But sometimes we get feedback from people who use our work in ways we could never have imagined. When Dr Jill Gordon, a GP who specialises in helping patients with mental health problems, got in touch to say she’d found Our World in Data valuable in her practice, we were surprised and curious to understand how. She very kindly agreed to share some of her experiences with us and you on our blog. The text below was written by Dr Gordon; we hope you find it as interesting as we do.
Christopher is 15 and last year he was feeling bad – hopeless and helpless. At home his parents are unhappy and seem to talk less and less. In the playground there’s been a lot of bullying and some experimentation with alcohol and marijuana. His best friend has switched allegiances, and makes fun of him in front of others. In the classroom, there have been discussions on climate change, and it seems to Chris that adults lack the political will to do enough to mitigate its effects. The future looks bleak.
Margaret used to have health anxiety – it started when she was in her late teens and both of her parents died of cancer within two years of each other. Not only was she overwhelmed by grief, but she actually had no-one with whom to share the grief. She took off overseas to work, to bury the sadness and ‘get on with life’. Now at 46, she can’t stop worrying about her son and daughter’s health, not to mention her husband and herself.
Ian has nothing but regrets. Having retired from a career in journalism 13 years ago, he is lonely and aimless. His marriage broke down when he was in his forties because of his infidelity, something that led him to lose a lot of friends and move away from his home city. All of his three children live overseas. Last week he realised that he hadn’t spoken to a single person all week. He says that he’s a certainty to develop dementia, from which his own father suffered for 15 long years. He experiences difficulty in concentrating, early morning waking and poor appetite.
Mental health issues are rarely single. Linda is managing her bipolar disorder relatively well these days, but hospital admissions have been associated with very significant weight gain due to treatment with atypical antipsychotic medication. She no longer takes that particular medication, but the damage has been done, as far as her weight is concerned. She has moved beyond the heroin addiction that she had 20 years ago, and now food is one of her few pleasures, while impulse control is one of her least developed skills. It’s difficult for Linda to move about, far less do serious exercise. Like Brian, she lives alone and questions the value of her life.1
There is more, much more, to each of the stories, but four threads bind them together. They are the same four threads that bind all of our individual stories. One of the threads is an awareness of our mortality; another is anxiety about the choices that we make. A third is the challenge to build a life with meaning. The last thread is the feeling of loneliness that savages us in moments of crisis, and dogs the path of some most of the time.
If it sounds strange to say that Our World in Data has something to contribute to helping Chris, Margaret, Brian and Ian; that’s because, I guess, I’m a bit strange to see it that way. But I do.
For me, Chris is the most clear cut example. In the course of talking about his low mood, we chanced upon the fact that he had an assignment due at school; it was just another reason for feeling overwhelmed. The assigned topic was peace and conflict in the 20th century, and I mentioned in passing that the world was way more peaceful today than it had been when I was his age. Chris didn’t believe it. Knowing that I was on the winning side of that particular argument, I pointed him in the direction of the War and Peace entry on Our World in Data (OWID). I forgot about it, but Chris didn’t. He used it for his assignment, and it seemed to lift a weight from his mind – the weight of belief that our 21st century world is becoming less and less safe. Climate change was bad enough, but climate plus conflict felt altogether too much. Plus, he received a good mark for the assignment for the first time in the year. Chris wasn’t cured by OWID, but he’s found a useful resource, and he’s realised that there are people who do interesting work on all sorts of subjects that matter to him.
Margaret laughs at herself, but somehow she just can’t shake the anxiety. There are no health statistics that will help her to still the persistent voice in her head that says that, no matter how unlikely, her headache could be a brain tumour, and the pins and needles in her fingers could be multiple sclerosis. Her daughter’s pallor could be the start of leukaemia and her son’s tendency to sleep late could be the onset of chronic fatigue syndrome. No amount of data can guarantee that she won’t be that one in a million who can’t find a place to sit on one of the 999,999 healthy chairs when the music of chance stops. I can’t guarantee it either. But there is one thing that I can tell her: almost 5% of women experience an anxiety disorder at any given time – many more experience one at some point in their lives. For me, that statistic underscores an important truth. Anxiety is not rare, it’s common. And like most common things, it’s there for a reason. The graphs on OWID only go back to the 14th century, but they confirm that the world used to be very, very unsafe. If we could go further back into pre-history, it would thoroughly vindicate Thomas Hobbes’s observation of early life as “nasty, brutish and short”. It used to be a damned good idea to be anxious in a world of conflict and lawlessness – and an even better idea if you happen to be female. What we need in the 21st century are strategies to reassure ourselves that it is, indeed, the 21st century – with its rule of law, its scientific progress and its health care systems.
In a crazy twist, Margaret developed breast cancer last year. She’s come through surgery and chemotherapy very well. And now she’s angry – angry at herself for wasting so much time on health anxiety. When it came to a real health challenge, Margaret was completely admirable – calm, organised and realistic. She found the statistics on OWID reassuring, not frightening, even though breast cancer is right up at the top of the graphs. She knows the number of deaths from breast cancer, worldwide, and she’s grateful for the clear explanations what’s been happening in relation to breast cancer survival and how Australia compares with other countries. Most of all, she is impressed by her own ability to understand and accept the facts, rather than jumping at shadows.
When Ian came along with his own firm diagnosis of incipient dementia, he wasn’t inclined to agree that he might simply be depressed. A perfect score on a mini-mental state examination (MMSE) and some further assessments helped him to come around to the idea. He found it difficult to engage with behaviour change strategies that could help to relieve the depression, and he wasn’t convinced that medication would be helpful either. That’s where OWID came in handy – a graph that clearly showed that antidepressant medication works, and has a role in alleviating the symptoms of some types of depression. So, in a spirit of shared scientific inquiry we agreed to trial medication that might also help him to sleep a little better at night, and sure enough, it did. With the burden of insomnia lifted, it became easier for Ian to focus on making some changes in his thinking and his way of relating to others. He’s also making plans against that day when he might actually have to deal with a significant decline in his cognitive capacity, while he is still capable of doing so.
It may or may not have been a wise move to introduce Linda to OWID, because she has a tendency to do everything and anything with twice the normal speed and enthusiasm. Be that as it may, OWID came up in conversation one day, when Linda challenged some of my observations about the prevalence of bipolar disorder worldwide. We looked at some of the data, and ever since then she’s been treating me to tidbits of information from the site (mostly gleaned at 2am, but the sleep inversion is something we’re working on). She’s also started to make a serious attempt to lose weight and to get moving, with the result that she’s lost 12 kg so far, and if feeling pleased with herself – she’s no longer dreading her niece’s upcoming wedding quite so much, now that she may be able to find something to wear.
It is always intriguing to see how fear can be brought down to size, simply by being met head on. It is a fact that we will all die, that we will all make regrettable decisions and that life sometimes seems to lack meaning and purpose. We know, deep down, that we can never be completely understood by others, no matter how much we may love each other. Nevertheless, ‘scientia potentia est’ – knowledge is power. Even when the statistics are frightening, patients tend to appreciate a fact-based perspective. And there’s another good reason for introducing certain patients to OWID. I like to point them toward the OWID blog because it in turn directs our attention to some amazingly positive statistics. I can’t in good conscience say to a struggling patient “Let’s just be grateful to be living in Australia, to have clean water, good food, shelter and security.” But I can let OWID do that, surreptitiously, on my behalf. After all, it works for me!