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Saturday, 18 May 2013

How the Case for Austerity Has Crumbled


 
 
The Alchemists: Three Central Bankers and a World on Fire
by Neil Irwin
Penguin, 430 pp., $29.95                                                  
Austerity: The History of a Dangerous Idea
by Mark Blyth
Oxford University Press, 288 pp., $24.95                                                  
The Great Deformation: The Corruption of Capitalism in America
by David A. Stockman
PublicAffairs, 742 pp., $35.00                                                  
krugman_1-060613
President Barack Obama and Representative Paul Ryan at a bipartisan meeting on health insurance reform, Washington, D.C., February 2010
In normal times, an arithmetic mistake in an economics paper would be a complete nonevent as far as the wider world was concerned. But in April 2013, the discovery of such a mistake—actually, a coding error in a spreadsheet, coupled with several other flaws in the analysis—not only became the talk of the economics profession, but made headlines. Looking back, we might even conclude that it changed the course of policy.
Why? Because the paper in question, “Growth in a Time of Debt,” by the Harvard economists Carmen Reinhart and Kenneth Rogoff, had acquired touchstone status in the debate over economic policy. Ever since the paper was first circulated, austerians—advocates of fiscal austerity, of immediate sharp cuts in government spending—had cited its alleged findings to defend their position and attack their critics. Again and again, suggestions that, as John Maynard Keynes once argued, “the boom, not the slump, is the right time for austerity”—that cuts should wait until economies were stronger—were met with declarations that Reinhart and Rogoff had shown that waiting would be disastrous, that economies fall off a cliff once government debt exceeds 90 percent of GDP.
Indeed, Reinhart-Rogoff may have had more immediate influence on public debate than any previous paper in the history of economics. The 90 percent claim was cited as the decisive argument for austerity by figures ranging from Paul Ryan, the former vice-presidential candidate who chairs the House budget committee, to Olli Rehn, the top economic official at the European Commission, to the editorial board of The Washington Post. So the revelation that the supposed 90 percent threshold was an artifact of programming mistakes, data omissions, and peculiar statistical techniques suddenly made a remarkable number of prominent people look foolish.
The real mystery, however, was why Reinhart-Rogoff was ever taken seriously, let alone canonized, in the first place. Right from the beginning, critics raised strong concerns about the paper’s methodology and conclusions, concerns that should have been enough to give everyone pause. Moreover, Reinhart-Rogoff was actually the second example of a paper seized on as decisive evidence in favor of austerity economics, only to fall apart on careful scrutiny. Much the same thing happened, albeit less spectacularly, after austerians became infatuated with a paper by Alberto Alesina and Silvia Ardagna purporting to show that slashing government spending would have little adverse impact on economic growth and might even be expansionary. Surely that experience should have inspired some caution.
So why wasn’t there more caution? The answer, as documented by some of the books reviewed here and unintentionally illustrated by others, lies in both politics and psychology: the case for austerity was and is one that many powerful people want to believe, leading them to seize on anything that looks like a justification. I’ll talk about that will to believe later in this article. First, however, it’s useful to trace the recent history of austerity both as a doctrine and as a policy experiment.

1.

In the beginning was the bubble. There have been many, many books about the excesses of the boom years—in fact, too many books. For as we’ll see, the urge to dwell on the lurid details of the boom, rather than trying to understand the dynamics of the slump, is a recurrent problem for economics and economic policy. For now, suffice it to say that by the beginning of 2008 both America and Europe were poised for a fall. They had become excessively dependent on an overheated housing market, their households were too deep in debt, their financial sectors were undercapitalized and overextended.
All that was needed to collapse these houses of cards was some kind of adverse shock, and in the end the implosion of US subprime-based securities did the deed. By the fall of 2008 the housing bubbles on both sides of the Atlantic had burst, and the whole North Atlantic economy was caught up in “deleveraging,” a process in which many debtors try—or are forced—to pay down their debts at the same time.
Why is this a problem? Because of interdependence: your spending is my income, and my spending is your income. If both of us try to reduce our debt by slashing spending, both of our incomes plunge—and plunging incomes can actually make our indebtedness worse even as they also produce mass unemployment.
Students of economic history watched the process unfolding in 2008 and 2009 with a cold shiver of recognition, because it was very obviously the same kind of process that brought on the Great Depression. Indeed, early in 2009 the economic historians Barry Eichengreen and Kevin O’Rourke produced shocking charts showing that the first year of the 2008–2009 slump in trade and industrial production was fully comparable to the first year of the great global slump from 1929 to 1933.
So was a second Great Depression about to unfold? The good news was that we had, or thought we had, several big advantages over our grandfathers, helping to limit the damage. Some of these advantages were, you might say, structural, built into the way modern economies operate, and requiring no special action on the part of policymakers. Others were intellectual: surely we had learned something since the 1930s, and would not repeat our grandfathers’ policy mistakes.
On the structural side, probably the biggest advantage over the 1930s was the way taxes and social insurance programs—both much bigger than they were in 1929—acted as “automatic stabilizers.” Wages might fall, but overall income didn’t fall in proportion, both because tax collections plunged and because government checks continued to flow for Social Security, Medicare, unemployment benefits, and more. In effect, the existence of the modern welfare state put a floor on total spending, and therefore prevented the economy’s downward spiral from going too far.
On the intellectual side, modern policymakers knew the history of the Great Depression as a cautionary tale; some, including Ben Bernanke, had actually been major Depression scholars in their previous lives. They had learned from Milton Friedman the folly of letting bank runs collapse the financial system and the desirability of flooding the economy with money in times of panic. They had learned from John Maynard Keynes that under depression conditions government spending can be an effective way to create jobs. They had learned from FDR’s disastrous turn toward austerity in 1937 that abandoning monetary and fiscal stimulus too soon can be a very big mistake.
As a result, where the onset of the Great Depression was accompanied by policies that intensified the slump—interest rate hikes in an attempt to hold on to gold reserves, spending cuts in an attempt to balance budgets—2008 and 2009 were characterized by expansionary monetary and fiscal policies, especially in the United States, where the Federal Reserve not only slashed interest rates, but stepped into the markets to buy everything from commercial paper to long-term government debt, while the Obama administration pushed through an $800 billion program of tax cuts and spending increases. European actions were less dramatic—but on the other hand, Europe’s stronger welfare states arguably reduced the need for deliberate stimulus.
Now, some economists (myself included) warned from the beginning that these monetary and fiscal actions, although welcome, were too small given the severity of the economic shock. Indeed, by the end of 2009 it was clear that although the situation had stabilized, the economic crisis was deeper than policymakers had acknowledged, and likely to prove more persistent than they had imagined. So one might have expected a second round of stimulus to deal with the economic shortfall.
What actually happened, however, was a sudden reversal.

