Sunday, 11 January 2015

Understanding Democracy

In these exclusive interviews we speak to Noam Chomsky, Professor Emeritus of Linguistics at the Massachusetts Institute of Technology (MIT), who (with over 150 books published) is regarded as "one of the most critically engaged public intellectuals alive today" and Glenn Greenwald (Multi Award Winning Journalist, Constitutional Lawyer and Author). We discuss the state and future of democracy around the world together with the role that government, corporations and the media play in shaping our lives. We also look at the global war on terror, globalisation, and how the world will look in the next quarter century.


Vikas Shah, Thought Economics, Originally Published April 2011 - Updated January 2015

In March 1949, Dr. Quincy Wright (1890-1970) of the University of Chicago presented a paper for the United Nations Educational Scientific and Cultural Organisation (UNESCO) entitled "Philosophical Enquiry Into Current Ideological Conflicts; The Meaning of Democracy". Dr. Wright states, "Like all social and political terms which serve at the same time as slogans for movements and as symbols for conceptions, the word democracy has in fact varied in meaning according to time, place, and circumstances. This variability is, in fact, a condition of most forms of popular discourse. They are continually acquiring new meanings as can be seen by studying any historical dictionary." He continues by citing examples of this variability. "Democracy..." he writes, "has always suggested a wide popular participation in the support, conduct and benefits of government, but the conception has taken colour from the conditions and opinions which advocates of democracy have at particular times and places found in opposition to their aims. Thus, in a struggle against an unpopular rule of a monarch or oligarchy, democracy has referred to government by the many, rather than the few; in a struggle against social privilege, class or race discrimination, and economic inequality, democracy has referred to equality in social position and economic welfare; in a struggle against government monopoly of economic initiative, public opinion and political association, democracy has referred to freedom of enterprise, communication, opinion and association; in a struggle against corrupt and arbitrary manipulations of opinion, democracy has referred to procedures for regulating elections and party action in order to assure freedom of opinion, wide participation and fair representation; in a struggle against excesses of majorities and oppression of minorities, democracy has referred to the rule of law and protection of fundamental human rights; in a struggle for freedom of dependent or oppressed peoples, democracy has referred to home rule, self government, and self determination of distinctive groups; in a struggle for influence of suppressed groups or classes, democracy has referred to consent of the governed, non-discrimination and procedures for consultation among all interested groups in policy formation."

Humanity is a plurality made-up of many different individuals forming highly interconnected communities of mutual interest and co-operation (families, political groups, cities, countries, and so forth) and it is the individuals within the groups rather than the group 'in general' who, ultimately, exert power. "Democracy is [therefore] a compromise designed to balance interests among members of a community." (Han Zhen, Democracy as a Way to Social Compromise, 2006). As our society has grown from small villages of (at most) few hundred people to a vast interconnected global economy of six billion, the complexity of the compromise along with the incredibly varied interests of group members has introduced profound challenges to democracy itself. These challenges (often left unaddressed) leave our society in a near-permanent state of visible conflict (albeit with varying intensity) across all dimensions of struggle (akin to those outlined by Wright, above).

Against this backdrop of social, economic and political conflict, what is the future of democracy?

In these exclusive interviews we speak to Noam Chomsky, Professor Emeritus of Linguistics at the Massachusetts Institute of Technology (MIT), who (with over 150 books published) is regarded as "one of the most critically engaged public intellectuals alive today" and Glenn Greenwald (Multi Award Winning Journalist, Constitutional Lawyer and Author). We discuss the state and future of democracy around the world together with the role that government, corporations and the media play in shaping our lives. We also look at the global war on terror, globalisation, and how the world will look in the next quarter century.

Noam Chomsky was born in Philadelphia, Pennsylvania on December 7, 1928. He received his early education at Oak Lane Country Day School and Central High School, Philadelphia. He continued his education at the University of Pennsylvania where he studied linguistics, mathematics, and philosophy. In 1955, he received his Ph. D. from the University of Pennsylvania, however, most of the research leading to this degree was done at Harvard between 1951 and 1955. Since receiving his Ph. D., Chomsky has taught at Massachusetts Institute of Technology, where he now holds the Ferrari P. Ward Chair of Modern Language and Linguistics. Respected and honoured numerous times in the academic arena, he has been awarded an Honorary Doctorate by the University of London and the University of Chicago, as well as having been invited to lecture all over the world. In 1967, he delivered the Beckman Lectures at the University of California at Berkeley. In 1969, he presented the John Locke Lectures at the University of Oxford and Sherman Memorial Lectures at the University of London.

Glenn Greenwald is a journalist, constitutional lawyer, and author of four New York Times best-selling books on politics and law. His most recent book, No Place to Hide, is about the U.S. surveillance state and his experiences reporting on the Snowden documents around the world. Prior to his collaboration with Pierre Omidyar, Glenn’s column was featured at The Guardian and Salon. He was the debut winner, along with Amy Goodman, of the Park Center I.F. Stone Award for Independent Journalism in 2008, and also received the 2010 Online Journalism Award for his investigative work on the abusive detention conditions of Chelsea Manning. For his 2013 NSA reporting, he received the George Polk award for National Security Reporting; the Gannett Foundation award for investigative journalism and the Gannett Foundation watchdog journalism award; the Esso Premio for Excellence in Investigative Reporting in Brazil (he was the first non-Brazilian to win), and the Electronic Frontier Foundation’s Pioneer Award. Along with Laura Poitras, Foreign Policy magazine named him one of the top 100 Global Thinkers for 2013. The NSA reporting he led for The Guardian was awarded the 2014 Pulitzer Prize for public service.

Looking at the UK, USA & Europe

Q: To what extent are our societies free and democratic?

[Noam Chomsky] These Societies are quite free by historical standards. They are democratic in the sense that they have formal elections that aren't stolen, and so on. They're undemocratic to the extent that forces other than popular will have an overwhelming affect on who can participate in electoral outcomes. The United States is the most extreme in this respect. Right now in the United States, elections are essentially bought. You can't run an election unless you have a huge amount of capital- which means overwhelmingly, although not one hundred percent, that capital was sought from strong corporate backing. For example, in the 2008 election- what carried Obama across the finish line first at the end was a very substantial amount of support from financial institutions which are now the core of the economy. The coming elections are supposed to be a two-billion-dollar election, and there's only one place to go for that kind of money.

There used to be a system of chairs of committees in congress, who were there through seniority and so on. By now, it is generally required that funding go to the party committee- which means those are also, in large part, bought. This means that popular opinion is very much marginalised. You can see this very clearly on issue after issue. So the huge issue right now, domestically, is the deficit. Well... People have ideas about how to get rid of the deficit. For example- most of the deficit is the result of a highly dysfunctional healthcare system which has about twice the per-capita cost of other countries and by no means better outcomes- in fact, rather poorer outcomes. The population has long favoured moving toward some kind of national healthcare system- which would be much less expensive and (judging by the outcomes) no worse, maybe better. That would, in fact, eliminate the deficit! That's not even considered!

[Glenn Greenwald] The extent to which our society is free and democratic is all relative, the question is- relative to what?

There are clearly a lot of ways in which the range of acceptable ideas within society is narrowed, and the political choices we have are seriously constrained. In a lot of senses we have the appearance of freedom and democracy, and much less so a reality. You can have societies in which people can go to a ballot box once every 3-5 years and pick who their leaders are going to be, but that doesn’t mean you have freedom or democracy in any meaningful sense; and that’s generally how I would describe most western countries.

Q: What really drives our foreign policy? and how does that impact us, as citizens?

[Noam Chomsky] Foreign policy in the UK and Europe tends to follow the United States, not entirely- but the US does remain the prime driver in foreign policy. It's not a secret what foreign policy is driven by. For example, Bill Clinton was quite explicit about it. His position, expressed clearly in congress, was that the US has the right to carry out a unilateral military action, sometimes supported by a (so-called) coalition of the willing in order to secure resources and markets and it must have military forces forward deployed- meaning foreign bases in Europe and elsewhere- in order to shape events in our interest. Our interest does not mean the American people, but rather the interests of those who design policy- primarily the corporate sector.

Foreign Policy can be undertaken in ways which are expected to harm security. In fact, that's not at all uncommon. If you follow the Chilcot enquiry- the head of MI5 testified- merely extending what was already known- but she testified that both the United States and Britain recognise that Saddam Hussein was not a threat and that the invasion would very likely increase the threat of terror. And, in fact, it did! About seven-fold in the first year according to quasi-governmental statistics. So an invasion was undertaken which would harm the citizens of the invading countries, as indeed it did. At first, of course, the reasons were presented with the usual boiler-plate which is informative presentation which goes along with every act of force citing democracy and all-sorts of wonderful things. When it was becoming clear that the war-ends could not be easily achieved, towards the end of the invasion- certain policies were stated clearly. In November 2007 the Bush administration issued a declaration of principles stating that any agreement with Iraq would have to ensure the unlimited ability of US forces to operate there- essentially permanent military bases- and such an agreement would also secure the privileging of US investors in the energy systems. In 2008 Bush re-iterated and, in fact, strengthened this in a message to congress where he said that he would ignore any legislation that limits US capacity to use force in Iraq or that interferes with US control over Iraqi oil. That was stated very clearly and explicitly. In fact, the US had to back down from this goal as a result of Iraqi resistance; but the goals themselves were clear and explicit and had nothing to do with the security of Americans. The same is true elsewhere, so one leading specialist on Pakistan recently reviewed US policies in Afghanistan and Pakistan revealing once again that these policies are significantly increasing the threat of terror and in fact possibly nuclear terror. He concluded that American and British soldiers are dying in Afghanistan in order to make the world less secure for Americans and British. That's not so unusual. Security is not, typically, a very top priority of states. There are other interests.

