The Far Right Movement in Germany and the Burden of History

A friend who was invited to serve as a visiting professor at a German university recently contacted me and asked whether staying in Germany would be safe for him and his family. His concern was prompted by the September 2017 election of the federal German parliament in which the far-right AfD (Alternative für Deutschland, translated as “Alternative for Germany”) party received approximately 13% of the popular vote. AfD had campaigned on an anti-immigrant and anti-Muslim platform, and has been referred to by various media outlets as a nationalist, racist, far-right populist, right wing extremist or even Neo-Nazi party. For the first time in history since World War 2, a far-right or nationalist party would be sitting in the federal German parliament by crossing the 5% minimum threshold designed to keep out fringe political movements. Even though all other political parties had categorically ruled out forming a government coalition with the AfD, thus relegating it to an opposition role in parliament with only a limited role in policy-making, my friend was concerned that its success could be indicative of rising neo-Nazism and hatred towards immigrants or Muslims. As a Muslim and visibly South Asian, he and his family could be prime targets for right-wing hatred.

I was flabbergasted by his concern. What surprised me most was that someone living in the US would be worried about safety and racial prejudice in Germany. Violent crime rates in major German cities are much lower than those of their US counterparts. While it is true that AfD garnered 13% of the popular vote in Germany, the US president who also ran on a similar populist, nationalist and anti-immigrant platform (with promises of building walls and enacting Muslim bans) received 46% of the popular vote! Many of the views of the AfD – for example the claims that traditional Islam is not compatible with Western European culture and the constitution, that immigrants and refugees represent a major threat to the economy and safety or that multiculturalism and progressive-liberal views have betrayed the ideals of the country’s heritage – are increasingly becoming mainstream views of the ruling Republican party in the US. White supremacists, supporters of confederate ideology and neo-Nazis now feel emboldened to hold rallies in the US, knowing that they might only receive lukewarm or relativistic criticism from the US government whereas such acts would be unequivocally condemned by the German government. Racial or religious prejudices held by members of the government and the ruling party can lead to severe institutional reprisals against individuals. When these views are held by a minority party, there is much less danger of immediate institutionalized discrimination and persecution by the government or law enforcement.

So why is it that the 13% vote for AfD is causing such concern, both in Germany and outside of Germany?

One of the obvious reasons is Germany’s history. If the AfD emergence were to foreshadow a re-awakening of Nazi ideology, then it could indeed have devastating consequences for Germany and the world in general. But there is no real evidence to suggest that Nazi ideology is espoused by the AfD leadership or by its base. Terms such as neo-Nazism and fascism are readily used by opponents of the AfD to describe the party but the AfD tries to clearly distance itself from Nazism. The AfD does not accept membership applications from former members of the NPD – a right wing extremist fringe party in Germany with an ideology that was far closer to that of the Nazis. The AfD not only disavows anti-Semitism, it has successfully recruited many Jewish members and offered them leadership roles in the party by portraying itself as a bulwark that will protect German Jews from Muslim anti-Semitism. These approaches effectively counter accusations of Nazism but they have not convinced all. The president of the German Council of Jews, Josef Schuster, recognizes that there is a growing problem with anti-Semitism perpetrated by Muslims in Germany but is not ready to accept the AfD as an ally. It may be advantageous to scape-goat Muslims in the current political climate but who is to say that the AfD won’t switch its scape-goat to Jews in the future if the latter were politically more expedient?

Part of the confusion about what the AfD really stands for is that it has rapidly evolved over the course of just a few years. It started out in 2013 as a party founded by economics professors, who were opposed to Angela Merkel’s handling of the euro crisis and the loss of Germany’s fiscal sovereignty in the European Union. But once it became apparent that feared massive economic crash and recession had been averted (at least transiently), it morphed into an anti-Islam and anti-immigrant party. This modified AfD ousted its co-founder, the economics professor Bernd Lucke, from his leadership role in 2015. The party gained far more traction with its anti-Islam and anti-immigrant views after Merkel’s government allowed more than 1 million refugees (predominantly from Syria but also from other countries in the Middle East) to enter Germany.

During this evolution, the AfD also become increasingly populist. Jan-Werner Müller, a German political scientist and professor at Princeton University, defined the key characteristics of populism in his recent book Was ist Populismus? (“What is Populism?”). Populist movements portray themselves as anti-establishment or anti-elite, but a second key element of a populist movement is their attitude towards pluralism. Müller uses the phrase “Wir sind das Volk” (“We are the people“) that was chanted by the East German demonstrators during the final months of the DDR in 1989 to illustrate anti-pluralism. The “We” can be an inclusive “We” in the sense of “We are the people, too. Let us have a say!” This may be an apt description of the DDR demonstrators where several political factions demonstrated side-by-side in opposition against the socialist dictatorship. However, in populist movements, the “We” is exclusive: “Only we represent the people!” Those who do not agree are seen as traitors. In the past 2 years, the AfD leaders and base increasingly began to claim this exclusivity. Merkel was accused of betraying Germany and colluding with leftists, environmentalists and Muslim to betray the true values of the German people. Such anti-pluralism is antithetical to democracy and is thus a major cause of concern for democratic parties and institutions in Germany. The sense of exclusivity allows populists to develop a unique zeal and promote conspiracy theories about the political establishment and media, brandishing rational criticisms as pro-establishment collusions.

AfD is not just an anti-immigrant populist party, it also embodies a broader “Neue Rechte” (“New Right”) movement. This is supported by the fact that some of the AfD positions have garnered the “philosophical blessing” of German intellectuals, an expression used by Müller in his excellent 2016 essay about the AfD. Müller cites the intellectuals Marc Jongen, Peter Sloterdijk and Botho Strauβ but this list now needs to be extended to include the prominent history professor Rolf Peter Sieferle who committed suicide in September of 2016 (one year before the election). His posthumously published and scandal-provoking book Finis Germania (alluding to the Latin phrase Finis Germaniae which means “The End of Germany”), became a best-seller in the months leading up to the 2017 election.

