#systematic review | Explore Tumblr Posts and Blogs

religion-is-a-mental-illness · 3 days

Text

By: Andy L.

Published: Apr 14, 2024

It has now been just little under a week since the publication of the long anticipated NHS independent review of gender identity services for children and young people, the Cass Review.

The review recommends sweeping changes to child services in the NHS, not least the abandonment of what is known as the “affirmation model” and the associated use of puberty blockers and, later, cross-sex hormones. The evidence base could not support the use of such drastic treatments, and this approach was failing to address the complexities of health problems in such children.

Many trans advocacy groups appear to be cautiously welcoming these recommendations. However, there are many who are not and have quickly tried to condemn the review. Within almost hours, “press releases“, tweets and commentaries tried to rubbish the report and included statements that were simply not true. An angry letter from many “academics”, including Andrew Wakefield, has been published. These myths have been subsequently spreading like wildfire.

Here I wish to tackle some of those myths and misrepresentations.

Myth 1: 98% of all studies in this area were ignored

Fact

A comprehensive search was performed for all studies addressing the clinical questions under investigation, and over 100 were discovered. All these studies were evaluated for their quality and risk of bias. Only 2% of the studies met the criteria for the highest quality rating, but all high and medium quality (50%+) studies were further analysed to synthesise overall conclusions.

Explanation

The Cass Review aimed to base its recommendations on the comprehensive body of evidence available. While individual studies may demonstrate positive outcomes for the use of puberty blockers and cross-sex hormones in children, the quality of these studies may vary. Therefore, the review sought to assess not only the findings of each study but also the reliability of those findings.

Studies exhibit variability in quality. Quality impacts the reliability of any conclusions that can be drawn. Some may have small sample sizes, while others may involve cohorts that differ from the target patient population. For instance, if a study primarily involves men in their 30s, their experiences may differ significantly from those of teenage girls, who constitute the a primary patient group of interest. Numerous factors can contribute to poor study quality.

Bias is also a big factor. Many people view claims of a biased study as meaning the researchers had ideological or predetermined goals and so might misrepresent their work. That may be true. But that is not what bias means when we evaluate medical trials.

In this case we are interested in statistical bias. This is where the numbers can mislead us in some way. For example, if your study started with lots of patients but many dropped out then statistical bias may creep in as your drop-outs might be the ones with the worst experiences. Your study patients are not on average like all the possible patients.

If then we want to look at a lot papers to find out if a treatment works, we want to be sure that we pay much more attention to those papers that look like they may have less risk of bias or quality issues. The poor quality papers may have positive results that are due to poor study design or execution and not because the treatment works.

The Cass Review team commissioned researchers at York University to search for all relevant papers on childhood use of puberty blockers and cross-sex hormones for treating “gender dysphoria”. The researchers then graded each paper by established methods to determine quality, and then disregarded all low quality papers to help ensure they did not mislead.

The Review states,

The systematic review on interventions to suppress puberty (Taylor et al: Puberty suppression) provides an update to the NICE review (2020a). It identified 50 studies looking at different aspects of gender-related, psychosocial, physiological and cognitive outcomes of puberty suppression. Quality was assessed on a standardised scale. There was one high quality study, 25 moderate quality studies and 24 low quality studies. The low quality studies were excluded from the synthesis of results.

As can be seen, the conclusions that were based on the synthesis of studies only rejected 24 out of 50 studies – less than half. The myth has arisen that the synthesis only included the one high quality study. That is simply untrue.

There were two such literature reviews: the other was for cross-sex hormones. This study found 19 out of 53 studies were low quality and so were not used in synthesis. Only one study was classed as high quality – the rest medium quality and so were used in the analysis.

12 cohort, 9 cross-sectional and 32 pre–post studies were included (n=53). One cohort study was high-quality. Other studies were moderate (n=33) and low-quality (n=19). Synthesis of high and moderate-quality studies showed consistent evidence demonstrating induction of puberty, although with varying feminising/masculinising effects. There was limited evidence regarding gender dysphoria, body satisfaction, psychosocial and cognitive outcomes, and fertility.

Again, it is myth that 98% of studies were discarded. The truth is that over a hundred studies were read and appraised. About half of them were graded to be of too poor quality to reliably include in a synthesis of all the evidence. if you include low quality evidence, your over-all conclusions can be at risk from results that are very unreliable. As they say – GIGO – Garbage In Garbage Out.

Nonetheless, despite analysing the higher quality studies, there was no clear evidence that emerged that puberty blockers and cross-sex hormones were safe and effective. The BMJ editorial summed this up perfectly,

One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally.

Myth 2: Cass recommended no Trans Healthcare for Under 25s

Fact

The Cass Review does not contain any recommendation or suggestion advocating for the withholding of transgender healthcare until the age of 25, nor does it propose a prohibition on individuals transitioning.

Explanation

This myth appears to be a misreading of one of the recommendations.

The Cass Review expressed concerns regarding the necessity for children to transition to adult service provision at the age of 18, a critical phase in their development and potential treatment. Children were deemed particularly vulnerable during this period, facing potential discontinuity of care as they transitioned to other clinics and care providers. Furthermore, the transition made follow-up of patients more challenging.

Cass then says,

Taking account of all the above issues, a follow-through service continuing up to age 25 would remove the need for transition at this vulnerable time and benefit both this younger population and the adult population. This will have the added benefit in the longer-term of also increasing the capacity of adult provision across the country as more gender services are established.

Cass want to set up continuity of service provision by ensure they remain within the same clinical setting and with the same care providers until they are 25. This says nothing about withdrawing any form of treatment that may be appropriate in the adult care pathway. Cass is explicit in saying her report is making no recommendations as to what that care should look like for over 18s.

It looks the myth has arisen from a bizarre misreading of the phrase “remove the need for transition”. Activists appear to think this means that there should be no “gender transition” whereas it is obvious this is referring to “care transition”.

Myth 3: Cass is demanding only Double Blind Randomised Controlled Trials be used as evidence in “Trans Healthcare”

Fact

While it is acknowledged that conducting double-blind randomized controlled trials (DBRCT) for puberty blockers in children would present significant ethical and practical challenges, the Cass Review does not advocate solely for the use of DBRCT trials in making treatment recommendations, nor does it mandate that future trials adhere strictly to such protocols. Rather, the review extensively discusses the necessity for appropriate trial designs that are both ethical and practical, emphasizing the importance of maintaining high methodological quality.