[Glenn Greenwald] One of the most amazing and illuminating exchanges over the past couple of years was an incident in the House of Commons in the UK where George Galloway stood up and questioned Prime Minister, David Cameron about British policies in Syria, and the people with whom the UK has aligned itself. David Cameron’s response- in essence- was that he wasn’t surprised to hear that question because this particular member always found ways to ingratiate themselves with the world’s dictators.

If you look at the foreign policy of the UK, and specifically the allies of Cameron; you see these trips he makes, and the praise he heaps on people who are the worst dictators of the Arab world.

In each countries foreign policy, there is a very overt form of loving dictators whilst spewing the rhetoric of freedom. It’s more disguised and subtle at home, but it’s very much the same dynamic.

Q: To what extent is the media influenced by corporate and government objectives?

[Noam Chomsky] There are cases where direct government and corporate interference takes place, but I don't think that's the major issue concerning corporate and government influence over the media. Using the United States as an example, the media are major corporations- so it's not a question of corporate influence, they are corporations who are closely linked to government. There's a constant flow of people from the corporate sector to government, the interactions are very close. The framework of selection of what to report, how to report it and so on is shaped overwhelmingly by the shared interests of elite sectors in the business world, government and so forth. In fact it's not very different in the Universities, and you can see it day by day. Just take the no-fly zone in Libya. In Libya, the intervention- whether one approves of it or not- is being carried out by the three traditional imperial powers, the US, Britain and France. There is marginal participation by several other NATO countries, but the major countries are simply refusing to be involved, and many are just opposed to it. The BRICS for example, are opposed and Turkey doesn't want to get involved and so on. Well the three, this imperial triumvirate, quite heavily in their propaganda discussed an Arab league request for a no-fly zone. The Arab league statement was rather tepid and was qualified shortly after but there was, in fact, a call for a no fly zone. At the same time, the Arab league called for a no-fly zone over Gaza. In the United States that literally was not reported. While some small newspapers may have discussed it, there was no majors- no New York Times, Washington Post, none of the major media reported it. In fact, in the entire Anglo-American press the only apparent story was in the Financial Times. Well, that's a no-fly zone over Gaza.. which doesn't fit US objectives and therefore it wasn't news. At the same time, the no-fly zone over Libya did fit the objectives of the imperial triumvirate and so that was major news. And this is standard, it happens all the time.

One of the very striking examples which tells you something about the general intellectual culture, had to do with Wiki Leaks. The exposure that received by far the most attention in terms of headlines and euphoric commentary was that the Arabs support US policy on Iran, hostility towards Iran. That was all over the place and was quite interesting because what it was, in fact, referring to was Arab dictators. What about Arab public opinion? Well.. that was also studied and was studied by the most prestigious US polling institutions and released by prestigious institutions like Brookings. These studies are not reported! In the United States, literally not reported- I believe there was one report in England. These reports rank Egypt as the most important country in the region, and within Egypt over ninety percent of the population regard the United States as the most major threat. Eighty percent think the region would be more secure if Iran had nuclear weapons. Only a small number, maybe ten percent, regard Iran as a threat. Those figures are rather similar throughout the region. But, for policy makers that doesn't matter- as long as the dictators support us? what else matters.

This takes us back to our first question looking at the attitude towards democracy. The attitude is that the population doesn't matter, as long as it's under control; and you can see that. Incidentally, this is quite an old issue. If we had serious reporting on these issues, it would not only report Arab public opinion, but would report that the policy of ignoring Arab public opinion has been around for some time. Back in the 1950's President Eisenhower was concerned about what he called the 'campaign of hatred' in the Arab world; not by governments, but by people. In the same year, the national security council released a study concluding that there is a perception among the people of the Arab world that the United States supports harsh and brutal dictatorships, blocks democracy and development, and we do so because we want to maintain control over their energy supplies. It went onto conclude that the perception (of foreign policy objectives) is more or less accurate, and as long as the dictators support us- then who cares that there's a campaign of hatred? as long as we can control the population... That has remained a consistent policy, very dramatically so today- and as you can see by the reaction to these exposures and unreported crucial data- that's become a generally accepted attitude among educated sectors.

[Glenn Greenwald] One of the most significant trends in the past several decades of mass media has been the fact that media outlets have become large corporations themselves, functioning with the same dynamics that every other large corporation would that may sell arms, insurance policy and investment funds.

The finer attributes of large corporations; to be as uncontroversial as possible, to affirm orthodoxy as much as you possibly can to avoid upsetting those who wield power over your business… those are rational powers to adopt if you’re running a business, as they will maximise your profits. Unfortunately, that’s the same dynamic that drives corporate media outlets. It’s not just about maximising profits, but making sure that these corporations- that have so many other interests besides their media outlets- end up not suffering for them as a result of what their journalists are producing. This has produced a very pro-orthodoxy, pro-power posture in media outlets. Maybe that’s OK when you have a company selling insurance policies, but when you’re trying to engage in journalism? Nothing could be more harmful.

Q: What is the role of press freedom as it relates to the justice system and wider democracy?

[Glenn Greenwald] The theory of why the free press is protected in the US constitution is one that I believe in. The founders of the United States were mostly preoccupied with the notion of how you create a centralised government without imbuing it with the kinds of authoritarian power that they had waged wars to raise themselves from. The only answer they could come up with was to create a whole bunch of checks on those kinds of power, things that would push back and be adversarial to it, and be designed to work against it.

One of the instruments for providing some limits on political power was a free-press. This did not mean people who got a degree in journalism and went to work for a media corporation, but rather anyone citizen who does journalism! Any citizen with a printing press! This was protected on the grounds that it pushed back against power. If all media was going to do was just amplify the claims of people in power, you wouldn’t need to protect the free press; for one, it wouldn’t have any value, and for another it would never be targeted with repression.

The only way that free-press can be valuable is if it serves as an adversarial force against those who wield the greatest power. That’s what journalism is all about.

Q: What is the reality of the level of capability of government and state monitoring of our communications?

[Glenn Greenwald] The capabilities that governments have to monitor communication are genuinely limitless. Whenever people ask me what the most shocking or significant revelation was from the Snowden archive, I always say the same thing. It wasn’t any specific story, but rather all these documents that describe what their [government] aspirations were as a spying agency. The thing that shocked me, even though I have been working on surveillance for a long time was that they literally had a stated goal of converting the internet into a limitless realm of monitoring and surveillance. That’s a motto that appears over and over again in these documents, they literally want a scenario where there are no communications that take place electronically between human beings that are beyond their surveillance and monitoring reach. In essence, they want to eliminate privacy in the digital age.

There are steps that can be taken to protect your communications, but by and large there are no limits on what government surveillance systems are capable of monitoring.

Q: To what extent is government monitoring of communications necessary?

[Glenn Greenwald] The crucial difference is between targeted surveillance and mass surveillance. I don’t think there is anyone in this debate who believes that it is inherently illegitimate for the state to ever target someone for surveillance. The difference is between targeting individuals where it is believed that they are engaged in some form of wrong-doing versus indiscriminately putting entire populations of hundreds of millions of people under a surveillance microscope despite any evidence of wrong-doing of any kind.

It’s because the US government and their allies are engaged in mass surveillance rather than targeted surveillance that there has been an Edward Snowden, and there has been a debate at all. If it were just them monitoring suspected members of Al Qaeda or people who are likely to engage in terrorist attacks, their would have been no whistleblowing or debate.

Q: Can you balance the need for state security and privacy?

[Glenn Greenwald] It’s always difficult to find the exact perfect balance between security and privacy. It’s difficult to assess what the government needs to prove in order to target someone with the legitimate extent of surveillance- but you could certainly much more reasonably proximate what is a legitimate and reasonable balancing point, even if it’s imperfect.

The current surveillance posture of the US has no balance. They want to collect everything because they can; it’s the opposite of a balanced mind-set, and that’s what makes it so pernicious.

Q: Has the Internet enabled our freedom of speech and democratic liberty?

[Glenn Greenwald] The Internet has been vital in rejuvenating the idea of free speech, the free press, and democratising political and media discourse. That’s long been the promise; as heralded by fans of the Internet, and I think it’s finally starting to come to fruition.

For one thing, in order to reach a large audience a decade ago- you had to work for a large media outlet such as the New York Times, NBC news or one of the big British newspapers- and you’d have to submit yourself to all of their editorial strictures and methods for doing journalism. Now? There are all kinds of people who have built very large readerships by starting a blog! That’s how I began journalism! Even now, there are people with thousands of followers they reach, even without having worked at a large media agency- that has really enabled people outside the corporate structure to have a serious influence on how we think about things.

Q: What are the greatest threats that exist to our democratic freedom of expression?

[Glenn Greenwald] The existence of mass surveillance is- itself- a huge threat to the values the Internet enables. The history of communication and media technology shows that whenever something is created that threatens to change the concentration and distribution of power; that the people who wield power try to subvert it, and try to annexe it for their own use. This is exactly what Internet surveillance is doing. One of the pre-requisites to being able to speak freely and use the Internet to engage in activism is the idea that you can do so with privacy and anonymity. The idea that you can express ideas without feeling like you’re being judged for them is important.

Studies show that when human beings are being watched, they become much more conformist and their behavioural traits narrow significantly. There’s a huge tension between the open thought the Internet enables, and how mass surveillance creates self-censorship.

