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Depression and recovery, one year on

A green journal with a pen on top of it sitting next to a cup of tea on a wooden table

Morning journaling

Almost a year after my earlier post about my experience of depression in grad school, I wanted to discuss some of what I’ve learned about recovering from depression.  I expected that recovery would be nonlinear, with good days and bad, and that’s been accurate.  I also expected that at some point, I would pass an obvious milestone labeled “fully recovered,” and would go on feeling happy and engaged with the world without needing to consciously work towards that goal.  This doesn’t actually seem to be the way that recovery functions.  I’ve come to find that preventing relapses of depressive symptoms requires consistent and active work on my part, and I suspect that it always will.  I wanted to share this in case it might be useful for anyone else in a similar position.

The Half-Life of Depression

One thing that really surprised me during the earlier stages of my recovery was that even after I’d dealt with some of the underlying problems which were leaving me depressed, I would still have days when I felt inexplicably sad or unable to focus.  I suppose I’d assumed that I would bounce right back to my usual self once my stress levels had gone down.  However, I’ve noticed three ways in which the effects of depression can persist beyond an immediately stressful situation.

First, untreated depression changes your brain.  In the short run, it shrinks the hippocampus and makes it more difficult to form new memories, although these effects appear to be reversible once the depression improves.  In the long run, it increases inflammation in various parts of the brain, including the prefrontal cortex, which helps to govern executive function and reasoning skills.  I’ve found that while I can still produce high quality work, I can’t maintain intensive focus for quite as long, and I need to take breaks more consistently.

Second, depression can lead to shifts in your habits which require some effort to undo.  At my worst, I was ignoring my email, letting all the dishes go unwashed for days, and so forth because I couldn’t get out of bed.  I’ve had to consciously work to re-develop all my previous good habits of time management and organization.  This has also led to some interesting new challenges.  For example, if I’m consistently washing the dishes and keeping on top of my email, this helps me to focus on my other work.  If I let the dishes pile up a bit, however, I’ve found that this sets off an anxiety klaxon in my brain saying “Look at this mess!  You’re getting depressed again!  You’ll never recover!”  Over time I’ve learned to acknowledge that klaxon and then think about all the ways that I am recovering, rather panicking over it, but that was another totally new habit to develop.

Third, the process of recovering from depression might also bring up other mental health challenges that you hadn’t previously dealt with.  For me, a big part of my recovery was journaling about my emotions, and trying to figure out why I was feeling sad or stressed rather than just ignoring those feelings.  In the process, I realized that I’ve probably had a mild-to-moderate anxiety disorder for most of my life.  It’s ultimately been good to address this more openly, but at the time it felt like a big setback as I tried to reach my goal of Being Mentally Healthy, and led to a relapse of depressive symptoms for a while.  (As it turns out, most of the steps for dealing with depression also work on anxiety, at least for me.)

Rethinking Recovery and Productivity

The other thing that’s struck me about recovery is how much more sensitive my moods are to my general level of self-care.  If I’m getting enough sleep, exercise, and time to journal, then I can bounce back from stressful events pretty quickly.  If I’m not, stressful events can quickly lead me to feel depressed again.  I’ve come to think about self-care not as something indulgent, but as a process of investing in resilience.

This has required some fundamental shifts in how I think about my productivity.  There are strong narratives within American academia and American culture more broadly about how productivity can only be achieved at the expense of one’s physical and emotional health.  When I was younger, before my period of severe depression, I absolutely lived into this.  I was regularly overcommitting myself at school and at work, and skipping sleep and social events so that I could finish my projects.

In some ways, that mindset has been the biggest reason why I don’t think I’ll ever arrive at “fully recovered” — because my idea of what being fully recovered looks like is actually an unhealthy one.  I’ve held on to the perception that “recovery” means being able to work extremely long hours without ever having to take care of myself, and without suffering ill effects.  Uprooting this deeply held belief is still a work in progress for me.  In particular, I’ve had to really work to not compare my current rate of productivity to the unsustainably high rates I could produce in my teens and twenties.

