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Alzheimers blood test could predict onset up to 20 years in advance

United States scientists state blood test can be 94% reliable in finding those at threat of the illness

A blood test that can discover indications of Alzheimer’s as much as 20 years prior to the illness starts to have a devastating result has actually been established by scientists in the United States.

Scientists at the Washington University School of Medicine in St Louis in Missouri think the test can recognize modifications in the brain suggestive of Alzheimer’s with 94% precision, while being more affordable and easier than a PET brain scan.

The outcomes of the research study, which was released in the journal Neurology on Thursday, represent a prospective advancement in the battle versus the illness.

“Right now we evaluate individuals for medical trials with brain scans, which is pricey and lengthy, and registering individuals takes years,” stated the senior author, Randall Bateman, a leading teacher of neurology.

“But with a blood test, we might possibly evaluate countless individuals a month. That indicates we can more effectively register individuals in scientific trials, which will assist us discover treatments quicker, and might have a huge effect on the expense of the illness in addition to the human suffering that opts for it.”

The scientists stated they had actually discovered a method to determine levels of the protein amyloid beta, an essential sign of Alzheimer’s, in the blood. They can then utilize such levels to forecast whether the protein has actually collected in the brain.

That analysis might then be integrated with 2 other significant Alzheimer’s threat elements– age and the existence of the hereditary alternative APOE4– to precisely recognize the pertinent modifications in the brain.

The scientists stated the clumps of protein start to form in the brain approximately twenty years prior to the start of the particular amnesia, recommending the tests might be utilized to anticipate Alzheimer’s years ahead of time.

However, the advantages of such screening would not be seen to their max degree up until treatments to stop the illness are established.

In January 2018 , a group of researchers exposed their deal with a test that utilized mass spectrometry strategies to recognize clients with a rogue peptide in their blood plasma, suggesting an accumulation of beta-amyloid in the brain.

The newest research study took a look at 158 individuals aged older than 50. All however 10 of the individuals in the brand-new research study were cognitively regular and each offered a minimum of one blood sample and went through one PET brain scan.

The scientists discovered that the blood tests provided the exact same outcomes as the PET scans 88% of the time, which was not satisfying. In order to enhance the precision, the researchers started including the other threat aspects, increasing the precision to more than 90%.

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Sentenced to prison without a crime: mental health patients locked up in New Hampshire

After 30 years, a New Hampshire males case might alter practice of moving non-criminal psychiatric clients to jail

Douglas Butler was puzzled. He believed his kid, Andrew Butler, had actually been moved to another, more safe and secure psychiatric health center. When he drove to the address of the protected psychiatric system on the borders of New Hampshire’s capital of Concord, he could not see anything that looked like a medical facility.

Instead, he saw the coils of razor wire and enforcing walls of the New Hampshire state jail for males.

“They declare it’s a psychiatric healthcare facility. It’s absolutely nothing of the kind,” stated the older Butler. “It’s a dang jail. That’s all it truly is.”

Butler, then 21, had actually been charged with no criminal activity. For the psychologically ill considered too much of a risk to themselves or others to stay atNew Hampshire medical facility– the state’s only psychiatric health center– that can imply a transfer to the protected psychiatric system (SPU) at the jail, where Butler was dressed in a jail one-piece suit and kept in singular confinement.

According to psychological health supporters, New Hampshire stands alone in the United States in warehousing involuntarily devoted psychological health clients in jail. There have actually been efforts to reform the system for several years now, however the state’s legislature never ever settled on the countless dollars required to construct a protected psychiatric center, leaving the jail SPU as the only choice for some clients.

The New Hampshire department of corrections has actually protected the system’s usage, stating clients get the very same level of care as they would at a psychiatric healthcare facility which clients get “remarkable treatment”.

But inside the SPU, clients are dressed like detainees. They are kept secured cells geared up with steel toilets and pieces working as beds. Cell doors have slots to get food. Their neighbours can be founded guilty felons. Guards patrol halls. Visitors are limited. Telephone call are tape-recorded. Mental health supporters promoting reform state medications considered important in the illegal jail economy are prohibited. Group treatment sessions are performed in cages. Like prisoners, clients can be subjected touse of force. There is no impression of liberty.

It is a plain contrast to a standard psychiatric medical facility setting.

“They are in most likely the worst location you can think of to be with a psychiatric crisis,” stated Frankie Berger, director of advocacy at the Arlington, Virginia-based Treatment Advocacy.

