While not the first such minister, the loneliness epidemic in Japan will make this one the hardest working.
- The Japanese government has appointed a Minister of Loneliness to implement policies designed to fight isolation and lower suicide rates.
- They are the second country, after the U.K., to dedicate a cabinet member to the task.
- While Japan is famous for how its loneliness epidemic manifests, it isn't alone in having one.
At the time of writing, the COVID-19 pandemic is just a few weeks shy of being one year old. Many people have been practicing social distancing, quarantine, and isolation procedures for most of that time. While these practices have had a real effect on case numbers, they have also had more than a few adverse side effects. In Japan, the government is blaming a recent increase in suicide rates on the difficulties caused by isolation.
Japan, which has done an excellent job of keeping COVID death rates low, saw an increase in the number of suicides among women and students during the last year. Despite the continued fall in the suicide rate for men, Japan still has the highest suicide rate among any G7 nation.
In hopes of attacking the problem at its perceived source, the Japanese government has taken the bold step of appointing a cabinet member dedicated to the loneliness crisis.
The Ministry of Loneliness
Tetsushi Sakamoto, already in the government as the minister in charge of raising Japan's low birthrate and revitalizing regional economies, was appointed this month to the additional role. He has already announced plans for an emergency national forum to discuss the issue and share the testimony of lonely individuals.
Given the complexity of the problem, the minister will primarily oversee the coordination of efforts between different ministries that hope to address the issue alongside a task force. He steps into his role not a moment too soon. The loneliness epidemic in Japan is uniquely well known around the world.
Hikikomori, often translated as "acute social withdrawal," is the phenomenon of people completely withdrawing from society for months or years at a time and living as modern-day hermits. While cases exist in many countries, the problem is better known and more prevalent in Japan. Estimates vary, but some suggest that one million Japanese live like this and that 1.5 million more are at risk of developing the condition. Individuals practicing this hermitage often express contentment with their isolation at first before encountering severe symptoms of loneliness and distress.
Kodokushi, the phenomenon of the elderly dying alone and remaining undiscovered for some time due to their isolation, is also a widespread issue in Japan that has attracted national attention for decades.
These are just the most shocking elements of the loneliness crisis. As we've discussed before, loneliness can cause health issues akin to smoking. A lack of interaction within a community can cause social problems. It is even associated with changes in the brain. While there is nothing wrong with wanting a little time to yourself, the inability to get the socialization that many people need is a real problem with real consequences.
The virus that broke the camel's back
A global loneliness pandemic existed before COVID-19, and the two working in tandem has been catastrophic.
Japanese society has always placed a value on solitude, often associating it with self-reliance, which makes dealing with the problem of excessive solitude more difficult. Before the pandemic, 16.1 percent of Japanese seniors reported having nobody to turn to in a time of need, the highest rate of any nation considered. Seventeen percent of Japanese men surveyed in 2005 said that they "rarely or never spend time with friends, colleagues, or others in social groups." This was three times the average rate of other countries.
American individualism also creates a fertile environment for isolation to grow. About a month before the pandemic started, nearly 3 in 5 Americans reported being lonely in a report issued by Cigna. This is a slight increase over previous studies, which had been pointing in the same direction for years.
In the United Kingdom, the problem prompted the creation of the Jo Cox Commission on Loneliness. The commission's final report paints a stark picture of the U.K.'s situation in 2017, with millions of people from all parts of British society reporting feeling regular loneliness at a tremendous cost to personal health, society, and the economy.
The report called for a lead minister to address the problem at the national level, incorporating government action with the insights provided by volunteer organizations, businesses, the NHS, and other organizations on the crisis's front lines. Her Majesty's Government acted on the report and appointed the first Minister for Loneliness in 2018, Tracey Crouch, and dedicated millions of pounds to battling the problem.
The distancing procedures necessitated by the COVID-19 epidemic saved many lives but exacerbated an existing problem of loneliness in many parts of the world. While the issue had received attention before, Japan's steps to address the situation suggest that people are now willing to treat it with the seriousness it deserves.
