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Wednesday 19 March 2014

Fred Phelps, the Inadvertent Ally

This week saw the announcement that Fred Phelps lies near death in a care facility in Topeka, Kansas. (Update - shortly after this was posted, his death was announced.) Phelps is the former pastor of the Westboro Baptist Church in Topeka.

He may also be the one man more responsible than any other person or organization for the widespread embrace of LGBT rights and same-sex marriage in North America.

In case you’ve been living under a rock, this church has the distinction of getting probably more press coverage per parishioner than any other religious institution on Earth. Despite having fewer than 50 adherents, most of them members of Phelps’ own extended family, they manage to be almost continuously in the public eye thanks to their practice of picketing using eye-catching signs saying things like “God Hates Fags,” “God Hates America,” and “Thank God for Dead Soldiers.”

They have picketed concerts, family planning clinics, and, most odiously, funerals. They were present at the funeral of Matthew Shepard, the young gay man beaten and hung to die on a fence near Laramie Wyoming in 1998. More recently, the organization (to call it a “church” risks slandering the religious) took to picketing the funerals of soldiers returning from overseas wars, using the reasoning that God so disapproves of American liberalism (especially its acceptance of gay and lesbian citizens) that he desires and celebrates the deaths of its servicemen and women.

Phelps and his family became notorious both for their extreme views and for the heartlessness of their actions. Apparently never physically violent, they have practiced a form of psychological violence upon their targets through actions from which the general population shrinks in revulsion.

And there, in that revulsion, is the group’s influence. If the church ever actually convinced anyone that they were in the right, it was surely a rare case. Even among the extreme religious, the actions of Phelps and associates are reviled. Far more people are repulsed by their actions than attracted to them.

Social movements benefit from public figures in two main ways. First, and most obviously, having an admired public figure (Desmond Tutu, Nelson Mandela, even Tina Fey) on your side causes others to consider joining in. If I like Stephen Lewis, and Stephen Lewis likes Cause X, then maybe I should view Cause X in a positive light.

But there are also negative examples. If Adolph Hitler loves Rice Krispies, and I dislike Adolph Hitler, then I might question my love of Rice Krispies. If I can’t bear Fred Phelps, and Fred espouses certain views of social issues, then I might tend to rethink and move away from those views. Phelps is uncomfortable company to keep.

Which of these two influences is more powerful – the positive or negative role models?

We’d like to think that the admirable always wins out over the foolish, but it probably depends on the potency of the model. The potency of Westboro’s imagery and actions is powerful.  Imagine picketing someone’s child’s funeral and calling this a religious act. Even the Jerry Falwells, the Pat Robertsons, and the James Dobsons of the world didn’t and don’t do such things and one cannot imagine them endorsing such actions.

The actions (the means, if you like) of Phelps and Westboro are undeniably hateful, and no one could defend them no matter what the consequences might be.  Let’s take that as given.

But consider the ends. Not the purposes they've aimed at, but the actual ends: What did they really achieve? They provided such a potent image of homophobia that anyone espousing similar views had to confront those images. “Am I like that? Do I really believe the same things as these people? Is this the kind of hatred I stand for?” Social conservatives the world over saw a real-life depiction of hatred  and shied away from it. It became impossible not to think about the logical consequences of some of their attitudes.

As for people working to broaden support for gay rights and same-sex marriage, Fred Phelps was a godsend. He became the poster boy for homophobia, a hobgoblin to display to the world. Generally the pictures of his protests were accompanied by disclaimers. “Most people who disagree with gay rights aren’t like this; Phelps represents the far extreme only and his ‘church’ is miniscule.” But the pictures were powerful. I have used them myself at workshops (with the disclaimers), and there are always sharp intakes of breath when the images hit the screen.

Phelps and his followers became cartoon bogeymen for the culture, showing the consequences of a too-literal interpretation of Leviticus. Christians surely tired of having him held up as an example of their faith, which was always a bit of unfair slander. Like holding up Joseph McCarthy supporter Roy Cohn as a representative example of gay men, or Justin Bieber as representative of heterosexuals.

