Intro: This is Citations Needed with Nima Shirazi and Adam Johnson.
Nima Shirazi: Welcome to Citations Needed a podcast on the media, power, PR and the history of bullshit. I am Nima Shirazi.
Adam Johnson: I’m Adam Johnson.
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Nima: A CNN headline from this past summer read: “Mental health during coronavirus: Tips for processing your feelings.” Psychology Today gave us an article on “Coping With Loneliness During a Pandemic,” while the Washington Post presents “A guide to taking care of yourself during the pandemic.” Everywhere we’ve turned over the past 9 months, American media has been covering the mental health downside of the COVID-19 pandemic and the subsequent lockdown and economic crash on one of these two settings: Awareness Mode or Self-Help Mode.
Adam: The first setting — “Awareness Mode” — is merely witnessing mass suffering; that is, reporting on the topic with no prescriptions offered. Second is “Self-Help Mode,” which is, to the extent these articles do put forth prescriptions for wellness and mental health, it is entirely individualistic in nature. Your well-being during this once-in-a-century pandemic is up to you — but don’t fret, here are some quote-unquote “guides,” ”plans,” “hacks,” and “tricks” to help you out.
Nima: Missing from the vast bulk of coverage is the glaringly obvious third option: actionable, proven, political solutions to mental health crises that operate under the radical assumption that — wait for it — social problems may require social solutions. Nowhere in any of these articles is the idea that socialized medicine, guaranteed income, free childcare, student debt relief or rent and mortgage cancellations may be the best and most rational “hacks” or “tricks” to actually improve mental health of people at scale.
Adam: Obviously, a robust social safety net wouldn’t solve all mental health problems — after all, countries with universal healthcare and generous unemployment and childcare benefits still have depression and suicides — but we have decades and decades of data showing basic social welfare very clearly improves mental welfare because mental health crises are seen as moral failings rather than diseases thrust upon innocent people. We are conditioned to view those suffering from their effects as inevitable, losses simply factored into the moral framework of the world.
Nima: It basically goes like this: If a giant blood-sucking monster were ravaging the country killing thousands of people and terrorizing millions more, the media would never provide us “hacks” or “plans” or “tricks” to cope with the giant blood-sucking monster. It would ask the obvious question: What are those in power doing to stop the monster from killing and terrorizing in the first place?
Adam: Unfortunately, such an approach is sacrilege in U.S. media when it comes to mental health. The solution is never to lobby for a specific candidate or policy that would provide immediate relief to the masses because neoliberal hyper-atomization, unlike appeals to social solutions, is not seen as political. It’s simply the objective reporter voice mode of journalism U.S. media has uncritically adopted. But collectivist solutions, marked by the political choice to redistribute resources to the less well-off, is a proven technique to help those suffering mental health issues, doubly so during a pandemic that has cut people off from socialization, radially increased substance abuse and has left millions unemployed.
Nima: Later on the show, we’ll be joined by Colette Shade, an essayist and Masters student at the University of Maryland School of Social Work, where she focuses on behavioral health and psychotherapy. Her writing has appeared in publications including The New Republic, Current Affairs, Jacobin, and The Baffler, and she is currently working on a book about the political causes of mental illness.
Colette Shade: People have certain needs that must be met in order for them to feel safe and content and to say that, ‘Oh well, it doesn’t really matter if you can afford rent or not, you can just be happy.’ Well, you kind of can’t, if you are being threatened with homelessness, your body’s going to be flooded with cortisol, which is a stress hormone, and then that’s going to have all kinds of knock down effects in terms of affecting your memory, affecting your concentration and then you’re going to have all these other problems where you’re maybe getting in car accidents or losing your keys or forgetting things at work and it all just kind of piles up.
Adam: To start off with, we want to establish the stakes and what the science says about the correlation, or the connection between social welfare and mental health.
Nima: The data really is quite clear. For instance, a 2014 World Health Organization report on “Social Determinants of Mental Health” found, unsurprisingly, that, “Mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live. Social inequalities are associated with increased risk of many common mental disorders.” The report also notes the well-evidenced understanding that “the poor and disadvantaged suffer disproportionately from common mental disorders and their adverse consequences.” While also adding that, “Taking action to improve the conditions of daily life from before birth, during early childhood, at school age, during family building and working ages, and at older ages provides opportunities both to improve population mental health and to reduce the risk of those mental disorders that are associated with social inequalities.”
Adam: One study, published in February 2020 in Social Science & Medicine, looked at welfare policies in all 50 U.S. states between the years of 2000 to 2015 finding, “After adjusting for a number of confounding factors, higher participation in SNAP is associated with lower overall and male suicide rates. Increasing SNAP participation by one standard deviation (4.5% of the state population) during the study period could have saved the lives of approximately 31,600 people overall and 24,800 men.” Another study, published in 2014 in European Journal of Public Health, looked at the impact of the 2008 economic recession in eight European countries. It found, quote, “The effect of unemployment on suicide is higher in countries with lower social spending.” Another study in 2009 in the Lancet journal looked at the impact of unemployment in European Union countries from 1970 to 2007. It found, quote, “Every U.S. $10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0.038%.”
Nima: There are also clear correlations between austerity measures and mental health problems in populations. So, for instance, Greece offers a very stark example of this very thing. A BMJ Open journal article from 2015 looked at the country Greece from January 1, 1983 to December 31, 2012. Over that period it found that “In 30 years, the highest months of suicide in Greece occurred in 2012. The passage of new austerity measures in June 2011 marked the beginning of significant, abrupt and sustained increases in total suicides.” The number went up by more than 35 percent and male suicide, specifically, which went up 18.5 percent.
Adam: So, let’s look at data about poverty and unemployment during the COVID-19 pandemic. Almost 13 million people in the US were unemployed in the month of September, that’s roughly 7 million more than pre-pandemic unemployment numbers. So as the pandemic continues, a greater share of the unemployed are long term unemployed. The Bureau of Labor Statistics found that as of September the number of permanent job losses — meaning it’s not just a temporary layoff or furlough — spiked to 3.8 million, which is 2.5 million more than the pre-pandemic levels. While 638,000 jobs were added in October, all indicators suggest that the COVID spike combined with winter weather is poised to continue dismal unemployment numbers.
