Is everything you think you know about depression wrong?

In this extract from his new book, Johann Hari, who took antidepressants for 14 years, calls for a new approach

In the 1970s, a truth was accidentally discovered about depression one that was quickly swept aside, because its implications were too inconvenient, and too explosive. American psychiatrists had produced a book that would lay out, in detail, all the symptoms of different mental illnesses, so they could be identified and treated in the same way across the United States. It was called the Diagnostic and Statistical Manual. In the latest edition, they laid out nine symptoms that a patient has to show to be diagnosed with depression like, for example, decreased interest in pleasure or persistent low mood. For a doctor to conclude you were depressed, you had to show five of these symptoms over several weeks.

The manual was sent out to doctors across the US and they began to use it to diagnose people. However, after a while they came back to the authors and pointed out something that was bothering them. If they followed this guide, they had to diagnose every grieving person who came to them as depressed and start giving them medical treatment. If you lose someone, it turns out that these symptoms will come to you automatically. So, the doctors wanted to know, are we supposed to start drugging all the bereaved people in America?

The authors conferred, and they decided that there would be a special clause added to the list of symptoms of depression. None of this applies, they said, if you have lost somebody you love in the past year. In that situation, all these symptoms are natural, and not a disorder. It was called the grief exception, and it seemed to resolve the problem.

Then, as the years and decades passed, doctors on the frontline started to come back with another question. All over the world, they were being encouraged to tell patients that depression is, in fact, just the result of a spontaneous chemical imbalance in your brain it is produced by low serotonin, or a natural lack of some other chemical. Its not caused by your life its caused by your broken brain. Some of the doctors began to ask how this fitted with the grief exception. If you agree that the symptoms of depression are a logical and understandable response to one set of life circumstances losing a loved one might they not be an understandable response to other situations? What about if you lose your job? What if you are stuck in a job that you hate for the next 40 years? What about if you are alone and friendless?

The grief exception seemed to have blasted a hole in the claim that the causes of depression are sealed away in your skull. It suggested that there are causes out here, in the world, and they needed to be investigated and solved there. This was a debate that mainstream psychiatry (with some exceptions) did not want to have. So, they responded in a simple way by whittling away the grief exception. With each new edition of the manual they reduced the period of grief that you were allowed before being labelled mentally ill down to a few months and then, finally, to nothing at all. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.

Dr Joanne Cacciatore, of Arizona State University, became a leading expert on the grief exception after her own baby, Cheyenne, died during childbirth. She had seen many grieving people being told that they were mentally ill for showing distress. She told me this debate reveals a key problem with how we talk about depression, anxiety and other forms of suffering: we dont, she said, consider context. We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labelled as brain diseases. If we started to take peoples actual lives into account when we treat depression and anxiety, Joanne explained, it would require an entire system overhaul. She told me that when you have a person with extreme human distress, [we need to] stop treating the symptoms. The symptoms are a messenger of a deeper problem. Lets get to the deeper problem.

*****

I was a teenager when I swallowed my first antidepressant. I was standing in the weak English sunshine, outside a pharmacy in a shopping centre in London. The tablet was white and small, and as I swallowed, it felt like a chemical kiss. That morning I had gone to see my doctor and I had told him crouched, embarrassed that pain was leaking out of me uncontrollably, like a bad smell, and I had felt this way for several years. In reply, he told me a story. There is a chemical called serotonin that makes people feel good, he said, and some people are naturally lacking it in their brains. You are clearly one of those people. There are now, thankfully, new drugs that will restore your serotonin level to that of a normal person. Take them, and you will be well. At last, I understood what had been happening to me, and why.

However, a few months into my drugging, something odd happened. The pain started to seep through again. Before long, I felt as bad as I had at the start. I went back to my doctor, and he told me that I was clearly on too low a dose. And so, 20 milligrams became 30 milligrams; the white pill became blue. I felt better for several months. And then the pain came back through once more. My dose kept being jacked up, until I was on 80mg, where it stayed for many years, with only a few short breaks. And still the pain broke back through.

I started to research my book, Lost Connections: Uncovering The Real Causes of Depression and the Unexpected Solutions, because I was puzzled by two mysteries. Why was I still depressed when I was doing everything I had been told to do? I had identified the low serotonin in my brain, and I was boosting my serotonin levels yet I still felt awful. But there was a deeper mystery still. Why were so many other people across the western world feeling like me? Around one in five US adults are taking at least one drug for a psychiatric problem. In Britain, antidepressant prescriptions have doubled in a decade, to the point where now one in 11 of us drug ourselves to deal with these feelings. What has been causing depression and its twin, anxiety, to spiral in this way? I began to ask myself: could it really be that in our separate heads, all of us had brain chemistries that were spontaneously malfunctioning at the same time?

To find the answers, I ended up going on a 40,000-mile journey across the world and back. I talked to the leading social scientists investigating these questions, and to people who have been overcoming depression in unexpected ways from an Amish village in Indiana, to a Brazilian city that banned advertising and a laboratory in Baltimore conducting a startling wave of experiments. From these people, I learned the best scientific evidence about what really causes depression and anxiety. They taught me that it is not what we have been told it is up to now. I found there is evidence that seven specific factors in the way we are living today are causing depression and anxiety to rise alongside two real biological factors (such as your genes) that can combine with these forces to make it worse.

Once I learned this, I was able to see that a very different set of solutions to my depression and to our depression had been waiting for me all along.

To understand this different way of thinking, though, I had to first investigate the old story, the one that had given me so much relief at first. Professor Irving Kirsch at Harvard University is the Sherlock Holmes of chemical antidepressants the man who has scrutinised the evidence about giving drugs to depressed and anxious people most closely in the world. In the 1990s, he prescribed chemical antidepressants to his patients with confidence. He knew the published scientific evidence, and it was clear: it showed that 70% of people who took them got significantly better. He began to investigate this further, and put in a freedom of information request to get the data that the drug companies had been privately gathering into these drugs. He was confident that he would find all sorts of other positive effects but then he bumped into something peculiar.

Illustration
Illustration by Michael Driver.

We all know that when you take selfies, you take 30 pictures, throw away the 29 where you look bleary-eyed or double-chinned, and pick out the best one to be your Tinder profile picture. It turned out that the drug companies who fund almost all the research into these drugs were taking this approach to studying chemical antidepressants. They would fund huge numbers of studies, throw away all the ones that suggested the drugs had very limited effects, and then only release the ones that showed success. To give one example: in one trial, the drug was given to 245 patients, but the drug company published the results for only 27 of them. Those 27 patients happened to be the ones the drug seemed to work for. Suddenly, Professor Kirsch realised that the 70% figure couldnt be right.

It turns out that between 65 and 80% of people on antidepressants are depressed again within a year. I had thought that I was freakish for remaining depressed while on these drugs. In fact, Kirsch explained to me in Massachusetts, I was totally typical. These drugs are having a positive effect for some people but they clearly cant be the main solution for the majority of us, because were still depressed even when we take them. At the moment, we offer depressed people a menu with only one option on it. I certainly dont want to take anything off the menu but I realised, as I spent time with him, that we would have to expand the menu.

This led Professor Kirsch to ask a more basic question, one he was surprised to be asking. How do we know depression is even caused by low serotonin at all? When he began to dig, it turned out that the evidence was strikingly shaky. Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is deeply misleading and unscientific. Dr David Healy told me: There was never any basis for it, ever. It was just marketing copy.

I didnt want to hear this. Once you settle into a story about your pain, you are extremely reluctant to challenge it. It was like a leash I had put on my distress to keep it under some control. I feared that if I messed with the story I had lived with for so long, the pain would run wild, like an unchained animal. Yet the scientific evidence was showing me something clear, and I couldnt ignore it.

*****

So, what is really going on? When I interviewed social scientists all over the world from So Paulo to Sydney, from Los Angeles to London I started to see an unexpected picture emerge. We all know that every human being has basic physical needs: for food, for water, for shelter, for clean air. It turns out that, in the same way, all humans have certain basic psychological needs. We need to feel we belong. We need to feel valued. We need to feel were good at something. We need to feel we have a secure future. And there is growing evidence that our culture isnt meeting those psychological needs for many perhaps most people. I kept learning that, in very different ways, we have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us.