Explanation

Cass goes into great detail explaining the nature of clinical evidence and how that can vary in quality depending on the trial design and how it is implemented and analysed. She sets out why Double Blind Randomised Controlled Trials are the ‘gold standard’ as they minimise the risks of confounding factors misleading you and helping to understand cause and effect, for example. (See Explanatory Box 1 in the Report).

Doctors rely on evidence to guide treatment decisions, which can be discussed with patients to facilitate informed choices considering the known benefits and risks of proposed treatments.

Evidence can range from a doctor’s personal experience to more formal sources. For instance, a doctor may draw on their own extensive experience treating patients, known as ‘Expert Opinion.’ While valuable, this method isn’t foolproof, as historical inaccuracies in medical beliefs have shown.

Consulting other doctors’ experiences, especially if documented in published case reports, can offer additional insight. However, these reports have limitations, such as their inability to establish causality between treatment and outcome. For example, if a patient with a bad back improves after swimming, it’s uncertain whether swimming directly caused the improvement or if the back would have healed naturally.

Further up the hierarchy of clinical evidence are papers that examine cohorts of patients, typically involving multiple case studies with statistical analysis. While offering better evidence, they still have potential biases and limitations.

This illustrates the ‘pyramid of clinical evidence,’ which categorises different types of evidence based on their quality and reliability in informing treatment decisions

The above diagram is published in the Cass Review as part of Explanatory Box 1.

We can see from the report and papers that Cass did not insist that only randomised controlled trials were used to assess the evidence. The York team that conducted the analyses chose a method to asses the quality of studies called the Newcastle Ottawa Scale. This is a method best suited for non RCT trials. Cass has selected an assessment method best suited for the nature of the available evidence rather than taken a dogmatic approach on the need for DBRCTs. The results of this method were discussed about countering Myth 1.

Explainer on the Newcastle Ottawa Scale

The Newcastle-Ottawa Scale (NOS) is a tool designed to assess the quality of non-randomized studies, particularly observational studies such as cohort and case-control studies. It provides a structured method for evaluating the risk of bias in these types of studies and has become widely used in systematic reviews and meta-analyses.

The NOS consists of a set of criteria grouped into three main categories: selection of study groups, comparability of groups, and ascertainment of either the exposure or outcome of interest. Each category contains several items, and each item is scored based on predefined criteria. The total score indicates the overall quality of the study, with higher scores indicating lower risk of bias.

This scale is best applied when conducting systematic reviews or meta-analyses that include non-randomized studies. By using the NOS, researchers can objectively assess the quality of each study included in their review, allowing them to weigh the evidence appropriately and draw more reliable conclusions.

One of the strengths of the NOS is its flexibility and simplicity. It provides a standardized framework for evaluating study quality, yet it can be adapted to different study designs and research questions. Additionally, the NOS emphasizes key methodological aspects that are crucial for reducing bias in observational studies, such as appropriate selection of study participants and controlling for confounding factors.

Another advantage of the NOS is its widespread use and acceptance in the research community. Many systematic reviews and meta-analyses rely on the NOS to assess the quality of included studies, making it easier for researchers to compare and interpret findings across different studies.

As for future studies, Cass makes no demand only DBRCTs are conducted. What is highlighted is at the very least that service providers build a research capacity to fill in the evidence gaps.

The national infrastructure should be put in place to manage data collection and audit and this should be used to drive continuous quality improvement and research in an active learning environment.

Myth 4: There were less than 10 detransitioners out of 3499 patients in the Cass study.

Fact

Cass was unable to determine the detransition rate. Although the GIDS audit study recorded fewer than 10 detransitioners, clinics declined to provide information to the review that would have enabled linking a child’s treatment to their adult outcome. The low recorded rates must be due in part to insufficient data availability.

Explanation

Cass says, “The percentage of people treated with hormones who subsequently detransition remains unknown due to the lack of long-term follow-up studies, although there is suggestion that numbers are increasing.”

The reported number are going to be low for a number of reasons, as Cass describes:

Estimates of the percentage of individuals who embark on a medical pathway and subsequently have regrets or detransition are hard to determine from GDC clinic data alone. There are several reasons for this:

Damningly, Cass describes the attempt by the review to establish “data linkage’ between records at the childhood gender clinics and adult services to look at longer term detransition and the clinics refused to cooperate with the Independent Review. The report notes the “…attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services”.

We know from other analyses of the data on detransitioning that the quality of data is exceptionally poor and the actual rates of detransition and regret are unknown. This is especially worrying when older data, such as reported in WPATH 7, suggest natural rates of decrease in dysphoria without treatment are very high.

Gender dysphoria during childhood does not inevitably continue into adulthood. Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6–23% of children.

This suggests that active affirmative treatment may be locking in a trans identity into the majority of children who would otherwise desist with trans ideation and live unmedicated lives.

I shall add more myths as they become spread.

It's not so much "myths and misconceptions" as deliberate misinformation. Genderists are scrambling to prop up their faith-based beliefs the same way homeopaths do. Both are fraudulent.

#Andy L.#Cass Review #Cass Report #Dr. Hilary Cass #Hilary Cass #misinformation #myths #misconceptions #detrans #detransition #gender affirming healthcare #gender affirming care #gender affirmation #affirmation model #medical corruption #medical malpractice #medical scandal #systematic review #religion is a mental illness

152 notes · View notes

rehobothacademicservices · 29 days

Text

Rehoboth Academic Services based out of Bengaluru, India is the World's # 1 Dependable Thesis consultation experts since 2013. Founded by Dr. Ganasoundari, a renowned thesis expert, Systematic Review, Meta analysis and statistician she mentors 1000s of research scholars in accomplishing their PhD and Masters dream. email: mailto:[email protected] Mobile: + 91 9731988227 Website: https://www.thesiswritingsupport.com

#systematic review #meta analysis #phd #data analysis #writing #phd research #researchers #thesis #statistics #phd support #workshop #masters #phd help #phd thesis writing service

1 note · View note

investmentorsec · 5 months

Text

Should You Invest In SIP?

Over the past five years, the stock market has witnessed an unprecedented surge in investor participation, with the majority favoring mutual funds as their investment vehicle of choice. Within this realm, the Systematic Investment Plan (SIP) has emerged as a game-changing strategy, captivating investors with its disciplined approach and promising returns. Let’s unravel the secrets behind SIP and understand why it stands out as the most effective way to navigate the dynamic landscape of mutual fund investing.

Why SIP? A Gateway to Financial Discipline:

One of the most significant challenges individuals face is saving money consistently. SIP tackles this issue head-on by instilling financial discipline through regular, automated investments. By committing to investing at regular intervals each month, SIP ensures that saving becomes a priority before discretionary spending.