Butler’s journey to the New Hampshire state jail for guys started on a journey to Vermont with buddies in the summertime of 2017. As college kids in some cases do, they took hallucinogenic drugs. The results appeared to set something off in Butler. He was hospitalised in Vermont and when he returned house to New Hampshire, he wasn’t the exact same. He informed his dad it seemed like he was not in control of his actions. Ultimately, police officers discovered him going through the forest punching trees.

In a relocation his daddy supported, Butler was civilly dedicated to New Hampshire healthcare facility to get psychiatric treatment.

After a couple of months, Douglas stated Butler began ending up being significantly aggressive with the medical professionals. And at one point while he was going to, Butler took a swing at him. Douglas stated it wasn’t severe, simply “a tap on the nose”.

Hospital personnel did not see the occurrence so gently. They considered Butler a considerable risk to others and he was moved out of New Hampshire health center and into the SPU.

In ahabeas corpus petition submitted in 2015, Butler’s legal representative Sandra Bloomenthal composed: “He is kept in an optimal security jail. He is held as a psychological health client without remaining in a recognized health center, rejected contact sees with his daddy, rejected contact check outs with his lawyer, required to use jail clothes. He is locked down 23 hours a day. He has actually been tasered.”

She included: “The treatment he has actually gotten is uncommon and harsh penalty without having actually been founded guilty of a criminal activity and without any pending criminal procedure.”

It stays uncertain the number of civilly dedicated clients have actually wound up in the SPU over its more than 3 years of presence. The New Hampshire department of corrections did not give the Guardian’s ask for interviews and a trip of the center, nor did they react to a list of concerns.

In statement from 12 February, the SPU director, Paula Mattis, stated of 41 beds inhabited, 32 “are people whose transfer to the SPU originated from the justice system”.

In an interview with the Guardian, the New Hampshire health center CEO, Lori Shibinette, stated there had actually been 7 transfers of clients from her center to the SPU in 2015. She stated all of those moved in 2015 had actually been gone back to New Hampshire healthcare facility which there had actually been no transfers up until now this year.

Those moved, Shibinette stated, were usually clients who showed duplicated, premeditated or unforeseeable violence in addition to those whose self-harm efforts might not be managed. One client she explained would try to consume “anything she might get her hands on” from ceiling tiles to screws and pens.

Shibinette stated the SPU provided the very same level of care as New Hampshire health center, simply in a more safe and secure setting.

“SPU is a far more regulated environment,” she stated.

While Shibinette worried the SPU is a short-term step, some clients have actually been there for years. One client, Anthony Heath, was civilly devoted in 2016. His household states that after he made risks towards New Hampshire medical facility personnel, he was sent out to the SPU, where he has actually stayed for almost 3 years now.

The general variety of transfers appears little enough that the SPU program mostly prevented attention within the state and throughout the country.

Berger initially became aware of the SPU a couple of years earlier, when a New Hampshire costs intending to end the practice of sending out civilly dedicated clients there was passed along to her. As she reviewed the file, she believed there was a misconception.

“I believed there’s no possible situation– since it’s so unconstitutional– that what this expense is being utilized to address is a truth,” she stated.

The nature of the SPU was likewise a surprise to nurse Beatrice Coulter, who took a task there in 2015 with the understanding that she would be dealing with detainees. Her work in the SPU lasted just days, as she chose to give up when she understood that there were civilly devoted clients jailed there.

“I was definitely shocked when I understood that there was an entire population of clients there who were not prisoners,” she stated. “I did not wish to belong of this.”

After her stint at the SPU, Coulter partnered with the criminal justice reform activist Wanda Duryea to discovered Advocates for Ethical Mental Health Treatment, a group that united households of civilly dedicated clients in the SPU and promoted reform.

New Hampshire Disability Rights Centerstaff lawyer Andrew Milne stated that couple of looking for psychiatric aid in the state most likely understand that they might possibly wind up in jail.

“I believe it would be a huge surprise to many people that you might be confessed to the state health center due to the fact that of signs of mental disorder and discover yourself moved to the jail and dealt with as a prisoner– and after that discover yourself stuck there for years or months longer than any person believes you require to be there,” he stated.

Now, more than 30 years after the SPU was developed and a law was passed permitting civilly dedicated clients to be sent out there, the days of the practice might quickly be numbered.

Butler’s case struck home in the state, triggering demonstrations and formerly hidden press protection as an attorney demanded his release.

In June, Butler was moved back to the New Hampshire healthcare facility after almost half a year in the SPU. Quickly after, he was enabled to return house.