Q: What is the true nature of information subversion seen by governments and corporate institutions?

[Noam Chomsky] I should say that, by now, there are thousands of pages of detailed documentation on this topic. Without going too far afield, let's look at the topics we just mentioned. Is it important for us to know that the invasion of Iraq was undertaken with the expectation that it would increase terror? was undertaken with the intention of ensuring US corporations have privileged access over Iraqi oil? and it would be a permanent US military base? I think it would have been important for the public to know that. I think it would be important for the public to know now that Arab public opinion is so hostile to western (specifically US) power- that it regards the US as a prime threat, and thinks the region would be better off if Iran had nuclear weapons. Is it important for people in the United States and Britain to know that? I would think so! We can go on with case after case. Is it important for Americans, for example, to know that if we had a healthcare system similar to other industrial societies the deficit would be erased and we wouldn't have to go after teacher's pensions and Medicare payments for the elderly and so forth? Yeah, I think that would be important to know. I think, in fact, that ought to be blaring headlines!

All this information can be found out if you do a research project- but it doesn't even enter the public eye.

Q: What influence do large corporations exert in society?

[Noam Chomsky] Corporations play an overwhelming role in society. I don't think that fact is even contentious. Similar observations have been made as far back as Adam Smith who pointed out that in Britain the principal architects of policy were merchants and manufacturers, the people who own society- and they ensure that their interests are served however grievous the impact on the people of England. This is far more true today, with much higher concentrations of power- we are not just manufacturers, we have financial institutions and multinational corporations. They have an enormous influence, and the influence can not only be harmful, but in many cases lethal.

Taking the United States as an example- the corporate sector has been carrying out major propaganda campaigns to try to convince the population that there is no threat from global warming. This, in effect, has led to the majority of people now agreeing it is not a real issue. Business funding has also been the primary instrument in bringing a new group of cadres to congress- figures who are virtually all climate change deniers. These individuals are about to enact legislation to cut-back funding for the international organisation (the IPCC) and the capacity of the environmental protection agency who may not even be able to monitor the effect of greenhouse gases or carry out any other actions which could reduce the impact of global warming which is a very serious threat! This has been done by the corporate executives who are carrying out these propaganda campaigns and funding political figures who are undercutting such efforts. They understand as well as anyone else that global warming is a very serious threat, but there is an institutional role that enters here. If you are the CEO of a corporation, your task is to maximise short-term profit. That's much more true now than it ever has been in the past. We are in a new stage of state-capitalism in which the future just doesn't matter very much, even the survival of the firm doesn't matter very much. What matters increasingly is short term profit and if a CEO doesn't pursue that, he will be replaced with someone who will do it. This is institutional effect, not individual effect, and has extraordinary implications on society. It may, in fact, destroy our very existence.

[Glenn Greenwald] There is an artificial division when we talk about the government versus large corporations such as Google. Aside from the fact that they work together on all kinds of common-objectives and goals- such as the PRISM programme and so on.

In Western democracies, money plays a huge influence in political outcomes. In some ways, the government becomes a tool for those who wield the greatest economic power. It’s not as though there’s a separate thing called the Government, and this other thing called Google – but rather that they’ve become one. You have all this mass surveillance on the part of the government, but similarly Google, Facebook and a whole bunch of other corporations act the same way and carry it out.

Q: To what extent does a class-system still exist in western societies?

[Noam Chomsky] The business-classes are constantly fighting a bitter class war, and they are aware of it. If you read the business press they mourn about the hazard facing industrialists and the rising political power of the masses- and the need to fight the everlasting battle for the minds of men, and so forth... and they act on it! They are constantly carrying out major campaigns to ensure the concentration of power in the hands of the corporate sector will increase. In the last thirty years or so, there have been changes in the nature of the economy- shifting from capitalist to state-capitalist. A lot of the dynamism in an economy comes from the state; computers, the internet, the IT revolution and so on. The applications come from the private sector, but not the basic research and development. That has remained true, across the board. Over the past thirty years, there has been a significant change- a move towards "financialisation" of the economy. Financial institutions now have a far higher share of the profit in the economy than forty years ago. Another shift has been towards the outsourcing of production which, in effect, places working people throughout the world in competition- with obvious consequences. Well those changes have set in motion a vicious cycle in which wealth is more and more concentrated within an extremely small population. In the United States, the primary factor of inequality is the extreme concentration of wealth within a fraction of one percent of the population comprising CEO's, hedge fund managers and so on. As that concentration of wealth increases, it carries with it a concentration of political power since wealth has an enormous effect on the political system- and the political power in turn leads to legislation, which enhances the concentration of wealth. Fiscal policies, deregulation, rules of corporate governance and so on. This cycle exists all through the world, but is very striking in the United States. Within the last generation, for one thing, we have seen repeated financial crises which simply didn't occur in the fifties and sixties when new-deal regulations were still in place and the financial system was much more restricted. Increasing financial crises are not a problem for the big banks and investment firms because they can rely on the nanny state to bail them out. If we had a capitalist system, financial crises would be serious but they would be overcome simply by bankruptcy of the culprits, so Goldman Sachs, J.P. Morgan Chase and Citigroup simply wouldn't exist- they would have gone bankrupt a long time ago! But since we don't have a capitalist system, they have been rescued by the taxpayer repeatedly. In fact, they are given what amounts to a government insurance policy called "too big to fail" and the credit-ranking agencies take that into account. When they determine the credit-level of Goldman Sachs, they take into account that if they partake in a lot of risky transactions, and hence make a lot of profit and the system collapses, there will be a bailout- that increases the firms credit-ranking and means that can get cheaper loans and so on. Meanwhile, for the general population of the past generation or so- for the overwhelming majority, incomes have pretty much stagnated while working hours have increased and benefits have declined leaving a very angry, frustrated and confused population that is pretty much divorced from political decisions. Decisions which are extremely in the hands of an extremely narrow concentration of power- and the media go along with it, as they are essentially part of the system. There is some sniping around the periphery, this is a free society after all- but the overwhelming thrust tends to support the system. These are very anti-democratic tendencies, and also quite dangerous.

Looking at Conflict:

Q: What is your view on the 'global-war-on-terror'?

[Noam Chomsky] One problem is that it doesn't exist. You don't fight a war on terror by carrying out actions which you anticipate will increase terror. The invasion of Iraq, again, was undertaken with the expectation that it would increase terror- and in fact it did. That is not a war on terror. There shouldn't be a war on terror, but rather an effort to undercut terror. The ways to do this are well-understood. Britain is a perfectly good example. Take, for example, IRA terror which was pretty serious! As long as Britain responded using violence, that increased and escalated the cycle of terror. Finally- partly through United States influence, and partly from internal pressure- they responded by paying some attention to the legitimate grievances that existed in the background of the terrorist actions. Well, that led to a decline in terror. By now, Northern Ireland- while not utopia- is certainly not how it was even fifteen years ago. That's the way you deal with terror! Look at its roots, sources and do something about them.

[Glenn Greenwald] The War on Terror has spiralled so far out of control, so far beyond what it claims to be; from the question from what even is terrorism and who is actually doing it, to the way that there’s an enormous gap between the policies that are justifying the means versus the reality.

When I was in New Zealand a couple of months ago, I was reporting about mass surveillance in the run-up to that country’s elections and at first the government denied it engaged in mass surveillance even though documents proved it did; and of course they resorted to claims of ISIS and all these other terrorist groups that they had to keep people safe from. This is New Zealand! A country with a small population, at the very bottom of the Pacific Ocean!

The spectre of fear mongering has become so potent, that all politicians have to do is utter the words and citizenry capitulates and acquiesces to whatever they want. The War on Terror has become a justifying mantra for Western Governments to do whatever they want.

Looking at Globalisation & Society:

Q: What are your views on globalisation and a shift of economic power to China and India?

[Noam Chomsky] First of all, we should be a little careful when discussing a "shift of economic power". It is certainly true that China and India have had very significant growth rates, but these are very poor countries. Take a look at their GDP per capita for example. According to World Bank figures (which are grossly underestimated) China has maybe five percent of the GDP per capita of the United States, India maybe two percent. These figures ought to be doubled or tripled, but even so they are a small fraction of western power. China has grown spectacularly and there's been quite significant impact on reducing poverty and so on. Nevertheless China remains, as of now, an assembly plant. If you take a look at the trade deficit of the United States with China (which is much discussed) and calculate it accurately, in terms of value-added, it turns out the trade deficit with China is over-estimated by about twenty five to thirty percent. The trade deficit with Japan, Taiwan and South Korea is underestimated by the same figure. The reason is, within the dynamic East Asian production system- the high technology parts and components come from the periphery- from Japan, South Korea, Taiwan and China assembles. Over time, this will change as China moves up the technology ladder, but that's how it is now. It's even more the case in India- which has hundreds of millions of people who are completely excluded from the system. Peasant suicides are increasing at roughly the same rate as the creation of billionaires. A couple of hundred million people have gained, and many more have not- and their situation has been getting worse. There are also enormous ecological problems which are not counted as costs, though they should be. What's going on there is pretty spectacular.

There is much talk of China's holding of US debt and what that implies and so on. Japan's holding of US debt is approximately the same, that does not give Japan power over the United States. There's a lot of misleading commentary about these topics.

Q: What do you think the world will look like 25 years from now?

