NꙮW WITH MꙮRE MULTIꙮCULAR ꙮ

Reflections From The Halfway Point

I.

A while back one of my patients was having a foot problem, so I consulted the hospital podiatrist. He met me in my workroom, and I explained exactly what I needed from him, but over the course of the explanation he started looking more and more uncomfortable and distracted, so finally I stopped and was just like “Okay, out with it, what’s your problem?”

And he said: “That guy with the wild hair pounding on the window and shouting threats and obscenities at us.”

And I said: “Oh, him? That’s just Bob. Don’t worry about him, he always does that.”

The podiatrist seemed inadequately reassured.

I thought about this because as of today I am halfway done with my four-year psychiatry residency.

One of my teachers told me that you go to medical school to learn things, and then you go to residency to get used to them. It’s not quite that simple – you certainly learn a lot in residency – but there’s a lot of truth to it. I remember that my first week on call, somebody had a seizure and I totally freaked out – AAAAH SEIZURE WHAT DO I DO WHAT DO I DO? – even though I had previously been able to pass tests on that exact situation. But my last time on call, somebody also had a seizure, and I sort of strolled in half-asleep, ordered the necessary tests and consultations and supportive care, then strolled out and went back to bed.

And then there are the little things, like learning to tune out a psychotic guy banging on the window and yelling threats at you.

II.

It’s interesting that psychiatric hospitals are used as a cliche for “a situation of total chaos” – I think I’ve already mentioned the time when the director of a psych hospital I worked at told us, apparently without conscious awareness or irony, that if Obamacare passed our hospital would have too many patients and “the place would turn into a madhouse”. There’s a similar idiom around “Bedlam”, which comes from London’s old Bethlehem psychiatric hospital.

In fact, psych hospitals are much more orderly than you would think. Maybe 80% of the patients are pretty ‘with it’ – depressed people, very anxious people, people with anger issues who aren’t angry at the moment, people coming off of heroin or something. The remaining 20% of people who are very psychotic mostly just stay in their rooms or pace back and forth talking to themselves and not bothering anyone else. The only people you really have to worry about most of the time are the manic ones and occasionally severe autistics, and even they’re usually okay.

For a place where two dozen not-very-stable people are locked up in a small area against their will, violence is impressively rare. The nurses have to deal with some of it, since they’re the front-line people who have to forcibly inject patients with medication, and they have gotten burned a couple of times. And we doctors are certainly trained to assess for it, defuse it, and if worst comes to worst hold our own until someone can get help.

Yet in the two years I’ve worked at Our Lady Of An Undisclosed Location, years when each doctor has talked to each of their patients at least once a day, usually alone in an office, usually telling them things they really don’t want to hear like “No, you can’t go home today” – during all that time, not one doctor has been attacked. Not so much as a slap or a poke.

I am constantly impressed with how deeply the civilizing instinct has penetrated. When I go out of the workroom and tell Bob, “I’m sorry, but you’re disturbing people, you’re going to have to stop banging on the window and shouting threats, let’s go back to your room,” then as long as I use a calm, quiet, and authoritative voice, that is what he does. With very few exceptions, there is nobody so mentally ill that calmness + authority + the implied threat of burly security guards won’t get them to grumble under their breath but generally comply with your requests, reasonable or otherwise.

III.

I’d like to say I’ve taken advantage of this to go mad with power. But it’s actually a really crappy situation for everyone involved.

The most common reason for admission to a psychiatric hospital is “person is a danger to themselves or others”. The average length of stay in a psychiatric hospital is about one week.

Some clever person might ask: “Hey, don’t most psychiatric medicines require more than a week to take effect?” Good question! The answer is “yes”. Antidepressants classically take four weeks. Lithium and antipsychotics are more complicated, but the textbooks will still tell you a couple of weeks in both cases. And yet people are constantly being brought to psychiatric hospitals for dangerousness, treated with medications for one week, and then sent off. What gives?

As far as I can tell, a lot of it is the medical equivalent of security theater.

The most common type of case I see is “person who was really angry, said ‘I’ll kill myself’ in a fit of rage, and then their partner called the cops and they were brought to hospital.” These people stop being angry after a day or two and then no longer make these comments, even assuming they meant it in the first place which most of them don’t.

The second most common type of case I see is “person who was really angry, did try to kill themselves, and it didn’t work.” Again, these people have stopped being angry. Failed suicide attempts also have their own interesting way of clearing the mind for a little while, so they’re in a sort of grace period. Sending these people to a psychiatric hospital makes the public feel good because they’re Doing Something About Suicide, and makes psychiatrists feel good because after a few days they’ve stopped being suicidal so it looks like we’re Making A Difference. There is no way we could leave this equilibrium now even if we wanted to, because if we didn’t keep these people for a week and they ever attempted suicide again, we would get sued to oblivion.

The third most common type of case I see is “severely mentally ill person who’s been living at a care home for twenty years, but then they got in a fight and so their care home sent them to the hospital.” We shuffle their medications around and send them back to the care home where they’d been living happily for twenty years until some random trigger set them off.

We don’t call this “security theater”. We do sometimes call it a “holding environment”. Psych hospitals are kind of boring. There’s no boyfriend to get in a screaming match with, no boss pushing you to work harder, and no drug dealers to get heroin from. On the other hand, there’s lots of structure – art therapy at 10, meeting with your doctor at 11, recreation group at 12, and so on. It’s like a terrible vacation in the world’s least attractive hotel. People get a chance to cool off and forget about whatever set them off. Then they go back to their life. If they’re lucky, our social workers have managed to connect them to a better outpatient psychiatrist, care home, or support group, and maybe that will improve their lives sometime down the line. But I don’t think anyone imagines there was some fundamental Quality Of Dangerousness in them which is now gone.

To the degree that it is all security theater, it’s really hard to give an honest answer to a patient asking why they have to stay in hospital.

When I first started this work, my reaction to these people was “Come on, it’s only a week, it’s not like you’re stuck here forever, just deal with it.” This lasted until I remembered that when some stupid policy forces me to come into hospital on a day I would otherwise have off, I freak out, because I value my free time too much to be okay with having it taken away from me for bad reasons. Heck, my power was out the past couple of days, and I couldn’t use the Internet, and I was calling the power company and being like “COME ON YOU NEED TO FIX THIS ALREADY I AM LOSING DAYS OF MY LIFE THAT I COULD OTHERWISE BE SPENDING IN IMPORTANT STUFF.” So now I try to avoid throwing stones.

(there’s another aspect of this, which is that people constantly protest that horrible things will happen to them based on that week. For example: “My boss said if I miss one more day of work, I’ll lose my job, and then I’ll have no way to support my family.” Or: “My rent payment is due tomorrow, if I miss it I’ll be evicted and all of my stuff will go to the landfill, and there’s no way I can handle this through Internet or telephone or asking a friend to help.” I assume 90% of these stories are false, but the 10% that are true are still bad enough to more than outbalance any good we can do.)

After that, my reaction to these people was “Yes, you may be angry now, but you will thank us later.” This is true of many people, including some of the most histrionically upset. But I’ve since learned that it’s probably not true of the majority. The Shrink Rap blog surveyed former psychiatric inpatients and found that 62% said their experience was not helpful and they were “the same or worse at discharge”. I’d like to dismiss this as people just carrying a grudge for having to be there at all, but the same survey finds that a very similar 56% of voluntarily admitted patients said the same thing (although not all “voluntary” admissions are as voluntary as the name expects). Now, I don’t know for sure what to think about that survey – a lot of people describe their hospitals as doing things which are super illegal and which I wouldn’t expect a hospital to be able to get away with and stay open for more than twenty-four hours, and the population of psych patients who read psychiatric blogs is probably a nonrandom sample – but I no longer feel like I can confidently say that our patients will thank us later.

(none of this is to say that you shouldn’t check yourself into a hospital if you’re feeling suicidal – you’ll get the holding environment that makes sure you don’t kill yourself for the immediate future, you’ll get connected to a system that can give you useful referrals and medications much faster, and 38% will also end up being directly helped.)

So now what I tell people is the Cliffs’ Notes version of the above – “I’m sorry you have to be here, but we are going to keep you for a few more days to evaluate you, your estimated day of discharge is X but that’s not a promise, if there’s anything specifically making you uncomfortable please let me or the nurses know and we’ll see what we can do.”

I can’t figure out a good way to say the spiel without the last sentence, which is too bad because then they do let me and the nurses know things. Most of them are things that I, as a low-ranking doctor who cannot totally rearrange the unit according to my will, have no ability to change. Some of them are things nobody can change.

Like! It turns out when you lock constitutionally anxious people in a new environment full of psychotic people, they become really really anxious. They tend to request antianxiety drugs. I am happy to give them reasonable doses of the non-addictive anti-anxiety drugs, which then totally fail to do anything, because their idiot outpatient psychiatrist was giving them heroin mixed with horse tranquilizers every day or something. They demand whatever they were getting on the outside, but twice as much, and I can’t give it to them even if I want to because of our safety policies. And now I’m the bad guy.

Or! Some people don’t like noise. I sympathize with this as I am just about the most misophonic person in the world. On the other hand, there’s always one screamer in a psychiatric hospital. Sometimes this screamer chooses to do their thing at four in the morning. The law gives us limited ability to lock them in a soundproof room, and definitely not all the time. So if you are startled by loud noise, you are kind of out of luck. Even if we can put you on the other side of the ward, you’re still going to be bothered by staff coming in your room every fifteen minutes to make sure you haven’t killed yourself, which they are legally required to do. You can complain that the lack of sleep is hurting your recovery, and I believe you, but aside from showing you where we keep the earplugs there’s not much I can do. Once again, now I’m the bad guy.

Add to this people with picky tastes that our kitchen can’t satisfy, people who get bored in the absence of some kind of entertainment we can’t provide, smokers who are unsatisfied by nicotine patches, and the occasional very honest drug addict who just wants some drugs, and I spend about 30% of my day patiently explaining to people why their preferences are totally reasonable and I realize they’re in pain but there’s nothing I can do for them at this moment.

And I know it sounds really selfish of me to say so, but this is really exhausting.

As you may have guessed, I do not very much like inpatient work. You can adjust to having to treat someone having a seizure. You can adjust to somebody banging on the window and screaming. But it’s really hard to adjust to constant moral self-questioning.

IV.

Now I am halfway done with my residency. I will be switching to outpatient work. Everyone who sees me will be there because they want to see me, or at worst because their parents/spouses/children/friends/voices are pressuring them into it. I will be able to continue seeing people for an amount of time long enough that the medications might, in principle, work. It sounds a lot more pleasant.

I have two equal and opposite concerns about outpatient psychiatry. The first is that I might be useless. Like, if someone comes in complaining of depression, then to a first approximation, after a few basic tests and questions to rule out some rarer causes, you give them an SSRI. I have a lot of libertarian friends who think psychiatrists are just a made-up guild who survive because it’s legally impossible for depressed people to give themselves SSRIs without paying them money. There’s some truth to that and I’ve previously joked that some doctors could profitably be replaced by SSRI vending machines.

The second concern is that everybody still screws it up. There’s an old saying: “Doctors bury their mistakes, architects cover theirs with vines, teachers send theirs into politics.” Well, outpatient psychiatrists send their mistakes to inpatient psychiatrists, so as an inpatient psychiatrist I’ve gotten to see a lot of them. Yes, to a first approximation when a person comes in saying they’re depressed you can just do a few basic tests and questions and then give them an SSRI. But the number of cases I’ve seen that end in disaster because their outpatient psychiatrist forgot to do the basic tests and questions, or decided that Adderall was the first-line medication of choice for depression – continues to boggle my mind. So either it’s harder than I think, or I’m surrounded by idiots, or I’m an idiot and don’t know it yet. In which case I’m about to learn.

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485 Responses to Reflections From The Halfway Point

  1. disciplinaryarbitrage says:

    I enjoyed this post a lot. I find it personally reassuring that even smart, rational, internet-famous people like yourself find themselves haunted by questions like: “Is it just me, or do I have no damn clue whether this job is net-positive or net-negative for the world?” (And maybe: “if it’s net-negative, why aren’t I getting paid more?”)

    I mean, societally speaking, that’s horrifying. But to my selfish ape-brain that wonders the same kinds of things: reassuring.

    Good luck on the outside!

    • Vaniver says:

      And maybe: “if it’s net-negative, why aren’t I getting paid more?”

      If it’s negative, why aren’t they getting paid less?

      • Hedonic Treader says:

        It can be socially negative, but the system is set up that way anyway for various reasons. And assuming most people have a conscience, no matter how weak, and assuming they know it’s net-negative, you’d expect they require some extra compensation for guilt.

        What I took away is that he is earning money with systematic human rights violations. Especially the people who are only “dangers to themselves” (suicidal, drug users) should never have been there against their will. You can’t even know whether a particular person is worse off choosing suicide, using drugs, etc., or not.

        • Why’d you need to be sure? You seem to be arguing that its OK to sacrifice the lives of N people who don’t really want to commit suicide for the rights of M people who do.

          Basically, treating rights as absolutes means treating them as more important than life, and that causes problems.

          • Hedonic Treader says:

            Your entire framing is wrong. You talk about “sacrificing lives”, but no one is sacrificing anything. Individual people choose to end their own life, or not.

            I will also point out, for the zillionth time, the hypocricy in pretending life is voluntary when it comes to discussions about natalism and the utility of poor African children, etc., and then, in the context of the prerequisites of an actual voluntariness of life, that is, suicidality and discussions thereof, suddenly switching to coercive paternalism.

            Suicide is totally an option when people need it for victim-blaming (“If they didn’t really want to suffer, they would find a way…”), but totally not an option if you actually want to define it as a legal option.

            Bait and switch, bailey and motte, whatever you want to call it.

            For me, I have found a simple position: My life is my own, and only my own, and anyone who disagrees is an enemy who deserves retaliation.

          • Ghatanathoah says:

            @Hedonic Treader

            I think the Ancient Geek is saying that suicide attempts primarily consist of two groups of people:
            1. People who genuinely want to kill themselves because they have rationally concluded that they are literally better off dead.
            2. People who would not want to kill themselves if their brains were functioning properly, but mistakenly believe suicide is a good idea for them for some reason.

            I agree with you that Group 1 should be allowed to commit suicide and it is monstrous that they are not allowed to. I suspect the Ancient Geek does as well. However, I also think that Group 2 is much larger than Group 1, and that Group 2 should be prevented from killing themselves because it is not what they would want to do if they were sane.

            I think that it is bad to force Group 1 to live, and bad to allow Group 2 to die. The problem is, there is a risk of mistaking a Group 2 person for a Group 1 person, and letting them kill themselves when they wouldn’t rationally want to. There is also a risk of mistaking a Group 1 person for a Group 2 person, and saving a life that doesn’t want to be saved. Both these potential disasters deserve serious consideration. At the moment I believe Group 2 greatly outnumbers Group 1, and desire to err on the side of caution in the direction of saving lives.

            But I fully support efforts to allow Group 1 members their right to suicide, after making sure sufficient effort is made to distinguish them from Group 2 members. For instance, allowing suicide after a waiting period and a psych examination.

          • Arcaseus says:

            One idea for fixing this dilemma would be to ask people in advance whether they would want to be commited/restrained in case they become suicidal.

            Changes to this wish would only be changed from yes to no one year after the person asks for it, and/or after a psychiatric evaluation.

            I think there was already some discussion on a similar idea on the comment thread to a previous post by Scott about the ability to pre-commit to things/make arbitrary contracts.

          • Faradn says:

            @Ghatanathoah

            That’s largely correct. People prevented from committing suicide mostly do not re-attempt.

        • Deiseach says:

          Okay, I’ll bite here, Hedonic Treader.

          At the moment, for the second time in my life, I am seriously considering suicide (the first time was when I was twelve).

          Rationally, I cannot think of a reason why I should continue living. I am not contributing and indeed net utility for my society might go up by a tiny but positive amount should I cease to exist.

          On the other hand, I also think that I am not thinking out of a completely rational, objective position because of other things (such as the feeling that my mental processes are being affected by worsening depression, one sign of which is that I am continually bursting into tears with no triggering stimulus for this, intense feelings of sadness for no reason, inclination to react angrily and to become angry very quickly and out of proportion to the situation, and general subjective perception that my mental state is not remaining stable, it is worsening)

          Now, if I go to my doctor and talk about my suicidal ideation, should they or should they not interfere? I haven’t made a serious attempt to kill myself (yet) so they probably can’t have me committed for a week, but should they (according to your lights) say “Okay, you have rationally considered the matter and feel this is the best outcome, so go ahead and top yourself”?

          Given that, as I say, my powers of reasoning are not affected in their ability to process (I know a hawk from a handsaw) and I can do my work, but there is more going on than merely reasoning about the situation and I can perceive for myself that those processes are affected in a negative way?

          As an adjunct to this, given that I am as bad or worse off now, should I indeed have tried killing myself when I was twelve and should I have been permitted to do so?

          • Teresa says:

            Please do not kill yourself. I de-lurked just to say that you’re my favorite commenter. I realize it means very little, coming from someone you have never heard of and will never meet. But you give utility to me.

          • Matt M says:

            “Now, if I go to my doctor and talk about my suicidal ideation, should they or should they not interfere?”

            Of course, assuming you’re still rational enough to think logically, this question is irrelevant in a real life example – because you know they WILL interfere, and you know that the consequences of the intervention can be potentially quite serious.

            Therefore, you are incentivized to NOT seek help until it’s really REALLY serious, by which point it will be too late.

          • Deiseach says:

            Thank you, Teresa, that was a very kind and generous thing to do.

            I’m not doing the old trick of “Oh, I’m going to KILL MYSELF, everyone rush to give me attention and affirmation”, I promise. I was using myself as an example for Hedonic Treader as I don’t think there’s so clear-cut a distinction between “I am not visibly exhibiting signs of mental distress and my reason is intact and operative” and those who are incapable of rational thought when it comes to suicide as they present.

            I think if you asked people in contact with me on a daily basis “Is this person suicidally depressed?”, they would answer “No, of course not”. And I think my reason is functional enough that, were there Euthanasia Booths on the street corners, I’d be able to make a case to qualify for the state-sanctioned draught of hemlock.

            My point is that I know my reasoning is being warped not by a failure of the power to think coherently and make a logically connected series of thoughts, but by other mental processes which are malfunctioning (it may be as simple – if it can be said to be simple – as an imbalance in my neurotransmitters).

            So letting people, who can speak in a calm and pleasant manner about why it is rational for them to commit suicide, kill themselves without intervening is more tangled a question than merely “I have the right to do what I like with my own body”.

          • So letting people, who can speak in a calm and pleasant manner about why it is rational for them to commit suicide, kill themselves without intervening is more tangled a question than merely “I have the right to do what I like with my own body”.

            I agree. Or, to put it differently, you’ve proven yet again how valuable you are to this forum.

          • Anthony says:

            my powers of reasoning are not affected in their ability to process (I know a hawk from a handsaw) and I can do my work, … I can perceive for myself that those processes are affected in a negative way?

            Your thought processes may be rational, but your emotions are, in some sense, lying to you, therefore, you are reasoning from bad data.

            Whether there’s an effective-in-your-case way to fix that, I don’t know. Presumably there’s a better way than telling a psychiatrist that you’re thinking of killing yourself and getting locked up with Scott’s classmates for a week.

          • Eli Sennesh says:

            Please don’t kill yourself. I can’t see how the net utility of your society is supposed to go up from having lost a unique individual, never to be recovered.

          • shemtealeaf says:

            I’ll throw in my agreement with Teresa here: You are undoubtedly contributing to the awesomeness of this comment section, and your insights would be missed by many readers, including me.

            I can’t presume to estimate the value of your existence, but you are definitely providing value to some people, possibly a fairly large number of people, just by writing some comments on this blog.

          • Like Teresa, I enjoy your comments. So consider that in your calculations as a small positive contribution to the utility of the world.

          • Fuck society, get joy from annoying people!

            Get joy out of sunshine!

            Stop caring, its not your fucking problem..did you make the world?

          • Creutzer says:

            Aren’t you presenting a false dichotomy, Deiseach? Of course a psychiatrist shouldn’t encourage you to ignore your doubts in the reliability of your own mental processes. What he should do is tell you to only kill yourself if you have conclusively (that is, in a lasting manner) resolved these doubts to the satisfaction of your rational self, which in your current situation would seem to imply that you should abstain from it for the time being.

          • BD Sixsmith says:

            So consider that in your calculations as a small positive contribution to the utility of the world.

            Sixeded.

          • Hedonic Treader says:

            Creutzer is right; if you ask a psychiatrist whether you should kill yourself, it’s not their job to encourage you. In fact, they’ll probably think (probably correctly) that it is a way to ask for help. But this certainly doesn’t mean you should be locked up against your will, or that other people should be prevented from ending their own life against their will.

            As an adjunct to this, given that I am as bad or worse off now, should I indeed have tried killing myself when I was twelve and should I have been permitted to do so?

            Well, you certainly should have been permitted to do so, since being born is not voluntary in the first place. Exit should be, in my intuition, an inalienable right. (Although religious belief may distort this, perhaps especially for children who tend to believe it literally.)

            I can sympathize with the model that there are different groups of suicidal people, some of which are benefitted by coercive paternalism and some of which aren’t. And I agree it would be better to distinguish between the two better. If the suicide prohibition, which angers me so much, were actually really useful overall, I would not be so angry about it.

            But the utility of a person, unique as they may be, is not infinite. We have costs of living that someone has to pay, we get into conflicts, we eat animal products, we use up environmental resources, and so on. It is nice to say we are all valuable, but that doesn’t make it true, it just makes it more likely people will give lip-service to it.

            Do people get enough benefit from my existence that they would voluntarily pay my (meager) cost of living for that benefit? Of course not. You’d have to make up convoluted assumptions about wild-animal suffering displacement from my consumption or some such to actually conclude positive utility. Even organ donations turn this around decisively.

          • Nathan says:

            Suicide is horrible. I’m in the funeral industry, I see families dealing with suicide every other day. To my mind if you’re defending it as a “right” something has gone badly wrong in your moral calculus (one of many reasons I’m not libertarian).