Nima: Meanwhile, staggering numbers of people are losing their health insurance. One study released in July 2020, by the consumer advocacy group Families USA, found, “Because of job losses between February and May of this year, 5.4 million laid-off workers became uninsured. These recent increases in the number of uninsured adults are 39%, higher than any annual increase ever recorded.” So, the idea that mass unemployment and certainly long-term unemployment, coupled with the fact that in our absurd system, health insurance is so often directly related to your employment, that losing your job often means losing your health insurance, which means that your family is suffering much more. You and your family are suffering much more. Obviously, these things are going to contribute to a massive decline in mental health of a population.
Adam: And this isn’t even to mention the second-order death and mental health effects of the pandemic. Deadly drug overdoses are also on the rise. On October 31, 2020, the American Medical Association issued a brief saying they are “greatly concerned by an increasing number of reports from national, state and local media suggesting increases in opioid- and other drug-related mortality.” The AMA continues, “More than 40 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder.” NBC reported on October 20, “National data is incomplete, but available information suggests U.S. drug overdose deaths are on track to reach an all-time high.” The CDC reported in August that “During June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.”
A survey by Recovery Village, a drug and substance abuse facility, found that 55 percent increase in alcohol consumption, month-to-month, with 18 percent reporting a significant increase. 36 percent reported an increase in illicit drug use in the states hardest hit by the coronavirus, which under the time frame of their study was New York, New Jersey, Massachusetts, Rhode Island and Connecticut. 67 percent reported an increase in past-month alcohol consumption, with 25 percent reporting a significant increase.
So I think we’ve kind of made our case that this pandemic has had tremendous mental health effects, the clear picture of which we won’t see for probably several years because it’s very difficult to study these things as they’re kind of playing out but it’s an urgent crisis not just in terms of the sort of terror of the coronavirus, but the logical effects of locking people in their apartments and homes for months on end without any end in sight. This of course, is going to compound existing mental health problems, substance abuse problems, which themselves are compounded with existing inequities. So you have this perfect storm of shit rolling downhill and we’ve seen a bunch of indicators that people are suffering en masse and the extent to which we’ll get into this, politicians and the media have responded to this, they’ve done so in a very self-help, atomized way in the degree of urgency and collectivism required to address these issues, which again predate the pandemic, but are now made five times worse since the pandemic, are simply never ever talked about as social problems.
Nima: Because so often the quote-unquote “solutions” that are sought are band aids compared to the actual root causes of this kind of suffering. So, you know, you have unemployment, health insurance loss, stress and anxiety, which have skyrocketed, especially among people who are providing unpaid caregiving to oftentimes adults, and certainly also children, and so you have all of these compounding factors that are really increasing levels of mental health problems in this society. Meanwhile, our highest profile liberal politicians can’t seem to get around to the root causes part, but they really like talking about all the things that they are going to do. They’re kind of like the living embodiment of the drowning hand-slap meme. So we’re going to read off just a couple examples that have been compiled by writer Olga Lexell, who has the Twitter handle @RunOlgaRun, of people like say, Representative Joe Kennedy III, who wrote this back in May: “Not a single patient should be forced to fight off medical bankruptcy in the midst of a global health pandemic without a lawyer by their side.”
Adam: That was so good. That was so good.
Nima: You thought it was going somewhere.
Nima: But then it kept going. He just wants people to have lawyers.
Adam: The simple moral declaration of “Not a single patient should be forced to fight off medical bankruptcy” was not enough but he had to add “in the midst of a global pandemic” and you’re like, okay, and then “without a lawyer by their side” is just peak neoliberalism. Somehow these get worse. Then Chuck Schumer in October, he subsequently deleted this tweet after he was internet bullied, he said, “We recently learned a tragically sad story of a veteran in the Rochester region. When he stopped receiving increased unemployment assistance, he couldn’t pay his mortgage and heartbreakingly committed suicide. I just demanded we pass suicide prevention acts.”
So there’s a few things with this one. Number one, the superfluous edition of “veteran,” the industries with the highest suicide rates are not veterans — although they do have a higher suicide rate than the mean — it’s medical healthcare professionals, artists, and construction workers, but for some reason, you can’t pass anything or talk about anything without attaching Veteran — capital “V” Veteran — to everything. So it’s this absurd, hyper specific qualifier that doesn’t make a ton of sense and then instead of saying we’re going to do rent and mortgage abatements and provide free healthcare for everyone, which would go a long way to ameliorating this suffering, we get a suicide prevention act, which presumably —
Nima: That’s right.
Adam: Is the cops just calling your house and seeing if you’re okay.
Nima: Right. I mean, it’s saying, ‘We’re not going to help you not be miserable, we’re just going to make sure that you stay alive while you’re miserable.’ It is absolutely appalling. You also have Hillary Clinton — what list would be complete without a Hillary Clinton tweet? — where she wrote, quote, “Millions of people have lost their employer-tied health care over the last two weeks because of the pandemic. It’s an easy call: Re-open the health care exchanges.”
Nima: Don’t just give people healthcare!
Adam: Or anything else, or give then $5,000 a month or something simple the federal government could do.
Nima: No, “open the exchanges,” make sure the websites don’t crash this time.
Adam: Open the healthcare exchanges, Nima, the bold moral leadership we demand in a time of crisis, when the bottom was falling out of the economy and we had 30 percent unemployment, everybody was sitting home, looking at their children, looking at the residual grease in their KFC bucket they had to buy for dinner because they couldn’t afford anything else, worrying how they’re going to pay their electric bill and the first thing they thought of? ‘How are we going to reopen the healthcare exchanges?’ I don’t even know what that is.
Nima: Right. ‘Once more into the healthcare exchanges, my friends!’
Adam: Yeah, but somehow again, these all pale in comparison, these all bow in worship on the altar of this next one. The mayor of Los Angeles, Eric Garcetti — make sure you’re sitting for this one, you ready?
Nima: This one’s so amazing.
Adam: “ We’re delivering assistance to Angelenos facing economic hardship during the COVID-19 pandemic. Starting Monday, with our new Early Pay LA program, @LADOTOfficial will offer a $20 discount on parking citations paid within 48 hours.” Because you read the first clause and you’re like they’re offering assistance to Angelenos facing economic hardship. That is awesome. What are we talking about?
Nima: They’re still handing out traffic tickets.
Adam: Are you gonna pay my heating bill over the winter? Are you going to maybe make Boston subway fares free? No, we’re offering a $20 discount.