Start Small, Dream Big:

One of the remarkable features of SIP is its accessibility. With an entry point as low as INR 500 per month, even individuals with modest earnings or limited savings can participate in the growth of the Indian stock market. SIP plans across various mutual funds open doors to wealth creation for a diverse range of investors.

Timing Stress? Not with SIP:

Unlike attempting to time the market, a daunting task even for seasoned investors, SIP alleviates the stress associated with market timing. Through the power of averaging, investors benefit whether the market is at its peak or in a downturn. The consistent investment intervals ensure a balanced portfolio over time.

Compounding Magic:

SIP harnesses the magic of compounding by reinvesting monthly returns until maturity. This compounding effect leads to exponential growth in your investment over time. The longer you stay invested, the greater the impact of compounding on your wealth.

Flexibility and Freedom:

SIP offers unparalleled flexibility, allowing investors to stop their plans at any point without incurring penalties. This freedom contrasts sharply with traditional investments like Fixed Deposits or Recurring Deposits, providing investors with control over their financial decisions.

Skip a Month, No Worries:

Life is unpredictable, and financial constraints may arise. SIP understands this reality, allowing investors to skip a month without penalties. This feature distinguishes SIP from rigid investment options, offering breathing room during challenging times.

Scaling Up with Extra Income:

As your financial situation evolves, SIP provides a seamless way to scale up your investments. If you find yourself with additional disposable income, starting another SIP plan in different mutual funds diversifies your portfolio and maximizes returns.

Emotion-Free Investing:

Emotions have no place in successful investing. SIP introduces discipline, steering investors away from impulsive decisions driven by market fluctuations. By sticking to a systematic approach, investors shield themselves from short-term volatility and emotional reactions.

Past Performance: A Glimpse into the Future:

The success stories of SIP investors speak volumes. Consider a SIP of ₹3000 per month in HDFC Top 200 initiated in 1999. Over 15 years, a total investment of ₹5.4 lakh burgeoned into almost ₹35 lakh. Similarly, Franklin India Prima Plus, with the same SIP amount, turned ₹5.4 lakh into nearly ₹31 lakh in 15 years. These examples underscore the long-term wealth-building potential of SIP.

Key Takeaways: Mastering the Art of SIP Investing:

1. Discipline is the Key:

- SIP embodies disciplined investing, promoting consistency over time.

2. Diversification through Multiple SIPs:

- Investors can diversify their portfolio by initiating SIPs in two or more funds.

3. Tax Benefits with SIPs:

- Certain SIP investments are eligible for tax deductions under Section 80C of the Income Tax Act, providing an additional financial incentive.

4. Harness the Power of Compounding:

- To fully benefit from compounding, it’s crucial to hold onto investments for an extended period.

5. Start Early, Stay Committed:

- Beginning your SIP journey early is akin to planting the seeds of wealth. Patience is key, and the earlier you start, the more significant your financial harvest.

Conclusion:

In the ever-evolving landscape of financial markets, SIP emerges as a beacon of financial prudence and growth. Its ability to instill discipline, coupled with the flexibility it offers, makes SIP a powerful tool for investors of all levels. As we navigate the complexities of wealth creation, SIP stands as a testament to the idea that consistent, disciplined investing is the cornerstone of financial success. So, embark on your SIP journey, stay committed, and let the power of compounding pave the way for a prosperous financial future.

For more information or To open Trading / Demat Account — Visit our Website 👩‍💻 𝐰𝐰𝐰.𝐢𝐧𝐯𝐞𝐬𝐭𝐦𝐞𝐧𝐭𝐨𝐫𝐨𝐧𝐥𝐢𝐧𝐞.𝐜𝐨𝐦 To talk to our expert team — Call us ☎️ +𝟗𝟏 𝟕𝟗𝟔𝟗𝟏 𝟓𝟑𝟔𝟎𝟎

0 notes

jppres · 1 year

Text

Impact of intervention of community pharmacists on cardiovascular outcomes in Spain: A systematic review

Article published in J. Pharm. Pharmacogn. Res., vol. 10, no. 5, pp. 952-976, September-October 2022. DOI: https://doi.org/10.56499/jppres22.1422_10.5.952 Marjan Manouchehri1,2, María S. Fernández-Alfonso1,2, Marta Gil-Ortega3* 1Instituto Pluridisciplinar, Unidad de Cartografía Cerebral, Universidad Complutense de Madrid, 28040 Madrid, Spain. 2Departamento de Farmacología, Facultad de…

View On WordPress

#cardiovascular interventions #Cochrane risk of bias #Community pharmacy #PRISMA-S #Spanish cohort #systematic review

0 notes

trustedevidence · 1 year

Text

What are Systematic Reviews?

If someone decides to look critically at articles that have appeared in the medical or health literature on a particular topic they are said to be ‘reviewing the literature’. The authors may review, say, all the drug treatments available for one type of heart disease. A review is very clearly defined and sets out to find what evidence there is for prescribing one particular intervention or drug in a specific health condition, often in a certain group of people.

Examples of review topics are: Single dose celecoxib for acute postoperative pain; Artichoke leaf extract for treating hypercholesterolaemia; Chocolate avoidance for preventing migraine; Etidronate for treating and preventing postmenopausal osteoporosis. What is a systematic review?

A systematic review summarises the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions.

The review authors set about their task very methodically following, step by step, an advance plan that covers:

the way existing studies are found;

how the relevant studies are judged in terms of their usefulness in answering the review question;

how the results of the separate studies are brought together to give an overall measure of effectiveness (benefits and harms) – statistical techniques used to combine the results are called meta-analysis.

#cochrane library #cochrane review #science communication #systematic review

0 notes

pubricas · 1 year

Text

Mothers with Mental Health Issues Involved in Child Welfare

Many moms with mental health problems get caught up in the child welfare system and fear having their children taken away from them. This study intended to determine the common mental health difficulties among mothers and their children in child abuse cases initiated for investigation. With numerous potentially confounding variables maintained constant, a strong link was discovered between maternal mental health concerns and child maltreatment investigation outcomes. Support for moms with mental health concerns requires a wide range of multidisciplinary treatments. Effective mental health treatment is important, but it isn't enough. Trauma healing, social relationship building, and poverty alleviation are all important. Systemic advocacy is required to guarantee that women with mental health concerns can access a wide range of services.