If you or a loved one are having suicidal thoughts, help is available. The suicide prevention hotline can be reached at 1-800-273-8255.
As a new industry emerges, therapists need to be educated.
- Psychedelic therapy is predicted to become a $7 billion industry by 2027.
- Emerging research on psilocybin, MDMA, ibogaine, and LSD is showing a lot of promise in treating a variety of conditions.
- Therapists will not be able to write a script and send patients on their way, which will create a new training model.
Psychedelic therapy is imminent. Within six years, the market for this new wave of therapeutics is predicted to reach nearly $7 billion. With advocates and investors like Tim Ferriss leading the way, protocols for implementing psilocybin, MDMA, LSD, and ibogaine into treatments for depression, PTSD, addiction recovery, and existential distress are being crafted right now.
How will psychiatrists adapt to these new substances?
This is no easy question. Unlike antidepressants currently on the market, you cannot visit a psychiatrist or general practitioner and receive a script within 10 minutes—a longstanding issue in modern psychiatry, especially given that antidepressants don't work better than talk therapy (or as this meta-analysis shows, work better in conjunction with psychotherapy) and carry with them many physical risks. One of the most prominent side effects is weight gain, which has the potential to lead to a whole series of further physical and mental health problems.
Psychedelics are also not without risks. Early results from esketamine—this ketamine variant is not actually a psychedelic but has been generally lumped into the same category and provides a cautionary tale—have not been overly encouraging:
"Through an analysis of adverse events reported to the FDA, the authors found several adverse events related to the use of esketamine nasal spray, such as dissociation, sedation, feeling drunk, completed suicide, and especially suicidal and self-injurious ideation."
This isn't to write off the protocol, which has shown efficacy in trials (though not without issues either). Anecdotal reports have been positive for some depression sufferers. More importantly, the emerging ketamine clinics across North America feature robust protocols that run counter to many current antidepressant-driven psychiatric evaluations. We should continue to explore this line of therapeutics, just more carefully.
The future of psychedelic-assisted psychotherapy | Rick Doblin
The Multidisciplinary Association for Psychedelic Studies (MAPS) foresaw the possibility of psychedelic therapy decades ago. The organization's founder, Rick Doblin, argued against the scheduling of MDMA in the mid-80s. The group's training protocols for MDMA, ayahuasca, ibogaine, and LSD are holistic and include screening sessions, pre-treatment meetings, day-long sessions, and post-treatment integration.
You cannot ingest psychedelics and go about your day. Unlike SSRIs and SNRIs, they don't take weeks for you to feel the effects. This is an entirely different model than current psychiatry protocols. If psychedelic therapy is going to be integrated into psychiatry, mental health professionals need training. They'll have to adapt. Cutting corners will be impossible.
Besides overcoming the hurdle of federal regulations (which is quickly happening), psychedelics should be subject to Risk Evaluation and Mitigation Strategies (REMS), writes Paul Tulls in Nature. This means these novel therapies will be administered according to current FDA guidelines.
"The effect would be to bundle the delivery of the drug with the therapy component, and potentially certify practitioners. A source working on one of the trials says that discussions are under way with the FDA over whether therapists who administer the drugs ought to be trained, what that training might involve and whether therapist certification should be required."
Credit: Microgen / Adobe Stock
This will not be without its challenges. As Tullis writes, some therapists have been skirting federal law by offering psychedelic therapy for 30 years, reminiscent of LSD sessions in the 1950s and MDMA therapy in the 1970s. In fact, LSD was subjected to over 1,000 studies before being criminalized, though it's admittedly hard to offer a placebo. (Niacin has worked in some trials.) The comprehensive protocols being developed now have early pioneers to thank.
Psychedelics are also entering an industry with standard practices. Some therapists are likely to remain skeptical; others might not train properly before administering the drugs, which could create problems for the entire industry should some patients experience adverse effects. Psychotherapy will always be necessary before and after administration. In an industry where many are accustomed to writing scripts, not providing in-depth existential explorations with their patients—and many patients are accustomed to quick visits that result in refills—a giant learning curve is necessary.