            Des, I really hope things turn up for you and you start feeling better.

          • Hedonic Treader says:

            @Nathan: And yet, miraculously, this does not stop you from taking those families’ money.

            If life should be a non-consensual obligation, as defined by the government, then perhaps your job should also be a non-consensual obligation, without payment of course…

          • Nathan says:

            “Oppose suicide? COMMUNIST!” Lol.

            I think there are many problems with libertarian thinking, but one of the big ones is that they frame everything as a choice between the individual and the state.

            I think in terms of family. Yes I think I have a responsibility to my family not to kill myself and yes I do work for my family without monetary reward.

          • onyomi says:

            “I think there are many problems with libertarian thinking, but one of the big ones is that they frame everything as a choice between the individual and the state.”

            I have heard the libertarian stance described as “no unchosen positive obligations.” I think this should be expanded somewhat to include, for example, responsibility for the results of unchosen pregnancies, especially if carried to term, but the basic point is that it doesn’t say “no non-economic obligations.”

            Most people choose to take on a variety of personal, non-economic obligations, and I’ve never heard a libertarian deny that or suggest there’s anything wrong with that. We just deny that we have unchosen obligations to strangers simply because we and those strangers are on the same side of an arbitrary political boundary.

          • Hedonic Treader says:

            Nathan, we are talking about legal rights here. That, by definition, makes it about a decision between government and individual.

            Your sense of responsibility toward your family is clearly voluntary and does not depend on government coercion, nor could it be created by such coercion.

            Finally, your mockery speaks volumes about your true character. If you weren’t a random scumbag on the internet, but a person from my real life, and you mocked my right to self-determination in this way, I’d make sure you pay for it.

          • Furrfu says:

            I realize that this probably doesn’t mean very much when you’re depressed, but I really value your comments a great deal, and so I hope that you go on living and able to make such comments for a long time. On this basis I think you are mistaken that your value to society is negative, since I am part of society. Also, I hope that, whether through your own action or through happenstance, your life ceases to seem unlivable.

          • Nathan says:

            I was talking about suicide as a moral right, as I understood you to be (and indeed as you still seem to be doing, using terminology like “right to self determination”). Legal rights I don’t tend to think make much difference since a person who strongly and consistently wants to die can usually find a way (for good or ill).

            I do not regard myself as having a voluntary obligation to my family. I regard mostly everyone as having obligations to their families, which they can morally choose to observe or immorally choose not to. I don’t think it’s misinterpreting libertarianism to say it is inconsistent with my view of those obligations.

            BTW I’m curious. How, exactly, would you “make” me pay? That sounds like an awfully… Coercive sentiment, no?

          • notes says:

            Rationality is imperfect, and has always been subject to garbage in, garbage out… even before one comes to problem of rationalization.

            Without disputing your reasoning, consider your concerns about how your mental processes are being affected. The selection of which truths to foreground and which to background, which to highlight, what order to examine them in… all these things can and do shift conclusions.

            It would be more of a surprise if you did not feel your mental processes affected by your mood. Which makes the process of compensation simple, if painfully difficult: lighten the depression.

            For what it is worth, I have had some success in thinking not on my contributions to the world, made or unmade, but rather on those I have received. Gratitude has been a light to me when no others reached. Even if that one is not the lamp for you, there are other such.

            Or if reasoning truly is the necessary currency in this specific debate, perhaps more Aquinas? That dumb ox seemed to bring you joy earlier.

          • Scott H. says:

            I agree with everyone else here with one additional thing to add: life is good. Any other conclusion is a sign of irrationality.

          • Hedonic Treader says:

            Scott H: What you are trying to do is set a narrow, universalized norm without paying the true cost of that norm.

            Just an example: We know people are willing to pay a cost in order to be not conscious for a time, e.g. when they are undergoing surgery. We also know that people are willing to trade off expected length of life with expected quality. Basically no one is trying to maximize mere lifespan.

            To say “life is good” without considering the details is setting a cheap applause light. The negative consequences, of course, are for others.

            I do not think my life is net good, or that is has net positive externalities overall. Perhaps it turns out that way eventually, but there are no guarantees for this, and pretending otherwise is irrational.

          • @ Nathan

            I think there are many problems with libertarian thinking, but one of the big ones is that they frame everything as a choice between the individual and the state.

            @ Hedonic Treader

            Finally, your mockery speaks volumes about your true character. If you weren’t a random scumbag on the internet, but a person from my real life, and you mocked my right to self-determination in this way, I’d make sure you pay for it.

            Scumbag? Mocked your right to self-determination? Make him “pay”?

            Wow.

            If that’s the way gentle criticism of libertarianism is going to be treated around here, then I need to rethink my participation.

          • onyomi says:

            Though I tend to agree with Hedonic’s view on suicide–that is, it’s hard for me to view it as immoral when none of us chose to be here in the first place–I do agree that the vague threats are well beneath the standard I’d hope to find on SSC.

          • Hedonic Treader says:

            Standards of debate culture? We don’t even have human rights standards! The acceptance of systematic physical violence against nonviolent citizens was given from the start in the OP.

            You can play this hypocritical bullshit game if you want but I’m not giving it even lip service.

            And as for threats, the violence implied by various legal and moral positions here is itself a threat. After all, they are supposed to be involuntary, and you get three guesses what that implies for their implementation.

          • Nathan says:

            It’s fascinating to see someone who is so deathly opposed to using physical force to save someone’s life but totally cool with it if someone disagrees with him.

          • Hedonic Treader says:

            I’m not opposed to use violence to save a life. If you are faced with an aggressor, you have the right to defend yourself.

            Of course, if you lock nonviolent people up against their will, you’re the aggressor.

          • houseboatonstyx says:

            @ Larry K
            If that’s the way gentle criticism of libertarianism is going to be treated around here, then I need to rethink my participation.

            Oh, come on. His statement sounded like a drunk. What happens around here is, instead of such statements being engaged online, they, or anything else well below standards, is ignored. Is let die from lack of oxygen. And, for the worst, reported with the little Report Comment link, after which they may silently disappear.

            I’m finding your posts balanced and responsive, with a touch of the same fresh air as Scott’s and Deiseach’s.

          • Hedonic Treader says:

            Yes, that was rude of me. I can’t delete it now, but I don’t object if it gets filtered out.

            You know what else is rude? Locking noncriminal people up against their will, or forcing them to die an extra unpleasant degrading death against their will.

          • Nita says:

            @ Hedonic Treader

            Please keep in mind that most people sincerely, viscerally do not understand what it’s like to be depressed and/or suicidal. They don’t see that they’re making it worse.

            @ Deiseach

            Well, I haven’t met twelve-year-old you, but the current version of you seems to have serious doubts about depression’s competence as a life adviser. It sounds like what you really want is to get better, if at all possible. (So you can contribute more, or think more rationally, or whatever else matters to you.) And that’s what you’re working on already, right?

          • Berna says:

            I agree with Teresa. I don’t know you, apart from your comments here, but I can tell you’re an intelligent and kind person, and you’d be missed.

          • Deiseach says:

            Do people get enough benefit from my existence that they would voluntarily pay my (meager) cost of living for that benefit?

            Hedonic Treader, this is exactly my rationale for why it would be more useful for me to cease existing. However, as I said, I can perceive that my mental state is affected in a negative way; my reasoning ability is functioning (I can broadly distinguish between fantasy and reality*, I agree that 2+2=4, not “whoops a daisy spotted dick with custard where’s me washboard missus!”) but the grounds from which I am reasoning are, most likely, erroneous or at least tainted and you know what they say: Garbage In, Garbage Out.

            I know that my emotional and other mental processes are not functioning correctly due to things like irrational and too much anger out of proportion for the cause of the angry reaction, weeping fits without any stimulus, tendency to get caught in spirals of fantasising about situations before they happen, etc.

            So I do not trust the fruits of my reasoning since I cannot say they are based solely on objective fact. I used to consider Chesterton’s “The madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason” nothing but a neat bit of turning a phrase, but now that I am sinking into depression, I see the truth of it.

            And please don’t call people “random scumbags on the Internet”; it doesn’t make you sound like you are arguing from a stance of solid reasoning but rather are reacting emotionally and, as I’ve said, I am mistrusting over-emotional reactions at present.

            *Last night I had a dream that ended with the realisation that the universe is constructed of 6,500 pairs of socks. Yellow socks, if anyone is interested in the particular colour. Even in the dream, I was going “That… does not seem correct, somehow”.

          • Deiseach says:

            Again, thanks to everyone for the kind words, but I feel like I’m emotionally blackmailing you all into giving me validation which is certainly not what I am trying to do.

            I think I’ll give this counselling lark a try this time round, because I am definitely not coping any more. Digging into my resistance, I think part of it is pride (you can now see why I agree with Aquinas and not the scriptwriters that pride is a sin).

            Part of the problem is that accessing a counsellor is going to be a lucky dip; stick your hand in and see what you pull out. Until I get assigned one, I have no idea under this Counselling in Primary Care programme what they’re like or what approach they use, and I’m very doubtful – to be frank, I don’t think I’ll be able to talk to them usefully about my concerns.

            Part of that is that my only contact with counselling has been in the context of word processing the thesis for a secondary school counsellor going for their Masters in Educational Guidance and Counselling, and the amount of social science theory bollocks in that had me rolling my eyes and muttering “Sacred Heart of Jesus” every third paragraph.

            Part of it is my pride, as I’ve mentioned. Right now, I feel like the best solution to my particular problems is the “nuke ’em from orbit” option – I Am Such A Special Snowflake, doncha know! Not like ordinary people with their ordinary problems that can respond to the ordinary solutions!

            But the trouble is that I don’t expect anything but the run of the mill “Okay, so you’re a bit stressed at work and maybe your communication with your partner isn’t great right now and you don’t feel like you can talk to your friends, so here’s a coping strategy” approach, and I’m going to have to go the whole merry-go-round of “Stop right there. For a start, no partner” and do the whole dance of “No, not separated or last relationship broke up; no, not worried that I’m d’un certain âge and will be left on the shelf; I’ve never been partnered” and will end up having to explain to them about aromanticism/asexuality and they’ll be thinking “Crap, I’m not trained for this level of weirdo”.

            And that’s before getting into the rest of my problems.

            Basically, it’s pride and vanity and snobbery on my part that I can’t have the kind of conversation or exchange with this putative counsellor that I can have on here with you guys 🙂

          • Nita says:

            @ Deiseach

            You’re right — you should give it a try. In the worst case, you’ll have another horrifying story for us, and in the best case… well, it might even work!

          • Creutzer says:

            Deiseach, I think that’s the depression speaking: you’re calling it pride and vanity because you’re set on finding negative things about yourself. Other people would call the same thing reasonable expectations.

            Is the aromanticism/asexuality thing actually on the list of your problems? I mean, I can see how asexuality in the absence of concomitant aromanticism might be an issue, but if you have both, isn’t that fine and one less area of life to worry about? Are there serious drawbacks to not having a partner and not wanting one, or am I misunderstanding aromanticism?

            Hedonic Treader, this is exactly my rationale for why it would be more useful for me to cease existing.

            Well, you’re far from alone in that sort of situation. I know my parents would pay my costs of living, but that doesn’t count because it would be peanuts for them and also come one, they’re my parents. But when I consider the inverse – the amount by which the world would be improved if I ceased to exist -, I’m distinctly underwhelmed. Unless you have an EA-like value system or are an extreme direct burden on an uncompensated caretake, this really doesn’t strike me as an issue you ought to be worrying about.

            And if you’re worried about, for example, the medical system… From a social contract perspective, you’re perfectly allowed to be a net negative for your society. We know that this will happen to some people and that is why we have an insurance-like social contract in the first place. And there isn’t a clause that says you’re allowed to be a burden on the medical system only if you make up for it by bringing lots of people happiness by being a great friend to them, or any such thing.

          • Brian Donohue says:

            @D,

            “but the grounds from which I am reasoning are, most likely, erroneous or at least tainted and you know what they say: Garbage In, Garbage Out.”

            FWIW, this sounds to me like The Human Condition.

            Hang in there. It’s supposed to be a struggle, I think.

          • Nathan says:

            I relate to how you feel, Deiseach. Or rather, how you feel about how you feel. Never had much in the way of depression to worry about, but I think I’d be way too proud/embarrassed to actually go and talk to someone in real life about my *emotions*, dear God. Actually going and doing it takes guts and I admire people who are able to.

            And, uh, don’t feel bad about the appearance of fishing for compliments or whatever. What really sucks is when someone offs themselves without the people who cared about them ever knowing they were struggling or having the chance to say something. Or to be less bleak, people would rather help you get through things than let you muddle through alone. I know your depression is going to try and spin everything to make you look bad to yourself, but talking about it really is the best choice from everybody’s perspective.

          • Matt M says:

            “Creutzer is right; if you ask a psychiatrist whether you should kill yourself, it’s not their job to encourage you. In fact, they’ll probably think (probably correctly) that it is a way to ask for help. But this certainly doesn’t mean you should be locked up against your will, or that other people should be prevented from ending their own life against their will.”

            Too bad – because this is exactly what they will do. If they have any reason to think you might be dangerous and they DON’T lock you up, they run the risk of being sued and held responsible for behavior.

            Incentives matter.

          • onyomi says:

            @Hedonic

            “Standards of debate culture? We don’t even have human rights standards! The acceptance of systematic physical violence against nonviolent citizens was given from the start in the OP.”

            As a libertarian, I can sympathize with constant outrage that everyone is always advocating and voting for coercion against us. If anyone is justified in fighting dirty, it would seem to be us, since we are literally just trying to stop people using force against us.

            Yet, as pointed out in in “Favor of Niceness…” it’s a very bad precedent to make an exception to the rules of niceness and non-violence for your own cause… because everyone else can think of equally plausible (to themselves) reasons to make an exception for their cause. Plus, I’d rather be on the side of the nice people who disagree with me than the mean people who agree with me.

            But those nice people are arguing for and voting for violence to be used against you! Yes, and that disturbs me all the time. Yet I don’t think we’d ever win that fight with threats and/or actual violence. People are more won over by niceness than tit-for-tat.

          • Scott H. says:

            Hedonic Trader: Sure, there are exceptions to every rule, and life has a natural cycle to it that informs and shades all opinions.

            However, as a starting point in search of moral bedrock — in league with countless trillions of other entities struggling to maintain life — I stand by my original comment.

          • houseboatonstyx says:

            Deiseach, for God’s sake! You’re a non-fucking Catholic. In Ireland. Surely you’re not the only Catholic in Ireland that still reads GKC. Find a forum of Catholics who read GKC. Demonstrate literacy and logic there and locate the Inner Ring of those who know Joseph, er, GKC or at least CSL. After some on-topic posts, go “Oh by the way, are there any counselors around here who speak that language? I’m asking for a friend, of course.”

          • switchnode says:

            Scott H.:

            “Good” is a subjective valuation. “Rationality” is not defined over the domain of utility functions (or of non-utilitarian moral systems). Assuming life is good may be the most convenient starting point for your moral reasoning, or the most popular, but this does not make it a “rational” one. Do not pretend your axiomata are theorems.

          • Winter Shaker says:

            Houseboat:

            Deiseach, for God’s sake! You’re a non-fucking Catholic.

            Actually, I’m pretty sure Deiseach is a Cath- …Oh, I see.
            🙂

            Anyway, Deiseach, I am not remotely qualified to give any useful advice, but I’ll second … um, seventh? … the sentiment that you are pretty much integral to the parts of the internet where I hang out now, and it would certainly feel like a net negative without you.

          • Scott H. says:

            Switchnode: I didn’t say that “life is good” is rational. I said that “any other conclusion (subjective valuation) is a sign of irrationality”.

          • Creutzer says:

            You could be a bit more precise about what you’re saying instead of repeating vague wording.

            I think the most charitable construal I can come up with is that you say that is just so happens that most humans who don’t assign intrinsic value to life are also less rational than other humans.

            I’m really not sure what the evidence is. But I’m pretty sure this doesn’t apply to the particular species of value-of-life-deniers that can be found in discussion threads such as this.

        • Addict says:

          Heroin addict from a while back here.

          The best possible thing somebody might do for me would be to lock me in a room against my will for a week. I silently beg for it to happen, almost every day, but there is no one to do it for me.

          I don’t see how your philosophy could be practically tenable. If a person’s desires could be cleanly separated into ‘like’ and ‘dislike’, then sure, but because it’s more complex than that, with desires like “likes but shouldn’t” or “likes to like, without actually liking”, you can get caught in situations where the best solution is for someone outside you to impose their will on you. Do you think these situations do not come up?

          Or is it the uncertainty on the part of the helper as to whether this is a proper situation, which bothers you? Or the potential for abuse by malicious parties? It seems to me that these drawbacks simply call for a more nuanced system rather than the absolute inviolability of a person’s autonomy.

          (If anyone is ever interested in learning some interesting facts about how addiction feels from the inside, let me know; I had a very long essay queued up on the last open thread, about the nature of reinforcement learning, wireheading, etc, and basically all issues touched by transhumanism on which i felt i had a unique perspective, but I ended up not posting it on the assumption that I greatly overestimate how interesting my predicament is)

          • onyomi says:

            I have never been an addict, but I think I can sort of relate to this complexity of feeling.

            For example, I know that water-only fasting is very good for me on a number of levels. I’ve done it on my own for as long as 5 days. I’d like to do longer–maybe even 2-3 weeks, but it’s hard to find the time, and, most of all, hard to find the willpower.

            Voluntarily not eating for five days is the hardest thing I’ve ever done. Not because it was all that uncomfortable–I felt kind of weak, occasional stomachache, grumpy mood, etc. but significantly less uncomfortable than, say, having the flu.

            What makes it the hardest thing ever is that you feel uncomfortable but it is constantly within your power to stop feeling uncomfortable. Like if you had the flu, and your body needed to make you feel crappy for a week in order to kill the virus, but you had the power to completely halt the immune reaction and make yourself feel fine at any time. That would actually make having the flu much worse in a way.

            This conflict between an executive function telling you one thing and a more base-level urge telling you another is super annoying, though I think that practice can actually make it slightly easier (willpower itself can function a bit like a muscle).

          • Psmith says:

            “I had a very long essay queued up on the last open thread, about the nature of reinforcement learning, wireheading, etc, and basically all issues touched by transhumanism on which i felt i had a unique perspective, ”

            I’d read it.

          • ThoughtMule says:

            I’d definitely read it!

          • stillnotking says:

            The best solution may be for “someone” to impose their will on you, but not just anyone — presumably that’s why you have not joined a cult or gotten yourself thrown in prison, either of which is easily accomplished. The “someone” has to be competent and have your best interests at heart, a combination which can be hard to find.

          • Addict says:

            Err, I would rather say that either of those situations would have negative utility beyond the simple pain of withdrawal, which make them significantly less attractive as solutions.

            But anyway, the point I was trying to get across is that I as much as I am desiring of someone to imprison me and truly precommit to not letting me out until my withdrawals had subsided, in a way which convinced me of the futility of bargaining and/or attempting escape as quickly as possible… as much as I desire that, I would never be able to sign a contract that made it happen. I sit there, thinking about all the reasons I ought to sign it, and start sweating, and become viscerally terrified to the point of nausea, etc.

            No, such a solution must be imposed upon me without my present consent. The only mitigating factor would be the certain knowledge that my future self would grant retroactive consent; but this is absolutely not, in a general sense, a good enough reason to impose a change on someone’s mind, since you could use the same reasoning to justify addicting someone in the first place, or any other form of self-enforcing mind rape.

            No, the moral of the story is *not* “respect others’ autonomy as inviolable”, because the universe is allowed to be as horrible as physically possible, and no deontological restraint on your actions can possibly keep you from screwing up. (The moral of the story is, reinforcement learning is an extremely fragile mechanism that can go wrong with even the most nearby edge-cases, and is certainly not a stable platform to ethically build a conscious entity upon.)

          • Furrfu says:

            I find your offered essay summary very appealing.

            Have you thought about detox under sedation? I understand some people approximate this with vodka, but I understand that benzodiazepenes and medical supervision have better outcomes overall.

          • 1212 says:

            Someone directly asking you to lock them up and ignore their howling is the only remotely realistic standard a society could morally accept as a reason for doing so.

            People should not be attuned to looking out for the perverse situation where someone needs someone else to lock them up against their will, but can not ask for it.

            You can get in situations where the best thing for you is to impose their will on you, but which pure of heart psychic is going to be entrusted with the right? practically speaking, it’s everyone or no one, because we can’t know if someone is taking a big risk because as bad as it is it has to be better than not doing so (and is, importantly, right), and someone who is indulging an impulse, or everything else in between.

            What’s gonna be more common, the “only human” impulse, or the psychic, pure of intent, interventionist guardian angel that is willing to take the moral risk to fuck with your life at the right moment, in the right way?

            And, even ignoring the relative rarities, what’s a better standard for a society to give people to build their lives around: “you can rely on not being interfered with”, or “if you need intervention, or if you don’t, or if you really, really don’t, people can take a shot at fixing you -as they see it.

            Like, people can also get into situations where the best possible thing for someone to do is physically attack them, but that doesn’t mean that attacking someone for their own good shouldn’t be well beyond the pale. If it’s ever a good idea, it should be as the exception to a strongly established rule.

        • me says:

          I once had an interesting discussion with someone if suicidal thoughts or suicides are just the result of an off-limits environment. Which itself raises questions if a week long stay could actually change anything to this environment or is otherwise pointless.

          The point of being in a psychriatic institution against your will is a question of options and choice. I admit that there are people that have never taken alternative ways into account to solve problems and therefore should have the chance to see their situation at a distance. Or use the time to learn how to take the proper actions, like learning how to evade situations that worsen someones life or projecting where what kind of reaction leads to. This could lead to some empowerment and improve self esteem and is useful anyway.

          However, there are environments that are hostile on purpose and react to such changes as well. In other words: you can apply a constructive approach to life, evade hostile people and still will be punished for having done so. And there are plenty of people that take or try to take a benefit from doing exactly that. E.g. by pushing others in that direction and waiting for the backlash. It is not up to them to suffer from it, so they´re unlikely to have problems with it and therefore rarely see a psychiatrist about it. That´s where some bias might be found.

