The drugs do work, but they can't cure unhappiness

Antidepressants are sometimes prescribed when they aren't needed, but never to use them is to miss an opportunity

• Tim Cantopher
• theguardian.com, Wednesday 20 November 2013 16.20 GMT

Antidepressants buy you time to sort out the issues that caused the depression in the first place. Photograph: Cultura/Rex Features

I can't stand zealots. Unfortunately, the literature on antidepressants is full of them. I'm not impressed by the protagonists in the polarised argument over the efficacy or otherwise of these drugs, whose positions are firmly held and loudly proclaimed. Many researchers appear to have written the conclusion of their study before the protocol.

At the one pole are the pharmaceutical industry and academic psychopharmacologists. I'll call them the pros. They urge us to practise only evidence-based medicine, by which they mean following rigid protocols based on treatments that have achieved positive results either in double-blind placebo-controlled drug trials, or meta-analyses (a method for grouping together results from several trials). Most of these studies focus on antidepressants because their effects are easy to measure.

The pros despise any practice not based on this narrow definition of evidence. One of them once told me: "Employing clinical experience to decide how to treat patients means continuing to make the same mistakes and never learning from them." So much for the lessons I've learned from treating about 3,000 people with this illness.

At the other pole are a group of naysayers who assert that antidepressants don't work any better than placebo. I'll call them the cons. They use the available statistics in the way best suited to their argument and are equally dismissive of any contrary view.

It's part of our culture to take up polarised positions. Our political and legal systems are based on this premise and our media rely on it. The middle ground isn't interesting and is rarely aired. It is this environment in which the pros and cons dominate the literature on antidepressants. Meanwhile, sufferers from the depressive illness don't know which way to turn.

The root of the problem is that good research is difficult and limited. Research is good at showing big effects in large groups of people. It's not so good at showing more subtle, or difficult to define, effects in subgroups of people. The results of your study will depend on whom you study, what you measure, what you define as an effect and what you do with your data.

The cons say that the pros have suppressed some findings that didn't suit them. If you compare two identical groups 20 times, you will find an apparently significant difference between them once. Test your ineffective antidepressant 20 times and you'll be able to publish a positive result, so long as you suppress the other 19. We clinicians knew this was happening years ago. One particular antidepressant was known by everyone to lack efficacy, yet the studies appeared to show that it worked as well as all the rest. Something was wrong with the published research and it seems we may now know what it was. Recent research seems to under-report some side-effects and withdrawal effects of antidepressants.

The cons are equally selective. They point to meta-analyses showing that antidepressants don't out-perform placebo sufficiently to reach this arbitrary level of significance. They conclude that antidepressants don't work. This is the oldest misuse of statistics in the book. An insignificant difference doesn't mean that you've proven no difference; it just means that you haven't proved that there is one.

Another issue is failing to exclude the outlier. As I've already pointed out, one expects occasional misleading results from research. A meta-analysis should deal with this problem by excluding from the analysis any study with results wildly different from all the others. The pros say that this hasn't always happened in the cons' analyses, potentially producing misleadingly negative results.

So research is failing us in this field. Unfashionable though this is in the environment currently existing in medicine, it means we clinicians need to use our experience, powers of observation and common sense, bearing in mind the experience of other clinicians.

We need to take note of the available research, while also taking a critical view of it. Here is the upshot, accepted by most of us on the ground: antidepressants usually work, but only for real clinical depression, the type involving a chemical disturbance in the brain, with a full range of characteristic physical symptoms. They don't work for unhappiness, grief or chemically induced depression and if you take them irregularly or for too short a period, the depression comes back.

Prescription numbers are rising mainly because doctors are getting better at identifying depression, though antidepressants are sometimes prescribed when they aren't needed and won't work. Except for people suffering from recurrent depression they are only first aid, buying you time to sort out the issues that caused the depression in the first place, but never to use them is to miss an opportunity to provide relief from this horrible illness.