Introduction

The mental disease affects people of all ages, jobs, levels of education, socioeconomic status, cultures and Food and Nutraceuticals. Mental illness will touch most people at some time in their lives, whether through a family member, a friend, or a coworker. According to the US Surgeon General's Report on Mental Health, over 20% of the adult population suffers from a diagnosable mental condition each year (US Department of Health and Human Services). Many moms have mental health problems, including but not limited to those with psychiatric diagnoses. These women endure various obstacles that may influence their ability to parent. Many people take other stresses in addition to their condition, such as poverty, social isolation, and a lack of support. Substance misuse and domestic violence can exacerbate the difficulties that these women endure. Despite these difficulties, many of these mothers find enormous joy and pleasure in their roles, citing enhanced self-esteem and favorable effects on their mental health.

Child Welfare Investigation

Child protection authorities are more likely to examine parents with mental health difficulties than parents without mental health concerns. For 4,827 Medicaid-eligible women between the ages of 15 and 45, data from the Medicaid eligibility and claims system in Philadelphia was integrated with data from the child welfare system from 1995 to 2000. Mothers with a mental health diagnosis were nearly three times as likely as mothers without a diagnosis to have engaged with the child welfare system after adjusting for various potentially confounding characteristics such as race and age.

The core data for the Incidence Study of Reported Child Abuse and Neglect was collected. The study had three goals:

(1) to look into the prevalence of mothers with mental health issues in child maltreatment investigations in Canada;

(2) to profile cases involving mothers with mental health issues, including alleged maltreatment type, child, caregiver, and family/household risk factors; and

(3) to look into the outcomes of child protection investigations involving mothers with mental health issues. The investigating medical data collection child protection professional's evaluation and other information available, such as whether the mother had a verified mental health diagnosis and was receiving mental health care, were used to specify maternal mental health concerns. Child factors such as age, sex, aboriginal status, language, and functional impairments (i.e., physical, cognitive, emotional, and behavioral disorders) are predictor variables. Caregivers' risk factors include childhood maltreatment, drug and alcohol abuse, social isolation/lack of social supports, and domestic violence exposure; household socioeconomic characteristics, such as household structure, maternal educational attainment, employment, income, and housing; and child protection concern/s, such as alleged maltreatment type.

Source and Reason for Referral

There was no primary source of referrals to child welfare authorities for children whose mothers had mental health problems. 19 distinct sources, including families, friends/neighbors, doctors, and mental health experts. The 'police' and school were the most prevalent referral sources. The police and the school referred 22.1 and 18.9 % of all referrals to child welfare agencies involving mothers with mental health difficulties. The kid was the source of referral in 1.4 percent of cases. Recommendations were made for a variety of reasons. In 59.8% of instances involving mothers with mental health difficulties, suspected mistreatment was the initial cause for referral. In another 14.8 % of cases, domestic violence was the primary cause for referral.

Child Protection Concerns

Neglect (47 percent) and physical abuse (47 %) were the most prevalent child safety concerns in situations involving moms with mental health disorders (32 %). In instances involving moms with mental health concerns, neglect and emotional mistreatment allegations were substantially more prevalent than in other cases. For example, maternal mental health difficulties tend to raise the likelihood of reported emotional abuse by more than double. On the other hand, physical and sexual abuse allegations were far less prevalent in these situations.

Household Socioeconomic Characteristics

Mothers with mental health disorders were over-represented on all indices of household socioeconomic disadvantage. Almost half of the women with mental health concerns (49%) were single mothers, and nearly half (48%) did not have a high school diploma. More than half of the moms with mental health concerns (63 %) had low earnings (under $24,999), and more than one in five lived in social/public housing or shelters.

Caregiver Risk Factors

Few social supports (64 %), drug and alcohol use (60%), maltreatment as a child (50 %), and marital violence were the most frequent caregiver risk factors in instances involving mothers with mental health concerns, in that order (48 % ). Each of the six caregiver risk variables was more prevalent in situations involving moms with a mental illness.

Child Welfare Investigation

Outcomes 62 % of inquiries involved moms with mental health difficulties, and 44 % of all other instances found maltreatment. After adjusting for claimed maltreatment type, child, caregiver risk, and household socioeconomic variables, maternal mental health difficulties were a significant predictor of substantiation. Only concerns with child functioning and domestic violence were more powerful predictors of substantiation.

This exploratory review showed that nearly one in every five child abuse investigations includes moms diagnosed with mental health concerns. Furthermore, the study shows that these moms and their children have distinct outcomes: mistreatment is more likely to be proven, their children are more likely to be removed, their cases are more likely to be kept open, and they are more likely to file a court application. Consistent with previous research, significant links were found between maternal mental health issues, socioeconomic disadvantage (lower educational attainment, low income, public housing, low employment), and other caregiver risk factors such as exposure to domestic violence and fewer social supports. The differences in results reported in this study were somewhat explained by these various disadvantages, but not entirely: The adjusted odds ratios are significantly higher.

Conclusion

Overall, the conclusions of this study indicate that mothers with mental health disorders are involved in a significant minority of all child maltreatment instances investigated in Canada. Furthermore, the research reveals that these moms are virtually always confronted with a slew of environmental and personal issues, which may exacerbate the difficulty they already encounter in living with their disease while balancing their parental responsibilities. The demands of these moms are frequently distinct from those of other mothers, and many of these requirements result from environmental, societal, and personal circumstances that are typically exclusive to this group of women. Early intervention is critical, and it should focus on assisting these women in effectively managing their illnesses and symptoms and giving them the tools needed to ease their suffering.

References

Black, T., Trocme´, N., Fallon, B., & MacLaurin, B. (2008). The Canadian child welfare system response to exposure to domestic violence investigations. Child Abuse and Neglect, 32, 393–404.

Brunt, C. C. (2004). Parental psychiatric disorder and the law: The American case. In M. G}opfert, J. Webster, & M. V. Seeman (Eds.), Parental psychiatric disorder: Distressed parents and their families (pp. 257–270). Cambridge: Cambridge University Press.

Diaz-Caneja, A., & Johnson, S. (2004). The views and experiences of severely mentally ill mothers. Social Psychiatry and Psychiatric Epidemiology, 39, 472–482.

Westad, Callie, and David McConnell. "Child welfare involvement of mothers with mental health issues." Community mental health journal 48.1 (2012): 29-37.