          However, some methods only work in a perfect world and even helping someone can have a negative impact to their life, because their environment simply ups it´s game to get the usual result.

          As most questions in psychatry are relative to the background of “normal” or “socially accepted behavior”, it would be impossible to ignore the stigmata or prejudice attached to it – circulating both is a normal behavior to a lot of people as well, because it empowers them. This leads to a less stable social situation and more problems, no matter how good or bad that hospital stay actually was.

          To make a long story short: some co-worker accused me of having expressed suicidal thoughts to get rid of me because he had a different point of view (maybe there was more to it, i really don´t remember), that landed me in such an institution, i suddenly needed to convince people that it is not a problem because i was about to sort my life out anyway. My employer did his thing to stay out of it and some people even tried to take a benefit from it. Try calling the cops if that happens _while_ you were evading such behavior, which already left it´s scars on you. The cops don´t care at all.

          The real crime is to utilize health professionals for an illegal practice or as a judical system without a defense lawyer. Because psychiatrists are no private investigators they have no intention to accept evidence. It keeps you in the uncomforting situation of having the criminals documenting their crimes for you.

          Bad thing, if you are far away from anyone who would be inclined to help you.

        • li says:

          Thank you for the reminder that there are people like you.

      • FeepingCreature says:

        If it’s negative, why aren’t they getting paid less?

        But then nobody would want to do i– ooooh.

      • Eli Sennesh says:

        A socially negative (negative-sum or zero-sum) job that doesn’t capture net value for the employer wouldn’t exist. If it does exist, and is socially negative, it must be helping the employer extract wealth from others, in which case, you’d expect the employer could pay well (even if they probably don’t because they’re the kind of asshole who engages in negative-sum business in the first place).

        • Matt M says:

          Clarification: A “socially negative” job can only sustain itself over any reasonably long length of time with government protection.

          Consider how often Scott (and others in the medical field) use phrases like “our hands are tied” or “our only option is…” Now consider where the hand-tying and limiting of options comes from.

          • Nita says:

            Uh, what about the time-honored professions of thieves, burglars, robbers and con-men?

          • John Schilling says:

            Those are usually sole practitioners or partnerships; “job” implies working for an organization of some sort.

            There are of course criminal organizations, even ones which can be described as hiring people for low-level criminal jobs. There is also the argument that criminal organizations only exist when the government has reason to tolerate them; this is I think generally overstated but does have some merit.

          • Matt M says:

            Indeed. Also, I probably phrased it poorly. I don’t mean that the occupation cannot exist indefinitely, but rather than any particular individual or entity probably cannot exist in that particular occupation indefinitely.

            I wonder how many professional thieves have continued thieving their entire life and never been caught and forcibly stopped?

          • Eli Sennesh says:

            Clarification: A “socially negative” job can only sustain itself over any reasonably long length of time with government protection.

            Nonsense.

          • vV_Vv says:

            Clarification: A “socially negative” job can only sustain itself over any reasonably long length of time with government protection.

            Most of government action actually consists in banning practices which are considered socially harmful. You may disagree on the details of what should be considered socially harmful, but the fact is that without government regulation these practices would be unchecked.

            Without government regulation you would have environment-polluting sweatshops which use child slave labor to make stuff that causes cancer, falsely advertise it, defraud their customers and make “offers they can’t refuse” to their competitors.

            (I’m assuming that you don’t believe in the Ancap market self-regulation magic, do you?)

            I wonder how many professional thieves have continued thieving their entire life and never been caught and forcibly stopped?

            Who does catch and forcibly stop thieves? The government does.

          • Nathan says:

            In Scott’s last post, he listed an example of a guy who was a con man pretending to be a soccer star for twenty years. I don’t believe there was any government protection for him.

            I’d recommend against overly broad statements. They are usually false, if only because the world is big.

          • There is also the argument that criminal organizations only exist when the government has reason to tolerate them; this is I think generally overstated but does have some merit.

            If we accept this as a valid argument at all then the meaning of Matt M’s statement changes radically. Initially it sugested that a noninterventionalist approach would be more socially positive approach for the government to take as then it would protect less socially negative processes. This is clearly a libertarian idea. However, if merely tolerating a criminal organization counts as a form of “protection”, then it implies that the government should actively oppose the organizations it does not approve of. This is much less libertarian.

          • Matt M says:

            For the record – that is NOT the point I was trying to make.

            It was more along the lines of John Schilling’s point. Thieves aren’t typically all that well organized, and someone independently stealing from others and keeping all the proceeds for themself is not really a “job” any more than driving yourself to the grocery store makes one a professional chauffeur.

            It was meant as more of a pre-emptive counter to vV’s typical post. One can not automatically assume that monopolies, child labor, or environmental pollution are, on net of things, “socially negative.” If they were, they could not be profitable. He is imposing his own value scale on all of society, as statists are apt to do.

            Eli’s original post said that socially negative jobs simply wouldn’t exist at all. My point is that such jobs do exist, we just don’t call them “socially negative,” instead we call them “public sector.” In addition, our government overlords can also mandate that certain jobs that aren’t directly public sector still exist, even if they wouldn’t otherwise (tax accountants, for example, are quite possibly providing negative value to society as compared to an ideal state where there were no taxes, or at least where the tax code was very simple).

          • James Picone says:

            @Matt M:
            Just to be clear, are you claiming that externalities cannot exist?

            I’m pretty certain that overfishing is extremely profitable while the fish last, or that CFCs are excellent industrial chemicals up until everybody has skin cancer, for example, and so arguably those are clear examples of profitable-yet-socially-negative goods and services.

          • Matt M says:

            Externalities exist *because* private property rights are not sufficiently enforced.

            Overfishing only happens because the fisheries have been collectivized. My neighbors own a large pond and stocked it with fish when they moved in. Guess how many times they’ve removed too many and ran out of fish?

            Pollution only happens because there’s a central authority (the government) who decrees what is and isn’t pollution, and what the acceptable amounts are, as opposed to a rights-based regime which would be primarily concerned with “did you do harm to this person yes or no” rather than “did you fall above or below the threshold that some centralized body has deemed acceptable”

            The only true solution to the “tragedy of the commons” is to not have a commons in the first place.

          • Creutzer says:

            I don’t see how either ocean fishing or pollution are amenable to a solution along the lines of “not having commons”.

          • HeelBearCub says:

            @Matt M:
            I think what you are advocating is that if their was an one owner of the worlds oceans they would regulate everyone else’s access to the ocean and charge people a fee for fishing in it, dumping garbage in it, etc.

            Is that your proposal for the externality problem?

          • Matt M says:

            Note – My entire knowledge of fishing consists of watching a few seasons of “Deadliest Catch”, but fishing isn’t the best example because the current government system seems to be about right – they advocate property rights in the catch based on geography and size of the catch.

            How they distribute these rights and whether they are the legitimate authority to dispense them in the first place is probably up for debate, but I don’t know enough about fishing to get into that too much.

            Of course the US Government isn’t “one owner of the world’s oceans.” It has no right to assign fishing rights to waters that are in Canadian territory, for instance.

            So in a very important sense, property rights among ocean waters and fish populations already exist and are already enforced, so there is no “tragedy of the commons” here.

            Of course, to the extent that any of my basic facts are wrong (as I said, my information comes from a reality TV show), the above analysis is probably wrong too.

          • James Picone says:

            Matt M: I agree, there would be no overfishing problem if one centralised company owned the entire ocean, and it would even mostly go away if one centralised company owned the entire region of ocean where specific fish are found.

            I don’t think blaming the existence of government for that not happening is entirely sensible. For starters, don’t the usual arguments for why monopolies are unstable apply here? Why won’t the single-owner-of-the-entire-ocean get outcompeted by agriculture or something and have to sell off assets, including, for example, chunks of ocean? Not to mention the cost of enforcement – you’ve still got the thing where there’s a huge bureaucracy for making sure people don’t catch fish they’re not allowed to catch/too many fish, it’s just owned by a different entity to the one that owns the courts.

            I don’t see how legal action solves the CFC problem. Broadly speaking, the facts:
            – CFCs are excellent industrial gases
            – Sometimes they leak during industrial processes. This is close to impossible to prevent
            – The leaked gases make their way up into the stratosphere, where they catalyse breakdown of ozone into oxygen.
            – Slowly losing density of ozone layer increases UV radiation at ground, increasing cancer risk

            Are you seriously proposing that this is stopped by someone bringing a lawsuit against a company that uses CFCs in their industrial processes (and/or a CFC manufacturer) claiming that their skin cancer was caused by that company using CFCs? I am not a lawyer, but my understanding of jurisprudence is that there’s enough potentially-injured actors and enough of a causal disconnect between the CFC emissions and the cancer that it would be both practically and philosophically difficult for that to work. And, of course, ideally we want this to all happen before it becomes a serious problem, not after, so you’d be suing on the basis that the company has taken actions that increase your risk of cancer down the line.

            Meanwhile, Evil Statists just banned uses of CFCs where there were vaguely economical alternatives ~15 years after the problem made it into research. And the ban has mostly been followed.

            Is asbestos a good model here? It took decades upon decades for those trials to get any kind of resolution.

            EDIT: And, of course, this is all irrelevant to the claim you made – that if something is ‘socially negative’, it is not profitable, absent government intervention keeping it so. Asbestos was profitable even with the lawsuits.

          • Matt M says:

            There doesn’t need to be one solitary owner of all the ocean.

            So long as every piece of ocean is properly owned by SOMEONE (whether it’s one owner or one thousand owners), the risk of overfishing is near zero, because the property owners are incentivized to protect their investment.

            The enforcement costs being high suggests that this might be a particular case where few owners (and maybe even one) might be more economical than many owners, but that’s a minor and unrelated issue.

            I don’t know much about asbestos cases, but if it was proven that CFCs are damaging to the o-zone, which is damaging to human health, putting together a class action suit should be very easy.

            The fact that our current jurisprudence (under a statist model) doesn’t allow for that type of lawsuit is irrelevant. Design a better form of jurisprudence that’s more suited to private property protection rather than to assigning all authority into one body and then being solely tasked with determining whether those rules were violated or not.

            Pollution actually worked like this in the early days of the industrial revolution. Farmers whose crops were damaged by the soot of nearby railroads and factories routinely sued the railroads and factories and usually won damages, which incentivized the railroads and factories to pollute less.

            But the government was having none of it. These stupid farmers and their precious property rights were standing in the way of progress and industrialization! So they passed rules saying that a certain amount of pollution was too much, but any amount below that was OK.

            So rather than being incentivized to not pollute at all, industry was now incentivized to reduce pollution to level X. Now, even if the farmer can go to court and prove that there was soot on his corn and that this damaged his livelihood, it didn’t matter, so long as the factory could prove it was polluting less than X.

            Edit to your edit: I’m not sure of what the eventual numbers were, but it seems like asbestos wasn’t profitable long-term. If it WAS still profitable long-term, than the notion that it is socially undesireable is up for dispute. Either asbestos was “worth it” in the end, or the (government run) courts did a poor job of awarding damages. If I didn’t specify that, I certainly meant to. You can do socially undesireable things for a certain amount of time, but eventually society will catch on and punish you for it.

          • John Schilling says:

            The property owners may be incentivized to protect their investment, but the fish are not. And fencing in the whole of the sea will probably be even more troublesome than was fencing in the whole of the American West.

            There’s also the mobility problem when nobody can leave their own property without negotiating transit rights with every other private land(sea?)holder on their route; I don’t think that model is really compatible with anything most of us would recognize as liberty.

            Successful anarcho-capitalist societies, to the extent that they existed at all, avoided the tragedy-of-the-commons by having a lot of basically worthless commons, and no industry capable of decimating their more valuable commons. Modern libertarians are going to need a better model.

          • “For the record – that is NOT the point I was trying to make.”

            Is that a response to my previous post?

          • Nornagest says:

            So long as every piece of ocean is properly owned by SOMEONE (whether it’s one owner or one thousand owners), the risk of overfishing is near zero, because the property owners are incentivized to protect their investment.

            That’d work if you’re fishing for oysters, maybe even some bottom-dwelling fish. But many economically important species of fish are more mobile than that; some migrate thousands of miles. If you own fishing rights to a square mile of the Pacific, it’s very likely that the fish there today will not be there a month from now. This introduces a free-rider problem: overexploitation of your property diminishes the economic value of your neighbors’ properties. That incentivizes overexploitation by everyone as soon as nontrivial actors start defecting. Brings to mind an old meme about milkshakes, doesn’t it?

            There are solutions to this problem that’re both long-term stable and compatible with libertarian ideals. But to get them to work, you need to bake in a legal or a strong cultural expectation of conservation (if you want to use Red Tribe language) or sustainable use (if Blue) somewhere — spatial property rights won’t do it.

          • HeelBearCub says:

            @John Schilling/@Nornagest/@Matt M:

            I think John and Nornagest have the right of it here. But I will add the further wrinkle that the ocean has a thousand and one uses. What’s good for this species of fish may not be so good for that other one over there. And many people want to use the ocean for things that aren’t fishing, and this can also effect fisheries.

            As a for instance, agricultural runoff has a strong impact on fisheries, but in an indirect manner, good luck establishing that causal link in court. Bubba Gump Fisheries vs. Farmer of 100 Acres in Minnesota Bob Johnson isn’t going anywhere. Do libertarians support the idea of class action suits, except in reverse? Can Bubba Gump sue every farmer within the watershed of the Mississippi en masse?

          • Jame Picone writes:

            “Why won’t the single-owner-of-the-entire-ocean get outcompeted by agriculture or something and have to sell off assets, including, for example, chunks of ocean?”

            You make some legitimate points elsewhere in your post, but this one is wrong. For precisely the reason you have been arguing, the ocean is worth more as a single asset than in pieces. So the owner who runs short of money won’t sell off parts of the ocean, he will sell shares in the entire ocean.

            This is essentially the same analysis that went into my first published economics article, applied not to oceans but to a theory of the size and shape of governments, where the “fish” were the humans that governments controlled and taxed.

            http://www.daviddfriedman.com/Academic/Size_of_Nations/Size_of_Nations.html

          • onyomi says:

            On the one hand, I think it’s useful to think of ocean simply as land which happens to have a lot of water on it. On this interpretation, private ownership of some or all of it doesn’t seem as crazy. Yet as John Schilling points out, fish move, sometimes over thousands of miles, seemingly creating a bad incentive.

            But game also used to move, sometimes over hundreds, maybe thousands of miles too, no? Of course game hunting now is largely done on public land, I believe, but there were days when that was not the case, when plains Indians still hunted, to cite only one example, of which there are surely many more. How did they handle the fact that the game might move out of their territory?

            Looked at from another perspective, we have no lack of cows and other animals we might once have hunted, though obviously the buffalo is greatly diminished (though I don’t think that would be the case if white people liked eating them). Where people once hunted, now we get meat from private ranches. Why could there not be “ocean ranches”?

            Obviously, it would be much harder to control the movements of fish, but there might be a convention of selling the rights to say, “the northwestern tuna migration route” (just making something up–I know nothing about fishing), and those rights would encompass the right to fish tuna (but maybe not other stuff) within a specific region where they are usually found. If someone tried to catch the baby tuna before they got big and migrated to the place where you usually catch them then that would be a property violation, since a company would be buying the rights, in effect, to the whole lifecycle/territory of this particular fish in this particular region. Someone who had the rights to the whole lifecycle of a particular fish in a particular region would have a strong incentive to make sure it wasn’t disrupted by pollution, poachers, overfishing, etc. no?

          • Nornagest says:

            there were days when that was not the case, when plains Indians still hunted, to cite only one example, of which there are surely many more. How did they handle the fact that the game might move out of their territory?

            Well, I could point to a mass extinction of megafauna in the Americas that started about the time the first Indians came over. Some put the blame for that on climate, but I don’t really buy it.

            Now, indigenous models of land use did often differ substantially from European, though I’m suspicious of the “Indians had more respect for the land” meme that gets trotted out occasionally. But whatever models existed over those twelve thousand years and probably hundreds of cultures, they didn’t save the glyptodont or the giant ground sloth. Those megafauna that did survive probably did so thanks to the lower population density and technological sophistication that prevailed until European contact; note that e.g. the aurochs managed to survive in Europe until the 1600s.

          • HeelBearCub says:

            @Mark M:
            Western frontier society treated the land as commons, mostly. Then you ended up with really ugly range wars between cattle ranchers and sheep farmers.

            As to the buffalo, people used to shoot them from moving trains and leave their carcasses to rot, simply for sport.

            I don’t think that is particularly useful either way, as these would have been on public lands. But of course, the idea that the entirety of all of land of the west would have been bought privately immediately after the the various purchase, annexations, secessions, etc. of the first half of the 19th century begs for an explanation of how this would possibly have worked.

            Should the homestead acts of 1860s have expired and then simply sold all the lands at auction to the highest bidder? How much of that land would gone for much at all? Given no investment, why would the owners have felt the need to protect the land instead of simply treat it as a prospective bet for mineral rights or something else?

          • John Schilling says:

            Setting aside the trivia about fisheries for the moment, it may be worth pointing out that the world’s oceans have been the de facto property of the Anglo-American alliance for as long as such an alliance has existed. And, out of classically liberal principles, the owners of the seas have jointly and consistently chosen to keep them open, free of charge, to essentially all travelers except for slave traders and literal Nazis.

            That, plus the low cost of water transportation, means that every seaport on Earth is essentially adjacent to every other seaport. The benefits of this, both economic and libertarian in nature, are enormous beyond my thesaurus’s supply of superlatives.

            I’ll take the Royal Navy of ages past and the United States Navy of the modern era, and all the trillions of taxpayer pounds and dollars used to finance them, over any an-cap scheme to divvy up the seas into private plots infested with swarms of rent-seeking (toll-seeking?) privateers, thank you.

            We now return you to your regularly-scheduled debate over how to avoid a tragedy of the commons in the insignificant little fishing industry.

          • vV_Vv says:

            when plains Indians still hunted, to cite only one example, of which there are surely many more. How did they handle the fact that the game might move out of their territory?

            Plain Indians were nomadic or semi-nomadic, they just followed game on its migration patterns. Their effective territory was limited by their often hostile relations with other tribes, there were no AnCap private courts and protection agencies to enforce borders.

          • Matt M says:

            Except that some tribes DID in fact assign hunting rights, sometimes based on geography, and sometimes based on total amount of animals killed.

          • vV_Vv says:

            Do you mean that they didn’t hunt all the animals they could kill and eat in order to maintain a viable population?

            This is quite surprising to me, do you have a reference?

            As far as I know, no traditional culture had any notion of ecology.

            Even well-educated Europeans, from Aristotle to Renaissance natural philosophers, believed in various forms of spontaneous generation, the idea that animals spawned from inanimate objects like monsters in RPGs.

        • Ever An Anon says:

          @Eli,

          That’s not necessarily the case.

          Look at something like an ERB (Edit: Ethical Review Board) at your typical university or big lab. They’re not making any money for the organization, quite the opposite, and while they’re government mandated it’s not an obvious case of cronyism either. At the same time I’m confident no ERB has earned it’s keep at least for the century: they seem to exist solely as obstacles to research.

          Antisocial jobs can exist due to inertia and poor incentives. If anything that seems more common than greed.

          • Creutzer says:

            What’s an ERB? Google failed me.

          • HeelBearCub says:

            @Creutzer:
            Ethics Review Board, I believe.

            Although I dispute Ever An Anon’s contention.

            ERBs are the price that is paid to prevent gross abuses like the Tuskegee syphilis experiment.

          • LHN says:

            I’m pretty sure that they’re seen as saving the institution money by avoiding lawsuits and being disqualified for future research grants.

          • LHN says:

            It somewhat surprises me that the system is as robust as it is. I’d have thought that if it got to onerous, we’d see a migration of research to countries with less stringent procedures, and possibly the development of journals that care less about compliance.

            Presumably it ultimately reflects a strong consensus among funding sources (still largely concentrated in the US and other Western countries), but I’d still expect to see the equivalent of regulatory arbitrage within science.

          • Deiseach says:

            they seem to exist solely as obstacles to research

            I refer you to Larry Niven’s BuSab stories 🙂

          • Nornagest says:

            I refer you to Larry Niven’s BuSab stories

            Frank Herbert, surely? The only one I’ve read is The Dosadi Experiment, but that was definitely Herbert.

          • At the same time I’m confident no ERB has earned it’s keep at least for the century: they seem to exist solely as obstacles to research.

            (Usually, it’s IRB for Institutional Review Board.)

            Granted, operationally, review boards impose delay and red tape, without adding any specific value. But that’s not why they exist.

            There’s an ugly history of well-intentioned scientific abuse of human subjects. It would be disastrous for science if the public had reason to think such abuses were still going on.

            There’s only one way to assure that all research meets this standard: individual experimenters cannot have the final word on the ethics of their own work.

          • Deiseach says:

            You are indeed correct, Nornagest, and I should turn in my skiffy nerd badge with my head hanging in shame 🙂

            I haven’t seen any great advances being made in countries that are laxer in ethical oversight; remember the alleged giant leap forward in cloning where it turned out the scientist involved had faked the results? And this was before there was a national bioethics council in Korea, so that he certainly hadn’t been fettered by a pesky ethics committee tying his hands.

            I think it sounds very tempting to say “If only science was left to pursue pure research no matter where the road leads and no matter the methods used, we’d be living on our extra-solar colonies with jet packs and flying cars by now and everyone would naturally live to be a thousand years old while looking twenty!”

            But I don’t think that works in practice. “The end justifies the means” may not pay out practically, and then you have to deal with the fall-out from encouraging the attitude that ethics is for losers. Why shouldn’t I cheat in my finals, try and undercut my rivals, bilk the public, run bucketshops or Ponzi schemes, fake scandals to get the other person going for a promotion fired and lie, cheat and steal to get the funding over you?

          • Nornagest says:

            There’s only one way to assure that all research meets this standard: individual experimenters cannot have the final word on the ethics of their own work.

            This seems to fit the pattern of “something must be done; this is something; therefore, this must be done”. Never was terribly impressed by that argument.