Dr Tim Cantopher, consultant psychiatrist, Priory Hospitals Group, author of Depressive Illness – the Curse of the Strong (Sheldon)

Post-crash economics: some common fallacies about austerity

Propositions in economics are rarely absolutely true or false – what is true in some circumstances may be false in others

• 
• • Robert Skidelsky
  • theguardian.com, Thursday 21 November 2013 16.29 GMT

Two Swabian housewives in Germany. 'One should simply have asked the Swabian housewife,' said German chancellor Angela Merkel after the collapse of Lehman Brothers in 2008. 'She would have told us that you cannot live beyond your means.' Photograph: Frederick Florin/AFP

The period since 2008 has produced a plentiful crop of recycled economic fallacies, mostly falling from the lips of political leaders. Here are my four favourites.

The Swabian Housewife: "One should simply have asked the Swabian housewife," said German chancellor Angela Merkel after the collapse of Lehman Brothers in 2008. "She would have told us that you cannot live beyond your means."

This sensible-sounding logic currently underpins austerity. The problem is that it ignores the effect of the housewife's thrift on total demand. If all households curbed their expenditures, total consumption would fall, and so, too, would demand for labour. If the housewife's husband loses his job, the household will be worse off than before.

The general case of this fallacy is the "fallacy of composition": what makes sense for each household or company individually does not necessarily add up to the good of the whole. The particular case that John Maynard Keynes identified was the "paradox of thrift": if everyone tries to save more in bad times, aggregate demand will fall, lowering total savings, because of the decrease in consumption and economic growth.

If the government tries to cut its deficit, households and firms will have to tighten their purse strings, resulting in less total spending. As a result, however much the government cuts its spending, its deficit will barely shrink. And if all countries pursue austerity simultaneously, lower demand for each country's goods will lead to lower domestic and foreign consumption, leaving all worse off.

The government cannot spend money it does not have: This fallacy – often repeated by British prime minister David Cameron – treats governments as if they faced the same budget constraints as households or companies. But governments are not like households or companies. They can always get the money they need by issuing bonds.

But won't an increasingly indebted government have to pay ever-higher interest rates, so that debt-service costs eventually consume its entire revenue? The answer is no: the central bank can print enough extra money to hold down the cost of government debt. This is what so-called quantitative easing does. With near-zero interest rates, most western governments cannot afford not to borrow.

This argument does not hold for a government without its own central bank, in which case it faces exactly the same budget constraint as the oft-cited Swabian housewife. That is why some eurozone member states got into so much trouble until the European Central Bank rescued them.

The national debt is deferred taxation: According to this oft-repeated fallacy, governments can raise money by issuing bonds, but, because bonds are loans, they will eventually have to be repaid, which can be done only by raising taxes. And, because taxpayers expect this, they will save now to pay their future tax bills. The more the government borrows to pay for its spending today, the more the public saves to pay future taxes, cancelling out any stimulatory effect of the extra borrowing.

The problem with this argument is that governments are rarely faced with having to "pay off" their debts. They might choose to do so, but mostly they just roll them over by issuing new bonds. The longer the bonds' maturities, the less frequently governments have to come to the market for new loans.

More important, when there are idle resources (for example, when unemployment is much higher than normal), the spending that results from the government's borrowing brings these resources into use. The increased government revenue that this generates (plus the decreased spending on the unemployed) pays for the extra borrowing without having to raise taxes.

The national debt is a burden on future generations: This fallacy is repeated so often that it has entered the collective unconscious. The argument is that if the current generation spends more than it earns, the next generation will be forced to earn more than it spends to pay for it.

But this ignores the fact that holders of the very same debt will be among the supposedly burdened future generations. Suppose my children have to pay off the debt to you that I incurred. They will be worse off. But you will be better off. This may be bad for the distribution of wealth and income, because it will enrich the creditor at the expense of the debtor, but there will be no net burden on future generations.

The principle is exactly the same when the holders of the national debt are foreigners (as with Greece), though the political opposition to repayment will be much greater.

Economics is luxuriant with fallacies, because it is not a natural science like physics or chemistry. Propositions in economics are rarely absolutely true or false. What is true in some circumstances may be false in others. Above all, the truth of many propositions depends on people's expectations.