2.

Neil Irwin’s The Alchemists gives us a time and a place at which the major advanced countries abruptly pivoted from stimulus to austerity. The time was early February 2010; the place, somewhat bizarrely, was the remote Canadian Arctic settlement of Iqaluit, where the Group of Seven finance ministers held one of their regularly scheduled summits. Sometimes (often) such summits are little more than ceremonial occasions, and there was plenty of ceremony at this one too, including raw seal meat served at the last dinner (the foreign visitors all declined). But this time something substantive happened. “In the isolation of the Canadian wilderness,” Irwin writes, “the leaders of the world economy collectively agreed that their great challenge had shifted. The economy seemed to be healing; it was time for them to turn their attention away from boosting growth. No more stimulus.”
krugman_figure1-060613
How decisive was the turn in policy? Figure 1, which is taken from the IMF’s most recent World Economic Outlook, shows how real government spending behaved in this crisis compared with previous recessions; in the figure, year zero is the year before global recession (2007 in the current slump), and spending is compared with its level in that base year. What you see is that the widespread belief that we are experiencing runaway government spending is false—on the contrary, after a brief surge in 2009, government spending began falling in both Europe and the United States, and is now well below its normal trend. The turn to austerity was very real, and quite large.
On the face of it, this was a very strange turn for policy to take. Standard textbook economics says that slashing government spending reduces overall demand, which leads in turn to reduced output and employment. This may be a desirable thing if the economy is overheating and inflation is rising; alternatively, the adverse effects of reduced government spending can be offset. Central banks (the Fed, the European Central Bank, or their counterparts elsewhere) can cut interest rates, inducing more private spending. However, neither of these conditions applied in early 2010, or for that matter apply now. The major advanced economies were and are deeply depressed, with no hint of inflationary pressure. Meanwhile, short-term interest rates, which are more or less under the central bank’s control, are near zero, leaving little room for monetary policy to offset reduced government spending. So Economics 101 would seem to say that all the austerity we’ve seen is very premature, that it should wait until the economy is stronger.
The question, then, is why economic leaders were so ready to throw the textbook out the window.
One answer is that many of them never believed in that textbook stuff in the first place. The German political and intellectual establishment has never had much use for Keynesian economics; neither has much of the Republican Party in the United States. In the heat of an acute economic crisis—as in the autumn of 2008 and the winter of 2009—these dissenting voices could to some extent be shouted down; but once things had calmed they began pushing back hard.
A larger answer is the one we’ll get to later: the underlying political and psychological reasons why many influential figures hate the notions of deficit spending and easy money. Again, once the crisis became less acute, there was more room to indulge in these sentiments.
In addition to these underlying factors, however, were two more contingent aspects of the situation in early 2010: the new crisis in Greece, and the appearance of seemingly rigorous, high-quality economic research that supported the austerian position.
The Greek crisis came as a shock to almost everyone, not least the new Greek government that took office in October 2009. The incoming leadership knew it faced a budget deficit—but it was only after arriving that it learned that the previous government had been cooking the books, and that both the deficit and the accumulated stock of debt were far higher than anyone imagined. As the news sank in with investors, first Greece, then much of Europe, found itself in a new kind of crisis—one not of failing banks but of failing governments, unable to borrow on world markets.
It’s an ill wind that blows nobody good, and the Greek crisis was a godsend for anti-Keynesians. They had been warning about the dangers of deficit spending; the Greek debacle seemed to show just how dangerous fiscal profligacy can be. To this day, anyone arguing against fiscal austerity, let alone suggesting that we need another round of stimulus, can expect to be attacked as someone who will turn America (or Britain, as the case may be) into another Greece.
If Greece provided the obvious real-world cautionary tale, Reinhart and Rogoff seemed to provide the math. Their paper seemed to show not just that debt hurts growth, but that there is a “threshold,” a sort of trigger point, when debt crosses 90 percent of GDP. Go beyond that point, their numbers suggested, and economic growth stalls. Greece, of course, already had debt greater than the magic number. More to the point, major advanced countries, the United States included, were running large budget deficits and closing in on the threshold. Put Greece and Reinhart-Rogoff together, and there seemed to be a compelling case for a sharp, immediate turn toward austerity.
But wouldn’t such a turn toward austerity in an economy still depressed by private deleveraging have an immediate negative impact? Not to worry, said another remarkably influential academic paper, “Large Changes in Fiscal Policy: Taxes Versus Spending,” by Alberto Alesina and Silvia Ardagna.
One of the especially good things in Mark Blyth’s Austerity: The History of a Dangerous Idea is the way he traces the rise and fall of the idea of “expansionary austerity,” the proposition that cutting spending would actually lead to higher output. As he shows, this is very much a proposition associated with a group of Italian economists (whom he dubs “the Bocconi boys”) who made their case with a series of papers that grew more strident and less qualified over time, culminating in the 2009 analysis by Alesina and Ardagna.
In essence, Alesina and Ardagna made a full frontal assault on the Keynesian proposition that cutting spending in a weak economy produces further weakness. Like Reinhart and Rogoff, they marshaled historical evidence to make their case. According to Alesina and Ardagna, large spending cuts in advanced countries were, on average, followed by expansion rather than contraction. The reason, they suggested, was that decisive fiscal austerity created confidence in the private sector, and this increased confidence more than offset any direct drag from smaller government outlays.
As Mark Blyth documents, this idea spread like wildfire. Alesina and Ardagna made a special presentation in April 2010 to the Economic and Financial Affairs Council of the European Council of Ministers; the analysis quickly made its way into official pronouncements from the European Commission and the European Central Bank. Thus in June 2010 Jean-Claude Trichet, the then president of theECB, dismissed concerns that austerity might hurt growth:
As regards the economy, the idea that austerity measures could trigger stagnation is incorrect…. In fact, in these circumstances, everything that helps to increase the confidence of households, firms and investors in the sustainability of public finances is good for the consolidation of growth and job creation. I firmly believe that in the current circumstances confidence-inspiring policies will foster and not hamper economic recovery, because confidence is the key factor today.
This was straight Alesina-Ardagna.
By the summer of 2010, then, a full-fledged austerity orthodoxy had taken shape, becoming dominant in European policy circles and influential on this side of the Atlantic. So how have things gone in the almost three years that have passed since?