Sieferle was a respected professor of history and sociology, and thought of as a pioneer in studying environmental history. Finis Germania appears to have been written in the mid-1990s because it refers to the atrocities of the Nazis as having occurred 50 years prior. It is a short collection of mini-essays and aphorisms, grouped together in a handful of chapters. The tone is pessimistic and cynical, pointing towards a decline and likely collapse of German heritage and Germany. The most controversial passages revolve around Vergangenheitsbewältigung, a German word for processing and overcoming history. In Germany, Vergangenheitsbewältigung primarily refers to how Germany deals with its Nazi past. The Holocaust, the guilt of the Germans who participated in committing the atrocities and the historical responsibility (historische Verantwortung) that resulted from it for modern Germany are among the most extensively discussed topics in German school curricula and public intellectual discourse.

There is no denial of the Holocaust in the book. Sieferle uses the expressions “Verbrechen” (crime) and “Greueltaten” (atrocities) to describe the genocide committed by the Nazis, as was recently emphasized by Christopher Caldwell. However, Sieferle openly criticizes the style of contemporary Vergangenheitsbewältigung in which Germans are cast as perennial villains who need to demonstrate never-ending penance to atone for their collective guilt. Sieferle uses religious metaphors in which the Holocaust is compared to a new form of Erbsünde (literally translated as “inherited sin”, but it is a German expression for the biblical original sin of Adam and Eve). Vergangenheitsbewältigung is likened to a new state religion which is meant to keep Germans docile.

There is no doubt that Sieferle’s book touched a raw nerve with many Germans living today who feel that they are still held responsible for crimes committed by the Nazis. Any expression of German pride or patriotism is often self-scrutinized carefully to ensure that it in no way challenges Vergangenheitsbewältigung. Especially when interacting with non-Germans, Germans may consciously or subconsciously perceive themselves being pigeon-holed as descendants of Nazi perpetrators. They go out of their way to prove that they are different from their parents or grand-parents who may have lived during their Nazi era. Sieferle specifically contrasts Germans with Anglo-Americans who do not engage in self-flagellating Vergangenheitsbewältigung. A recent poll showed that 43% of British citizens are proud of their colonial past and do not feel shame for the atrocities of the British Empire. One example of British atrocities is the diversion of food from India in 1943 to feed British soldiers that was authorized by Winston Churchill and resulted in a famine which killed 4 million Indians.

A member of a book jury initially recommended this book because it would initiate a discussion about German history and the book quickly became a non-fiction best-seller. While there is no explicit Holocaust denial in the book, the subtext of the book was seen as dallying with anti-Semitism. Modern day anti-Semites cannot deny the Holocaust because the evidence for the atrocities is so overwhelming but they instead try to cast Jews as post-war perpetrators who use the memory Holocaust as a means of suppressing dissent. Some passages of Finis Germania are ambiguous enough to provide fodder for anti-Semites. The massive popularity of a book that could potentially promote anti-Semitic ideas came as a shock to the German literary and intellectual establishments. But the rash reaction of the leading German magazine Der Spiegel to delete the book from its best-seller listturned a marginally intelligible book with fragmented ideas into a heroic anti-establishment tract. Book-shops refused to sell the book but it remained an Amazon best-seller, suggesting that the ban had not diminished its popularity. While some German writers and intellectuals supported the decision of Der Spiegel, others saw it as a form of censorship to suppress undesirable ideas.

How does this book about the German history connect to the success of the AfD and the New Right movement? A second posthumously published Sieferle book also became a best-seller: Das Migrationsproblem (“The migration problem“). This book discusses the basic challenge for a welfare state such as Germany which aims to provide excellent housing, healthcare and food for all to take large numbers of refugees or immigrants who would be eligible for all the welfare services. The stability of the welfare state depends on a balance of workers who pay into the system and the beneficiaries. It performs a semi-quantitative analysis and suggests that Germany cannot handle the influx of political and economic refugees without compromising its welfare state character. The book also touches on the cultural differences between indigenous Germans and “tribal” refugees who hail from aggressive cultures. This second book also became a best-seller but it is the combination of the two themes that may form the intellectual foundation for the success of the AfD. Finis Germania decries the culture of collective guilt which in turn has lead Germans to be so docile that they accept millions of refugees as their inherited burden even if it undermines their economy and culture.

The AfD has tried to avoid public discussions of Vergangenheitsbewältigung in order to escape accusations of anti-Semitism and instead focused on Islam, immigrants or refugees. However, in a widely criticized speech, Björn Höcke – the leader of AfD in Thuringia – referred to the Berlin Holocaust memorial as a “monument of shame” in January of 2017. He suggested that German history was crippling contemporary Germans and there was a need to re-think how Germans should handle their past. The federal AfD leadership was taken aback by these overt and public comments about a taboo topic and initiated a process to remove him for the party. However, Höcke remains an AfD member and has received support from many other AfD leaders. The success of the AfD may suggest that his speech may have been an intentional ploy to link German frustration with collective guilt to voting for AfD as a means to escape from the burden of the past.

How should Germany move forward after the success of AfD? As a Muslim German of South Asian descent, I am of course worried about the racist, anti-immigrant, anti-Muslim and populist rhetoric promoted by the AfD. There is no easy solution for how to deal with the rise of the far right but we can glean insights from this election and the success of far right movements in the United States or other countries. Censoring or banning books that simply express unpleasant view-points is the wrong approach. Denouncing 13% of German voters as Nazis, fascists or “deplorables” would be equally wrong. Burying our heads in the sand and hoping that right-wing populism will just disappear would be a folly. There is a sense of panic about the results of the German election but we can also see it as a wake-up call. Many countries have seen a rise in right-wing populist movements but the social and historical context of each movement is different and needs to be analyzed contextually. What is needed now is a rational analysis and the required actions.

Those of us who believe in the German democratic institutions and the power of rational dialogue need to engage the citizens who voted for AfD. One may agree or disagree with the positions of the AfD and its voters but this should not prevent meaningful dialogue. Concerns about the future of a welfare state with an imbalance between payers and beneficiaries are not unreasonable. The concerns revolving around immigration, refugees, the right to experience national pride and Vergangenheitsbewältigung should be addressed without condescension or throwing around insults and clichés. Another major concern voiced by AfD supporters is that key decisions about the future of Germany are made unilaterally by the government elites without engaging in a meaningful discussion with the electorate. Voters felt disempowered and ignored. This may also explain why the AfD received more than 20% of the vote in some parts of East Germany (the former DDR). Former DDR citizens wrested their freedom to vote and participate in public policy-making from a dictatorship less than 30 years only to find that the post-DDR Germany was also ignoring their opinions. The government and members of parliament have to learn how to routinely meet citizens so that they can listen to their concerns.