[Noam Chomsky] Well, there are a number of things taking place. The United States after the second World War was overwhelmingly dominant, its power has been declining since and is declining right now. In part, this decline has to do with the increasing growth in Asian production- we shouldn't exaggerate but it's certainly a part of it. Another factor is the internal attack on the health of American society- the corporate onslaught that has taken place over the past generation has severely weakened American society. There is an attack on the educational system which will have severe long-term effects on economy- there is a general attack on the workforce- the vicious cycle I described is fine for a very small sector of the population, but is harmful for everyone else. The infrastructure is in very poor shape. Anyone who travels from Europe or even Asia to the United States often think they are coming to a third-world country! This is increasing. It is not a problem for the small-sector of wealth and power that off-shore's production and engages in financial manipulations- for them it doesn't really matter if the country declines. It is declining, and it is under attack internally. The United States does have a financial crisis- deficit and debt problem- that is due to two things. One, the enormously bloated military budget which is approximately the same as the rest of the world combined and secondly, a highly dysfunctional privatised unregulated healthcare system. Those two elements are being protected and that, along with the vicious cycle that I mentioned, is leading to severe internal problems which will continue the decline. In addition, the environmental problem is very serious. If the United States does not take the lead, the rest of the world is not going to do very much. If the United States undermine efforts deal with environmental problems- as is now happening- that is going to be even more serious and that's exactly what we see in front of us for the institutional reasons that I mentioned. Thirty years from now, that will be much more significant.

There is also, unfortunately, an increasing threat of nuclear war and even nuclear terror. That's why I mentioned before US policy in Afghanistan and Pakistan- part of that policy increases the risk that fissile materials will fall into the hands of radical Islamists. I should say that radical Islam has been strongly supported by the United States and Britain for a long time as a barrier to secular nationalism. The US has also supported the nuclear programmes of Pakistan, India and Israel- the three non-signers of the non-proliferation-treaty. All of that is a very combustible mix.

There are also going to be increasing conflicts over resources. Resources are being pressed to the limit and with increasing growth, there will be competition- which will lead to severe resource conflict and maybe wars of some kind. They may not be military wars, but some kind of conflict. For example- if we look at the major world energy resources in the Middle-East, more are now going East than West! The United States so far is tolerating this- they want Saudi oil to go to China to undercut China's initiatives in Iran- that's part of US geopolitical strategy but that will cause conflict and is true of other resources- Iron, Copper, Lithium and so -on. This is a growing and serious problem- and gives a pretty gloomy prediction of the future unless something significant changes.


In his 2009 book "Freedom For Sale", John Kampfner discusses that by 2000, "... for the first time, democracy had acquired majority status in the world. Yet, as the writer Paul Ginsborg points out, at the very time it appeared to be dominant, liberal democracy had actually entered a profound crisis. This was not a crisis of quantity; quite the opposite. The crisis, rather, was one of quality." Kampfner continues by citing many cases of this quality-issue including the "dubious judicial legitimacy" of the 2000 US Presidential election along with the more recent manipulation of evidence leading up to the Iraq war, the humiliations of prisoners at Abu Ghraib, the systematic use of torture in secret jails around the world, and more.

"In order to succeed in this moral void..." he writes, "the new authoritarians came to a pact with their peoples. The specific rules varied between countries, but the template was similar. Repression was selective, confined to those who openly challenged the status quo. The number of people who fell into that category was actually very few... The rest of the population could enjoy freedom to travel, to live more or less as they wished and to make and spend their money. This was the difference between public freedoms and private, or privatised, freedoms.... After all, how many members of the public, going on about their daily lives, wish to challenge the structures of power? One can more easily than one realises be lulled into thinking that one is sufficiently free".

His view of being sufficiently free brings us back to the view of democracy being a "...compromise designed to balance interests among members of a community" albeit rather than balancing interests in a true sense, democracy (as we see it) becomes a pseudo-negotiation between a ruling elite (be they political or corporate) and their peoples as to what freedoms they (the peoples) are prepared to cede in exchange for perceived comforts. This moral-equilibrium-point is further provoked into volatility by the huge inequality we see between societies with the population of one wishing for the freedoms (be they economic, social, or political) in another. In 'western' civilisation, consumerism has provided a unique substrate for this pact. As Kampfner points out, "...people in all countries found a way to disengage from the political process while living in comfort. Consumerism provided the ultimate anaesthetic for the brain."

Unlike true-dictatorships, citizens in 'the west' have a sense of debate, control and participation in the issues affecting their lives. This sense of participation is supported by the level of information citizens receive about their democracy and the opportunities they have to interact with it through voting rights, panels, protest, and many other means. If, therefore, they feel sufficiently engaged in the democratic process- why should they even question the democracy of it!

The fact is we are encountering what can only be described as a participation-fallacy. Yes, citizens have the right to elect leaders (albeit who have sufficient capital to run for election) and vote on a wide variety of issues; but if we consider the most important issues which have had the most profound influence on western society in the past decade (including wars, bank-bailouts, climate change and more) aside from the right to show public-opinion through protest, have citizens really had the opportunity to exercise public-opinion? The answer is no- and even the most cursory glance of public opinion polls and outlets will show the widespread displeasure at many decisions which, while ostensibly "taken in citizens' best interest", rarely were.

This is not a problem we can solve overnight, the status-quo has become embedded and systemic in every part of our society. For our world to truly become democratic, the process has begin with education and end with culture meaning that citizens are not only more aware of the opportunities and processes of democracy, but are also culturally driven towards a culture which Dr. Wright describes as, "...a theory, policy, procedure and art, emphasising human welfare, individual freedom, popular participation and general tolerance. It can adapt itself to many conditions, but it thrives in an atmosphere of education, toleration, peace and prosperity." The traits of "Ignorance, dogma, war and poverty.." Dr. Wright argues (traits which have almost become hallmarks of our civilisation) "are its enemies. They breed absolute and arbitrary government, uncritical and lethargic people, which are the reverse of democracy."

"People in the long run.." stated David Eisenhower, "are going to do more to promote peace than our governments. Indeed, I think that people want peace so much that one of these days governments had better get out of the way and let them have it." For that to happen, though, we must realise that we (as people) are in this together and that the notions of society and self-interest are, for the most part, incompatible. By understanding that in exchange for a few notional-comforts we (actively) give-up our own freedom and the freedoms of billions of citizens around the world, we lose any perceived moral high-ground we have and any assertion of the freedom of our society.

"There is no such thing as a little freedom..." said Walter Cronkite, "either you are all free, or you are not free."

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Wednesday, 10 December 2014

Mental Health

The World's Most Profound Health Challenge

In these exclusive interviews we speak to: Dr. Thomas Insel (Director of the National Institutes of Mental Health, NIMH), Dr. Shekhar Saxena (Director of Mental Health for the World Health Organisation), Paul Farmer (Chief Executive of Mind, the world’s largest Mental Health NGO), Sergeant Kevin Briggs (Guardian of the Golden Gate Bridge) and Marcus Trescothick (International Cricketer and Mental Health Campaigner). We look at the realities of mental health worldwide, understand the true burden on individuals, communities and countries and look at the opportunities to deal with our global mental health crisis.


Vikas Shah, Thought Economics, December 2014

Everything we are now, and will ever be, is contained within 1.5 kilos of matter- intricately woven into what, as far as mankind knows, is the most complex object in the universe- the mind. This cage provides a filter that allows us (as individuals) to make sense of the incomprehensible diversity of sensory noise that fills our world and the billions of other beings that we share it with.

It should perhaps come as no surprise therefore that an object this complex- and in many ways beautiful- comes at a huge price. The mind is the seat of our self, and with this amazing capacity comes the ability to cause us profoundly deep pain; illustrated by the fact that every 40 seconds, someone in our world commits suicide (around 1 million people each year).

It is estimated (conservatively) that 1.3 billion people around the world suffer from mental health disorders, with around 600 million people doing so severely enough to be disabled (in some capacity) by them; and losing many years of their lives to mental health related disability. Barely an individual exists on this earth that has not directly or indirectly been impacted by mental health in some way, perhaps fighting their own battles, or experiencing them by proxy through a friend, family member or colleague.

The burden of mental health also puts huge financial pressure on our world. By 2020 (less than half a decade from now) it is estimated that mental health will cost our world over U$6 trillion in lost-productivity and direct costs each and every year (a similar figure to the aggregate current global health expenditure). Yet- with this in mind- we find that mental health is underfunded, poorly understood, and abhorrently low down the social, political and economic agenda of our world.

In these exclusive interviews we speak to: Dr. Thomas Insel (Director of the National Institutes of Mental Health, NIMH), Dr. Shekhar Saxena (Director of Mental Health for the World Health Organisation), Paul Farmer (Chief Executive of Mind, the world’s largest Mental Health NGO), Sergeant Kevin Briggs (Guardian of the Golden Gate Bridge) and Marcus Trescothick (International Cricketer and Mental Health Campaigner). We look at the realities of mental health worldwide, understand the true burden on individuals, communities and countries and look at the opportunities to deal with our global mental health crisis.

Thomas R. Insel, M.D., is Director of the National Institute of Mental Health (NIMH), the component of the National Institutes of Health charged with generating the knowledge needed to understand, treat, and prevent mental disorders.

Prior to his appointment as NIMH Director in the Fall 2002, Dr. Insel was Professor of Psychiatry at Emory University. There, he was founding director of the Centre for Behavioural Neuroscience, one of the largest science and technology centres. Dr. Insel has served on numerous academic, scientific, and professional committees and boards. He is a member of the Institute of Medicine, a fellow of the American College of Neuropsychopharmacology, and is a recipient of several awards including the Outstanding Service Award from the U.S. Public Health Service.