3.

Clear evidence on the effects of economic policy is usually hard to come by. Governments generally change policies reluctantly, and it’s hard to distinguish the effects of the half-measures they undertake from all the other things going on in the world. The Obama stimulus, for example, was both temporary and fairly small compared with the size of the US economy, never amounting to much more than 2 percent of GDP, and it took effect in an economy whipsawed by the biggest financial crisis in three generations. How much of what took place in 2009–2011, good or bad, can be attributed to the stimulus? Nobody really knows.
The turn to austerity after 2010, however, was so drastic, particularly in European debtor nations, that the usual cautions lose most of their force. Greece imposed spending cuts and tax increases amounting to 15 percent of GDP; Ireland and Portugal rang in with around 6 percent; and unlike the half-hearted efforts at stimulus, these cuts were sustained and indeed intensified year after year. So how did austerity actually work?
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The answer is that the results were disastrous—just about as one would have predicted from textbook macroeconomics. Figure 2, for example, shows what happened to a selection of European nations (each represented by a diamond-shaped symbol). The horizontal axis shows austerity measures—spending cuts and tax increases—as a share of GDP, as estimated by the International Monetary Fund. The vertical axis shows the actual percentage change in real GDP. As you can see, the countries forced into severe austerity experienced very severe downturns, and the downturns were more or less proportional to the degree of austerity.
There have been some attempts to explain away these results, notably at the European Commission. But the IMF, looking hard at the data, has not only concluded that austerity has had major adverse economic effects, it has issued what amounts to a mea culpa for having underestimated these adverse effects.*
But is there any alternative to austerity? What about the risks of excessive debt?
In early 2010, with the Greek disaster fresh in everyone’s mind, the risks of excessive debt seemed obvious; those risks seemed even greater by 2011, as Ireland, Spain, Portugal, and Italy joined the ranks of nations having to pay large interest rate premiums. But a funny thing happened to other countries with high debt levels, including Japan, the United States, and Britain: despite large deficits and rapidly rising debt, their borrowing costs remained very low. The crucial difference, as the Belgian economist Paul DeGrauwe pointed out, seemed to be whether countries had their own currencies, and borrowed in those currencies. Such countries can’t run out of money because they can print it if needed, and absent the risk of a cash squeeze, advanced nations are evidently able to carry quite high levels of debt without crisis.
Three years after the turn to austerity, then, both the hopes and the fears of the austerians appear to have been misplaced. Austerity did not lead to a surge in confidence; deficits did not lead to crisis. But wasn’t the austerity movement grounded in serious economic research? Actually, it turned out that it wasn’t—the research the austerians cited was deeply flawed.
First to go down was the notion of expansionary austerity. Even before the results of Europe’s austerity experiment were in, the Alesina-Ardagna paper was falling apart under scrutiny. Researchers at the Roosevelt Institute pointed out that none of the alleged examples of austerity leading to expansion of the economy actually took place in the midst of an economic slump; researchers at the IMF found that the Alesina-Ardagna measure of fiscal policy bore little relationship to actual policy changes. “By the middle of 2011,” Blyth writes, “empirical and theoretical support for expansionary austerity was slipping away.” Slowly, with little fanfare, the whole notion that austerity might actually boost economies slunk off the public stage.
Reinhart-Rogoff lasted longer, even though serious questions about their work were raised early on. As early as July 2010 Josh Bivens and John Irons of the Economic Policy Institute had identified both a clear mistake—a misinterpretation of US data immediately after World War II—and a severe conceptual problem. Reinhart and Rogoff, as they pointed out, offered no evidence that the correlation ran from high debt to low growth rather than the other way around, and other evidence suggested that the latter was more likely. But such criticisms had little impact; for austerians, one might say, Reinhart-Rogoff was a story too good to check.
So the revelations in April 2013 of the errors of Reinhart and Rogoff came as a shock. Despite their paper’s influence, Reinhart and Rogoff had not made their data widely available—and researchers working with seemingly comparable data hadn’t been able to reproduce their results. Finally, they made their spreadsheet available to Thomas Herndon, a graduate student at the University of Massachusetts, Amherst—and he found it very odd indeed. There was one actual coding error, although that made only a small contribution to their conclusions. More important, their data set failed to include the experience of several Allied nations—Canada, New Zealand, and Australia—that emerged from World War II with high debt but nonetheless posted solid growth. And they had used an odd weighting scheme in which each “episode” of high debt counted the same, whether it occurred during one year of bad growth or seventeen years of good growth.
Without these errors and oddities, there was still a negative correlation between debt and growth—but this could be, and probably was, mostly a matter of low growth leading to high debt, not the other way around. And the “threshold” at 90 percent vanished, undermining the scare stories being used to sell austerity.
Not surprisingly, Reinhart and Rogoff have tried to defend their work; but their responses have been weak at best, evasive at worst. Notably, they continue to write in a way that suggests, without stating outright, that debt at 90 percent ofGDP is some kind of threshold at which bad things happen. In reality, even if one ignores the issue of causality—whether low growth causes high debt or the other way around—the apparent effects on growth of debt rising from, say, 85 to 95 percent of GDP are fairly small, and don’t justify the debt panic that has been such a powerful influence on policy.
At this point, then, austerity economics is in a very bad way. Its predictions have proved utterly wrong; its founding academic documents haven’t just lost their canonized status, they’ve become the objects of much ridicule. But as I’ve pointed out, none of this (except that Excel error) should have come as a surprise: basic macroeconomics should have told everyone to expect what did, in fact, happen, and the papers that have now fallen into disrepute were obviously flawed from the start.
This raises the obvious question: Why did austerity economics get such a powerful grip on elite opinion in the first place?
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4.

