Wednesday, November 25, 2020

MIA Reports

In-depth reporting on stories and issues related to all aspects of psychiatry and its impact on society today.

The Latest “Breakthrough Therapy”: Expensive New Drugs for Tardive Dyskinesia

The increased prescribing of antipsychotics, which frequently cause a brain injury that manifests as tardive dyskinesia, has provided pharmaceutical companies with a lucrative new market opportunity.

How Culture Influences Voice Hearing: An Interview with Stanford Anthropologist Tanya Luhrmann

Ayurdhi Dhar interviews Tanya Luhrmann about cultural differences in voice-hearing, diagnosis and damaged identities, and conflicts in psychiatry.

Surviving Antidepressants: An Interview with Adele Framer

That is the truth about withdrawal syndrome: It’s like a 50-50 chance that you’re going to have a problem. If you’re in the unlucky half, you’re gonna be really unlucky.
illustration of a voter box in a stormy ocean with a ladder

Voting While “Mentally Ill”: A Legacy of Discrimination

Legal and practical barriers to voting disenfranchise people judged "mentally incompetent." The centuries-old, unclear laws and regulations also disproportionately affect people of color.

Can We Move Toward Mindful Medicine? An Interview with Integrative Psychiatrist Natalie Campo

MIA's Madison Natarajan interviews Natalie Campo about integrative psychiatry and holistic approaches to drug tapering and withdrawal.
Illustration of the Queer Eye cast

Diving into Your Soul: Lessons from “Queer Eye”

"Queer Eye" has a fresh, therapeutic twist: Installment after installment, it sends the repeated messages: Take care of yourself. Be kind to yourself. You’re beautiful. You’re good. We love you. Love yourself. Or, in the words of Van Ness: Yass, queen!

Leading Psychology in Existential Times: An Interview with Kirk Schneider

MIA’s Justin Karter interviews humanistic-existential psychologist Kirk Schneider about how psychology can play a role in confronting the political, social, and climate crises facing humankind.

“I Found My Lion’s Roar”: Ro Speight on Combining Peer Support and Open Dialogue

MIA's Ana Florence interviews recovery advocate Ro Speight about her journey from receiving Peer Support to working as a facilitator in Peer Partnered Open Dialogue.

Will the Mental Health Industry Undermine the Community-Based Climate Change Revolution?

As mainstream mental health ideas and approaches are increasingly incorporated by community resilience-building groups, critics warn about the dangers of pathologizing and medicalizing reactions to climate change.

An FDA Whistleblower’s Documents: Commerce, Corruption, and Death

In 2008, a reviewer of psychiatric drugs at the FDA, Ron Kavanagh, complained to Congress that the FDA was approving a new antipsychotic that was ineffective and yet had adverse effects that increased the risk of death. Twelve years later, a review of the whistleblower documents reveal an FDA approval process that can lead to the marketing of drugs sure to harm public health.

Psychiatry and the Selves We Might Become: An Interview with Sociologist Nikolas Rose

MIA’s Ayurdhi Dhar interviews the well-known sociologist of medicine, Nikolas Rose, about the role psychiatry plays in shaping how we manage ourselves and our world.

How to Know What We Don’t Know: An Interview with Psychologist and Novelist Jussi...

MIA's Gavin Crowell-Williamson interviews the neuropsychologist and novelist Jussi Valtonen about how novels can lead us to see the limits of our understanding.

Mental Health and Emotion in the Digital Age: An Interview with Ian Tucker

MIA's Tim Beck interviews psychologist Ian Tucker about the relationships between digital technologies, emotion, and mental health.
covid in a psychiatric hospital

Reporting the COVID Crisis at Psychiatric Hospitals: A Missed Opportunity

In its coverage of the impact of COVID on psychiatric hospitals, the media missed opportunities to challenge stereotypes and interrogate problems with current carceral approaches to mental health treatment.

World Benzodiazepine Awareness Day 2020

This week on MIA Radio, we present the second part of our podcast to join in the events for World Benzodiazepine Awareness Day 2020...

Bridging Critical and Conceptual Psychiatry: An Interview with Awais Aftab

MIA’s Justin Karter interviews psychiatrist Awais Aftab about how “conceptual competence” uses philosophy to transform psychiatry.