Lets look at one of those causes, and one of the solutions we can begin to see if we understand it differently. There is strong evidence that human beings need to feel their lives are meaningful that they are doing something with purpose that makes a difference. Its a natural psychological need. But between 2011 and 2012, the polling company Gallup conducted the most detailed study ever carried out of how people feel about the thing we spend most of our waking lives doing our paid work. They found that 13% of people say they are engaged in their work they find it meaningful and look forward to it. Some 63% say they are not engaged, which is defined as sleepwalking through their workday. And 24% are actively disengaged: they hate it.

A
Antidepressant prescriptions have doubled over the last decade. Photograph: Anthony Devlin/PA

Most of the depressed and anxious people I know, I realised, are in the 87% who dont like their work. I started to dig around to see if there is any evidence that this might be related to depression. It turned out that a breakthrough had been made in answering this question in the 1970s, by an Australian scientist called Michael Marmot. He wanted to investigate what causes stress in the workplace and believed hed found the perfect lab in which to discover the answer: the British civil service, based in Whitehall. This small army of bureaucrats was divided into 19 different layers, from the permanent secretary at the top, down to the typists. What he wanted to know, at first, was: whos more likely to have a stress-related heart attack the big boss at the top, or somebody below him?

Everybody told him: youre wasting your time. Obviously, the boss is going to be more stressed because hes got more responsibility. But when Marmot published his results, he revealed the truth to be the exact opposite. The lower an employee ranked in the hierarchy, the higher their stress levels and likelihood of having a heart attack. Now he wanted to know: why?

And thats when, after two more years studying civil servants, he discovered the biggest factor. It turns out if you have no control over your work, you are far more likely to become stressed and, crucially, depressed. Humans have an innate need to feel that what we are doing, day-to-day, is meaningful. When you are controlled, you cant create meaning out of your work.

Suddenly, the depression of many of my friends, even those in fancy jobs who spend most of their waking hours feeling controlled and unappreciated started to look not like a problem with their brains, but a problem with their environments. There are, I discovered, many causes of depression like this. However, my journey was not simply about finding the reasons why we feel so bad. The core was about finding out how we can feel better how we can find real and lasting antidepressants that work for most of us, beyond only the packs of pills we have been offered as often the sole item on the menu for the depressed and anxious. I kept thinking about what Dr Cacciatore had taught me we have to deal with the deeper problems that are causing all this distress.

I found the beginnings of an answer to the epidemic of meaningless work in Baltimore. Meredith Mitchell used to wake up every morning with her heart racing with anxiety. She dreaded her office job. So she took a bold step one that lots of people thought was crazy. Her husband, Josh, and their friends had worked for years in a bike store, where they were ordered around and constantly felt insecure, Most of them were depressed. One day, they decided to set up their own bike store, but they wanted to run it differently. Instead of having one guy at the top giving orders, they would run it as a democratic co-operative. This meant they would make decisions collectively, they would share out the best and worst jobs and they would all, together, be the boss. It would be like a busy democratic tribe. When I went to their store Baltimore Bicycle Works the staff explained how, in this different environment, their persistent depression and anxiety had largely lifted.

Its not that their individual tasks had changed much. They fixed bikes before; they fix bikes now. But they had dealt with the unmet psychological needs that were making them feel so bad by giving themselves autonomy and control over their work. Josh had seen for himself that depressions are very often, as he put it, rational reactions to the situation, not some kind of biological break. He told me there is no need to run businesses anywhere in the old humiliating, depressing way we could move together, as a culture, to workers controlling their own workplaces.

*****

With each of the nine causes of depression and anxiety I learned about, I kept being taught startling facts and arguments like this that forced me to think differently. Professor John Cacioppo of Chicago University taught me that being acutely lonely is as stressful as being punched in the face by a stranger and massively increases your risk of depression. Dr Vincent Felitti in San Diego showed me that surviving severe childhood trauma makes you 3,100% more likely to attempt suicide as an adult. Professor Michael Chandler in Vancouver explained to me that if a community feels it has no control over the big decisions affecting it, the suicide rate will shoot up.

This new evidence forces us to seek out a very different kind of solution to our despair crisis. One person in particular helped me to unlock how to think about this. In the early days of the 21st century, a South African psychiatrist named Derek Summerfeld went to Cambodia, at a time when antidepressants were first being introduced there. He began to explain the concept to the doctors he met. They listened patiently and then told him they didnt need these new antidepressants, because they already had anti-depressants that work. He assumed they were talking about some kind of herbal remedy.

He asked them to explain, and they told him about a rice farmer they knew whose left leg was blown off by a landmine. He was fitted with a new limb, but he felt constantly anxious about the future, and was filled with despair. The doctors sat with him, and talked through his troubles. They realised that even with his new artificial limb, his old jobworking in the rice paddieswas leaving him constantly stressed and in physical pain, and that was making him want to just stop living. So they had an idea. They believed that if he became a dairy farmer, he could live differently. So they bought him a cow. In the months and years that followed, his life changed. His depressionwhich had been profoundwent away. You see, doctor, they told him, the cow was an antidepressant.

To them, finding an antidepressant didnt mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place. We can do the same. Some of these solutions are things we can do as individuals, in our private lives. Some require bigger social shifts, which we can only achieve together, as citizens. But all of them require us to change our understanding of what depression and anxiety really are.

This is radical, but it is not, I discovered, a maverick position. In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that the dominant biomedical narrative of depression is based on biased and selective use of research outcomes that must be abandoned. We need to move from focusing on chemical imbalances, they said, to focusing more on power imbalances.

After I learned all this, and what it means for us all, I started to long for the power to go back in time and speak to my teenage self on the day he was told a story about his depression that was going to send him off in the wrong direction for so many years. I wanted to tell him: This pain you are feeling is not a pathology. Its not crazy. It is a signal that your natural psychological needs are not being met. It is a form of grief for yourself, and for the culture you live in going so wrong. I know how much it hurts. I know how deeply it cuts you. But you need to listen to this signal. We all need to listen to the people around us sending out this signal. It is telling you what is going wrong. It is telling you that you need to be connected in so many deep and stirring ways that you arent yet but you can be, one day.

If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. The only real way out of our epidemic of despair is for all of us, together, to begin to meet those human needs for deep connection, to the things that really matter in life.

This is an edited extract from Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions by Johann Hari, published by Bloomsbury on 11 January (16.99). To order a copy for 14.44 go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over 10, online orders only. Phone orders min p&p of 1.99. It will be available in audio at audible.co.uk

Read more: https://www.theguardian.com/society/2018/jan/07/is-everything-you-think-you-know-about-depression-wrong-johann-hari-lost-connections

I just want to cut it off: the weight-loss patients who no longer fit their skin

Bariatric surgery is a highly cost-effective way to lose life-changing amounts of weight but the NHS rarely removes the excess skin that is left behind. Desperate patients are now crowdfunding their operations while struggling with anxiety, depression and identity issues

When Haze Atkin passed the 32kg (5st) mark on her weight-loss programme, something strange began happening to her skin. First it grew softer. Then it grew emptier. By the time she had shed her 64th kilo, her body had shrunk so much that her loose skin needed to be folded into her clothes. Now, when Haze sits, a hovercraft of skin skirts her seat. When she takes a bath, her spare skin floats. In bed, her husband Chris accidentally rests an elbow on it; he cant always be sure where Haze ends. The edges of her have become mistakable.

To her childrens delight, Haze can wobble her skin and make it talk like a puppet. Sometimes her daughter holds out her hands like a set of scales and Haze places her stomach skin on them. She thinks it weighs a stone. It has become oddly plastic, so that Haze can gather it in her hands and stretch and shake it, fold and mould it. But the one thing she can never do with her skin is forget it.

Like many people with excess skin, Haze lost a lot of weight after bariatric surgery. In the 10 months after her gastric bypass an operation the NHS has come to see as highly cost-effective she shrank from 149kg (23.5st) to 70kg (11st). She met all her targets. Her surgeons called her a model patient. And yet, just when Haze should have felt she had achieved her goal, her skin held her back. The scales said she had reached the end of her journey, but the mirror told a different story.