While many are hopeful that psychedelic therapy will have broad appeal, the more likely result is a slow integration with specialized clinics (such as with ketamine today). There will undoubtedly be players with no history of psychedelics involved only for economic gain; we're already seeing it with tens of millions of dollars pouring into companies. The competing forces of revenue maximization and psychedelic ritual are likely to create friction.
Regardless, this emerging industry requires funding to get off the ground. We just need to temper expectations with the real-world consequences of the psychedelic model—a hard sell in a world accustomed to quick returns. And we'll need therapists willing to explore uncharted territory on its own terrain, not the ground they're accustomed to walking on.
Stay in touch with Derek on Twitter and Facebook. His most recent book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."
Textual analysis of social media posts finds users' anxiety and suicide-risk levels are rising, among other negative trends.
A team of MIT and Harvard University researchers has shown that they can measure those effects by analyzing the language that people use to express their anxiety online.
Using machine learning to analyze the text of more than 800,000 Reddit posts, the researchers were able to identify changes in the tone and content of language that people used as the first wave of the Covid-19 pandemic progressed, from January to April of 2020. Their analysis revealed several key changes in conversations about mental health, including an overall increase in discussion about anxiety and suicide.
"We found that there were these natural clusters that emerged related to suicidality and loneliness, and the amount of posts in these clusters more than doubled during the pandemic as compared to the same months of the preceding year, which is a grave concern," says Daniel Low, a graduate student in the Program in Speech and Hearing Bioscience and Technology at Harvard and MIT and the lead author of the study.
The analysis also revealed varying impacts on people who already suffer from different types of mental illness. The findings could help psychiatrists, or potentially moderators of the Reddit forums that were studied, to better identify and help people whose mental health is suffering, the researchers say.
"When the mental health needs of so many in our society are inadequately met, even at baseline, we wanted to bring attention to the ways that many people are suffering during this time, in order to amplify and inform the allocation of resources to support them," says Laurie Rumker, a graduate student in the Bioinformatics and Integrative Genomics PhD Program at Harvard and one of the authors of the study.
Satrajit Ghosh, a principal research scientist at MIT's McGovern Institute for Brain Research, is the senior author of the study, which appears in the Journal of Medical Internet Research. Other authors of the paper include Tanya Talkar, a graduate student in the Program in Speech and Hearing Bioscience and Technology at Harvard and MIT; John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center; and Guillermo Cecchi, a principal research staff member at the IBM Thomas J. Watson Research Center.
A wave of anxiety
The new study grew out of the MIT class 6.897/HST.956 (Machine Learning for Healthcare), in MIT's Department of Electrical Engineering and Computer Science. Low, Rumker, and Talkar, who were all taking the course last spring, had done some previous research on using machine learning to detect mental health disorders based on how people speak and what they say. After the Covid-19 pandemic began, they decided to focus their class project on analyzing Reddit forums devoted to different types of mental illness.
"When Covid hit, we were all curious whether it was affecting certain communities more than others," Low says. "Reddit gives us the opportunity to look at all these subreddits that are specialized support groups. It's a really unique opportunity to see how these different communities were affected differently as the wave was happening, in real-time."
The researchers analyzed posts from 15 subreddit groups devoted to a variety of mental illnesses, including schizophrenia, depression, and bipolar disorder. They also included a handful of groups devoted to topics not specifically related to mental health, such as personal finance, fitness, and parenting.
Using several types of natural language processing algorithms, the researchers measured the frequency of words associated with topics such as anxiety, death, isolation, and substance abuse, and grouped posts together based on similarities in the language used. These approaches allowed the researchers to identify similarities between each group's posts after the onset of the pandemic, as well as distinctive differences between groups.
The researchers found that while people in most of the support groups began posting about Covid-19 in March, the group devoted to health anxiety started much earlier, in January. However, as the pandemic progressed, the other mental health groups began to closely resemble the health anxiety group, in terms of the language that was most often used. At the same time, the group devoted to personal finance showed the most negative semantic change from January to April 2020, and significantly increased the use of words related to economic stress and negative sentiment.