Nima: (laughing) You get a sawbuck discount, my friend, off your parking ticket if you pay it within two days.
Adam: If you pay within the first 48 hours. That’s the kicker because without “the first 48 hours” it wouldn’t quite have the real neoliberal oomph. You just look at that and you see what fucking Wharton School grad psycho came up with this fucking policy and please point me to a wall.
Nima: ‘Everyone is suffering during this incredibly once in a lifetime pandemic, so what we’re gonna do is we’re gonna make sure that everyone gets a coupon to Arby’s every time they post bail.’
Adam: No, a coupon for Arby’s will be better than that, because at least you’re feeding someone. This is like, and by the way, this was him announcing that they had started ticketing people, again, or forcing people to pay tickets, because they actually during the pandemic, they got rid of that. This announcement is him announcing them bringing it back, but he’s framing it as economic relief, which is so —
Nima: ‘You’re welcome.’
Adam: Yeah, and people wonder why people are cynical about politics. So this is, of course, not unique to politicians. This is how the media largely frames it in its own way, which is to say, there are two modes of reporting on mental health crises during COVID. There’s Awareness Mode, which we discussed in the intro, is where you’re sort of allowed to witness it, you’re allowed to kind of acknowledge it, and you report on it and there’s a place for that, there’s a place for a kind of reporter who says, you know, this is happening. This is the thing without necessarily being prescriptive, although I tend to think that the prescription, much like the blood-sucking monster, lends itself to the coverage. Then the second mode is Self-Help Mode. So the awareness mode has had reports in The Washington Post, from May 4 of this year, “The coronavirus pandemic is pushing America into a mental health crisis.” August 13, CNN, “CDC study sheds new light on mental health crisis linked to coronavirus pandemic.” September 4, The Washington Post, “During pandemic, growth of U.S. adults with mental health issues jumps to 53 percent.” So this is sort of like a kind of straight report.
Nima: And so often they’re tied to new studies or surveys that come out and they just kind of run down the data.
Adam: Telling us what we already know, which is that mental health is going to be affected by global catastrophe/pandemic/economic depression.
Nima: Right. So you have CNN also in October of this year with this headline, “Covid-19 pandemic takes added toll on those with mental illness.” Again, just runs down the stats. In November, CNN came back with a similar article, “Teens who spend more time in extracurricular activities and less time in front of screens have better mental health, study finds.” So, again, this is very true. It’s not about disputing the science. It’s just the ‘we’d like you to know that based on studies, everyone is suffering. This is a nightmare. Anyway, back to your regularly scheduled programming.’
Adam: Yeah, the thing that’s patently obvious that’s happening, which is that there’s mental health effects from a pandemic in an economic lockdown, some egghead somewhere affirms what is obvious to everybody, but ho hum, nothing to be done about it. Which leads to our second which is what we call the self-help mode of reporting, where journalists understandably take the step from saying, Well, here’s this mental health crisis, here’s what we can do about it and what is never ever, ever, ever, ever, ever, ever, ever offered as a prescription or a solution is pushing for policies that can create social welfare that we know scientifically, as we explained in the intro, will help alleviate mental health problems. Now to be clear — we’re going to say this several times in this episode — we are not saying that social solutions and socialism and social welfare solve mental health problems. That is not what we are saying, of course not we’re saying, but as a baseline, we know for a fact that things like not having to worry about money, not having to worry about education, not having to worry about student loans and debt, and healthcare, we know for a fact, with 100 percent certainty beyond any reasonable doubt that this gives a baseline of mental health for which people can build on. It is the easiest, most elegant, most simple, most logical way, especially in the event of a mass catastrophe like the COVID-19 pandemic, to help out people with mental health problems, but time and time again, because this is considered quote-unquote “political” we get what is not considered political —
Nima: Which is doing it yourself.
Adam: Just doing it yourself.
Nima: Which is all of these individualistic solutions to what are actually mass systemic problems.
Adam: And again, if this was a blood-sucking monster ravaging the countryside, we would not be having article after article about how to cope with a blood-sucking monster with zero articles telling us how to get rid of the monster or at least contain the monster.
Nima: So for instance, you have this article from The New York Times back in April of this year, written by Jessica Grose, the subheadline is “Ways to find headroom and even joy right now.” So, in this article, and many like it, and there have been many over the past nine months, the issue is not so much the problems that they lay out, these are very real problems, people are going through hellish shit on tons of levels. This is not to say people aren’t suffering in these ways. It’s just what are the prescriptions that are offered through our corporate media that always somehow avoid talking about political policy solutions? So for instance, in this article, from April, you get this:
“Finding places where you can have space for yourself to reflect and think and feel” is crucial in this moment, said Dr. Pooja Lakshmin, M.D., a clinical assistant professor of psychiatry at the George Washington University School of Medicine and Health Sciences. Dr. Lakshmin pointed out that all of the ‘in between transition times’ we used to have to ourselves — like during our commutes, and after we dropped off our kids at school — are gone. So it’s important to create those spaces for yourself in new ways, she said.
“Dr. Lakshmin mentioned meditation as a great option. And in fact, parents with children under 18 at home are more likely to meditate than the general population right now, according to a new report from the American Enterprise Institute, a public policy think tank. Thirty-six percent of these parents ‘say they have meditated to cope with stress in the past week,’ the report said, compared with 30 percent of Americans overall. If you want to receive the full benefits of meditating, Dr. Lakshmin said, ‘consistency is the most important thing. Five minutes every day is a lot better than 30 minutes every week.’”
Adam: It’s worth noting that the American Enterprise Institute is one of the, if not the, maybe second to Heritage Foundation, ideological outputs of quote-unquote “reopening” back in May and June, the American Enterprise Institute and fellows at the American Enterprise Institute and their op-eds, they are right-wing, as we mentioned in our J.D. Vance News Brief, they’re a right-wing funded, basically a domestic U.S. interior petrochemical and oil firm lobbying company. That’s their job. Their job is to promote business.
Nima: Listed here in the Times as a “public policy think tank.”
Adam: Right. So, you, of course, it makes a lot of sense then that a corporate lobbying firm dressed up as a think tank would love for us to find ways of coping with the solution that are not social.
Nima: ‘Do some fucking yoga and get back to work.’