Consider the belief that the more the government borrows, the higher the future tax burden will be. If people act on this belief by saving every extra pound, dollar, or euro that the government puts in their pockets, the extra government spending will have no effect on economic activity, regardless of how many resources are idle. The government must then raise taxes – and the fallacy becomes a self-fulfilling prophecy.

So how are we to distinguish between true and false propositions in economics? Perhaps the dividing line should be drawn between propositions that hold only if people expect them to be true and those that are true irrespective of beliefs. The statement, "if we all saved more in a slump, we would all be better off," is absolutely false. We would all be worse off. But the statement, "the more the government borrows, the more it has to pay for its borrowing," is sometimes true and sometimes false.

Or perhaps the dividing line should be between propositions that depend on reasonable behavioural assumptions and those that depend on ludicrous ones. If people saved every extra penny of borrowed money that the government spent, the spending would have no stimulating effect. True. But such people exist only in economists' models.

Teaching philosophy to children? It's a great idea

Studying philosophy cultivates doubt without helplessness, and confidence without hubris. I’ve watched children evolve to be more rational and open-minded because of it

• 
• • Michelle Sowey
  • theguardian.com, Wednesday 20 November 2013 22.23 GMT

'I quickly saw that kids, too, have the capacity to enquire philosophically from an early age'. Photograph: Christopher Furlong/Getty Images

Recently I’ve seen a spate of articles along the lines of "what philosophy can do for you", focusing on the high results that philosophy students score on standardised tests, the marketability of philosophical skills, and the impressive earning potential of philosophy graduates. I’ve even seen pitches like: "If you want to succeed in business, don’t get an MBA. Study philosophy instead." I find this strange, because career advancement and commercial success are the most peripheral of the benefits of philosophy.

In my university days, still uncertain of my future directions, I came across an unforgettable quote by Alex Pozdnyakov, a philosophy student on the other side of the world: “I have this strange phrase I use when people ask me why I chose philosophy. I tell them I wanted to become a professional human being.”

Perfect, I thought. That’s what I want to be.

Since then, training in various jobs has made me into various kinds of professional, but no training has shaped my humanity as deeply as philosophy has. No other discipline has inspired such wonder about the world, or furnished me with thinking tools so universally applicable to the puzzles that confront us as human beings.

When I started running philosophy workshops for primary school children, I quickly saw that kids, too, have the capacity to enquire philosophically from an early age. They’re nimble in playing with ideas and deft in building on each other’s arguments. They’re endlessly inquisitive, wondering about values (“What’s the most treasured object in the world?”), metaphysics (“Is the earth a coincidence?”), language (“If cavemen just went ‘ugh-ugh-ugh’, how did we learn to speak?”) and epistemology (“Since you can have dreams inside dreams, how can you know when you’re dreaming?”).

In small groups, they’ve discussed artificial intelligence, environmental ethics, interspecies communication and authenticity in art. They’ve contemplated the existence of free will, the limits of knowledge, the possibility of justice and countless other problems from the history of philosophical thought. By continually questioning, challenging and evaluating ideas, the children have been able to see for themselves why some arguments fail while others bear up under scrutiny.

Studying philosophy cultivates doubt without helplessness, and confidence without hubris. I’ve watched kids evolve to be more rational, sceptical and open-minded, and I’ve seen them interact in more fair-minded and collaborative ways. As one 10-year-old said, “I’ve started to actually solve arguments and problems with philosophy. And it works better than violence or anything else.”

Over 400 years ago, the French writer Michel de Montaigne asked: “Since philosophy is the art which teaches us how to live, and since children need to learn it as much as we do at other ages, why do we not instruct them in it?” We urgently need to ask ourselves the same question today.

The central place of Theory of Knowledge in the International Baccalaureate (a globally recognised high school diploma) reflects a worldwide appreciation for the importance of philosophy – a discipline that underpins all other academic disciplines. A growing international movement is inviting young children to philosophise in primary schools in the USA, the UK and elsewhere – but Australia is lagging.

Although philosophy features on the high school curriculum in most Australian states, only a very few primary schools dedicate class time to broad philosophical enquiry or to the explicit teaching of critical and creative thinking.

