this psychological assault but to reinforce it by blaming the victims for not being thin enough.

Given that they've entirely missed the obvious here, I'm not convinced that the claimed causation of other health conditions by "obesity" really holds either, especially since they admit that the evidence they review has weaknesses, and that the psychological impact is "likely to be the most widespread" consequence in childhood.

So, that's the quality of the evidence that the government is using. It's either terrible, or relies on assumptions for which the evidence is terrible. There doesn't seem a lot of point in writing back to point this out, though.

A distorted image of science

[trigger warning for eating disorders]

The BBC, in its usual uncritical way, reports on a paper claiming that people's sense of proprioception is not great. Proprioception, if you haven't heard the term before, is the internal sense of position - you know where any limbs you have are in relation to the rest of your body, at what angle your head is to your shoulders, and so on, without having to look.

The paper itself (payment/subscription needed for full text) is really quite interesting. They tested how exact this sense of proprioception is by asking people to point to the fingertips and knuckles of one hand with the other hand while not being able to see it, and found that people tended to miss by a fair bit, estimating their hands to be shorter and wider than they really were.

I tested this briefly in an uncontrolled fashion with my own hands, and yes, this does seem to happen to at least some people.

So, the next time someone tells you that they know X like the back of their hand? Worry.

This is not an area I have much knowledge about, so if there are giant flaws in the research methodology, I don't stand much chance of finding them. There are none stunningly obvious to me as a scientific generalist, though some things that do stand out are:

• All of their experimental samples (for four variations of the study) have more women than men, some by a significant margin. If gender was significantly affecting the results they didn't mention it, but this suggests some other bias in how they recruited their samples which might be significant.
• They don't mention, but it seems likely by implication, that all of the sample had relatively average vision. Whether this effect also occurs in people who aren't able to use vision to supplement proprioception in most cases seems an important question.

The flaws, as usual, come in the interpretation for the press release and news articles, where, according to the BBC:

The brain naturally distorts body image - a finding which could explain eating disorders like anorexia, say experts.

[...]

Distorted perception may dominate in some people, leading to body image problems, a US journal reports.

Lead researcher Dr Matthew Longo said: "These findings may well be relevant to psychiatric conditions involving body image such as anorexia nervosa, as there may be a general bias towards perceiving the body to be wider than it is.

"Our results show dramatic distortions of hand shape, which were highly consistent across participants."

...and in come the wild extrapolations.

It is, I suppose, possible that the body image distortions of anorexia nervosa have the same basic cause as this one, and it would be entirely reasonable to do some follow-up studies in this direction.

But there's no evidence yet to justify Dr Longo's speculation that there's even a tendency to misperceive your own body width in the general¹ case, or that people with anorexia nervosa misguess where the edges of their body are more than people without.

The proprioception errors they report on are fairly clearly not "proprioception plus vision" errors, but anorexia nervosa is not generally a condition that only takes effect when not observing oneself visually, which is some evidence that they aren't the same effects.

The hand distortion seems to be fairly consistent across the sample and not related to any obvious social effects. Anorexia nervosa has been fairly strongly linked to social effects, and varies widely in severity across the population.

It's an interesting study with potentially interesting follow-ups, but both the news article and Dr Longo's quotes are assuming prior to doing the needed follow-up studies that the distorted body image of proprioception and the distorted body image of anorexia nervosa are distorted in the same way, or even involve the same meaning of "body image". As usual, the BBC seems to have largely uncritically reported and extended a press release.

Here's the original press release - there's one relevant quote at the end, in a press release that otherwise actually summarises the research very well:

“These findings may well be relevant to psychiatric conditions involving body image such as anorexia nervosa, as there may be a general bias towards perceiving the body to be wider than it is. Our healthy participants had a basically accurate visual image of their own body, but the brain’s model of the hand underlying position sense was highly distorted. This distorted perception could come to dominate in some people, leading to distortions of body image as well, such as in eating disorders,” said Dr Longo.