Exercise for Youth Mental Health in the Lockdown: Interview with Psychologist Scott Greenspan

School Psychologist Scott Greenspan discusses how to promote exercise and mental wellbeing for adolescents stuck indoors during the pandemic.

Bringing Human Rights to Mental Health Care: An Interview with UN Envoy Dainius Pūras

MIA's Ana Florence interviews United Nations Special Rapporteur Dainius Pūras about his own journey as a psychiatrist and the future of rights-based approaches to mental health.

“Free Our People!” Ex-Psychiatric Patients Demand COVID-19 Accountability in State-Run Facilities

Residents and workers are dying from COVID-19 exposure in Massachusetts state hospitals. One group of ex-psychiatric patients and allies has had enough.

When Psychology Speaks for You, Without You: Sunil Bhatia on Decolonizing Psychology

MIA’s Ayurdhi Dhar interviews Sunil Bhatia about decolonizing psychology, confronting the field’s racist past, colonial foundations, and neoliberal present.

The Latest “Breakthrough Therapy”: Expensive New Drugs for Tardive Dyskinesia

The increased prescribing of antipsychotics, which frequently cause a brain injury that manifests as tardive dyskinesia, has provided pharmaceutical companies with a lucrative new market opportunity.
illustration of a voter box in a stormy ocean with a ladder

Voting While “Mentally Ill”: A Legacy of Discrimination

Legal and practical barriers to voting disenfranchise people judged "mentally incompetent." The centuries-old, unclear laws and regulations also disproportionately affect people of color.
Illustration of the Queer Eye cast

Diving into Your Soul: Lessons from “Queer Eye”

"Queer Eye" has a fresh, therapeutic twist: Installment after installment, it sends the repeated messages: Take care of yourself. Be kind to yourself. You’re beautiful. You’re good. We love you. Love yourself. Or, in the words of Van Ness: Yass, queen!

An FDA Whistleblower’s Documents: Commerce, Corruption, and Death

In 2008, a reviewer of psychiatric drugs at the FDA, Ron Kavanagh, complained to Congress that the FDA was approving a new antipsychotic that was ineffective and yet had adverse effects that increased the risk of death. Twelve years later, a review of the whistleblower documents reveal an FDA approval process that can lead to the marketing of drugs sure to harm public health.

World Benzodiazepine Awareness Day 2020

This week on MIA Radio, we present the second part of our podcast to join in the events for World Benzodiazepine Awareness Day 2020...
A woman holding a sign that says LA Jails are the Largest Mental Health Institution in the Country."

Bedlam: Public Media, Power, and the Fight for Narrative Justice

A new mental health documentary awakens longstanding tensions around voice, representation, and the power to define problems and solutions.

Muzzled by Psychiatry in a Time of Crisis

The American Psychiatric Association and its former president, Jeffrey Lieberman, have used the Goldwater Rule to try to silence Yale psychiatrist Bandy Lee and colleagues who warned, in a collection of essays, about why President Trump is "dangerous." Why would a guild choose to do this?
Hospital entrance with no visitors sign.

Life Inside America’s Psychiatric Facilities During the Pandemic: Eyewitness Accounts

Insiders paint a picture of chaos and fear in public and private psychiatric hospitals across the country. "Now that she has been discharged, Sevigny is getting the truth out, just as the nurse asked her to do. She also plans to continue to organizing in her state, with and on behalf of those who continue to be subjected to dangerous conditions in the name of care."

America’s Psychiatric Facilities Are ‘Incubators’ for COVID-19

As the novel coronavirus continues to wreak havoc around the globe, whistleblowers at American psychiatric facilities paint a picture of mismanaged COVID-19 responses and lax safety protocols, putting patients, workers, and the surrounding communities in harm’s way. Some even allege coverups of deaths.

“Not Fragile”: Survivor-Led Mutual Aid Projects Flourish in a Time of Crisis

During the current pandemic, the practice of mutual aid—defined broadly as the ways that people join together to meet one another’s needs for survival and relationship—has become mainstream. Yet, often missing from major media coverage of mutual aid is any acknowledgment of its roots in movements led by marginalized people, including Black and Brown people, disabled people, mad people, and psychiatric survivors.