          • Matt M says:

            “I’d have thought that if it got to onerous, we’d see a migration of research to countries with less stringent procedures”

            In the pharma world, there’s some concern that this is going on, and that many new drug trials are disproportionately taking place in third world countries with lax standards and a local population who can be “compensated” for very little money (by American standards).

            Of course, journalists have done a pretty decent job of outing stuff like this when it happens, and the major companies are very protective of their brands, and are therefore reluctant to engage in this type of thing.

          • LHN says:

            If it were going to happen, I’d expect it to be done by a startup, which would then be acquired once it had a product through human trials. (Presumably of the compelling “serious effect on cancer” or “any effect on Alzheimer’s” sort, since e.g., a better antihistamine is more easily rejected by the FDA pour discourager les autres.)

            I should note that I’m in no way endorsing the idea. The IRB process almost certainly could stand to be improved or replaced because that’s pretty much presumptively true of any human institution. And I worry that there are important things we’ve learned from, e.g., psych experiments that would never get past one today, and what are we likely to miss going forward as a result? But the dramatic abuses of the past are clear evidence we need something to prevent their repetition, beyond the hoped-for good will of the researchers involved.

          • Ever An Anon says:

            @Larry,

            Yeah I’ve seen both acronyms before, though ERB is the one I’m more familiar with.

            The first thing that comes to mind about Tuskegee and all of the other go-to examples is that they’re really really bad science to begin with. My guess is that the kind of personality that says “sure, let’s open up some orphans and see what we find” is not compatible with good experimental design (psychopaths aren’t well known for their meticilousness outside of cop shows). The only counter-example I can think of that actually came close to publishable results would be the Nazi hypothermia experiments.

            And that leads into the second thing: most (all?) of these famous excesses weren’t the work of some nutty researcher trying to publish but part of a military project. Review boards in university labs aren’t going to slow the DoD or CIA down at all, but they can make the already obnoxious process of starting a new project significantly more annoying for ordinary semi-mad scientists.

            I do agree with you though, individual researchers can’t have the final word on whether their research was ethical. That is something for the scientific community as a whole to decide when and if they are published.

          • LHN says:

            My impression is that there are historical experiments that did produce important results, weren’t pure atrocities like Tuskegee, but didn’t operate within what would currently be considered acceptable bounds of participant safety and informed consent. The Milgrom experiment and the Stanford Prison Experiment are two examples that tend to come up. (Though if my impression that those wouldn’t fly today is wrong, I’m open to correction.)

            What I’ve read about the development of the Pill likewise at least seems as if it would be looked at pretty askance by a modern review board, especially for a new class of drug that wasn’t aimed at treating a recognized disease.

            Those are the sorts of things that concern me about IRB-type limits. It’s the usual risk-aversion problem that no one gets blamed for benefits that don’t appear because of research that doesn’t get done, while they do for letting through something that’s later judged to be harmful. I’m not sure what the answer is, if there is one.

          • Douglas Knight says:

            Tuskegee was great as science. Sure, a randomized controlled study would have been better science, but it was pretty ordinary for its time. (As for the standard of publication: it published a lot.) It demonstrated that existing treatments for syphilis were worse than no treatment. The really bad part of the study, after the introduction of penicillin, demonstrated that syphilis does not cause insanity, but rather arsenic treatment does.

            The role of IRBs in medicine and psychology really should be distinguished.

            Everyone today agrees that Zimbardo’s experiment is unacceptable. Milgram’s is on the edge: I think that people do regularly get permission to replicate, but most boards would not approve. Milgram and Zimbardo played a big role in the fight over regulating psychology research. Zimbardo was in favor of banning experiments because he didn’t want to people to test his claims. Milgram was in favor of more experiments because he wanted people to test his.

          • Matt M says:

            I’ll admit that I don’t follow the area closely, but I have a VERY tough time believing that any modern IRB would approve ANY experiment where you allowed people (even for a brief period of time) to believe that they just killed someone.

            Personally I consider Milgram a huge jerk who probably did irreparable psychological harm to his voluntary participants for the purpose of proving a relatively common sense abstract theory that has little practical value other than being discussed by teenage hippies in political debates.

        • ton says:

          Unless the employer doesn’t know that they aren’t getting value from the employee.

          See: https://github.com/bibanon/bibanon/wiki/American-Dream

        • CJB says:

          Jesus, this thread got ridiculous…

          Plains Indians typically had the extremely large territory + small populations typical to primitive nomadic tribes. So the Sioux, a powerful tribe, could kick other people out of their land and follow the herds.

          And, of course, they weren’t stupid. They had peace treaties and deals the same as anyone else. So from an an-cap perspective, a lot of the aspects of native society developed to compensate for that- a high focus on personal honor, strength, courage, etc. If you lied, broke your word, proved untrustworthy- in many cases even your own people would shun you.

          Much as counting coup clearly evolved as a sort of universally respected proxy war to reduce bloodshed in low density populations.

    • Deiseach says:

      Scott’s reaction of “Oh, that’s just Bob” makes me think of my own workplace, where applications for social housing with background circumstances that are straight out of a soap-opera script (quasi-incestuous pregnancies; love triangles; woman comes out as lesbian, leaves her husband, forms new relationship, they befriend straight married couple living next door, lesbian couple’s relationship breaks up when her partner runs off with the neighbour’s husband, ex-partner and ex-husband go to Australia, get married and have a baby, etc.) is just “Yeah, normal day” 🙂

      • John Schilling says:

        OK, the bit about how you’re not really putting cameras in your clients’ toilets: Maybe you ought to be – sounds like you could finance the entire organization by selling the footage to a reality TV show, with enough left over to do some real good for the sane and functional minority of your clientele 🙂

        Oh, yeah – “ethics”. Pesky, that. Hopefully you all manage to find it privately entertaining, at least.

  2. John Schilling says:

    Congratulations, and thanks for an enlightening post.

    I find myself wondering if psychiatry, like many professions, is structured to hit you with the least-rewarding aspects of the field up front, on the grounds that if you can’t handle them it’s best to weed you out first. The down side being that it also weeds out people who could handle them on a roughly proportional basis but not full-time, and that it preferentially selects for people who actually prefer what most of us would consider the worst aspects of the job.

    • That would be the non cynical view. The cynical view would be that the most junior people are hit with the worst aspects of the job because they’re the most junior people.

  3. ton says:

    but aside from showing you where we keep the earpluts

    should read earplugs.

  4. Ash says:

    > (there’s another aspect of this, which is that people constantly protest that horrible things will happen to them based on that week. For example: “My boss said if I miss one more day of work, I’ll lose my job, and then I’ll have no way to support my family.” Or: “My rent payment is due tomorrow, if I miss it I’ll be evicted and all of my stuff will go to the landfill, and there’s no way I can handle this through Internet or telephone or asking a friend to help.” I assume 90% of these stories are false, but the 10% that are true are still bad enough to more than outbalance any good we can do.)

    I see no reason to think 90% of these stories are true.

    I bet most people missing work for a week and telling the boss they were in bedlam will have a pink slip just as soon as one can be generated.

    Similarly, take me off the street for a week and there will be all sorts of bills unpaid, maybe a service or two disconnected, loss of income, and a cascading and increasing series of fines and penalties resulting in a major financial calamity for me. Now take someone with depression or other forms of mental illness and they probably are already on shaky financial grounds, and so….

    Okay, here what gets me about shrinks and psychs. I know several people who are hoarders. Some of them have been seeing their shrink for years. Well, decades in some cases. Talking their issues seems to have helped them not at all.

    What would help them? 50 minutes a week of the shrink visiting them, taking out the garbage, physically dumping magazines in the trash, repainting rooms, opening shades, roller skating, breathing some fresh air into their lives.

    Anyway.

    • Scott Alexander says:

      Did you mean “…see no reason to believe 90% of these stories are false”?

      We give everyone a doctor’s note that doesn’t mention psychiatry. It just says “So-and-so was in the hospital for the past five days receiving treatment for a serious medical condition.”

      The problem with your hoarder idea is that most hoarders (as per my admittedly solely textbook-based knowledge – I’ve yet to treat one) don’t have a motivation problem, they have a desire problem. That is, they want to hoard. If the psychiatrist came in and threw away their stuff without their consent, that would be breaking-and-entering.

      • Evan Þ says:

        That’s good, and I see why you can’t do any better. But I don’t believe that note would satisfy my power company, my phone company, my credit card company, or my landlord.

        (Admittedly, I personally could probably pay those over the phone, or through a friend, or at worst deal with a week’s worth of late fees on all of them put together. But, a lot of other people couldn’t.)

      • chaosmage says:

        Couldn’t you, for near-zero work, give them two? The other could mention psychiatry and the need for isolation, and a patient could show that when they’re told “even in hospital you could bloody well have called.”

        • Jiro says:

          Why would the power company or credit card company care that you had a reason to not call? If anything, they would prefer that you not call, so that they can benefit from the extra fees they can charge you.

        • Deiseach says:

          a patient could show that when they’re told “even in hospital you could bloody well have called.”

          Most billing is computer-generated, so all that will show up is that you missed a payment. Maybe two. Then the “final warning” and “disconnection of services” notices are computer-generated, and not only will you have the hassle of (a) paying the bills (b) paying the reconnection charges but (c) getting a black mark on your credit history.

          Trying to find real live humans to answer the phone on the other end when you’re calling the utility company, phone company, etc, is a pain in the neck because everything has been as automated as possible e.g. “Press 1 if you want to pay the bill, press 2 if you want to open an account…”

          Our Housing section often has to ring up the power company to get vacant properties disconnected/reconnected for billing purposes, and you can spend a good half an hour on the phone trying to get through and get it sorted. Someone mentally fragile may not be able to handle that.

          • Deiseach says:

            Well, I congratulate you on your good fortune, Mark 🙂

            I had the experience of needing to ring up Company X for something work-related, getting a Real Human, and being given a number to ring for the matter.

            Which was not just one of those automated “Press #1…” type lines, it was the Polish-speaking option. I had to go online and Google the English-language number for myself 🙂

            (Yes, we have sufficient number of Polish immigrants in Ireland that a call-line in Polish is worth it).

      • Richard Metzler says:

        Does your hospital have a social worker who can help patients take care of everyday problems and can handle stuff like talking to the boss, the landlord, the utilities company, the spouse etc.? I could imagine that that would help some patients more than a dose of antidepressants…

        • Matt M says:

          I’m not an expert in this area – but I wonder how much HIPAA and various other regulations constrain the ability for this to happen.

          Presumably, there are a lot of people out there who wouldn’t approve of their doctor or hospital saying to their employer “Please excuse Bob from missing work. We locked him up for a week because we believed him to be a danger to himself and others, but don’t worry, we just gave him an experimental new drug and we think that he’ll probably be fine for a bit.” And we have laws preventing this from happening for that very reason.

          And yet, “Bob was sick for a week” is so vague as to potentially be useless.

          • Deiseach says:

            Most doctors’ letters we get in support of housing applications are that level of useless.

            “My patient tells me that they have back pains/are unable to go upstairs, please provide them with ground floor or bungalow accommodation”. So does your patient have mobility trouble or not?

            “This patient would benefit from living independently”. Yes, but are they capable of living independently? If we put them in a house or flat on their own, will they burn it down, be totally unable to manage their money, be the soft touch mark that all the druggies and petty criminals leech off?

            That’s why we ask for letters from hospitals or consultants in support of medical grounds for housing. Any thing that’s vaguely “Mr Jones spent a week in General Hospital” won’t help at all. We do practice confidentiality so we’re not going to tell anybody if it’s “Mr Jones spent a week in the in-patient psychiatric ward because he is a paranoid schizophrenic who suffered a relapse after going off his meds”. We’ll treat Mr Jones as fairly as we can, and to be blunt, we’ll probably find out pretty fast if he is a paranoid schizophrenic when he rings us up complaining the government are putting cameras in his toilet to spy on him (true anecdote of one of our tenants, not by the name of “Jones”).

          • Deiseach says:

            What we generally do, when our tenant rings up complaining that the neighbours have keys to their house and are coming in and tearing their clothes, smearing chocolate on the walls, setting fire to the kitchen, etc. is send one of our workmen out to change the locks (actually, we send two for mutual protection; one, if it’s one guy plus the tenant in the house and the tenant later rings up to say the workman attacked/sexually assaulted them – well, it’s ‘he said she said’ and just because they are mentally unwell doesn’t mean that they can’t be really robbed, attacked or assaulted and two, in case the person turns violent and attacks the worker – it’s handy to have a witness/backup in these cases).

            Anyway, even though technically we’re not supposed to change the locks, we do because it’s only a small job for us and it does give the person reassurance for a while, anyway.

            Re: cameras in the bathroom in their house – all you can really do is try and talk them down and reassure them that we are not agents of the government and not putting cameras in their toilet bowls to spy on them. How well that works – again, depends on how bad this bout is and how long it takes for them to get stable on their meds again.

            Mental illness is tough on the person and their families and whatever support they have, and there isn’t nearly enough community support services out there for people like that.

      • Ash says:

        Did I mean false? Yes I did. Sorry about that.

        “We give everyone a doctor’s note that doesn’t mention psychiatry. It just says “So-and-so was in the hospital for the past five days receiving treatment for a serious medical condition.”

        Sorry to hear of your illness, but we fired you automatically per your hiring agreement with us, 3 days without appearing at the job with no notice is an automatic termination. (Boeing for one.)

        > I’ve yet to treat one) don’t have a motivation problem, they have a desire problem. That is, they want to hoard. If the psychiatrist came in and threw away their stuff without their consent, that would be breaking-and-entering.

        I’m not sure they have either motivation or desire issues. I think they may be operating on all sorts of levels, including badly framing the issue.

        So let me rephrase this using my own experience in therapy. I don’t mean this to sound like a caricature, but it really might go something like this:

        “Doctor I hoard things. I’m afraid to throw old papers out. I’m afraid when I need them I won’t be able to find them”

        “Well how does that make you feel?”

        As opposed to

        “Doctor I hoard things. I’m afraid to throw old papers out. I’m afraid when I need them I won’t be able to find them”

        “Let’s talk about how you organize things. Are you aware of …”

        Desire problem? Motivation problem? It might just be finding filing complex with little reward, finding chores boring, not being physically fit enough to take the trash out, being depressed, seeing the existing pile as overwhelming.

        Down below in the comments, someone mentions that they spent 40 hours cleaning up a friend’s place, than within 6 months no one could tell the difference.

        That’s not a loss. That’s a win.

        If that person spent the money they may be spending on therapy on having a trained assistant come in twice a week to help them file papers, socialize with them while doing chores, …

    • Tau says:

      I lived with a hoarder briefly. I spent the equivalent of probably a 40-hour work week moving things and cleaning things. Other mutual friends (who had known the hoarder longer) came to a party we threw at the house after the cleaning and were astounded. The hoarder, before and during the cleaning, said that she wanted it done and was SUPER happy about it. She didn’t help at all. And she insisted that we leave approximately 1/3 of the house trashed, although she didn’t state it that clearly. After I moved out, it might have been six months before the entire effect of the cleaning was gone, but probably not.

      Also my ex’s dad is a hoarder, and one year for father’s day or something we and several others spent a day cleaning and decluttering. Again, he expressed nothing but happy gratitude that this happened, although he insisted that we stay out of several parts of the house and leave them alone. Again, the house had returned to its base condition in a matter of months.

      What I’m saying here is that from my n of two, assisting with physical labor doesn’t make any difference at all either. Generalize with caution.

      • Deiseach says:

        We get cases of people living in terrible conditions, where the public health nurse rings us up and reports it on grounds of “unfit for human habitation”, and the person does not want to move because it’s their home, they like it there, it suits them, etc. (sometimes but by no means all the time mental problems are involved).

        Even when you offer them nice, clean, decent housing instead of a health-hazard falling down around their ears dump, they don’t want to go. And what can you do? If you force them to leave, they’ll be miserable in the new place and probably let it fall into the same condition through neglect.

        If people genuinely are suffering from their health because of the conditions, they can be temporarily hospitalised, but if they don’t want to leave – unless you get the premises condemned, you have to let them go back there.

  5. CatCube says:

    So either it’s harder than I think, or I’m surrounded by idiots, or I’m an idiot and don’t know it yet.

    I’m in engineering, not medicine, but it’s probably all three of these. At least, that’s what I’ve discovered in my own field.

    • FJ says:

      Lawyer confirming the same discovery. I suspect that idiots tend to gravitate to fields where the person who writes the checks has a hard time figuring out if you did a good job. The typical prostitute is probably much more competent in his field than the typical lawyer is in hers.

      • Foo says:

        More precisely wouldn’t those fields be selected for ability to impress superiors rather than competence?

      • Shenpen says:

        The funny part is that in some professions both extremes totally exist. Consider something like implementing SAP software at Hershey chocolate. Consultants arrive, work for two years, their employers charges per the hour, they get a decent monthly salary, paperwork is getting filled, user acceptance test is signed off and so on, and then they go live and the whole thing fails horribly. Consultants quit the consulting company, put 2 years of experience of implementing SAP for a huge company in their resume and get hired for 30% more.

        OTOH Mr. Small Business buys an accounting software package. During a sales demo asks a difficult question, the sales consultant says we need to test that and Mr. Small Business starts yelling don’t send me dumb salespeople, send me experts who know their product. Ultimately everybody who is incapable of uploading the whole code base into their head and answer any possible question prompt and simulate complicated 4-5 scenarios in a minute move out because they are tired of the yelling and only the smart folks stay.

        • HeelBearCub says:

          If you think the state of small business software is excellent … hoooo boy.

          • Anthony says:

            The smart expert says “No, our software doesn’t do that without you spending a bunch of time on it, but our competitors’ doesn’t either. But it’s still better than doing all your books in Excel.”

          • PDV says:

            Mark, I think I worked for that guy briefly (at a startup in Vancouver, WA). He’s nuts, frankly.

          • Anthony says:

            I think my employer is doing better with Quickbooks than she would with Excel. She does, too, as we have Excel for lots of other uses.

          • brad says:

            In my experience any software with an insufficiently large userbase is just awful UX-wise. Mind you some that have a large userbase are awful as well (I’m looking at you Epic Systems) but it is all but guaranteed otherwise.

            The only examples I can think of to the contrary are really simple web CRUD apps (not that there aren’t plenty of those that are terrible too).

            It just takes too much work to do all the quality of life polishing for a niche product.

          • HeelBearCub says:

            @brad:
            “In my experience any software with an insufficiently large userbase is just awful UX-wise.”

            Not only does the userbase need to be large enough, but their use cases need to be sufficiently convergent. My wife works as an NP at an OB/GYN and has had extensive responsibilities for making their EMR system work.

            Every single doctor within each practice and every single practice in the alliance wants to do things slightly differently. Some of this is due to personal preference, but much of it is driven by the differing needs based on the type of care provided. OB/GYN, Midwife only, Primary Care provider, etc.

      • CatCube says:

        My current example for (1) and (3) is where I was looking over the existing design for a project we’re working on that was built in the 60s. A certain part had a very complicated shape, and I commented to a co-worker that it was silly that there seemed to be no right angles on this thing.

        Then I went and designed a new part with a sensible rectangular shape. That was when I discovered that a sensible rectangular shape wouldn’t meet the design requirements and fit into the space available. So, it was harder than it looks and I’m an idiot.

      • Anthony says:

        In my experience, lawyers and architects are, on average, really terrible at their jobs; worse than most other professions. One reason for this is that they’re not doing the jobs they thought they were going into.

        People go into the law because there’s lots of money in it, and because they all want to be the hot-shot litigator at trial (or writing Important Constitutional Opinions). They don’t go to law school because they want to spend 14 hours a day meticulously combing through boring contract documents for errors and gotcha clauses. If they *wanted* to do that, they’d have become accountants or engineers.

        Architects want to design buildings. What they really do, mostly, is construction management for small-to-medium-sized projects. They communicate between the contractor, the subcontractors, the engineers, and the regulators. Oh, and the client. People who really want to do construction management get civil engineering degrees and get paid more to do construction management on bigger jobs.

        • FJ says:

          “People go into the law because there’s lots of money in it, and because they all want to be the hot-shot litigator at trial (or writing Important Constitutional Opinions). They don’t go to law school because they want to spend 14 hours a day meticulously combing through boring contract documents for errors and gotcha clauses.”

          You are absolutely correct, but that doesn’t fully explain my experiences. I happen to work in the field of Important Constitutional law. But a surprising fraction of Important Constitutional lawyers are kind of bad at it.

          Then again, I have a fair number of cases I don’t brag about either. Maybe I’m just a walking example of the Dunning-Kruger Effect.

  6. Nestor says:

    I recently came across a short story be Jules Verne, “Adam the eternal” that reminded me of some of your short stories. It’s available online but only in French and Polish that I could find.

    Also have you seen the latest google chat logs? The one where google bot says the purpose of life is to live forever? Looks like Eliezer was worrying for nothing, AGI will come with built in Coherent Extrapolated Volition thanks to all the data mining google does on us every second of the day. Whew!

    Completely unrelated comment to your post, though I assure you I read it. The anecdote about the screaming guy was funny.

    • Harald K says:

      Ha! Nice examples of two cop-outs, google bot. But either way, it’s not much more than a glorified chatbot, so no reason to care much about what it says.

      As I may have told before, it’s easy to train a neural net on the games of top Go-players, and it will learn to make moves that look strong. Most of the time, it will even be the moves a pro would make. But it still plays abysmally, because it has no conception of why those moves are good – and so the moves that are bad, are really bad, and throw away all the advantage to be gained from aping pro players. (Another matter is that if they play against a normal human, they will very quickly reach a situation unlikely to ever appear in a pro game – and then they’d be helpless.)

      Richard Feynman’s quote about not fooling yourself is very relevant to AI research. There seems to be a lot of people who need to believe in AI, like some sort of religion substitute, and they’re eager to see things that just aren’t there.

      • Tasty says:

        A bot like the ones you describe named neuro plays on KGS server and is said to be at around 3k-1k level. Would you call that abysmal?