Condescension and hatred against the supporters of far right populist movements only strengthens them and their resolve to fight democratic pluralism. By peacefully and rationally engaging fellow citizens, Germany will be able to avoid the fate of the United States where a far right movement now controls the government. The historical responsibility of Germany lies in providing balance and reason in a world that could succumb to populism and chaos.

References:

Jan-Werner Müller. Was ist Populismus?. Suhrkamp Verlag, 2016.

Rolf Peter Sieferle. Finis Germania. Verlag Antaios. 2017

Rolf Peter Sieferle. Das Migrationsproblem. Manuscriptum Verlagsbuchhandlung. 2017

Note: An earlier version of this article was first published on the 3Quarksdaily blog.

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Alternative Facts and Realities: How the Brain Anticipates Perception

The Russian physiologist Ivan Pavlov is best known for his studies on classical conditioning showing that dogs repeatedly presented with a combination of food and a sound would subsequently salivate upon hearing the sound alone, in anticipation of the meal. The combination of the two stimuli – food and sound – over time “conditioned” the dogs’ brains to link these two stimuli. A variation of this experiment was performed on human subjects by Ellson and published in the Journal of Experimental Psychology in 1941. In Ellson’s study, 40 subjects were “conditioned” over time by hearing a sound and seeing a light. Ellson later on exposed the subjects to only the light, yet 32 of 40 subjects claimed to have also heard the sound. Ellson concluded that such conditioning could lead to hallucinations – the hearing of sounds which, objectively speaking, are not present.

Recently, the Yale University psychiatrist Philip Corlett and his colleagues conducted a very interesting variation on this earlier study by asking whether some people are especially vulnerable to having auditory hallucinations induced by conditioning. The researchers recruited four groups of study subjects: 1) Fifteen patients with severe mental illnesses who also regularly heard voices (an auditory hallucination), 2) fifteen patients with severe mental illnesses who did not hear voices, 3) fifteen individuals without any evidence of mental illnesses who also claimed to hear voices and 4) fourteen healthy individuals who did not hear voices. Group 3 consisted of voice-hearing psychics (“clairaudient psychics”) who identified themselves as such via their own websites, at psychic meetings, or referrals from other psychics. Another important innovation in Corlett’s study was the inclusion of brain imaging studies on all subjects, thus allowing the researchers to study functional brain responses when exposing them to auditory and visual stimuli. The researchers then repeatedly exposed the study subjects to a checkerboard image and 1 kHz tone while they were lying in the brain scanner. The subjects were asked to press one button to indicate that they heard the tone, and a second button if they did not. They were also instructed to press down the button longer, the more confident they were in having heard the tone.

After conditioning the subjects, the researchers then intermittently began to show them images of the checkerboard without playing the tone. As expected, many subjects indicated having heard the tone even when it had not been played. However, patients with severe mental illness and a history of hearing voices (group 1) as well as healthy psychics with a history of hearing voices (group 3) were significantly more likely to wrongly indicate that they had heard the non-existing tone. Members of these two groups were also more confident that their hallucination was actually real, since they pressed down the button for longer. Healthy subjects and patients with mental illness who did not have a history of hearing voices were comparatively more correct in identifying whether or not the tone was present. Importantly, when the researchers repeatedly showed the image without the tone, voice-hearing, mentally ill patients were unable to “update” their beliefs when compared to the other groups, whereas the psychics gradually recognized that the tone was non-existent.

Brain imaging showed that the brain regions which respond to sounds were activated by the auditory hallucinations, meaning the brain perceived the non-existent tone as being real! The researchers also found that the subjects who continued to perceive the non-existent tones and did not update their beliefs – even after repeatedly being exposed to the image without the tone – had reduced activation in the brain areas which help integrate and coordinate predictions and perceptions. This could suggest that suppressed activity in these brain regions may contribute to persistent voice-hearing or other hallucinations.

The study has some important limitations: 1) The sample sizes are quite small and the some of the finds – especially those related to the brain imaging – are often only borderline statistically significant; 2) as is the case in many behavioral brain imaging studies, it is difficult to establish cause and effect – was the reduced activity in the parts of the brain which coordinate and integrate perceptions the cause of the inability to update beliefs or merely a correlation; 3) tones are well-suited for conditioning experiments in the laboratory but in the real world, conditioning may occur via specific words or phrases and this could have greater bearing on understanding voice-hearing.

Future studies could therefore address these issues by increasing the sample size, introducing more complex stimuli such as phrases or words, and perhaps also ask other inter-connected questions. Are individuals who are prone to voice-hearing also more likely to have visual hallucinations and hallucinations of smell? Can magnetic stimulation of selected brain areas perhaps improve the ability to update false beliefs? Does conditioning by political, religious or cultural education also affect us in a way that we perceive our hallucinations? For example, would adherents of an extreme political ideology mis-perceive words uttered by political opponents because their brains are conditioned to expect a narrow spectrum of answers and they are unable to update their beliefs? The study by Corlett and colleagues provides some very interesting insights into how our brain anticipates reality due to conditioning which could have important implications for understanding the nature of hallucinations in mental illness and develop new targeted therapies. However, it raises even more fascinating questions which – if addressed in future studies – could have an even broader impact on understanding our perception.

Reference

AR Powers, C Mathys, PR Corlett. (2017). Pavlovian conditioning–induced hallucinations result from overweighting of perceptual priors Science, 357 (6351):596-600; DOI: 10.1126/science.aan3458

 

Note: An earlier version of this article was first published on the 3Quarksdaily blog.

Optimizing Ourselves into Oblivion

The short story “Anekdote zur Senkung der Arbeitsmoral” (“An anecdote about the lowering of work ethic”) is one of the most famous stories written by the German author Heinrich Böll. In the story, an affluent tourist encounters a poorly clad fisherman who is comfortably napping in his boat. The assiduous tourist accidentally wakes up the fisherman while taking photos of the peaceful scenery – blue sky, green sea, fisherman with an old-fashioned hat – but then goes on to engage the lounging fisherman in a conversation. The friendly chat gradually turns into a sermon in which the tourist lectures the fisherman about how much more work he could be doing, how he could haul in more fish instead of lazing about, use the profits to make strategic investments, perhaps even hire employees and buy bigger boats in a few years. To what end, the fisherman asks. So that you could peacefully doze away at the beach, enjoying the beautiful sun without any worries, responds the enthusiastic tourist.