If it were more widely embraced, the practice of philosophical enquiry in primary schools could make schooling a lot more meaningful and engaging for students. It would certainly promote the development of reasoned argument and higher-order thinking – skills which underlie learning in most other domains (including literacy and numeracy) and which are essential for responsible civic engagement.

By setting children on a path of philosophical enquiry early in life, we could offer them irreplaceable gifts: an awareness of life’s moral, aesthetic and political dimensions; the capacity to articulate thoughts clearly and evaluate them honestly; and the confidence to exercise independent judgement and self-correction. What’s more, an early introduction to philosophical dialogue would foster a greater respect for diversity and a deeper empathy for the experiences of others, as well as a crucial understanding of how to use reason to resolve disagreements.

The benefits to students would be there for the taking, if only philosophy educators in Australia could access appropriate funding and institutional support. Such support is provided by charitable organisations like the Philosophy Foundation in the UK and theSquire Foundation in the USA, which lead the way in embedding philosophy in primary school curricula. Unless funding is made available here to pay expert philosophy practitioners or to provide classroom teachers with rigorous training, our kids are condemned to forgo the many rich rewards that philosophy promises – or to suffer from the variable level of professionalism that characterises many volunteer-run educational programs.

Here’s something to think about on World Philosophy Day: while academic achievement, career advancement and financial success are no trifling things, they’re simply visible husks that may grow around a philosophical life. The hidden kernel is made of freedom, clarity of thought, and a professional mastery of what it means to be human. These are qualities we should seek for all our children, no matter what they grow up to become.

Orthodox economists have failed their own market test

Students are demanding alternatives to a free-market dogma with a disastrous record. That's something we all need

• 
• • Seumas Milne
  • The Guardian, Wednesday 20 November 2013 21.00 GMT

Ha-Joon Chang, one of the last surviving independent economists at Keynes's Cambridge: 'The supporters of neoclassical economics have an almost religious mentality.' Photograph: Sean Smith for the Guardian

From any rational point of view, orthodox economics is in serious trouble. Its champions not only failed to foresee the greatest crash for 80 years, but insisted such crises were a thing of the past. More than that, some of its leading lights played a key role in designing the disastrous financial derivatives that helped trigger the meltdown in the first place.

Plenty were paid propagandists for the banks and hedge funds that tipped us off their speculative cliff. Acclaimed figures in a discipline that claims to be scientific hailed a"great moderation" of market volatility in the runup to an explosion of unprecedented volatility. Others, such as the Nobel prizewinner Robert Lucas, insisted that economics had solved the "central problem of depression prevention".

Any other profession that had proved so spectacularly wrong and caused such devastation would surely be in disgrace. You might even imagine the free-market economists who dominate our universities and advise governments and banks would be rethinking their theories and considering alternatives.

After all, the large majority of economists who predicted the crisis rejected the dominant neoclassical thinking: from Dean Baker and Steve Keen to Ann Pettifor, Paul Krugman and David Harvey. Whether Keynesians, post-Keynesians or Marxists, none accepted the neoliberal ideology that had held sway for 30 years; and all understood that, contrary to orthodoxy, deregulated markets don't tend towards equilibrium but deepen the economy's tendency to systemic crisis.

Alan Greenspan, the former chairman of the US Federal Reserve and high priest of deregulation, at least had the honesty to admit his view of the world had been proved "not right". The same cannot be said for others. Eugene Fama, architect of the "efficient markets hypothesis" underpinning financial deregulation, concedes he doesn't know what "causes recessions" – but insists his theory has been vindicated anyway. Most mainstream economists have carried on as if nothing had happened.

Many of their students, though, have had enough. A revolt against the orthodoxy has been smouldering for years and now seems to have gone critical. Fed up with parallel universe theories that have little to say about the world they're interested in, students at Manchester University have set up a post-crash economics society with 800 members, demanding an end to monolithic neoclassical courses and the introduction of a pluralist curriculum.

They want other schools of economic thought taught in parallel, from Keynesian to more radical theories – with a better record on predicting and connecting with the real world economy – along with green and feminist economics. The campaign is spreading fast: to Cambridge, Essex, the London School of Economics and a dozen other campuses, and linking up with university groups in France, Germany, Slovenia and Chile.