Haze is one of the 9,325 UK patients who in 2013 underwent bariatric surgery on the NHS, according to statistics held by NHS Digital. The same year, NHS England reported that the price of keyhole bariatric surgery for diabetes patients with a BMI of 35, for instance, is recoverable in just 26 months. According to projections from the Department of Health, the cost to society and the economy of people being overweight and obese could increase to almost 50bn in 2050, so it is easy to see why bariatric procedures make financial sense. But is the surgery causing a different kind of health crisis? Is such massive weight loss MWL, as healthcare professionals call it solving one problem only to create a new one, a generation of weight-loss survivors tormented by anxiety and depression because they no longer fit their skin?

Haze has a simple message to the NHS. You dont just leave people half-done. Finish it.

The NHS does perform some skin removal operations. But the only mention of skin removal in all Nices recommendations is that a multidisciplinary bariatric team provide information on, or access to, plastic surgery (such as apronectomy) when appropriate (an apronectomy is a mini tummy tuck to remove the apron of skin that hangs over the pubic area). This provision varies hugely by region. In theory, a patient needs to show that skin removal surgery is a health rather than a cosmetic intervention.

In practice, the local clinical commissioning groups, which commission NHS healthcare, rarely approve such applications which is why crowdfunding websites are full of people who have lost massive amounts of weight and are desperate to remove their skin, even if it means posting explicit, naked or near-naked photographs that play to a sort of pornography of excess skin. Hazes page has raised 332 of the 6,600 she needs for surgery. She applied to the NHS she suffers from skin infections, anxiety and depression, and believes the extra weight exacerbates her fibromyalgia (she is registered disabled). But she was rejected.

Lisa
Lisa Riley, who had skin surgery. Photograph: Ken McKay/ITV/Rex/Shutterstock

So each week for the past four years she and Chris have laid aside 20 every spare penny towards the cost of the fleur de lis abdominoplasty on which Haze has set her heart. This double incision runs vertically and horizontally, and was part of the suite of operations carried out on the actor and TV presenter Lisa Riley in her documentary Lisa Rileys Baggy Body Club. The fleur de lis leaves a wound so severe that Rob Winterton, the cosmetic surgeon who performed it on Riley, says it is comparable to a 20 or 30% burn.

But for Haze, the surgery is the only way out of an unbearable predicament. At 30, she finds her skin so invasive, so mentally hard to deal with, every day I just want to cut it off myself. It invades my thoughts, my feelings, all the time. Every time I get dressed.

If you catch yourself in the mirror, Chris interjects. If I touch you wrong. If I roll on you. If I see you getting dressed.

Hazes skin is always on her mind which is not, of course, where skin is meant to be. Her daily life has evolved to make dozens of minute accommodations. She must wash carefully, lying down and stretching her skin out in order to clean and dry it thoroughly. Where the skin is folded, bacteria grows, she says. Dressing is a military operation. Everything is tucked away. And her relationship, the way she and Chris interact, has changed too.

Haze has gone from one kind of person to another, and the speed of her transformation has caught both her and Chris by surprise. You went from having a plus-size, curvy, full wife which you never had a problem with to suddenly this petite woman with hanging sacks of skin, Haze says to Chris, who is seated at her side. And it really threw you.

It was trying to remember who she is, Chris replies. Not mentally but physically. Its like, are you sure its you?

The pair have been married for 13 years. But the surgery, so hyper-efficient and cost-effective, has not given their emotions, their instincts, their bodies, time to adjust. Ill get there in the end, Chris says. Its because the process is so quick. Very shocking.

They had a small amount of savings, which Haze spent on a breast augmentation to save my sanity because she was so depressed by her new paper bag breasts. Even so, in their most intimate moments, Hazes skin still comes between them. If Im on top and I lean forward, she says, my stomach gets there first. She turns to Chris. You literally hold it back, she says, putting her hands at her narrow waist to demonstrate. To try and make you feel better, he nods, and they reach for each others hands.

Two further years of saving lie between Haze and Chris Atkin and the promised land of an operation so extensive that Winterton says it puts two and a half feet of scar on a patient. Providing, of course, that inflation does not outstrip them. But Paul Watling, 34, from Manchester, has barely a week to wait. Like Haze, he was rejected for the operation on the NHS after months of psycho-evaluation. He was trying to get along with his skin, to live with it, until last summer when he picked up a friend from hospital after body lift surgery.

The sight of his friend in his new skin made Paul see himself with unexpected clarity. At lunch with his mother and his girlfriend, Charlotte, I turned around and said: I need it. I just felt the time had come to put this part of my life to bed.

We are talking in a breakout area of Manchester Metropolitan University where Paul works as a night-time duty manager for halls of residence. While students amble down the corridor, Pauls voice quickens. This is it! Something that has been a negative aspect of my life for all my life is banished for ever.

Paul
Paul Watling: I feel great. But I dont look it. I look awful. Photograph: Christopher Thomond for the Guardian

The negative aspect of Pauls life began as a child with a tendency to overeat. At 22, he weighed 191kg (30st). He was offered a gastric bypass after doctors discovered a lung tumour (he was too fat to operate on) and this was in 2005 was promised that his excess skin would be removed on the NHS. However, by the time his weight had stabilised, he was turned down for the skin surgery. Depressed by what he saw in the mirror, the nipples that sagged far below his chest, the reams of spare stomach and undereye sacks that made him look permanently tired, Paul began to eat and drink heavily.

I thought: If Im going to look this bad, I may as well fill it out and just be the fat guy again, he says.

Over the next 10 years his weight rose as he ate to fill up his skin; a gastric bypass is only a tool to help with weight loss, and depends on adjustments to diet and exercise to work. While his stomach expanded, Paul kept telling himself: Im nowhere near as bad as I was. Then, last Christmas, he woke up after a binge and needed the bathroom. Looking down at the toilet bowl, he realised he couldnt see what he was doing; his stomach was too large. I thought, thats not normal. I dont remember that.

He was staying at a friends house, and his friends bathroom contained a set of scales, something Paul hadnt seen in a long time. He stepped on. I was like: Wow! This is insane! The scales said he weighed 162kg (25.5st). He found his friend in the kitchen. I took my shirt off and said: Take a photo. And I could see, in that photo, the 21-year-old me. I said: This has to stop.

He researched nutrition and exercise plans and began to adjust his diet and lift weights. After 11 months, in an entirely self-directed effort, he had lost 64kg (10st).

I feel better than I have ever felt in my life, Paul says. I feel great. But I dont look it. I look awful. While we talk, Pauls right arm disappears beneath the table to shield his stomach from passersby.

Im happier now with the way people treat me and it is a world of difference. But when I was bigger, I was happier with the way I looked. I was just a fat guy. Thats all I was. Yeah, people take the piss and are cruel but its there for everyone to see. This, he says, looking down to where he can feel his skin pulling over his belt line, is a hidden shame. Even the fat guys in the gym hang around in the dressing room. But Im ashamed. I sneak into the family room and lock the door.

Paul is troubled not only by his skin but also by the fact that it troubles him. Its a constant internal struggle for me. Why are you spending 10 grand on this? Its just appearance. Come on! You can rise above this. Of course, how you look shouldnt matter, he says, but it does matter, because of the experiences you had when you were younger, the years of verbal and physical abuse. He is a heavy metal fanand has always identified as an outsider, found comfort in it. But his skin has made him feel more privately misplaced, estranged in a way that is unfamiliar he has become an outsider in his own body.

I know I should be proud of my excess skin. It should be a battle scar But the flip side, which is the stronger side that always wins, is: Look at the state of you, youre gross, youre disgusting, you cant let anyone see you I dont want to fit in with society, I want to fit in with myself.

Paul is right that not everyone with excess skin feels as he does. Krystina Wright, 31, from Grendon in Warwickshire, lost 44kg (7st) with the help of Slimming World, and has a pouch at her stomach.

She knows she has undergone a transformation, and that her skin tells the story of it. Last year she was shortlisted for Slimming Worlds woman of the year. Out dress shopping, she stood in the fitting room in her underwear, and her mum remarked, You can see youve lost weight. But I never see that in the mirror, Krystina says. When Im walking, [the skin] around my legs is obviously looser than somebody who hasnt lost weight but I just ignore it. Im so happy with my journey that everything negative about my old self doesnt seem to matter.

Even in her contentment, however, Krystina still associates the experience of being fat with an old self, and it is this sense of disjuncture between an old self and a new self, a fat self and a thin self, that challenges people who have lost a transformative amount of weight.