But oh, did they attract attention. People presenting plays or movies on gay issues would secretly hope the church would come and picket, bringing thousands of dollars of free publicity along with them.

A Massachusetts organization began the practice of holding Phelps-A-Thons, much like walkathons, in which people would pledge to donate a certain amount of money for every minute they picketed.  Thousands of dollars were raised for charities and social action groups.

Here’s a video of the organizer, Chris Mason, chatting with Phelps’ daughter Shirley about the fundraisers. She pulls no punches, issuing such a constant stream of nonsense that it's hard to imagine how anyone could ever satirize the family - the video looks like a put-on as it is.

It’s a Wonderful Life

In the classic Frank Capra / James Stewart film, the protagonist gets a chance to rewind time and see what the world would have been like had he never been born. Surely most people who have seen the film have conducted this thought experiment for themselves. “What would have been different if I wasn’t in the world?”

So what if there were no Fred Phelps or Westboro Baptist Church? Would the world be as far along the path to inclusiveness?

It seems impossible to believe that their impact has been anything but beneficial for progressive and socially-inclusive causes.  They have been the gift that has kept on giving to anyone hoping to combat homophobia.

So who has been more influential than them? You always want to reward supporters and positive models, and it would be nice to say that the best influence comes from someone on your side. But who are the nominees?

  • One who comes to mind is Harvey Milk, activist and first openly-gay person elected to public office in California.
  • Or Judy Shepard, mother of Matthew, who founded the Matthew Shepard Foundation and has worked tirelessly ever since.
  • Barack Obama ended the foolish “Don’t Ask Don’t Tell” policies of the US military, but mostly followed public opinion rather than led.
  • In Canada, Pierre Trudeau spearheaded the decriminalization of same-sex behaviour in a bill that passed in early 1969, months before New York’s Stonewall Riots, often taken as the starting pistol for the gay rights movement in the USA.
  • How about Ellen Degeneres, who risked her career by coming out on her television show and went on to become a much-loved (and definitely non-threatening) daytime host?

Who was the most influential? We’ll never really know, because we have no Clarence the Angel and cannot try out universes without them. But can we really say that any of these positive models (or any others we might name), admirable though they might be, have had as powerful an effect on public opinion as the toxic example of Fred Phelps?

A colleague once mused that Westboro might be secretly funded by a devious millionaire hoping to prod society toward greater openness and acceptance – and that if this wasn’t the case, maybe it should have been. Perhaps Phelps was always a secret mole working for LGBT rights; a kind of poison pill for the religious right. But of course this would mean funding and promoting Westboro’s revolting means as well as the pro-social results, and Westboro’s means are too hurtful to countenance. Surely no group, left nor right, funneled money to this group. They did it all on their own.

So no. No one is going to sing Phelps’ praises, nor argue for a continuation of Westboro’s victimization of the bereaved. But perhaps we can acknowledge – or consider – a painful possibility. Fred Phelps may have done more for the LGBT community and for marriage equality than anyone in history.

With enemies like him, the future got more friends.

UPDATE; The nature of hatred is that it sparks hatred in return, potentially poisoning the people it targets and turning them into mirror images of the person who began the cycle. Phelps was such a source of hostility toward the LGBT community that mention of Westboro would spark vengeful rage in many.

When he died, many wondered if people he had targeted would mock his death the way he had mocked the deaths of others: "Rot in hell, Fred" or "God hates Phelps." Or would people escape the trap?

Sure enough, signs and protesters appeared. Here's a sample:

Tuesday 11 March 2014

Sound the Alarm (again)! Energy Drinks and Teen Depression?

The latest demon drink.

A few weeks ago I wrote a post on a recent news meme concerning biological markers for teen depression, found here. This week the alarm bells are ringing again, linking teen consumption of caffeinated energy drinks with depression, sensation-seeking behavior, and substance use.

The source is an article recently published in Preventive Medicine by Azagba, Langille, & Asbridge (reference below).

My concern here is not the nature of the study itself, which included appropriate cautions about the interpretability of the data. It is about the way that studies are seized upon by media for maximum effect, obscuring and in some cases contradicting the actual content of the science on which they are supposedly reporting.