New The New Hampshire medical facility in Concord. Photo: Josh Wood/The Guardian

The restored spotlight on the SPU saw calls to do something about it to see other civilly dedicated clients launched. Quickly, the Republican guv, Chris Sununu, indicated his assistance for ending the transfer of civilly dedicated clients to the SPU.

In providing his budget plan last month, Sununu proposed a 60-bed safe and secure psychiatric center to be constructed at New Hampshire medical facility, a relocation that would get rid of civilly dedicated clients from the jail.

“Moving the civilly devoted population in the SPU out of the state jail has actually been an issue-in-waiting for a number of years. It is time to get it done– which is what I am going to do so we can treat our clients with the self-respect they should have,” the guv informed the Guardian.

But after Butler’s experience, his dad stays untrusting of the state. He lost guardianship of his kid throughout the experience and now concerns the health care he gets at the orders of a state that jailed his boy.

“In a method now we’re still type of in jail as we do not have control over his psychological health treatment,” he stated.

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The lost art of concentration: being distracted in a digital world

We check our phones every 12 minutes, often just after waking up. Always-on behaviour is harmful to long-term mental health, and we need to learn to the hit the pause button

It is difficult to imagine life before our personal and professional worlds were so dominated and switched on via smartphones and the other devices that make us accessible and, crucially, so easily distractible and interruptible every second of the day. This constant fragmentation of our time and concentration has become the new normal, to which we have adapted with ease, but there is a downside: more and more experts are telling us that these interruptions and distractions have eroded our ability to concentrate.

We have known for a long time that repeated interruptions affect concentration. In 2005, research carried out by Dr Glenn Wilson at Londons Institute of Psychiatry found that persistent interruptions and distractions at work had a profound effect. Those distracted by emails and phone calls saw a 10-point fall in their IQ, twice that found in studies on the impact of smoking marijuana. More than half of the 1,100 participants said they always responded to an email immediately or as soon as possible, while 21% admitted they would interrupt a meeting to do so. Constant interruptions can have the same effect as the loss of a nights sleep.

Nicholas Carr picked up on this again in an article in the Atlantic in 2008, before going on to publish his book The Shallows two years later. Immersing myself in a book or a lengthy article used to be easy, he wrote. My mind would get caught up in the narrative or the turns of the argument, and Id spend hours strolling through long stretches of prose. Thats rarely the case any more. Now my concentration often starts to drift after two or three pages. I get fidgety, lose the thread, begin looking for something else to do. I feel as if Im always dragging my wayward brain back to the text. The deep reading that used to come naturally has become a struggle.

Those distracted by emails and phone calls saw a 10-point fall in their IQ. Illustration: Andrea Ucini

The impact of interruptions on individual productivity can also be catastrophic. In 2002, it was reported that, on average, we experience an interruption every eight minutes or about seven or eight per hour. In an eight-hour day, that is about 60 interruptions. The average interruption takes about five minutes, so that is about five hours out of eight. And if it takes around 15 minutes to resume the interrupted activity at a good level of concentration, this means that we are never concentrating very well.

In August 2018, research from the UKs telecoms regulator, Ofcom, reported that people check their smartphones on average every 12 minutes during their waking hours, with 71% saying they never turn their phone off and 40% saying they check them within five minutes of waking. Both Facebook and Instagram announced they were developing new tools designed to limit usage in response to claims that excessive social media use can have a negative impact on mental health.

Continuous partial attention or CPA was a phrase coined by the ex-Apple and Microsoft consultant Linda Stone. By adopting an always-on, anywhere, anytime, any place behaviour, we exist in a constant state of alertness that scans the world but never really gives our full attention to anything. In the short term, we adapt well to these demands, but in the long term the stress hormones adrenaline and cortisol create a physiological hyper-alert state that is always scanning for stimuli, provoking a sense of addiction temporarily assuaged by checking in.

Myth of multitasking

Multitasking, or switching rapidly between conflicting activities? Photograph: Cultura Creative/Alamy

With our heavy use of digital media, it could be said that we have taken multitasking to new heights, but were not actually multitasking; rather, we are switching rapidly between different activities. Adrenaline and cortisol are designed to support us through bursts of intense activity, but in the long term cortisol can knock out the feel-good hormones serotonin and dopamine in the brain, which help us feel calm and happy, affecting our sleep and heart rate and making us feel jittery.