Everyone loves a morality play. “For the wages of sin is death” is a much more satisfying message than “Shit happens.” We all want events to have meaning.
When applied to macroeconomics, this urge to find moral meaning creates in all of us a predisposition toward believing stories that attribute the pain of a slump to the excesses of the boom that precedes it—and, perhaps, also makes it natural to see the pain as necessary, part of an inevitable cleansing process. When Andrew Mellon told Herbert Hoover to let the Depression run its course, so as to “purge the rottenness” from the system, he was offering advice that, however bad it was as economics, resonated psychologically with many people (and still does).
By contrast, Keynesian economics rests fundamentally on the proposition that macroeconomics isn’t a morality play—that depressions are essentially a technical malfunction. As the Great Depression deepened, Keynes famously declared that “we have magneto trouble”—i.e., the economy’s troubles were like those of a car with a small but critical problem in its electrical system, and the job of the economist is to figure out how to repair that technical problem. Keynes’s masterwork, The General Theory of Employment, Interest and Money, is noteworthy—and revolutionary—for saying almost nothing about what happens in economic booms. Pre-Keynesian business cycle theorists loved to dwell on the lurid excesses that take place in good times, while having relatively little to say about exactly why these give rise to bad times or what you should do when they do. Keynes reversed this priority; almost all his focus was on how economies stay depressed, and what can be done to make them less depressed.
I’d argue that Keynes was overwhelmingly right in his approach, but there’s no question that it’s an approach many people find deeply unsatisfying as an emotional matter. And so we shouldn’t find it surprising that many popular interpretations of our current troubles return, whether the authors know it or not, to the instinctive, pre-Keynesian style of dwelling on the excesses of the boom rather than on the failures of the slump.
David Stockman’s The Great Deformation should be seen in this light. It’s an immensely long rant against excesses of various kinds, all of which, in Stockman’s vision, have culminated in our present crisis. History, to Stockman’s eyes, is a series of “sprees”: a “spree of unsustainable borrowing,” a “spree of interest rate repression,” a “spree of destructive financial engineering,” and, again and again, a “money-printing spree.” For in Stockman’s world, all economic evil stems from the original sin of leaving the gold standard. Any prosperity we may have thought we had since 1971, when Nixon abandoned the last link to gold, or maybe even since 1933, when FDR took us off gold for the first time, was an illusion doomed to end in tears. And of course, any policies aimed at alleviating the current slump will just make things worse.
In itself, Stockman’s book isn’t important. Aside from a few swipes at Republicans, it consists basically of standard goldbug bombast. But the attention the book has garnered, the ways it has struck a chord with many people, including even some liberals, suggest just how strong remains the urge to see economics as a morality play, three generations after Keynes tried to show us that it is nothing of the kind.
And powerful officials are by no means immune to that urge. In The Alchemists, Neil Irwin analyzes the motives of Jean-Claude Trichet, the president of the European Central Bank, in advocating harsh austerity policies:
Trichet embraced a view, especially common in Germany, that was rooted in a sort of moralism. Greece had spent too much and taken on too much debt. It must cut spending and reduce deficits. If it showed adequate courage and political resolve, markets would reward it with lower borrowing costs. He put a great deal of faith in the power of confidence….
Given this sort of predisposition, is it any wonder that Keynesian economics got thrown out the window, while Alesina-Ardagna and Reinhart-Rogoff were instantly canonized?
So is the austerian impulse all a matter of psychology? No, there’s also a fair bit of self-interest involved. As many observers have noted, the turn away from fiscal and monetary stimulus can be interpreted, if you like, as giving creditors priority over workers. Inflation and low interest rates are bad for creditors even if they promote job creation; slashing government deficits in the face of mass unemployment may deepen a depression, but it increases the certainty of bondholders that they’ll be repaid in full. I don’t think someone like Trichet was consciously, cynically serving class interests at the expense of overall welfare; but it certainly didn’t hurt that his sense of economic morality dovetailed so perfectly with the priorities of creditors.
It’s also worth noting that while economic policy since the financial crisis looks like a dismal failure by most measures, it hasn’t been so bad for the wealthy. Profits have recovered strongly even as unprecedented long-term unemployment persists; stock indices on both sides of the Atlantic have rebounded to pre-crisis highs even as median income languishes. It might be too much to say that those in the top 1 percent actually benefit from a continuing depression, but they certainly aren’t feeling much pain, and that probably has something to do with policymakers’ willingness to stay the austerity course.