Mutual Support in an Age of Social Distancing

Connection, whether one-on-one or in groups, is at the heart of peer support. In a time when social distancing and stay-at-home orders proliferate, the Western Massachusetts Recovery Learning Community/Wildflower Alliance (WMRLC) is finding creative ways to adapt to rapidly changing circumstances dictated by the novel coronavirus.
cartoon drawing of many eyes on red background

Mental Health Apps: AI Surveillance Enters Our World

While the developers are promoting the apps as a public health initiative, they are effectively an AI that would be snooping on you at all times—ostensibly coming to know you better than you know yourself. And ultimately doing so for commercial purposes that will expand the psychiatric enterprise.
VA Secretary Robert Wilkie

An Open Letter to VA Secretary Robert Wilkie: A Plan for Deprescribing Veteran Suicides

Through my research and experiences, I've found that what the Veterans Administration has been doing to fight the veteran suicide epidemic isn't working and appears to be unintentionally exacerbating it. These problems are fixable. But I need your help.

The Whistleblower and Penn: A Final Accounting of Study 352

After 18 years, the full story of the scientific corruption in a study of paroxetine for bipolar disorder, and the psychiatrist who blew the whistle.

Prescribing an Epidemic: A Veteran’s Story

Had I known what I know now, I never would have taken any of these drugs, and I absolutely would not have taken a role in which my outreach efforts to get veterans into mental health treatment might place thousands of lives at risk.

Medication-Free Treatment in Norway: A Private Hospital Takes Center Stage

At the Hurdalsjøen Recovery Center in Norway, patients with a long history of psychiatric hospitalizations are tapering from their medications and, in a therapeutic environment that emphasizes a good diet, exercise, and asking patients "what do they want in life," are leaving their old lives as chronic patients behind.
veteran suicides

Screening + Drug Treatment = Increase in Veteran Suicides

For the past 15 years, the VA's suicide prevention efforts have focused on getting veterans screened and treated for psychiatric disorders, with antidepressants a first-line therapy. This effort has caused veteran suicide rates to steadily rise.
veterans do shakespeare

Veterans Find A Path to Healing Through Shakespeare

Veterans struggling with a diagnosis of PTSD, or depression and other difficulties find that learning to perform Shakespearean monologues, and developing their own dramatic monologues, can help them "unwire" from the traumas of war.
digital antipsychotic

The Rise of the Digital Asylum

The digital pill Abilify MyCite, which is now being introduced into the market, foretells of a future where such technology is used to monitor the behavior, location and "medication compliance" of a person 24 hours a day.

Mad Pride Rises in Mexico

The Mad Pride movement continues to spread around the world, with a first-ever march in Mexico City.
AOT

Andrew Rich: “I Didn’t Know Stuff Like This Existed”

In this second part of MIA’s report on compulsory outpatient treatment orders, Michael Simonson tells of how he came to report on this topic, the results from MIA’s survey of people who have experienced such forced treatment, his interviews with several of the survey respondents, and more on Andrew Rich’s life.

Twenty Years After Kendra’s Law: The Case Against AOT

The proponents of compulsory outpatient treatment claim that it leads to better outcomes for the recipients, and protects society from violent acts by the "seriously mentally ill." Those claims are belied by history, science, and a critical review of the relevant research.
adverse childhood experiences

Adverse Childhood Experiences: When Will the Lessons of the ACE Study Inform Societal Care?

The ACE study tells of how adverse childhood experiences increase the risk of psychological and physical problems in adulthood. When will we start incorporating these findings into public health policy and medical care?

William Styron: His Struggles with Psychiatry and Its Pills

Author William Styron is often remembered for speaking about depression as an illness. But a review of his life reveals that psychiatric drugs may have triggered and even worsened his depressive episodes.

MIA Survey: Ex-patients Tell of Force, Trauma and Sexual Abuse in America’s Mental Hospitals

In a MIA survey of people who had been patients in mental hospitals, nearly 500 respondents told of an experience that was often traumatic, and frequently characterized by a violation of their legal rights, forced treatment with drugs, and physical or sexual abuse. Only 17% said they were “satisfied” with the “quality of the psychiatric treatment” they received.

The Latest “Breakthrough Therapy”: Expensive New Drugs for Tardive Dyskinesia

The increased prescribing of antipsychotics, which frequently cause a brain injury that manifests as tardive dyskinesia, has provided pharmaceutical companies with a lucrative new market opportunity.