They also discovered that the mental health groups affected the most negatively early in the pandemic were those related to ADHD and eating disorders. The researchers hypothesize that without their usual social support systems in place, due to lockdowns, people suffering from those disorders found it much more difficult to manage their conditions. In those groups, the researchers found posts about hyperfocusing on the news and relapsing back into anorexia-type behaviors since meals were not being monitored by others due to quarantine.
Using another algorithm, the researchers grouped posts into clusters such as loneliness or substance use, and then tracked how those groups changed as the pandemic progressed. Posts related to suicide more than doubled from pre-pandemic levels, and the groups that became significantly associated with the suicidality cluster during the pandemic were the support groups for borderline personality disorder and post-traumatic stress disorder.
The researchers also found the introduction of new topics specifically seeking mental health help or social interaction. "The topics within these subreddit support groups were shifting a bit, as people were trying to adapt to a new life and focus on how they can go about getting more help if needed," Talkar says.
While the authors emphasize that they cannot implicate the pandemic as the sole cause of the observed linguistic changes, they note that there was much more significant change during the period from January to April in 2020 than in the same months in 2019 and 2018, indicating the changes cannot be explained by normal annual trends.
Mental health resources
This type of analysis could help mental health care providers identify segments of the population that are most vulnerable to declines in mental health caused by not only the Covid-19 pandemic but other mental health stressors such as controversial elections or natural disasters, the researchers say.
Additionally, if applied to Reddit or other social media posts in real-time, this analysis could be used to offer users additional resources, such as guidance to a different support group, information on how to find mental health treatment, or the number for a suicide hotline.
"Reddit is a very valuable source of support for a lot of people who are suffering from mental health challenges, many of whom may not have formal access to other kinds of mental health support, so there are implications of this work for ways that support within Reddit could be provided," Rumker says.
The researchers now plan to apply this approach to study whether posts on Reddit and other social media sites can be used to detect mental health disorders. One current project involves screening posts in a social media site for veterans for suicide risk and post-traumatic stress disorder.
The research was funded by the National Institutes of Health and the McGovern Institute.
A new study pushes back on psychiatry industry talking points.
- Australian researchers note a link between rising antidepressant usage and rising suicide rates in youth.
- Their research pushes back on psychiatry talking points that SSRIs decrease suicide risk.
- The top method for self-harm and suicide in younger age groups is overdosing antidepressants.
In 1947, Dr. Howard Rusk published an article in the NY Times. The doctor is advocating for better public education on issues of mental health. Considered to be the founder of rehabilitation medicine, Rusk was trying to destigmatize mental disorders in the same manner as physical disorders.
Psychiatrists were facing an upward battle. "Madness" was considered an aberration, not a treatable ailment, in a health care system that was increasingly relying on pharmacology. Thanks to a new class of tranquilizers showing promising results, Rusk drew a parallel between diseases of the brain and diseases of the body.
"We must realize that mental problems are just as real as physical disease," he wrote, "and that anxiety and depression require active therapy as much as appendicitis and pneumonia."
As a rehabilitation specialist, Rusk knew the importance of physical movement for trauma recovery. He was likely aware of the connection between physical and mental health. Unfortunately, his good intentions were usurped by the psychiatry industry. Desiring status equivalent to medical doctors, psychiatrists understood that having a "painkiller" in their arsenal would cause the public to treat their profession with the same regard.
The process took another four decades to unfold. By the time Prozac was released on the American market in 1987, the chemical imbalance theory of anxiety and depression had become the going narrative in the psychiatry industry. Once a narrative grips the public's imagination, it's difficult to overturn. Psychiatrists finally achieved a similar status as medical doctors thanks to the parallel Rusk drew forty years before.
A safety narrative has long been attached to the chemical imbalance story: antidepressants are a safe intervention in the treatment of anxiety and depression. As three Australian researchers—Martin Whitely at John Curtin Institute of Public Policy in Perth and Melissa Raven and Jon Jureidini at the University of Adelaide's Critical and Ethical Mental Health Research Group—write in a new study, that story is suspect.