        • Harald K says:

          That is not the bot I speak of. I’m talking of a much older different program. NeuroGo as far as I know uses a far more sophisticated approach than mere mining of expert games.

          I’m not saying there is no place for deep learning in Go. In Monte Carlo Tree search, the prior matters a lot – if you start off with the uniform prior, that all moves are equally likely to be good, you get a weak program even with MCTS. I think MoGo used a machine learning technique (a support vector machine) to assign weights to various patterns to get a good initial prior. I believe some people experimented with neural nets too – but as I recall, the best program used handcrafted patterns.

          Edit: I looked it up again. There have been a number of programs focused on predicting pro moves (though the first was actually after the invention of MCTS). Up until recently, the high success these programs have in predicting pro moves have not translated to strength, but it seems there is one program from 2014 that can at least beat GNU Go consistently and Fuego some of the time, just by move prediction.

          This strength may still be an artifact; I would expect these programs to do comparatively worse in situations very different from those arising in pro games. If KGS “neuro” is this player, I’m impressed (but I still think that is NeuroGo, which uses search in addition to neural net pattern recognition).

          • Tasty says:

            The reason I thought about neuro is that your description fits it pretty well. I’ve never played it, but I’ve seen it in action. It plays extremely fast and extremely “proper”, pro-like moves, but doesn’t seem to have any sort of understanding of life and death status of its groups and maybe even score. It’s impressive how good it is despite the major, gaping holes in its knowledge. From what I’ve heard people saying, the way to beat it is simply to kill something on the large scale.

          • Harald K says:

            If you can find out what program is behind neuro on KGS, I would be grateful 🙂 It’s very interesting.

          • Tasty says:

            I tried to find out which program powers neuro, but I didn’t find anything. Maybe it’s NeuroGo, maybe not. Its profile says nothing at all. Clicking through its games though, I was once again surprised by how little reading it does: sometimes it seems it can’t even read 2 moves ahead and makes really absurd plays. At the same time its sense of shape and direction of play is very strong. It can just crush mid level kyus again and again, but messes up horribly whenever a messy, unpredictable fight breaks out.

          • Harald K says:

            Yeah, I searched the Computer Go mailing list, but apparently they don’t know what program Neuro is either. At least it’s not one of theirs.

            I did find out though, that the bot NiceGo19N on KGS is oakfoam, and that apparently uses a DNN somehow. It’s pretty strong for being so new.

  7. Sooo…kickstarter to get Scott to switch jobs every five years or so, so he can write about them here?

    Seriously though, I always enjoy reading about your experiences as a resident. Keep it up.

  8. Thecommexokid says:

    Will you be administering any talk therapy as part of your out-patient residency, or will you dispense only prescriptions and referrals?

  9. Shmi Nux says:

    Two years on, how (in)famous are you (or your writings, if some of your colleagues don’t know your write SSC) at your workplace? Do you notice anyone, say, post the cactus-person writeup in their office or waiting room?

    • Scott Alexander says:

      No one I know in real life has ever read SSC as far as I know, let alone connected me to it.

      • “No one I know in real life has ever read SSC as far as I know”

        Meetups are not real? Imaginary perhaps?

        • Who wouldn't want to be anonymous says:

          If they are conducted pseudonymously, they are probably part of pseudo-life.

        • Leonard says:

          There’s real life, then there’s Internet mediated life. I think for most of us these are two very different animals. So, three categories.

          • LHN says:

            On the one hand, nearly all of my social interactions are at least partially mediated via the net. And I met my wife there, long enough ago that telling the story usually involved first explaining what the Internet was.

            (And now involves explaining that this was before dating sites– or except in the most experimental sense websites at all– let alone dating apps. Oddly, the need to analogize a Usenet newsgroup to something the other person might conceivably have heard of hasn’t changed.)

            On the other, there’s still a distinction for me between pure online connections, even long term ones, and “real life” ones. (Though it can transition from one to the other in either direction. And I don’t really like the term, since there’s nothing imaginary about internet-mediated interaction.)

            Rational or not, I don’t think of e.g., my cousins as primarily online relationships even though I see their status updates far more often than I see them. Likewise, I think of my local friends as primarily RL, even though many of us have been coordinating our outings via email since the 80s.

            On the other hand, there are also people I know, who live in the same city I do, whom I’ll converse with online all the time. But meeting up is vanishingly rare to nonexistent and we seem fine with that. (Why is an interesting question. But even if thinking about that moves me to try to change it, it’s been a stable situation for years up to this point.)

            So for me, they are different if overlapping ways to relate to one another. (YMMV, of course.)

          • HeelBearCub says:

            @LHN:
            I don’t think this is really all that new.

            My sense is that “pen-pals” were a thing long before there was the internet. The wikipedia article dates them to at least as old as 1965, but my sense is that article is incomplete in terms of the history.

          • LHN says:

            @HBC Oh, sure. Plus ça change. There was a book a few years back observing that a lot of the same behaviors and social phenomena that arose on the net showed up among telegraph operators in the 19th century (which I think Neal Stephenson then incorporated into one of his books). Centuries earlier, organizations like the Royal Society grew out of people corresponding with one another about their shared interest in natural philosophy across substantial distances. (Which, come to think of it, ditto.)

            That said, the net is more pervasive and immediate than previous communication techs, and quantity has a quality all its own.

          • Nornagest says:

            which I think Neal Stephenson then incorporated into one of his books

            I don’t remember it in Stephenson (though I haven’t read everything of his), but it definitely came up in later Pratchett, once the Discworld setting’s increasingly advanced telegraph analogue started getting going in earnest.

            Might also have been in The Difference Engine (William Gibson and Bruce Sterling), but I couldn’t say for sure — I don’t remember the plot of that book too well, but it’s congruent with what I do recall.

      • No one I know through my job has ever read SSC as far as I know, let alone connected me to it.

        Fixed that for you.

  10. Parker says:

    …maybe I can move somewhere else and hang out with some of you people full-time.

    New York will always welcome you with open arms…and obscene rents.

    • no one special says:

      The Michiganders will miss you. I’ve been trying to run a reclamation program where we pull good people out of the coastal hellholes and bring them here to Michigan. Remember, rent out there is probably 4x cost of living here. And midwesterners are far less likely to call you a shitlord (to your face anyway.)

      Memo to self: get someone with charisma to write these things.

  11. Emily says:

    (This comment is sad and you may want to skip it.)

    I had this friend in high school who was suicidally depressed. He didn’t keep it a secret: I won’t say it was the first thing he told me, but he definitely told me fairly quickly, and we weren’t incredibly close or anything.

    He was definitely in therapy. I don’t think he was ever actually hospitalized, but it was a long time ago/I don’t remember/I might not have known even at the time.

    Anyway, a few years after I met him, he killed himself. This was terrible and incredibly sad. But it wasn’t a surprise. When I’d heard someone had killed themselves, I didn’t have to be told who it was.

    So I’m wondering is, what do we know about how to prevent suicide for people who, repeatedly/over a period of years express that they don’t want to be living? If these people are teenagers, do they age out of it? Like, if he could have just gotten through high school, would he probably have made it?

    • yellowish fish says:

      I see myself in your dead friend as described (teenage suicide attempts and related mournful utterances) but then for the last 35 years zero recurrence…I don’t know if I “aged out” automatically or improved myself deliberately but very definitely all-better-now…so there is one anecdotal data-point, big whoop, FWIW

  12. Hyzenthlay says:

    Very insightful post. I must admit, it’s validating to hear an actual psychiatrist stating that a lot of it is security theater, since I’ve had similar thoughts. In the cases that a short stay in the psych ward actually helps resolve problems, it’s less about people actually being fixed and more along the lines of, “sit quietly in the corner until you’ve cooled down.”

    But yeah, the stuff about noise and screaming and the general lack of privacy or sleep and how that would negatively impact mental health is also a big concern. I hope I never end up in a ward for any length of time because I’m pretty sure it would just make me crazier.

  13. Congratulations! As a corporate attorney I have really enjoyed your residency posts and look forward to more.

    And hopefully your outpatient experiences won’t be, y’know, like this: http://thelastpsychiatrist.com/2011/03/bad_at_math.html

  14. NZ says:

    Do psychiatrists use EPIC to log patients’ EMRs? If so, how do you like it?

    I ask because I’ve heard that EPIC is horrible and that doctors are quitting over it, but then I sometimes meet random people in healthcare who like it just fine. I’m also curious if EPIC has psych builds and what those look like.

    (I work in software with a specialization in healthcare, but I don’t work for EPIC or any of EPIC’s competitors.)

    • Scott Alexander says:

      I use their competitor PowerChart. Like most programs, I spent a week thinking it was horribly designed, and after that it felt perfectly natural and I freak out whenever anything changes.

      • meyerkev248 says:

        As a programmer (Not for Epic, mostly because they could pay my West Coast salary in the Midwest and I still wouldn’t work with MUMPS), and I can confirm that this is fairly standard.

        Also, that if you think humans are bad, computers are worse and this is why everything you use is a kludge of stuff that was either designed in the ’70’s when the internet was literally 3 computers or designed to work with the ’70’s stuff, held together with duct tape.

        /For example, there is absolutely nothing stopping you from sending an email as someone else. Because they don’t check that the person in the TO: field is the person sending the email.

      • NZ says:

        I spent a week thinking it was horribly designed, and after that it felt perfectly natural and I freak out whenever anything changes.

        Hah, yeah that’s the problem with bad designs that get used anyway.

      • Deiseach says:

        Oh, most software designed for large corporate/organisational use like that is horrible. You get used to working around it and finding ways to make it do what you need it to do, so naturally when the updates are implemented, it freaks you out because now you have to find new ways of making it work.

        What generally seems to happen (going on my work experience) is that the system gets designed for a certain spec (issued from the top-down instead of asking the people on the factory floor, as it were, what they need in everyday use), it gets rolled out nationally with great to-do, then when people start using it in real life all the bugs turn up, and of course, what suits Group A is not what Group B is not what Group C needs or wants.

        It’s already taken too much time and public money to implement so it can’t be changed for a competitor’s product, and the old systems have all been scrapped because Shiny New System is supposed to be the one and only way from now on, so it can’t be torn down and redesigned from scratch, so patches and kludges and work-arounds accumulate over the years.

        • NZ says:

          The South Park episode “Taming Strange” parodied this pretty well.

        • Goldblum says:

          Yes. In fact there is a trend (referred to in the software dev world as “consumerization”) for companies to make do with software originally designed for consumers like Gmail and Dropbox instead of “enterprise” solutions. My theory is that the higher visibility of consumer software companies makes them more prominent places to work and allows them to attract better employees, who produce better software.

          (Companies are organisms made out of people.)

          • suntzuanime says:

            Isn’t it just a matter of the tightness of the feedback loops? B2B involves negotiating contracts and dealing with other businesses’ bureaucracies, whereas consumers either like your shit or they don’t. You don’t have the friction of stuff like purchase orders and service contracts when dealing with consumers.

          • HeelBearCub says:

            @Suntzuanime:
            I think much of it has more to do with the pressures that lead to everyone using their cellphone camera and not having a “better” one.

            It’s good enough and free-ish.

            And I won’t get the benefit from the $500 model anyway. I don’t know how to use it. I just want to take pictures of my kids inside with a flash anyway…

          • NZ says:

            I think it has way more to do with the particular methods each software company uses. Google has embraced a lot of newer methods (like Agile), while a lot of B2B developers haven’t.

          • Goldblum says:

            @NZ

            Yes but why would B2B developers systematically ignore best practices? Good developers embrace good practices.

            B2B companies have a self-fulfilling reputation for being inferior places to work.

            @suntzuanime

            Yes I’m sure it has something to do with the sales cycle as well. B2B companies are selected on the basis of sales ability rather than software dev ability.

  15. I was getting occupational therapy for misophonia for a while. The same clinic treated sensory avoiders and sensory seekers, and had one waiting room.

  16. Jaskologist says:

    This sounds profoundly demoralizing. I hope the next half is better.

  17. Goldblum says:

    It’s too bad society doesn’t let us make the Coasian bargain (misconcept?) where Scott gets paid to treat the psychiatric problems of his readers.

  18. cassander says:

    If you read historical descriptions of mental hospitals, they were indeed bedlam. In the 18th century, tickets were sold to spectators who wanted to gawk at the loons.

  19. TK-421 says:

    Conclusion

    Simply sitting instead of standing at a patient’s bedside can have a significant impact on patient satisfaction, patient compliance, and provider–patient rapport, all of which are known factors in decreased litigation, decreased lengths of stay, decreased costs, and improved clinical outcomes.

    Well, it’s good to see our priorites are in order…

    • Deiseach says:

      It does make a difference in perception, though; a doctor standing seems like they are only waiting to rush off to the next patient, so you don’t feel they’re really listening to what you’re telling them, having to crane your neck to look up at them is uncomfortable, being in bed while everyone else is fully dressed is already demoralising, and in general you feel powerless.

      Sitting on the bed seems friendlier and putting themselves on the same level as you, it’s closer, more intimate, you don’t have to speak as loudly to be heard by them so the entire ward doesn’t get to eavesdrop on the account of your bowel movements, etc.

      Bedside manner is a legitimate part of the doctor’s art.

      • TK-421 says:

        I fully agree, I just thought it was telling how “decreased litigation” came before “improved clinical outcomes” in the list.

    • FullMetaRationalist says:

      Patients love this one weird trick!

  20. Azure says:

    So. I’ve been in a mental hospital twice. The second time was stupid and pointless. It was basically security theatre.

    The first time was useful. Sort of. Briefly. To some degree. I was having a mixed state which is, basically, the worst thing in the world. The worst part of it is that it’s such an overwhelming emotional awfulness that you start seriously worrying that even though you don’t WANT to harm yourself if the mixed state doesn’t go away you’re going to suffer a failure of willpower or something and throw yourself under a bus. Now, I don’t actually know how likely this is to actually happen. I’ve never made a suicide attempt. (Though during my first mixed state I was thinking about how I might go about it.) And I don’t know the statistics of how likely a mixed state is to lead to one.

    However, it is the case that being pulled out of my daily life and stuck in, as you put it, the most boring vacation in the world, where they made me wake up early and go to bed early and …well, that’s pretty much it. When your emotions are going haywire you can at least FEEL better if someone interrupts your life, it defuses some of the feedback stress. And I suspect there’s a certain value to “Hey! Modern science is here to save me! Modern science is great!”.

    At least the first day or two was pretty nice as a means to let me catch my breath and calm down and feel like I could deal with all this awful stuff my mind was doing to me.

    But the actual therapy was worthless. There’s something really insulting about making crazy people go through a ‘twelve step’ style program.

    And the psychiatrist was actively harmful. What kind of person prescribes someone drugs and then, when they start causing involuntary muscle movements, just throws an anticonvulsant on top of it?

    But, for certain kinds of emotional overload, there’s some value in the world’s worst resort.

  21. xzd7rys9ao says:

    Do you know anything about psychiatric care in post-soviet countries? I’m considering seeking help, but I’m really prejudiced against it. Is self-treating my best option?

    • Scott Alexander says:

      I don’t know much except that they use some cool medications like piracetam and Noopept. Any Eastern European readers know more?

      • xzd7rys9ao says:

        I did piracetam. Twice, actually, first time as a Quantified Self-style nootropics stint, with careful journaling and predictions. I found that it somewhat quells anxiety and enhances learning, but makes me unpleasantly prone to anger.

        Second time was when I took a lot of various medication over the last six months that I *have* been seeing a psychiatrist, and I can’t even say that it didn’t help. I felt some changes, but ultimately I found our relationship unproductive: I didn’t understand what’s wrong with me, nor did I get decisively better.

        What’s interesting about noopept? I remember trying it for some reason, for a week or so, but didn’t notice any effects.

      • chaosmage says:

        East German psychiatry was a lot like West German psychiatry, except 1. less talk therapy and more occupational therapy, 2. disagreeing with the state could sometimes be considered insanity, and get you committed and 3. there were no special particularly good clinics for people who could afford more, except one, in Berlin, for high-ranking party members.

        After re-unification, East German medicine in its entirety copied the West German way of doing things (down to using disposable stuff rather than sterilized and re-usable stuff for everything), this included psychiatry of course, so now there’s no difference that I can see.

        When a political system breaks down, it is way easier to just copy some functional system’s laws and regulations than it is to design them anew, so my guess is that other former Soviet Bloc countries did much the same.

      • Shenpen says:

        As far as EU-member Eastern Europe goes, there is a huge dearth of doctors, they go west working for 5x the money so currently it is more and more about just doing the minimum i.e. keeping violent people in.

        There is not really a culture of taking antidepressants. People self-medicate with booze and while technically alcohol is a depressant, quite frankly when I see older guys who have a bad life drunk happily singing I think for them it is an antidepressant.

        Rich people pay for private therapy. State hospitals cannot really deal with but the most extreme cases.

    • Nita says:

      I imagine it depends on the country. If yours is like mine, there’s a lot of variety — up-to-date and sympathetic doctors, old-fashioned doctors, “alternative” therapists of various kinds, doctors who also do “alternative” stuff etc. I would try looking for recommendations online, as well as popular articles or interviews. It’s not true that only “the rich” use mental health services, but people usually don’t talk about it unless asked.

  22. Tau says:

    “So either it’s harder than I think, or I’m surrounded by idiots, or I’m an idiot and don’t know it yet. In which case I’m about to learn.”

    My experience as an early-career clinician has been mostly the second, partly the third, and also a hefty dose of a fourth option: when I get reports from specialists to whom I have referred, it is not uncommon at all for me to only barely recognize the medical history as told to the specialist. I don’t think it’s exactly that people are lying to me or the specialists… I also try to remember this when I am considering a course of treatment that has been done and that is on the face of it insane.

    Also, of course, there are an awful lot of clinicians of every kind out there who fail entirely at keeping open minds, learning new things, reconsidering strongly-held but erroneous beliefs, etc. and make repeatedly bad treatment decisions because of that. This is probably different from being an idiot from an internal perspective, but not from an external perspective.

    • Scott Alexander says:

      Oooh, good point with that fourth option.

      OOC, what kind of clinician are you?

      • Tau says:

        Veterinary GP.

        (Which introduces the added wrinkle(s) that the people who are not telling a consistent story and/or not understanding what they’ve been told are generally not the sick organism* themselves.)

        *exclusions for Munchausen-by-proxy, delusional parasitosis by proxy, etc. The overlap of veterinary and psychiatric practice is a pretty interesting place.

    • I suspect some people diagnosis shop, emphasizing particular parts or interpretations of their behaviors in order to get a particular diagnosis. In turn, I suspect there are some shrinks who see the same disorder in almost every patient they see.

      I know one individual who’s gotten (at least) 5 different diagnoses over the years.

  23. sarah says:

    > how deeply the civilizing instinct has penetrated
    > doing things which are super illegal and which I wouldn’t expect a hospital to be able to get away with

    It’s interesting how different your experience is from my other close psych hospital experience. I had a roommate who worked as an underling at one of the Arbour Health System hospitals. (I’ll pause here so you can google all the investigations and citations they’ve undergone.) She would come home most days with a new story for the gallery of horrors. The people there were mostly lifelong poor and couldn’t get treatment anyplace else, and they often had multiple or poorly controlled conditions + other health complications.

    Violence was reasonably common, to the point that large male staff members could get away with a lot without getting fired. (To quote my roommate: “it’s annoying, but also I want them working the same shift as me.”)

    No one there was really getting paid enough to care. There was a sort of systemic dysfunction here things were terrible and out of control, so it was an awful and dangerous job, so all the staff phoned it in, so things were terrible and out of control. Why stop a patient from doing something non-deadly when it means you risk getting bitten without health insurance? etc.

    • PGD says:

      Maybe Scott just works at a better hospital. Seems like violence is something that would be highly susceptible to virtuous/vicious spirals — if the staff doesn’t act in an insulting/abusive/unnecessarily provocative manner then violence can be avoided, if the staff does act abusively then violent spirals start.

      If you watch prison/jail/cop reality shows on TV you can frequently see police or jail guards escalating to violence extremely quickly — prisoners use a curse word, don’t instantly comply, or move their body even slightly the wrong way, and BAM instant takedown and swarming on the prisoner. It almost seems like a ‘first strike’ philosophy that if there is any whiff of conflict in the air then bring in overwhelming force. I can imagine practices like that leading to a very violent atmosphere in a psychiatric hospital.

      • stillnotking says:

        Right out of college, I worked briefly at a residential facility for kids who had been court-ordered out of their homes. In about 80% of cases, this meant a history of abuse, sometimes very severe abuse. The rest were the children of incompetent parents, which always translated as “junkies”.

        It was a violent environment. The kids’ ages were between 12 and 17, IIRC. I worked in the boys’ wing. Teenage boys who grew up in abusive and/or neglectful homes are not paragons of restraint. There was at least one serious (i.e. potentially homicidal) fight a week, there was gang activity despite careful attempts to ban gang colors/signs/etc., there were kids sneaking off to have sex in the bathroom. Their attitude toward the staff was either total contempt or grudging submission, depending on their assessment of that particular staff member’s willingness to throw down. As you might expect, the veteran staff members were every bit as savage as the kids. Many of them were, in my semi-professional opinion, high-functioning sociopaths. The only two things at which they excelled were applying painful restraining holds, and creative collaboration in writing reports.

        I didn’t know such places existed in the United States. I lasted six months before realizing that: a) it wasn’t going to get better, b) I wasn’t improving anyone’s life in any way, and c) I was on the wrong track for doing what I’d really wanted to do, which was get into some kind of counseling job. All the counselors were MSWs, and I was a mere BA. I’d been told the potential existed for a promotion, but that didn’t seem to be the case, and distinguishing myself in my current position would’ve depended on cultivating the polar opposite mindset.

        This was in the mid 1990s. I gave up, went into computers, and haven’t used my psych degree since. My hat is off to anyone who can salvage a self-respect-worthy career out of the meat grinder that is the public mental health system, at least the little corner of it I saw.

      • Murphy says:

        Understaffing also correlates highly with violence on mental health wards.