Skin is a boundary between ourselves and the outside world. But for Haze Atkin, her skin, in its looseness, provides an untrue border; her skin seems to stop beyond her true edges. Instead, she strongly demarcates the line between old and new selves. When she was fat, she was Hayley. Two years ago, after weight loss, she changed her name legally. Its weird to see pictures of me before, she says. You cant I cant tie those two people together.

Im very proud of Hayley. But thats not me. Theres a real separation. She picks up her stomach. The thing thats hanging on is this. Hayleys skin.

Elna Baker can relate to Hazes divided self. The American writer and performer, 35, has documented her weight loss and skin removal surgery in blogs and podcasts such as This American Life. Between losing weight (nearly 50kg/8st) and losing the skin, she lived in the same sort of limbo as Haze she thinks of it now as a transitional place between fat and this idea of thin.

Elna
Elna Baker: I feel like Im wearing a disguise. Photograph: PR

But Baker also says she has travelled further along the timeline I dont know how to explain it. But theres, like, a core thing that youre still running from, she says, speaking on the phone from New York. And not to sound ungrateful for the means and the experience of getting to transform, but I also feel its more complicated than I expected, because its about identity and gender and worth. The thing that still saddens me is that I lived too long in the world as a fat woman to forget the way the world exists when youre fat. So now I feel like Im wearing a disguise, which allows me not to have to experience on a daily basis judgment, shame and hatred. But I also have all this muscle memory of that. So I sometimes feel confused like Im still experiencing a side-effect of a thing I no longer am.

Baker had implants to return her breasts to their former size, a body lift, a thigh lift and a circumferential body lift a cut around the circumference of the body. The scar draws a line between her top half and bottom half and has left her feeling, literally, a little divided.

Despite complications afterwards that meant that she had to pack her wounds with gauze, pushing wads into the holes left by burst stitches as if she were stuffing a soft toy, Baker is glad that she had the operations. But she has spent the past year using therapy, meditation and self-help to address the boundary between old Elna and new Elna. She hopes the division is an illusion and it is possible to reach into the depths of me and meet the person [I was] and integrate it.

Haze, meanwhile, hopes for the opposite, that surgery will not only make her proud of her body but sever her from the past. And Paul, only a week away from his operation, sometimes has to quiet the small voice that asks: What if I go through this and Im still not happy? He reminds himself: Ive set this up in my mind. This is closure of a lifetime of not being happy in my body.

All he, and Haze and anyone, really want is to be comfortable in their own skin.

Read more: https://www.theguardian.com/lifeandstyle/2018/jan/02/i-want-to-cut-it-off-weight-loss-patients-excess-skin

Dont listen to Gwyneth Paltrow: keep your coffee well away from your rectum | Jen Gunter

The colonic irrigation and coffee enemas promoted on Paltrows website Goop are not merely unnecessary, they are potentially dangerous, writes obstetrician and gynaecologist Dr Jen Gunter

It seems January is Gwyneth Paltrows go-to month for promoting potentially dangerous things that should not go in or near an orifice. January 2015 brought us vagina steaming, January 2017 was jade eggs, and here we are in the early days of January 2018 and Goop.com is hawking coffee enemas and promoting colonic irrigation.

I suspect that GP and her pals at Goop.com believe people are especially vulnerable to buying quasi-medical items in the New Year as they have just released their latest detox and wellness guide complete with a multitude of products to help get you nowhere.

colon
Ha ha, go deep. Nice play on words for a dangerous yet ineffective therapy. An advertisement on Goop.com.

One offers to help if youre looking to go deep on many levels. Ha ha, go deep. Nice play on words for a dangerous yet ineffective therapy. Goop.com is not selling a coffee machine, it is selling a coffee enema-making machine. That, my friends, is a messed-up way to make money. I know the people at Goop will either ignore the inquiries from reporters or release a statement saying the article is a conversation not a promotion and that they included the advice of a board-certified doctor, Dr Alejandro Junger, but any time you lend someone else your platform their ideas are now your ideas. That is why I never let anyone write guest posts for my blog. And lets be real, if you are selling the hardware to shoot coffee up your ass then you are promoting it as a therapy especially as Goop actually called the $135 coffee enema-making machine Dr Jungers pick. I mean come on.

The interview with Junger is filled with information that is unsupported both by the medical literature and by human anatomy and physiology. There is no data to suggest that a colonic helps with the elimination of the waste that is transiting the colon on its way out. That is what bowel movements do. There are no toxins to be cleansed or irrigated. That is fake medicine. A 2011 review on colonics concluded that doctors should advise patients that colon cleansing has no proven benefits and many adverse effects.

The idea that colonics are used in conjunction with a cleanse is beyond ridiculous. Junger tells us via Goop that a cleanse creates some kind of extra sticky mucus that blocks elimination of what needs to be disposed of (I will admit that hurt my brain more than a little). Dr Junger says this cleanse residue is a mucoid plaque, basically some kind of adherent, cleanse-induced super-glue that needs a colonic for removal. He supports this assertion not with published research, but by telling Goops readers to Google mucoid plaque.

No really. That is what he said. Google it. So I did. This is what came up first:

Mucoid plaque (or mucoid cap or rope) is a pseudoscientific term used by some alternative medicine advocates to describe what is claimed to be a combination of allegedly harmful mucus-like material and food residue that they say coats the gastrointestinal tract of most people.

Apparently, the term mucoid plaque was coined by Richard Anderson, who is a naturopath, not a gastroenterologist, so not a doctor who actually looks inside the colon. I looked mucoid plaques up in PubMed. Guess what? Nothing colon-related. There is not one study or even case-report describing this phenomenon. Apparently only doctors who sell cleanses and colonics can see them. I am fairly confident that if some gastroenterologist (actual colon doctor) found some crazy mucus that looked like drool from the alien queen that she or he would have taken pictures and written about it or discussed it at a conference.

If we needed cleanses to live and thus colonics to manage this alien-like mucous residue created by cleanses, how did we ever evolve? Wouldnt we have died out from these mysterious toxins? Wouldnt our rectums be different? Wouldnt we have invented irrigation tubing before the wheel? So many questions.

There is only a side mention in the Goop post of two of the many complications seen with colonics: colon perforation and damage to gastrointestinal bacteria. And as for coffee enemas? While Dr Kelly Brogan, Paltrows Aids-denialist doctor gal pal who is speaking at In Goop Health later this month, is also a huge fan, there is no data to suggest that coffee offers any benefit via the rectal route but there are plenty of reports of coffee enema-induced rectal burns.

So here are the facts. No one needs a cleanse. Ever. There are no waste products left behind in the colon that need removing just because or after a cleanse. If a cleanse did leave gross, adherent hunks of weird mucus then that would be a sign that the cleanse was damaging the colon. You know what creates excess, weird mucous? Irritation and inflammation.

There are serious risks to colonics such as bowel perforation, damaging the intestinal bacteria, abdominal pain, vomiting, electrolyte abnormalities and renal failure. There are also reports of serious infections, air embolisms, colitis, and rectal perforation. If you go to a spa and the equipment is not sterilised, infections can be transmitted via the tubing.

Coffee enemas and colonics offer no health benefit. The biology used to support these therapies is unsound and there can be very real complications. Keep the coffee out of your rectum and in your cup. It is only meant to access your colon from the top.

Dr Jen Gunter is an obstetrician, gynaecologist and pain medicine physician. This piece originally ran on Jen Gunters blog

Read more: https://www.theguardian.com/commentisfree/2018/jan/09/gwyneth-paltrow-goop-coffee-enema-colonic-irrigation

Excitement as trial shows Huntington’s drug could slow progress of disease

Hailed as enormously significant, results in groundbreaking trial are first time a drug has been shown to suppress effects of Huntingtons genetic mutation

A landmark trial for Huntingtons disease has announced positive results, suggesting that an experimental drug could become the first to slow the progression of the devastating genetic illness.

The results have been hailed as enormously significant because it is the first time any drug has been shown to suppress the effects of the Huntingtons mutation that causes irreversible damage to the brain. Current treatments only help with symptoms, rather than slowing the diseases progression.

Q&A

What is Huntington’s disease?