Published in Frontiers in Psychiatry, these researchers push back on the narrative that antidepressants decrease the risk of suicide. Since the FDA first issued a black box warning citing an increased risk of suicidal thoughts and behaviors in adults under age 18, psychiatrists and public officials have contested any link between antidepressants and self-harm.
Antidepressants Can Cause Suicide and Homicide — Peter Gotzsche, M.D.
Australia, which ranks second in the world in per-capita consumers of antidepressants among OECD countries, has never been provided the same safeguards as America—and the efficacy of America's safety measures are questionable at best. The FDA first issued that block box warning in 2004, updating it to reflect adults under age 25 three years later. In 2005, the Australian Therapeutic Goods Administration (TGA) required leaflets be included in antidepressant packages to reflect the risk of suicidal ideation.
The researchers write that the data put forward by psychiatrists and mental health organizations was misleading. Much like the industry ran with Rusk's assertion, many professionals cite a 2007 ecological study by Robert D. Gibbons that incorrectly associates SSRI usage with a decreased risk of suicide among U.S. youth. This misreading is the basis of the narrative of minimized harm.
The data tells another story. The researchers point out that between 2008-2018, prescriptions for antidepressant (predominantly SSRIs) increased by 66 percent in the 0-27 year age group, while suicide rates increased by 49 percent in a similar age group (0-24 years). Between the years of 2006-2016, there was a 98 percent increase in intentional poisonings in New South Wales and Victoria. An overlap emerges: the most common method of attempted self-harm and suicide is prescription antidepressants.
"There is clear evidence that more young Australians are taking antidepressants, and more young Australians are killing themselves and self-harming, often by intentionally overdosing on the very substances that are supposed to help them."
The researchers note that the FDA has long been criticized for not offering more non-pharmacological treatments. The cost of psychotherapy is prohibitive for many in the U.S. health care system. The reflex action of the medical establishment is to write a script. When one pill doesn't work or loses efficacy, it's usually replaced by another pill or added to an ever-growing pharmacological cocktail. Some people take four to six (or more) drugs to manage mental distress, each one countering the side effects of the other.
Photo: Ryan McGuire / Pixabay
As in America, Australia suffers from corporate lobbying. The team writes that many opinion leaders receive funding from pharmaceutical companies; it makes sense that these figures will tout the benefits of antidepressants while downplaying potential harm. They also note that governing bodies are likely relying on outdated evidence of risk, which translates into a lack of consumer awareness.
They also write that general practitioners account for 90.4 percent of antidepressant prescriptions in Australia. Since mental health is not their area of expertise, they often repeat what psychiatrists initially prescribed.
Correlation is not causation, a limitation the researchers acknowledge. They list another cocktail, this one labelled "drivers of mental health distress." Smartphone addiction, online bullying, lack of meaningful relationships, climate change, and debt top the list. Antidepressants are not the cause of mental distress. What we need to know is whether they help alleviate it or add to the burden.
This forces us to confront a longstanding question: Why are we treating the symptoms of mental health problems with pills while never addressing their actual cause? Put another way, why does the psychiatry industry rely on pills with a long list of side effects instead of addressing the environmental and social issues that are at the foundation of mental distress? And why are we putting increasingly higher numbers of teenagers on drugs that negatively impact their brains while their prefrontal cortex is still in development? This seems to set them up for a lifetime of dependence, which is a great profit model but a terrible health care solution.
The psychiatry industry faced an existential crisis in the nineteen-seventies when the public grew weary of their growing reliance on drugs. The industry's response was to double down on pharmacology. Thanks for a massive PR campaign around Prozac, that move worked. You cannot both have increasing numbers of prescriptions and increasing mental health problems and pretend that this intervention is working.
While more work needs to be done, the researchers are confident in their assertion between increased self-harm with antidepressant usage.
"These results are consistent with the hypothesis that antidepressants increase the risk of suicidality and self-harm in young people. Furthermore, they provide compelling evidence that the antidepressants prescribed to children and adolescents are frequently the means of self-harm."