        As you’d imagine if you’ve got one patient who’s not with it enough to understand the idea of property and a couple more with anger issues an understaffed ward is going to have a lot more issues with violence because the nurse isn’t there to gently prize the items out of the first patients hands before the others get angry.

  24. Douglas Knight says:

    decided that Adderall was the first-line medication of choice for depression

    When you get inpatients, do you have that much information about what their outpatient psychiatrists were thinking?

    • Scott Alexander says:

      No. Usually I just hear from the patient “I’m depressed. I told my psychiatrist that, and she put me on Adderall.”

      As someone upthread pointed out, the patient might not be telling a very accurate story. Or, well, the Adderall part is accurate since they might bring in their bottle of the medication, but they might have told their outpatient psychiatrist something different.

      • Creutzer says:

        Serious question, how bad is this, really? I wouldn’t be surprised if low doses of amphetamines were helpful for depression.

        • chaosmage says:

          That’s been tried many times, especially when amphetamines had been invented but SSRIs hadn’t. It relieves symptoms for a while, but tolerance develops too quickly for treatment of chronic conditions, and the addictive properties don’t go well with the willpower issues of depression.

          Paradoxically, stimulants help with mania, but also only to interrupt an episode, not as a long-term medication.

      • Deiseach says:

        I wonder, since depression does mean “not caring a straw about any damn thing”, did the patient maybe tell their psychiatrist “I have trouble concentrating on my job, I can’t focus, I forget stuff” because that is what is looming large in their mind rather than “Oh and as well I feel blue for no reason” and so that’s why the Adderall prescription?

        Then it’s only later it dawns on the patient that maybe they’re depressed?

        • brungl says:

          it can also happen the other way around, which is what happened to me. i was diagnosed with ADHD in high school but hated the medicine, so i stopped taking it. i kind of viewed my diagnosis as an excuse my parents were using for “not living up to my potential”.

          then late in undergrad i couldn’t coast through my classes anymore, found that i couldn’t focus, got poor grades, and thought i was depressed. finally bit the bullet and got tested for ADHD again, and started taking Adderall.

          suddenly my grades/employment prospects improved, i could focus on things for more than 20 seconds, and hey! turns out i wasn’t depressed, i was just upset with my inability to focus/perform academically.

          • HeelBearCub says:

            I had a somewhat similar experience, although I was not diagnosed until my mid 40s after struggling with un-diagnosed depression for most of my life, and then starting on SSRIs at about 40.

            The Adderal seemed to make more of a difference than all the SSRIs (with some confounders like sleep apnea and low testosterone being treated as well).

            Does anyone remember anything about CBT being used to treat feelings of worthlessness associated with adult ADD? I swear I read a linked article, but now I can’t find it again.

          • chaosmage says:

            Low testosterone can have quite an impact on mood, so treating that is a strong confounder.

          • HeelBearCub says:

            @chaosmage:
            Yes, and sleep apnea has the same effect. In fact sleep apnea is itself positively correlated with low testosterone, IIRC. That is is one reason I made a point of mentioning it.

            But, the flip side of this is that I didn’t really get “right” until we had a work “emergency” that lasted about 9 months. It wasn’t until I was able to be completely subsumed by my work, doing 12 and 16 hour days 6 and 7 days a week, that other concerns faded away.

            When I expressed this thought to my psychiatrist, he said “Well, some people are born to be firefighters.” That made complete sense to me. I have always been much better (both productivity and emotional state) when the next immediate task was screaming at me, instead of having to choose from a number of equally “important” but mundane tasks.

          • onyomi says:

            “I have always been much better (both productivity and emotional state) when the next immediate task was screaming at me, instead of having to choose from a number of equally “important” but mundane tasks.”

            I think most people are wired this way to some extent or another.

            Along with tight-knit social units, I think it goes a long way to explaining why third world people living in material conditions we would find abhorrent yet seem to suffer from less depression than we who have all our basic needs met.

  25. Moshe Zadka says:

    Yay by the time my little one is four and capable of having somewhat-sophisticated conversations, I’ll be able to drag her with me to talk to Scott in meet-ups! (I hope there’ll be meet-ups in kid-friendly hours and also that Scott likes kids?)

    • Emily says:

      Would you mind being asked some possibly overly-personal questions about children and values/religion?

      • Moshe Zadka says:

        I don’t mind being asked questions. I might not answer them, if they’re too personal, I guess 🙂

        • Emily says:

          How do you think about Conservative Judaism vs. other, more rationalist-oriented value systems in terms of what you want to teach your kids?

          • Moshe Zadka says:

            I think you have some incorrect implicit assumptions, that I’d like to clarify:

            1. At 2.5, the teaching of “value systems” tops out at “no, don’t take this toy away from your brother” (something I imagine is universally agreed upon…) — I’ll assume you meant for the future, but be aware that this means that the entire post might as well have been asked of people who don’t have children — I am speculating about what I will do in the future.

            2. My wife is reform, I’m a “conservative” in that I prefer the conservative worship style, not in that I necessarily identify more with conservative “values” (and I’m not sure if you understand the distinction between Orthodox and Conservative Judaism — I don’t want to make assumptions about your knowledge, but if you’re not Jewish [by upbringing] you probably want to read up on Wikipedia]).

            3. Currently, as much as we do go to shul, we go to a reform synagogue — mostly as a decision of convenience, that’s where our daycare is [it’s a long story, but the bottom line is “it’s close by, we don’t hate it too much and we get a discount on daycare”].

            So given all of these implicit assumptions here is the answer: my plan is to teach my kids “my” values, as far as they can understand at any point in time (so far, I think I’m doing this with “don’t take your brother’s toy”), so the question bottoms out in “what are my values”.

            I’m a kinda-consequentialist utilitarian in that I believe that this is the only ethical philosophy that makes sense. I also believe that it’s impossible to implement consequentialist utilitarianism from first principles in real life, for obvious reasons. I view the “moral parts” of Judaism as supplying some of that useful deontology — for example, showing kindness to the outsider (“for you were an outsider in the land of Egypt”), not delaying wages, taking care to greet people so they do not feel ignored, etc. I definitely intend to teach my kids these principles as “we are Jews, and Jews do not delay wages” (moving on to the deontology-as-approximation-to-utilitarianism when they’re quite a bit older).

            Separate from that, I do take seriously studies that show belonging to religious communities makes people better off, and I intend to teach my kids to take that approach to Judaism: we go to shul and celebrate the holidays as a way of belonging to a supportive community. I’m aware that I’m biased enough towards liking the Jewish-style of worship that most other semi-reasonable alternatives seem significantly worse.

          • Emily says:

            Thanks. I appreciate your response. I did mean for the future.

          • brad says:

            I feel the same way regarding the worship style. I don’t have any religious beliefs at all and I don’t attend regularly but if I’m at a wedding or a bar mitzvah or something I am much happier at a conservative synagogue than anywhere else. I don’t want to be completely lost while everyone else does their own thing (orthodox) and I don’t want to feel like I’m at a Peter, Paul, & Mary concert (reform).

      • houseboatonstyx says:

        Was that a microaggression? You did ask if you could ask, but even asking if you could ask if you could ask ad infinitum has the problem of who you can ask in the first place.

        • Faradn says:

          The rationalist community seems to be an ask culture, not a guess culture. I think most people who come here expect that.

        • Emily says:

          I think if you’re going to google people you don’t know and ask them questions about their religious beliefs when they’ve made comments that are not about their religious beliefs – well, probably you shouldn’t do that. But if you’re going to, you should be extra-polite about it.

    • Parker says:

      Four years old and being able to have sophisticated conversations? That’s impressive. My 22-month-old just learned “shit”. Not exactly sophisticated, but hey, useful nonetheless.

  26. Brian Donohue says:

    Great post. I suspect the change will be invigorating.

    OT question that you’ve probably covered: What do you think of Viktor Frankl? I found Man’s Search For Meaning to be an astonishing and beautiful book.

    • DiscoveredJoys says:

      I’ve read Viktor Frankl’s Man’s Search For Meaning and I found it an interesting and thoughtful book but it didn’t shoot bolts of enlightenment at me. Similarly I’ve read Abraham Maslow who came around to thinking that self-actualization was the tip of his pyramid. Again no drum-roll.

      Now it’s quite possible that when I re-read these books I’ll form a different view. I’m older, I have read more, and more widely. But my takeaway message is that there is probably more than one ‘Great Answer’ because people have different personalities and (contrary to common belief) personalities can change as people get older.

      Which brings us back to Scott’s ‘holding environment’ – I suspect some people will benefit from this, some will be unaffected, and some will be adversely affected. But which ones?

      • Brian Donohue says:

        I’m not talking about any kind of world-changing epiphany, I’m merely marveling at the indomitable human spirit. Humanity can be a beautiful thing, even in the muck and mire. Maybe especially in the muck and mire.

  27. TomA says:

    This sounds like another instance of “less worse” accommodation in service to civilized sensibilities. Does this form of treatment really make a dent in the problem, or does it primarily serve as salve for our social conscience?

  28. onyomi says:

    If you ever start to feel like an SSRI vending machine, just wait until you have a patient like me who will tell you “doc, this SSRI you prescribed made me feel much crazier than before!” The next step, after the obvious first-line solution has been tried, varies wildly from doctor to doctor in my experience, and can make all the difference, for good or for ill.

  29. Markus Ramikin says:

    Thank you for sharing about yourself, Scott. We all care about your pain here.

    *innocentlook*

    More seriously, great post as usual. Insights into your work may be my second favourite kind of posts here, after methodology-of-science type stuff.

  30. Paul Crowley says:

    No chance of time off for good behaviour?

  31. Shenpen says:

    Seems like a waste that you don’t do psych research instead.

    Let me ask a question: if you see a classic typical nerd-neckbeard, like https://40.media.tumblr.com/5edc3ec7223483c5276b8c71830505be/tumblr_mvzxgyp9dB1shzut6o1_500.jpg do you start to supect some kind of a personality disorder or condition, or it is “normal” ?

    • “Seems like a waste that you don’t do psych research instead.”

      I find it unlikely that Scott’s is making the most productive use of his considerable talents in his current day job. One alternative would be to do as a job what he now does for free–evaluate the literature on questions for other people. I don’t know where such jobs exist.

      Another would be to put together a book from a suitable collection of blog posts, publish it, then put together another, then a book of stories, then … . Making a living as an author is not easy. On the other hand, Scott is very good.

      But, obviously, it’s a decision for him to make. The rest of can only offer suggestions.

      And speculate as to whether the real explanation is masochism.

      • PGD says:

        For someone with Scott’s obvious writing talent and drive, it is frequently possible and productive to combine practice and writing. I find authors who are also practicing in the real world as XXX to frequently be much more insightful than pure theorists/researchers who often get lost in their theoretical constructs. In the case of writers about medicine, see for example Atul Gawande — a great model for someone like Scott to follow.

        You and others will probably disagree with this, but I think it’s particularly helpful for libertarians to get that practical seasoning, as libertarianism is a highly abstracted belief system.

        • creative username #1138 says:

          Anton Chekov, Arthur Conan Doyle, Louis-Ferdinand Céline. There’s a long tradition of combining writing with practicing medicine. Don’t know about Doyle but Chekov and Céline would have likely been much worse as writers if they stopped practicing.

        • triclops says:

          This is a fantastic insight, and I often notice the same problem with libertarianism, within myself and others.

      • Nita says:

        the real explanation is masochism

        Oh dear — not even shrinks can escape the epidemic of e-diagnosis!

        Scott won’t take donations from blog readers because he’s afraid it might mess with his intrinsic motivation. Under that paradigm, quitting his job and trying to sell books would be a terrible idea.

        • John Schilling says:

          Not without precedent; Richard Feynman produced professional-quality art as a hobby, right up to the point where he sold a few works – and found that a constant refrain of “will paying customers like this?” basically killed his creativity and productivity. I believe he was eventually able to return to purely amateur artistic endeavors.

          Agreed that Scott could probably make a pretty good living on his writing. As a “customer”, I’m in the if-it-ain’t-broke-don’t-fix-it camp, though it’s his call.

        • Nornagest says:

          I don’t think masochism is considered a disorder as such anymore. It’s pretty common for people to take obsolete medical concepts and use them as a schema for personality types (viz. “anal” for anxious perfectionists, originally Freudian), but is that really a diagnosis?

      • Murphy says:

        There’s always doing systematic reviews. Things like Cochrane Reviews are absolute gold in research and apparently even in Gov policy since they tend to be such high quality.

      • houseboatonstyx says:

        do as a job what he now does for free–evaluate the literature on questions for other people. I don’t know where such jobs exist.

        I know at least one does, or did, and wanted him to join them, with a Comment that sounded like Francisco d’Anconia inviting Hank Rearden.

      • JohannesD says:

        One alternative would be to do as a job what he now does for free–evaluate the literature on questions for other people. I don’t know where such jobs exist.

        Traditionally, that has been one of a librarian’s duties.

  32. chaosmage says:

    What about single parents who get committed? Do their kids go to a foster home or something? If so, doesn’t that make the parent worse too?

    • Katherine says:

      Do their kids go to a foster home or something?

      If they don’t have any relatives that they can stay with, and the other parent can’t/won’t take them while the first parent is in, yes.

  33. Steve Sailer says:

    It would be hard to test, but I suspect that just having a high quality person like Scott around does the troubled some good on average.

  34. nike says:

    …since none of the other Grammatik-Nazis has pointed it out yet – it’s “Gott im Himmel”, not “Gott in Himmel”, because you really wouldn’t expect a concentration camp guard to speak Yiddish.

    Good luck for the next two years! I do hope outpatient work gives you a good time, even if it means less lore for us.

    • Saint_Fiasco says:

      Well, the guards have to spend a lot of time near Jewish people, so one might expect them to acquire a mild accent.

      • Creutzer says:

        How often do you see, say, American social workers acquiring an AAVE accent?

        But the guard may be Bavarian or Austrian, in which case he might also say “in” instead of “im”. (And he would also pronounce “Himmel” in a way that nobody knows how to write.)

        • Gamer Imp says:

          I can’t speak to social workers, but a lot of cops pick up minor dialect/accents from AAVE after years of working in communities where it’s common.

        • Franz_Panzer says:

          Nobody knows how to write it? There are whole dictionaries for various Austrian dialects.

          But more to the point, I would find the use of “in” weird in any dialect

  35. PGD says:

    I have nothing to say except that this is an extraordinarily lucid, thoughtful, humane, and humble post. I wish all of our authority figures had your sort of perspective.

  36. Tarrou says:

    A fair warning, Scott. There does exist an early area of competence I like to call “Specialist’s plateau” (not medical specialist, the rank). It comes when you’ve mastered your job and are better at it than most people even above you. You think you’ve understood the whole thing and it infuriates you. So many dumb people doing dumb things. And you start to fight, because all that matters is the outcome, right? If you’re good at your job, that’s all that matters, right?

    People are people. Things are the way they are for a reason. Perhaps not a good one, but there is one if you look far enough. Personally, I kept getting promoted and then getting myself busted down so I could avoid the politics and stay where I was an expert. Then came the day when I couldn’t keep a talented and very young soldier in my team because I was a very junior sergeant. His new team lead, a terrible parade of idiocy and corruption, promptly got half the team, himself and my guy included, killed. My version of survivor’s guilt has been wondering for ten years if my youthful rebellion prevented me from attaining the rank I could have used to keep that kid. Am I really so proud I couldn’t kiss an ass or two to save a life? Apparently so.

    The E-4 Mafia. It feels so right, but ends so wrong sometimes.

    • Murphy says:

      A reason and a good reason are 2 different things.

      Above a certain level lots of things seem to happen mostly on autopilot and drift into local minima/maxima without anyone batting an eye. Sometimes the reason can be “we ended up stuck in this position because nobody cared enough to do anything when it would have been easy to solve. “

  37. Matt M says:

    “You can adjust to having to treat someone having a seizure. You can adjust to somebody banging on the window and screaming. But it’s really hard to adjust to constant moral self-questioning.”

    I hope your switch to outpatient gives you the satisfaction you’re looking for.

    I had this feeling when I was in the Navy, and changing jobs wasn’t the solution. I had to get out entirely and basically start my life over from scratch. Which is hard, but you know, worth it in the long run.

    I’ll be interested to see if things work out for you changing the nature of your psych work, or if you eventually feel the need to exit the profession completely. I’d encourage you to start considering your options in either case.

  38. Acedia says:

    As an outpatient shrink you’ll potentially have to be the person who orders a patient committed, no? I imagine the moral self-questioning isn’t quite over.

  39. Julie K says:

    “The average length of stay in a psychiatric hospital is about one week.
    “Some clever person might ask: “Hey, don’t most psychiatric medicines require more than a week to take effect?” Good question! The answer is “yes”. ”

    You could probably find similar examples from other departments in your hospital of patients being discharged when they are very far from being cured, simply because the hospital focuses on treating the patients during the period that they most in need, rather than for their entire case.

    It seems to me that there’s been a big change over the last hundred or so years in what the purpose of a hospital is- from providing nursing care, to providing medical care.

  40. Ronan says:

    Thanks for writing this. It’s fascinating to see the other side – I work as an EMT, so I see psychiatric emergencies from their inception but only up to the point we transfer care at the inpatient center.

    As such I’ve had similar thoughts about the efficacy of our healthcare system and how much emergency medicine can really help in the long term, after the stabilization is complete. At least with the acute psych jobs such as majorly psychotic patients or suicide attempts, you know that you’re at the very least removing them from their environment and whatever triggers brought it on, and ensuring that they don’t hurt themselves or others at least for the time being.

    What’s not so clear-cut is the kind of situation where the patient’s partner makes the allegation that the patient made a suicide threat while holding a knife to his neck. And then upon arrival no sign of knife, and upon questioning, the patient denies it and says she’s lying to get him sent away. The law ties our hands, we have to transport him, and the whole way to the hospital you get to hear “This is bullshit,” “I shouldn’t be here,” “I’m going to lose my job.” What the hell can you even respond to that. Especially knowing that much of the treatment is as you put it, security theater, and would not be helpful to an actual psych patient much less someone who may not have even had any suicidal ideations.

    Congrats on the half way point. It is a tough job and you’ll always be stemming an unstoppable tide, but there will be many, many lives improved because of you.

    • Acedia says:

      Where is this place that allows someone to get their partner committed simply by phoning in a bogus story? That sounds like an outrageously stupid and dangerous law.

      • Deiseach says:

        What generally happens to get stupid and bogus laws passed is that X rings in to say Y is threatening suicide. The authorities show up, Y is not standing there with a knife to their neck, the authorities are convinced this is just a domestic, and they leave.

        Then Y really does try killing themselves, maybe even succeeds, and/or attacks X first, and this becomes “But you were called out the first time! Why didn’t you do anything? Something Must Be Done!” and the “Bring someone in if they’re reported to be threatening suicide” law gets passed. Particularly if the family protest “If only you had taken in Y the first time and they had gotten treatment, this wouldn’t have happened”.

        There’s generally some kind of reason stupid laws/rules get made; very few times it’s because someone sits down and thinks of a dumb rule that has no purpose other than causing trouble.

        • Ronan says:

          This is correct. There are liabilities that emergency services have no control over – if we do not transport a suicidal gesture, and that person ends up attempting or successfully completing suicide an hour after we leave, the law would not be on our side. I personally believed her story, but it doesn’t matter, as the consequences would have been the same in absence of any hard evidence to the contrary.

      • Anthony says:

        How do you, or the cops, or the intake at the hospital, know the story is bogus? The same problem attends most policies regarding domestic violence – in many counties in California (and probably elsewhere in the U.S.), any DV call pretty much has to result in an arrest and booking. This creates the obvious perverse incentives.

      • mobile says:

        That place is called California.

    • Andrew M Farrell says:

      Is there a way to metaphorically convey “I fear I might be complicit in some terrifyingly unjust and obviously oppressive system but that my moral intuition is so weak I have not conclusively realized it.” without making reference to something that has the moral weight of the Holocaust? There is no word for this concept, so metaphor is really necessary to get the sense of it.

  41. Stephen Frug says:

    Don’t mean to focus on minor things, but let’s face it, if anyone complained to a camp guard at Auschwitz, the guard probably would’ve just shot them or sent them to the gas chambers. Unlike the other six death camps, Auschwitz was also a work camp, which meant some people stuck around (more than half-starved, often dying from the work) to do work, but of course most people who ended up there were just murdered. I’m fairly certain any complainer would have just been killed.

    I guess I’d just say: I think this metaphor is not only disrespectful to the mental hospital you work in (which you seemed apologetic for) but to those who experienced Auschwitz too. tl;dr: Really not loving the metaphor.

    • Nita says:

      Scott has a peculiar sense of humor. I guess he felt it’s OK because he’s using it to criticize himself?

      • Stephen Frug says:

        I presume you’re right. That’s what I was criticizing, since it wasn’t only disrespectful to the mental hospital (i.e. criticizing himself), but misrepresenting the situation at Auschwitz (i.e. disrespectful to the truth of the Shoah). So I think the criticism stands, even given your reading.

        • FullMetaRationalist says:

          I’ve never grokked arguments about jokes being disrespectful. In my mind, it’s all just a slippery slope where each individual Draws The Line wherever their personal aesthetics (arbitrarily?) dictate. Can you explicate the algorithm (or list of criteria) by which you judge a joke to be respectful or disrespectful? Or is the process one of those slippery, subconscious things that are difficult to pin down (like meta-ethics). For example,

          * Must the severity of “the two situations under comparison” exist within an order of magnitude? This strikes me as absurd because it would be disrespectful to compare a pond to the ocean. How severe must a situation be before it deserves respect at all?

          * Does a situation deserve respect in the sense that the analogy must be represented accurately? All analogies are imperfect to some extent, so to what thresh hold do we define “accurately”?

          Is there some aspect of this that I’m missing entirely?

          • Alraune says:

            It’s a “sacred values” thing.

          • FullMetaRationalist says:

            I thought the same thing at first. But down thread, Stephen distinguishes death camps like Auschwitz from other types of camps (labor camps and internment camps). He says comparisons involving labor camps and internment camps are permissible, but not Auschwitz or the rest of the Shoah.