One thing I’ve found helpful here is trying to focus more on process than on outputs.  If I get too focused on how soon I’m going to finish a report or an article, I end up falling back into unsustainable habits, like working late or skipping the gym.  I can do this for a few days, but I’ve found that I inevitably crash after that, and will then lose the next few days to another wave of depressive symptoms.  Conversely, when I prioritize meeting my standards for self-care, this leaves me feeling rested and focused for the rest of the day.  I’m trying to remind myself that working consistently is more sustainable in the long run than working intensely, if the latter pattern forces me to alternate between working intensely and not working at all.

Self-Care Suggestions

Here are the aspects of self-care which I’ve found most helpful during my recovery.  Everyone’s experience is different, and I don’t mean to claim that this is the royal road to mental health — simply things that have worked for me.  Also, I’ll note that I haven’t to deal with very inflexible work or caregiving responsibilities, which would definitely have made this more challenging.

  • Getting enough sleep.  I cut down on caffeine and stopped using an alarm clock if I didn’t have any early meetings, both of which help me to get the amount of sleep my body actually needs.  (The tea in the photo is caffeine free!)
  • Regular exercise.  Doing some moderate cardio every other day helps me to feel much more focused.  Being outside for a workout also seems to help, although if I’m working out indoors I’ll try to spend a bit of time outside at another point during the day.
  • Journaling.  If I wake up with something on my mind, I’ll write about it right away, so that I’m not worrying about it for the rest of the day.  I try to use the journal for immediate problem solving during the week (like “how should I handle this challenging conversation I’ve got coming up?”), and take time to write about bigger issues on the weekends.
  • Solving small problems right away.  If I notice a small issue that I need to resolve, I try to handle it promptly, so it’s not distracting me.  This seems trivial, but I’ve found that I otherwise get stuck in a cycle of being distracted, then blaming myself for being distracted about something small, then being even more distracted.  Something about the experience with depression means that I have a hard time snapping out of these cycles if I get into them, so I try to just avoid them.
  • No mind-reading.  Lots of people hesitate to bring up difficult topics with their partners or colleagues.  When I do this, I find that I often end up trying to guess at how the other person feels, or imagining worst-case scenarios for the conversation, and that’s a definite trigger for depressive symptoms for me.  Raising difficult topics directly and trying to resolve them helps me avoid that outcome.

Also, lots of other things haven’t worked for me!  Among them are giving up alcohol, cutting back on screen time, and meditating, none of which seemed to have any correlation with my mood.  I also haven’t tried any medication, although I’m open to that in the future if my current set of self-care practices no longer seems to be enough to keep depression at bay.  Recovery is definitely a trial and error process.

Interesting academic articles for March 2019

Here are some recent papers which I’m looking forward to reading!

Justin Esarey and Leslie Schwindt-Bayer. 2019. “Estimating Causal Relationships Between Women’s Representation in Government and Corruption.” Comparative Political Studies.

Does increasing the representation of women in government lead to less corruption, or does corruption prevent the election of women? Are these effects large enough to be substantively meaningful? Some research suggests that having women in legislatures reduces corruption levels, with a variety of theoretical rationales offered to explain the finding. Other research suggests that corruption is a deterrent to women’s representation because it reinforces clientelistic networks that privilege men. Using instrumental variables, we find strong evidence that women’s representation decreases corruption and that corruption decreases women’s participation in government; both effects are substantively significant.

Jesse Cunha, Giacomo De Giorgi, and Seema Jayachandran. 2019. “The Price Effects of Cash Versus In-Kind Transfers.” The Review of Economic Studies.

This article examines the effect of cash versus in-kind transfers on local prices. Both types of transfers increase the demand for normal goods; in-kind transfers also increase supply in recipient communities, which could lead to lower prices than under cash transfers. We test and confirm this prediction using a programme in Mexico that randomly assigned villages to receive boxes of food (trucked into the village), equivalently-valued cash transfers, or no transfers. We find that prices are significantly lower under in-kind transfers compared to cash transfers; relative to the control group, in-kind transfers cause a 4% fall in prices while cash transfers cause a positive but negligible increase in prices. In the more economically developed villages in the sample, households’ purchasing power is only modestly affected by these price effects. In the less developed villages, the price effects are much larger in magnitude, which we show is due to these villages being less tied to the outside economy and having less competition among local suppliers.