An FDA Whistleblower’s Documents: Commerce, Corruption, and Death

In 2008, a reviewer of psychiatric drugs at the FDA, Ron Kavanagh, complained to Congress that the FDA was approving a new antipsychotic that was ineffective and yet had adverse effects that increased the risk of death. Twelve years later, a review of the whistleblower documents reveal an FDA approval process that can lead to the marketing of drugs sure to harm public health.

Do Antipsychotics Protect Against Early Death? A Review of the Evidence

Psychiatry is now claiming that research has shown that antipsychotics reduce mortality among the seriously mentally ill. A critical review of the literature reveals that this claim is best described as the the field's latest "delusion" about the merits of these drugs.

The Charade of New Drug Approvals for Schizophrenia

The FDA recently approved lumateperone for schizophrenia. A review of the clinical trials reveals a testing process that is fatally flawed, and a new drug coming to market that doesn't provide a clinically meaningful benefit.
veteran suicides

Screening + Drug Treatment = Increase in Veteran Suicides

For the past 15 years, the VA's suicide prevention efforts have focused on getting veterans screened and treated for psychiatric disorders, with antidepressants a first-line therapy. This effort has caused veteran suicide rates to steadily rise.

Suicide in the Age of Prozac

During the past twenty years, the American Foundation for Suicide Prevention and American psychiatry have adopted a "medicalized" approach to preventing suicide, claiming that antidepressants are protective against suicide. Yet, the suicide rate in the United States has increased 30% since 2000, a time of rising usage of antidepressants. A review of studies of the effects of mental health treatment and antidepressants on suicide reveals why this medicalized approach has not only failed, but pushed suicide rates higher.
antidepressants

Do Antidepressants Work? A People’s Review of the Evidence

After a meta-analysis of RCTs of antidepressants was published in Lancet, psychiatry stated that it proved that "antidepressants" work. However, effectiveness studies of real-world patients reveal the opposite: the medications increase the likelihood that patients will become chronically depressed, and disabled by the disorder.

Psychiatry Defends Its Antipsychotics: A Case Study of Institutional Corruption

Jeffrey LIeberman and colleagues have published a paper in the American Journal of Psychiatry stating that there is no evidence that psychiatric drugs cause long-term harm, and that the evidence shows that these drugs provide a great benefit to patients. A close examination of their review reveals that it is a classic example of institutional corruption, which was meant to protect guild interests.

The Case Against Antipsychotics

This review of the scientific literature, stretching across six decades, makes the case that antipsychotics, over the long-term, do more harm than good. The drugs lower recovery rates and worsen functional outcomes over longer periods of time.

How Culture Influences Voice Hearing: An Interview with Stanford Anthropologist Tanya Luhrmann

Ayurdhi Dhar interviews Tanya Luhrmann about cultural differences in voice-hearing, diagnosis and damaged identities, and conflicts in psychiatry.

Surviving Antidepressants: An Interview with Adele Framer

That is the truth about withdrawal syndrome: It’s like a 50-50 chance that you’re going to have a problem. If you’re in the unlucky half, you’re gonna be really unlucky.

Can We Move Toward Mindful Medicine? An Interview with Integrative Psychiatrist Natalie Campo

MIA's Madison Natarajan interviews Natalie Campo about integrative psychiatry and holistic approaches to drug tapering and withdrawal.

Leading Psychology in Existential Times: An Interview with Kirk Schneider

MIA’s Justin Karter interviews humanistic-existential psychologist Kirk Schneider about how psychology can play a role in confronting the political, social, and climate crises facing humankind.

“I Found My Lion’s Roar”: Ro Speight on Combining Peer Support and Open Dialogue

MIA's Ana Florence interviews recovery advocate Ro Speight about her journey from receiving Peer Support to working as a facilitator in Peer Partnered Open Dialogue.

Psychiatry and the Selves We Might Become: An Interview with Sociologist Nikolas Rose

MIA’s Ayurdhi Dhar interviews the well-known sociologist of medicine, Nikolas Rose, about the role psychiatry plays in shaping how we manage ourselves and our world.

How to Know What We Don’t Know: An Interview with Psychologist and Novelist Jussi...

MIA's Gavin Crowell-Williamson interviews the neuropsychologist and novelist Jussi Valtonen about how novels can lead us to see the limits of our understanding.