5.

How could this happen? That’s the question many people were asking four years ago; it’s still the question many are asking today. But the “this” has changed.
Four years ago, the mystery was how such a terrible financial crisis could have taken place, with so little forewarning. The harsh lessons we had to learn involved the fragility of modern finance, the folly of trusting banks to regulate themselves, and the dangers of assuming that fancy financial arrangements have eliminated or even reduced the age-old problems of risk.
I would argue, however—self-serving as it may sound (I warned about the housing bubble, but had no inkling of how widespread a collapse would follow when it burst)—that the failure to anticipate the crisis was a relatively minor sin. Economies are complicated, ever-changing entities; it was understandable that few economists realized the extent to which short-term lending and securitization of assets such as subprime mortgages had recreated the old risks that deposit insurance and bank regulation were created to control.
I’d argue that what happened next—the way policymakers turned their back on practically everything economists had learned about how to deal with depressions, the way elite opinion seized on anything that could be used to justify austerity—was a much greater sin. The financial crisis of 2008 was a surprise, and happened very fast; but we’ve been stuck in a regime of slow growth and desperately high unemployment for years now. And during all that time policymakers have been ignoring the lessons of theory and history.
It’s a terrible story, mainly because of the immense suffering that has resulted from these policy errors. It’s also deeply worrying for those who like to believe that knowledge can make a positive difference in the world. To the extent that policymakers and elite opinion in general have made use of economic analysis at all, they have, as the saying goes, done so the way a drunkard uses a lamppost: for support, not illumination. Papers and economists who told the elite what it wanted to hear were celebrated, despite plenty of evidence that they were wrong; critics were ignored, no matter how often they got it right.
The Reinhart-Rogoff debacle has raised some hopes among the critics that logic and evidence are finally beginning to matter. But the truth is that it’s too soon to tell whether the grip of austerity economics on policy will relax significantly in the face of these revelations. For now, the broader message of the past few years remains just how little good comes from understanding.

Medical intervention is not always the answer to mental health issues









by Frank Furedi

 The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has just been published and the contents of this book should really be of interest to you. The DSM is not simply a medical handbook that provides a list of conditions worthy of the diagnosis of mental illness. It is also a secular bible that instructs people how to make sense of their predicament through the language of medicine.

With every edition of the DSM, the number of conditions diagnosed as a problem suitable for psychiatric intervention expands. You, dear reader, may be suffering from a mental illness that you never knew existed. So if like me you really get angry now and then, the DSM suggests that you may be suffering from “disruptive mood dysregulation disorder”. Or if you have the occasional senior moment, you may well be afflicted with the new diagnosis of “mild neurocognitive disorder”. And if you really feel anxious and scared about experiencing pain and discomfort, you may have “somatic symptom disorder”.
The eccentric loner, the shy stranger lacking in social skills, the naughty child, anyone who eats too much or the sexually confused teenager have all become candidates for the psychiatrist’s couch. What’s important about the DSM is that it provides a language and narrative through which the problems of existence become medicalised. And in a world where a medical diagnosis represents a claim for resources, what the DSM says really matters. The verdict of the DSM not only affects insurance and drug companies interested in their bottom line but also anxious parents who rely on a diagnosis to gain special help for their child.
Not surprisingly, the latest edition of the DSM has become a subject of controversy. Different groups of medics and psychiatrists have questioned the scientific reliability of some of the new diagnostic categories. Some have queried the dropping of the category of Asperger’s syndromeand the decision to include it under a general autism diagnosis. Others argue that the psychiatric lobby has become a captive of the pharmaceutical industry. But what is not at issue is the ethos of medicalisation promoted through this influential manual.
The term medicalisation refers to the cultural process through which a range of human experience is reinterpreted through the language of medicine. In recent decades, many everyday experiences have become redefined as issues of health that require medical intervention. Through reinterpreting existential problems such as loneliness, shyness, fear, anxiety, loss of control or grief as medical ones, the meaning people attach to them fundamentally alters.
Medical problems require treatment and rely on professional intervention to cure the patient’s illness. But why should grief or shyness or even anger be treated as a disease? And why should professionals possess a monopoly on how to interpret the pain and disappointment that people experience at different stages of their lives? The real threat posed by the expansion of mental health diagnosis is that it takes away from people the confidence that they need to make sense and give meaning to their personal experience.
The problem is not that professional advice is always misguided, but that it short-circuits the process through which people can learn how to deal with problems through their own experience. Intuition and insight gained from experience are continually compromised by professional knowledge. This has the unintentional consequence of estranging people from their own feelings and instincts since such reactions require the affirmation of the expert. In such circumstances, people’s capacity to handle relationships and to have confidence in their relationships diminishes further. In turn, this creates new opportunities for professional intervention in everyday life.
The manner in which emotional problems have become diagnosed as a form of disorder raises questions about the ability of the individual to deal with disappointment, misfortune, adversity or even the challenge of everyday life. And, sadly, when people are continually invited to make sense of their troubles through the medium of therapeutics, it severely undermines their resilience.
Once the diagnosis of illness is systematically offered as an interpretative guide for making sense of distress, people are far more likely to perceive themselves as ill. That is one reason why in Western society the number of people diagnosed as suffering from mental illness has risen exponentially. The explanation for this trend lies not in the fields of epidemiology, but in the realm of culture that invites people to classify themselves as infirm.
Recently, the British Psychological Society’s division of clinical psychology has attacked the psychiatric profession for offering a biomedical model for understanding mental distress. But its criticism was not directed at the ethos of medicalisation as such, but only at the tendency to associate mental illness with biological causes. What it offered was an alternative model of medicalisation – one where mental illness was represented as the outcome of social and psychological cause. It seems that medicalisation has become so deeply entrenched that even critics of the DSM accept its premise.
The problems of life can be painful. But this experience of existential agony must not be rebranded as an illness. Medicalisation empties experience of its creative content and assigns human beings the status of permanent patients. The promiscuous expansion of diagnosis also trivialises mental illness. Learning to distinguish between normal suffering and illness is a mark of a mature and confident culture.
Frank Furedi is a sociologist whose books include ‘Therapy Culture’

