15 September 2023. Mental health | Mobility
Developing our understanding of depression // ‘Free riders’ or e-bike ‘vandals’? It depends on what transport is for.
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1: Developing our understanding of depression
There’s a long review in the Guardian of two books on depression that challenge a lot of our notions both of what causes it and what we should do to help. Since depression is generally on the increase (even if we don’t fully understand why), and is a major cause of suicide, it’s worth spending some time on this. The books are Breaking Through Depression, by the American researcher Philip Gold, and The Balanced Brain by Camilla Nord, who’s based in Cambridge: the review is by science writer David Robson.
The starting point here is that the notion that depression is caused by a chemical imbalance in the brain has largely been discredited. This theory, that emerged in emerged in the 1990s, said that the symptoms of depression were caused by the lack of a “neurotransmitter” in the brain called serotonin. Antidepressant pills such as Prozac corrected this imbalance. However,
Last year, an influential review of the available data concluded that there was no clear evidence to support the theory, and the ensuing headlines left many bewildered about who or what to believe.
The two books attempt to fill this gap.
One of Gold’s observations is that the notion that depression is a form of “medicalised sadness” is wrong. He writes that
”true sadness is often associated with cherished, loving memories of, for instance, a lost loved one, combined with grief over their loss, and, at times, a bittersweet feeling encompassing both the bounties of life and the harsh reality that all relationships must come to an end”.
But these feelings are not available to someone who is suffering from depression. Instead “emotional repertoire is constricted to ‘a deadening litany of self-excoriation and hopelessness’”.
(Art therapy case study: The client Simon's drawing of his general depressive mood. Source: https://arttherapyresources.com/, via Wikipedia. CC BY-SA 4.0)
This has serious effects on one’s life outcomes. For one-fifth of depression sufferers, it is also associated with diabetes, strokes, osteoporosis, and coronary artery disease. It also knocks ten years off life expectancy, on average. This isn’t just a mental illness.
Gold’s model here is that depression is a result of a stress response that has gone awry. (Nord has a slightly different perspective). What he means by this is that in a dangerous situation it is a normal human response to focus on the danger. There are a whole lot of psychological and physical responses that are associated with this. But they go after the threat has passed:
For many people with depression, however, the brain’s alarm bells keep ringing long after a real threat has passed. It continues to look for potential signs of danger or hostility while ignoring things that might bring reward... Living in a state of permanent stress can result in brain-cell death and a reduced ability to form new neural networks, which leaves the person locked in their doom-laden thinking. For this reason, Gold describes depression as a neurodegenerative disease, and says that any effective treatments will need to undo this damage.
Nord suggests that it is more complex than this. For example, not every person with depression shows signs of stress responses such as “heightened inflammation”. Even for those showing signs of inflammation, the causes may lie in different parts of the immune system for different people.
Cognitive causes of depression are similarly complex:
One compelling explanation of depression concerns the basic ways that the brain learns from its experiences and predicts the future, but the exact nature of the problem will vary from patient to patient. Some people’s brains may place too much focus on negative outcomes; another person’s brain may fail to predict potential rewards. Either way, the overall outcome may be a more pessimistic and frightening view of the world that throws someone’s life into disarray.
But even if the chemical imbalance theory is not right, this doesn’t mean that anti-depressants are useless. The data suggests that they work better than placebos.
Nord says that this is because antidepressant drugs help to correct the fundamental biases in someone’s perceptions of the world. For example,
People with depression are more likely to see anger, and less likely to see happiness, in neutral facial expressions – but in many patients, this tendency begins to disappear after they have taken just one antidepressant pill.
Gold notes the studies that show that existing antidepressant pills encourage the birth of new brain cells and neural connections. These two explanations may in practice be different descriptions of the same thing. And the new kid on the anti-depressive block, psilocybin, has similar effects. (I have written about psilocybin here before).
Nord suggests that throwing open the doors of perception may help to reset the brain’s predictions, immediately breaking someone out of their bleak worldview. For Gold, it’s all about restoring connectivity between different brain regions and undoing neurological damage.
So far, in trials, psilocybin seems to work with a wide range of patients and with very few side effects.
And in general, both books suggest a whole range of emerging treatments, including other psychedelic drugs and forms of brain stimulation. It’s possible that we are getting to a point where we can tailor treatments to individuals, using genetic testing and brain imaging, although I have been reading about this kind of individualised medicine for a long time now without seeing much of it in health care. If psychedelics work as well as they so far seem to, perhaps we don’t need to be that complicated.
There was a paragraph in here that did catch my eye, although I’d need to know more about it:
One compelling explanation of depression concerns the basic ways that the brain learns from its experiences and predicts the future... Some people’s brains may place too much focus on negative outcomes; another person’s brain may fail to predict potential rewards. Either way, the overall outcome may be a more pessimistic and frightening view of the world.
As a futurist, I wondered if this might also be true, if only metaphorically, of how some organisations also fail to address the future.
2: ‘Free riders’ or e-bike ‘vandals’? It depends on what transport is for.
It turns out that if you start one of Lime’s ‘shared’ e-bikes in a particular way, you can break their locking mechanism and get a free ride. The people who have discovered this are London teenagers, and they have shared how to do it on social media.
It’s not a perfect solution to free transport: the bikes are heavy, and if you start them like this, you don’t get any help from the battery. The ‘click-click’ sound that the bikes make in this mode has been called the ‘new sound of the city’ by the journalist Peter Walker.