Huntingtons disease is a congenital degenerative condition caused by a single defective gene. Most patients are diagnosed in middle age, with symptoms including mood swings, irritability and depression. As the disease progresses, more serious symptoms can include involuntary jerky movements, cognitive difficulties and issues with speech and swallowing.

Currently there is no cure for Huntington’s, although drugs exist which help manage some of the symptoms. It is thought that about 12 people in 100,000 are affected by Huntington’s, and if a parent carries the faulty gene there is a 50% chance they will pass it on to their offspring.

Prof Sarah Tabrizi, director of University College Londons Huntingtons Disease Centre who led the phase 1 trial, said the results were beyond what Id ever hoped … The results of this trial are of ground-breaking importance for Huntingtons disease patients and families, she said.

The results have also caused ripples of excitement across the scientific world because the drug, which is a synthetic strand of DNA, could potentially be adapted to target other incurable brain disorders such as Alzheimers and Parkinsons. The Swiss pharmaceutical giant Roche has paid a $45m licence fee to take the drug forward to clinical use.

Huntingtons is an incurable degenerative disease caused by a single gene defect that is passed down through families.

The first symptoms, which typically appear in middle age, include mood swings, anger and depression. Later patients develop uncontrolled jerky movements, dementia and ultimately paralysis. Some people die within a decade of diagnosis.

Most of our patients know whats in their future, said Ed Wild, a UCL scientist and consultant neurologist at the National Hospital for Neurology and Neurosurgery in London, who administered the drug in the trial.

The mutant Huntingtons gene contains instructions for cells to make a toxic protein, called huntingtin. This code is copied by a messenger molecule and dispatched to the cells protein-making machinery. The drug, called Ionis-HTTRx, works by intercepting the messenger molecule and destroying it before the harmful protein can be made, effectively silencing the effects of the mutant gene.

How the drug works to slow the progress of Huntington’s disease

To deliver the drug to the brain, it has to be injected into the fluid around the spine using a four-inch needle.

Prof John Hardy, a neuroscientist at UCL who was not involved in the trial, said: If Id have been asked five years ago if this could work, I would have absolutely said no. The fact that it does work is really remarkable.

The trial involved 46 men and women with early stage Huntingtons disease in the UK, Germany and Canada. The patients were given four spinal injections one month apart and the drug dose was increased at each session; roughly a quarter of participants had a placebo injection.

After being given the drug, the concentration of harmful protein in the spinal cord fluid dropped significantly and in proportion with the strength of the dose. This kind of closely matched relationship normally indicates a drug is having a powerful effect.

For the first time a drug has lowered the level of the toxic disease-causing protein in the nervous system, and the drug was safe and well-tolerated, said Tabrizi. This is probably the most significant moment in the history of Huntingtons since the gene [was isolated].

The trial was too small, and not long enough, to show whether patients clinical symptoms improved, but Roche is now expected to launch a major trial aimed at testing this.

If the future trial is successful, Tabrizi believes the drug could ultimately be used in people with the Huntingtons gene before they become ill, possibly stopping symptoms ever occurring. They may just need a pulse every three to four months, she said. One day we want to prevent the disease.

The drug, developed by the California biotech firm Ionis Pharmaceuticals, is a synthetic single strand of DNA customised to latch onto the huntingtin messenger molecule.

The unexpected success raises the tantalising possibility that a similar approach might work for other degenerative brain disorders. The drugs like Lego, said Wild. You can target [any protein].

For instance, a similar synthetic strand of DNA could be made to target the messenger that produces misshapen amyloid or tau proteins in Alzheimers.

Huntingtons alone is exciting enough, said Hardy, who first proposed that amyloid proteins play a central role in Alzheimers. I dont want to overstate this too much, but if it works for one, why cant it work for a lot of them? I am very, very excited.

Prof Giovanna Mallucci, associate director of UK Dementia Research Institute at the University of Cambridge, described the work as a tremendous step forward for individuals with Huntingtons disease and their families.

Clearly, there will be much interest into whether it can be applied to the treatment of other neurodegenerative diseases, like Alzheimers, she added. However, she said that in the case of most other disorders the genetic causes are complex and less well understood, making them potentially harder to target.

About 10,000 people in the UK have the condition and about 25,000 are at risk. Most people with Huntingtons inherited the gene from a parent, but about one in five patients have no known family history of the disease.

The full results of the trial are expected to be published in a scientific journal next year.

Read more: https://www.theguardian.com/science/2017/dec/11/excitement-as-huntingtons-drug-shown-to-slow-progress-of-devastating-disease

Why the UN is investigating extreme poverty in America, the world’s richest nation

At the heart of Philip Alstons special mission will be one question: can Americans enjoy fundamental human rights if theyre unable to meet basic living standards?

The United Nations monitor on extreme poverty and human rights has embarked on a coast-to-coast tour of the US to hold the worlds richest nation and its president to account for the hardships endured by Americas most vulnerable citizens.

The tour, which kicked off on Friday morning, will make stops in four states as well as Washington DC and the US territory of Puerto Rico. It will focus on several of the social and economic barriers that render the American dream merely a pipe dream to millions from homelessness in California to racial discrimination in the Deep South, cumulative neglect in Puerto Rico and the decline of industrial jobs in West Virginia.

With 41 million Americans officially in poverty according to the US Census Bureau (other estimates put that figure much higher), one aim of the UN mission will be to demonstrate that no country, however wealthy, is immune from human suffering induced by growing inequality. Nor is any nation, however powerful, beyond the reach of human rights law a message that the US government and Donald Trump might find hard to stomach given their tendency to regard internal affairs as sacrosanct.

The UN special rapporteur on extreme poverty and human rights, Philip Alston, is a feisty Australian and New York University law professor who has a fearsome track record of holding power to account. He tore a strip off the Saudi Arabian regime for its treatment of women months before the kingdom legalized their right to drive, denounced the Brazilian government for attacking the poor through austerity, and even excoriated the UN itself for importing cholera to Haiti.

The US is no stranger to Alstons withering tongue, having come under heavy criticism from him for its program of drone strikes on terrorist targets abroad. In his previous role as UN special rapporteur on extrajudicial executions, Alston blamed the Obama administration and the CIA for killing many innocent civilians in attacks he said were of dubious international legality.

United
United Nations Special Rapporteur on extreme poverty and human rights, Philip Alston. Photograph: Ng Han Guan/AP

Now Alston has set off on his sixth, and arguably most sensitive, visit as UN monitor on extreme poverty since he took up the position in June 2014. At the heart of his fact-finding tour will be a question that is causing increasing anxiety at a troubled time: is it possible, in one of the worlds leading democracies, to enjoy fundamental human rights such as political participation or voting rights if you are unable to meet basic living standards, let alone engage, as Thomas Jefferson put it, in the pursuit of happiness?

Despite great wealth in the US, there also exists great poverty and inequality, Alston said in remarks released before the start of the visit. The rapporteur said he intended to focus on the detrimental effects of poverty on the civil and political rights of Americans, given the United States consistent emphasis on the importance it attaches to these rights in its foreign policy, and given that it has ratified the International Covenant on Civil and Political Rights.

Poverty experts are watching the UN tour closely in the hope that it might draw public attention to a largely neglected but critical aspect of US society.

David Grusky, director of the Center on Poverty and Inequality at Stanford, said the visit had the potential to hold a mirror up to the country at a moment when globalization combined with a host of domestic policies have generated a vast gulf between rich and poor.

The US has an extraordinary ability to naturalize and accept the extreme poverty that exists even in the context of such extreme wealth, he said.

Grusky added that the US reaction to Alstons visit could go either way. It has the potential to open our eyes to what an outlier the US has become compared with the rest of the world, or it could precipitate an adverse reaction towards an outsider who has no legitimacy telling us what to do about internal US affairs.

Alstons findings will be announced in preliminary form in Washington on 15 December, and then presented as a full report to the UN human rights council in Geneva next June. An especially unpredictable element of the fallout will be how Trump himself receives the final report, given the presidents habit of lashing out at anyone perceived to criticize him or his administration.

Trump has also shown open disdain towards the world body. In the course of the 2016 presidential campaign he griped that we get nothing out of the United Nations other than good real-estate prices.

On the other hand, observers have been surprised that the White House has honored the invitation to host Alston after the initial offer was extended by Barack Obama. US diplomats on more than one occasion since Trumps inauguration have said they welcomed the UN party.