I remembered Böll’s story which was written in the 1960s – during the post-war economic miracle years (Wirtschaftswunder) when prosperity, efficiency and growth had become the hallmarks of modern Germany – while recently reading the book “Du sollst nicht funktionieren” (“You were not meant to function”) by the German author and philosopher Ariadne von Schirach. In this book, von Schirach criticizes the contemporary obsession with Selbstoptimierung (self-optimization), a term that has been borrowed from network theory and computer science where it describes systems which continuously adapt and “learn” in order to optimize their function. Selbstoptimierung is now used in a much broader sense in German culture and refers to the desire of individuals to continuously “optimize” their bodies and lives with the help of work-out regimens, diets, self-help courses and other processes. Self-optimization is a routine learning process that we all engage in. Successful learning of a new language, for example, requires continuous feedback and improvement. However, it is the continuous self-optimization as the ultimate purpose of life, instead of merely serving as  a means to an end that worries von Schirach.

She draws on many examples from Körperkult (body-cult), a slavish worship of the body that gradually replaces sensual pleasure with the purpose of discipling the body. Regular exercise and maintaining a normal weight are key factors for maintaining health but some individuals become so focused on tracking steps and sleep duration on their actigraphs, exercising or agonizing about their diets that the initial health-related goals become lose their relevance. They strive for a certain body image and resting heart rates and to reach these goals they indulge in self-discipline to maximize physical activity and curb appetite. Such individuals rarely solicit scientific information as to the actual health benefits of their exercise and food regimens and might be surprised to learn that more exercise and more diets do not necessarily lead to more health. The American Heart Association recommends roughly 30-45 minutes of physical activity daily to reduce high blood pressure and the risk of heart attacks and stroke. Even simple and straightforward walking is sufficient to meet these goals, there is no need for two-hour gym work-outs.

Why are we becoming so obsessed with self-optimization? Unfortunately, von Schirach’s analysis degenerates into a diffuse diatribe against so many different elements of contemporary culture. Capitalist ideology, a rise in narcissism and egotism, industrialization and the growing technocracy, consumerism, fear of death, greed, monetization of our lives and social media are among some of the putative culprits that she invokes. It is quite likely that many of these factors play some role in the emerging pervasiveness of the self-optimization culture – not only in Germany. However, it may be useful to analyze some of the root causes and distinguish them from facilitators. Capitalist ideology is very conducive to a self-optimization culture. Creating beauty and fitness targets as well as laying out timelines to achieve these targets is analogous to developing corporate goals, strategies and milestones. Furthermore, many corporations profit from our obsession with self-optimization. Companies routinely market weight regimens, diets, exercise programs, beauty products and many other goods or services that generate huge profits if millions of potential consumers buy into the importance of life-long self-optimization. They can set the parameters for self-optimization – ideal body images – and we just obey. According to the German philosopher Byung-Chul Han, such a diffusion of market logic and obedience to pre-ordained parameters and milestones into our day-to-day lives results in an achievement society which ultimately leads to mental fatigue and burnout.  In the case of “working out”, it is telling that a supposedly leisure physical activity uses the expression “work”, perhaps reminding us that the mindset of work persists during the exercise period.

But why would we voluntarily accept these milestones and parameters set by others? One explanation that is not really addressed by von Schirach is that obsessive self-optimization with a focus on our body may represent a retreat from the world in which we feel disempowered. Those of us who belong to the 99% know that our voices are rarely heard or respected when it comes to most fundamental issues in society such as socioeconomic inequality, rising intolerance and other forms of discrimination or prejudice. When it comes to our bodies, we may have a sense of control and empowerment that we do not experience in our work or societal roles. Self-discipline of our body gives our life a purpose with tangible goals such as lose x pounds, exercise y hours, reduce your resting heart rate by z.

Self-optimization may be a form of Ersatzempowerment but it comes at a great cost. As we begin to retreat from more fundamental societal issues and instead focus on controlling our bodies, we also gradually begin to lose the ability to dissent and question the meaning of actions. Working-out and dieting are all about HowWhen and What – how do I lose weight, what are my goals, when am I going to achieve it. The most fundamental questions of our lives usually focus on the Why – but self-optimization obsesses so much about HowWhen and What that one rarely asks “Why am I doing this?” Yet it is the Why that gives our life meaning, and self-optimization perhaps illustrates how a purpose-driven life may lose its meaning. The fisherman prompted the tourist to think about the Why in Böll’s story and perhaps we should do the same to avoid the trap of an obsessive self-optimization culture.

Reference:

von Schirach, Ariadne. Du sollst nicht funktionieren: für eine neue Lebenskunst. Klett Cotta, 2014.

 

Note: An earlier version of this article was first published on the 3Quarksdaily blog. 

How Does Sleep Deprivation Affect the Brain?

How many hours of sleep does the average person require? The American Academy of Sleep Medicine and the Sleep Research Society recently convened an expert panel which reviewed over 5,000 scientific articles and determined that sleeping less than 7 hours in adults (ages 18-60) was associated with worsening health, such as increased obesity and diabetes, higher blood pressure as well as an increased risk of stroke and heart disease. In addition to increasing the risk for illnesses, inadequate sleep is also linked to impaired general functioning, as evidenced by suppressed immune function, deficits in attention and memory, and a higher rate of errors and accidents. Since at least one third of adults report that they sleep less than 7 hours a day (as assessed by the Centers for Disease Control and Prevention in a survey of 444,306 adults), one can legitimately refer to insufficient sleep as a major public health issue. Even though insufficient sleep and other sleep disorders have reached epidemic-like proportions affecting hundreds of millions of adults world-wide, they are not adequately diagnosed and treated when compared to medical risk factors and conditions. For example, in most industrialized countries, primary care physicians perform annual blood pressure and cholesterol level checks, but do not routinely monitor the sleep duration and quality of their patients.