Brian Palmer-Rubin. 2019. “Evading the Patronage Trap: Organizational Capacity and Demand Making in Mexico.Comparative Political Studies.

When do organizations broadly represent the interests of their economic sectors and when do they narrowly represent the interests of members? This article investigates how agricultural and small-business organizations in Mexico make demands for programmatic policies or patronage benefits. Contrary to explanations based on the class of members, I show that the source of organizational capacity shapes demand-making strategies. Organizations that generate selective benefits internally are able to engage in programmatic policies that shape sectoral competitiveness, whereas organizations that fail to solve membership challenges internally are vulnerable to the patronage trap, a self-reproducing cycle wherein they become specialized in demand making for discretionary private goods. I generate this argument through process tracing of two agricultural organizations in Mexico. Analysis of an original survey of economic interest organizations provides broader evidence that organizational capacity is a better predictor of policy demands than social class.

Christopher Blattman, Donald Green, Daniel Ortega, and Santiago Tobón. 2019. “Place-based interventions at scale: The direct and spillover effects of policing and city services on crime.” Innovations for Poverty Action working paper.

In 2016 the city of Bogotá doubled police patrols and intensified city services on high-crime streets. They did so based on a policy and criminological consensus that such place-based programs not only decrease crime, but also have positive spillovers to nearby streets. To test this, we worked with Bogotá to experiment on an unprecedented scale. They randomly assigned 1,919 streets to either 8 months of doubled police patrols, greater municipal services, both, or neither. Such scale brings econometric challenges. Spatial spillovers in dense networks introduce bias and complicate variance estimation through “fuzzy clustering.” But a design-based approach and randomization inference produce valid hypothesis tests in such settings. In contrast to the consensus, we find intensifying state presence in Bogotá had modest but imprecise direct effects and that such crime displaced nearby, especially property crimes. Confidence intervals suggest we can rule out total reductions in crime of more than 2–3% from the two policies. More promising, however, is suggestive evidence that more state presence led to an 5% fall in homicides and rape citywide. One interpretation is that state presence may more easily deter crimes of passion than calculation, and place-based interventions could be targeted against these incredibly costly and violent crimes.

Heather A. Knauer, Pamela Jakiela, Owen Ozier, Frances Aboud, and Lia C.H. Fernald. 2019. “Enhancing Young Children’s Language Acquisition through Parent-Child Book-Sharing: A Randomized Trial in Rural Kenya.” Center for Global Development working paper.

Worldwide, 250 million children under five (43 percent) are not meeting their developmental potential because they lack adequate nutrition and cognitive stimulation in early childhood. Several parent support programs have shown significant benefits for children’s development, but the programs are often expensive and resource intensive. The objective of this study was to test several variants of a potentially scalable, cost-effective intervention to increase cognitive stimulation by parents and improve emergent literacy skills in children. The intervention was a modified dialogic reading training program that used culturally and linguistically appropriate books adapted for a low-literacy population. We used a cluster randomized controlled trial with four intervention arms and one control arm in a sample of caregivers (n = 357) and their 24- to 83-month-old children (n = 510) in rural Kenya. The first treatment group received storybooks, while the other treatment arms received storybooks paired with varying quantities of modified dialogic reading training for parents. Main effects of each arm of the trial were examined, and tests of heterogeneity were conducted to examine differential effects among children of illiterate vs. literate caregivers. Parent training paired with the provision of culturally appropriate children’s books increased reading frequency and improved the quality of caregiver-child reading interactions among preschool-aged children. Treatments involving training improved storybook-specific expressive vocabulary. The children of illiterate caregivers benefited at least as much as the children of literate caregivers. For some outcomes, effects were comparable; for other outcomes, there were differentially larger effects for children of illiterate caregivers.