The Research

The study is an analysis of data from the 2012 Student Drug Use Survey, and examines associations with energy drink use among 8210 Atlantic Canada high school students.

Sure enough, the authors found a relationship between the consumption of energy drinks, positive replies to questions suggesting a sensation-seeking personality, self-reported symptoms of depression, and the use of other substances. The survey was a one-time measurement, so no data were available on factors predicting the subsequent emergence of other factors.

This is a classic correlational study that sharply limits the ability to make causal inferences. Given two variables, A and B, that seem to correlate, A might cause B, B might cause A, or some other variable C might cause both A and B.

“Correlation is not causation” are perhaps the most frequently-uttered four words in all of introductory statistics classes. But frequently-uttered is not, it seems, frequently-remembered. You could make a parlour game in which participants race to find violations of this principle in any given issue of your average newspaper.

The Coverage

At first, it might have seemed that we were going to get some sober reporting out of this study:

  • “Study finds energy drink consumption linked to depression, substance abuse in teens” says Global News.
  • “Report links teenage energy drinks with substance abuse” announces eCanada Now.
  • “Teen energy drink consumption linked to depression and substance abuse” reports the Hamilton Spectator.

Okay, there’s some fairly hefty implying being done in all of these headlines, but look carefully and we see the word “link” over and over, indicating a relationship but one without a directional arrow. But let’s not stop there.

  • “Could energy drinks increase the risk of depression in teens?” asks Science World Report futilely – a question to which the answer would have to be “God knows, but this study sure can’t tell us.”
  • “NS (Nova Scotia) teens on alert after energy drink study finds links to depression, substance abuse” hyperventilates Global BC, neglecting to display photographs of the apparently alarmed teens.

And my favorite:

  • “Beware – energy drinks can lead to heart problems in teens” screams the Health Site at – an article that actually does focus on the Canadian study, which has nothing, really nothing, to do with heart problems.

Look inside even the more soberly-headlined stories and all awareness of the correlation problem seems to vanish out the window. Suddenly the consumption of energy drinks causes depression, substance abuse, and depression. Most articles raise the issue of limiting access to these drinks for teens, and about half of most articles is devoted to public policy implications.

In the Global BC story, for example, we read this: "Doctors (in) Nova Scotia say the study is more proof something needs to be done to protect teens against energy drinks. Kevin Chapman, the organization’s director of health policy, wants legislation to restrict the sale of energy drinks to people younger than 19."

Umm. Really?

The Reality

Unfortunately, there are no public policy implications from this study, as it says nothing whatsoever about causality.

Let's try a little thought experiment. Imagine a game in which four contestants are each handed one of the four linked variables (depression symptoms, sensation seeking, substance use, and energy drink use) and each has to come up with a narrative in which their variable causes the others.

All four have a good chance at the trophy – and the one who gets “energy drink consumption” is probably in the worst position. Let’s look at the possibilities for the other three just with regard to energy drink consumption:

Depression as root cause. Depressive states tend to bring on sleep troubles, which tend to result in daytime sleepiness. Energy drinks and other caffeinated beverages are advertised and sold as antidotes to sleepiness, so depressed teens looking for greater cognitive sharpness and alertness are likely to seek them out. It would be a surprise to learn that depressed teens didn't try energy drinks more than others.

Sensation seeking as root cause. Sensation seekers tend to be easily bored, and high school is easily boring. The result is often an inability to focus, which can be countered temporarily by caffeine. As well, the drinks, being psychologically active, produce a sensation. Unsurprisingly, sensation seekers will seek that sensation more than non-sensation-seekers. Oh, and in case we see a link between sensation seeking and attention deficit disorder, how do we help kids with ADD focus? Stimulants. And what is caffeine again? Right.

Substance use as root cause. Substance users tend to a) stay up late, which results in daytime sleepiness, and b) use alcohol, which produces sleepiness in the acute phase and sleep disruption afterward. And how do people in this society combat sleepiness? Often, with caffeine. As well, teens tend to prefer sickly-sweet alcoholic libations, and few substances are as sickly sweet as energy drinks.