Adam: Yeah. So just to point out that it’s not a coincidence that our solutions are fully atomized and neoliberal in nature, because that’s, for the most part, the ideological framework that all these think tanks, and to some extent medical professionals are operating under. Now in the defense of medical professionals, they would argue, ‘Well, I’m not a public policy person, my job is to treat who I can treat in front of me,’ and that’s fair, although I think there are increasingly doctors like PNHP, the Physicians for a National Healthcare Program, who advocate for single payer health care, who are increasingly seeing the links between mental physical health and general social well being and the people who come to their office with public policy, that these things are not separate deals, but for the purposes of this episode, we are not dunking on the medical professionals being quoted here, because this is beyond the scope of their charge. I do think who we are dunking on is the editors and reporters who insist upon treating a macro problem like a micro moral failing.
Nima: So, with that you get another Times article from September 9 of this year with the headline, “The Pandemic Is a ‘Mental Health Crisis’ for Parents. New studies show caregivers with young children are stressed, with no signs of relief on the horizon.” Now, as someone who definitely fits into that category, I know that’s true. That is 100 percent true, but again, what prescriptions, what solutions, what is the framing of articles like this and what is offered as ways out. So you get this from the Times:
“Over 60 percent of caregivers who are experiencing extreme financial problems reported emotional distress, compared with just over 30 percent of caregivers who have no financial issues.
“So what can parents do to help bolster their mental health in this time of difficulty? Lucy Rimalower, a licensed marriage and family therapist in Los Angeles, recommends asking yourself: What kind of self-care is realistic for you now, not six months ago? The old coping mechanisms you had may not be available any time soon, so if you can even take a tiny break for yourself every day, that’s better than nothing. ‘Is that a five-minute yoga video on YouTube? Is it a five-minute text exchange with an old friend?’ Rimalower said.
“‘Traditional therapy is fantastic,’ but it’s not realistic or accessible for everybody, she added. Rimalower said asynchronous options like therapy apps that allow you to message therapists, rather than have a 50-minute video session, may be helpful for parents strapped for time.”
So again, these are not problematic suggestions, these recommendations all make sense, but they are all focused on the individual. What can you yourself do to help you be less stressed in this time?
Adam: Note how this overwhelmingly political problem — and Jessica Grose has done half a dozen of these articles — notice how no resources and energy are going into exposing the scandal of why the federal government was not providing people healthcare and immediate robust economic relief. There were stories about, you know, UI and people falling through the cracks but it was not it was not viewed in the context of mental or physical health. It was simply viewed as a ho hum, people are hurting.
Nima: Right. People are hurting, the tech is failing, government is not providing what they can and then in a different section of the paper, it’s like, ‘You should really try and take some walks and binge watch some shows with your partner,’ and never seeing how anything is actually related to each other and completely interconnected, as massive social problems that need social solutions.
Adam: Jessica Grose did this again. She wrote several versions of this. She wrote one on November 4 with the headline, “Practicing Self-Care in Uncertain Times — Sleep won’t fix what’s broken in the world, but it will prepare you for what lies ahead.” And October 9, she had one entitled, “How Will We Cope With the Pandemic Fall? Mental health experts offer advice on how to handle the return to indoor life the cooler weather will bring.” The writer and academic Adolph Reed, who I know is somewhat problematic, but he has a really, really great line that I think about a lot which is quote, “Liberals don’t believe in politics anymore, they simply believe in bearing witness to suffering.” And I think this article by Jessica Grose is a good example of that because it does do one of these kinds of woke check things where she goes over all the mental problems and says:
“This is especially true for underprivileged and marginalized communities, where large multigenerational families are often crammed into one home, said Dagmawi Dagnew, a psychologist with the Department of Veterans Affairs and co-founder of a volunteer organization providing mental health resources to the Ethiopian-American community in Philadelphia. ‘Some of us have the luxury where space is taken for granted,’ said Dr. Dagnew, but for low income people, the stress is ‘related to basic needs’ such as ventilation, child care or helping older parents.”
And then Jessica Grose goes on to provide solutions:
“So how can we handle the stress of heading back indoors? What are the best strategies?
“Dr. Teachman recommends a three-step approach: Acknowledge, find alternatives and then make a plan. Start by recognizing that it’s OK, and even helpful, for people to ‘grieve what they have lost,’ said Dr. Teachman, ‘because there are real losses.’
“This kind of acceptance is crucial for ‘emotional regulation,’ explained David Rosmarin, the founder of the Center for Anxiety in New York, and an assistant professor of psychiatry at Harvard Medical School. ‘Accept the fact that it might be a crappy winter. Don’t try to fight it. Let the emotions come. It’s a wave. It crashes over you, and then it passes.’”
But of course, to a large degree, this is not a wave. This is not a law of nature. This is a policy decision that the federal government and local and state governments have made to let people suffer. This is not an act of god. It’s not even like the blood-sucking monster, it’s as if the Defense Department created the blood-sucking monster. It is a political choice that is being made every single day, every single day we wake up, we make a political choice to let poor people and people with mental health suffer under COVID because we’re not providing healthcare, we’re not providing free mental care, we’re not doing rent and mortgage abatements and cancellations, we are not canceling student debt, we are not creating the foundational basis that social welfare states can provide to make everything else that much easier and so under her solution heading after she checks the sort of liberal box and sort of does the inequities in racial box checking, there’s never a sense of why don’t we pivot to say, ‘Well, why are people who are low income living in tiny, little apartments? How do we get them bigger apartments? If they’re having issues with child care how can the state provide child care? If they’re having issues with older parents how can we have state funded nursing care facilities for older parents?’ This is just not offered as a solution because it’s beyond the epistemological scope of what kind of official journalism is supposed to do and what we’re trying to insist upon you, in case it isn’t obvious at this point, is that these are not laws of nature, these are not things inherent in journalism, they’re ideological decisions that have been made, that neoliberal capitalism, where we often for ourselves, is a default or natural state and the idea that there would be social solutions is quote-unquote “political.”
Nima: Well, right because all it does is it sets up coping as the way to survive, as opposed to changing the material conditions of people’s lives so that they can actually survive better without having to cope, right? And so you have all of these articles, you have another one by Jessica Grose, from November of this year, “Practicing Self-Care in Uncertain Times — Sleep won’t fix what’s broken in the world, but it will prepare you for what lies ahead.”
Adam: But what will fix what’s broken in the world? Why don’t you fucking avail that to us?