Chris Mahony, Eduardo Albrecht, and Murat Sensoy. 2019. “The relationship between influential actors’ language and violence: A Kenyan case study using artificial intelligence.” International Growth Centre working paper.

Scholarly work addressing the drivers of violent conflict predominantly focus on macro-level factors, often surrounding social group-specific grievances relating to access to power, justice, security, services, land, and resources. Recent work identifies these factors of risk and their heightened risk during shocks, such as a natural disaster or significant economic adjustment. What we know little about is the role played by influential actors in mobilising people towards or away from violence during such episodes. We hypothesise that influential actors’ language indicates their intent towards or away from violence. Much work has been done to identify what constitutes hostile vernacular in political systems prone to violence, however, it has not considered the language of specific influential actors. Our methodology targeting this knowledge gap employs a suite of third party software tools to collect and analyse 6,100 Kenyan social media (Twitter) utterances from January 2012 to December 2017. This software reads and understands words’ meaning in multiple languages to allocate sentiment scores using a technology called Natural Language Processing (NLP). The proprietary NLP software, which incorporates the latest artificial intelligence advances, including deep learning, transforms unstructured textual data (i.e. a tweet or blog post) into structured data (i.e. a number) to gauge the authors’ changing emotional tone over time. Our model predicts both increases and decreases in average fatalities 50 to 150 days in advance, with overall accuracy approaching 85%. This finding suggests a role for influential actors in determining increases or decreases in violence and the method’s potential for advancing understandings of violence and language. Further, the findings demonstrate the utility of local political and sociological theoretical knowledge for calibrating algorithmic analysis. This approach may enable identification of specific speech configurations associated with an increased or decreased risk of violence. We propose further exploration of this methodology.

Vincent Hardy and Jostein Hauge. 2019. “Labour challenges in Ethiopia’s textile and leather industries: no voice, no loyalty, no exit?” African Affairs.

A state-led industrialization push inspired by the East Asian ‘developmental state’ model is at the centre of Ethiopia’s recent economic success. This model has historically proved potent for achieving rapid industrialization, but the business-state alliance at the heart of the model generally aimed to curb the power of labour. Focusing on textile and leather manufacturing in Ethiopia, this article addresses two questions: are workers capable of extracting gains from the process of industrialization, and have the actions of workers affected global value chain integration in the two industries? Our data show that opportunities for collective voice among workers are limited. However, workers have expressed their discontent by leaving employers when working conditions fail to meet their expectations. The resulting turnover has generated significant obstacles for local and foreign firms attempting to participate in global value chains. In response, the Ethiopian state and employers implemented a number of measures, including restrictions on emigration and more generous non-wage benefits. Recent research on global value chains and labour highlights how workers are able to influence work practices through individual action. The present article builds on these ideas, but shows that firms and governments have the ability to respond and limit this power.

Nicki Kindersley.  2019.  “Rule of whose law? The geography of authority in Juba, South Sudan.” The Journal of Modern African Studies.

This study asks: in the general absence of a functioning and effective civil administration in Juba’s huge suburbs, how have people negotiated personal disputes and neighbourhood management since conflict began in 2013? Who arbitrates in Juba, and on what terms? This study challenges top-down analyses that see political-military elites managing their ethnic enclaves of followers and fighters through nepotism and gifts. Such patronage requires the complex negotiation of responsibilities and rights, including over community safety and order. In Juba, the local authorities who mediate this have been built by men and women with extensive expertise and connections in South Sudan’s long history of ‘civil-military’ governance systems. These local authorities have established lasting institutions by negotiating rights to residence in, arbitrating over, and knowing the human geography of their neighbourhoods. Their authority is rooted in this deep politics, drawing on their detailed knowledge of topographies of power in these multi-ethnic, highly military neighbourhood spaces.

Peer Schouten. 2019. “Roadblock politics in Central Africa.” Environment and Planning D: Society and Space.