Friday, 17 May 2013

The Smith/Klein/Kalecki Theory of Austerity


by Paul Krugman

Noah Smith recently offered an interesting take on the real reasons austerity garners so much support from elites, no matter how badly it fails in practice. Elites, he argues, see economic distress as an opportunity to push through “reforms” — which basically means changes they want, which may or may not actually serve the interest of promoting economic growth — and oppose any policies that might mitigate crisis without the need for these changes:
I conjecture that “austerians” are concerned that anti-recessionary macro policy will allow a country to “muddle through” a crisis without improving its institutions. In other words, they fear that a successful stimulus would be wasting a good crisis.
If people really do think that the danger of stimulus is not that it might fail, but that it might succeed, they need to say so. Only then, I believe, can we have an optimal public discussion about costs and benefits.
As he notes, the day after he wrote that post, Steven Pearlstein of the Washington Post made exactly that argument for austerity.
What Smith didn’t note, somewhat surprisingly, is that his argument is very close to Naomi Klein’s Shock Doctrine, with its argument that elites systematically exploit disasters to push through neoliberal policies even if these policies are essentially irrelevant to the sources of disaster. I have to admit that I was predisposed to dislike Klein’s book when it came out, probably out of professional turf-defending and whatever — but her thesis really helps explain a lot about what’s going on in Europe in particular.
And the lineage goes back even further. Two and a half years ago Mike Konczal reminded us of a classic 1943 (!) essay by Michal Kalecki, who suggested that business interests hate Keynesian economics because they fear that it might work — and in so doing mean that politicians would no longer have to abase themselves before businessmen in the name of preserving confidence. This is pretty close to the argument that we must have austerity, because stimulus might remove the incentive for structural reform that, you guessed it, gives businesses the confidence they need before deigning to produce recovery.
And sure enough, in my inbox this morning I see a piece more or less deploring the early signs of success for Abenomics: Abenomics is working — but it had better not work too well. Because if it works, how will we get structural reform?
So one way to see the drive for austerity is as an application of a sort of reverse Hippocratic oath: “First, do nothing to mitigate harm”. For the people must suffer if neoliberal reforms are to prosper.

Thursday, 16 May 2013

Depression and physical decline: why retirement can seriously damage your health


Retirement can cause a drastic decline in health, according to a study released today.

Research found that both mental and physical health can suffer, said the Institute of Economic Affairs and the Age Endeavour Fellowship, who claim the Government should help people work longer and raise the state pension ages.

The study - Work Longer, Live Healthier: The Relationship Between Economic Activity, Health And Government Policy - shows there is a small boost in health immediately after retirement but that, over the longer term, there is a significant deterioration.

It suggests retirement increases the likelihood of suffering from clinical depression by 40% and the chance of having at least one diagnosed physical condition by about 60%. The probability of taking medication for such a condition rises by about 60% as well, according to the findings. People who are retired are 40% less likely than others to describe themselves as being in very good or excellent health.
The length of time spent in retirement can also cause further disadvantages, the study found.

It concluded that, for men and women alike, "there seem to exist longer-term health benefits of employment among older people".

Its authors said: "This, in turn, indicates that politicians do not face a trade-off between improving the health of the older population, increasing economic growth, decreasing health spending among the elderly and producing solvent pension systems.

"The policy implication is that impediments to continuing paid word in old age should be decreased. This does not necessarily mean that people should be expected to work full-time until they die, but rather that public policy should remove the strong financial incentives to retire at earlier ages."

Philip Booth, editorial and programme director at the Institute of Economic Affairs, said: "Over several decades, governments have failed to deal with the 'demographic time bomb'.

"There is now general agreement that state pension ages should be raised. The Government should take firmer action here and also deregulate labour markets. Working longer will not only be an economic necessity, it also helps people to live healthier lives."

Edward Datnow, chairman of the Age Endeavour Fellowship, said: "In highlighting the positive link between work and health in old age, this research is a wake-up call for the UK's extensive and well-funded retirement lobbies.

"More emphasis needs to be given to ways of enabling a work-life balance beyond today's normal retirement age with legislative discouragements to extending working life being replaced with incentives. There should be no 'normal' retirement age in future.

"More employers need to consider how they will capitalise on Britain's untapped grey potential and those seeking to retire should think very hard about whether it is their best option."

How Nawaz Sharif beat Imran Khan .....