Nima: How about the things that will fix what’s broken in the world? Don’t just get your rest, which is also good, people need sleep, that’s all good, but how about other things?
Adam: The general formula is that conservatism is ignoring suffering, neoliberalism is acknowledging it and suddenly monetizing it and liberalism is acknowledging suffering and hand wringing about it feeling bad and moving on and there’s never a sense that you can do anything. Again, you aren’t, you can witness suffering, which is what The New York Times does better than anyone, you can witness suffering, but there’s nothing you can really do about it politically. The only thing you can really do about it is to look inside, deep inside yourself, and meditate and somehow dig deep and find 30 minutes a day. But of course, on a micro level, and I’m sure even if you scale this up, even if you had 10,000 people read The New York Times and try to follow the advice, my guess is they probably fail, because the origin of the suffering, the author of the suffering is the brutal dog-eat-dog capitalist system, for the most part. Again, I know there are exceptions, we’re not trying to totalize it, but the thing that is causing the problem is not something anyone ever fucking talks about.
Nima: Well, to your point, Adam, about the kind of conservative versus liberal way of, you know, either ignoring suffering, as opposed to acknowledging it and doing nothing, there is also this thing that has happened lately, with the Republican kind of co option of the mental health debate, right?
Adam: Yeah, and the only time people talk about mental health as a public policy issue, or something that suddenly everyone cares about, you’ll notice, is when in April and May of this year, the Republicans started to speak about deaths of despair, and the social and mental cost of locking people down. Now, of course, their solution was not to provide $3,000 or $4,000 a month to everybody and do rent and mortgage cancellations, it was to send them back to their death traps of work. So when the pandemic was at its worst, and it still is in many ways, the options we were offered was liberal witnessing, acknowledging of the suffering, but no social solutions, as indicated by our dozens of episodes about Pelosi and Schumer and their inability to provide robust social safety nets other than a UI they lucked into. So it was to sort of suffer at home alone and be depressed with very little economic relief, or it was to go back to work and as we predicted the to go back to work movement, as much as it was astroturfed by corporations and the Heritage Foundation and FreedomWorks and American Enterprise Institute, that eventually it was going to begin to resonate with people and it did, because there was no other alternative. You know, if you don’t offer people social solutions in the time of crisis, they’re going to seek some other solutions. They’re not going to just sit home all day, for the most part.
Nima: Well, because also if they’re sitting home stressed and anxious, as opposed to feeling secure, and that the reason they’re staying home is to benefit their safety, the safety of their families and of their wider community, but that they don’t have to worry about money or healthcare or rent or their mortgage while they are at home, they will then not feel like they need to look for this other solution outside the home, which then gets weaponized and exploited by Republicans, which is the ‘go back to work, kill yourselves for our economy, where we are already extracting from you and now we’re going to extract everything including your health and your life.’
Adam: Yeah and suddenly you had people like Bob Corker, Senator from Tennessee, said on March 24:
“I am glad the debate is now balanced and the understanding of the mid- to longer-term health consequences as a result of suicides, domestic violence, deprivation, and lives of poverty as a result of a prolonged lock down are being taken into account.”
The day before you had President Trump say:
“You’re going to have suicides by the thousands. People get tremendous anxiety and depression, and you have suicides over things like this when you have terrible economies. You have death.”
And then Senators Ben Sasse, Tim Scott, Lindsey Graham and Rick Scott of Florida issued a joint press statement saying, quote, “the moment we go back to work, we cannot create an incentive for people to say, ‘I don’t need to go back to work because I can do better someplace else.’” Then they would go on to sort of explain why they thought the issue was people staying home and becoming depressed. So of course, looking at the tweets of both Corker and the other senators, none of them talked about mental health before the pandemic, they don’t care. It’s an excuse. But the problem was that Republicans, people were drowning and Republicans offered people barbed wire to get out of the water and the Democrats offered them nothing. Now the barbed wire would be worse than just drowning, but it looked like they were doing something. It looked like they were sort of offering some kind of respite, which is go back to work, which is go make money working and so the only time we had any kind of sense of mental health as a public policy issue, on a large scale, was when it was being used to concern troll so people would go back and help the bottom line of Walmart and the poultry industry and the fracking industry and all these people fund the Heritage Foundation, then suddenly, everyone’s heart bleeds and so the idea of mental health as a political issue, the ground was totally ceded to the Republicans and then suddenly, you had people who again, have who had previously not cared at all about the the mental health of the working man, suddenly, they were super concerned about the long term effects and the effects of suicide.
Nima: But their solution only went one way.
Adam: Well, it was to line corporate interests.
Nima: Which was to threaten those people’s health and the health of their communities, as opposed to actually doing the things that would make people less stressed, less anxious, and allow them to still stay healthy and stay home.
Adam: And again, the Democrats offered no counter narrative, they offered no counter moral arc, it was the big bad Republicans want to send you back to work, which is true, they are big and bad, and they did not care if you lived or died, but at least it was a narrative, at least it was doing something whereas Democrats did mass scolding some pretty decent UI, which they didn’t even take credit for and then that was pretty much it and things like rent cancellation, debt cancellation, free healthcare, meaningful cash payouts, non UI payouts for people who aren’t formal labor, undocumented labor, informal economy, etcetera, these people were just basically left to die, they were left to go on their own, they were left by themselves and the idea that this is not a law of nature, like gravity or the tides, but is in fact a political choice is just not the way American media views it. We view these things as being natural, having The New York Times bring up the injustice if I’m at an editorial board meeting, and I’m pitching a story and I say, ‘Well, why don’t we cover the mental health as a social crisis of a sort of form of violence and a form of oppression,’ you’d be laughed out of the room, you’d be laughed out of the room, because anything that involves social solutions is considered radical left-wing ideology. When again, we have the science, the data, the studies, the counter examples — again, there are several countries who have many of these things — we have the evidence that mental health can be meaningfully improved by having a robust social safety net and that is just not an approach or prescription that’s ever proffered by US media.
Nima: To discuss this more, we’re going to be joined by Colette Shade, an essayist and masters student at the University of Maryland School of Social Work, where she focuses on behavioral health and psychotherapy. Her writing has appeared in publications including The New Republic, Current Affairs, Jacobin, and The Baffler, and she is currently working on a book about the political causes of mental illness. She will join us in just a moment. Stay with us.