One reason for this may be the complexity of assessing sleep. Checking the blood cholesterol level is quite straightforward and provides a reasonably objective value which is either below or above the recommended cholesterol thresholds. However, when it comes to sleep, matters become more complicated. The above-mentioned expert panel acknowledged that there can be significant differences in the sleep requirements of individuals. Those who suffer from illnesses or have incurred “sleep debt” may require up to 9 hours of sleep, and then there are also significant environmental and genetic factors which can help determine the sleep needs of an individual. The average healthy person may need at least seven hours of sleep but there probably groups of individuals who can function well with merely 6 hours while others may need 9 hours of sleep. Then there is also the issue of the sleep quality. Sleeping for seven hours between 10 pm and 5 am has a higher quality of sleep than sleeping between 6 am and 1 pm because the latter will be associated with many more spontaneous awakenings and interruptions as well as less slow-wave sleep (a form of “deep sleep” characterized by classical slow wave patterns on a brain EEG recording during sleep). Unlike the objective cholesterol blood test, a true assessment of sleep would require an extensive sleep questionnaire asking details about sleep history and perhaps even recording sleep with activity monitors or EEGs.

Another reason for why insufficient sleep is not treated like other risk factors such as cholesterol and blood pressure is that there aren’t any easy fixes for poor sleep and the science of how poor sleep leads to cognitive deficits, diabetes and heart disease is still very much a topic of investigation.

In the case of cholesterol, numerous studies have shown that cholesterol levels can be effectively lowered by taking a daily medication such as a statin and that this intervention clearly lowers the risk of heart attacks and stroke. Furthermore, the science of how cholesterol causes stroke and heart disease has been worked out quite well by identifying the molecular mechanisms of how cholesterol contributes to the build-up of plaque in the arteries which can then lead to heart attacks and stroke. When it comes to sleep, on the other hand, multi-faceted interventions are required to restore healthy sleep levels. Medications to help patients sleep can be used in certain circumstances for a limited time but they are not a long-term solution. Instead, improving sleep requires individualized solutions such as developing a sleep schedule of fixed bed-times, minimizing the use of digital screens in the bedroom, and avoiding caffeine, large meals, nicotine or alcohol just before bedtime. The complexity of assessing and treating insufficient sleep also makes it very difficult to prove the efficacy of interventions. Controlled clinical studies can demonstrate that a cholesterol-lowering medication reduces the risk of heart attacks by treating thousands of patients with the active medication when compared to thousands of patients who receive a placebo, but how do you test the efficacy of individualized sleep interventions in thousands of patients?

Understanding the precise mechanisms by which insufficient sleep impairs our functioning and health has therefore become a major topic of research with significant advances that have been made in the past decades. Correlative studies which link poor sleep to worse health cannot prove that it is the inadequate sleep which caused the problems, but studies in which human subjects undergo well-defined sleep deprivation for a defined number of hours coupled with EEGs, brain imaging studies and cognitive assessments are providing important insights into how poor sleep can affect brain function. The sleep researcher Matthew Walker at the University of California and his colleagues recently reviewed some of the key studies in sleep research and identified some of the major categories of brain function impairment as a consequence of sleep deprivation:

1.      Attention:

Several studies of human subjects have consistently shown that sleep deprivation leads to a significant decrease in the ability to pay attention to tasks. Some studies have kept subjects awake for 24 hours at a stretch whereas other studies merely restricted sleep to a few hours a night and monitored the performance. Importantly, one study that restricted sleep to less than 3 hours for one week was able to show that the attentiveness and performance of subjects recovered rapidly once the sleep-deprived subjects were allowed to sleep for 8 hours but it still did not return back to the levels of those without sleep deprivation. This means that the after-effects of sleep deprivation can linger for days even when we start sleeping normally.

2.      Memory:

The impairment of working memory (the temporary memory we use to make decisions and complete tasks) is another key feature of sleep deprivation. Brain imaging studies have been able to identify specific abnormalities in certain areas of the brain that are critical for the “working memory” function such as the dorsolateral prefrontal cortex and thus provide somewhat objective measures of cognitive impairment. Interestingly, placing magnetic coils around the head of sleep-deprived subjects to initiate TMS (transcranial magnetic stimulation) has been reported to help restore some of the loss of visual memory, however, Walker and colleagues note that the benefits of TMS in sleep deprivation are not always consistent and reproducible.

3.      Responding to negative stimuli

Sleep deprivation increases responses to negative stimuli such as fear. For example, when subjects who had one night of sleep deprivation were shown images of weapons, snakes or mutilations, their aversion responses were much stronger than those of control subjects. Hyper-responsiveness of the amygdala, the part of the brain which processes emotional reactions, is thought to be one major element in these exaggerated responses of sleep-deprived subjects.

Walker and colleagues note that not all changes seen in the brain imaging studies are necessarily detrimental. In fact, some of these changes may be adaptations that have evolved to help our brains cope with the stress of sleep deprivation. Even though significant progress has been made in sleep deprivation research, understanding differences between individuals in terms of how and why they respond differently to sleep deprivation, distinguishing the mechanisms of beneficial adaptations in brain function from detrimental responses and also developing new studies that study the effects of chronic sleep deprivation – one that occurs over a period of weeks and months and thus mimics real-life sleep deprivation – instead of the short-term acute sleep deprivation studies that are currently performed in the laboratory are major challenges for sleep researchers. Hopefully, advances in sleep research will lead to a better understanding of sleep health and ultimately also translate into sleep becoming an integral part of medical exams in order to address this burgeoning public health problem.

References

Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 2015;11(6):591–592.

Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of Healthy Sleep Duration among Adults — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:137–141

Krause AJ, Simon EB, Mander BA, Greer SM, Saletin JM, Goldstein-Piekarski AN, Walker MP. (2017). The sleep-deprived human brain. Nature Reviews Neuroscience

 

Note: An earlier version of this article was first published on the 3Quarksdaily blog.

Dismantle the Poverty Trap by Nurturing Community Trust

Would you rather receive $100 today or wait for a year and then receive $150? The ability to delay immediate gratification for a potentially greater payout in the future is associated with greater wealth. Several studies have shown that the poor tend to opt for immediate rewards even if they are lower, whereas the wealthy are willing to wait for greater rewards. One obvious reason for this difference is the immediate need for money. If food has to be purchased and electricity or water bills have to be paid, then the instant “reward” is a matter of necessity. Wealthier people can easily delay the reward because their basic needs for food, shelter and clothing are already met.