  

The results of the Pakistan elections are in – but how did a former exile win the vote? By promising airports to people who can't afford bicycles, says novelist Mohammed Hanif
Here's a little fairytale from Pakistan. Fourteen years ago a wise man ruled the country. He enjoyed the support of his people. But some of his treacherous generals thought he wasn't that smart. One night he was held at gunpoint, handcuffed, put in a dark dungeon, sentenced to life imprisonment. But then a little miracle happened; he, along with his family and servants, was put on a royal plane and exiled to Saudi Arabia, that fancy retirement home for the world's unwanted Muslim leaders.
Two days ago that same man stood on a balcony in Lahore, thanked Allah and said: Nawaz Sharif forgives them all.
But wait, if it was a real fairytale, Imran Khan would have won the election instead, right? Can't Pakistani voters tell between a world-famous, world cup-winning, charismatic leaderand a mere politician who refers to himself in the third person?

Why didn't Imran Khan win?

Imran Khan Imran Khan in hospital after a fall at a campaign rally. Photograph: HO/AFP

Well he has, sort of. But not in the way he would have liked. Visiting foreign journalists have profiled Imran Khan more than they have profiled any living thing in this part of the world. If all the world's magazine editors were allowed to vote for Imran Khan he would be the prime minister of half the English-speaking world. If Imran Khan had contested in west London he would have won hands-down. But since this is Pakistan, he has won in Peshawar and two other cities. His party is set to form a government in Khyber Pakhtunkhwa, that north-western frontier province of Pakistan which Khan's profile writers never fail to remind us is the province that borders Afghanistan and the tribal areas that the world is so scared of. Or as some others never fail to remind the world: the land of the fierce pathans.
It's true that Khan ran a fierce, bloody-minded campaign, drawing huge crowds. When his campaign culminated in a televised tumble from a stage, during a public rally, the whole nation held its breath. Khan galvanised not only Pakistan's parasitical upper classes but also found support among the country's young men and women of all ages; basically the kind of people who use the words politics and politician as common insults. He inspired drawing-room revolutionaries to go out and stand in the blistering heat for hours on end to vote for him. For a few months he made politics hip in Pakistan. Partly, he was relying on votes from Pakistan's posh locales. He probably forgot that there was a slight problem there: not enough posh locales in Pakistan. There were kids who flew in from Chicago, from Birmingham to vote for him. Again, there are not enough Pakistani kids living and studying in Chicago and Birmingham. He appealed to the educated middle classes but Pakistan's main problem is that there aren't enough educated urban middle-class citizens in the country.
And the masses, it appears, were not really clamouring for a revolution but for electricity.
From the gossip columns of British tabloids to massive political rallies across Pakistan, Khan has been on a meaningful journey. In his campaign speeches, his blatantly Blairite message of New Pakistan did appeal to people but he really tested his supporters' attention span when he started to lecture them about how the Scandinavian welfare state model is borrowed from the early days of the Islamic empire in Arabia. Amateur historians have never fared well in Pakistani politics. Or anywhere else. Khan promised to turn Pakistan into Sweden, Norway or any one of those countries where everyone is blond and pays tax. His opponents promised Dubai – where everyone is either a bonded labourer or a property speculator and no one pays taxes – and won.
It's a bit of a fairytale that Khan, whose message was directed at educated urban voters, has found supporters in the north-western frontier province that profile writers must remind us is largely tribal and the front line of the world's war on terror. Khan has led a popular campaign against drone attacks. He has promised that he will shoot down drones, look Americans in the eye, sit down with the Taliban over a cup of qahwa and sort this mess out.
So we finally have someone who feels at home in Mayfair as well as Peshawar. He finally has the chance to rule Peshawar. Slight problem: as he speaks no Pashto, the language of the Pathans. But his first fight will be against American drones hovering in the sky. And drones speak no Pashto either. If Khan can win this match, he can challenge Nawaz Sharif in the next elections.

Is this Nawaz Sharif man for real?

Nawaz Sharif at a campaign rally in Liaquat Bagh, Pakistan. Nawaz Sharif at a campaign rally in Liaquat Bagh, Pakistan. Photograph: T. MUGHAL/EPA

Hasn't he been tried before? Twice? It seems voters in the largest province of Pakistani Punjab just can't have enough of this guy. At every campaign stop, Sharif reminded his supporters of two of his biggest achievements: I built the motorway, I built the bomb. He did build Pakistan's first motorway. And despite several phone calls from the then American president Bill Clinton and other world leaders and offers of million of dollars in aid, Sharif did go ahead and order six nuclear explosions in response to India's five. And then he thought that now that both countries have the bomb he could go ahead and be friends with India. While he was making history hosting the Indian prime minister in the historic city of Lahore, his generals were busy elsewhere repeating history on the mountains of Kargil. In a misadventure typical of Pakistani generals, they occupied the abandoned posts and then pretended that these were mujahideen fighting India and not regular Pakistan army soldiers.
When India reacted with overwhelming force and a diplomatic offensive, Sharif pleaded ignorance and rushed off to Washington to bail out the army and his own government. President Clinton praised his diplomatic skills and the crisis was resolved briefly. When, months later he tried to fire his handpicked army chief General Pervez Musharraf, the architect of the Kargil fiasco, a bunch of army officers put their guns to Sharif's head. Handcuffed, jailed, sentenced to life imprisonment, in the end Sharif was saved by his powerful friends in Saudi Arabia. A royal jet flew him, his family and his servants to a palace in Saudi Arabia. An exile in Saudi Arabia for Muslim rulers is generally considered a permanent retirement home where you get closer to Allah and atone for past sins. Sharif must be the only politician in exile in Saudi Arabia who not only managed to survive this holy exile but in the process got a hair transplant and managed to hold on to his political base in Pakistan.
Many of his political opponents say that if Sharif wasn't from the dominant province Punjab, where most of the army elite comes from, if he didn't represent the trading and business classes of Punjab, he would still be begging forgiveness for his sins in Saudi. But he returned just before the last elections and has been behaving like a statesman. A very rich statesman.
It has yet to be proven whether eight years of exile in Saudi Arabia can make anyone wiser but it has never made anybody poorer. Sharif was rich before he got into politics, then he became fabulously rich. Even in exile the Saudis gave him a palace and, on his return, a fleet of bulletproof limousines. His campaign proved that poor people don't really vote for somebody who understands poverty, or wants to do anything about it. People have voted him in because he talks money, talks about spending money, talks about opening a bank on every village street and who doesn't like that? He has promised motorway connections and airports to towns so small that they still don't have a proper bus station. Poor people, who couldn't afford a bicycle at the time of the elections, like to be promised an airport. You never know when you might need it.
In his five years' rule in Punjab, Sharif's party has had one policy about the Pakistani Taliban who have been wreaking havoc in parts of Pakistan: please go and do your business elsewhere. And they have generally obliged. But now that he is set to rule all of Pakistan, what's he going to tell them?