Nima: We are joined now by Colette Shade. Colette, thank you so much for joining us today on Citations Needed.
Colette Shade: Thanks for having me.
Adam: So, I’m calling it the year of COVID — I decided I needed more gravitas so I’ve now started to say pretentious things like ‘The Year of COVID’ — the year of COVID has clarified, I think, a stark reality of inequity and social isolation at the heart of the United States economic order. You note in your article that US media has largely framed the freefalling mental health crisis, which of course has been made much much worse by the pandemic and subsequent economic crash. The US media has failed to frame it as a social problem with social solutions instead presenting us with the kind of typical atomized, one-off, self-help approach, something we’ve talked about on the show with various other topics quite a bit. I want to begin by talking about how the American media broadly frames mental health quote-unquote “amid COVID,” which they love to say, versus what the science says, and I know that science is a very loaded concept, but what the science says would be a more robust approach.
Colette Shade: Right. So I think if you want to talk about the framing of mental health during COVID, you have to talk about how the media frames mental health more generally. In general, mental health is talked about as humans are brains in vats and sometimes you have a malfunction with some chemicals in your brain and you fix it with therapy or medicine and that’s the end of the story. But that really isn’t the end of the story because we are complex beings, we’ve got a lot going on chemically in our brains, but we also live in a complex society and economy and we’re constantly interacting with each other and with various social systems and so to say that mental health is only what’s going on in an individual’s own brain is really missing the larger picture.
Adam: Before we dive too much into it I want to talk about what the scientific literature says on this, because, you know, we want to be clear that we’re not saying that in a socialist Star Trek utopia, there would not be mental health problems. Of course, that’s not true. But there’s quite a bit of evidence that shows that underlying social economic issues like job precarity, financial stress, inadequate or unreliable housing, that these things contribute significantly to mental health issues. I want to talk a bit about what the scientific literature says about the connection between poverty and mental health problems.
Colette Shade: Right. So there have been a number of studies finding that people need a certain amount of money and economic security to be mentally healthy. So, for example, there’s a study that came out in January of this year in the Journal of Epidemiology and Community Health that found that for every dollar that the minimum wage is increased, there is a 3.4 percent to 5.9 percent decrease in the suicide rate. There has also been some famous research done by Anne Case and Angus Deaton, who are two economists at Princeton University, on the effects of economic poverty on life expectancy and they found that a big factor in the rising opioid epidemic and suicide epidemic is the fact that there are decreasing wages and increased unemployment among adult white men.
Nima: If you were to — I don’t know — boost wages, have a robust Medicare for All health system, have strong unions, these things would go a really long way to decreasing a lot of these major, major problems that you see in society. Again, you know, as Adam said, it’s not like it would wipe everything out.
Adam: Sure as shit would help and we know this because the rich and the rich have money they spend it on mental health.
Adam: One of the problems, I think, is this media cliche or this film and television cliche or even literature cliche that the rich are all actually secretly miserable.
Colette Shade: Right.
Adam: You know, you watch Succession and they’re all just miserable — and you know what? — they’re not. I mean, there are people who are obviously, but for the most part, no, economic security brings some degree of relative happiness. They have sleepovers in lake houses and noodle salad and for the most part, they’re doing just fine and I think there’s sort of this, there’s this coping mechanism of convincing ourselves that the rich are all actually secretly sad and it’s like, no, that’s just what they want you to think.
Colette Shade: Right. Although what’s interesting is that there is some research that was done by two British epidemiologists, Kate Pickett and Richard Wilkinson, that found that in more unequal countries, the rich are also not so happy. They actually found, and this is basically to do with what they refer to as the social evaluative threat, which leads to social anxiety because people are constantly anxious about where they place in this hierarchy, and in a more unequal society, where you place in this hierarchy matters a lot more than in a more equal society and so I think there actually might be some truth to that in the U.S. that a rich person in the U.S. is more miserable than a rich person in Sweden.
Adam: Yeah, I suppose I meant relative to poor people within the United States. Yeah. No, I don’t doubt that at all because I do think it can also have a kind of second order effect.
Colette Shade: But right, I mean, people have certain needs that must be met in order for them to feel safe and content and to say that, ‘Oh, well, it doesn’t really matter if you can afford rent or not, you can just be happy,’ well, you kind of can’t if you are being threatened with homelessness your body’s going to be flooded with cortisol, which is a stress hormone, and then that’s going to have all kinds of knockdown effects in terms of affecting your memory, affecting your concentration and then you’re going to have all these other problems where you’re maybe getting in car accidents or losing your keys or forgetting things at work and it all just kind of piles up. Whereas if you know that you will have somewhere to sleep every night and food to eat, you may well have anxiety, even very severe clinical anxiety, but this idea that, ‘Oh, well, you can be mentally healthy when you’re not economically secure is a bit silly.’
Nima: The atomization and moralizing of social problems is certainly not unique also to discussions of mental health, and I think that’s why we actually talk about this kind of thing on the show all the time, but when we think about how it manifests in the media, and in commentary or analysis or listicles, it feels like editors have just kind of given up on any broad political change in general. If the solutions are political and not individual, then we should be talking about political change.
Colette Shade: Yeah.
Nima: But with the refusal to do that, everyone is just kind of left alone as an island or a brain in a vat, as you said. Can you comment on the way this really kind of fatalistic or defeatist neoliberal ideology just pervades decision makers in the media? How much would a reporter or editor get laughed out of the roundtable discussion if they walked in and they were like, ‘Here’s the deal, let’s talk about mental health in a way that is not a self help thing but more of a social determinants of health kind of thing?’
Colette Shade: Right. Well, it seems to me having just written an article on this topic, that attitudes are changing because the COVID situation and the completely preventable economic and eviction crises and childcare crises and all of these other things going on, they have made life so unbearable, that I think that editors who previously would have, shunned to this idea of addressing the social determinants of mental health, they’ve really come around to it a little bit more, I think. Now, that’s not to say that that’s universal. I just read an article the other day in The New York Times that was quite a good article in terms of providing actual coping strategies mostly, I think, from cognitive behavioral therapy, they interviewed a psychologist about strategies to deal with the stress of the pandemic and other issues. At a lot of places, there just isn’t an interest in looking at structural issues in general and I also think that there is this idea that if you talk about social determinants of mental health, that you are somehow anti-therapy or anti-medicine or anti-psychiatry.