Dr. Shekhar Saxena is Director of the Department of Mental Health and Substance Abuse at the World Health Organization (WHO). A Psychiatrist by training; with about 30 years of experience in research and programme management, service delivery and information systems in the areas of mental health and neurological disorders, especially in low- and middle-income countries.

Paul Farmer has been Chief Executive of Mind, the leading mental health charity working in England and Wales since May 2006. Paul is Chair of the NHS England Mental Health Patient Safety Board, he is an advisor to the Catholic Bishops on mental health and was on the Metropolitan Police commission on policing and mental health. He is a trustee at the Mental Health Providers Forum, an umbrella body for voluntary organisations supporting people with mental distress. Paul is also trustee at Lloyds Banking Foundation and Chair of the ACEVO board. In November 2012 Paul received an Honorary Doctorate of Science from the University of East London in recognition for achievements in promoting the understanding and support of mental health.

Kevin Briggs entered the United States Army in 1981, where he spent three years serving across the United States and Europe. In 1987, he became a correctional officer and worked at Soledad and San Quentin State Prisons. In 1990, he graduated from the California Highway Patrol (CHP) academy and worked predominately on the Golden Gate Bridge (GGB). This assignment proved to be very challenging, as the GGB produced an average of four to six suicidal subjects, multiple collisions, and dozens of other law enforcement “calls” each month. In 1999, he completed training at the CHP Motor School, and in 2008, was promoted to Sergeant. Having graduated from the FBI’s Crisis Negotiation Course, one of his duties was to train new CHP officers and GGB staff on crisis interventions/negotiations. Sgt. Kevin Briggs retired from the CHP in November, 2013, to promote Crisis Management, Leadership Skills, and Suicide Intervention/Prevention worldwide.

Marcus Trescothick is an international cricketer, regarded as one of England’s most outstanding batsmen of the modern age.

At 29, Marcus Trescothick was widely regarded as one of the batting greats. With more than 5,000 Test runs to his name and a 2005 Ashes hero, some were predicting this gentle West Country cricket nut might even surpass Graham Gooch's record to become England's highest ever Test run scorer. But the next time Trescothick hit the headlines it was for reasons no one but a handful of close friends and colleagues could have foreseen. Marcus has since become one of the UK’s leading advocates for mental health awareness. He continues to play for Somerset, working as a commentator and analyst for Sky Sports in the off-season.

Q: What is the state of mental illness?

[Dr. Thomas Insel] Mental illness has been with us for centuries, perhaps forever.

We try to capture the public health significance of an illness by looking at mortality and morbidity. Mortality- when you think about it – is driven by heart disease, cancer, and to some degree infectious diseases. Morbidity - or disability- is quite another thing.

Mental illness accounts for 26% of all years lost to disability. It trumps virtually all other sources of disability- and this is for two reasons. Firstly, mental illnesses are highly prevalent. In the USA, nearly one in five adults had a diagnosable mental illness in the past year. More important, around 4-5% of the population is disabled by a severe mental illness- nearly 1 in 20 adults. Moreover, what makes mental conditions different from heart disease or cancer is that these disorders start very early in life- 75% before the age of 25. The current estimates are that depression is the single largest source of years lost to disability. That's extraordinary to think that depression is globally a leading source of disability -- this would not be on most people's lists of public health challenges.

[Dr. Shekhar Saxena] The state of worldwide mental health is a cause for very serious concern, not just for governments but also the World Health Organization. There are a very large number of people with mental disorders, but a huge number who also have mental and psychological symptoms (not amounting to disorders) who need support. Although some people require care and services, many require help to take care of their mental health, to prevent future disorders.

We are talking about a huge population; not just people who have diagnosed disorders and require treatment, but all of us - you and I - who need to pay more attention to our mental health.

3-5% of people in any given population, at any moment in time, have a mental disorder with substantial disability. 10% of people in any given population, at any moment in time, have a mild mental disorder. Overall, in 1 in 4 families there is someone with a mental disorder, and that's without including disorders related to alcohol and substance abuse.

What causes us great concern is that the attention paid to mental health by policy-makers and health services at large is extremely small. There is a large need, and not enough attention. The World Health Organization’s mental health programme is called the mhGAP – the Mental Health Gap Action Programme – which signifies the gap between the needs and availability of resources in this sector.

[Paul Farmer] We know that 1 in 4 of us will experience a mental health problem at any one given time- by which we mean people who will need help for their mental health. In broader terms however, we all experience mental health challenges- and one of the most important parts of our work is to think of mental health in context of the whole population as well as those specific individuals who do experience mental health problems.

[Sergeant Kevin Briggs] Mental illness in society today is more serious then ever before, in my opinion. According to the World Health Organization, there are approximately 800,000 suicides in the world each year. And, for each completed suicide, there are 20-25 attempts. We are still learning about the brain, how it operates, and how it is affected by mental illness. The key to reducing the stigma surrounding mental illness is education and an open mind. Take stress/mental illness in the workplace for example. They tend to remain near the top of the list for time lost from work. I believe if there were more training in the area surrounding this issue, particularly on how to recognize/approach a person suffering from mental illness/anxiety/stress, there would be a significant amount of money saved in lost time at work, thus reducing workmen’s compensation. People would also in fact be happier and contribute more to the success of their company.

Q: What was your experience of mental health challenges?

[Marcus Trescothick] If I look back, mental health impacted my life more back in 2006- when I was away playing in India, and became too much of an issue to deal with… which is why I returned from there and began the process of dealing with it, understanding it, and learning how to live your life with it.

In truth, it had been underlying for quite a long period of time. It had always been there and I hadn’t perhaps given it the credibility it warranted. I used to suffer quite a bit from homesickness from an early age- around 11- and the symptoms were very similar back then to how they are now still. At the time you think it’s just homesickness and you learn to cope with it for that period of time and it moves on. It’s only really at the time when it became more severe, that I understood what it was- and the reasons why. It became more of a ‘problem’ once I acknowledged what it was!

Mental health impacts everything. When I’m playing cricket, I could immerse myself in the game and what I had to do. I could distract myself and manage it more easily- and that’s part of the problem where if you’re not doing a great deal, you can sit with it, dwell on it, and it can become a bigger problem. My challenges certainly did have an impact on my job, but I learned to manage it to carry on and still deliver- and do what I need to do- even if I don’t feel 100% or as good as I would normally do on a daily basis.

Q: What is the social, economic and political burden of mental health on the community?

[Dr. Shekhar Saxena] Mental disorders have an impact on a number of levels. First, there is the health impact; they cause deaths and a huge amount of disability. More than 10% of the world's Disability Adjusted Life Years lost is due to mental and psychological problems. This is huge. We mustn't forget though that lives are lost. People frequently identify mental illnesses as causing disability, but not death; but that's not correct. Around the world over 800 000 people lose their lives to suicide each year, and a large number of people with mental disorders die significantly earlier than the general population as they ignore their health needs and may not therefore get treatment for tuberculosis, cardiovascular disease, respiratory disease, cancers and so on. Unfortunately mental illness are often ignored by the health system; and they get much less attention in the hands of policy makers and health-care providers.

The social burden of mental illness is huge. Mental health problems give rise to absenteeism in the workplace, marital discord, child maltreatment, neglect and abuse, and also violence. I don't want to feed the misconception that mentally ill people are violent, that's absolutely not true. People with mental health disorders are more often at the receiving end of violence. Both people with mental health disorders, and their families, often suffer from stigma and discrimination. Sufferers are often denied access to social services, the jobs market and even social and cultural activities. This is extremely hard to measure in monetary terms, but is hugely significant.

The economic impact of mental health disorders is also very large. Working populations may experience reduced productivity, greater absenteeism and even ”presenteeism” where the person is at the job but not performing at well. You also find economic burden within the justice system as a result of drug and alcohol usage. A very large proportion of the prison population all over the world, but particularly in North America, has mental health disorders. In effect, the state spends more money on the indirect effects of mental health on society than actually treating the disorders in the first place. 

The cost of mental health on society is not measured in millions or billions, but in trillions of dollars. This scale is largely unrecognised by policy makers.

The best voices to highlight these concerns are the people with the mental health disorders themselves, and their families; the advocacy organisations in this sector are not just few in number, but weak in stature. There is a lot of self-advocacy for HIV, cancer and so forth, but not so much for mental health. The people who suffer the most have the quietest voice - not just because of the illnesses themselves - but because of the stigma. This is one of the reasons why mental health issues do not get the attention they deserve.

[Paul Farmer] Mental health can be seen as a continuum. Many people manage their mental health well, and are able to live the lives they want to- and there are numerous examples of people who have achieved fantastic, incredible things whilst living with mental health problems… others have more complex and enduring problems that impact every aspect of their lives… ultimately and very sadly, there are also 6,000 people in the UK alone who take their own lives- and that is the ultimate impact of someone’s poor mental health.

Q: What is the toll and impact of suicide globally, and what is the challenge of suicide prevention?

[Dr. Shekhar Saxena] Over 800 000 people die by suicide each year, and the numbers are almost certainly under-estimated; a significant number of suicides are reported as natural or accidental deaths. For each death by suicide, there are over 20 attempts. These attempts leave a great deal of mental and physical disabilities. For each death by suicide, there are family members, friends and colleagues that are affected, and who sometimes blame themselves. It's a huge problem that countries need to discuss. This is beyond health; it is a cross-sectoral issue.

