Michael Sharpe skewered by @JohntheJack on Twitter

Bio - ME

Psycho - Psychiatrists talk rubbish and publish pseudo science

Social - DWP take people benefits away

A widely accepted framework for denying illnesses.

 

I don't know what studies SW may have had in mind when making that assertion, but I recollect encountering the following in the Working Paper:

The DWP Social Cost-Benefit Analysis framework (WP86)
Published: 10 April 2013
Author: Danial Fujiwara
(See p. 29 - subsection 4.1.1"The impacts of work and employment programmes on health"):

https://www.gov.uk/government/publications/the-dwp-social-cost-benefit-analysis-framework-wp86

p. 35:
"Studies that use natural experiments

"Latent and economic benefits of employment

"Factory closures have been widely used as natural experiments of the impacts of employment on health. This is because estimates based on factory closures are unlikely to suffer from reverse causality.

"However, there are some problems associated with these studies. Sample sizes tend to be small and the short duration of the follow-up surveys restricts detection of longer-term effects on health. They also use a number of different health outcome variables which makes it difficult to compare results.

"These studies generally find a significant negative effect of unemployment on physical and mental health for both clinically examined and self-reported illnesses. Iversen and Sabroe (1989) find rising hospital admissions in a sample of Danish workers after a large shipyard closure and Keefe et al. (2002) report excess risk of self-harm leading to hospitalisation or death in a sample of workers displaced after bankruptcy of a meat-processing plant. Similar evidence was found for a large furniture plant closure in Austria (Studnicka et al., 1991). The authors conclude that subjective health indicators and medical service usage increased with unemployment. Sullivan and von Wachter (2006), using administrative data from two US states, estimate a 15-20 per cent excess risk of death in the 20 years following a job loss.

"Beale and Nethercott (1985) (Wiltshire, England) and Iverson and Sabroe (1989) (Nordhavn, Denmark) found that after factory closure, general practitioner (GP) consultation rates increased by around 50 per cent. These results are consistent with Mathers’ (1994) more recent findings for Australia. These studies use a closely related set of control groups which help to account for other factors that determine health status.

"Burgard et al. (2005) find that involuntary job loss has significant negative effects on subjective levels of health. Their study uses a large longitudinal US dataset which demonstrates that the conclusions of the negative impacts of job loss derived from the factory closure studies, that focus on concentrated geographical areas or industries, can be extended to the general working population.

"There is also some evidence that job loss does not always lead to significant changes in medical service usage and expenditures. Kuhn et al. (2009) find that this is the case for a large sample of workers who lose jobs due to factory closure in Austria. However, sickness benefit payments drastically increased for these people as they were made redundant. The fact that these payments are based on a medical assessment by a GP would suggest that job loss has an adverse impact on health."

 

That makes for interesting reading @Sarah.

Could they really be using data gathered about reasonably healthy people, who are well enough to be in employment, suddenly losing their jobs and then simplistically applying that to people who are not at work because they are too ill?

I guess given the quality of the rest if their work, that is quite possible.

 

Could it possibly be the case that the evidence for it being good for the ill to be employed is that it is bad for people's health to lose employment?

I would say possibly, given the intellects involved.

EDIT I must have been a long time in composing that as I did not see the post above.

 

Pp. 33-34:
"Much of the early research on employment and health relied on cross-sectional findings. As such it was difficult to control for the problem of reverse causality and these results should be ignored. To solve for this, we rely solely on results from research that uses longitudinal data or from studies that use natural experiments to divest themselves of reverse causality problems.

"The impacts of employment have been studied using survey data from employees who experienced redundancy through factory closure. Factory closures have been examined in the UK and Scandinavia. Factory closure studies solve for reverse causality as people experience unemployment regardless of their initial health status. Any change in health after the closure is attributed to the effect of unemployment.

"The economic benefits of employment for health have been estimated by measuring the impact of exogenous changes in income on health. The two most highly cited natural experiments look at the impact of lottery winnings on health (Lindahl, 2005) and the impact on East Germans’ health due to increased income after German unification in 1990 (Frijters, 2003). In both of these cases income variation is independent of health status."

 

It would be interesting to know what studies SW has in mind as @Luther Blissett points out.

 

I am being stupid here? How do factory closure studies solve for reverse causality when by definition all of those workers were well enough to being in full time employment.

There is a massive assumption that what's beneficial for the healthy, is beneficial for the ill.

So if people who stop walking 10,000 steps a day become less healthy, then we should make people with broken legs walk 10,000 steps a day because it's good for them kind of logic.

 

It's referring to solving for reverse causality in the studies; ill health resulted from unemployment and not vice versa. I was supporting your observation that the studies are on previously healthy redundants, but I don't know precisely what conclusions are being drawn from these or other papers - apologies @Invisible Woman I should have made that clearer.