Adam: One cynical gambit that we see a lot that the right-wing used, especially in the early days of the pandemic, although they still do it, is to concern troll the concept of deaths of despair, to push for quote-unquote “reopening economy.” As contributor and friend of the show, Sarah Lazare, noted back in March, the think tanks like Heritage and American Enterprise Institute and senators like Lindsey Graham, their hearts suddenly started to bleed for the poor man who they said needed to go back to work to feel happy, and that the economic crash caused by the shutdown was going to be worse than the epidemiological value of shutting down. Now, this narrative leaves us with kind of two options, right? You have, and it’s true to some extent there is a mental health downside to locking people in, as we’ve seen, unfortunately, right? But without providing the economic conditions of survival $2,000 or $3,000 a month, and I know that there were some unemployment insurance, but that didn’t reach a lot of people and it was over in August, but without providing people a set income, without providing people mental healthcare as you note in your article, the shutdown will do that. But of course, Republicans weren’t offering those things, right? That’s how we know this was bullshit. So we’re left with two options. We have a Democratic Party that’s primarily predicated on finger wagging and scolding people but not really providing the robust economic safety net required for this kind of shutdown to work and then on the other hand you have a Republican Party who doesn’t want to shut down, wants to force everyone to come back and work for slave wages, and then everyone dies of coronavirus and so this was the binary choice we were offered, when of course, the solution people called for from the second this happened was we need to shut down, lockdown and also provide people financial stability and provide them mental health services, right?
Nima: Including a rent freeze or a mortgage freeze.
Colette Shade: Right.
Adam: Exactly and so I want to talk about the ways in which concepts of deaths of despair and depression can be weaponized to expedite the quote-unquote “reopening of the economy” in a way that really kind of misses the point.
Colette Shade: Well, what that actually reminds me of, is one Republican talking point that I’ve heard prior to COVID about the minimum wage is that, ‘Well, we can’t raise the minimum wage, because that means that there will be more unemployed people, because how can employers afford to have the same number of jobs if they raise the minimum wage?’ I think that this is the same kind of logic here where they’re saying, ‘Well, you know, here’s this thing we already want to do and we’re going to take this concept that you, the other side, claimed to be so concerned with, and we’re going to take it to argue for this thing we already want to do. We don’t really care about the outcome.’ I mean, it should be obvious to anybody that Republicans don’t really care about solving deaths of despair.
Nima: Well, right, because everything they do is anathema to any sort of actual systemic solutions. So it goes back to the personal responsibility over systemic problem argument.
Colette Shade: And it’s also worth pointing out that if you’re going to work at the grocery store, and everyone around you is dying of COVID, that’s not good for your mental health.
Nima: Right. It’s not like, ‘Well, you know, the happiness of work,’ right? ‘Whistle while you work and that is how you can stay happy’ is if you do your drudgery or if you’re lucky enough to not have, you know, a job that you hate, you still need to be able to go out, go to the office, talk around the watercooler — is that a thing people still do? I don’t know. I’m talking as if everyone works in a Madmen style ‘50s office, but I’ll do it anyway — that that’s what people need to be happy, as opposed to what having to work allows people to get in our system. Something you mentioned in your article, Colette, is the fact that our healthcare is so often tethered to our employment is so cynical and able to be weaponized. ‘Well, you know, I mean, how can you expect to keep having healthcare if you’re not working?’
Colette Shade: The answer is you just give them healthcare. The answer is you just give people money. There’s really nothing else to explain about it.
Nima: No, exactly, and I think that pointing that out can turn into like this pearl-clutching, ‘But what if you give people all these things that they actually want and need, then what?’
Colette Shade: Then they’re happy and our society is functioning.
Adam: So much of this is informed by this concept of not being political or apolitical or not being ideological. So you look at things that are so obviously on the whole political issues. Mental health is a political issue, healthcare in general is a political issue but god forbid, an editor or reporter was perceived as being political. So really, the only angle you can take as a reporter is either this kind of pure science where you review, you know, a bunch of scientists, and you sort of do a science report, or it manifests into this self-help 10 ways you can do X crap and so, I think, by the very nature of the genre of kind of objective neutral science reporting, everyone’s siloed off into this small little area where they’re permitted to talk about healthcare and mental health in a very atomized and very specific way that doesn’t touch the third rail of like, well, actually, there’s, you know, a whole server farm somewhere in Switzerland and the UK or in Brussels, or whatever, that shows that if you invest in robust universal healthcare there’s tremendous health benefits, mental health benefits from this and it seems like this obsession with not looking like you’re some socialist ideolog prevents people from saying what is, I think, established science in a large part of the world.
Colette Shade: Yeah, there was this study by an occupational sociologist named Robert Karasek in 1979 and what he found was that basically people who have more control over how fast they work and how they do their tasks in the workplace are happier and healthier. So it’s not even only about how much or how little you work or what your social insurance is like, but it’s also about what kind of power do you have over the minute to minute experience of life in the workplace.
Nima: So you know, before we let you go, a lot of people are obviously feeling very shitty during this pandemic that is ongoing and it will likely only get worse as at least those of us in the Northern Hemisphere descend into winter and as the holidays are rapidly approaching, this will all compound the usual seasonal depression that I think a lot of people unfortunately face. Now, I know we’ve been talking about self-help and cynically about it on this show, but what do you think maybe, Colette, you might want to tell folks who are worried about these forces all compounding at this time, where maybe can people seek help? Obviously getting, you know, politically involved to work against addressing the social determinants of health is really important, but that is also a very long term thing to do, urging people to do that, but also maybe folks who are more desperate right now, what are the things that we can look to for support?
Colette Shade: So in terms of individual approaches, if you’re anxious or depressed, if you’re looking for professional help to talk to a therapist or to see a psychiatrist and you’re not already with a provider already, what I would recommend is to get on a waitlist now. Contact someone now if you’re even feeling a little bit worried about ‘I don’t know where my mental health is going to be in a few months,’ start now, be proactive if you can and I would also recommend searching for, if money is an issue, providers that offer a sliding scale treatment. In case someone doesn’t know, sliding scale is basically where the full fee of the provider might be $150 or $200 per appointment, but if you make below a certain income, maybe you pay $30 or $20. Anyway, I would suggest that anyone who is looking for professional help get a move on it now if that’s possible. In terms of daily maintenance, it’s probably pretty trite, I’ve seen this around but it does work and I do this myself, I tell people that I work with to do this: keep a schedule. Just write out everything that’s on deck for the day so you don’t get overwhelmed and try to get a little bit of exercise if you can, even if it’s just doing jumping jacks or push ups in your home and try to keep a regular sleep schedule.