Unfortunately, escaping from poverty often requires the ability to delay gratification for a greater payout in the future. Classic examples are the pursuit of higher education and the acquisition of specialized professional skills which can lead to better-paying jobs in the future. Attending vocational school, trade school or college paves the way for higher future wages, but one has to forego income during the educational period and even incur additional debt by taking out educational loans. Another example is of delayed gratification is to invest capital – whether it is purchasing a farming tool that increases productivity or investing in the stock market – which in turn can yield greater pay-out. However, if the poor are unable to pursue more education or make other investments that will increase their income, they remain stuck in a vicious cycle of increasing poverty.

Understanding the precise reasons for why people living in poverty often make decisions that seem short-sighted, such as foregoing more education or taking on high-interest short-term loans, is the first step to help them escape poverty. The obvious common-sense fix is to ensure that the basic needs of all citizens – food, shelter, clothing, health and personal safety – are met, so that they no longer have to use all new funds for survival. This is obviously easier in the developed world, but it is not a trivial matter considering that the USA – supposedly the richest country in the world – has an alarmingly high poverty rate. It is estimated that more than 40 million people in the US live in poverty, fearing hunger and eviction from their homes. But just taking care of these basic needs may not be enough to help citizens escape poverty. A recent research study by Jon Jachimowicz at Columbia University and his colleagues investigated “myopic” (short-sighted) decision-making of people with lower income and identified an important new factor: community trust.

The researchers first used an online questionnaire (647 participants) to assess trust and asked participants to choose between a payoff in the near future that is smaller and a larger pay-off in the distant future. They also measured community trust by asking participants to agree or disagree with statements such as “There are advantages to living in my neighborhood” or I would like my child(ren) to be raised in the neighborhood I currently live in”. They found that lower income participants were more likely to act in a short-sighted manner if they had low levels of trust in their communities. In a second online experiment, the researchers recruited roughly 100 participants from each state in the US and assessed their community trust levels. They then obtained real-world data on payday loans – a sign of very short-sighted financial decision-making because people take out cash advances at extraordinarily high interest rates that have to be paid back when they get their paycheck – for each state. They found that the average community trust for each state was related to the use of payday loans. In states with high average community trust ratings, people were less likely to take out these payday loans, and this trend remained even when the researchers took into account unemployment rates and savings rates for each state.

Even though these findings all pointed to a clear relationship between community trust and sound financial decision-making, the results did not prove that increased community trust is an underlying cause that helps improve the soundness of financial decisions. To test this relationship in a real-world setting, the researchers conducted a study in rural Bangladesh by collaborating with an international development organization based in Bangladesh. The vast majority of participants in this study were poor even by Bangladeshi standards, earning less than $1/day per household member. The researchers adapted the community trust questionnaire and the assessment of financial decision-making for the rural population, with live interviewers asking the questions and filling out the responses for the participants. After assessing community trust and the willingness to delay financial rewards for greater payouts in the future, half of the participants received a two year intervention to increase community trust. This intervention involved volunteers from the community that acted as intermediaries between the local government and the rural population, providing input into local governance and community-level decisions (for example in the distribution of social benefits and the allocation of funds for development projects).

At the end of the two year period, participants who had received the community intervention showed significant increases in their community trust levels and they also improved their financial decision-making. They were more likely to forego immediate lower financial rewards for greater future rewards when compared to the villagers who did not receive any special intervention.

By combining correlational data from the United States with an actual real-world intervention to build community trust, the researchers show how important it is to build trust when we want to help fellow humans escape the “poverty trap“. This is just an initial study with a limited group of participants and a narrow intervention that needs to be replicated in other societies and with long-term observation of the results to see how persistent the effects are. But the results should make all of us realize that just creating “jobs, jobs, jobs” is not enough. We need to invest in the infrastructures of communities and help citizens realize that they are respected members of society with a voice. Empowering individuals and ensuring their safety, dignity and human rights are necessary steps if we are serious about battling poverty.

Reference

Jachimowicz, J. M., Chafik, S., Munrat, S., Prabhu, J. C., & Weber, E. U. (2017). Community trust reduces myopic decisions of low-income individuals. Proceedings of the National Academy of Sciences, 201617395.

Note: An earlier version of this post was first published on the 3Quarksdaily blog.

ResearchBlogging.org

Jachimowicz, J., Chafik, S., Munrat, S., Prabhu, J., & Weber, E. (2017). Community trust reduces myopic decisions of low-income individuals Proceedings of the National Academy of Sciences DOI: 10.1073/pnas.1617395114

Let Them Make My Cake: Exporting Burden, Importing Convenience in the Externalization Society

On 5 November 2015, an iron ore tailings dam burst in Bento Rodrigues near the Brazilian city of Mariana, releasing 60 million cubic meters of a reddish-brown mud-flood. This toxic flood buried neighboring villages and flowed into the Rio Doce, contaminating the river with several hazardous metals including mercury, arsenic and chromium as well as potentially harmful bacteria. The devastating and perhaps irreparable damage to the ecosystem and human health caused by this incident are the reason why it is seen as one of the biggest environmental disasters in the history of Brazil. The German sociologist Stephan Lessenich uses this catastrophe as a starting point to introduce the concept of the Externalisierungsgesellschaft(externalization society) in his book Neben uns die Sintflut: Die Externalisierungsgesellschaft und ihr Preis (“Around us, the deluge: The externalization society and its cost”).

What is the externalization society? According to Lessenich, this expression describes how developed countries such as the United States, Japan and Germany transfer or externalize risks and burdens to developing countries in South America, Africa and Asia. The Bento Rodrigues disaster is an example of the environmental risk that is externalized. Extracting metals that are predominantly used by technology-hungry consumers in developed countries invariably generates toxic waste which poses a great risk for the indigenous population of many developing countries. The externalized environmental risks are not limited to those associated with mining raw materials. The developed world is also increasingly exporting its trash into the third world.

