A Q&A with Richard Layard and David Clark, authors of THRIVE

Thrive jacketHow can mental illness—an affliction that affects at least 20 percent of people in developed countries, reduces life expectancy, and wrecks havoc on educational potential—remain chronically under-treated? The answer is simple: mental and physical pain are not viewed equally, and even in a relatively progressive culture, the former remains profoundly stigmatized. As a result, most who suffer from mental health issues suffer in silence, or receive inadequate support. Can this change? Richard Layard and David Clark say it can.

In Thrive, Layard and Clark look at the practical politics of increasing access to mental health care, arguing that the therapies that exist—and work—are available at little to no cost. Recently, both took the time to answer some questions about the book, and the transformative power of mental health care.

What is the message of your book?

Depression and anxiety disorders are the biggest single cause of misery in Western societies. They also cause enormous damage to the economy. But they are curable, in most cases, by modern evidence-based psychological therapy. The shocking thing is that very few of those who need it get any help and fewer still get help based on evidence. In England such help is now becoming available to many of millions who need it. As we show, this help involves no net cost to society. It’s a no-brainer.

What is the scale of the problem?

Surveys of households in rich countries show that around 1 in 6 adults have depression or anxiety disorders severe enough to cause major distress and impair the person’s functioning. Only a quarter of these people are in any form of treatment, most usually medication. This is shocking. For surveys show that mental illness is the biggest single reason why people feel dissatisfied with their lives – accounting for more of the misery in our societies than either poverty or unemployment do.

What is its economic cost?

Mental illness accounts for nearly a half of all absenteeism from work and for nearly a half of all those who do not work because of disability. This imposes huge costs on employers and taxpayers. Mental illness also increases the use of physical healthcare. People with a given physical illness of a given severity use 50% more physical healthcare if they are also mentally ill. This is a huge cost to those who fund healthcare.

Does psychological therapy help?

In the last 40 years considerable progress has been made in developing effective psychological therapies. The most studied therapy is CBT – cognitive behavioural therapy, which is a broad heading for therapies which focus on directly influencing thoughts and behaviours – in order to affect the quality of human experience. In hundreds of randomised controlled trials CBT has been shown to produce recovery rates of over 50% for depression and anxiety disorders. For anxiety, recovery is generally sustained; for depression, the risk of relapse is greatly reduced.

The range of therapies which have been shown to work has been surveyed internationally by the Cochrane Collaboration and in England by the National Institute for Health and Care Excellence (NICE). Besides CBT, NICE also recommend for all depressions Interpersonal Therapy (IPT) and, for mild to moderate depression, Brief Psychodynamic Therapy, Couples Therapy and Counselling. Modern psychological therapies have also been shown to be effective in a wide range of other mental health conditions.

Do these therapies really cost nothing?

Yes. If delivered to a representative group of patients they pay for themselves twice over. First, they pay in reduced invalidity benefits and lost taxes due to invalidity. We know this from a series of controlled trials. Second, they pay for themselves in reduced costs of physical healthcare. Again we know this from controlled trials. It is so partly because the typical cost of an evidence-based course of treatment is only about $2,000.

How can these therapies become more widely available?

Two things are needed. First, there have to be enough people trained to deliver these therapies. This is the responsibility of universities and colleges, including of course supervised on-the-job training. Second, there have to be effective frameworks where trained people can be employed. The evidence is that recovery rates are higher where people are employed in teams where they can get supervision, in-service training, and clear career progression.

Those who fund healthcare have in the USA and UK the legal obligation to provide parity of esteem for mental and physical healthcare, and this requires that they are willing to fund high quality evidence-based therapies that are made easily available and provide the necessary duration of treatment, based on evidence. Insurers never fund half a hip replacement and they should not fund only half a proper course of psychological therapy.

What can be learnt from the English experience?