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Ruby Dee Rudolph in her home in Lowndes County. A recent study suggests that nearly one one in three people in Lowndes County have hookworm, a parasite normally found in poor, developing countries. Photograph: Bob Miller for The Guardian

Alston himself is reserving his comments until the end of the tour. But his published work suggests that he is likely to be a formidable critic of the new president. In a lecture he gave last year on the challenges posed by Trump and other modern populist leaders, he warned that their agenda was avowedly nationalistic, xenophobic, misogynistic, and explicitly antagonistic to all or much of the human rights agenda.

Alston concluded the speech by saying: These are extraordinarily dangerous times, unprecedentedly so in my lifetime. The response is really up to us.

The UN poverty tour falls at a singularly tense moment for the US. In its 2016 state of the nation review, the Stanford Center on Poverty and Inequality placed the US rank at the bottom of the league table of 10 well-off countries, in terms of the extent of its income and wealth inequality.

It also found that the US hit rock bottom in terms of the safety net it offers struggling families, and is one of the worst offenders in terms of the ability of low-income families to lift themselves out of poverty a stark contrast to the much-vaunted myth of the American dream.

To some extent, Trumps focus on making America great again a political jingo that in itself contains an element of criticism of the state of the nation chimes with the UNs concern about extreme poverty. His call for greater prosperity for white working Americans in declining manufacturing areas that proved so vital to his election victory will be echoed in Alstons visit to the depressed coal-producing state of West Virginia, which backed Trump in 2016 by a resounding 69%.

In many other ways, though, the Trump administration in its first year has taken a radically hostile approach towards communities in need. He has tried, so far unsuccessfully, to abolish Obamacare in a move that would deprive millions of low-income families of healthcare insurance, was widely criticized for his lackluster response to the hurricane disaster in Puerto Rico that has left thousands homeless and without power, and is currently pushing a tax reform that would benefit one group above all others: the super rich.

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A man who lost his home during Hurricane Maria in September sits on a cot at a school turned shelter in Canovanas. Photograph: Alvin Baez/Reuters

The US poses an especially challenging subject for the UN special rapporteur because unlike all other industrialized nations, it fails to recognize fundamental social and economic rights such as the right to healthcare, a roof over your head or food to keep hunger at bay. The federal government has consistently refused to sign up to the international covenant on economic, social and cultural rights arguing that these matters are best left to individual states.

Such an emphasis on states rights has spawned a patchwork of provision for low-income families across the country. Republican-controlled states in the Deep South provide relatively little help to those struggling from unemployment and lack of ready cash, while more assistance is likely to be forthcoming in bigger coastal cities.

By contrast, raging house prices and gentrification is fueling a homelessness crisis in liberal cities such as Los Angeles and San Francisco the first stop next week of the UN tour.

Martha Davis, a law professor specializing in US human rights at Northeastern University, said that such vast regional variations present the UN monitor with a huge opportunity. Unlike other international officials, he has the ability to move freely at both federal and state levels and be equally critical of both.

Theres a lot that Philip Alston can say about basic inequality that goes to the heart of the rights that he is reviewing, Davis said.

Read more: https://www.theguardian.com/world/2017/dec/01/un-extreme-poverty-america-special-rapporteur

New Zealand bans vaginal mesh implants

Ministry of Health asks suppliers to stop marketing the mesh until they have proven its safety

New Zealand has become the first major country to effectively ban vaginal mesh implants in response to safety concerns over the surgery.

The countrys Ministry of Health announced on Monday that it had written to leading mesh suppliers asking them to stop marketing the products from January or prove that their products are safe.

Ministry of Health spokesman, Stewart Jessamine, told a New Zealand radio station: Were always cautious about the use of the word ban, but effectively the companies are agreeing no longer to sell these products … in New Zealand from the 4th of January.

The move goes considerably further than recent announcements in other countries, such as Australia and the UK, which only restrict the use of pelvic mesh operations for organ prolapse. In New Zealand, the use of mesh implants to treat urinary incontinence, which accounts for the vast majority of mesh operations, will also be effectively banned, according to an announcement posted on the government website.

The decision has been applauded by campaigners, many of whom argue that the potential complications of mesh surgery, which include chronic pain and implants cutting through the vagina, are unacceptable. However, doctors expressed concern at the far-reaching nature of the ban.

It is now widely accepted that vaginal mesh should not be routinely offered for prolapse, where the pelvic organs bulge into the vagina. But many doctors maintain that mesh surgery to treat stress urinary incontinence can have advantages over traditional surgery and believe that these procedures should continue to be offered.

This makes New Zealand the only country in the world to have banned all of these procedures and will leave women without effective surgical options for these debilitating conditions, said Giovanni Losco, a urologist in Christchurch and spokesman for the Urological Society of Australia and New Zealand.

Carl Heneghan, professor of evidence-based medicine at the University of Oxford, says the medical profession needs to acknowledge that there have been major failings in regulation and act to address the issue. If they dont then other regulators may also react with outright bans.

[New Zealand] is basically saying we cant guarantee patient safety, he added.

Jessamine said that the decision had been taken after reviewing data on mesh safety provided in November by the Australian government, which had been carrying out its own inquiry into the use of pelvic implants. Weve reviewed that data and come to the opinion that the data is sound and we now believe the risks of the use of these products in the pelvis for prolapse and stress incontinence far outweighs the benefits, he said.

Weve got an ability within our legislation to limit the use of those products, to discourage and ultimately remove those products from the market, he added.

Owen Smith, a shadow cabinet minister, who chairs the all-party parliamentary group on surgical mesh implants, described the announcement as hugely significant. Its the first major country to effectively ban mesh for all pelvic operations. Its precisely what weve been calling for in the UK.

Read more: https://www.theguardian.com/science/2017/dec/12/new-zealand-bans-vaginal-mesh-implants

Animal agriculture is choking the Earth and making us sick. We must act now | James Cameron and Suzy Amis Cameron

Film-maker James Cameron and environmentalist Suzy Amis Cameron writes that to preserve Americas majestic national parks, clean air and water for future generations leaders must be pressed to address foods environmental impact

Our collective minds are stuck on this idea that talking about foods environmental impact risks taking something very intimate away from us. In fact its just the opposite. Reconsidering how we eat offers us hope, and empowers us with choice over what our future planet will look like. And we can ask our local leaders from city mayors to school district boards to hospital management to help, by widening our food options.

On Monday and Tuesday, the city of Chicago is hosting a summit for the Global Covenant of Mayors for Climate and Energy to discuss climate solutions cities can undertake. Strategies to address and lower foods impact should be front and center.

Animal agriculture is choking the Earth, and the longer we turn a blind eye, the more we limit our ability to nourish ourselves, protect waterways and habitats, and pursue other uses of our precious natural resources. Raising livestock for meat, eggs and milk generates 14.5% of global greenhouse gas emissions, the second highest source of emissions and greater than all transportation combined. It also uses about 70% of agricultural land, and is one of theleading causes of deforestation, biodiversity loss, and water pollution.

On top of this, eating too much meat and dairy is making us sick, greatlyincreasing our risk of heart disease, type 2 diabetes, several major cancers (including breast, liver and prostate) and obesity. Diets optimal for human health vary, according to David Katz, of the Yale University Prevention Research Center, but all of them are made up mostly of whole, wholesome plant foods.

So what gives? Why cant we see the forest for the bacon? The truth can be hard to swallow: that we simply need less meat and dairy and more plant-based options in our food system if were to reach our climate goals.

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The Avatar movie set had plant-based menus. Photograph: 20th Century Fox/Everett/Rex Features

This can start with individual action. Five years ago, our family felt hopeless about climate change, and helpless to make meaningful change. But when we connected the dots on animal agricultures impact on the environment, coupled with the truth about nutrition, we took heart because it gave us something we could actually do.

To create change at the scale needed, this will take more than individual choice we need to get climate leaders on board about the impact of food. Cities and counties have used their buying power to transition fleets from diesel to electric, and we need to do the same with how we purchase food. We have done this in our own community, moving the lunch program of Muse School, in Calabasas, California, and the Avatar movie set to plant-based menus. Scaling up initiatives like these can make a big difference: if the US reduced meat consumption by 50%, its the equivalent of taking 26 million cars off the road. We think thats damn hopeful.

