An amuse bouche while I’m preparing the rest of the menu

I’ve been thinking a lot about the things going on in the Ruby community at the moment.

I’ve been trying to tease them out into separate threads where possible:

• the Ruby Central situation with RubyGems;
• the demise of RailsConf vs the rise of Rails World;
• the growing schisms in our community spaces (X vs Mastodon/BlueSky, Discord vs… Discord);
• and last but by no means least, the impact DHH’s personal blog & politics are having on our community.

… and although I realise that they are not entirely separate, I have to try and think about them separately to have any hope of figuring out what I believe, and how that should inform the choices I make.

I’m working on probably several posts about those things, but while doing research, I found something that I thought was worth sharing.

David’s personal blog is, unsurprisingly, a mingling of this thoughts on technology and, increasingly, opinions about politics, culture, health, demographics, and many other issues.

His post about London – which I find extremely problematic to say the least¹, and is will be one of the main topics of a future post here, I hope – is what inspired me to actually pay closer attention to some of the other things he’s written about in the past.

I’ve long understood that our personal views about many things were diverging, but since he seems to be at least reading books or citing sources, even though I might’ve disagreed with his arguments or conclusions, at least they seemed to be actual arguments instead of just, say, the edgy hot-takes of an increasingly radicalised anti-woke millionaire dressed up as insight.

But then I dug in a little.

Read the citations

Here’s a quote from his post “Building competency is better than therapy”, in which he argues that there’s deep fulfilment available from hard work and focus (probably true!) and perhaps that’s what most people need instead of talk therapy or medication (we’ll see).

The world is waking to the fact that talk therapy is neither the only nor the best way to cure a garden-variety petite depression. Something many people will encounter at some point in their lives. Studies have shown that exercise, for example, is a more effective treatment than talk therapy (and pharmaceuticals!) when dealing with such episodes. But I’m just as interested in the role building competence can have in warding off the demons.

He’s got citations for the assertion that “exercise is a more effective treatment that therapy or drugs”, which give the effect of lending weight to the assertion, but I actually looked at those studies, and… well, look:

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials

Results: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges’ g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.

Conclusions: […] These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.

Let me pull out the important parts for you:

1. “only one study met the Cochrane criteria for low risk of bias. As a result, confidence […] was low for walking or jogging and very low for other treatments.” Cochrane is the gold standard for performing meta-analyses across multiple studies. What this means is that these studies are low quality, and confidence of the results is accordingly low.
2. “These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.” You read it right: alongside.

Nowhere in the abstract for this study does it suggest that exercise is better than talk therapy or medications. Certainly the study does not suggest using them as an alternative.

Maybe the second one will support David’s point instead:

Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews

Results: Results Ninety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=−0.43, IQR=−0.66 to –0.27), anxiety (median effect size=−0.42, IQR=−0.66 to –0.26) and psychological distress (effect size=−0.60, 95% CI −0.78 to –0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions.

Conclusion and relevance: Physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.

I’ll save you some work and pull out the key points again:

“Most reviews […] had a critically low A MeaSurement Tool to Assess systematic Reviews score.”.

I hadn’t head of “A MeaSurement Tool”, so I had to ask AI about this. In the spirit of fairness I asked the AI most likely to be sympathetic with David’s perspective² and here’s what it said:

The sentence “Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score.” means that the majority of the 97 systematic reviews included in this umbrella review were judged to be of very poor methodological quality.

And guess what – again, nowhere does the study conclude that exercise is better than therapy or medical interventions for depression, nor that they should be considered as a replacement.

Pointless assertions

I don’t mean to seize on this particular post of David’s to say “Gotcha! You are wrong!”. I almost laugh at myself, spending all this time because “someone is wrong on the internet!” Oh James, you sweet summer child.

No, I’ve written this, is because I think it’s a good illustration of how individual opinions can be dressed up with selective citation and important sounding sentences to give the appearance of insight.

I’m not disputing that many people might benefit from exercise to help their mental health, nor with – assuming best intentions – David’s assertion that many people would feel their days improved via hard work and focus on something they can really invest it.

But there’s no reason to couple those uncontroversial ideas with the assertions that therapy and medication are less effective, or even inappropriate. It’s not supported by the studies he cites, but more importantly, asserting those baseless “facts” isn’t even necessary to make the point he cares about. Why bother?

Share your actual experience

Has he had negative experiences with either therapy or medication, irst-hand or otherwise? If so, he could write about that, I think that would be really interesting, and personal experience is always valid. Here’s a great example from Richard Schneeman – co-incidentally refuting a similar hot-take from David about ADHD.

But I am not sure David has experience of either depression or therapy/medication. Nor, I suspect, does he have any experience as a minority, or as neuro-atypical, or someone who’s even slightly overweight, or as the parent of a girl³, or so many other aspects of existence that fall outside of his personal experience. But that doesn’t stop him writing about them as if, just because he’s done a bit of selective reading, he’s acheived some insight and can bring his New Wisdom down from Millionaire Mountain for the rest of us to benefit from.

So many of David’s non-technical posts are written in this way, making some kind of proclamation, seemingly backed up by research or reading, and yet now I wonder, how much of that is just scaffolding constructed to prop up an opinion or intuition that he already had, and just wanted to justify.

Look… I’m getting worked up. As Tom said, he’s just one man, with one man’s experience. That’s the human condition, after all!

But, as I hope to get to in a later post, when you’re the leader of a community, I think you have to hold yourself to a higher standard than just any old dude on the internet firing their dressed-up reckons out into an echo chamber of sychophantic back slappers. Oops, I mean: X.

I think DHH has great taste in software. I have done, and continue to benefit greatly from his Open Source gifts. I’ve had constructive disagreements with him in the past, always respectful. He’s even told me, on one rare occasion, that he was wrong! That kind of humility would be a breath of fresh air.

But despite saying “whoever shows up is welcome”, his personal politics are becoming increasingly hard to ignore. There’s a bitter irony in his ban of politics at his own place of work, while yet he doesn’t recognise that, because of his position in our community, when we work with Rails we are all his colleagues in this community space, and his amplified position makes it almost impossible to filter out his own politics.

Anyway. I’ve more to say about that, but it’s for another time. Soon I hope.

Not every thought needs to be framed as counter to another

I guess I should wrap this up. I only wanted to make a small point.

When you’re making some point, you don’t have to frame it as a counterpoint to something else.

Maybe exercise and building competency can be good without diminishing the value of talk therapy or medication.

Maybe the same cultural “ideals” don’t apply to both Cophenhagen and London.

Maybe there’s lots of ways to live life, and maybe we should spend a bit less time trying to invalidate the experiences of others, and a bit more time listening, practicing humility, and thinking about our privileges and biases instead.