Have we defeated the Taliban or sent them a friend request?

A voter displays her inked thumb after marking her ballot paper at a polling station in Karachi. A voter displays her inked thumb after marking her ballot paper at a polling station in Karachi. Photograph: Athar Hussain/REUTERS

When Pakistan decided to throw itself an election party, the first ones to arrive were the Taliban. They weren't really interested in the party because they keep reminding us that elections are un-Islamic and a major sin on a par with educating girls. But they were interested in watching what party games were played and who got to play them. They decided that the three political parties that had ruled Pakistan for the past five years and taken a clear stand against the Taliban would be targeted. And the Taliban started their own campaign, targeting candidates and their supporters with bomb attacks and drive-by shootings. In one case, a candidate in Karachi was shot as he came out of a mosque. Along with his six-year-old son. The election campaign across Pakistan looked like this: some parties held huge rallies, in a carnival-type atmosphere with live tigers and massive music systems. Other candidates sneaked from one little corner meeting to another trying to remind people of their heroic stand against the Taliban. Many of the candidates were never seen in public. Many journalists refused to visit them because they were sitting targets. Bilawal Bhutto Zardari, the public face of the ruling People's party, could only deliver a couple of video messages from Dubai.
The other parties, the ones who were allowed to campaign freely, were grateful in their silence. When we look at the election results we must not forget that while the Pakistani Taliban didn't contest the elections as a political party, they did see themselves as kingmakers. In Pakistan's liberal media the Taliban are often described as brutes with an endless bloodlust. But by making allies and choosing partners they have demonstrated that they are at least as canny as the average campaigning politician.
But in the end the Taliban failed to deliver the kind of devastation they had promised. They managed to kill about 130 people in eight weeks. In the past they have achieved that kind of number in a single day. Also, 60% of Pakistanis who came out to vote seem to be politely disagreeing with the Taliban by saying that there is nothing un-Islamic about standing in a queue and stamping a ballot paper.
The Taliban's real success is that they bet on the winners. They promised not to attack Khan and Sharif's parties. And these parties will be in power. But the Taliban have never contested an election before. And they are soon to find out that politicians never keep the promises they make during the heat of the campaign.

Why does this election mean nothing for Farzana Majeed?

Pakistani elections Pakistani voters line up at a polling station in Karachi. Photograph: Athar Hussain/Reuters

Three weeks before the elections, a 27-year-old biochemistry graduate stood outside Karachi Press club. Farzana Majeed and a couple of dozen young people carried pictures of Zakir Majeed, a literature student who was abducted by Pakistan's military intelligence four years ago and since then has become one of the hundreds of missing Baloch people, mostly young, political activists. Their mutilated, tortured bodies turn up on the roadsidewith sickening regularity. The Pakistani media, otherwise quite noisy about every subject under the sun, stay quiet. None of the political parties campaigning in recent elections uttered a word about Zakir Majeed or hundreds of other people languishing in military-run dungeons. Why? Because it's a security issue. A militant separatist movement in parts of Balochistan means that the rest of Pakistan sees it as an enemy. The protesters distributed pamphlets encouraging the fellow Balochs not to participate in the elections. The voter turn out in Baloch areas in Balochistan has been less than 10%. No political party in the country had the heart to go and ask Farzana Majeed or thousands of other families to vote. Farzana is a polite, articulate person but mention the word elections and she is likely to wave her missing brother's picture in front of you. And just like Pakistan's last political government, the new one also doesn't want to see this picture.

So what happens to the federation?

Watching the election results come in, in a teashop in Lahore. Watching the election results come in, in a teashop in Lahore. Photograph: Damir Sagolj/REUTERS

Who needs a federation when you can have so much more fun doing things your own way. So in the post-election Pakistan, Khan will rule the north and shoot down American drones while discussing Scandinavian social welfare models with the Taliban. Sharif will rule in Punjab and the centre, try to do business with India and build more motorways all the while looking over his shoulder for generals looking at him. In the south, Bhutto's decimated People's party will keep ruling and keep saying that folks up north are stealing its water, destroying its social welfare programmes and secular legacy. And, in Balochistan, Farzana Majeed will keep waving her missing brother's picture.
Do these bits add up to a country? They do, if you are sitting in Islamabad and showing off your nuclear weapons to the world or planning a motorway to central Asia. But if you are an old woman waiting for her 2,000-rupee welfare cheque or a student activist in a military dungeon waiting for your next interrogation session, you are not likely to dream of motorways and new airports.
Pakistan as a federation has gone through its first rite of passage: handover of power from one elected civilian setup to another. It took Pakistan 67 years to get here. Let us not forget that the reasons that caused this delay haven't disappeared.
Mohammed Hanif is BBC Urdu's special correspondent based in Karachi. He is the author of A Case of Exploding Mangoes and Our Lady of Alice Bhatti