Decision-makers on all levels can make it easier for us to eat better, by expanding access to food options that are good for our health, affordable, and climate-friendly. Nationwide, cities and school districts have adopted food purchasing policies that include environment, health and fair labor standards. The city of Chicago is a recent adopter of this Good Food Purchasing Program, and so the solutions-focus of the summit is the perfect place to discuss how food can move us toward climate goals. In the same breath that we discuss fossil fuels, we should be talking animal ag, or were missing a big part of the problem and a big part of the solution.

Yes, food is inherently personal. Its the cornerstone of holidays, it fuels high school athletes and long workdays, and it nourishes nursing mothers and growing children. And yes, Americans love meat and cheese. But more than that, we love our majestic national parks, family beach vacations and clean air and water for our children and grandchildren.

As individuals, we can make choices on how to better nourish our families, and as citizens, we can encourage local leaders to make choices that will allow us to enjoy our land and natural resources now and in the future.

James Cameron is a film-maker and deep-sea explorer. Suzy Amis Cameron is a founder of Muse School and Plant Power Task Force.

Read more: https://www.theguardian.com/commentisfree/2017/dec/04/animal-agriculture-choking-earth-making-sick-climate-food-environmental-impact-james-cameron-suzy-amis-cameron

Mass starvation is humanitys fate if we keep flogging the land to death | George Monbiot

The Earth cannot accommodate our need and greed for food. We must change our diet before its too late, writes Guardian columnist George Monbiot

Brexit; the crushing of democracy by billionaires; the next financial crash; a rogue US president: none of them keeps me awake at night. This is notbecause I dont care Icare very much. Its only because I have a bigger question onmy mind. Where is all the food going to come from?

By the middle of this century there will be two or three billion more people on Earth. Any one of the issues I am about to list could help precipitate mass starvation. And this is before you consider how they might interact.

The trouble begins where everything begins: with soil. The UNs famous projection that, at current rates of soil loss, the world has 60 years of harvests left, appears to be supported by a new set of figures. Partly as a result of soil degradation, yields are already declining on 20% of the worlds croplands.

Now consider water loss. In places such as the North China Plain, the central United States, California and north-western India among the worlds critical growing regions levels of the groundwater used to irrigate crops are already reaching crisis point. Water in the Upper Ganges aquifer, for example, is being withdrawn at 50 times its recharge rate. But, to keep pace with food demand, farmers in south Asia expect to use between 80 and 200% more water by the year 2050. Where willit come from?

The next constraint is temperature. One study suggests that, all else being equal, with each degree celsius of warming the global yield of rice drops by 3%, wheat by 6% and maize by 7%. These predictions could be optimistic. Research published in the journal Agricultural & Environmental Letters finds that 4C of warming in the US corn belt could reduce maize yields by between 84 and 100%.

The reason is that high temperatures at night disrupt the pollination process. But this describes just one component of the likely pollination crisis. Insectageddon, caused by the global deployment of scarcely tested pesticides, will account for the rest. Already, in some parts of the world, workers are now pollinating plants by hand. But thats viable only for the most expensive crops.

Then there are the structural factors. Because they tend to use more labour, grow a wider range of crops and work the land more carefully, small farmers, as a rule, grow more food per hectare than large ones. In the poorer regions of the world, people with fewer than fivehectares own 30% of the farmland but produce 70% of the food. Since 2000, an area of fertile ground roughly twice the size of the UK has been seized by land grabbers and consolidated intolarge farms, generally growing crops for export rather than the food needed by the poor.

While these multiple disasters unfoldon land, the seas are being sieved of everything but plastic. Despite a massive increase in effort (bigger boats, bigger engines, more gear), the worldwide fish catch is declining by roughly 1% a year, as populations collapse. The global land grab is mirrored by a global sea grab: small fishers are displaced by big corporations, exporting fish to those who need it less but pay more. About 3billion people depend to a large extent on fish and shellfish protein. Where will it come from?

All this would be hard enough. But as peoples incomes increase, their diet tends to shift from plant protein to animal protein. World meat production has quadrupled in 50 years, but global average consumption is still only half that of the UK where we eat roughly our bodyweight in meat every year and just over a third of the US level. Because of the way we eat, the UKs farmland footprint (the land requiredto meet our demand) is 2.4 times the size of its agricultural area. If everyone aspires to this diet, how exactly do we accommodate it?

Graph from Our World in Data.

The profligacy of livestock farming is astonishing. Already, 36% of the calories grown in the form of grain and pulses and 53% of the protein are used to feed farm animals. Two-thirds of this food is lost in conversion from plant to animal. A graph produced last week by Our World in Data suggests that, on average, you need 0.01m2 of land to produce a gram of protein from beans or peas, but 1m2 to produce it from beefcattle or sheep: a 100-folddifference.

Its true that much of the grazing land occupied by cattle and sheep cannot be used to grow crops. But it would otherwise have sustained wildlife and ecosystems. Instead, marshes are drained, trees are felled and their seedlings grazed out, predators are exterminated, wild herbivores fenced out and other life forms gradually erased as grazing systems intensify. Astonishing places such as the rainforests of Madagascar and Brazil are laid waste to make room for yet more cattle.

Because there is not enough land to meet both need and greed, a global transition to eating animals means snatching food from the mouths of the poor. It also means the ecological cleansing of almost every corner of theplanet.

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I see the last rich ecosystems snuffed out, the last of the global megafauna lions, elephants, whales and tuna vanishing. Photograph: Douglas Klug/Getty Images

The shift in diets would be impossible to sustain even if there were no growth in the human population. But the greater the number of people, the greater the hunger meat eating will cause. From a baseline of 2010, the UNexpects meat consumption to rise by70% by 2030 (this is three times the rate of human population growth). Partly as a result, the global demand for crops could double (from the 2005 baseline) by 2050. The land required to grow them does not exist.

When I say this keeps me up at night, I mean it. I am plagued by visions of starving people seeking to escape fromgrey wastes, being beaten back byarmed police. I see the last rich ecosystems snuffed out, the last of the global megafauna lions, elephants, whales and tuna vanishing. And when I wake, I cannot assure myself that it was just anightmare.

Other people have different dreams: the fantasy of a feeding frenzy that neednever end, the fairytale of reconciling continued economic growth witha living world. If humankind spirals into societal collapse, these dreams will be the cause.

There are no easy answers, but the crucial change is a shift from an animal- to a plant-based diet. All else being equal, stopping both meat production and the use of farmland to grow biofuels could provide enough calories for another 4 billion people anddouble the protein available for human consumption. Artificial meat will help:one paper suggests it reduces water useby at least 82% and land useby 99%.

The next green revolution will not be like the last one. It will rely not on flogging the land to death, but on reconsidering how we use it and why. Can we do this, or do we the richer people now consuming the living planet find mass death easier to contemplate than changing our diet?

George Monbiot is a Guardian columnist

Read more: https://www.theguardian.com/commentisfree/2017/dec/11/mass-starvation-humanity-flogging-land-death-earth-food

India expands payment scheme for Hindus to marry person of Dalit caste

Government is to scrap income ceiling for cash incentive but critics say slow uptake is due to millennia-old prejudice not economics

Indias government has expanded a scheme offering payment incentives to Hindus who marry members of the countrys poorest and most oppressed caste, the Dalits.

A scheme introduced in 2013 offered 250,000 rupees (2,900) to encourage Hindus from higher castes to marry members of the untouchable community, in the hope that it would help to remove the stigma of intercaste marriage and foster greater social cohesion.

To qualify, the annual income of the spouse from the high caste had to be less than 500,000 rupees (5,800).

The government envisaged about 500 such marriages annually, but less than 100 have taken place each year.

On Wednesday, the Ministry of Social Justice and Empowerment announced it would scrap the income ceiling, and said all couples in which one spouse is from the Dalit caste would receive the cash incentive.

Ancient prejudices against Dalits remain stubbornly entrenched in India. Marriages between the higher castes and Dalits are very rare, with the vast majority of Indians marrying within their own caste. Many Indians will not even eat with a Dalit.

Dalits were traditionally thought to fall outside the four main classes of caste that determined the shape of Hindu lives, from jobs and diets to marriage prospects.

As a result, they were considered impure and banished to the periphery of Indian society, suffering thousands of years of exclusion and extreme poverty that affirmative action programmes over the last 70 years have done little to address.