Nima: I think that’s really helpful. I think what we see too often, though, is the idea that the solution has to start with the problem and I know that sounds absurd, as opposed to the cause of the problem.
Colette Shade: Right.
Nima: There’s a reason why there’s a problem.
Colette Shade: Yeah.
Nima: The solution should attack the cause of that problem, not just the problem. Which gets back to your brain-in-a-vat thing.
Colette Shade: But then if you can’t get out of bed, then that’s also a problem.
Nima: Mm hmm.
Colette Shade: So in short, things are rather complicated.
Nima: They are rather complicated, brains are complicated. Well, before we let you go, Colette is there anything that you are currently working on that our listeners can be paying attention to or looking out for that you want to talk about?
Colette Shade: So I’m currently working on a piece for The Nation about mental health awareness campaigns and I’m currently working on a piece for The New Republic about mental health in the workplace and I’m also working on a book proposal about the intersection of mental health and politics.
Nima: We will absolutely be looking out for that. I really can’t thank you enough for joining us today, Colette shade, who writes essays about the intersection between mental health politics and history, currently a masters student at the University of Maryland School of Social Work, where she focuses on behavioral health and psychotherapy and, as just mentioned, working on a book and numerous articles that we must all read, you can follow her on Twitter @MsShade. Colette Shade, thank you so much for joining us today on Citations Needed.
Colette Shade: Thanks for having me.
Adam: Yeah, I think, again, it’s not as if we don’t think the interpersonal micro tips or life hacks are important. I think they’re good, I think they are useful. It’s just interesting, it’s the Cass Sunstein crippling epistemology that the very nature of the way journalism is set up is that you can witness and you can provide sort of atomized solutions but anything beyond that is considered — I don’t know — Communist propaganda or sort of ideological. But again, the act of atomizing is itself very ideological.
Nima: Because it all winds up being just palliative as opposed to preventative, so it’s never going to investigate why these issues are so deep, right? It goes back to the, ‘You’re going to get a $20 discount on the parking ticket. You’re already getting a parking ticket, you’re already getting something that’s punitive but, you know what, maybe we can kind of discount it like a little bit if you pay up right away,’ and just extrapolating that into all of these articles and into all of the punditry and all the political statements, it shows you that there is such a fundamental resistance to discussing systems, to discussing structural oppression, to discussing any way out, any solutions that actually take the changing of the way things are as opposed to merely coping, just dealing with it, do your yoga, do your meditation, go for a long walk, hug your kids when, you know, you don’t want to run the other way because they’re always in your house. So, there is such a resistance to viewing issues at a systemic level and that’s why you get everything which is just either ‘Hey, just so you know, things are really shitty, here’s a study,’ or ‘Just so you know, I know you’re feeling really shitty but here’s how maybe like five minutes a day you could not want to go completely nuts.’
Adam: Yeah, we have, we have another CDC study confirming that it’s traumatic that a blood-sucking monster is wreaking hell. I mean, no shit, we know this and so it’s like, I was so struck by the psychiatrist for the professor of psychiatry at Harvard Medical School, where he says, quote, “Accept the fact that it might be a crappy winter. Don’t try to fight it. Let the emotions come. It’s a wave. It crashes over you, and then it passes.” Which I think is a perfect distillation of neoliberal ideology, which again, in a sort of interpersonal sense, it’s sort of true enough, I doubt there’s anything the average person in and of themselves can do, but let’s say there’s 100 people for whom this applies in the greater Manhattan area, what is those 100 people got together and what if they started a political organization or letter writing campaign to their Congressperson asking for more— I mean, these things are not waves.
Nima: The wave is not going to crash and then pass if you’re dead or someone in your family dies or you lose your job that you don’t get back and you can’t pay rent and then you’re evicted. That’s not a passing, crashing wave.
Adam: You don’t have to accept the fact that it’s going to be a crappy winter. That is not a law of nature. Now, again, I want to make very clear, we’re not saying that socialized medicine and mortgage cancellations are, we’re not saying they’re a panacea at all. But they’re a very important first step to any serious conversation about how to immediately ameliorate suffering and I tell you when I read this, “Accept the fact that it might be a crappy winter. Don’t fight it. It’s a wave.” I’m telling you, this is indistinguishable from Sunday school when I grew up as a kid, this is a religious statement. It’s saying suffering is not only inevitable, but it’s noble and you have to just accept it, but you don’t have to accept it. This is why one of the core liberating tenets I think of atheism, and we’ve dunked on atheism in the show a lot and I’ve been thinking about it a lot lately my own sort of perceptions of atheism, the reason why I think that rejecting spiritualism and rejecting superstition and rejecting religion in all its forms is essential to any meaningful leftist ideology is because when you get rid of those things, you suddenly realize that the world is man-made, person-made, it is not ordained by god and it won’t be fixed by solipsism and prayer. It is fixed by doing things. It is fixed by a collection of humans getting together and saying we can change this. When things start to tell you to suck it up and eat shit, your red flag should start going off because there’s a lot of ideological work done by something ‘It’s gonna be a hard winter. Fucking accept it.’ Well, don’t accept it.
Nima: Yeah, we don’t have to accept this. We can get together and actually try and change things for the better. But that will do it for this episode of Citations Needed. Thank you everyone for listening. You can follow the show on Twitter @CitationsPod, Facebook Citations Needed, become a supporter of the show through Patreon.com/CitationsNeededPodcast with Nima Shirazi and Adam Johnson. An extra special shout out as always goes to our critic level supporters through Patreon. I am Nima Shirazi.
Adam: I’m Adam Johnson.
Nima: Citations Needed is produced by Florence Barrau-Adams. Associate producer is Julianne Tveten. Production assistant is Trendel Lightburn. Newsletter by Marco Cartolano. Transcriptions are by Morgan McAslan. The music is by Grandaddy. Thanks again, everyone. We’ll catch you next time.
This episode of Citations Needed was released on Wednesday, November 25, 2020.
Transcription by Morgan McAslan.