The English National Health Service has in recent years developed a totally new service to deliver evidence-based psychological therapies. (It’s called Improving Access to Psychological Therapies (IAPT)). This service has, over six years, trained altogether 6,000 therapists and is now treating nearly half a million people a year, with a recovery rate of 46% and rising. The prestigious journal Nature has called it “world-beating”.

How can we prevent mental illness in the first place?

First we must of course treat it as soon as it appears. This is often in childhood, where the same evidence-based treatments for depression and anxiety disorders apply as in adulthood. For children’s behaviour problems, parent training and family therapy are recommended.

But we must also reduce the overall prevalence of mental illness. This requires major changes throughout society. First, more support and education for parents. Second, schools which give more priority to the well-being of children. Third, employers who treat their workers with appreciation and encouragement and not as income-maximising machines. Fourth, more positively-oriented media. And finally, a new citizens’ culture giving more priority to compassion, both as an emotion and as a spring for action.

Richard Layard is one of the world’s leading labor economists and a member of the House of Lords.  David M. Clark is professor of psychology at the University of Oxford. Layard and Clark were the main drivers behind the UK’s Improving Access to Psychological Therapies program.

Read chapter one here.

Happy Birthday, Søren Kierkegaard

Lowrie jacket5-8 Kierkegaard_TheSeducersDiaryIntroversion has been having a moment of late, and today happens to be the birthday of one of the world’s most famous—and brilliant—introverts. To quote the (excellent) copy for A Short Life of Kierkegaard by Walter Lowrie, Kierkegaard was “a small, insignificant-looking intellectual with absurdly long legs, a veritable Hans Christian Andersen caricature of a man.” In life, he often hid behind pseudonyms, and yet, he remains one of the most important thinkers of modern times. Read about Kierkegaard’s turbulent life in this classic biography (literary duel? Check. Tragic love affair? Check.) or sample The Seducer’s Diary, which John Updike called, “An intricate curiosity—a feverishly intellectual attempt to reconstruct an erotic failure as a pedagogic success, a wound masked as a boast.”

Happy Birthday, Søren Kierkegaard.

Read Chapter 1 of The Seducer’s Diary here.

Read the Introduction to A Short Life of Kierkegaard here.

George Akerlof and Robert Shiller pose with their new book jacket

Nobel Prize winners Robert Shiller and George Akerlof got the chance to pose with the phenomenal cover for their forthcoming book, Phishing for Phools, the lead title on our Fall 2015 list (stay tuned for the posting of our new seasonal catalog!)  The drawing on the cover is an original by New Yorker cartoonist Edward Koren, and the jacket design is by our own Jason Alejandro. You can catch George talking about the book, which is a fascinating look at the central role of manipulation in economics, at this lecture at Duke University.

Akerloff and Shiller

 

Christopher Bail on anti-Muslim sentiment

In this clip from the documentary aftertheshooting.com, sociologist and author Christopher Bail discusses whether the sea change in American public opinion about Islam over the past few years may have contributed to the recent murder of three young Muslims in Chapel Hill, North Carolina. His recent book, Terrified, employs computer analytics techniques to show how anti-Muslim organizations have gained visibility in the public sphere. In this clip, Bail speaks with a close friend of one of the victims. You can watch the entire documentary here.

Last month, Bail spoke with Paul Rosenberg at Salon about his innovative new methodology for studying how fear is fostered in the broader cultural landscape. He was interviewed about the aftermath of the Chapel Hill shootings in the Guardian earlier this year.