Officials believe the schemes low success rate so far is also due to a combination of other factors: the income ceiling and also lack of awareness of the scheme. Many Dalits contacted by the Guardian had never heard of it.

Rahul Sonpimple, 28, a sociology PhD student in New Delhi, had no idea about the scheme but said it was a waste of time.

Caste is not to do with money or wealth or materialism. If it were, then a poor Brahmin would happily marry a billionaire Dalit. But he wont, because it is about caste pride, pride in your birth, he said.

John Dayal, secretary general of the All-India Christian Council, said the scheme was fundamentally misconceived because it monetised hatred and attempted to use cash to end a millennia-old system which is rooted not in economics, but in prejudices.

I know of several intercaste marriages but they are all done in secret or under police or court protection, Dayal said. What we need is not cash incentives but a social upheaval to end discrimination against Dalits.

Crimes against Dalits show no sign of abating. The latest statistics from the National Crime Records Bureau show a rise of 5.5% between 2015 and 2016.

Michael Safi contributed to this report

Read more: https://www.theguardian.com/world/2017/dec/06/india-expands-payment-scheme-for-hindus-marry-person-dalit-caste

The sound of mega orgasms: the female composers taking music into intimate places

A soundtrack to an erotic feminist film, the crunch of crisps in your own mouth, a composition for strap-on and electric guitar meet the women who are making music and telling stories on their own terms

In the early 1990s, the accordionist and musical improviser Pauline Oliveros wrote the soundtrack for a feminist porn film called The Sluts and Goddesses Video Workshop. The film is presented and co-directed by Annie Sprinkle, a sex worker turned academic whose lecture covers everything from deep breathing and vaginal bling to STD prevention and mega orgasms. Along the way, we get a spectacular sonic counterpart of drones, glitches, bleeps, twangs and pulsations.

Conventional porn music this is not: no sultry saxophones, no oily bass guitars. Instead, Oliveros made sounds that are fun, tactile and inquisitive. If Sprinkles mission was to confront industry standards of what erotic looks like, freeing viewers to define their own tastes, Oliveros reminded us that the power to decide what music means should ultimately belong to the listener.

This autumn, in the wake of the allegations against Harvey Weinstein and others, a couple of things became urgently clear. We must listen more carefully to womens voices, and we must change the power structures that govern much of public and private life, including the arts.

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A screengrab from The Sluts and Goddesses Video Workshop (1992) by Annie Sprinkle and Maria Beatty Photograph: Vimeo

Pauline was empowering her listeners, says the writer Ione, the late Oliveross partner and regular collaborator. Sluts and Goddesses was not pornography, not if you mean the word in any pejorative or sleazy sense. It was about sexual freedom, showing that sexuality is a natural and wonderful thing for women. The sounds Pauline made were deeply sensual because they related to the body. Her music was always about the Earth, the body, being human, the cosmos.

The film gets a rare public screening this week at the London contemporary music festival, in a section termed (brace yourself) New Intimacy. Contemporary music has a long and tetchy history of labels, schools and isms, almost all coined by programmers or academics rather than artists themselves. New Intimacy seems a cheeky throwback to the contentiously named New Complexity and New Simplicity movements of the 1980s.

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Empowering listeners Pauline Oliveros. Photograph: Vinciane Verguethen

There is a particular irony to the new bit, given several of the works at LCMF are three or four decades old. But what about the intimacy? Modernism was about removing the body from art, says festival director Igor Toronyi-Lalic. About removing personal identity and prioritising science, abstraction and objectivity. With postmodernism, the body is reinserted into feminist art, queer theory. That is whats at the heart of the New Intimacy movement.

The series includes a work by Kajsa Magnarsson for strap-on and electric guitar; a piece by Claudia Molitor to be performed by audience members within their own mouths as they chew sweets, popcorn and crisps; and the 1965 film Fuses, in which Carolee Schneemann documents the most intimate moments of her relationship with composer James Tenney. Also in the mix is the pristine and ultra-sparse Second String Quartet by Wandelweiser composer Jrg Frey music so stripped back and delicate it can start to feel febrile, like the tender stuff left exposed after some kind of sonic disrobing. Aesthetically, its probably the diametric opposite to the sparkly dildos and nipple tassels of the film, but maybe the point is how these works share a potential to empower and turn the attention back on audiences.

Claudia Molitor has been exploring the haptic in music for nearly two decades, and welcomes the wide scope of New Intimacy. Its a provocation, right? Most of the time, women arent supposed to express ourselves in certain ways because its considered unbecoming, so maybe its good to put something out there that is unbecoming. If it makes people uncomfortable, thats all right. A lot of women spend quite a lot of their lives feeling uncomfortable. Anyway, its hardly new. Mozart said it with Cosi Fan Tutte: women have the same desires as men.

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Eva-Maria Westbroek in the opera Anna Nicole by Mark-Anthony Turnage in 2014. Photograph: Tristram Kenton for the Guardian

Composer and performance artist Jennifer Walshe likewise uses her work to deal with gender and identity. Her confrontational 2003 music theatre piece, XXX Live Nude Girls, featured Barbie dolls in all manner of sexual positions and scenarios of abuse. If you want to privilege the female gaze, she says, you have to privilege it at every level of production, right down to technical crews. Think of an opera like Anna Nicole. This was a work by Mark-Anthony Turnage, about the Playboy star Anna Nicole Smith. The librettist is a man, the composer is a man, the director was a man. Why arent women allowed to write their own stories?

Walshe also questions the potential in New Intimacy for exploitation or plain voyeurism. Sometimes I feel that women are forced into a position where they are only permitted to have a voice by articulating their most intimate details, she says. Memoirs by musicians like Viv Albertine, Kim Gordon, Carrie Brownstein, Kristin Hersh all of which are books I love get very deep into the personal in a way many memoirs by male musicians dont.

Is there the expectation that in telling their stories, they have to get into these details? That their stories are only worth being heard if they are explicit? Or, as women, is part of dealing with life being forced to deal with gender or sexuality in a way many of their male collaborators dont have to, which means its only natural to talk about it?

One lesson from Weinstein is that his alleged victims didnt speak out because the industry granted him a power that robbed them of their agency. We need to trust ourselves, wrote Mona Chalabi in the Guardian. The sickening allegations have reminded me just how important it is that we trust our instincts.

This also applies to the danger of glorifying artists. For centuries, we built up personality cults around composers made gods out of men like Mozart, Beethoven, Wagner, Britten and Stockhausen. These genius narratives might have let us believe we were accessing the divine when listening to Tristan und Isolde or Mittwoch aus Licht and so feel somehow aggrandised by proxy but if composers were supposed to be superhumanly talented, their means of production remained unattainable to the rest of us, and their behaviour potentially unaccountable. It was a recipe for alienation, for too much licence, for abuse.

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Red Note Ensemble perform 13 Vices by Jennifer Walshe and Brian Irvine at the New Music Biennial in Hull. Photograph: James Mulkeen

Pauline was very much not into all that, Ione says. All that genius crap. Just look at the collaborative, collegial, supportive way she worked with Annie and the group of women who made Sluts and Goddesses. Look at the way she improvised with anybody.

It seems contemporary music is moving increasingly in that direction. Gone are the towering iconoclasts of the 20th century. Instead, programmers from Huddersfield contemporary music festival to Glasgows Counterflows to LCMF are looking to provide nimbler, more personal experiences.

Its about getting us to relate to ourselves better, says Molitor, whose piece 10 Mouth Installationsincludes an instruction sheet suggesting the best order in which to eat the sweets, popcorn and crisps (Hula-Hoops to be precise). Its about not going for a big public statement where one person declares something and the audience laps it up. Its more of a negotiation: Im an individual, youre an individual, so lets all acknowledge our bodies and our presences in this space.

If contemporary classical music seemed a branch of the avant-garde too erudite for everyday gender politics, too esoteric to deal with the erotic, think again. With its flexible forms, exploratory sound worlds and playful intellectual provocations, this music is proving to have a special potential to redress the way we relate to status, to each other, to ourselves not only for those making music, but also for those listening.

Read more: https://www.theguardian.com/music/2017/dec/06/sound-of-mega-orgasms-female-composers-london-contemporary-music-festival-new-intimacy