#Medical Data Collection #meta analysis #systematic review #case report #literature review #publication support

0 notes

smiqgen · 2 years

Photo

Systematic review services:A systematic literature review requires a comprehensive analysis of the published and unpublished scientific literature about the research questions in context. The systematic review helps in determining the evidence-based treatment interventions. See more:https://bit.ly/3aIpW1o

#systematic review #journalpaper #smiqgen #researchpaper

0 notes

ashhh-14 · 2 years

Text

Reblogs

Posts I've reblogged from other people's blogs whether they be requested by me or something I like or relate to. This is both to line up my blog in order and to give fellow writers the credit they so rightfully deserve ʕ　˵·ᴥ·ʔ

Fan fiction 1

Fan fiction 2

Fan fiction 3

Fan fiction 4

Quiz 1

Quiz 2

Quiz 3

Picrew 1

Picrew 2

Event 1

Match up 1

Match up 2

Match up 3

Match up 4

Match up 5

Match up 6

Match up 7

Match up 8

Random 1

Random 2

Random 3

Random 4

Random 5

Random 6

Random 7

Random 8

Random 9

Random 10

Random 11

Random 12

Random 13

1 note · View note

libraryben · 8 months

Text

youtube

Is Your Evidence Really Based? Behaviourist Capture, Autistic Self-Advocacy, and Librarianship

In the history of science and medicine there are numerous examples of how the “best available evidence” promoted by professional societies was profoundly, destructively wrong. This can be seen in the widespread support of scientific racism and eugenics as well as the pathologization of “sexual inversion” and gender variance. When, as librarians, we talk about the nature of authority and hold up peer review as an example of a methodological gold standard in academic and medical research, we must always ask ourselves: whose peers are we talking about? For that matter, whose interests are we talking about? It is becoming increasingly evident even to those outside the autistic community that despite claims of being grounded in evidence-based practices, most studies on the effectiveness of Applied Behavioral Analysis (ABA) are poorly designed, do not disclose conflicts of interest, display a strategic disregard of the harmful outcomes of interventions, and do not reflect the interests of the majority of autistic people. At best, ABA is expensive, intensive, and ineffective at improving life outcomes. At worst, it is actively traumatic and makes us more susceptible to further victimization.

This discussion will examine recent challenges to the evidence-based nature of ABA and how ABA practitioners have historically taken advantage of the internalist nature of the peer-review system. These challenges reinforce what autistic activists have been saying for over twenty years and have consequences for how librarians deliver information literacy instruction. Information literacy and librarianship are not neutral activities and must include a place for own voice narratives, patient, and survivor accounts if we are to avoid perpetuating harmful industry standards with a shrug and a gesture to how “well, everyone’s doing it.”

#Evidence Based #Autism #Libraries #Systematic Reviews #Evidence Based Medicine #Youtube #Library Ben

7 notes · View notes

khlur · 8 months

Text

i got somewhere w my fucking literature review

#can i power thru a whole entire thesis from start to finish in a month??? watch this space #watch me abstract screen 7k papers in 3 days <3 #i think i will give myself a week to code the qual papers i find and then run a thematic analysis #the most straightforward shit i can do to get me a good mark in this overwhelmingly positivist public health uni #idk what to do for the quant arm tho #ig i'll just have to re read prev systematic reviews #it's rly telling that a lot of published articles on my topic literally focus on only one community #and even then it's so.....laden with an upper caste gaze #and i know a systematic review doesn't help #but i'm hoping that being reflexive abt my own experiences + learning frm the experiences of my tribal family members #+ my grey lit reading #will help me sort of bring something to the discussion session that ISN'T superficial and in the trap of 'noble savage' thinking

5 notes · View notes

religion-is-a-mental-illness · 4 months

Text

By: Bernard Lane

Published: Dec 12, 2023

The gist

Analysis

An Australian health minister, Shannon Fentiman, who is responsible for the busy gender clinic of the Queensland Children’s Hospital, has acknowledged the lack of consensus on how to treat gender dysphoria.

Four words stood out in Ms Fentiman’s otherwise cagey, scripted response to a question in state parliament about the source of the evidence justifying the puberty blockers and cross-sex hormones given to minors by the Brisbane-based clinic.

“Whilst acknowledging that best practices rely on some aspects of transgender health care and there is not consensus [Emphasis added], the work continues,” she said on November 30.

Child and adolescent psychiatrist Dr Jillian Spencer, who has been calling for an independent federal inquiry into the care of gender dysphoric youth, welcomed Ms Fentiman’s concession reflecting the state of medical opinion—a concession not forthcoming from Australia’s other health ministers.

“It is such a relief to have [Queensland’s] health minister finally acknowledge that there is not consensus regarding the best practices for transgender healthcare,” Dr Spencer told GCN.

Dr Spencer is a critic of the “gender-affirming” treatment approach followed by the Queensland gender clinic. Earlier this year she was suspended from clinical duties at the children’s hospital reportedly after a patient lodged a complaint of “transphobia”.

“The minister says that the work of the [clinic] continues despite the lack of consensus on best practice for transgender healthcare,” Dr Spencer said.

“Why is the work of the [clinic] continuing if there is no consensus? Shouldn’t we be more careful than that—especially when the health of children is at stake? Parents want cautious and evidence-based healthcare for their children.

“The children and parents of Queensland deserve to have paediatric gender services that are based on a systematic review of the research evidence similar to what is happening in the UK with the Cass Review.”

She challenged the advice given to Ms Fentiman that the work of the Queensland gender clinic represented “international best practice”.

“[It appears her advisers] have failed to let her know that, internationally, when [countries such as Finland, Sweden and the UK] have conducted independent, systematic reviews of the research literature, they have moved away from an affirmative approach to prioritise psychosocial interventions rather than puberty blockers and cross-sex hormones”.

“A new front in the struggle over transgender issues has opened up. Two [US] medical malpractice lawsuits, each levied by a plaintiff who regrets having undergone medication-based gender-transition treatment—one at age 14—have taken aim at the American medical establishment’s support for prescribing such drugs to minors.”—Journalist Benjamin Ryan, news report, New York Sun, 5 December 2023

---

The detail

Behind the scenes

Minister Fentiman’s remarked on the lack of medical consensus during her short November 30 reply to Robbie Katter MP, whose question was prompted by Ms Fentiman’s earlier reassurance that care at the gender clinic was “of very high quality and based on the best available evidence.”

The minister’s surprising concession to critics of the gender-affirming approach—the approach enforced at the gender clinic—chimes with the reference by Queensland’s chief psychiatrist, Dr John Reilly, to plans for an “independent review” of the clinic.

GCN has sought clarification on both points from the government; there was no reply.