It would seem then that this physiological adaptation, fostered by our behaviour, is a predominant reason for the poor concentration so many people report. The fact that we are the cause of this is, paradoxically, good news since it hands back to us the potential to change our behaviour and reclaim the brain function and cognitive health thats been disrupted by our digitally enhanced lives. And this may even be more important than just improving our levels of concentration. Constant, high levels of circulating stress hormones have an inflammatory and detrimental affect on brain cells, suggests the psychiatrist Edward Bullmore, who has written about the link between inflammation and depression in his latest book, The Inflamed Mind. Depression, along with anxiety, is a known factor in knocking out concentration.

Put simply, better concentration makes life easier and less stressful and we will be more productive. To make this change means reflecting on what we are doing to sabotage personal concentration, and then implementing steps towards behavioural change that will improve our chances of concentrating better. This means deliberately reducing distractions and being more self-disciplined about our use of social media, which are increasingly urgent for the sake of our cognitive and mental health.

It takes about three weeks for a repeating behaviour to form a habit, says Jeremy Dean, a psychologist and the author of Making Habits, Breaking Habits. Getting into a new habit will not happen overnight and adaptation can be incremental. Start by switching off smartphone alerts, or taking social media apps off your phone, then switching off the device for increasingly long periods.

Practise concentration by finding things to do that specifically engage you for a period of time to the exclusion of everything else. What is noticeable is that you cannot just go from a state of distraction to one of concentration, in the same way that most of us cannot fall asleep the minute our head hits the pillow. It takes a bit of time and, with practice, becomes easier to accomplish.

The five more rule

Meditation can restore equilibrium. Photograph: Alamy

This is a simple way of learning to concentrate better. It goes like this: whenever you feel like quitting just do five more five more minutes, five more exercises, five more pages which will extend your focus. The rule pushes you just beyond the point of frustration and helps build mental concentration. Its a form of training as well as being a way of getting something accomplished.

Sitting still would seem an easy thing to achieve. But it is harder than it sounds. It is akin to meditation, which can be a useful way to improve concentration. In this case, however, just get in to a comfortable, supported position and sit still and do nothing for five minutes. Use it as a pause between activities. Of course, if you already practise meditation, combine this with breathing for a quick time out.

Meditation and focus

Switching off from both external and internal distractions does not come easily. Learning how to be more mindful, practising mindfulness or meditation, can all help facilitate greater concentration, not least because feeling calmer restores equilibrium and focus.

Most of us breathe poorly: we tend to over-breathe, taking three or four breaths using only the upper part of our lung capacity, when one good breath using the lungs more completely would serve us better. This shallow breathing is very tiring, not only because we expend unnecessary muscular energy, but because we reduce our oxygen intake per breath.

In its extreme form, over-breathing becomes hyperventilation, which can trigger panic attacks. In all mindfulness or meditation practice, breathing is key. So its wise to learn good techniques first. A daily practice, starting with 10 minutes and building on it, means that the ability to take some restorative time out will also be available to you:

  • Lie comfortably on the floor, knees bent, chin tucked in what Alexander Technique teachers call the constructive rest position or sit upright in a chair, legs uncrossed, feet flat on the floor.

  • Consciously relax your neck and drop your shoulders, rest your arms by your sides with your palms turned upwards.

  • Breathe long and gently through your nose, into your belly until you see it gently rise, for a slow count of five.

  • Pause, and hold that breath for a count of five, then gently exhale through your mouth for another count of five.

  • While doing this, try to clear your mind of all other thoughts, or if this is difficult close your eyes and visualise a pebble dropping into a pool of water and gently sinking down.

  • Repeat this breathing cycle 10 times; then see how your regular breathing adjusts.

  • You can also use this breathing technique at any time you feel tense or stressed, or as the basis of any meditation.

We all need to take time out, so set a timer to signal a break, or use an app such as Or you can just play a favourite music track, knowing that it will give you a set amount of time in which to press pause and do nothing.

Another effective technique for boosting concentration is counting backwards. Counting backwards in sevens from 1,000 might sound like an exercise in exasperation, but it does require you to concentrate very hard: try it. It requires persistence and the use of different skills, which for some may include visualising the numbers as you count. Whatever it takes, keep at it for long enough to completely focus and youll also have the added bonus of finding that you have, temporarily, cleared your head of everything else for a few minutes.

Similarly, spelling words backwards is a good way to focus: start with words that are easy: dog, box, cup, and then build up to longer words including nouns and more abstract words such as cushion, blonde, effort, number increasing the length and complexity of the word. Again, this is an exercise that can be built on.

Another way to focus is to sit in a comfortable position and find a spot on the wall to stare at. This works best when you have no conscious association with it to distract you so, a black spot about two inches in diameter at eye level works well. Focus all your attention on this for around three minutes to start with (you can set a timer if this helps) and let any thoughts that arise drift away, constantly returning your focus to the spot.