It's not as bad as some of the BBC's science reporting, but it's got all the same types of error - unjustified extrapolation, uncritical reprinting of press releases, not reading the actual paper, etc.

¹ They might also need to sharpen up their recruitment strategies to get a control group from a society where "thin is good / fat is bad" isn't the overwhelming social message.

Election compact on mental health: take action

Four mental health organisations have, together with the All Party Parliamentary Group on Mental Health, released an Election Compact (PDF) on mental health.

It's supported by the leaders of all three major parties in the Commons and can apply to prospective candidates and their campaigners and supporters at all levels of government. Despite this, none of the three parties seem to have (so far) said anything centrally about it, so it appears that they're all leaving the decision as to whether to sign up to the compact to individual candidates.

I'm therefore sending the following letter, or a slight variation, to each of the local candidates (so far, Conservative, Labour, Liberal Democrat and UKIP).

Dear [candidate],

The All-Party Parliamentary Group on Mental Health, the Royal College of Psychiatrists, and the charities "Rethink", "Mind" and "Stand to Reason" have recently released an "Election compact on mental health". The full text is available as a PDF at http://www.mind.org.uk/assets/0000/7488/election_compact.pdf

This compact is an undertaking to not stigmatise, slur or discriminate against anyone with a mental health problem, to challenge negative attitudes towards mental health, and to represent the interests of all your constituents regardless of their mental health. It is supported by the leaders of all three major political parties, and is open to candidates at all levels as well as their campaigners supporters to sign up to.

Will you, as the [party] candidate in [constituency] for the coming general election, be signing up to this compact and requiring your campaign team to follow it also? If so, will you make a public announcement of this? If you will not be signing up to the compact, why not?

Yours sincerely,

[constituent]

If I get any replies I'll mention them in the comments. I'll also, obviously, be carefully watching election publicity to see if the parties follow the compact or not, regardless of whether they formally sign up.

I encourage you, if you're in the UK, to write to your own candidates - ask in comments if you need help finding out who they are or how to contact them - to ask them to sign up too, if they haven't already.

Rethink also have a petition related to this to ask the next government to take action outside the campaign too (UK residents only).

Those of you outside the UK - is there anything similar available in your elections? If so, do many candidates sign up to it, and do they stick to it if so?

Disability benefits and the government

Via Mind and The F-Word, the Conservatives seem to be agreeing with Labour's plans to move people from disability benefits to unemployment benefits.

The whole thing is based on the belief that there is a significant proportion of people claiming disability benefits who don't need them, and that the good to society of removing these claims (in tax income that can be spent elsewhere) will exceed the harm to society (in additional tax income that needs to be spent on the new stricter assessments¹, and more importantly in personal stress to the majority of genuine claimants, who will either have to jump through an additional set of hoops, or who will lose benefits they need). I don't think either part of that is true. Neither is it true - certainly not at the moment, but not really even when the economy was doing better - that there are jobs available for these people to take anyway.

Amy's F-Word post goes into a lot of detail on the issue, including the issue of "invisible" disabilities - the sort which stricter assessment is most likely to wrongly disbelieve.

There's a petition to the government on this.

¹ More on this bit later, after I've had time for research.

Prejudice as accepted fact

Sunny at Liberal Conspiracy comments on the recent controversy over Andrew Marr's questioning of Gordon Brown. [don't read the comments]

Andrew Marr, for the BBC, asked:

A lot of people in this country use prescription painkillers and pills to help them get through; are you one of those people?

The Prime Minister, unsurprisingly, refused to answer the question.

Sunny criticises the way that this "legitimised a smear" that's been going around for ages, but I think this misses the point.

The most irritating thing is that the entire controversy over it is based on a very dangerous chain of illogic. There have been plenty of people leaping in to deny that Gordon Brown takes painkillers, and to criticise the people who've suggested it. This is entirely expected, all part of politics, etc. What's getting lost in this is that it shouldn't be an issue in the first place.