            I find this odd, since my model of “what others find disrespectful” predicts that the labor and internment camps would be considered sacred as well. This leads me to believe that maybe it’s not a sacred values thing.

          • Stephen Frug says:

            It’s not that Auschwitz is sacred. It’s that he gets Auschwitz wrong. The reason other labor camps would not be disrespectful is not because they aren’t sacred (whatever that means) but because they were different, so that to make the same joke about them wouldn’t get the history wrong.

            The only respect I’m calling for is getting the history right: Auschwitz was a death camp. Scott’s joke misses that. If you want to joke about that in a way that at least recognizes the history, then have at it as far as I’m concerned.

          • onyomi says:

            I thought the labor camps became death camps when they realized they were losing and didn’t want to give any food to prisoners.

            I’m no expert, but Wikipedia seems to support this general notion with respect to Auschwitz as well. It started out as a more of a prison/labor camp and was gradually retooled as the fight against Russia went badly. I don’t think “kill all the prisoners!” was plan A, even for Nazis. Which is another reason to remain vigilant against thinking “well, THOSE people were just evil, but something like that could never happen here.”

          • John Schilling says:

            The labor/concentration camps and the extermination camps were two separate things; Auschwitz is a misleading example because the name covers two separate camps under common administration – Auschwitz proper being a labor camp and Auschwitz-Birkenau having been planned as a second labor camp but repurposed as an extermination camp during construction.

            The labor camps were places to live and work – with a high mortality rate due to e.g. inadequate food, but with no specific intent of death. Particularly for inmates who were still capable of useful work. The death camps, weren’t even “camps” in any normal sense of the word, as the expectation was that the average inmate would be dead before they had any need of e.g. a cot or a toilet. There weren’t really any prison facilities, save for a modest janitorial workforce, in the death camps. Lots of “showers”, though.

            People incidentally starved in labor camps, particularly towards the end, but generally didn’t live long enough to starve in a death camp. And if someone in a labor camp fell into the category of “can’t work any longer, and we can’t spare food for useless mouths”, they were shipped off to the death camps rather than being deliberately starved to death in the labor camps – that would needlessly demoralize both the guards and the remaining laborers.

            All of which began in late 1941, when the Nazis were still winning. What changed was, it had become clear that the ultimate Nazi victory was still many years in the future, and plans like “ship all the Jews to Madagascar” were right out.

    • onyomi says:

      See, I really like it, because I think we make a big mistake if we think the prison guards at Auschwitz were a fundamentally different type of human being than we are. The fact is, they were normal people in rather extreme circumstances reacting the way normal people do to a combination of ideology and fear of authority.

      • LHN says:

        Less of the latter than most of us would think. Obviously, there’s always pressure to go along with what everyone else is doing, especially in a strongly ideological regime. But objectors weren’t generally facing serious personal risks beyond that. E.g.,

        The consequences of their holding aloof from the mass murder were not grave. The reserve lieutenant of 1st Company who had protested against being involved in the Jozefow shooting and had been allowed to accompany the work Jews to Lublin subsequently went to Major Trapp and declared that in the future he would not take part in any Aktion unless explicitly ordered. He made no attempt to hide his aversion to what the battalion was doing, and his attitude was known to almost everyone in the company. He also wrote to Hamburg and requested that he be recalled from the General Government because he did not agree with the “non-police” functions being performed by the battalion there. Major Trapp not only avoided any confrontation but protected him. Orders involving actions against the Jews were simply passed from battalion or company headquarters to his deputy. He was, in current terminology, “left out of the loop.” In November 1942 he was recalled to Hamburg, made adjutant to the Police President of that city, and subsequently promoted!

        (From Christopher R. Browning, ONE DAY IN JOZEFOW, Initiation to Murder. Later expanded to the book Ordinary Men.)

        • onyomi says:

          People don’t have to actually fear real negative consequences in order to fear authority (perhaps “fear” is not the right word here–I mean, bow to authority, even when authority is demanding you do something which personally upsets you).

          I assume you’ve heard of the Milgram experiment? What is especially scary about that and the Stanford prison experiment is that the participants were screened in advance to be psychologically normal (or at least not obviously aberrant). One might think that “concentration camp guard” being a self-selected group of psychopaths might explain their behavior, but I think these two experiments show that that isn’t necessary. “Normal” people will do terrible things in the right circumstances, and especially in the presence of perceived authority, even without fear of direct personal harm to themselves.

          The fear of defying authority is probably deeply rooted in our evolutionary past, when currying favor with the chief could be very advantageous, and refusing to heed him disastrous.

          I think we make a big mistake if we think Nazi prison guards had these “heed authority” genes and we do not.

          • LHN says:

            I make no assumptions that I’d be the one out of N who raised objections to something comparable that didn’t pattern-match to “already well-known historical atrocity”. Just that the reason for obeying wasn’t fear per se. (As in Milgrom, where if the subject thought about it they’d know they could just walk out.)

        • Anthony says:

          The consequences don’t have to be real, or consistent, for people to fear them. Especially in a totalitarian state, where people *did* disappear for trivial reasons (or no reason at all), the fear is rational. That lieutenant was lucky to have found a superior officer who agreed enough with him to not have him shot, or sent to the Russian Front, or otherwise punished. Other lieutenants similarly situated probably did suffer those fates.

          • Stephen Frug says:

            I take your point that fear can exist even if the threat isn’t carried through. Nevertheless, if you read the history of the Shoah, it’s remarkable how rarely people were punished (and particularly rarely severely) for refusing to participate in mass murder. (It helped, of course, that (as Browning details in ORDINARY MEN (great book, btw)) they tended to portray it as a personal failing (“I’m not strong enough”) rather than a moral critique (“how dare you do this”). Fact still remains, though.)

      • Stephen Frug says:

        My point doesn’t depend on the guards at Auschwitz being different from us; it depends on the circumstances being vastly more extreme, to the point where the analogy breaks down utterly.

        • Stephen Frug says:

          There are lots of examples Scott could use here — that would be extreme but not so much as to break the metaphor (in my view). For instance, he could talk about a guard at one of the internment camps the US put the Japanese in during WW2. He could talk about one of the original concentration camps, set up by the British for the Boer in fin de siecle South Africa. (By the way, although Auschwitz, Treblinka & the others are often referred to as “concentration camps”, they weren’t: they were death camps. “Concentration camps” is when you take a population and relocate them to (essentially) a large, open-air prison. Death camps are factories for industrializing death. Labor camps are yet a third thing. (These categories can overlap, of course. But of the six main death camps in the Shoah, only Auschwitz had any sort of dual function (one reason we have more memoirs, & more survivors, from there.))

          The point being, there is a long history of human crime to go to here. Scott doesn’t need to go to the Shoah for this. And I think he shouldn’t, because the metaphor doesn’t work (and it’s disrespectful).

      • CJB says:

        To a point- but what doesn’t come up is that the extermination camp guards usually WERE. Death Camp guards were specially segregated units within the SS, which was itself a specially segregated group mostly loyal to hitler.

        So these were the specially chosen of the specially chosen, picked to be able to be death camp guards.

    • walpolo says:

      I think it was a joke, and a funny one, and the idea that it’s not OK to make rather unspecific jokes about horrible stuff is a big part of what’s wrong with America (grumble grumble).

      • HeelBearCub says:

        @walpolo:
        People in America make jokes about horrible stuff all the time. Usually you make the humor work for the most aggrieved party.

        But for this particular humor to work very well, the aggrieved party doing the kvetching about the even more aggrieved party has to be sympathetic. You can actually totally make this joke work by setting it in a German POW camp. That was the basis for Hogan’s Heroes.

        But setting it in a concentration camp and making it funny in a way that is not horrible and cringe inducing to anyone who thinks about what happens to Jews after the guard is done kvetching requires a lot more work than Scott had room for. You could set as this very, very dark, macabre, theatre-de-l’absurde where the humor is only in the laughing-at-the-kafkaesque situation, which is I think what Scott was going for. “One Flew Over The Cuckoo’s Nest” has those moments, sort of.

        I think Scott set himself to high a bar to clear, and he missed it. IMHO, etc.

        • walpolo says:

          I don’t know, I just love humor that’s flippant about nasty stuff. Ricky Gervais’s standup, for example: https://www.youtube.com/watch?v=KcqinGqHQCg

          The guiltier I feel for laughing, the funnier the joke, IMO.

          • HeelBearCub says:

            I have a pet theory that some people like to laugh AT other people, and some like to laugh WITH other people.

            I’m definitely the latter.

          • walpolo says:

            I’m not averse to laughing at people, but to be fair to Scott, I also don’t think he intended to be laughing at anyone with the Auschwitz joke (except maybe himself and his colleagues).

          • HeelBearCub says:

            @walpolo:

            Sorry, that was about Gervais, not Scott.

            There is probably some judgement in my comment, but I really just meant it as an observation.

          • Cauê says:

            I have a pet theory that some people like to laugh AT other people, and some like to laugh WITH other people.

            I don’t think this is carving reality at the joints.

            While I’d say we do have humor with status-regulating functions, I think different triggers are getting mixed up here.

            A few of our theories of humor deal with relief from scary or threatening situations, and also “benign” violations of “how the world ‘ought to be'”. I haven’t dived into the literature, but my take is that we get a laughing reaction when we perceive we’re close to either danger or a moral violation, but also perceive it’s actually safe/ok.

            The point: when we treat identity politics and similar things as sacred, it gets harder to identify whether a joke is status-based or actually about pushing against the sacredness (as do jokes about, e.g., religion, diseases, or recent tragedies).

          • HeelBearCub says:

            @Cauê :
            The wiki article mentions superiority theory, which probably comes closest, all though the specific thing mentioned is Schadenfreude, which actually seems like a special case of the more general thing.

            We are all familiar with the idea of the school yard bully, who delights in pushing the smallest of their classmates into a puddle of mud and then laughs at their impotent rage. This is one example.

            But then you look at a finely crafted comedy act like “Mr. Bean”, or at least my impression of him. The character does not find their situation at all funny. We are not supposed to empathize with him, not really. He is not evil or morally bad. He just does stupid things, then is punished for them (frequently via some form of physical situation which would be very painful if it were not imaginary) and then the audience laughs.

            This is what I am talking about. Certainly it can be mixed with other forms. Compare Mr. Bean to The Three Stooges to The Marx Brothers, which I think exist on a continuum.

          • Cauê says:

            Yes, this is one type of “humor trigger”, whatever the technical term is.

            I should have made my disagreement clearer: there are a number of such triggers, and I don’t think the “at/with” distinction is the most natural slicing. I read it as “laugh at people” vs “laugh for any of the other reasons we laugh”. Also: it’s unlikely that some people like one and some people like the other; we probably all react to some extent to the same kinds of humor, although not to the same specific examples.

        • onyomi says:

          I think the bar is, and should be, lower when being self-deprecating.

          • HeelBearCub says:

            @onyomi:
            Yes, definitely.

            But the joke only works as a self-deprecating joke if you can view the putative Nazi guard empathetically.

            Imagine trying to re-tell that joke, but instead insert an ISIS guard watching over James Foley, or the KKK guy watching over the man about to be lynched. It doesn’t really work, and for the same reasons. Or it can work, but only if you set it up really, really well.

            Look, I’m really tolerant when it comes to people trying to make comedy work. I try to make as many jokes as I can every day. Humor is how I get through life. I know I have missed with jokes.

            But it’s important to recognize when a joke doesn’t work and why, so you don’t double-down on it. Otherwise you end being the guy trying to make “Polak” jokes work in a room with Lech Walesa.

          • onyomi says:

            But I think the joke is that you don’t empathize with the Nazi prison guard who had a bad day just as, Scott is humbly implying, you shouldn’t feel bad for him and his problems, since they pale in comparison to the problems suffered by some of the patients themselves.

          • FullMetaRationalist says:

            This reminds me of David Foster Wallace’s This is Water speech.

          • Stephen Frug says:

            I think the problem is that the joke is self-deprecating, but it relies upon a distortion of the history to work. And that distortion is not in the direction of self-deprecation; it’s just distorting.

        • HeelBearCub says:

          Cauê:
          Maybe it’s typical mind fallacy. I find all humor that requires me to turn off my empathy to be, at some level, repugnant.

          But there are plenty of people that don’t feel this way. My assumption, seeming to be born out by observation, is that this group has a lower probability of feeling empathy in general, especially when it comes to outgroups. Obviously, this is subject to confirmation bias.

          The caveats are why I especially called it a pet theory. I don’t particularly have a leg to stand on. And I am not talking about any person in particular.

          • Jaskologist says:

            Roadrunner vs. coyote tended to annoy me, especially when the roadrunner just flat-out broke the laws of physics. It always seemed so unfair.

  42. Stephen Frug says:

    Incidentally, have you ever read VALIS by Philip K. Dick? It’s a wonderful novel, lots going on, but it also includes some scenes in a psychiatric hospital (the narrator, who weaves back and forth between being and being friends with Dick himself, is placed in one; in real life, PKD was in one more than once) which, of course, are parodies & meant to be funny, but which also get at a lot of the misery of the place. I don’t know what you’d make of it, having actually worked in one, but having done no more than visit people in them, I found it good.

    The part I always remember (which is certainly unfair to nurses, but again, remember this is parody & meant to be humorous) is this:

    Medication, which is always referred to as “meds,” gets doled out at irregular intervals, from tiny paper cups. Everyone is given Thorazine plus something else. They do not tell you what you are getting and they watch to make sure you swallow the pills. Sometimes the meds nurses fuck up and bring the same tray of medication around twice. The patients always point out that they just took their meds ten minutes ago and the nurses give them the meds again anyhow. The mistake is never discovered until the end of the day, and the staff refuses to talk about it to the patients, all of whom now have twice as much Thorazine in their systems as they are supposed to have.

    I have never met a mental patient, even the paranoid ones, who believed that double-dosing was a tactic to oversedate the ward deliberately. It is patently obvious that the nurses are dumb. The nurses have enough trouble figuring out which patient is which, and finding each patient’s little paper cup.

  43. onyomi says:

    The issue of wildly divergent patient-reported medical history and doctor-reported medical history is interesting to me, because I think it gets at one of the tougher issues in medical care more generally: I think doctors look at patients and see horses, even if they’re looking at a zebra, and patients look at themselves and see a zebra, even though they’re probably a horse.

  44. Michael vassar says:

    I think that your maybe overly optimistic about the probability that super illegal behaviour would cause a hospital to be quickly shut down.

  45. As far as I can tell, a lot of it is the medical equivalent of security theater.

    My wife (a clinical psychologist) really enjoyed this line, and thanks you for it.

    • albatross says:

      There needs to be a broader term, which includes security theater as an instance, for these social rituals where there’s a standard procedure done to make everyone feel like something’s being done, but there’s not much reason to think that anything is made better by the procedure.

      • Alraune says:

        Other than “Government”?

        • Nita says:

          OK, the libertarian snark around here is getting out of hand. SSC needs to replenish its supplies of communists, neoreactionaries and singularitarian transhumanists.

          • HeelBearCub says:

            Personally, I think we should socially punish snark and bad arguments, whoever they come from.

          • Nita says:

            Are you saying my counter-snark wasn’t the perfect punishment?

          • suntzuanime says:

            The comic strawman is one hundred percent correct about everything and that’s the same guy who made a comic about how black people shouldn’t complain when people say racist things.

          • HeelBearCub says:

            Somehow I feel this is at my expense.

            And this comment, somehow, merely serves to prove it.

            Apparently, even in a rationalist community, my love of process and fairness of process apparently marks me as weird. Sigh.

          • Nornagest says:

            That’s the same guy that did the sealion comic, isn’t it? This must be how non-nerds feel when nerds do that XKCD-as-argument thing.

            Except that XKCD, annoying as it is, usually admits some dim and refracted scraps of reasoning. This is just raw tribalism. No, it’s worse: it’s not cheerleading for a tribe, it’s cheerleading for tribalism as a concept.

          • suntzuanime says:

            I also feel this way when people do the XKCD as argument thing. Have you seen the one about free speech, lol

          • onyomi says:

            If it makes you feel any better, Heelbearcub, I mostly identify with the guy in the top hat.

            It may not be obvious here, but I often engage Youtube libertarians in debate when I perceive their arguments for libertarianism to be bad, or if I just want to play devil’s advocate against some aspect of libertarianism I perceive to be relatively weak.

            What’s interesting about it is, even though I always preface my arguments with “I am a hardcore libertarian myself, but…” people react to arguments against their positions just as badly as if they had come from their ideological enemies. Maybe even worse, in fact, since it might feel like, in some sense, a betrayal.

          • Nornagest says:

            I often engage Youtube libertarians in debate

            How does that old adage about playing chess with a pigeon go?

          • Alraune says:

            SSC needs to replenish its supplies of communists, neoreactionaries and singularitarian transhumanists.

            I’ll sockpuppet as two transhumanists and a neo-feudalist if you’ll cover two communists and an ethnonationalist.

            The comic strawman is one hundred percent correct about everything and that’s the same guy who made a comic about how black people shouldn’t complain when people say racist things.

            The main division between Wondermark and the average political cartoonist is that Wondermark usually loses track of its point halfway through and just runs off having a silly conversation with itself.

          • @ HeelBearCub

            Somehow I feel this is at my expense.

            No, I thought it was about a lot of us here. Don’t you remember the conversation a couple of threads ago?

            @ Nornagest

            This must be how non-nerds feel when nerds do that XKCD-as-argument thing.

            Um, what? I posted it because I thought it was funny, and because several of us have been making the same point.

            This is just raw tribalism. No, it’s worse: it’s not cheerleading for a tribe, it’s cheerleading for tribalism as a concept.

            WHAT THE SCREAMING FUCK??? You had better be snarking here.

            Look, if there’s anything tribal about that particular webcomic, it went right over my head.

            @ onyomi

            If it makes you feel any better, Heelbearcub, I mostly identify with the guy in the top hat.

            As do many of us, I think!

            @ Alraune

            The main division between Wondermark and the average political cartoonist…

            Wondermark is a political cartoonist?

          • Nornagest says:

            WHAT THE SCREAMING FUCK??? You had better be snarking here.

            I’m dead serious, though I may have exceeded occupational health standards on exposure to Tumblr.

            I don’t follow Wondermark. I don’t know what its deal is in its own context. But I do see comics posted from it now and then, and when I do, they’re usually in service of a line that goes something like this: this is our space, we can fill it with unsupported hateful rhetoric if we want to; a challenge to that is an insult to us. That’s more meta-tribal than tribal, really, but it’s definitely political and I only see it coming from one tribe.

            Now I’m getting that you were actually trying to indulge in some gentle self-deprecation? Well, okay, but I don’t know you, either, and this passed the duck test on its own merits. Judging from the comments around mine, I’m not alone in thinking so.

          • HeelBearCub says:

            @Larry:

            I definitely do remember.

            You are definitely in the “I am going to be nice and hope it rubs off” camp. It suits you wonderfully.

            But, I know I can grate on people.

          • I don’t follow Wondermark. I don’t know what its deal is in its own context. But I do see comics posted from it now and then, and when I do, they’re usually in service of a line that goes something like this: this is our space, we can fill it with unsupported hateful rhetoric if we want to; a challenge to that is an insult to us. That’s more meta-tribal than tribal, really, but it’s definitely political and I only see it coming from one tribe.

            I do follow Wondermark, I don’t think I’m into hateful rhetoric, and the above makes less than no sense to me. Could you provide an example?

            (If you don’t want to post it here, you can send it to my surname at Gmail dot com.)

          • Nornagest says:

            If it’s not ringing a bell, I don’t think digging for examples is going to do much good.

            But an analogy might. You know how a certain breed of Christian conservative tries to push the “War on Christmas” meme every year? How the holiday isn’t and has never been seriously under threat, but its exclusivity in pop culture is, and that gets interpreted as a threat to the holiday itself?

            It’s kinda like that, but instead of a holiday we’re talking about the hegemony of a certain ideology and discourse style within e.g. Tumblr.

          • HeelBearCub says:

            @Nornagest:
            Is this the kind of thing you are talking about?

            I can see how, in isolation, that might seem like mere tribalism. But it seems like in going back through the archives, he really just likes to turn things on their head and then reduce them to absurdity.

            To wit this one seems fairly typical. Or this one.

          • Nornagest says:

            No, that one’s… well, overtly political, yes, and the bit about a maniacal desire to prove others wrong annoys me, but on the whole it’s fairly benign. (Also an idea I’ve flirted with myself, although I ended up rejecting it for the same reasons I’m not a libertarian, which are out of scope for this discussion.)

            But I seem to have given the impression that I care about Wondermark a lot more than I actually do. I don’t care about Wondermark. I care about the way a handful of comics from it get abused, and I could say the same about a number of other sources. I already mentioned XKCD above, though that mainly gets abused by a different tribe.

            Now, if you wanna talk comics that I actually have a problem with, as such, because of their tribal content, we can discuss Subnormality. Or a bunch of others that didn’t have the sphinx, and which I therefore dropped much earlier.

          • FullMetaRationalist says:

            Regarding Wondermark:

            “Forcing myself to justify my every action and opinion” I consider a formative experience in becoming a nerd. So I can identify with the guy in the top hat as well (though I eventually realized that others did not share my love for epistemology, and mostly kept my criticisms and justifications to myself).

            Regarding XKCD:

            What’s wrong with the Free Speech comic?

          • Alraune says:

            What’s wrong with the Free Speech comic?

            It’s a dog whistle in approval of censorship-by-mob. The words are all technically true and unobjectionable, but the emphases are evil.

            EDIT: In fact, on rereading it, “dog whistle” is far too generous. The title text outright states that arguing for free speech should be taken as evidence of immorality.

            Now I remember why I don’t follow xkcd anymore.

          • suntzuanime says:

            It treats “free speech” as a weird religious obligation of the government, rather than an important foundation of a functioning society. See discussion on this blog at http://slatestarcodex.com/2013/12/28/a-comment-i-posted-on-what-would-jt-do/ and http://slatestarcodex.com/2013/12/29/the-spirit-of-the-first-amendment/

          • LHN says:

            It’s also a point-for-point argument supporting, e.g., the Hollywood anticommunist blacklist.