Anyone familiar with meditation will recognise this technique. If it helps to notice your breath, slow and steady this too, but always make your visual focus on the spot the priority. Practiced regularly, this can become so familiar it creates a resource on which to draw, enabling you to consciously refocus at will, even without the visual prompt.

Watching the clock

An old-fashioned clock face with hands and a second hand is needed for this. Starting with the second hand at the 12, focus intently on its progress around the clock face without allowing any distracting thoughts to intervene. Every time your concentration is interrupted by a stray thought, wait until the second hand is at the 12 again, and start again. Its harder than it sounds and can feel very frustrating initially, but once the ability is learnt its easy to access again and again, whenever you need to create a more concentrated state of mind.

We access so much information through what we see, but often we are not particularly observant about what we are looking at, leaving us with just an impression or feeling about what weve seen. In an effort to improve concentration skills, its worth considering how looking at and then visualising something, can reinforce concentration. Start by paying more attention, whether this is looking at a picture in an art gallery, or taking a bus ride, or just enjoying the scenery from a window. You dont have to commit an exact graphic image to memory, but engage with it, notice details, reflect on it and, within a short time, you will be able to close your eyes and visualise it. There is no right or wrong way to do this, its just an opportunity to practise focus and improve concentration.

Theres a huge difference between hearing and listening. Learning to listen well starts quite self-consciously but will also become a useful habit. You can use music to practise this, the length of a track giving you between three to five minutes (or longer) on which to focus. Really listen to the nuances of the music, its notes, cadences, instruments used, lyrics. Music is often just a background noise but real, complicated musical notation can be more than just pleasurable, it can be a real boon to helping relearn concentration skills.

Physical exercise

For any extended period of exercise whether it be yoga, playing a team sport or dancing the engagement of the brain with the body is also an exercise in concentration. Regular exercise also activates the body and this is beneficial for the brain.

A Dutch study of schoolchildren published in the Journal of Science and Medicine in Sport in 2016 showed that interspersing lessons with a 20-minute stretch of aerobic exercise measurably improved attention spans in the children that participated. Another 2014 study from the American Academy of Paediatrics, on the benefits of exercise in 7 to 9-year-olds, not only found that the childrens physical health improved as they got fitter, but also their brain function, cognitive performance and executive control.


Lack of sleep affects concentration at work. Photograph: Sam Edwards/Getty Images

Poor sleep and being chronically under-slept affects concentration, while also reinforcing those stress hormones to compensate, making it a bit of a vicious circle. Improving sleep cannot happen overnight, particularly if it is a chronic problem, but taking measures to improve this will yield results over a period of weeks, rather than days.

One place to start is clearing your bedroom of TVs, computers and other technology. Although any type of light can inhibit sleep, research has shown that light towards the blue end of the spectrum is especially effective at keeping you awake because it stimulates the retina in the eye and inhibits the secretion of melatonin from the pineal gland in the brain.

Computer screens, tablets, smartphones, flat-screen TVs and LED lighting all emit large amounts of blue light, and it is important to avoid these before trying to sleep. Around 80% of people routinely use these devices running up to bedtime, and among 18 to 24-year-olds this figure increases to 91%, according to research carried out by Prof Richard Wiseman.

Amber-tinted glasses can cut out glare, and it is also possible to fit screens with commercially produced blue-light blocking filters. Another solution, of course, is to avoid all electronic devices before bed in order to help avoid insomnia and improve sleep.

Reading for pleasure

One thing that many people who feel they have lost the ability to concentrate mention is that reading a book for pleasure no longer works for them. We have got so used to skim reading for fast access to information that the demand of a more sophisticated vocabulary, a complex plot structure or a novels length can be difficult to engage with. Like anything, single-minded attention may need relearning in order to enjoy reading for pleasure again, but close reading in itself can be a route to better concentration. To help that, read from an actual book, not a screen: screens are too reminiscent of skim reading and just turning pages will slow your pace. Read for long enough to engage your interest, at least 30 minutes: engagement in content takes time, but will help you read for longer.

Digital apps

Somewhat ironically, digital apps may have their place in monitoring, managing or restricting digital time, but bear in mind that they still keep you connected to digital devices. Better perhaps to wean yourself away from excessive digital use by doing something alternative: read a book, go to a movie (where turning off phones is required), take a walk, eat a meal without checking basically restore some sort of self-discipline through the benefit of alternate activities.