In the 2008 US Presidential campaign, Barack Obama was accused by his opponents of being "a Muslim". This was denied strongly and repeatedly refuted by numerous people - but very few people thought to add - or start with - "and so what if he is?". Colin Powell is the only major US political figure I can remember raising that point, though there may have been others.

It's the same issue here - Andrew Marr was undoubtedly entirely in the wrong to ask a question about Brown's medical history: there are very few questions a journalist can ask about anyone's medical history, and none of those possibilities applied here.

The rumours that have been started about Brown's medical history and mental health are undoubtedly intended by their initiators as smears. They really shouldn't be - it should be as pointless a question as "So, I hear you ate a carrot yesterday, Prime Minister. Could you confirm or deny this rumour?"

It works as a 'smear' because enough people vaguely believe a variation on one of these two clearly false statements:

• People with chronic pain should not be Prime Minister. Our Prime Minister needs to be an idealised specimen of humanity (and, you know, straight, white, male, and other defaults would be good, while you're at it)
• People with chronic pain should not take medication for it, and doing so makes them unsuitable to be Prime Minister

You can substitute for chronic pain any of the other numerous mental health problems people have suggested Brown might have (most commonly depression, something which the generally popular and successful Prime Minister Churchill also lived with). I'd certainly rather any politician with health problems, mental or physical, was receiving appropriate treatment for those problems. Laurie at Penny Red covered this well the last time it came up (which, note the post dates, was 3 weeks ago...). Going back a bit further, Charles Kennedy was forced to resign as leader of the Liberal Democrats over his alcholism, and has since been replaced by various people who are neither as competent nor as popular with the public. Good going there, Lib Dems.

The people responding to this and criticising the "legitimisation of a smear" need to be more careful not to legitimise the idea that it would be bad if it was true while they're at it. Breaking that illogic is the only long-term way out of this.

Permanently marked

The news articles on this story are generally so full of poor assumptions and ablism that I don't have a good one to link to. The BBC one isn't quite as bad as the others, so: a man has been removed from the London taxi training course. The facts of the case, as far as I can tell through the reporting, are this:

[trigger warning]

In 2000, while living with paranoid schizophrenia, he strangled his wife. He pleaded guilty on grounds of diminished responsibility, and was sentenced for manslaughter to indefinite imprisonment in 2001.

Some time after this, the parole board assessed that he was no longer a danger to society and he was released. In early 2009 he worked for a private hire company in London, and later on began training for the London black cabs (which have a higher standard of training required).

Transport for London's guidelines, at the time, allowed people with 'spent' convictions to train with them. When the press discovered, via a leak, that this man was taking this training, they raised a giant fuss. TfL then disallowed the man to continue with the training, and announced that it would change its licensing guidelines to exclude people with spent convictions for violent offences except in exceptional mitigating circumstances.

What no-one seems to be generally pointing out in the mainstream press, though, is that this is surely precisely one of those circumstances. He was under the effects of a severe mental illness at the time he killed his wife. The court at the time accepted that this was the only reason for his actions in allowing the diminished responsibility plea (which is really quite rare). He has since been assessed as healthy by the parole board.

Let's take an example with a physical illness. Someone gets a highly contagious, highly dangerous physical illness. A family member catches it and dies, but they survive after extensive treatment in hospital. Having recovered, they apply for a job as a taxi driver, but are turned down because a previous health problem once led to someone's death. The logic being used, of course, is "what if they're wrong about being healthy?" to which the answer is "and where did you get your license to practice medicine again?".

Of course, it's in all the press, and the existing taxi drivers were up in arms about it, so that sort of thinking is never going to be possible in this case. TfL had been trying to be reasonable about it...

[a few days ago] Jeroen Weimar, chief operating officer at TfL, said: [...] "We have got five to six years of independent medical advice saying this man is no danger to the community and fit and proper to be a taxi driver or a minicab driver."

...but have since presumably calculated that it's better to stop taking hits to their reputation than to support people with previous mental health problems. It's appalling that the two things are contradictory.