Might Queensland be the first Australian jurisdiction to publicly acknowledge the force of the international debate about medicalised gender change for minors? Have there been frank discussions, even talk of doing something, in Ms Fentiman’s office or among her health and hospital officials?

The main focus now for Queensland’s governing Labor Party is re-election. In power since 2013, the party has shuffled its leadership as it prepares for the state poll scheduled for 26 October 2024.

It appears that Steven Miles, a former health minister, will succeed the long-serving Annastacia Palaszczuk as premier.

Ms Fentiman, a solicitor from the party’s left faction, was briefly in the running. Her narrative was change and renewal, a government with “the maturity to admit where we have fallen short.”

Does anyone think that concerns about gender medicine will have evaporated by next October?

Affirmed by guidelines

Minister Fentiman’s November 30 defence of the gender clinic boiled down to its “adherence to peer-reviewed national and internationally accepted published practice clinical guidelines”.

She cited the latest, 8th edition of standards of care issued last year by the World Professional Association for Transgender Health (WPATH), which she said evinced “a rigorous and evidence-based approach”.

She also invoked the 2017 clinical guideline of the Endocrine Society, offering to get a copy for Mr Katter, who represents a minor party in the parliament.

And she cited a third document, the 2018 “Australian standards of care” issued by the Royal Children’s Hospital Melbourne.

Back in September, Ms Fentiman had said the gender medicine practised by the Queensland clinic was “an emerging field globally—no-one shies away from that—but the evidence base is sound.”

In fact, the evidence base for medicalised gender change for minors is very weak and uncertain, according to five independent systematic reviews since 2019 in Finland, Sweden, the United Kingdom (one review each for puberty blockers and cross-sex hormones) and the American state of Florida.

The founder of the Queensland gender clinic, Dr Stephen Stathis, recently conceded the complaint of sceptics that the evidence base for gender-affirming treatment is of low quality, although he argued this was not unusual in the field of child and adolescent psychiatry.

Lack of solid evidence has led gender-affirming clinicians and activists to rely heavily on treatment guidelines and position statements from medical organisations when claiming that puberty blockers, cross-sex hormones and surgery are “settled science”.

But systematic reviews are regarded as the highest form of evidence, while treatment guidelines and position statements—representing expert opinion or professional consensus—are the lowest.

And it’s arguable that gender-affirming treatment guidelines do not even reflect expert consensus, as Ms Fentiman’s arresting remark suggests.

The extent of health professional dissent from the gender-affirming model is masked because it is well known that critics will be smeared as “transphobic”, subjected to bad-faith complaints and have their careers put at risk.

If in truth there is no consensus, the treatment guidelines cited by Ms Fentiman are misleading and cannot justify the risky medical interventions given by the gender clinic.

It’s unclear how this contradiction in the minister’s November 30 statement arose. Does it reflect a confused briefing from her advisers and officials, or a belated awareness that gender-affirming medicine is hardly settled science?

Reviewphobia

In any case, the problem for Ms Fentiman is that her faith in those three treatment guidelines is misplaced.

The “rigorous” WPATH guideline process involved a chaotic last-minute abandonment of minimum ages for most hormonal and surgical interventions; the rationale appears to be to give clinicians better protection against malpractice suits.

Credible guidelines draw on a systematic review of the evidence. WPATH’s new chapter on adolescents—the group that is the focus of international concern—involved no such review. WPATH pleaded the scarcity of studies on early medical intervention.

And yet early medical intervention is what the guideline recommends. Perhaps WPATH was worried about the predictable output of a systematic review, not the meagre input.

Scarcity of studies did not prevent Sweden’s systematic review of the evidence. Its literature search began with almost 10,000 research abstracts and identified just 24 relevant studies for evaluation.

One of the experts involved, Professor Mikael Landén of the Karolinska Institute said—

“Against the background of almost non-existent long-term data, we conclude that [puberty blocker] treatment in children with gender dysphoria should be considered experimental treatment rather than standard procedure. This is to say that treatment should only be administered in the context of a clinical trial under informed consent.”

The gender clinic that Ms Fentiman celebrates for its “life-changing care” gives puberty blockers as routine treatment. And remember, Queensland’s parliament has been assured by the minister that “the evidence base is sound”.

A matter of trust

Ms Fentiman also cited the 2018 “Australian standards of care” from the Royal Children’s Hospital Melbourne (RCH), noting its publication as a position statement in the Medical Journal of Australia (MJA).

But that cut-down version of the guideline, shielded by the journal’s pay wall, contains an admission not found in the full guideline which is the document that is readily available on the hospital website and relied on by youth gender clinics across Australia.

The MJA version says: “The scarcity of high-quality published evidence on the topic prohibited the assessment of level (and quality) of evidence for these recommendations.”

Earlier this year, GCN put this claim to Professor Gordon Guyatt, a pioneer of evidence-based medicine and the GRADE system for rating evidence quality.

“[That claim] is enough for me to say this is not a trustworthy guideline”, Professor Guyatt said.

The RCH guideline was considered for inclusion in the National Health and Medical Research Council’s online portal Australian Clinical Practice Guidelines but did not qualify.

“At the screening stage it was determined that the guideline did not include a funding statement, an evidence base for the recommendations or information about conflict of interest, and that it would not meet the portal selection criteria, so a full assessment was not carried out,” a spokeswoman for the NHMRC said in 2021.

[ Screenshot: Advice from the 2018 RCH “Australian standards of care” document ]

Divided opinion

Also in 2021, the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which had previously endorsed the RCH guideline, issued a new more cautious policy on gender dysphoria.

Its policy says that “evidence and professional opinion is divided as to whether an affirmative approach should be taken in relation to treatment of transgender children or whether other approaches are more appropriate.” (Note: After posting this article, I was alerted to an update of the RANZCP’s gender dysphoria policy, which I will report elsewhere.)

In its recently updated guide, the National Association of Practising Psychiatrists says “there is no consensus that medical treatments such as the use of puberty-blocking drugs, cross-sex hormones or sexual reassignment surgery lead to better future psycho-social adjustment.”

No consensus, but the Queensland Children’s Hospital requires health professions to follow the gender-affirming model rather than allowing a neutral therapeutic approach.

We know this because psychiatrist Dr Spencer has raised concerns—initially within the hospital, then publicly—about the potential harm done to minors by unthinking “affirmation”. She even wrote to the minister about this.

“I started testosterone five years ago today. After 4+ years of weekly injections to maintain such dangerously high hormone levels, I had elevated liver enzymes, heightened red blood cell counts, and regular heart palpitations. I am so grateful I stopped when I did.”—American detransitioner Morgan, tweet, 4 December 2023

Low-quality advice

Ms Fentiman’s third guideline, from the Endocrine Society, has an important feature that her advisers appear to have overlooked.