But if you must turn to a digital solution to solve a digital problem, try these: track usage with Moment; access Facebook limiter; go Cold Turkey; try Stay On Task; use the App detox blocker; or break phone addiction with Space.

Harriet Griffey is the author of The Art Of Concentration, published by Pan Macmillan at 10.99

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‘I try to bury that pain’: Rohingya refugees on the trauma they carry

Award-winning photographer Robin Hammond says survivors of ethnic cleansing in Myanmar carry deep psychological scars

One of lifes greatest misconceptions is that time is a healer. A year ago, the ethnic cleansing perpetrated by the Myanmar military against the Rohingya sparked a massive refugee crisis. Nearly a million Rohingya those who escaped the flames and executions are now living in camps in Bangladesh. Many of them were raped, most saw loved ones killed, thousands arrived wounded. This monsoon-soaked corner of Bangladesh is among the most densely populated with people affected by trauma and post-traumatic stress disorder (PTSD).

Here, time has not healed.

Fleeing flames and bullets, the Rohingya had little time to gather their possessions. Crossing monsoon-swollen rivers and trekking through sucking mud, what they held onto tightly were their very young, their very old, their injured, and their religion.

The Rohingya are a Muslim minority in Buddhist Myanmar. Their religion and the fact they speak a different language has contributed to the perception they are foreigners or illegal immigrants. After decades of marginalisation and persecution, they have clung onto their faith.

Johura Begum, 12, lost 14 of her 16 family members when the Myanmar military attacked her village. All photographs: Robin Hammond/Witness Change/MSF

In the Bangladesh refugee camp where hundreds of thousands of Rohingya live, mosques have been built. So have Islamic schools. On an empty white World Food Programme sack, 12-year-old Johura Begum sits reading the Quran in this bamboo-walled madrasa, obediently reciting versus in Arabic. She sits slightly apart from the other girls, who giggle covering their faces with their scarves when a camera is raised to take their picture. Johura doesnt laugh with them. That kind of laughter is not part of her life. Not since she watched 14 of her 16 family members be killed.

Nightmares take her back to the execution of her parents and siblings. But her most regular dream is of eating a meal with her mother and sister in their Myanmar village.

What food do you like? I dont feel hungry. Ever? If I feel very hungry I have a little rice. Why dont you enjoy eating? When I think of my parents I dont feel good eating. Do you think about them often? Yes. I do. With every breath I take.

I do not feel peaceful, Johura says.

Mental illness does not translate into the Rohingya language. Instead they talk about a peaceful state of mind to express wellbeing. Un-peaceful minds are troubled, depressed, anxious, traumatised.

The Rohingya have more reason than most not feel at peace.

The severity of the violence they have faced is difficult to comprehend. There have been many accounts of men being rounded up and killed. Women have been raped. Some women and children have been killed too.

Every single moment I remember this

Rohima Khatuns story is typical. After encircling her village, the Myanmar military started burning houses. Through the smoke and heat strode the uniformed executioners and rapists. They went house to house and shot the men. Rohima saw her husband killed. The women were gathered in the village school. Rohima, five months pregnant, held her four-year-old to her chest, and her six-year-old to her side. The older of the two was screaming. A soldier marched forward, picked him up, and threw him into the burning flames of a house.

Rohima Khatun comforts her son who has a fever

Then the raping began.

Somehow Rohima, in a state of shock, managed to slip through the smoke and into the jungle. She saved herself, her four-year-old, and her unborn child.

Every single moment I remember this, she says. And I get emotional, because I lost my neighbour, my husband, my child, my relatives.

While the physical wounds of the surviving Rohingya have healed, the psychological scars remain. Few have been left unscathed.

Refugee camps are what some organisations working in mental health call disabling environments. It is really hard when they are living in the camp to be able to cope, says Jodi Nelan, Mdecins Sans Frontires (MSF) mental health activities manager. So a lot of people find it difficult to move forward.

A group of Rohingya children

Nelan heads a team trying to help people get back on their feet. They can learn to put their lives back together, she says. They do that by relying on coping skills. We can help them. A team of MSF counsellors has carried out 5,700 individual consultations and just under 12,000 group sessions.

In the most recent months MSF psychologist Shariful Islam has seen a shift, from symptoms indicating trauma to depression, anxiety, hopelessness and domestic violence.

They say: I dont have any hope and most of the time the scenery comes to my mind, how they tortured me, and how they killed my mother, how they killed my very small child. And when I remember all of this I cant keep control of myself and how I behave. Sometimes I beat my family member. We are noticing that this kind of patient is increasing significantly.