Madness in Civilization

Madness in Civilization is a stunningly illustrated new cultural history of mental disturbance from antiquity to the present time.  Written by Andrew Scull, professor of sociology at University of California, San Diego and preeminent historian of psychiatry, the book’s mesmerizing subject matter ranges from exorcisms to Victorian asylums, from pharmacology to the introduction of psychiatry into popular culture. The Telegraph called it “ambitious and gruesome”, and the book has received wonderful write-ups in The Literary Review and The Financial Times. Scull has been blogging for Psychology Today as well, where he shares insights on his fascinating and frightening work. Check out chapter 1 here, and a slide show of some of the book’s most compelling images:

Types of Insanity
The Tranquilizer, 1811
Maniac in a strait-jacket, in a French asylum.
Battle Creek Sanitarium
Battle Creek Sanitarium
The first stage of General Faradization
The second stage of General Faradization
The third stage of General Faradization
Attitudes passionelles: extase (1878)
Advert for the psychiatric drug Thorazine
Depression Advertisement
Murder of Thomas Becket
Franz Joseph Gall examining the head of a pretty young girl
Hieronymus Bosch's The Cure of the Folly
Nebuchadnezzar as a wild animal
No Sex Please! (We're on antidepressants)

'Types of Insanity,' the frontispiece to John Charles Bucknill and Daniel Hack Tucke's A Manual of Psychological Medicine (1858), one of the first widely used textbooks on the diagnosis and treatment of insanity. Wellcome Library, London.

The Tranquilizer, 1811. Its inventor Benjamin Rush boasted that: "Its effects have been truly delightful to me." His patients' reactions are not recorded. Courtesy of the U.S. National Library of Medicine, Bethesda, Maryland

The French alienist J.-E.D. Equirol included many drawings of insane patients in the throes of their madness, such as this one, in his treatise Des Maladies mentales, published in 1938. Wellcome Library, London.

Photography at the Battle Creek Sanitarium, one of many therapies on offer there. 271

A postcard of the Battle Creek Sanitarium, for affluent and nervous patients. By 1933 it had been forced into receivership, a causality of the Great Depression. The Tichnor Brothers Collection, Boston Public Library.

Treatment with an electrical vibrator (1900); a nurse applies faradic current to a female patient. Wellcome Library, London.

Treatment with an electrical vibrator (1900); a nurse applies faradic current to a female patient. Wellcome Library, London.

Treatment with an electrical vibrator (1900); a nurse applies faradic current to a female patient. Wellcome Library, London.

The erotic overtones of Charcot’s pictures of his hysterical patients at the Salpêtrière are nowhere more obvious than here. Harvey Cushing/John Jay Whitney Medical Library, Yale University, New Haven.

An early advertisement for the virtues of Thorazine, touting its value in curbing the agitated husband's inclination to beat his wife. Wellcome Library, London.

Depressed? We have the solution! An advertisement for 'mother's little helper' - a pill for the housewife trapped in a prison of domesticity. Harvey Cushing/John Jay Whitney Medical Library, Yale University, New Haven.

A vivid portrayal of the murder of Thomas Becket, from a mid-thirteenth century codex. The saint's blood was thought to cure insanity, blindness, leprosy, and deafness, not to mention a host of other aliments. Walters Art Museum, Baltimore.

Franz Joseph Gall examines the head of an attractive young woman, while three gentlemen wait their turns to have their own characters read, in a satirical image published in 1825. Wellcome Library, London.

Hieronymus Bosch’s The Cure of the Folly: The Extraction of the Stone of Madness (c. 1494). A doctor, possibly a quack, uses a scalpel to remove the supposed cause of madness from the head of the patient. Museo del Prado, Madrid.

Nebuchadnezzar as a wild animal, his hair grown long and his nails like claws. This striking image of the biblical story of the Babylonian king’s madness is a detail from a manuscript painted by an unknown artist in Regensburg, Germany. Paul J. Getty Museum, Los Angeles (Ms. 33, fol. 215v)

Types of Insanity thumbnail
The Tranquilizer, 1811 thumbnail
Maniac in a strait-jacket, in a French asylum. thumbnail
Battle Creek Sanitarium thumbnail
Battle Creek Sanitarium thumbnail
The first stage of General Faradization thumbnail
The second stage of General Faradization thumbnail
The third stage of General Faradization thumbnail
Attitudes passionelles: extase (1878) thumbnail
Advert for the psychiatric drug Thorazine thumbnail
Depression Advertisement thumbnail
Murder of Thomas Becket thumbnail
Franz Joseph Gall examining the head of a pretty young girl thumbnail
Hieronymus Bosch's The Cure of the Folly thumbnail
Nebuchadnezzar as a wild animal thumbnail
No Sex Please! (We're on antidepressants) thumbnail