As one of the Manchester society's founders, Zach Ward-Perkins, explains, he and a fellow student agreed after a year of orthodoxy: "There must be more to it than this." Neoclassical economics is after all built on a conception of the economy as the sum of the atomised actions of millions of utility-maximising individuals, where markets are stable, information is perfect, capital and labour are equals – and the trade cycle is bolted on as an afterthought.

But even if it struggles to say anything meaningful about crises, inequality or ownership, the mathematical modelling erected on its half-baked intellectual foundations give it a veneer of scientific rigour, valued by students aiming for well-paid City jobs. Neoclassical economics has also provided the underpinning for the diet of deregulated markets, privatisation, low taxes on the wealthy and free trade we were told for 30 years was now the only route to prosperity.

Its supporters have an "almost religious mentality", as Ha-Joon Chang – one of the last surviving independent economists at Keynes's Cambridge – puts it. Although claiming to favour competition, the neoclassicals won't tolerate any themselves. Forty years ago,most economics departments were Keynesian and neoclassical economics was derided. That all changed with the Thatcher and Reagan ascendancy.

In institutions supposed to foster debate, non-neoclassical economists have been systematically purged from economics faculties. Some have found refuge in business schools, development studies and geography departments. In the US, corporate funding has been key. In Britain, peer review through the "research excellence framework" – which allocates public research funding – has been the main mechanism for the ideological cleansing of economics.

Paradoxically, the sharp increase in student fees and the marketisation of higher education is creating a pressure point for students out to overturn this intellectual monoculture. The free marketeers are now being market-tested, and the customers don't want their product. Some mainstream academics realise that they may have to compromise, and have been colonising a Soros-funded project to overhaul the curriculum, hoping to limit the scale of change.

But change it must. The free-market orthodoxy of the past three decades not only helped create the crisis we're living through, but gave credibility to policies that have led to slower growth, deeper inequality, greater insecurity and environmental degradation all over the world. Its continued dominance after the crash, like the neoliberal model it underpins, is about power not credibility. If we are to escape this crisis, both will have to go.

Police are cracking down on students

Police are cracking down on students – but what threat to law and order is an over-articulate history graduate?

For most of my life student politics has been little more than a joke. Suddenly it's become both serious and admirable

• 
• • Aditya Chakrabortty
  • The Guardian, Monday 18 November 2013 20.00 GMT

A protester against the proposed closure of the ULU student union last week. Photograph: Paul Davey/Demotix/Corbis

Why are some of the most powerful people in Britain so terrified of a bunch of students? If that sounds a ridiculous question, consider a few recent news stories. As reported in this paper last week, Cambridge police are looking for spies to inform on undergraduate protests against spending cuts and other "student-union type stuff". Meanwhile, in London last Thursday, a student union leader, Michael Chessum, was arrested after a small and routine demo. Officers hauled him off to Holborn police station for not informing them of the precise route of the protest – even though it was on campus.

The 24-year-old has since been freed – on the strict condition that he doesn't "engage in protest on any University Campus and not within half a mile boundary of any university". Even with a copy of the bail grant in front of me, I cannot make out whether that applies to any London college, any British university – or just any institute of higher education anywhere in the world. As full-time head of the University of London's student union, Chessum's job is partly to protest: the police are blocking him from doing his work. But I suppose there's no telling just what threat to law and order might be posed by an over-articulate history graduate.

While we're trawling for the ridiculous, let us remember another incident this summer at the University of London, when a 25-year-old woman was arrested for the crime of chalking a slogan on a wall. That's right: dragged off by the police for writing in water-soluble chalk. Presumably, there would have been no bother had she used PowerPoint.

It all sounds farcical – it is farcical – until you delve into the details. Take the London demo that landed Chessum in such bother: university staff were filming their own students from a balcony of Senate House (the building that inspired the Ministry of Truth in Orwell's Nineteen Eighty-Four, appropriately enough). Such surveillance is a recent tradition, the nice man in the University press office explains to me – and if the police wanted the footage that would be no problem.