Unlike the RCH document, the 2017 Endocrine Society guideline did rate the quality of evidence supporting their treatment recommendations.

Five of the society’s six recommendations on puberty blockers depend on evidence rated as “low quality”.

The sixth recommendation—for administering blockers in early puberty, as is done at Queensland’s gender clinic—rests on “very low-quality” evidence, the lowest possible rating. Awkward but important details, rarely mentioned.

Also unmentioned is the society’s careful disclaimer that its “guidelines cannot guarantee any specific outcome, nor do they establish a standard of care.” Not helpful for those demanding a monopoly for gender-affirming care.

In July this year, the society’s president, Dr Stephen R Hammes, made the claim that, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.”

This, he said in a letter to The Wall Street Journal, was the evidence used by the society in its “rigorous process” to develop the 2017 treatment guideline.

He provoked a dramatic and humiliating response—a letter of sharp dissent signed by 21 clinicians and researchers from nine countries involved in the care of teenagers with gender distress.

Among them was Finland’s reformist pioneer of gender medicine, Professor Riittakerttu Kaltiala, whistleblower clinicians from England’s Tavistock clinic Dr Anna Hutchinson and Dr Anastassis Spiliadis, and Belgian expert on evidence-based medicine Dr Patrik Vankrunkelsven.

All systematic reviews to date, the letter’s authors pointed out, had “found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty.”

“Dr Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, ‘We could not draw any conclusions about death by suicide.’ There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.

“The politicization of transgender healthcare in the US is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.”

So, is Minister Fentiman confident that she had been given an apolitical and accurate summary of the benefits and risks of treatment at Queensland’s gender clinic?

“Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth. Proponents claim that these treatments are well supported, while critics claim the poor-quality evidence base warrants extreme caution. Psychotherapy is one of the only available alternatives to the gender-affirming approach. Discussion of the treatment of gender dysphoria in young people is generally framed in terms of two binary approaches: affirmation or conversion. Psychotherapy/exploratory therapy offers a treatment option that lies outside this binary, although it is mistakenly conflated with conversion therapies.”—Psychiatrist Dr Roberto D’Angelo, article, Journal of Medical Ethics, 2023

Just the one

Also, in the spirit of governments owning up to mistakes, Ms Fentiman might revisit something she said about Dr Spencer.

On September 14, Mr Katter raised the issue of the compulsion for doctors to use the gender-affirming model with dysphoric children, and asked, “Will the minister intervene to restore the ability of doctors—including Dr Jillian Spencer, who has been stood down—to use their professional medical discretion when treating gender dysphoric children?”

Ms Fentiman replied—

“I understand there have been a number of complaints made by patients in relation to Dr Spencer. These complaints are subject to a number of HR processes within Children’s Health [which runs the hospital] as well as referrals to [the health professions regulator] Ahpra and the Health Ombudsman.”

A possible implication of Ms Fentiman’s comment is that Dr Spencer had engaged in a pattern of conduct attracting multiple complaints from patients.

Last month, thanks to a right of reply mechanism, a correction from Dr Spencer was placed on the parliamentary record—

“The minister’s statement suggests that I am the subject of a number of patient complaints. That is incorrect. There is only one patient complaint lodged against me.”

“After being expelled from my master’s degree for speaking out about the impact of gender ideology on child safeguarding, I am extremely pleased to announce that I have agreed a settlement with the UK Council for Psychotherapy. [The council] have published a formal statement protecting therapists who believe in biological reality and stand against irreversible medicalisation of children. They say training institutions should never discriminate against students on this basis.”—UK lawyer turned trainee therapist James Esses, tweet, 11 December 2023

GCN sought comment from Ms Fentiman and RCH

Australia lumbers drunkenly towards figuring out this is all a major medical disaster.

#Bernard Lane #Gender Clinic News #systematic review #gender clinic #queer theory #gender ideology #medical scandal #medical malpractice #medical corruption #gender affirming care #gender affirming healthcare #affirmation model #Shannon Fentiman #no consensus #cross sex hormones #wrong sex hormones #puberty blockers #low quality evidence #religion is a mental illness

10 notes · View notes

bougainvillea-and-saltwater · 10 months

Text

Me: preparing my flowchart for my systematic review, full of hopes and dreams.

Google Scholar, PubMed, and all these similar vicious websites: "We're going to destroy this woman's whole career."

#damn it's the first time i do a systematic review and it's been *unfold the long-ass papyrus*#5000 ARTICLES THERE?#which I have to start screening one by one :)#i think i prefer quantitative research despite the Beloathed Statistics #personal #personal rambles

4 notes · View notes

lilmackiereads · 1 year

Text

Does “The Help” Help? What I learned and review of the book.

In February 2022 when I was sick for a few months due to a chronic illness that led me to lose my job, I decided to pick up The Help (2009) by Kathryn Stockett to pass the time. It had been sitting in my bookshelf for years, unread. I had seen the movie once shortly after it came out in 2011 when I was a teenager, but I couldn’t remember it well. I thought to myself “it’s Black History Month, I should educate myself on what life was like.” Little did I know, two years prior in 2020, many people, mostly privileged white people, thought the same thing. As a white person in their mid 20s from a middle-class urban neighborhood in California, the Black Lives Matter movement was something I felt like I supported but was very distant from because I thought that it didn’t really affect me. Or so I thought at the time. The murders of George Floyd, Breonna Taylor, and many others were all over the news. I only knew bits and pieces of what had happened, and I thought reading up on Black culture through books, movies, and tv shows would make me an ally.

According to these news articles and reviews, The Help (2011) became the most watched film on Netflix during this major point in the BLM movement as an attempt for white people to educate themselves and become allies. I didn’t realize the harm of thinking this way until reading the book and the aforementioned reviews since the story is written by a white author and has a major white savior storyline. In an attempt to not misquote these articles, I encourage you to read them and check out the media they recommend. However, that doesn’t mean I would skip on The Help altogether as a book or film. It is important to be aware of the issues it presents within the story as well as the media coverage of it because by acknowledging these flaws we can get down to the real nitty-gritty. Then, we can use this knowledge to better present stories that are more truthful and central to the true experiences of Black people.