Mental Health and Emotion in the Digital Age: An Interview with Ian Tucker

MIA's Tim Beck interviews psychologist Ian Tucker about the relationships between digital technologies, emotion, and mental health.

Bridging Critical and Conceptual Psychiatry: An Interview with Awais Aftab

MIA’s Justin Karter interviews psychiatrist Awais Aftab about how “conceptual competence” uses philosophy to transform psychiatry.

Exercise for Youth Mental Health in the Lockdown: Interview with Psychologist Scott Greenspan

School Psychologist Scott Greenspan discusses how to promote exercise and mental wellbeing for adolescents stuck indoors during the pandemic.

Bringing Human Rights to Mental Health Care: An Interview with UN Envoy Dainius Pūras

MIA's Ana Florence interviews United Nations Special Rapporteur Dainius Pūras about his own journey as a psychiatrist and the future of rights-based approaches to mental health.

When Psychology Speaks for You, Without You: Sunil Bhatia on Decolonizing Psychology

MIA’s Ayurdhi Dhar interviews Sunil Bhatia about decolonizing psychology, confronting the field’s racist past, colonial foundations, and neoliberal present.

Where Western Medicine Meets Indigenous Healing: An Interview with Anthropologist Ian Puppe

MIA's Micah Ingle interviews the anthropologist Ian Puppe on how the imposition of psychiatric treatments can lead to harmful iatrogenic effects with Indigenous peoples.
Rows and rows of metal markers commemmorating unmarked patient graves.

Narrating Asylum History Through an Anti-Racist Lens: An Interview with Author Mab Segrest

Mab segrest is Professor Emeritus of Gender and Women's Studies at Connecticut College and the author of Administrations of Lunacy: Racism and the Haunting...

Psychology is Not What You Think: An Interview with Critical Psychologist Ian Parker

MIA’s Ayurdhi Dhar interviews Ian Parker about critical psychology, discourse and political action, and whether psychology has anything left to offer.
Laysha Ostrow

Live and Learn: An Interview with Laysha Ostrow

MIA’s Peter Simons interviews Laysha Ostrow about her mental health research and consulting company, the inclusion of peer specialists in mental health care, and her personal experience with the mental health system.

Moving Mental Health Work Away from Diagnosis: Sarah Kamens and Peter Kinderman on New...

MIA's Justin Karter interviews two leaders of the Task Force on Diagnostic Alternatives, a group of mental health professionals who have issued an open letter demanding a new look at psychiatric diagnosis.

Psychology and Poverty: An Interview with APA President Rosie Phillips Davis

MIA’s Gavin Crowell-Williamson interviews psychologist Rosie Phillips Davis about her presidential initiative to address deep poverty.
prison

The Management of Captive Populations with Psychiatric Drugs: An Interview with Anthony Ryan Hatch

Dr. Anthony Ryan Hatch is a sociologist and associate professor of Science in Society, African American studies and Environmental Studies at Wesleyan University, who...

Opening Doors in the Borderlands: An Interview with Liberation Psychologist Mary Watkins

MIA’s Micah Ingle interviews Mary Watkins about reorienting psychology toward liberation and social justice.

“Free Our People!” Ex-Psychiatric Patients Demand COVID-19 Accountability in State-Run Facilities

Residents and workers are dying from COVID-19 exposure in Massachusetts state hospitals. One group of ex-psychiatric patients and allies has had enough.

Capitol Hill Briefings Debunk Myth Linking Gun Violence to Mental Illness

The public is regularly led to believe that mass shootings are committed by people diagnosed with a serious mental illness. Researchers explain that is just plain wrong, and prevents our society addressing the most common causal factors.
Bernie Sanders

Bernie Sanders’ ‘Revolutionary’ Disability Plan Opposes Expanding Involuntary Treatment

Candidate Bernie Sanders' 'disability rights as civil rights' plan is distinctive in its explicit inclusion of people with psychiatric disabilities and diagnoses, an orientation that runs counter to prevailing policy discourse in the U.S. 
Trump at mental health summit

Trump Calls for “Keeping Very Dangerous People Off Our Streets” at Mental Health Summit

A common refrain from the pro-forced treatment advocates at the summit was that "four walls" are not the solution to the crisis. Dr. Drew slammed such efforts in California during his presentation: "The vast majority have serious mental illness and drug addiction. Four walls are not going to do anything, if they would even go in."
Kamala Harris

Kamala Harris’s ‘Mental Health’ Plan: Why It Still Matters

Harris’s plan was met with vociferous condemnation from psychiatric survivors, civil libertarians, and disability justice advocates, who vowed to fight it. While Harris has dropped out of the presidential race, the ideas behind her policy proposal have existed for decades, and are likely to endure.
RESPONSE Act

Here We Go Again: RESPONSE Act Pushes Forced Treatment of the “Mentally Ill” As...