The US, for example, are the world’s largest exporter of paper trash, exporting scrap paper worth US$ 3.1 billion each year. The US is also the largest producer of electronic waste (E-Waste), estimated at more than 7 million tons of E-Waste per year (PDF). Every new smartphone or tablet release generates mountains of E-Waste as consumers discard their older devices. Re-cycling the older devices sounds like a reasonable solution bu true recycling and re-using of electronic components is quite costly and time-consuming. It is also often not clear which electronic components of devices actually get recycled. To track the fate of discarded electronic devices, Jim Puckett from the Basel Action Network and his colleagues placed GPS-trackers in old electronics dropped off at US-based recycling centers. They found that a third of the “recycled” electronics were shipped overseas to countries such as Mexico, Taiwan, China, Pakistan, Thailand and Kenya. Puckett used the GPS signal to identify the sites where the E-Waste ended up and visited such a location in Hong Kong, where he found that the “recycled” electronics were being dismantled in junkyards by migrant workers from mainland China who were not wearing any protective clothing that would have protected them from hazardous materials released during the extraction of salvageable E-Waste materials. There are many regulations that restrict the trading of E-Waste but the United Nations Environment Program (UNEP) estimates that up to 90% of the world’s E-Waste is traded or dumped illegally. This means that even though dropping off old devices at a recycling center may alleviate the conscience of consumers, a significant number of these will not be re-used but instead shipped off to junkyards in other countries – without appropriate monitoring of how these electronic waste products will affect the local environment and health of the population.

Exporting environmental risks to developing countries by either outsourcing high-risk extraction of raw materials or simply dumping waste is just one example of externalization according the Lessenich. Externalizing occupational health risks and poverty by severely under-paying workers are other examples. Bangladesh has now emerged as one of the world’s largest manufacturers of clothing because of its cheap labor. In 2011, the typical monthly wage of a garment industry worker in Bangladesh was estimated at $91 per month – roughly one and a half dollars per day! In addition to this dismally low pay, garment factory workers in Bangladesh also face terrible occupational risks. The collapse of the Rana Plaza garment factory building in 2013 which called over 1,100 people and injured more than 2,500 people is just one example of the occupational risks faced by the workers.

Lessenich’s concept of the externalization society isn’t just another critique of the global inequality that we so often hear about. The fundamental principle of the externalization society put forth by Lessenich is the interdependence between the “imperial lifestyle” of wealth and comfort in the developed world and the “wretched lifestyle” of poverty and hardship in the developing world. If those of us who live in the developed world want the convenience of upgrading our smartphones every few years or buying cheap cotton t-shirts, then we need those who manufacture these products in the developing world to be paid lousy wages. If those workers were paid humane wages and their employers instituted appropriate occupational safety measures, as well as health and disability insurance plans that are routine in most parts of the developed world, then the cost of the products would be incompatible with our current economy and lifestyle which are fueled by consumerism and the capitalist imperative of incessant growth.

The pillars of the externalization society are indifference and ignorance. We are indifferent because we see the differential in lifestyle as a Selbstverständlichkeit – a German word for obviousness or taken-for-grantedness. They were born in developing countries, so of course they have to struggle – tough luck, they ended up with the wrong lottery tickets. This Selbstverständlichkeit also extends to the limited mobility of the people born in the developing world. They lack the birthright of the developing world citizens whose passports allow them to either travel visa-free or obtain a visa to nearly any country in the world with minimal effort. This veneer of Selbstverständlichkeit is easiest to maintain if “they” and “their” problems are invisible and thus allow us to ignore the interdependence between our good fortune and their misery. We might see images of the toxic flood in Brazil but few, if any, members of the externalization society will link the mining of cheap iron in Brazil to the utensils they use in their everyday life.

A decade ago, disposable single-use coffee pods such as the Keurig K-cups or the Nespresso pods were extremely rare but by 2014, K-cup manufactures sold a mind-boggling 9 billion K-cups! A new need for disposable products that had previously been met by standard coffee machines arose without considering the environmental and global impact of this need. In theory, the K-cups are recyclable but this would require careful separating of the paper, plastic and the aluminum top. It is not clear how many K-cups are properly recycled, and the E-Waste example shows that even if items are transported to recycling centers, that does not necessarily mean that they will be successfully recycled. Prior to the advent coffee pods, our coffee demands had been easily met without generating additional mountains of disposable plastic and aluminum coffee pod trash. Out of nowhere, there arose a new need for aluminum which again is extracted from the aluminum ore bauxite – another process that generates toxic waste. Instead of feeling a sense of absolution when we drop a disposable item into a recycling bin, we should simply curtail unnecessary consumption of products in disposable containers.

How do we overcome the externalization society? We can make concerted efforts through advocacy, education and regulations that restrict exporting environmental waste, improve health and safety conditions for workers in the developing world and try to restrict our consumerist excesses by clarifying the interdependence between wealth in the externalization society and the poverty in the developing world as well as the moral imperative to abrogate the inequality and asymmetry. Numerous advocates have already attempted this approach for the past decades with limited success. Maybe instead of appealing to the ethics of interdependence, a more effective approach may be to educate each other about the consequences of the interdependence. When millions of refugees show up at the doorstep of the externalization society, “they” are no longer invisible. One can blame wars, religious extremism and political ideologies for the misery of the refugees but it becomes harder to ignore the extent and central role of the underlying inequality. Creating humane working and living conditions for people in the developing world is perhaps the most effective way to stop the so-called “refugee crisis“.

Global climate change is another threat to the externalization society, a threat of its own making. Transferring carbon footprints and pollution to other countries does not change the fact that the whole planet is suffering from the consequences of climate change. Political leaders of the externalization society often demand the closing of borders, erecting walls and expanding their armed forces so they are less likely to have to confront the victims of their externalization but no army or wall is strong enough to lower the rising water levels or stabilize the climate. The externalization society will end not because of a crisis of conscience but because its excesses are undermining its own existence.

Reference:

Lessenich, S. (2016). Neben uns die Sintflut: Die Externalisierungsgesellschaft und ihr Preis. Hanser Berlin.

 

Note: An earlier version of this article was first published on the 3Quarksdaily blog.