Spotlight on…Letter-Writers

Italo Calvino: Letters, 1941-1985

Italo Calvino:
Letters, 1941-1985

For the final post in this series, we turn to the raw materials of biography with two volumes of collected letters. Private letters often give a very different picture from public writings – less guarded, more spontaneous and immediate. They can shed light on the development of ideas and concepts over time, revealing the struggle so often obscured by the perfection of the finished work. These letters are a vital primary source for biographers. It seems certain that the rise of email and decline of letter-writing will profoundly affect the work of future biographers. Will email prove as durable as paper? Will the sheer volume of electronic correspondence defeat even the most dedicated researchers? It may be decades before the answers to these questions are clear. For now, we are still seeing significant collections of letters published, allowing readers to make their own first-hand acquaintance with Carl Jung and Italo Calvino.

Analytical Psychology in Exile collects the correspondence between Jung and one of his most brilliant students, Erich Neumann. The letters span nearly three decades, offering a fascinating insight into the maturing of Jung’s theories as he shares them with, and defends them against, the younger Neumann. Jung has been accused of sympathy with the Nazi regime in Germany, and of anti-semitism, yet here we see him in dialogue with a Zionist Jew who was forced to flee Germany for Tel Aviv in 1934. Inevitably, given the impending catastrophe, these letters touch on complex and controversial issues such as the psychology of fascism and anti-semitism, and the crushing experience of exile. Neumann lived to see the founding of the state of Israel and died there in 1960; although nearly thirty years his senior, Jung outlived him by a year.

While Jung passed the Second World War in the comparative security of Switzerland, Italo Calvino experienced first-hand the dangers of life in Fascist Italy. In Italo Calvino: Letters, 1941-1985, that experience is most profoundly seen in an absence, the lack of any correspondence from his years in hiding as a member of the Italian resistance. Although his letters rarely refer to the war, his time fighting with the resistance resulted in a deep philosophical and personal commitment to communism. We see his disillusion and resignation from the Communist Party following the crushing of the Hungarian revolution of 1956 and his excitement at the fresh hope offered by the événements of 1968 in Paris. The course of his writing, from the autobiographical realism of The Path to the Nest of Spiders to the dazzling metafiction of If On A Winter’s Night A Traveller, perhaps reflects his withdrawal from political life. Nonetheless, Calvino remained an acute critic and his letters are filled with sharp assessments of post-war Italy’s vibrant cultural life.

Christopher Bail talks to Salon about “Terrified”

Christopher Bail, author of Terrified: How Anti-Muslim Fringe Organizations Became Mainstream, recently spoke with Paul Rosenberg for a feature in Salon on how anti-Muslim sentiment is fostered by the broader cultural landscape, and the innovative new methodology he has used to study that process. Paul Rosenberg at Salon writes:

It may be hard to fathom or remember, but in the immediate aftermath of 9/11 the American public responded with an increased level of acceptance and support for Muslims. President Bush—who had successfully courted the Muslim vote in 2000—went out of his way to praise American Muslims on numerous occasions in 2001 and 2002. However, the seeds were already being planted that would change that drastically over time.  Within a few short years, a small handful of fringe anti-Muslim organizations—almost entirely devoid of any real knowledge or expertise, some drawing on age-old ethno-religious conflicts—managed to hijack the public discourse about Islam, first by stoking fears, grabbing attention with their emotional messaging, then by consolidating their newfound social capital, forging ties with established elite organizations, and ultimately building their own organizational and media infrastructure.