Notice, please, that I’m not saying that using energy drinks is a good idea. For one thing, they’re loaded with sugar. A can of Red Bull has 110 calories, a can of Monster Energy 100 calories – almost as much as soda pop. Coincidentally, the World Health Organization has just slashed their recommendations for daily dietary sugar to less than the amount in a single can of Coke - a move that seems consistent with the evidence.

I’m simply saying that there are alternative explanations for the association between the use of energy drinks and these other variables that have nothing to do with energy drinks causing depression, substance abuse, or sensation seeking.

Two other observations stand out...

First, energy drinks are hardly the only source of caffeine out there. Red Bull contains about 80 mg of caffeine per can, and Monster Energy has 140-160 mg. Both are less than the caffeine content of a 10 oz. (Starbucks tall) cup of coffee. Red Bull’s total is about equivalent to a largish cup of black tea. But we don’t hear panicked reports of high school students mainlining tea out behind the gym. And none of the reports suggest that high school students should be barred from purchasing tea and coffee, as well as energy drinks. (Though given a forced choice, I’d give them a cup of tea rather than a Red Bull, given the sugar content of the latter.)

Second, no one comments on the actual consumption figures found in the study. The authors report that 62% of students reported consuming at least one energy drink in the past year, and (just) 20% reported use once or more per month.  Fully 80% of students, then, denied any consistent use of energy drinks, and 38% had virtually no consumption of them at all. If we could get figures for soda pop down this low we’d be dancing in the streets.

We’re used to the “Have you in the past month used…” question from other drug studies, but let’s face it: There’s a difference between using heroin once in the past month and saying the same of an energy drink. If a teen came into my clinic and said “Well, I have tried energy drinks, but I only consume about one a month” I’d wave it off. If that’s the worst story this kid has to tell, he’s doing pretty well, about like the one who guiltily confesses a seasonal trip to Starbucks.

So should we be banning the purchase of energy drinks by minors? 

Well, why? If we’re worried about the caffeine, then let’s ban the tea that parents happily serve their kids. If we’re worried about the sugar, then let’s ban soft drinks. (Actually, I could get behind that one, believing as I do that routinely serving soft drinks to kids is a form of child abuse.) If it’s some other component of energy drinks that concerns us, then let’s have some research verifying (or at least suggesting) damaging effects.

If we’re worried that somehow energy drinks lead to depression, then let’s do some research bearing out that link. Maybe an experimental study is difficult to imagine (“Here, you kids drink water and you other kids drink Red Bull for a year…”), but a naturalistic study of usage and mood over time is not beyond us.

Do we, perhaps, imagine that energy drinks change kids’ personalities and turn them into sensation-seekers? It’s hard to see how this would work – at least not any more than any other part of our ephemera-obsessed culture.

Or are we worried that energy drinks lead to the abuse of other substances? Great, we’re back on the “slippery slope” argument that worked so well for marijuana. Maybe we should be on the lookout for “gateway drugs” that lead to energy drinks, which in turn lead, one supposes, to crack. Oolong, perhaps? Earl Grey? Or, more likely, Coca Cola?

Maybe before we start issuing or even suggesting public policy, we should conduct the research to determine whether our ideas are fully or only half-baked. Science can be a helpful guide to policy, but only if used wisely. Treating findings as Rorschach cards from which to free-associate is only likely to lead us in unhelpful directions.

Read it Yourself

Azagba, S, Langille, D, & Asbridge, M (2014). An emerging adolescent health risk: Caffeinated energy drink consumption patterns among high school students. Preventive Medicine, 62, 54-59.

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We also have courses entitled UnDoing Depression, What Is Depression, Diagnosing Depression, Cognitive Behavioral Group Treatment of Depression, How to Buy Happiness, and Breathing Made Easy. For the full list with previews and substantial discounts, visit us at the Courses page of the Changeways Clinic website.

Tuesday 4 March 2014

Travel, Training, and Learning to Know Less

Where I sat in the heat and wrote this post.
Part of my work involves training young clinicians in various aspects of therapy and mental health service. Sometimes they ask about particularly valuable elements of training that I would recommend. By this they usually mean psychological texts, or practicum settings, or skill-building workshops.