We must recognise mental disorders at an early stage and provide proper care so that suicides can be reduced. We must also make sure that people at the front-end of services (such as medical staff, together with those working in the law enforcement and judicial systems) are trained to ask the right questions to detect people with suicidal tendencies early. Most people who eventually commit suicide and die have sought help within the previous 12 months, but did not receive appropriate help. We must also ensure that the means of committing suicide, such as pesticides and firearms, have restricted access. It's genuinely believed that if a person is bent on suicide, that they will do but this is not true. Suicidal tendencies are often transitory and if you can prevent the person from taking their own life for a few hours or days, they may often never do it. We must also look at the fact that alcohol is very closely linked to thoughts of suicide and death by suicide. Reducing the amount of alcohol consumed in society will have a very positive impact on preventing suicide.

We believe that there is no acceptable rate of suicide, that each and every suicide is one too many and that each and every country has a responsibility to act on this issue.

Q: Why do you think people see suicide as a final way out?

[Sergeant Kevin Briggs] This of course is just my opinion with regards to why people become suicidal. This is based on my own observations of the many folks I have dealt with. With mental illness comes shame. In most of the world, mental illness is looked upon as a sort of made up concoction is one’s head. You dare not speak about, for fear of loosing family, friends, even your employment. So, people suffer for years with getting treatment. Even those who face this head on can struggle greatly, due to the severity of the illness at times. Some of those who suffer, even after seeking help, become so ashamed and incapacitated by their illness, they believe they simply cannot go on. They feel they are a burden, and are actually doing everyone a favour by their demise. Then they are the one’s who have committed criminal acts, such as lewd acts with children. When they are discovered, they shame and embarrassment is too much. As many ways as there are to loose one’s life to suicide, are that many reasons to do it.

As far as a cry for help, there are those that start to do an act, say, come to the Bridge and go over the rail because they know they are going to get attention. It is my belief that most do not do this for attention. We do have our “frequent guests” so to speak, but each and every time they are handled with respect and as if it was their first time on the Bridge. You just never know what is really going on in a person’s mind, so it is important to take each case with the utmost care and concern.

Q: What were the reasons why people had decided to make attempts at taking their own lives on the Golden Gate Bridge?

[Sergeant Kevin Briggs] There are a multitude of factors why people think suicide is their only way out of the pain/loneliness they are suffering. The vast majority of the time years of suffering from mental illness have occurred. Mental illnesses like Depression and Bi-Polar disorders wreak havoc on a person. Some do very well with therapy and medication. Others loose their way and decline steadily, over the years, emotionally, financially, and finally loose their ability to cope. Once is a while a person will loose their life to show another person what they have done to them. It is a retaliatory action based on what a loved one, business partner, or person close to them has done.

Q: What was the mental state of those you observed on the Golden Gate Bridge?

[Sergeant Kevin Briggs] Most of the people I have encountered over the rail did in fact suffer from a diagnosable mental illness in one form or another, and varying degrees of severity. Alcohol and drugs was observed in many, as this helps to alleviate pain and give them courage for the task at hand. Two of the people I dealt with directly were in fact not under the influence of alcohol/drugs. They had been suffering from mental illness for years. Their demeanour was generally calm and collective. Both were extremely polite, and seemed as if they were ok with what they intended to do, and had made peace with it.

Q: What was the impact you saw from suicide?

[Sergeant Kevin Briggs] The impact of what occurs when we observe a suicide is difficult to fully explain. If we have spoken to the person for some time, it is like loosing a friend. The bond created just before one’s death leaves an emptiness in your heart and guilt in your soul. “Could I have done better?” We ask this of ourselves each and every day. But this is just the tip of the iceberg. The family and friends can be affected so deeply that it may trigger other suicides. I have seen parents simply give up on life after their child has lost his/her life to suicide. The guilt can be tremendous. Although they may, and probably did, do everything to the best of their ability, a suicide has ripple affects that lasts a lifetime.

Q: How did suicides impact you (personally) and the officers/personnel you worked with?

[Sergeant Kevin Briggs] The suicides that we do witness will forever be ingrained in our minds. It is very personal, and each of us deals with it differently. We (the California Highway Patrol) have what’s called an Employee Assistance Program (EAP) where we can see a psychologist seven times a year. This has helped many of us.

I look at it a couple of different ways. One is that fact that I believe we help many more then we loose. The other are words a Rabbi from New Jersey told me once after I spoke to a young man, just 32 years old, who flew out to the Bridge from New Jersey and jumped after I spoke with him for an hour. I was feeling extremely guilty and very down on myself. The Rabbi told me, “Kevin, if you ever stop feeling the way you do right now, get out of the business.” He explained it is the compassion and thoughtfulness that’s helps so many, and that even though we try with all our heart and soul, some folks just cannot be reached.

Q: In your role; how would you try and diffuse the situation(s) and talk-down individuals?

[Sergeant Kevin Briggs] I use active listening skills in the hopes of generating conversation to find out what is going on in their life. Honesty is huge. I in no way advise them their life will be a piece of cake if they come back over the rail, but I do relate the importance of their life, their self worth, their responsibilities, and try and install hope. Listening is critical. Many times, all a person needs is someone who will listen, without an agenda or argument.

Q: What is the state of attitudes towards mental health?

[Dr. Thomas Insel] There is a lack of understanding about mental illness.

In the developing world, mental illnesses tend to be viewed as a first-world problem. In the developed world, it's often seen as a private family issue and is rarely a priority for people who set the public health agenda. Mental health oddly has been carved away from the rest of medicine as being a social-services problem rather than a medical or public health problem. That's a critical part of the difficulty we've had bending the curve for mortality and morbidity as they relate to mental illness; we've not been able to get traction in the world of medical practice.

The World Health Organisation reckons that around 3% of healthcare dollars are spent on mental disorders, yet these disorders account for 26% of years lost to disability. It's a huge gap between investments and costs.. Patients receive the equivalent of less than $2 per person per year in this space- and that's incredible considering the disability associated with mental illness. It's not simply a question of disability – mortality is also a concern. The WHO global suicide report cites conservatively that there are more than 800,000 suicides in the world each year, 90% of which can be attributed to mental disorders and 75% of which are in low and middle income countries. Mental health is not only a first-world problem, and the suicide data demonstrate that, when neglected, this a problem with fatal consequences.

In the USA we have around 12 suicides per 100,000 people each year- a rate which is about average for an OECD country. Note that the deaths from suicide are more than double the deaths from homicides each year: the USA has around 16,000 homicides each year, and 39,000 suicides! In the USA, there is an immense focus on homicides, it's a lead story in each and every newspaper but you rarely read about suicide which is twice as prevalent. In fact... homicides have come down around 50% whereas suicides have only trended upwards.

There's a remarkable neglect for suicide. Around the world we have people accountable for reducing medical deaths, road traffic accidents and so forth, but it's difficult to find who's accountable for preventing suicide in most countries.

[Dr. Shekhar Saxena] The stigmatisation of, and discrimination against, those with mental health disorders is found all over the world.

The stigma is not just due to a lack of knowledge, but attitudes. It's easy to change knowledge, but hard to change attitudes and behaviours.

One of the reasons self-advocacy is weak, and we are experiencing a policy hiatus, is because policy makers don't like to think or plan around mental health because of the stigma. The public discourse in developed countries is changing, but it's far from adequate ̶ and in much of the world, the discrimination is rampant.

There is also a very clear link between mental health disorders and human rights violations. These violations occur in mental institutions and in the community. Almost 70% of psychiatric beds are in mental hospitals and not general hospitals. Mental hospitals, by their definition, are isolated and often far from cities. They have conventionally been more of a place to keep people with mental disorders away from society, rather than for treatment and services; this unfortunate reality continues in the present day in both the developed and the developing world. Human rights violations are rampant and because of a lack of transparency and accountability, these violations are able to occur both within and outside the law. In many countries, there are laws that deprive people with mental disorders of their basic civil rights such as voting, driving, property ownership and so forth. Laws aside, we see frequent abuse of people with mental disorders; they are deprived of their liberty, and sometimes locked-up in institutions for life. Even basic physical needs, such as food, clothing, shelter and basic healthcare, are often denied.

It's not just within healthcare settings that these abuses occur. Communities frequently violate the human rights of their citizens who are suffering with mental health disorders. We hear stories about people being chained and locked-up in their houses for years ̶ this is indicative of the way society treats people with mental disorders. This is not just illegal, it’s immoral.

Mental disorders are disorders like any other, but they are stigmatised and deprive people of their human rights. Society must do something about this.

[Paul Farmer] There is no doubt that mental health stigma remains a huge challenge to overcome. For generations, we’ve ignored the issue of mental health, and those with mental health problems have been literally kept out of sight, out of mind. Let’s not forget that it wasn’t that long ago that people were locked-up in long-stay institutions! That was the way that society viewed mental health!

We are beginning to see progress… For the first time, partly as a result of the Time to Change campaign, that we run with ReThink Mental Illness we’ve seen an improvement in public attitudes to mental health. In specific areas, attitudes are changing quite quickly. In the workplace for example we know that many employers are recognising the importance of improving well-being for employees, and supporting people who need it. We also still know that many people feel they can’t disclose their mental health problems to their employer or colleagues. 

It’s important for leaders to be open about their experiences, and that’s not something that happens very often. It makes a huge difference. There’s been a lot of work around how leaders can be open about their mental health challenges, as it can often be doubly-difficult in a workplace. If you’re a member of staff, it’s hard enough going to your manager – but if you’re in charge? Who do you talk to and how!?