That link with the police is becoming increasingly important across more and more of our universities. London students allege that officers and university security guards co-ordinate their attempts to rein in demonstrations while staff comment on the increased police presence around campus. At Sussex, student protests against outsourcing services were broken up this April, when the university called in the police – who duly turned up with riot vans and dogs. A similar thing happened at Royal Holloway university, Surrey in 2011: a small number of students occupied one measly corridor to demonstrate against course closures and redundancies; the management barely bothered to negotiate, but cited "health and safety" and called in the police to clear away the young people paying their salaries.

For most of my life, student politics has been little more than a joke – the stuff of Neil off the Young Ones, or apprentice Blairites. But in the past few years it has suddenly become both serious and admirable, most notably with the protests of 2010 against £9,000 tuition fees and the university occupations that followed. And at just that point, both the police and university management have become very jumpy.

For the police, this is part of the age-old work of clamping down on possible sources of civil disobedience. But the motivation for the universities is much more complicated. Their historic role has been to foster intellectual inquiry and host debate. Yet in the brave new market of higher education, when universities are competing with each other to be both conveyor belts to the jobs market and vehicles for private investment, such dissent is not only awkward – it's dangerously uncommercial. As Andrew McGettigan, author of The Great University Gamble, puts it: "Anything too disruptive gets in the way of the business plan."

Last month it appeared that Edinburgh University had forced its student union to sign a gagging clause (now withdrawn). No union officer is allowed to make any public criticism of the university without giving at least 48 hours' notice. University managers reportedly made that a deal-breaker if the student union was to get any funds.

The managers of the University of London want to shut down the student union at the end of this academic year. The plan – which is why Chessum and co were marching last week – is to keep the swimming pool and the various sports clubs, but to quash all university-wide student representation. After all, the students are only the people paying the salary of the university vice-chancellor, Adrian Smith – why should they get a say? The plan, it may not surprise you to learn, was drawn up by a panel that didn't number a single student. What with sky-high fees and rocketing rents in the capital, you might think that the need for a pan-London student body had never been higher. But then, you're not a university manager on a six-figure salary.

Where universities were historically places of free expression, now they are having to sacrifice that role for the sake of the free market. For students, that comes in the form of a crackdown on dissent. Yet the twentysomethings at university now will end up running our politics, our businesses and our media. You might want these future leaders to be questioning and concerned about society. Or you might wonder whether sending in the police to arrest a woman chalking a wall is proportionate. Either way, you should be troubled.

For Pope Francis the liberal, this promises to be a very bloody Sunday

Francis is the poster pope for progressives. But the canonisation of Junípero Serra epitomises the Catholic history problem

• 
• • George Monbiot
  • The Guardian, Monday 18 November 2013 20.30 GMT

Pope Francis in the Vatican on 18 November. 'There is a strange omission that puts the pope on the wrong side even of John Paul II. It's his failure so far to engage with or even acknowledge the past horrors over which the church has presided.' Photograph: Franco Origlia/Getty Images

He is a pin-up for liberals and progressives, "the obvious new hero of the left". So says the Guardian's Jonathan Freedland of Pope Francis, and it's true that most of the surprises have been good ones.

His statements denouncing capitalism are of the kind that scarcely any party leader now dares to breathe. He appears to have renounced papal infallibility. He intends to reform the corrupt and scheming Curia, the central bureaucracy of the Catholic church. He has declared a partial truce in the war against sex that his two immediate predecessors pursued (while carefully overlooking the rape of children) with such creepy fervour.

It's worth noting that these are mostly changes of emphasis, not doctrine. Pope Francis won't devote his reign to attacking gays, women, condoms and abortion, but nor does he seem prepared to change church policy towards them. But it's not just this that spoils the story. There is a strange omission that puts the pope on the wrong side even of John Paul II. It's his failure so far to engage with or even acknowledge the past horrors over which the church has presided.

From the destruction of the Cathars to the Magdalene laundries, the Catholic church has experimented with almost every kind of extermination, genocide, torture, mutilation, execution, enslavement, cruelty and abuse known to humankind. The church has also, at certain moments and places across the past century, been an extraordinary force for good: the bravest people I have met are all Catholic priests, who – until they were also crushed and silenced by their church – risked their lives to defend vulnerable people from exploitation and murder.