Some families have been in the camp since 1991 and despite the difficulties, aspects of normal life continue

Heightened aggression is associated with PTSD and some victims of violence are developing mental health issues that see them perpetrate abuse. When societies and the connections that bind them are ripped apart, piecing them back together rarely results in full harmony.

Abdul Hafez, 47, fled the attacks by the Myanmar military in September 2017

The situation differs for men and women. Women can still be carers and mothers, and run affairs inside the house. In this conservative culture, men are expected to be protectors and providers. Unable to work, and watching their families live off handouts, many feel useless their role and identity taken from them.

Abdul Hafez, 47, used to be a farmer but his life has been turned upside down. I cant provide the things that my women and children are looking for, he says.

Losing his sense of self has added to the trauma he lives with. I often remember what happened, I try not to be angry, sad, frustrated I try to bury that pain and sleep more.

The suffering here is immense, but walking through the camp, it is evident how much life there still is here. Children are born, couples get married, boys play football, girls apply makeup. The vegetable market is busy, the call to prayer reminds the devout to go to mosque, little children all over the camp chase foreigners shouting bye bye, bye bye, laughing like its the funniest thing ever. The resilience of humanity, the ability to find light and peace in even the darkest places, is on display.

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About the boys: Tim Winton on how toxic masculinity is shackling men to misogyny

In an excerpt from a speech about his brand-new book The Shepherds Hut, the author states it is males who have to step up and free young boys from the race, the video game, the battle

I do not have any grand theory about masculinity. I understand a bit about young boys. Due to the fact that I’m at the beach and in the water a lot, partially.

As an internet user you invest a great deal of time bobbing about, awaiting something to occur. Ultimately, you get talking. Or you pay attention to others talking. And I invest my work days alone, in a space with individuals who do not exist, so these maritime discussions comprise the bulk of my social life. And the majority of individuals in the water are below me, some by 50 years or more.

I like the teasing and the joking that goes on, the shy unbalanced discussions, the fitful minutes of shared confusion and interest. A great deal of the time I’m simply listening and viewing. With love. Extravagance. Amusement. Frequently puzzled, often frightened. Intrigued, however cautious, naturally, not to appear too interested. And the terrific thing about aging– something lots of ladies will comprehend– is that after a specific age you end up being unnoticeable. And for me, after years of being much too noticeable for my own convenience, this late life waterborne obscurity is a present.

There are a lot more ladies in the water nowadays, and hallellujah for that; I cannot inform you how heartening this is. I desire to focus on the kids for a minute. For exactly what a secret a kid is. Even to a grown guy. Possibly particularly to a grown guy. And how simple it is to forget exactly what gorgeous animals they are. There’s a lot about them and in them that’s beautiful. Stylish. Dreamy. Susceptible. Qualities we either do not see, or merely blind ourselves to. You see, there’s fantastic native inflammation in kids. In young boys, as much as in ladies. So frequently I see kids having the inflammation shamed out of them.

Boys and boys are so regularly anticipated to betray their much better natures, to smother their consciences, to renounce the very best of themselves and send to something low and indicate. As if there’s just one method of being a chap, one legitimate analysis of the part, the function, if you like. There’s a continuous pressure to get, to pull on the uniform of misogyny and sign up with the Shithead Army that implements and cops sexism. And it grieves me to state it’s not simply males pushing those kids into service.

These young boys in the browse. The important things they state to me! The things I hear them stating to their mates! A few of it makes you wish to hug them. A few of it makes you wish to weep. A few of it makes you embarrassed to be a male. Specifically the things they feel entitled or required to state about ladies and women.

What I’ve pertained to discover is that these kids are forecasting and practicing. Attempting it on. Practicing their masculinity. Forecasting their speculative variations of it. And wordlessly trying to find hints the entire time. Not simply from each other, however from older individuals around them, particularly the guys. Which can be heartbreaking to witness, to inform you the fact. Since the feedback they get is so damn unhelpful. , if it’s well-meant it’s half-hearted weak often frequently.. Due to the fact that excellent males do not constantly stick their necks out and make an effort.

True, the chaps around me in the water exist, like me, for reprieve, to get away intricacy and duty for an hour or more, to conserve themselves from freaking in their working lives, however their dignified silence in action to misogynistic garbage talk permits other messages, other harmful postures to thrive. Frequently, in my experience, the methods of guys to young boys do not have all conviction, they do not have a sense of obligation and gravity. And I believe they do not have the strength and coherence of custom. Regretfully, modernity has actually cannot change conventional codes with anything specific, or benign or meaningful. We’re entrusted worths that are recurring, fuzzy, sniggeringly conspiratorial or unintentional.