(Image: Westminster City Council)
In a piece on her Oversharing newsletter, Ali Griswold reviews what’s happened here. As you can imagine Lime is not pleased, although that is probably the least of this story. But since fairness demands it, as Griswold notes:
Riding a Lime bike like this violates the company’s user agreement, which warn users not to “tamper with, vandalize or try to gain unauthorized access to our Services.”
The company has described this use of their bikes as “criminal damage” and “vandalism”:
“We are working with the police and local schools to identify, limit and warn against it. We are also in contact with social media platforms, which bear the responsibility of removing criminal content like this if shared by its users.” In a written report for local government earlier this summer, Lime said it had “contacted more than 20 local London schools to remind pupils that vandalism of Lime vehicles is a criminal offence.”
This is all pretty problematic stuff, of course. For one thing, the riders aren’t responsible for a badly designed bike. That’s all down to Lime. And using them, even in breach of Lime’s user agreement, hardly constitutes vandalism.
Further: You can’t even be a ‘user’ of a Lime bike unless you’re 18, so it’s not clear how you would be breaking their agreement. And although Uber says that adults (i.e. over-18s) can rent non-electric bikes on behalf of those who are over 16, Griswold checked and discovered that there are no non-electric bikes on the platform. “Oh wow, good find”, said a company spokesperson.
And one more point here:
By choosing words like “criminal” and “vandalism” to describe the behavior predominantly of kids and teens, many of whom are minorities and live in underprivileged areas, Lime is actively perpetuating harmful and racist stereotypes.
So let’s look at this from the other side.
The first point is that its not clear what is being stolen here, beyond “a window of time in which that bike might have been rented by a paying user”. This is the economics of the “sharing economy,” after all.
The second is even if they were allowed to hire the bikes, it’s very unlikely that they would be able to afford it. A Lime bike costs £1 plus £0.27 per minute. Even a short journey costs more than one of London’s expensive tube tickets.
The third is that—as Griswold points out—these irregular users are effectively using the bikes in the way that is intended: they are riding them for short journeys around the city:
Bike-share advocates love to talk about how the big advantage of the system is that you can just hop on and hop off, without having to worry about stuff like maintenance and parking. That’s literally what we’re seeing in London—bike-share used the way it was intended, except by people who’ve figured out how to do so without paying for it.
It’s also worth saying that the young people are working quite hard to pedal a hacked bike. Lime bikes are heavy, and riding them without the help of the battery is a full-scale workout. Peter Walker, the journalist quoted above, joked on Twitter that
“Lime should get some sort of NHS grant for their contribution to teenage activity levels. Manually pedalling a bike that heavy definitely falls into ‘strenuous’ exertion.”
Actually, it might be even harder than ‘strenuous’. Apparently if you stop pedalling the bike locks itself again. This is a serious workout.
One of the things that planners talk about in public space is “desire lines”, which is the routes that people choose to take if they aren’t constrained by the existing paths.
It’s hard not to see this behaviour as a form of “desire line”. Sure, part of the thrill might be getting something for nothing, but some of it seems to be a desire to get around. As Griswold says, to this extent Lime has been a victim of a relatively strong performance in London this year. The bikes are all over the place: paying users are leaving them all over the city.
Uber is fixing its design fault, and expects that this process will be completed for its London bikes by the end of October. But this doesn’t really fix the social design problem.
In general, we accept that access to transport is an important part of social inclusion, and that’s one of the reasons why young people’s transport is subsidised in various ways. They have access to free and discounted travel cards on buses and tubes, for example. As Griswold says, there are ways to extend this to ‘shared bike’ services.
She says this raises questions about the kind of company that Lime wants to be:
is it a private company selling a private service that limits its rider pool in order to minimize risk and maximize profit, or one that works proactively with transport authorities in pursuit of a service that is an inclusive and comprehensive addition to public transport?
But I think we know the sort of company that Lime wants to be. It’s a private company in which Uber, Alphabet, and the private equity company Bain Capital Management all have significant stakes. There’s venture capital money in there, and other private equity stakes. It is keen to float on the stock exchange as soon as it can.
The problem is a different one. If you allow private companies to run chunks of your transport system, and you also want to have an inclusive transport system, you need to licence them and regulate them. Otherwise it’s all about the money.
Update: Chile
In my piece on Tuesday about the 1973 coup in Chile, I mentioned that my teenage self had not expected the United States to involve itself in overthrowing a democratically elected government, and suggested that this was naive of me. Robert Reich, the senior American economist who seems to be becoming more radical as he gets older, had a piece on his newsletter excoriating Henry Kissinger for his part in promoting the coup. The view that Kissinger should have been tried as a war criminal isn’t so controversial these days.
But what really struck me in Reich’s piece was the opinion expressed in 1970 by Viron Vaky, the American diplomat who was at the time “Kissinger’s “senior deputy” at the National Security Council, which I had not seen before, arguing strongly that America should not get involved in subverting the Allende government:
On September 14, 1970, Vaky wrote a memo to Kissinger arguing that coup plotting would lead to “widespread violence and even insurrection.” He also argued that such a policy was immoral: “What we propose is patently a violation of our own principles and policy tenets .… If these principles have any meaning, we normally depart from them only to meet the gravest threat to us, e.g. to our survival. Is Allende a mortal threat to the U.S.? It is hard to argue this.”
(Thanks to John Naughton’s Memex 1.1 blog for the link.)
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