In the name of preventing mass shootings, Senator John Cornyn (R-TX) introduced a bill that calls for "enhanced mental health services," including involuntary treatment and long-acting antipsychotic injections. It also calls for increased collaboration between mental health and law enforcement authorities, and promotes online monitoring of American students.

Congress Holds Historic Hearing on Childhood Trauma

On July 11, the House Committee on Oversight and Reform held its first-ever hearing on childhood trauma, featuring emotional testimony from survivor witnesses, as well as a number of prominent public health experts and government officials.
proposed act would address childhood trauma in america

Bipartisan “RISE from Trauma Act” Introduced to Address Childhood Trauma in America

The Resilience Investment, Support, and Expansion (RISE) From Trauma Act, legislation designed to increase support for children who have been exposed to Adverse Childhood Experiences, includes $50 million in funding for a “mental health in schools” program. Exactly what these programs would entail remains unclear.
Illustration of the Queer Eye cast

Diving into Your Soul: Lessons from “Queer Eye”

"Queer Eye" has a fresh, therapeutic twist: Installment after installment, it sends the repeated messages: Take care of yourself. Be kind to yourself. You’re beautiful. You’re good. We love you. Love yourself. Or, in the words of Van Ness: Yass, queen!
covid in a psychiatric hospital

Reporting the COVID Crisis at Psychiatric Hospitals: A Missed Opportunity

In its coverage of the impact of COVID on psychiatric hospitals, the media missed opportunities to challenge stereotypes and interrogate problems with current carceral approaches to mental health treatment.
medical mask

Inside a Pandemic: Media Struggle to Define What’s Normal

Press coverage of the effect of COVID-19 on mental health sends a confusing message: Becoming anxious about it is normal if you are mentally healthy but a sign of illness if you’re not. Although apparently some "normal" people might experience so much anxiety that they, too, could now be seen as mentally ill.

The Carter Center’s Guide for Mental Health Journalism: Don’t Question, Follow the Script

The Carter Center’s Journalism Resource Guide on Behavioral Health is a manual for docile journalism. There is no encouragement to be skeptical of the powerful in psychiatry. Rather, the guide provides reporters with a template to follow that reifies conventional wisdom, offering a message similar to what the American Psychiatric Association has sounded for years.
Britney Spears

The Media’s New Hashtag: #GuardianshipIsGood for Britney Spears

Recent press coverage of top star Britney Spears, who remains under a personal and professional guardianship, reflects conventional attitudes about “mental illness” that are both stigmatizing and encourage legislation that promotes forced treatment.

The Media Scolds Marianne Williamson (And Gets It Wrong)

Journalists have called Marianne Williams’ comments on depression dangerous and irresponsible. A closer look reveals that her “opinions” on mental health treatment are more in line with the science, and that the know-it-all assertions by Cooper and colleagues are belied by it.
the new yorker

The New Yorker Peers into the Psychiatric Abyss… And Loses Its Nerve

The New Yorker's story on Laura Delano and psychiatric drug withdrawal is a glass-half-full story: It addresses a problem in psychiatry and yet hides the deeper story to be told. A story of how her recovery resulted from seeing herself within a counter-narrative that tells of the harm that psychiatry can do.

Adolescent Suicide and The Black Box Warning: STAT Gets It All Wrong

STAT recently published an opinion piece arguing that the black box warning on antidepressants has led to an increase in adolescent suicide. It is easily debunked, and reveals once again how our society is regularly misled about research findings related to psychiatric drugs. STAT has lent its good name to a false story that, unfortunately, will resonate loudly with the public.

Will the Mental Health Industry Undermine the Community-Based Climate Change Revolution?

As mainstream mental health ideas and approaches are increasingly incorporated by community resilience-building groups, critics warn about the dangers of pathologizing and medicalizing reactions to climate change.