 

Sorry @Sarah. I think I could have been clearer myself. I understood you were showing us what their document says in support of their claims.

Very interesting document.

I didn't intend to shoot the messenger.

 

Not feeling at all shot, @Invisible Woman. I hope you aren't either.

 

In capitalism, people depend on earning money. If an income gets lost, this poses an existential problem. Social systems aren't the best nowadays, so there's always the danger of poverty.
It's not about work, it's about having an income that might affect health.

 

Exactly. It's not a "model", that is a misnomer.

It was ultimately about Engel's effort to re-legitimise psychiatry.

 

When the latest Welfare Reform Act was going to the House of Lords, Lord Freud was giving out Waddell and Burton’s paper posing the question “Is Work Good for your Health and Well-Being?” He was trying to show that there was scientific evidence behind his strategy for Universal Credit, the assessment program and the treatment of people claiming Incapacity Benefit/Employment Support Allowance.

He liked it so much he couldn't stop mentioning it's importance. Here's it being mentioned in a speech. (A good summary of the DWP thinking, and the BPS too.) https://www.gov.uk/government/speeches/opportunities-for-occupational-therapists

Brian Waddell is an influential member of the BPS. In fact at the time of his "independent report" he was working at the Centre for Psychosocial and Disability Research, Cardiff University. (A department created for Mansell Aylward by UNUM).

He is famous for Waddell's signs, his proposed method of detecting malingerers https://en.wikipedia.org/wiki/Waddell's_signs . Turns out his signs don't actually detect malingerers, or those who try for "Secondary Gain", but I'm sure that was of little interest to those who used his signs to deny benefits.

It was surely just co-incidence that his known views and biases just so happened to align with the Government, who commissioned his "independent report", and were looking to pay out less money on sickness benefits.

His report is https://assets.publishing.service.g...ata/file/214326/hwwb-is-work-good-for-you.pdf (257 pages)

 

I guess he doesn't understand how to infer causality from correlation.

 

From Lord Freud's speech:

"But no part of the benefit system is more illuminated by Antonovsky’s theory than how we deal with illness.

"He said 'we are coming to understand health not as the absence of disease, but rather as the process by which individuals maintain their sense of coherence' to allow them the resilience needed to thrive."

Coherence doesn't seem to have been a priority where logic is concerned.

 

Actually that is a misapplication of CBT. We should not confuse the really bad CBT with the classical CBT. CBT is not about getting rid of anything, its about giving you tools to manage symptoms a bit better. When applied as curative its a nonsense.

But if the unscientific mismash is not published, most of their papers will disappear and never see the light of day.

On this we are going to disagree. How the brain works must be understood if you are to figure out how its broken.

Its really just a mnemonic, to remind doctors to think outside of a narrow box. Its clinical. Its research basis is highly dubious, aside from direct clinical application, where the ideas have been shoved into small psychosomatic boxes.

 

I have read the document, so apologies if this is covered. The impact of losing employment is perhaps more complex.

Health may be impacted when the closure and redundancy is associated with a major employer and there is little opportunity for other employment - such was the case in the 1980s when heavy industry and manufacturing, which was the employment in many places, was decimated. Whole communities were adversely affected and a collective self confidence was negatively impacted.

Lack of opportunity, lack.of comparable work ( not just income but skill level and status) is a slow insidious drip that has had a generational effect. There is not only financial poverty, but a poverty of ambition, a distinct lack of self belief. Our firm offers work experience for a week for 16 year olds and there have been a couple who have grown up in families where noone gets up in the morning to go to work and who have no confidence that their children will have a better fate.
In these circumstances i can understand the impact on health, both mental health and also the impact of poor diet and environment.

Locally, there is a walled garden on a small estate which took 40 years to build in the eighteenth/ nineteenth century. It provided employment for miners between seams being developed and kept the local community largely intact . It is hailed as an act of philanthropy by the local estate owner - perhaps also a sound business decision ( he no doubt was a significant shareholder in local mining companies) , as it kept a skilled workforce from going elsewhere and imbued a sense of loyalty and community.

If we look back at the true costs of the great neoliberal experiment of the latter twentieth century pethaps we could learn a thing or two. Even Michael Heseltine had second thoughts after witnessing the impact on Liverpool and called for significant regeneration. Unfortunately, politics in Liverpool precluded central intervention on any significant scale .

 

Sorry have not read the document ...

 

A friend of Wessely's, previously unaware, wants to know about PACE. Wessely only tweeted him the link to the original work, although he is also interested in the dispute. Anyone feel like tweeting links to the special issue of J Health Psych, the Wilshire reanalysis and Tuller's blog to the guy? @dave30th?

No harm in letting as many people as possible know what's going on, especially if they then retweet. Mike Godwin is an attorney and author based in Washington DC with over 17k twitter followers.