It's not just that he has said nothing about this legacy; he has eschewed the most obvious opportunities to speak out. The beatification last month of 522 Catholics killed by republican soldiers during the Spanish civil war, for example, provided a perfect opportunity to acknowledge the role the church played in Franco's revolution and subsequent dictatorship. But though Francis spoke at the ceremony, by video link, he did so as if the killings took place in a political vacuum. The refusal in July by the four religious orders that enslaved women in Ireland's Magdalene laundries to pay them compensation cried out for a papal response. None came. How can the pope get a grip on the future if he won't acknowledge the past?

Nowhere is the church's denial better exemplified than in its drive to canonise the Franciscan missionary Junípero Serra, whose 300th anniversary falls on Sunday. Serra's cult epitomises the Catholic problem with history – as well as the lies that underpin the founding myths of the United States.

You can find his statue on Capitol Hill, his face on postage stamps, and his name plastered across schools and streets and trails all over California. He was beatified by Pope John Paul II, after a nun was apparently cured of lupus, and now awaits a second miracle to become a saint. So what's the problem? Oh, just that he founded the system of labour camps that expedited California's cultural genocide.

Serra personified the glitter-eyed fanaticism that blinded Catholic missionaries to the horrors they inflicted on the native peoples of the Americas. Working first in Mexico, then in Baja California (which is now part of Mexico), and then Alta California (now the US state of California), he presided over a system of astonishing brutality. Through various bribes and ruses Native Americans were enticed to join the missions he founded. Once they had joined, they were forbidden to leave. If they tried to escape, they were rounded up by soldiers then whipped by the missionaries. Any disobedience was punished by the stocks or the lash.

They were, according to a written complaint, forced to work in the fields from sunrise until after dark, and fed just a fraction of what was required to sustain them. Weakened by overwork and hunger, packed together with little more space than slave ships provided, they died, mostly of European diseases, in their tens of thousands.

Serra's missions were an essential instrument of Spanish and then American colonisation. This is why so many Californian cities have saints' names: they were founded as missions. But in his treatment of the indigenous people, he went beyond even the grim demands of the crown. Felipe de Neve, a governor of the Californias, expressed his horror at Serra's methods, complaining that the fate of the missionised people was "worse than that of slaves". As Steven Hackel documents in his new biography, Serra sabotaged Neve's attempts to permit Native Americans a measure of self-governance, which threatened Serra's dominion over their lives.

The diverse, sophisticated and self-reliant people of California were reduced by the missions to desperate peonage. Between 1769, when Serra arrived in Alta California, and 1821 – when Spanish rule ended – its Native American population fell by one third, to 200,000.

Serra's claim to sainthood can be sustained only by erasing the native peoples of California a second time, and there is a noisy lobby with this purpose. Serra's hagiographies explain how he mortified his own flesh; they tell us nothing about how he mortified the flesh of other people.

In reviewing Hackel's biography a fortnight ago, the Catholic professor Christopher O Blum extolled Serra for his "endless labour of building civilisation in the wilderness". He contrasted the missionary to "the Enlightened Spanish colonial officials who wanted ... to leave the Indians to their immoral stew". "The Indians there not only went around naked much of the year – with the predictable consequence of rampant promiscuity – but were divided into villages of 250 or fewer inhabitants ... ready-made for the brutal petty tyrant or the manipulative witch doctor". The centuries of racism, cruelty and disrespect required to justify the assaults of the church have not yet come to an end.

I would love to see the pope use the tercentenary on Sunday to announce that he will not canonise Serra, however many miracles his ghost might perform, and will start to engage with some uncomfortable histories. Then, perhaps, as Jonathan Freedland urges, I'll put a poster of Francis on my wall. But not in the bedroom.

The Most Important Question You Can Ask Yourself Today

Mark Manson

 Everybody wants what feels good. Everyone wants to live a care-free, happy and easy life, to fall in love and have amazing sex and relationships, to look perfect and make money and be popular and well-respected and admired and a total baller to the point that people part like the Red Sea when you walk into the room.