We’ve scraped our culture bare of routine paths to their adult years. There are great deals of factors for having scorched and clear-felled our own customs considering that the 1960s, and a few of them are great factors. I’m not sure exactly what we’ve changed them with. We’ve left our youths to take care of themselves. We keep a type of indulgent, patronising, approval of initiation rites in other cultures, consisting of those of our very first individuals, however the hardship of mainstream contemporary Australian routines is impressive.

What are we entrusted to? The sly very first beer your uncle slips you. The 18th birthday celebration where the keg is the icon. Perhaps the B&S ball, if you reside in the bush. Beverage, very first root, very first bog-lap in your mum’s Corolla. Call me a snob, however that strikes me as quite thin things. This, definitely, is cultural impoverishment. And in such a thriving nation. To my mind, that’s salt increasing to the surface area, poisoning the future.In the lack of
specific, widely-shared and improving initiation rites, boys in specific are required to make themselves up as they go along. Which normally implies they put themselves together from extra parts, and the things closest to hand has the tendency to be malfunctioning and inexpensive. Which’s dangerous.Toxic masculinity is a concern to males. I’m not for a minute recommending ladies and males suffer similarly from misogyny, since that’s plainly and essentially not real. And no one has to hear me mansplaining on the topic of the patriarchy. I believe we forget or merely do not see the methods in which males, too, are shackled by misogyny. It narrows their lives. Misshapes them. Which sort of damage radiates; it takes a trip, simply as injury is ingrained and journeys and metastasizes in households. Slavery needs to have taught us that. The Stolen Generations are still teaching us. Misogyny, like bigotry, is among the terrific engines of intergenerational injury.

A guy in manacles does not totally comprehend the risk he postures to others. Even as he’s raving versus his bonds. Specifically as he’s raving versus his bonds. When you’re reproduced for proficiency, when you’re trained to combat and withstand and reduce compassion, how do you discover your method a world that can not be mastered? How do you live a life where everybody must ultimately come and give up to terms? A lot of males are blunt instruments. Otherwise understood, I think, as tools. They’re just not fit for function due to the fact that of bad training. Since life is not a race, it’s not a video game, and it’s not a fight.Can we wean young boys off machismo and misogyny? Will they ever give up the race, the video game, the battle, and sign up with the dance? I hope so. Since freedom– a procedure of disarmament, reflection
and renewal– isn’t really simply preferable, it’s frantically required. In our houses, in organisation, and plainly, and a lot of plainly of all, in our politics.

Boy ‘The hardship of mainstream contemporary Australian routines is impressive,’ composes Winton. Picture: Andy Andrews/Getty Images

Children are born wild. Which’s stunning, it’s marvelous, despite gender. Even when they’re feral animals, kids are tanks of inflammation and compassion. Some do turn into savages. And unfortunately the majority of those are young boys. They’re trained into it. Since of overlook or extravagance. When we fulfill them in the street, and have them in our class, and carry them into the courts, we recoil from them in scary and disgust. Our detention centres and prisons are heaving with them. These wild colonial kids, they’re a horror to Australia. Genuine and pictured. I fret about our revulsion for them, our desire to eliminate them from awareness for their noncompliance, their errors, or their devoted adherence to the scripts that have actually been composed for them.

Boys require aid. And, yes, guys require repairing– I bear in mind that. Males show up in our neighborhood on the coattails of a practically limitless chain of unexamined advantage. I do not reject that for a 2nd. Patriarchy is chains for young boys, too. It injures them. If they’re the last to see, even. If they benefit from it, even. And their disfigurement decreases the supreme potential customers of everybody, anywhere we are on the gender spectrum. I believe we have to confess this.

But prior to we even get to that point, we need to acknowledge the uncomfortable, implacable reality of their presence, specifically those who most anger our perceptiveness. We must withstand our impulse or our ideological desire to cross the street to prevent them, our impulse to shut them down and shut them out and lastly lock them up. We have to have greater expectations of them. Supply much better modelling for them.

But prior to any of that is possible we have to address them. Yes, kids require their unexamined opportunity cut. Simply as they require particular proscribed advantages and behaviours provided to them. The very first action is to see them. To discover them worthwhile of our interest. As topics, not things. How else can we wish to take duty for them? And it’s guys who have to step up and lastly take their complete share of that duty.

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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 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.

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 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

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