How this all happened is the subject of a fascinating new book, “Terrified: How Anti-Muslim Fringe Organizations Became Mainstream,” by sociologist Christopher Bail, of the University of North Carolina.  The book not only lays bare the behind-the-scenes story of a momentous shift in public opinion, it employs cutting-edge computer analysis techniques applied to large archives of data to develop a new theoretical outlook, capable of making sense of the whole field of competing organizations struggling to shape public opinion, not just studying one or two the most successful ones. The result is not only a detailed account of a specific, significant, and also very pernicious example of cultural evolution, but also a case study in how to more rigorously study cultural evolution more generally in the future. In the process, it sheds considerable light on the struggles involved, and the difficulties faced by those trying to fight back against this rising tide of misdirected fear, anger and hatred.


Read the full interview with Christopher Bail that follows here.

Terrified, by Christopher Bail

Jason Weeden and Robert Kurzban on 2014 elections

weedenElections are almost always a polarizing event in this country, but Jason Weeden and Robert Kurzban, authors of The Hidden Agenda of the Political Mind: How Self-Interest Shapes Our Opinions and Why We Won’t Admit It, explain why it’s more complex than just liberals and conservatives going twelve rounds in the ring. Two days ago, The New York Times published Weeden and Kurzban’s opinion piece, Election 2014: Your Very Predictable Vote, and it has generated some internet buzz; over 500 comments have already been submitted.

The gist? Americans vote out of self-interest. The proof? “Unemployed people are more than twice as likely as people working full time to want unemployment benefits increased. African-Americans are by far the most likely proponents of affirmative action and government help for African-Americans. Rich white men are especially likely to oppose income redistribution.” Furthermore, but  unrelated to economic motivations, Weeden and Kurzban note, “People who want to have sex but don’t at the moment want babies are especially likely to support policies that ensure access to birth control and abortion. Immigrants favor generous immigration policies. Lesbians and gay men are far more likely to oppose discrimination based on sexual orientation. Those who aren’t Christian are far more likely to oppose discrimination based on religion.”

This all sounds like common sense, yet, there are many political scientists focused on the influence “parents and peers, schools and universities, political parties and leaders, and…’values'” have on American voters, and self-interest is overlooked. Weeden and Kurzban argue, “the most straightforward explanation, demographics, is also the most persuasive.” The authors go on to theorize as to what the United States might look like if policy was determined by polling residents:

“There would be greater spending on the poor, health care, Social Security and education. Immigration would be reduced. School prayer would be allowed. Anti-American speech by Muslims would be restricted. Abortion would be legal in cases of rape and fetal deformity, but illegal if the abortion was motivated by not wanting more children, by being poor, or by being single.”

So why doesn’t the United States look like this? Weeden and Kurzban have an answer for that too!

“Negotiations at the federal level result in more conservative economic policies, and more liberal social policies. That’s because they involve one set of highly educated, wealthy representatives negotiating with another, and the policies that result reflect their own core interests.”

You can read the article in its entirety, here and don’t forget to  pick up a copy of The Hidden Agenda of the Political Mind in time for the 2016 presidential election!

A look within — MRI technology in action

It’s 2014, and although we don’t have flying cars or teleportation, we do have some truly amazing technologies. The video of a live birth posted below has been making the social media rounds in recent weeks, and it is a wonderful glimpse of the imaging possible through magnetic resonance imaging (MRI) technology.

To fully understand the history and future challenges of imaging technology, we recommend Denis Le Bihan’s book Looking Inside the Brain: The Power of Neuroimaging. Le Bihan is one of the leading scientists and developers of MRI technology, so who better to guide readers through the history of imaging technology from the x-ray and CT scan to the PET scan and MRI. He also explains how neuroimaging uncovers afflictions like stroke or cancer and the workings of higher-order brain activities, such as language skills and also takes readers on a behind-the-scenes journey through NeuroSpin, his state-of-the-art neuroimaging laboratory.


