Thursday, April 16, 2020

No Question

The Slate article that is headlined above opens with a photograph of President Trump, I think, because despite the fact that it is ostensibly about suicides, it's mainly about the President. It's well known that the President is not a fan of most leisure and other discretionary activities and businesses being shut down in the name of either (depending on who one asks) slowing or stopping the spread of Coronavirus Infectious Disease 2019. His willingness to advocate for his position on this has not endeared him to may in the public health community, who feel that the current pseudo-isolation/quarantine measures are clearly, and perhaps even self-evidently, best for everyone involved.

The President doesn't help his case in doing what he usually does; namely go with his gut, rather than marshaling the factual case for whatever argument he's making. Therefore, when, late last month, he claimed that "a really horrible recession" would lead to increases in depression and suicide, thus blunting the lifesaving effects that enforced distancing was enacted to capture, it was a safe bet that, if pressed, he wouldn't have been able to produce any concrete information to back that up, outside of his assertion that it was "common sense." (A concept that I've had more than enough of by this point.)

But the article came across a somewhat contrarian, disagreeing with the President out of some combination of partisanship and disagreement on the best way forward. While it likely true that "There is no evidence to suggest that suicide will increase as a result of the global pandemic," perhaps because it's too early to have done any studies, that isn't what the President actually said.
It’s common sense. You’re going to have massive depression … you’re going to have large numbers of suicides, take a look at what happens in a really horrible recession or worse, so you’re going to have tremendous suicides, but you know what you’re going to have more than anything else? Drug addiction.
And there IS evidence that suicide risk is higher in economic downturns. Back in 2015, there was a paper in the World Journal of Psychiatry, namely: Systematic review of suicide in economic recession. The conclusion was thus: "Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries." In all, of the thirty-eight studies that met the paper's selection criteria, "thirty-one of them found a positive association between economic recession and increased suicide rates."

Mesdames Betz and Gold seemed to conclude that the President was creating a "narrative to push an agenda." And while I don't doubt this, that doesn't mean that the narrative is unsupported. The use of "agenda" as a synonym for false, immoral or otherwise wrong-headed policies has taken on a life of its own, and I think that it often leads people to want to shoot the messengers. When an 891% increase in calls to the Disaster Distress Helpline is brushed off as meaningless because "the majority of callers to crisis lines are not suicidal at the time of their call," it begins to strain credulity, even if one accepts that the increase in calls likely doesn't map to a similar increase in suicidal ideation.

The conflict here is not between harmful actions (business as usual) on one side and a harmless action (enforced distancing and the widespread closing of businesses in support of that) on the other. It is appropriate to ask which is the lesser evil and if the response is being calibrated properly. Even if the final determination is that business as usual would be so bad that no level of economic damage could outweigh it, that's different from saying that the effectively self-inflicted recession that many see coming has no other downsides. I understand the desire to deny ammunition to those who would question the measures in place. But arguments so labored as to see disingenuous don't seem to serve even that dubious purpose.

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