A frequent sight along many roads, roadblocks form a banal yet persistent element across the margins of contemporary global logistical landscapes. How, this article asks, can we come to terms with roadblocks as a logistical form of power? Based on an ongoing mapping of roadblocks in the Democratic Republic of Congo and the Central African Republic, it sketches a political geography of “roadblock politics”: a spatial pattern of control concentrated around trade routes, where the capacity to disrupt logistical aspirations is translated into other forms of power, financial and political. While today’s roadblocks are tied up with the ongoing conflict in both countries, the article shows, roadblock politics has a much deeper history. Before colonization, African rulers manufactured powerful polities out of control over points of passage along long-distance trade routes crisscrossing the continent. The article traces how since precolonial times control over long-distance trade routes was turned into a source of political power, how these routes were forcefully appropriated through colonial occupation, how after the crumbling of the colonial order new connections were engineered between political power and the circulation of goods in Central Africa, and how control over these flows ultimately became a key stake in ongoing civil wars in the region.

Louisa Lombard and Enrica Picco. 2019. “Distributive Justice at War: Displacement and Its Afterlives in the Central African Republic.Journal of Refugee Studies.

One of the defining features of the crisis in the Central African Republic (CAR) since 2013 has been massive displacement. Currently, about a quarter of the country’s population is displaced. People who have been forcibly displaced, whether internally or abroad, and people who stayed behind this time (but frequently have their own memories of displacement) provide particular kinds of information about war and its not particularly peaceful aftermath. In this article, based on interviews with a broad range of people affected by displacement, we show that Central African views about the prospects for peace are deeply affected by how displacement has shaped tensions over the political senses of distribution (who has a right to what, and on what basis). Who should pay for war, in senses both material and otherwise, and who should be compensated? However, distribution and belonging are not the issues prioritized in the aftermath of war, when elite deals, punitive justice and technocratic recovery plans crowd out treatment of the material justice and belonging questions that dominate neighbourhoods. The political dimensions of material justice in the aftermath of war require more thorough treatment, as listening to people who have experienced displacement makes abundantly clear.

Wenjie Hu, Jay Harshadbhai Patel, Zoe-Alanah Robert, Paul Novosad, Samuel Asher, Zhongyi Tang, Marshall Burke, David Lobell, and Stefano Ermon. 2019. “Mapping Missing Population in Rural India: A Deep Learning Approach with Satellite Imagery.” AAAI / ACM Conference on Artificial Intelligence, Ethics and Society working paper.

Millions of people worldwide are absent from their country’s census. Accurate, current, and granular population metrics are critical to improving government allocation of resources, to measuring disease control, to responding to natural disasters, and to studying any aspect of human life in these communities. Satellite imagery can provide sufficient information to build a population map without the cost and time of a government census. We present two Convolutional Neural Network (CNN) architectures which efficiently and effectively combine satellite imagery inputs from multiple sources to accurately predict the population density of a region. In this paper, we use satellite imagery from rural villages in India and population labels from the 2011 SECC census. Our best model achieves better performance than previous papers as well as LandScan, a community standard for global population distribution.

Is Arusha developing according to its urban plan?

The answer is not really, according to a new World Bank report on urbanization in Tanzania.  A summary of the report from Brookings notes that only 35 – 45% of the land in the country’s urban centers is being used in accordance with their master plans.

I thought the graph below did a good job making the differences in land use clear.  Notably, large percentages of land intended for other uses have been repurposed for agriculture and housing.

global_arusha_conformity_20190307

Tensions on the rise between Rwanda and Uganda

A white metal bar with raised red letters spelling "Rwanda" on it, in front of a paved road

The Rwanda-Uganda border crossing at Cyanika, December 2014

Rwanda and Uganda are solidly into their twentieth year of tense relations, after their respective presidents Paul Kagame and Yoweri Museveni fell out in the late 1990s over the management of looted resources from eastern DRC during the Second Congo War.  The tension between them has entered the headlines again lately after Rwanda closed one of its major border crossings with Uganda at Gatuna.   The government has issued mixed messages about the reasons for the closure, with some officials saying that it was simply for road work, but others claiming that it was done in retaliation for harassment of Rwandan citizens in Uganda.  For its part, there are persistent but unsubstantiated rumors within Uganda that Rwandan citizens are involved in plots to overthrow Museveni.