Overall, here is my review of the book as exactly what it is, a book. Stockett made it clear in her acknowledgments that it is a work of fiction, but her intertwining of fact and fiction and basing characters on herself and her maids can be problematic for readers when trying to tell the difference between what was real and what was made up. I recommend whether you read it or not to fact check and be aware that it is a book written in a different time, place, and race that what it entails. This review is filled with spoilers as it is necessary to discuss certain passages in a critical way.

----

As a whole: 3.5 out of 5 stars. See below:

This book took me over a year to read. I finished it in April 2023, fourteen months after I cracked it open. This is very unusual for me as I am a fast reader, but after catching wind of the articles I was ambivalent about continuing the story because I didn’t want to be one of those people who thinks reading this makes me a better person (because it doesn’t).

Let’s start with the basics. I like the cover a lot since it is bright and the three birds are symbolic of Skeeter, Minny, and Aibileen. My favorite type of books are those written in first person since I like how they delve into the person’s stream of consciousness and explore their hopes and troubles. The beginning of the book seemed to drag as it was mainly a description of what Aibileen and Minny do day to day. I believe this was intentional by Stockett to show readers how redundant and tedious a lot of maid’s work was and still is.

I thought the characters were very well developed, however it seemed very obvious that Skeeter was an insert for Stockett. While that was all fine and dandy, it made me concerned as Skeeter’s views toward Black women are a bit wishy washy. Over the story she becomes more “woke,” but never really understands because she leaves for New York after being encouraged to go by Minny and Aibileen. Skeeter does struggle with this decision to leave Mississippi, but it ultimately felt very “Fairy Godmother” to me because she leaves before it gets worse for the black women. I felt the same way when she was gifted a copy of The Help that was signed by all the Black churchgoers as it also felt very white savior-y instead of sweet. I was annoyed when Skeeter considered marrying Stuart and abandoning all the work she had done and being unable to decide if she was advocating for civil rights or not. This systematic racism should have been touched on a bit more because it seems like Skeeter herself (and thus Stockett) doesn’t even understand it. I don’t believe that anyone is born racist, but I think they learn it. Therefore, I think having a chapter from Hilly or Elizabeth’s perspectives would have been helpful to unpack that a little more as they were two of the more racist characters in the story. I loved to hate on Hilly, but I really liked how ditsy and sweet Celia was and how she liked spending time with Minny. I would have liked more content with Lou Anne, who we find out is suicidal and getting sent away for shock treatment. She was one of the few characters who was making her way out of Hilly’s web and seemed to be more inclined to treating her maid as a person instead of scum. I felt up and down about Skeeter’s and Hilly’s mothers. They could be really funny, but also very cold-hearted and stuck in their ways. Skeeter’s mother’s most important moment to me was when she talked about Constantine’s firing and untimely death. This was the most eye-opening moment for Skeeter and should have been a bit more in-depth since it made her face her mother’s flaws.

I really enjoyed the humor and wit of both Aibileen and Minny and liked reading their chapters. I was constantly nervous that they would be caught and punished. Aibileen losing her son and having to say good-bye to Mae Mobley nearly brought me to tears. Meanwhile, Minny’s sharp remarks and specialty pie had me giggling. The contrast between Aibileen and Minny were well done, and I loved seeing Minny’s sympathetic side toward Ms. Celia. The moments with the stillborn in the bathroom and the naked man outside of the house were terrifying. I felt relieved when Minny finally left Leroy and wished she had done it earlier, but at least she and her children got away in the end. It was frustrating that Aibileen only got her writing job because of Skeeter. I would have liked for Aibileen to have not been viewed as a victim so much. Also, I like to think that Aibileen was right about Mae Mobley being an old soul who is going to grow up to be independent and strong and ready to fight. I like to think that she grows up to be a feminist and is out there fighting for civil rights and love. It would make sense for the timeline since she would be in her teens/ 20s throughout the majority of Second Wave Feminism (mid 1960s to 1980s) and the end of the Vietnam War (1955s to 1975) since The Help takes place from 1962 to 1964.

My five favorite parts, in no specific order, are as follows:

*Minny’s Terrible Awful

*The Jackson Junior League Annual Holiday Ball where Celia is getting all the attention in her va-va-voom gown and tears Hilly’s dress and then writing a check to Two-Slice Hilly.

*At that same event when Hilly’s mom bids on Minny’s pie as a joke.

*When Skeeter swaps the charity “coat” drive for a “commode” drive and Hilly’s yard is RUINED.

*When Aibileen tells Mae Mobley about the “Green Martian” Martin Luther King Jr. I think it is a creative way to talk about racism and belonging without being too complicated for a toddler to understand.

Something I would have liked Stockett to touch on a lot more were the imprisonment, murder, and abuse that many Black people faced (and still face) in a more moving way. Many of the Black characters in this story experience at least one of the three, but Stockett always seems to be glossing over how truly dangerous and corrupt societal racism is. For instance, one of the maids, Yule Mae, ends up in prison for stealing an unwanted and forgotten piece of jewelry from Hilly so she can support both her son’s college tuitions. Sending her character to jail keeps her out of the reader’s mind until she is brought up into the storyline again. Yule Mae being easily forgotten shows that this part of the story is not distressing readers enough to critically think about it and make a change even though Black incarceration rates are very high across the United States to this day. Both the murder of Medgar Evers and Martin Luther King Jr’s peaceful protest “March on Washington [D.C.] for Jobs and Freedom” are two very important moments in Black History and I wish she had spent more time discussing how huge turning points they were in American History.

Even though his writing is very different, Cormac McCarthy is a master of Southern Gothic. I think if this novel was written by him, that it would have been much more raw and honest as he was unafraid to get down to the true horrors this world has to possess. (See Outer Dark (1968) where he writes about incest and child murder, No Country for Old Men (2005) with more murder and torture, or The Road (2006) which features cannibalism and kidnapping.) Of course, regardless of whether Stockett or McCarthy wrote this book, it still would have the lens of a white author on it. What readers really need to do is choose more stories that are by Black creators that feature Black stories. A good list is mentioned in the articles linked above.

Overall, I enjoyed reading the story and appreciated how it began with Aibileen and Mae Mobley and ended with them as well, even though it was to part ways. The full circle technique demonstrated a lot of growth, but at the same time showed that both groups have a long road ahead. I would read it again and recommend reading it as long as you read articles on why it is problematic. On that same note, having a discussion about the story with people from lots of backgrounds such as different races, ethnicities, genders, sexes, and nationalities would get lots of fresh perspectives on it. By continuing to dissect and discuss stories such as The Help, we light the way of change by working together.

#the help #the help book #kathryn stockett #book review #critical thinking #systematic racism #black voices #white savior

5 notes · View notes