These children deserve more from us at a pivotal time in their development. The psychiatry industry needs to come through this existential crisis with better solutions.
As little as an extra dollar could mean a significant decrease in suicide rates.
- A new study found that a dollar increase in minimum wage correlated to nearly a six percent reduction in suicide rates among adults aged 18 to 64 with a high school degree or less education.
- Increasing the minimum wage was found to be most effective in the reduction of suicides when unemployment levels were the highest.
- According to the researchers' predictions, raising the minimum wage by just one dollar during the 2008 economic collapse could have prevented over 13,000 suicides.
Over the last few years, suicide rates have been on an alarming rise in the United States. An analysis by the Center for Disease Control found that American suicide rates have gone up by 33 percent since 1999, the highest rate recorded in the country since 1942.
Mental health is a complex topic, and suicide cause and prevention can't be chalked up to any one thing or solution. But, according to a recent study, one answer to preventing at least some of these suicides might be a simple little public policy adjustment: Raising the minimum wage.
The link between financial stress and suicide
Topical Press Agency / Stringer
There are, of course, a multitude of variables that can foster the extreme anxiety and depression that might lead a person to consider ending his or her life. A number of studies in the past indicated that financial stressors — such as mounting debt, the loss of a job, or unemployment — are a big contributor when it comes to the factors that play the most significant roles in suicide. The likelihood of suicide increases among financially distressed people as things like debt become harder to manage.
Because suicide and depression more often affect people who have lower incomes and levels of education, it means that this demographic is also likely to be working at or close to the minimum wage. It seems obvious that researchers would be interested in looking at the correlations between suicide and minimum wage.
New research on suicide and minimum wage
Recently, a team of researchers from Emory University took an in-depth look at the relationship between minimum wage laws and suicide rates. They found that the two do correlate, but only during times of high unemployment and among those with a high school level education, or less.
When it comes to minimum wage, state and federal governments both set standards. The federal government sets a bottom "safety net" for minimum wage. State governments can't dip below that, but they can exceed it. The minimum wage rules of individual states are easy to track and, conveniently, a few states changed their minimum wage during the time period of the study providing a usefully before-and-after comparison for the researchers. Collecting the rest of the data was relatively simple. States provide their unemployment rates, share of GDP, and various other forms of public assistance. Additionally, the National Vital Statistics System provided researchers with a trove of death information, including the cause of death as well the individual's educational background.
Researchers used a "differences in differences" analysis to determine how minimum wage laws were linked to suicide rates. This is a statistical technique used to measure data from two groups, a "treatment" group and a "control" group, at at least two different time periods. One time period being before the "treatment" (in this case, higher minimum wage) and the other being after. In this study, the researchers used individuals with a college-level education as the control group as they are statistically less likely to work a minimum wage job or commit suicide. So, that group's response to changes in the minimum wage laws was compared to that of individuals with a maximum of a high school education. This data was then tracked monthly.
Findings: Higher minimum wage meant lower suicide rates
Photo Credit: Wikimedia
The effect of a one U.S. dollar increase in the minimum wage ranged from a 3.4 percent decrease to a 5.9 percent decrease in the suicide rate among adults aged 18 to 64 with a high school degree or less education. The researchers estimated a six percent reduction in suicide for every dollar increase in minimum wage among that population.
Researchers also observed that increasing the minimum wage was most effective in the reduction of suicides when unemployment levels were the highest. Specifically, a higher minimum wage had maximum impact on reducing suicide when the unemployment rate was over seven percent and minimum wages were at least $1.75 over the national minimum. According to the researcher's predictions, during the 2008 economic collapse raising the minimum wage by just one dollar could have prevented over 13,000 suicides!
Of course, poverty is not the root cause of all suicides, and mental health issues go deeper than one single economic factor. But the study underlines how reducing economic burdens during times when financial stresses are higher can reduce some of the anxiety and depression that leads to suicide risk. Ultimately, this study shows that beyond being good economic policy, raising the minimum wage can save lives by improving the quality of life for America's working class.
Now the question is, will legislators do it?