The East African has a good overview of the regional geopolitics of the Rwanda – Uganda relationship.  As they note, this has major implications for the development of regional infrastructure.

Rwanda, a small landlocked country, is served by two major transport corridors — the Central Corridor that runs from Dar es Salaam through Tanzania’s heartland, and the Northern Corridor that runs from Mombasa through Kenya and Uganda.

About 80 per cent of Rwanda’s import cargo is handled through the Dar port, but its major exports — minerals, tea and coffee — go through Uganda to the port of Mombasa.

Oil and capital goods to Rwanda come in mainly through Dar es Salaam. It is this route that President Kagame is seen to be moving to secure, as prospects of undertaking joint infrastructure projects with Kenya and Uganda grow dimmer as relations with Kampala get icier.

Meet the sapeuses of Congo-Brazzaville

Two women and a young boy wearing sharply tailored suits walk along a dirt road

Two sapeuses and a young sapeur (middle) in the streets of Brazzaville

Al Jazeera just published a fantastic photo essay about the female sapeurs of Congo-Brazzaville.  The Societé des Ambianceurs et des Personnes Elegantes (Society of Ambiance-Makers and Elegant People) is a long-runningaesthetic and social movement which privileges extreme elegance in the face of poverty.  Historically, it’s mostly been practiced by men, but this essay highlights the sharp style of the sapeuses as well.

A woman in a suit and dark sunglasses with a traditionally carved wooden pipe in her mouth

Celmantine inherited this pipe from her father, who was also a sapeur

Le Journal International provides more context for the movement’s social appeal:

Although there has been a long history of dandies in the Congo following the slave trade and French and Belgian rule, the social movement as we know it today was revived in the 1970s by musician Papa Wemba, in Kinshasa, the capital of the Democratic Republic of the Congo. He promoted la Sape culture, placing a heavy emphasis on the smart dress of all Congolese men, regardless of their social differences.
An ethos centred around respect, peace, integrity and honour accompanies the wardrobe of la Sape. This holds that a Sapeur has to be non-violent, well mannered and an inspiration through their attitude and behaviour. Wemba used this with a political motive. It gave birth to a wave of popular resistance to President Mobutu Sese Seko’s regime of “authenticity”, which prescribed a condemnation of symbolic ties with the coloniser and a return to traditionalism, following the recently regained independence. Wemba made use of la Sape’s culture of extravagant dress to challenge the strict dress codes which outlawed European and Western styles, imposed by the government.
A woman in a suit poses next to a large sign for Prisca Coiffure, with another woman sitting in a chair braiding a girl's hair in front of the sign
Le sape extends to hairstyles as well

On the long run effects of colonialism and slavery in Africa

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A 16th century depiction of the capital of the kingdom of Loango, in what is today’s Congo-Brazzaville (via African Agenda)

Stelios Michalopoulous and Elias Papaioannou have a new working paper out reviewing the literature on the long-run effects of colonization and the international slave trade on African state capacity.  They’ve summarized their findings in a piece at VoxDev.

Most of their discussion of colonial infrastructure investments and the slave trade was familiar to me, but I hadn’t previously seen much work on the role of African states’ arbitrarily-drawn borders in provoking conflict.  They make a compelling case that borders which divided ethnic groups tend to increase local conflict.

Homelands of partitioned ethnicities are disproportionately affected by conflict between state forces and rebels that have an explicit agenda to overthrow the government.  …  Partitioned ethnicities are more likely to engage in civil wars that have an explicit ethnic dimension. Since the early 1960s, roughly a third of split groups have participated in an ethnic-based civil war, while the share of non-split groups that have engaged in an ethnic war is around a fifth.  …  Survey data show that education and public goods provision is significantly lower for individuals of split ethnicities, even when compared to Africans from non-split groups in the same town/village.

Definitely worth a read.  I’ve previously discussed some of their earlier work on the long-run effects of precolonial political centralization in Africa.