There's merit to all of these. But just as important, I think, are experiences that are not designed with the mental health clinician in mind - things that do not appear on any curriculum and are not taught in psychotherapy classes. Things like having relationships, going through your own losses, reading insightful fiction, confronting your fears and limitations, and learning about your own biases.

One of the best tools for any clinician, and indeed any person wanting to understand more about their own life, their own culture, and their place in the world, is travel. By this I do not mean flying to a tennis-fenced compound around a pool with a swim-up bar and overdosing on margaritas for a week. I mean travel. A process of eroding the protective and comfortable boundaries we have grown up with and seeing other cultures and people from as close to inside as you can get (which is typically not very close, but close enough to challenge long-held assumptions).

The odd time I've said this to someone, I typically get a vague smile and knowing nod, because partly I'm just repeating a cultural cliche. Travel is broadening. But beneath that pat truism I think there's a more complicated way of thinking.

Imagine that you fly from your home planet down to Earth and are presented with what the inhabitants call a "chair". It's red, made of plastic, and has four concave legs. From this you develop an understanding of the concept of "chair."

Later in your journey you see something black that is made of tubular steel and leather, and that has runners rather than legs. Is this too a chair, or is it a distinct class of object with a different name? What makes something a chair? What are the core elements of chair-ness, and which elements are optional, irrelevant, or incidental? You can get a lecture on the subject, but it will remain vague until you actually experience various examples of "chair" - as well as similar non-chair objects such as "coffee table," "couch," and "ottoman".

We all grow up in the presence of adults. For many of us, there is a single example of the entity "woman" around, and often a single example of the object called "man". From this we learn what women and men are like, and this creates a powerful impression on us. So powerful that when we meet other examples of women, our perception of them is at first blurred by our assumptions created by the characteristics of that first woman. Imagine becoming a "men's therapist" having met only one man, and how little perspective, flexibility, or appreciation and allowance for differences you would have.

Now imagine being raised within an object that is more amorphous: a culture. Unlike chairs or women, we aren't even aware we are being presented with something. It is simply our reality. Girls wear skirts, school starts at eight-thirty, dinners are eaten at a table, salt is one of the two condiments left on that table, the purpose of life is to become an individual, and on and on. This isn't an object, or an assumption. It's the way things are. It's natural law, like gravity. So it seems.

Until, that is, you go far enough from home that you see people living in very different ways, with very different assumptions. And surviving. They violate the laws of your universe, and still function as human beings. They build their cities differently. They treat their relationship with their family differently. They eat differently. They have different perspectives on sexuality. The role of friendship is different. They even have toilets that are "built wrong."

As the pillars of truth you rely upon, the things that have been solid and immutable all your life, fall away, you get a queasy feeling of uncertainty and an impulse to retreat back into what you used to think of as reality. And if that queasy feeling, as though the floor beneath you has become transparent and hangs over a chasm, doesn't occur? That means you haven't gone far enough from home. Yet. The discomfort is the signal that you are working at the edge of your tolerance, pushing it back, farther, and a little farther.

The main outcome of travel is not that you learn more, it's that you are certain of less. A professor once told me that the function of an undergraduate degree is to teach you a lot of things, and the function of a graduate degree is to teach you that none of those things are really true. Travel is the graduate school of culture. It is exposure therapy designed to overcome our fear of cultural ambiguity.

The obvious point of all this is that in order to help people from various cultures it helps to have some appreciation of what their culture is like. So if you're going to see a lot of Cambodians, visit Cambodia. But a bigger point is that travel reveals and dismantles our own assumptions about our own culture, and erodes our sense that we know how things are supposed to be, or how they work best.

Having met diverse men, when we see that the next scheduled client is a man, we can sit back and clear our minds of some assumptions about men, opening our receptivity to what this particular man might be like. Having encountered hundreds of families, we can relinquish our Brady Bunch preconceptions of what families are like. And having visited various cultures, we can loosen our dogmatism about what works, how things should be, and the role of humans in the world.