[Marcus Trescothick] I [personally] don’t see this perhaps as much as it’s reported in the media, but I can only really judge it on my own circumstances and a few friends in the profession who’ve been through it. Whether we’re just lucky and people allow us to carry on playing the game? …it doesn’t affect us too much. It doesn’t affect the decisions made on us, we’re still allowed to carry on and do as normal. You do hear a lot about it in other areas.

Even now however, I know lots of people who still don’t want to admit to their boss or team-mates what they’re going through. That’s people within the game, but also from other walks of life.

People still believe there’s an issue or stigma… but it’s not until it’s a major problem that people go, ‘sod it, I’ll just tell everyone….’ And that made it a lot easier for me!

Q: Is there a link between high performance careers and mental health?

[Marcus Trescothick] From what I see, I think there probably is. There’s a lot of demand put on yourself – you push yourself through hours and hours of work; that could be hours of training at the gym, practice, on the pitch, travelling and being away from home. The England team for example spend around 270 days a year away from their families and homes- that’s pretty demanding.

There must be some correlation between demanding lives and mental health… that said, I know many people that suffer these problems who don’t have those same life challenges. Everyone’s issues are relative to how their brain operates- they still have the same stresses and worries that we all do.

Q: What is the state of treatment for mental illness?

[Dr. Thomas Insel] We think of treatment in two big buckets. One is medications. The medications we have today, around 30 anti-depressants and 20 anti-psychotics, are not strikingly different from the drugs we had 40 years ago. That's not to say they're not effective; they're actually quite useful and may be essential for those who are severely ill.

Medication isn't sufficient however... you need a series of non-pharmacological interventions deployed with medication. In much of the developed world, people get medication but not much of anything else. The second bucket includes the range of non-pharmacologic treatments, from psychotherapies to devices, including mobile health apps. There is a lot of innovation right now in the development of inexpensive, accessible treatments that can be used in low resource environments.

Medications can treat the symptoms, but may fail to address the core of these illnesses, which are often cognitive. In the developed world, we're too singular in our approach- focusing on medication or cognitive therapy but rarely combining treatments to get optimal outcomes.. In many developing world, patients don't- in many cases- even have access to the medication! The WHO estimates that 85% of people in the developing world receive no treatment whatsoever! All these medicines are generic and incredibly cheap, and could be available everywhere to everyone. It wouldn't be enough of course, but antidepressant and antipsychotic medications should be in every formulary in the world.

[Paul Farmer] There is a very long history of mental health being continuously underfunded as a result of which, only 25-35% of people with mental-health problems receive treatment at all. There’s an enormous treatment gap between the number of people who need help and support and the number of people who get help and support.

Evidence suggests if we invest systematically in mental health, not just at the treatment-end, but also with early interventions and appropriate crisis care, that it can be clinically and economically effective. There isn’t any reason why these investments can’t be made now, especially given the savings that could be made in acute hospitals and primary care; lots of people who go to their Doctor or A&E have mental-health problems, and many people on acute wards have some mental health problem. There’s a really good opportunity to change the way that mental health services are provided, and in our manifesto for the next government, we’re encouraging this to be at the heart of thinking.

Q: What are the most promising areas of science in mental health?

[Dr. Thomas Insel] At the NIMH we think a lot about how we get better at diagnosing and treating these disorders. Much of what we do today, and have done for the past several decades has been focussed on symptoms rather than the underlying cause or strategic treatments. The hypothesis we have here is that mental illness is related to something going on in the brain, just as chest pain is usually related to something going on in the heart or the lungs. We don't know enough about these illnesses as brain disorders, but if we apply the extraordinary tools of modern neuroscience- there's great potential. Modern genomics and neuroscience could transform how we think of mental disorders and provide us with new diagnostic tests and treatments. Just as an example: in the era where pharmacology was the main foundational science for mental disorders, there was a tendency to think of the brain as a black-box and to consider an illness as a chemical imbalance- as if depression meant you were a quart low in serotonin. The new perspective views depression as a problem with circuits in the brain that aren't operating properly- something more like an arrhythmia in the heart. The task of treatment is to get the circuit synchronised in the right way- Medications can help but circuit tuning may require cognitive psychotherapy or targeted brain stimulation. It's becoming increasingly clear also that depression is many different disorders that impact brain circuitry, as much as fever comes from many different causes- neuroscience should give us the assays to understand depression in this way.

Science is taking us in a new transformative direction for mental illness.

Q: What are the key determinants of mental health?

[Dr. Shekhar Saxena] Mental health disorders have many causes. I can say upfront that we don't fully understand the causes of all mental disorders, although for some we have a very good idea.

The causes of mental health disorders vary from biological to social, and also psychological. Biological causes are to do with brain functioning, neurotransmitters, genetics and even structural lesions within the brain. The psychological and social causes are due to stress factors, and the risk factors that exist as a result of inequality, conflict, wars and so-forth. There are avertable causes, and also non-avertable causes, but we do know that rapidly changing societies, and those going through upheavals caused by conflict and natural disaster for example, predispose their populations to a higher incidence of mental disorders; and we can do something about that through anticipatory action and the right interventions post-event.

Q: How do demographics impact mental illness?

[Dr. Thomas Insel] One of the things that is so unique about mental illness is its prevalence in children. A fascinating question has come up about the genetics of conditions ranging from autism to schizophrenia and bipolar to ADHD. It turns out that the genetics are very similar across them all, indicating there may be a common vulnerability. Some disorders occur more in children, some more in men than women. Autism and ADHD are 4 times more common in boys for example, while depression and eating disorders are more common in women. Is there something about the fundamental mechanisms of these diseases that causes some to occur by aged 2-3 (such as autism) and some much later (such as schizophrenia) which emerge in the early 20's. Could the age of symptoms reflect the development of relevant brain pathways? Do the gender differences represent hormonal influences that are protective?

It is also possible that age and gender alter the presentation of these disorders.  One line of thinking today argues that the same disorder looks like anxiety at aged 8, depression at 28, and dementia at 68. It can be the same biology and may require the same treatment. We know that men and women with the same disorder have different presentations. For instance, women with depression more often present with the sadness and gulit; men often exhibit irritability and hopelessness.

[Paul Farmer] At Mind we’ve been thinking about how we can support the resilience of those who are most at-risk of developing mental health problems. We’ve been doing quite a lot of work thinking about mental health in a public health concept in much the same way as people look at smoking or obesity. There’s also benefit in identifying groups who are at specific risk; for example- older people who are at risk of isolation, mums-to-be, who are at risk of post-natal depression, unemployed men in particular due to the elevated risk of mental health problems in those who are not at work, vulnerable migrants, people from the African and Afro-Caribbean community, and also those with long-term physical health problems- they are all at greater risk of developing mental health problems. We want to work with public health teams at a local-level to put in place strategies that allow people to have the resilience they need to deal with mental health problems.

[Sergeant Kevin Briggs] Most of the time it is white males, ranging from 18 to 45 years old that jump from the Bridge. They differ in socio-economic levels. There really are no patterns to suicide on the Bridge. Some years have more age groups then others and sometimes more in the spring and after school begins, but really, suicide from the Bridge crosses all races and economic borders.

Q: How do the justice system and our political framework deal with mental health?

[Paul Farmer] We have three cornerstones in legal terms when thinking of mental health. The Human Rights Act is an incredibly important part of the support and safeguards that people with mental health problems have, and so too is The Equalities Act. Since mental health is perhaps the only situation where someone can be forced to receive treatment against their will, The Mental Health Act and The Mental Capacities Act provide those legal policies and frameworks to safeguard and define any state intervention in someone’s life.

We are detecting a greater degree of political interest in mental health as an issue, and all of the [UK] political parties are taking it a lot more seriously. There is still a long road to travel down before mental health is embedded into government policy-making, and that’s really what we would like to see.

Q: Is there enough will to fight mental illness?

[Dr. Thomas Insel] We're stuck in a situation where mental health has become hugely fragmented and misunderstood. Secretary Hillary Clinton recently spoke about the need to redefine mental health as a public health problem. She pointed out that in some countries, including the US, mental health has become a criminal justice problem- as more people with mental illness are in jails than in hospitals.

There's a great need to educate policymakers as to the importance of this problem, and the need to address it. It's not expensive! We're not talking about high tech diagnostics and therapeutics for each ill-person, but re-organising resources to achieve better outcomes. In fact, we know how to do this. For example, NIMH supported scientists are about to publish the results of a large study to improve outcomes in individuals following their first psychotic break (usually in their early 20s). To reduce subsequent arrests, re-hospitalisations, and poor treatment compliance, this study bundled together treatments that have been available for three decades. We can do so much better without any new science; just by making sure we do what we need to.

Q: Who are the key stakeholders in mental health solutions?

[Dr. Shekhar Saxena] Mental health issues should be everyone's business, starting from policy makers who have a responsibility to make national policies to prevent mental disorders and promote mental health, and service providers. The budget allocated to mental health in low- and middle-income countries is less than 2%, and less than 3% elsewhere in the world - but the burden of mental and neurological disorders worldwide is around 10% of the total disease burden.

Civil society has a huge responsibility to highlight issues and take action to make things better. Those with mental health disorders (and their families) have a responsibility to speak out and demand the services they need. The media also has a role to play. Many misconceptions about mental health are strengthened by inappropriate reporting ̶ meaning that people are given the picture that those with mental health disorders are abnormal, cannot be cured, are violent and aggressive, cannot take responsibility and more. All of these things are untrue. In the majority of cases, those with mental health disorders can become 'normal,' and work, marry, look after themselves and their families and have good lives. People with mental health disorders need the support of society, not the ridicule that is often heaped upon them.