Everybody wants that -- it's easy to want that.

If I ask you, "What do you want out of life?" and you say something like, "I want to be happy and have a great family and a job I like," it's so ubiquitous that it doesn't even mean anything.

Everyone wants that. So what's the point?

What's more interesting to me is what pain do you want? What are you willing to struggle for? Because that seems to be a greater determinant of how our lives end up.

Everybody wants to have an amazing job and financial independence -- but not everyone is willing to suffer through 60-hour work weeks, long commutes, obnoxious paperwork, to navigate arbitrary corporate hierarchies and the blasé confines of an infinite cubicle hell. People want to be rich without the risk, with the delayed gratification necessary to accumulate wealth.

Everybody wants to have great sex and an awesome relationship -- but not everyone is willing to go through the tough communication, the awkward silences, the hurt feelings and the emotional psychodrama to get there. And so they settle. They settle and wonder "What if?" for years and years and until the question morphs from "What if?" into "What for?" And when the lawyers go home and the alimony check is in the mail they say, "What was it all for?" If not for their lowered standards and expectations for themselves 20 years prior, then what for?

Because happiness requires struggle. You can only avoid pain for so long before it comes roaring back to life.

At the core of all human behavior, the good feelings we all want are more or less the same. Therefore what we get out of life is not determined by the good feelings we desire but by what bad feelings we're willing to sustain.

"Nothing good in life comes easy," we've been told that a hundred times before. The good things in life we accomplish are defined by where we enjoy the suffering, where we enjoy the struggle.

People want an amazing physique. But you don't end up with one unless you legitimately love the pain and physical stress that comes with living inside a gym for hour upon hour, unless you love calculating and calibrating the food you eat, planning your life out in tiny plate-sized portions.

People want to start their own business or become financially independent. But you don't end up a successful entrepreneur unless you find a way to love the risk, the uncertainty, the repeated failures, and working insane hours on something you have no idea whether will be successful or not. Some people are wired for that sort of pain, and those are the ones who succeed.

People want a boyfriend or girlfriend. But you don't end up attracting amazing peoplewithout loving the emotional turbulence that comes with weathering rejections, building the sexual tension that never gets released, and staring blankly at a phone that never rings. It's part of the game of love. You can't win if you don't play.

What determines your success is "What pain do you want to sustain?"

I wrote in an article last week that I've always loved the idea of being a surfer, yet I've never made consistent effort to surf regularly. Truth is: I don't enjoy the pain that comes with paddling until my arms go numb and having water shot up my nose repeatedly. It's not for me. The cost outweighs the benefit. And that's fine.

On the other hand, I am willing to live out of a suitcase for months on end, to stammer around in a foreign language for hours with people who speak no English to try and buy a cell phone, to get lost in new cities over and over and over again. Because that's the sort of pain and stress I enjoy sustaining. That's where my passion lies, not just in the pleasures, but in the stress and pain.

There's a lot of self development advice out there that says, "You've just got to want it enough!"

That's only partly true. Everybody wants something. And everybody wants something badly enough. They just aren't being honest with themselves about what they actually want that bad.

If you want the benefits of something in life, you have to also want the costs. If you want the six pack, you have to want the sweat, the soreness, the early mornings, and the hunger pangs. If you want the yacht, you have to also want the late nights, the risky business moves, and the possibility of pissing off a person or ten.

If you find yourself wanting something month after month, year after year, yet nothing happens and you never come any closer to it, then maybe what you actually want is a fantasy, an idealization, an image and a false promise. Maybe you don't actually want it at all.

So I ask you, "How are you willing to suffer?"

Because you have to choose something. You can't have a pain-free life. It can't all be roses and unicorns.

Choose how you are willing to suffer.

Because that's the hard question that matters. Pleasure is an easy question. And pretty much all of us have the same answer.

The more interesting question is the pain. What is the pain that you want to sustain?

Because that answer will actually get you somewhere. It's the question that can change your life. It's what makes me me and you you. It's what defines us and separates us and ultimately brings us together.

So what's it going to be?