 

bookjacket

Looking Inside the Brain
The Power of Neuroimaging
Denis Le Bihan
Translated by Teresa Lavender Fagan

Throwback Thursday #TBT: Selected Letters of C. G. Jung, 1909-1961

Jung, Selected Letters, 1909-1961

Hello everybody! It’s Thursday again, and for this week’s Throwback (#TBT), we’re celebrating the Selected Letters of C. G. Jung, 1909-1961. The letters collected in this volume chronicle the founder of analytical psychology’s correspondence with friends, colleagues, and the people who came to him with problems. They also provide crucial insights into the beginnings of his theories and trace their development over the years.

Originally published in 1984, Selected Letters is one of many texts brought back by the Princeton Legacy Library series. It is also part of Princeton University Press’s esteemed Bollingen Series, named after the very Swiss village where Jung maintained a personal retreat.

That’s all for now, folks. See you next Thursday!

 

Princeton at Hay Festival


Hay on Monday evening
Blackburn at Hay
Simon Blackburn talks to Rosie Boycott
Mitton at Hay
Jacqueline Mitton broadens our knowledge of the solar system
Bethencourt at Hay
Francisco Bethencourt discusses “Racisms”

Last week was an important week in the British literary calendar–the week of Hay Festival! Set in beautiful Hay-on-Wye on the Welsh Borders, and running since 1988, the festival attracts thousands of book and culture enthusiasts from around the world every year. This year’s line-up was as strong as ever: with names such as Toni Morrison, Richard Dawkins, Stephen Fry, Mervin King, Jeremy Paxman, Simon Schama, Sebastian Faulks, William Dalrymple, Benedict Cumberbatch, Bear Grylls, Max Hastings, Rob Brydon, Bill Bailey and Dame Judi Dench (to name but a few to catch my eye in the jam-packed programme), 2014’s Festival could not fail to enthrall and delight anyone who walked its muddy paths.

And of course, Princeton University Press authors have been gracing the Hay stages this year, with a variety of wonderful events. From Diane Coyle, explaining GDP to us in plain English (and lo0king very stylish in her Hay wellies) to Michael Wood (translator of Dictionary of Untranslatables) discussing words that defy easy–or any–translation from one language and culture to another, to Ian Goldin’s talk about globalization and risk (The Butterfly Defect), last weekend got off to a great start.

Then, earlier in the week, Jacqueline Mitton (author of From Dust to Life) took a gripped audience on a journey through the history of our solar system in her “John Maddox Lecture”.  On Tuesday, Rosie Boycott spoke to Simon Blackburn about his book Mirror, Mirror–a fascinating conversation which covered everything from psychopathic tendencies displayed in senior management to whether Facebook is really that damaging to the young. Francisco Bethencourt, meanwhile, managed to squeeze a history of racisms into an hour and gave us lots to ponder.

If all this leaves you wishing you’d been there, there is still more to envy! Later in the week, Roger Scruton, Will Gompertz and others discussed the value of a Fine Art degree – does contemporary art celebrate concept without skill? On a parallel stage, renowned historian Averil Cameron (author of Byzantine Matters) convinced us that an understanding of the Byzantine era is just as important as studying, say, Rome or Greece. Finally, Michael Scott (author of Delphi), whom it is almost impossible to miss on the BBC these days, delivered a talk about Delphi: A History of the Center of the Ancient World on Friday.

Whether you swoon for science are potty for poetry, whether you want to dance the night away in a frenzy of jazz or are hoping to meet your favourite on-screen star, Hay Festival offers something new and exciting every year.

Untranslatable Tuesdays – Gender

Cassin gender image

To mark the publication of Dictionary of Untranslatables: A Philosophical Lexicon, we are delighted to share a series of playful graphics by our design team which illustrate some of the most interesting terms from the Dictionary. For week five in the “Untranslatable Tuesdays” series we present Gender:

FRENCH différence des sexes, identité sexuelle, genre

GERMAN Geschlecht

ITALIAN genere

SPANISH género