Commercial organisations play a role. The healthcare sector (including pharmaceutical companies and researchers) have the responsibility to further research treatments of mental health disorders ̶ this is not just good business, but also in the public health interest. Employers must do a better job of looking out for the mental health of their employees. We have a large responsibility for mental health in the workplace, and that's often ignored.

Even you and I are stakeholders in the mental health agenda. We need to be on the look-out for people who may need help, in our own families and among our friends and colleagues. Often, because of stigmatisation, those needing help do not get it in a timely way and may be at risk of suicide.

Q: Will we see a world free of mental health problems?

[Dr. Thomas Insel] The community of people involved with mental health have really never sought a cure, the way advocates have campaigned for cures for cancer, heart disease, and AIDS. Mental health advocates are developing a culture of recovery -- their most ambitious aim is to make sure that everyone can recover. That is fine, but prevention and cure need to become part of our vision when we think about autism, severe depression, and schizophrenia.

People are now starting to talk about prevention, recovery and cure in their agendas. We need to look at this in similar terms to heart-disease. We need early detection- rather than waiting for someone's first psychotic break at 22, we need to detect the prodromal problem at aged 8, 12 or even 15. In the USA, we have around 100,000 people who have their first psychotic break each year, we want to reduce that by 50% through early detection and intervention. This field simply hasn't had a vision of prevention and cure – which will require better science. We’ve been mostly about provision of services. Better services are critical but will this reduce morbidity and mortality? It's a real challenge for us to realise that maybe what we have to offer today is not good enough and that we need to do something better to prevent psychosis and suicide.

[Dr. Shekhar Saxena] I don't see a world in the foreseeable future that is free from mental health disorders, but I do see a world with greater attention given to mental health, and a world where people are encouraged to promote their mental health and to effectively take care of disabilities and conditions if and when they occur. I also see greater participation of people in society within the mental health agenda, and the mainstreaming of mental health into policy making. This is a realistic goal. We are not seeing the end of cancers in the foreseeable future for example, but we have a better understanding of prevention, care and services, and this is what we want for mental health.

The World Health Assembly Resolution on Mental Health was passed by all the health ministers in 2013. I see this as a major advancement in the recognition of mental health, and a commitment by the world. It was remarkable that all 194 Member States of the World Health Organization, committed themselves to the same vision, objectives and targets for mental health. This gives me a lot of hope about future actions and achievements in improving the lives of people suffering from mental health disorders and their families.

Q: What is the role of education as it relates to mental health?

[Paul Farmer] There is a serious need to give young people a good grounding in mental health. In the Time to Change campaign, we take mental health messages directly into schools and work with teachers, pupils and support staff. When our team leave, we hope that people are able to ask the right kinds of questions and talk around these issues. Formally and informally, there’s a huge job to be done…

We’ve also seen positive evidence around supporting mental health right back in the 0-2 year old group where you can do a lot to build positive resilience through positive parenting programmes for example.

Q: How is technology impacting mental health?

[Paul Farmer] Accessing information and support has helped people with mental health issues tremendously. For example, our Ele-Friends peer-support community is a fantastic example of what you can do in a positive way using online empowerment. We are also seeing the emergence of access to online therapy, and the use of apps to monitor mood and so forth.

There’s also a strange-paradox where people may feel that technology can make them more isolated rather than less isolated; so despite the fact that we have may ways of communicating perhaps we’re doing it less in quality terms.

We have to keep a close eye on the impact of modern technology on the mental health and mental wellbeing of any society, but on the whole we see it as a force for good.

Q: What would be your view of the future of mental health?

[Paul Farmer] We are living through a key-part of mental health’s journey. We are coming out of the shadows, and mental health issues are now much more visible in a positive way. The next 10 years or so could hold a great opportunity to reach a tipping point in public attitudes to mental health in the same way that attitudes have changed towards gender, sexuality or race. With that will come a significant increase in demand for help, and so it’s important that the support services are in place to absorb that demand.

In a really optimistic way, I think there’s an opportunity for a real significant sea-change, and we are on an inexorable path towards that.

Q: What was the greatest lesson you learned in your time as a guardian on the bridge?

[Sergeant Kevin Briggs] I have learned so many things since I began working on the Bridge, not only about people in general, but about myself also. My professional career has been primarily in “macho” jobs (military, corrections, CHP). This path had hardened me somewhat, making me emotionally shut down. To see what we see in this business and still be able to go back and do see the same thing the next day, you need to be able to put the bad away and move forward in a fast manner. What has really struck me is the empathy you show can really make others shine, no matter where that be. Everyone of us has emotions, and when confronted by obstacles in our life that can seem overwhelming, all it can take is just one caring individual to really make a difference. That little amount of time you spend with someone can make a lifetime’s worth of hope for them.

Q: What has been your greatest insight during your recovery journey?

[Marcus Trescothick] One of the most valuable lessons I learned was that you only start to learn how to cope with your problems when you acknowledge what they are. You then come to terms with what it is, learn about it, understand it – and start to improve yourself!

I had been hiding from my mental health problems for a long time, almost since I returned from India. You’re almost trying to cover your tracks, and cover your ‘secret’ – the best thing to do at that point was to tell everybody. It made it easier, it meant I didn’t have to lie to the media about the reasons why I was doing this or that – when you talk about it, you find that people understand what you’re going through and often are going through it too. The point where I was open and honest about my mental health was definitely an important turning point for me.

I didn’t have any preconceptions about mental health before then. You obviously hear a lot of people talking about how they’re depressed and so on; and I didn’t really realise what it was about – I thought maybe people were run down or worn out. You hear a lot of stories about people prejudging those with mental health issues, but you never really understand it until you go through it yourself.

Q: What would be your message to those currently experiencing mental illness?

[Dr. Thomas Insel] I am hopeful but also I think we need to be realistic. The tools we have today are unprecedented, we have never been able to offer so much to so many.... however.... we need to admit that the quality of care in most places is not good and that, in contrast to much of medicine, diagnosis and treatment depends more on whom you ask rather than what you have.

All of us have family members who have been impacted by mental health issues, and many have done remarkably well, while for some it's still a challenge. We need to be honest -- we don't have the treatments we need for autism, for many aspects of schizophrenia, and for dementia. I am hopeful that science will give us better diagnostics and therapeutics, but this is a long-term effort. We also need to recognize that we can do much better with the treatments we have today. For instance, creating toolkits with medication and evidence-based psycho-social treatments could make a big difference in the short term. And for the best outcomes, we need to involve families and patients to empower them to direct their own care. If we can do that, my message is that there is hope for recovery in the short-term and prevention and cure in the long-term.

[Dr. Shekhar Saxena] People with mental disorders can help change the world around them. By recognizing and articulating their needs, and by having a say in decisions made, they can not only improve their own lives, but make the world a better place.

[Paul Farmer] It’s important for people to realise that you are not alone. So many people who are developing a mental health problem feel very alone, isolated and even scared about seeking-help. We want to send a message to people saying that it’s OK, you’re not on your own, and that there’s a lot of help and support out there for you- formally and informally. We want to encourage people to seek-out and reach that help.

[Sergeant Kevin Briggs] To those who are suffering from mental health challenges, or just feeling low at times, which very much includes myself, I’d like to give you some advice that I use for myself. I know all too well how hard this illness can be in your life. At times there is extreme loneliness, lethargy, and even disgust with one’s self over what may be occurring in your life. At least this is how I feel at times. But, I also know there will be days when all just seems right with the world. When those days occur, write down how you felt, what you did, whom you were with (if anyone) and if anything assisted you in feeling better (sunlight, foods, walking the dog….). On your bad days, look at this and it will help you get through it, knowing it will pass.

[Marcus Trescothick] You have to seek help straight away; whether that’s a doctor or a psychologist. You have to try and get a bit of direction, and get to a point where you know how to start dealing with your mental health. You need to get to an area where things start to improve, and that takes time- but if you’re not asking or seeking the advice, then you’ll never get the clarity about how it’s going to get better.

If I broke my leg, I’d go straight to a hospital and they’d put a cast on me and give me a rehabilitation programme; but because you don’t see the physical problem, you move away from it, and think you can cope with it yourself.

Men are often guarded about what they’re feeling, and may perceive it as a weakness to ask for help. It’s often only when they have been through-it and experienced it that they realise this isn’t true. We [as men] can get help, we can ask for help, we’re just normal people at the end of the day.


It is perhaps appropriate for this author to conclude this piece by disclosing a rather personal interest in the subject matter.

I have lost more than one of my closest friends to suicide, and have spent decades at the torment of my own mind’s depressive states and, on occasion have come to understand- quite vividly- the depths of darkness that lead people to think- and do- the unthinkable.

I contend that I am me, and nobody else will ever know how I feel- and with that contention comes the realisation that the challenges of mental health are solitary unspoken battles between myself and my soul, with invisible wounds and selfish victories, which- in turn- create my greatest weaknesses and most profound strengths. It is this contention that means that I (and many more) fight alone….

… The truth is, I am not alone. Should humans be categorised by those with, and those without mental health challenges – I would be part of an immense family – and one desperately in need of a voice.

Mental health challenges kill over a million people each year, and cause profound levels of suffering to billions more. Given we have the technology and capability to treat the vast majority of mental health disorders, each and every life lost is a failure on our conscience- and each and every moment of suffering is an injustice at our hands.

I hope, dear reader, that you will join me in taking up arms – and speaking from the heart, on behalf of the mind.

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