Politics Trump Healthcare Information: News Coverage of the Affordable Care Act

The Affordable Care Act, also known as the “Patient Protection and Affordable Care Act”, “Obamacare” or the ACA, is a comprehensive healthcare reform law enacted in March 2010 which profoundly changed healthcare in the United States. This reform allowed millions of previously uninsured Americans to gain health insurance by establishing several new measures, including the expansion of the federal Medicaid health insurance coverage program, introducing the rule that patients with pre-existing illnesses could no longer be rejected or overcharged by health insurance companies, and by allowing dependents to remain on their parents’ health insurance plan until the age of 26. The widespread increase in health insurance coverage – especially for vulnerable Americans who were unemployed, underemployed or worked for employers that did not provide health insurance benefits – was also accompanied by new regulations targeting the healthcare system itself. Healthcare providers and hospitals were provided with financial incentives to introduce electronic medical records and healthcare quality metrics.

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As someone who grew up in Germany where health insurance coverage is guaranteed for everyone, I assumed that over time, the vast majority of Americans would appreciate the benefits of universal coverage. One no longer has to fear financial bankruptcy as a consequence of a major illness and a government-back health insurance also provides for peace of mind when changing jobs. Instead of accepting employment primarily because it offers health benefits, one can instead choose a job based on the nature of the work. But I was surprised to see the profound antipathy towards this new law, especially among Americans who identified themselves as conservatives or Republicans, even if they were potential beneficiaries of the reform. Was the hatred of progressive-liberal views, the Democrats and President Obama who had passed the ACA so intense among Republicans that they were willing to relinquish the benefits of universal health coverage for the sake of their political ideology? Or were they simply not aware of the actual content of the law and opposed it simply for political reasons?

A recent study published by a team of researchers led by Sarah Gollust at the University of Minnesota may shed some light on this question. Gollust and her colleagues analyzed 1,569 local evening television news stories related to the ACA that were aired in the United States during the early months of when the health care reform was rolled out (between October 1, 2013, and April 19, 2014). They focused on analyzing local television news broadcasts because these continue to constitute the primary source of news for Americans, especially for those who are age 50 and higher. A Pew survey recently showed that 57% of all U.S. adults rely on television for their news, and among this group, local TV new (46%) is a more common source than cable news (31%) or network news (30%).

Gollust and colleagues found that 55% of the news stories either focused on the politics of the ACA such as political disagreements over its implementation (26.5%) or combined information regarding its politics with information on how it would affect healthcare insurance options (28.6%). Only 45% of the news stories focused exclusively on the healthcare insurance options provided by the law. The politics-focused news stories were also more likely to refer to the law as “Obamacare” whereas healthcare insurance focused news segments used the official name “Affordable Care Act” or “ACA”. Surprisingly, the expansion of Medicaid, which was one of the cornerstones of the ACA because it would increase the potential access to health insurance for millions of Americans, was often ignored. Only 7.4% of news stories mentioned Medicaid at all, and only 5% had a Medicaid focus.

What were the sources of information used for the news stories? President Obama was cited in nearly 40% of the stories, whereas other sources included White House staff or other federal executive agencies (28.7%), Republican (22.3%) or Democratic (15.9%) politicians and officials. Researchers, academics or members of think tanks and foundations were cited in only 3.9% of the news stories about the ACA even though they could have provided important scholarly insights about the ACA and its consequences for individual healthcare as well as the healthcare system in general.

The study by Gollust and colleagues has its limitations. It did not analyze TV network news, cable news, or online news outlets which have significantly gained in importance as news sources during the past decade. The researchers also did not analyze news stories aired after April 2014 which may have been a better reflection of initial experiences of previously uninsured individuals who signed up for health insurance through the mechanisms provided by the ACA. Despite these limitations, the study suggests that one major reason for the strong opposition among Republicans against the ACA may have been the fact that it was often framed in a political context and understated the profound effects that the ACA had on access to healthcare and the reform of the healthcare system itself.

During the 2016 election campaign, many Republican politicians used the idea of “repealing” the ACA to energize their voters, without necessarily clarifying what exactly they wanted to repeal. Should all the aspects of the ACA – from the Medicaid expansion to the new healthcare quality metrics in hospitals –be repealed? If voters relied on the local television news to learn about the ACA, and if this coverage – as is suggested by Gollust’s study – viewed the ACA predominantly as a political entity, then it is not surprising that voters failed to demand nuanced views from politicians who vowed to repeal the law. The research also highlights the important role that television reporting plays in framing the debate about healthcare reform. By emphasizing the actual content of the healthcare reform and its medical implications and by using more scholars instead of politicians as information sources, these media outlets could educate the public about the law.

There are many legitimate debates about the pros and cons of the healthcare reform that are not rooted in politics. For example, electronic medical records allow healthcare providers to easily monitor the results of laboratory tests and avoid wasting patient’s time and money on unnecessary tests that may have been ordered by another provider. However, physicians who are continuously staring at their screens to scroll through test results may not be able to form the interpersonal bond that is critical for a patient-doctor relationship. One could consider modifying the requirements and developing better record-keeping measures to ensure a balance between adequate documentation and sufficient face-to-face doctor-patient time. The ACA’s desire to track quality of healthcare delivery and penalize hospitals or providers who deliver suboptimal care could significantly improve adherence to guidelines based on sound science. On the other hand, one cannot demand robot-like adherence to guidelines, especially when treating severely ill, complex patients who require highly individualized care. These content-driven discussions are more productive than wholesale political endorsements or rejections of the healthcare reform.

Healthcare will always be a political issue but all of us – engaged citizens, patients, healthcare providers or journalists – need to do our part to ensure that this debates about this issue which directly impacts millions of lives are primarily driven by objective information and not by political ideologies.

Reference:

Gollust, S. E., Baum, L. M., Niederdeppe, J., Barry, C. L., & Fowler, E. F. (2017). Local Television News Coverage of the Affordable Care Act: Emphasizing Politics Over Consumer Information. American Journal of Public Health, (published online Feb 16, 2017).

Note: An earlier version of this article was first published on the 3Quarksdaily blog.

 

ResearchBlogging.org

Gollust SE, Baum LM, Niederdeppe J, Barry CL, & Fowler EF (2017). Local Television News Coverage of the Affordable Care Act: Emphasizing Politics Over Consumer Information. American journal of public health PMID: 28207336