            (Which would at least be consistent as far as it goes if Munroe really believes that. But the odds of that given his general tribal position strike me as vanishingly small.)

          • FullMetaRationalist says:

            Huh. We seem to have interpreted the comic in different ways.

            The first time I saw it, I imagined a 4chan raid on some podunk website. In such a scenario, censorship by the host seemed entirely appropriate. The Phil Robertson controversy did not come to mind. I agree that censorship-by-mob is a bad idea. But as of writing, I’m still deciding how exactly to interpret the comic.

            Incidentally: Given upthread, I take it your distaste of XKCD isn’t an isolated incident? What larger pattern am I missing?

            It treats “free speech” as a weird religious obligation of the government, rather than an important foundation of a functioning society.

            I’ve always assumed that the 1st Amendment was a bunch of rules originally intended to restrain the Big Bad Government from bullying Alice, rather than to restrain Bob from bullying Charlie. And then maybe the Cold War morphed the meme from a “Government vs Citizen” thing into a “free market of ideas” thing. So in my mind, “weird religious obligation of the government” sounds accurate. If it were a “free market of ideas” thing, wouldn’t we extend the censorship ban to the private sector as well (such that nobody could censor Phil Robertson [0])? (But then again, I am not a historian. Does anyone around SSC know definitively?)

            [0] hm… but maybe that’s impractical.

            The title text outright states that arguing for free speech should be taken as evidence of immorality.

            “outright”? … I’m not sure about this one either. I think Randall’s complaining about the Red Herring Fallacy. What if by “not literally illegal” Randall meant to emphasize how poor of an argument it is to cite the 1st Amendment in a debate which isn’t directly relevant to politics.

            (If my comment is inconsistent, it reflects confusion in medias res. I’ve never really thought about the 1st Amendment this hard.)

          • Anonymous says:

            FMR, yes, it is ridiculous to invoke the first amendment in a context that is not politics. But that is exactly what you and the xkcd cartoon do. You and it start with the phrase “free speech” and as a total non sequitur insist that the topic is the first amendment. There is a reason that they are different phrases.

          • Creutzer says:

            @Nornagest: re forbidding inheritance…

            Also an idea I’ve flirted with myself, although I ended up rejecting it for the same reasons I’m not a libertarian, which are out of scope for this discussion.

            That’s a pity because I’m quite curious what reason it is for which you both reject libertarianism and the idea of preventing people from doing with their money what they like, such as giving it to their off-spring.

          • houseboatonstyx says:

            @ Alraune
            It’s a dog whistle in approval of censorship-by-mob.

            I agree with you, and it’s a bad thing. Especially the timing. People had already been posting that thought as though it were new! fresh! something I just thought of all by myself!

          • Bugmaster says:

            Regarding the Free Speech issue, this is a pattern I see quite often, on all sides of the US political spectrum: people tend to see the Bill of Rights as some sort of an immutable holy writ. This is the premise that the xkcd comic tacitly assumes (only to follow it up by saying, essentially, “yes, the First Amendment is inviolate, but it doesn’t apply in this specific case and so it’s still ok for me to censor you”). And it’s the same premise that conservatives assume, when they argue in favor of gun rights — only w.r.t. the 2nd Amendment instead of the 1st.

            The thing is, thought, these Amendments were written by mortal humans. We’ve got their signatures and everything. So, when they wrote that stuff, presumably they did so because they thought it was a good idea. They thought that a stable, prosperous society needs to be built upon certain principles, and hence they cemented them into law.

            You could argue that they were right, or they were wrong, or maybe they used to be right (or wrong) but the world has changed so much that their original reasoning doesn’t apply, etc. But IMO it is pointless to delve into the minutiae of what exactly the 1st/2nd/etc. Amendments were meant to convey, unless one is a lawyer who is arguing a case. Who cares what the Founders did or did not mean ? Is freedom of speech / guns / alcohol / whatever a good idea in general, or not ? That’s what we should be talking about.

          • FullMetaRationalist says:

            Oh. I think I understand now. By viewing the Bill of Rights as literal axioms (inscribed on stone tablets), I’ve privileged an ideology over the outcomes. And by failing to distinguish Free Speech (normative ethics) from the 1st Amendment (applied ethics), I’ve confused an abstract idea with one of its implementations.

            ———————

            In other news… it turns out American Civil Religion is actually a thing.

          • Alraune says:

            I’ve always assumed that the 1st Amendment was a bunch of rules originally intended to restrain the Big Bad Government from bullying Alice, rather than to restrain Bob from bullying Charlie.

            At the point of original intent, those were equivalent concerns. The federal government didn’t yet have a community and mind of its own like it does now, so if “big government” was stomping on Alice, that had to be either Bob or Charlie acting by proxy. And further, Alice, Bob, and Charlie all lived weeks of travel apart, in different communities with substantially distinct cultures that would laugh in the face of any uppity outsider who showed up and told them to change how they did things. (For that matter, they would probably also beat them with ax handles and run them out of town. It was a pretty exciting era for traveling evangelists.) Since there weren’t shared levers of cultural authority between A, B, and C, the only way Bob could “bully” Charlie while staying within his home territory (where he has the power to do the bullying) would be to get the newly established shared source of authority up in the federal government to do it for him.

            What if by “not literally illegal” Randall meant to emphasize how poor of an argument it is to cite the 1st Amendment in a debate which isn’t directly relevant to politics?

            The people who point to the first amendment in that context generally aren’t saying “it’s not illegal,” they’re saying “freedom of speech is a revered value and positive good in itself, which we have recognized by making respect for it the first of our greatest laws.” That he thinks that’s a “poor argument” is precisely the problem here. Randall Munroe has taken the fact that the government is a monster we have chained to stop it from eating people, and inferred that since he is not chained, he has permission to eat people.

            The crux of the debate over free speech is that some people believe Free Speech is a positive good and a necessity for a stable society, while others think that the First Amendment is an inconvenient ceasefire. And the worst of the second group think the correct behavior in a ceasefire is to use knives.

            Oh, and my general complaint with xkcd is that it’s unbelievably smug. The free speech thing was just the last straw.

            Edits:

            The thing is, thought, these Amendments were written by mortal humans. We’ve got their signatures and everything.

            We’ve also got a mountain carved to look like their heads, which tends to be a tiebreaker on the gods/not gods question.

            In other news… it turns out American Civil Religion is actually a thing.

            The civil religion isn’t just a thing, it’s the key thing. If people stopped attributing supernatural qualities to America the whole contraption would break down in 6 months.

          • Nita says:

            @ Alraune

            Ah, a metaphor where cannibalism represents online moderation. You’re on a roll!

          • Who wouldn't want to be Anonymous says:

            “Freedom of speech” is, and has always been, a right that is defined in relation to government restriction. Any claims to the contrary are objectively wrong.

            There is neither legal (in the US) nor moral obligation for anyone to (a) actually listen to what someone has to say, and, (b) provide someone with platform on which to speak.

            I really fail to see how this is controversial.

          • Alraune says:

            Ah, a metaphor where cannibalism represents online moderation. You’re on a roll!

            I was envisioning The Birds, but with a thousand little anthropomorphic Twitter icons. They also had knives and piranha fangs, because dreamscapes have zero qualms mixing metaphors.

          • Deiseach says:

            I don’t know anything about Wondermark but the only objectionable part of what Man In Top Hat was saying was the “arbitrary” part of “prove to my opponent’s satisfaction”.

            Looking at bad arguments by your side (whatever your side may be) and either steelmanning them or demolishing them is often helpful; for instance, I’ve been embarrassed by Christians putting forward godawful ‘arguments’ in online debates and thinking to myself “No, the other guy has a real point here and you’re not even approaching anything dealing with it in a serious way”.

            But perhaps that is me; I didn’t see why the sealion was being unreasonable in asking “Okay, so what is your deal with sealions?” Even if the reason was “Look, I just don’t like them”, that would have been something; by not giving any reason at all, the point being made wasn’t being made really (and yes, I know “I just don’t like them” would invite further questioning about “Why?”, but simply saying “Sealions – ugh” and nothing more isn’t reasonable either).

            And free speech is used widely in society to apply to more than “the government can’t stop me saying this”; all kinds of activism has been built on “I have the right to make my case” and if the newspapers won’t print it or a group of private citizens says it’s immoral, that’s censorship.

            Of course, it’s only censorship when X is stopping Y from saying things that challenge the norms; when Y is in a position of authority, X saying things about the new orthodoxy is not free speech, it’s hate speech and preventing them from disseminating their ideas is not censorship, it’s denying them the oxygen of publicity.

          • Alraune says:

            There is neither legal (in the US) nor moral obligation for anyone to actually listen to what someone has to say.

            That is a lie. You are legally required to listen both to numerous individual people by a myriad of laws and regulations (most prominently those involving compulsory education), and to remain engaged with society as a whole by the forbidding of secession. Neither are you off the hook morally, though your moral obligation to pay attention to any specific person is subject to all sorts of fungibility calculations and generally low enough that it’s considered a minimal rudeness. (But see anti-spam and anti-segregation laws, where a million minimal rudenesses are considered to sum into evil and bannable anti-social behavior, as well as criminal negligence cases, where failing to listen to people can be straight-up murder.)

            These are the facts of society, and anyone who argues that obligations to engage in civil communication do not exist in the present (as opposed to after some hypothetical anarchist eschaton) is either insane, or a malefactor attempting to rig a “heads I win, tails you lose” conflict.

          • Whatever Happened To Anonymous says:

            >What’s wrong with the Free Speech comic?

            Personally, I’m offended by its Americo-centrism. You know, besides all the other stuff others pointed out.

            But to be fair to Munroe, often the problem with “xkcd as arguments” is that people extrapolate their meaning far beyond what I asume was intended. So, for example this comic: https://xkcd.com/774/ , which presumably is about people being smug about their centrist position being dicks, gets turned into “If you have a centrist position, you’re a smug dick”.

          • Alraune says:

            Personally, I’m offended by its Americo-centrism.

            I’d usually just reply with a joke about the anglosphere internet being a province of California, but I’ve begun to find that somewhat horrifying lately. I generally approve of whatever disruptive cultural thing the internet is doing when I hear about one, but I expect those stories only make it stateside when they let us go “rah rah USA” and the total picture is a lot less one-sided.

            Also, Munroe would have a lot less of that problem if the thesis of every “argument” comic he writes wasn’t “I am better than everyone else.”

          • Who wouldn't want to be Anonymous says:

            At the point of original intent, those were equivalent concerns. The federal government didn’t yet have a community and mind of its own like it does now, so if “big government” was stomping on Alice, that had to be either Bob or Charlie acting by proxy.
            … [Long block quote trimmed in the middle.]

            Since there weren’t shared levers of cultural authority between A, B, and C, the only way Bob could “bully” Charlie while staying within his home territory (where he has the power to do the bullying) would be to get the newly established shared source of authority up in the federal government to do it for him.

            Your line of reasoning is incoherent. You are saying that back in the day the country was composed of insular communities that could commit all sorts of abuse against outsiders, so the only way they could commit abuse against outsiders was to use the government. To quote Justice Scalia (without endorsing his dissent, which I haven’t read yet), huh?

            Nowadays, you imply, things are different!

            But… This “Tumbler” thing I keep hearing about seems like a pretty good candidate for an insular community that commits all sorts of abuses against outsiders. We’ll sidestep the question of how being called a shitlord compares with being beaten with an ax handle, and observe that they would be really, really keen on using the government to commit abuses against outsiders without having to turn off their computers.

            See, you are making a distinction without a difference. And the reason appears to be a sort of historical chauvinism. Those silly backwards people with their horses and their boats! There’s no way they could have a sophisticated system of communication stretching across the country. And even if they did, there is no way that it would be sufficient to build any sort of culture that stretches more than a mile. And even if there was a widespread culture, it certainly wouldn’t be strong enough to cause anyone discomfort that even remotely compares with being doxxed (whatever that is).

            Because, you know, the Federalist/anti-Federalist schism isn’t a complete refutation of that poorly articulated premise. Like how the whole country (and individual communities) rapidly split into warring factions that used every cultural lever available in an attempt to destroy the lives, fortunes, and sacred honor of everyone on the opposite side. And let’s not even get into how effectively those cultural levers were, or how aggressively individual outlets censored the speech they chose to publish.

            Frankly, Ye Olde Time pricks made SJWs Tumblers look like a box of kittens. (There is joke in there somewhere…)

            But, surprise all around, it didn’t kill the nascent country part deux in the cradle. This is a validation of the design.

            As an orbital matter: even now, when the federal government abuses a grand jury subpena and attendant gag order to stomp on a publication that we’ll call Alice.com… it doesn’t do so sua sponte. The government is acting as a proxy for someone that we’ll call Judge Bob or Charlie.

            The people who point to the first amendment in that context generally aren’t saying “it’s not illegal,” they’re saying “freedom of speech is a revered value and positive good in itself, which we have recognized by making respect for it the first of our greatest laws.”

            And those people would be wrong. Government suppression of speech is an unmitigated horror that we recognize by making the prevention of which the first of our greatest laws.

            What you consider “freedom of speech” is nothing more than a petulant child crying that nobody is listening to their puerile tantrums. Everyone must listen to all speech, all the time! Be damned if you think the speech is worthwhile. You must hear it. Everyone must submit to all demands for their resources in the furtherance of the speech of someone else. Be damned if you agree with it. Be damned if compliance causes you injury. You must provide it.

            This notion is abhorrent.

            Demanding that people support speech that is injurious to them is wicked evil. The inability to chose what to hear destroys communication.

            It only makes sense if you presuppose that all speech contains intrinsic value; moreover, that it is so valuable that our overriding moral duty is to proliferate as much of every kind of speech as possible.

            But speech does not contain intrinsic value. A speech maximizing God would be a very, very bad one. A deafening cacophony would result, making it impossible to communicate.

            The value of speech is derived from its content and the context. Pornography, for example, is a class of speech classically considered to be completely devoid of content [presented without judgement]. To me, the weather in Albuquerque is useless noise drowning out information I value. In six months when I fly there, that information will be very important to me.

            How do we collect, filter, sort, digest the speech around us? Exactly what you implicitly condemn. Which, ironically enough, is by people exercising their right to free association (or to not associate). A right included in the First Amendment. Funny how that works. When the strongest counter argument to what appears to be your understanding of the First Amendment is… to read the First Amendment.

            That he thinks that’s a “poor argument” is precisely the problem here. Randall Munroe has taken the fact that the government is a monster we have chained to stop it from eating people, and inferred that since he is not chained, he has permission to eat people.

            What Randall is saying is that if the only value that your speech has is that it is speech… Well, then your speech probably doesn’t contain a whole lot of value. If you are wasting people’s time, they are right to ignore the absolute SHIT out of you. Because, all together now: Speech. Is. Not. Intrinsically. Valuable.

            You have to have content. Preferably content that other people find valuable.

            Just because the government has been chained from performing value judgments on speech does not mean the people cannot. It is entirely just and proper that they do so.

            In a “free marketplace of ideas” valuable speech will rise to the top and be widely received. Valueless speech will be relegated to poorly Xeroxed pamphlets handed out on street corners. The analogy should be blindingly obvious, and there are enough libertarians around to argue whether free markets actually work so that I don’t have to. (Hint: They do. Most of the time.)

            If you find yourself Xeroxing pamphlets, you might consider if your neotransantidisestablishmentarianism is really the solution to all the ills of the world. If, after all that, the only positive thing you can say about your pamphlets is that they are in fact pamphlets……

          • Who wouldn't want to be Anonymous says:

            That is a lie. You are legally required to listen both to numerous individual people by a myriad of laws and regulations

            Listen to government agents in performance of their duties != Listen to pseudoneocalvanist screed.

            And, since you brought it up, I am pretty sure you’re not actually required to listen to compulsory education. Attend, yes. Listen, not so yes. I spent an awful lot of time sitting in the back of the room reading Plato, and it didn’t land me in jail.

          • Whatever Happened To Anonymous says:

            >Everyone must listen to all speech, all the time! Be damned if you think the speech is worthwhile. You must hear it. Everyone must submit to all demands for their resources in the furtherance of the speech of someone else.

            I think there’s a difference between, “ignoring and not giving a platform to speech you don’t like” and “using non-government collective action to shut down speech you don’t like”.

            In the fourth panel of the comic, there is a clear endorsement for the latter, and I disagree with that.

          • Ever An Anon says:

            The theory is that the public, being well informed and truthseeking, will use debate to gradually winnow out unjustifiable and untrue ideas while holding onto actual knowledge. And in domains where those assumptions hold, such as in the natural sciences and mathematics, we do in fact see that play out. But in broader society neither assumption holds.

            Free speech, like freedom of religion, is a societal value because it allows us to work together with people we disagree with in other areas. In our society we have profound cultural and ideological differences but also shared needs: if we want the latter to be met, we need the ability to call a truce on the former. “No platforming” and similar tactics encourage partisanship and thus gridlock.

            It’s possible to run a functonal society on other rules: most states in history have had state religions and state ideologies, and that includes most of history’s great empires. But it’s also a fundamentally different basis of society than we have in America, and that should be recognized.

          • Jiro says:

            What’s interesting about it is, even though I always preface my arguments with “I am a hardcore libertarian myself, but…” people react to arguments against their positions just as badly as if they had come from their ideological enemies.

            It’s perfectly possible for their ideological enemies to lie and say “I am a hardcore libertarian myself, but”. Just saying that doesn’t distinguish you from the people you’re trying to distinguish yourself from.

            Given a situation where a certain percentage of libertarians say that and a certain percentage of ideological enemies lie and also say that, and the second percentage is larger, saying that you’re a hardcore libertarian may even be Bayseian evidence that you’re not one.

          • Who wouldn't want to be Anonymous says:

            Whatever Happened:

            I think there’s a difference between, “ignoring and not giving a platform to speech you don’t like” and “using non-government collective action to shut down speech you don’t like”.

            Non-government collective action is, like, the definition of free association. Just saying.

            But let’s look at what Randall says in that panel.

            If you are yelled at, boycotted, have your show cancelled, or get banned from an internet community, your free speech rights aren’t being violated.

            Yelled at: Answering speech with more (maybe not very valuable) speech. Seems legit.
            Boycotted: Not directly supporting speech you disagree with. Seems legit.
            Have your show cancelled: A private venue determines that giving you a platform for your speech is injurious to them. Seems legit.
            Banned from an internet community: A private association not giving a platform to speech they disagree with/is injurious to them. Seems legit.

            What are you seeing that I am not?

          • Alraune says:

            you are making a distinction without a difference.

            I am not making a distinction. I argued that B = A, and A = B, and the conception of “big government oppression” as separate from “the guys in the other state trying to get one over on me” is simply a product of the Iron Law of Bureaucracy turning D.C into yet another faction in that process.

            Your point about historical chauvinism is well-taken, but the national integration of media was a going concern into the late 60s.

            Government suppression of speech is an unmitigated horror that we recognize by making the prevention of which the first of our greatest laws. blah blah Marketplace of Ideas.

            Drop the “government” and you’d be right. Belief that the marketplace of ideas is functional necessitates belief that censorship-by-mob is as morally wrong as (equivalently intense) censorship-by-tyrant.

            For a strong believer, the mob is a needless and useless cruelty, because the marketplace of ideas would make the same proper judgment of the strength of the victim’s ideology regardless of whether he had been supported by a million sycophants or is driven to destitution out of fear of the mob.

            For a weak believer, the market only functions while civil social norms hold, and can be disrupted by a sufficiently dedicated and loud campaign, making such mobs not merely evil but existentially dangerous.

            In either case, the First Amendment was written to stop people from attempting to disrupt the marketplace of ideas regardless of their hopes of success, and Randall Munroe is a shit-eating, unprincipled coward who finds a new way every week to brag about how wise he must be in order to preach what his choir already believes.

          • John Schilling says:

            “Freedom of speech” is, and has always been, a right that is defined in relation to government restriction. Any claims to the contrary are objectively wrong.

            This statement is objectively wrong. “Freedom of speech”, at least in the past, has been generally understood to include e.g. academic freedom as applied to the relationship between a private university’s administrators and its tenured faculty. Freedom of speech has, in the past, been a generally-accepted principle that people should not be needlessly prevented – by anyone, government official or no – from speaking their mind in any sphere of public life, and that any alleged “need” to restrict speech should be viewed with extreme skepticism.

            The United States Constitution, while it tries to encompass the highest ideals of Western Civilization generally, is by nature limited in scope to the functions of the government. It is also very explicit about the fundamental rights of the American people extending far beyond the motte that is directly secured by the Bill of Rights.

            When someone sees “Freedom of Speech” and responds “First Amendment and nothing else”, they are A: wrong, B: completely missing the point, and C: taking a sledgehammer to one of the pillars of classical liberal civilization but promising to leave a few bits of rebar intact.

          • Whatever Happened To Anonymous says:

            >Non-government collective action is, like, the definition of free association. Just saying.

            Yes. But I’m not sure what you’re getting at, there are a lot of free associations which are “bad things”

            >What are you seeing that I am not?

            Personally, I find boycotts as they are usually employed distatsteful. However, I must admit that I jumped the gun. I will recant that statement, and restate a previous one:

            >But to be fair to Munroe, often the problem with “xkcd as arguments” is that people extrapolate their meaning far beyond what I asume was intended.

            Being aware of something doesn’t mean being immune to it.

          • Who wouldn't want to be Anonymous says:

            Drop the “government” and you’d be right.

            Okay, so, we have pretty good reason to believe that government censorship can be incredibly effective. Just look at [pretty much every country, ever].

            On the other hand, I see no reason to believe that “censorship-by-mob” is at all effective, if it even qualifies as a thing.

            I mean, look at Moldbug. He got dropped from a venue, and as a result he got way, way, way, way more exposure than he would have received otherwise.

            And not only for his neoreactionary stuff, which was ostensibly the target of the supposed censorship, but his technical stuff, too. If either variety of his ideas have merit, they will survive just fine. But more importantly, even if they don’t have merit they will survive just fine.

            But almost nobody really cares about neoreactionaries. How about neoNazis? They’re universally reviled and the poster child for why some people want censorship. They’re doing just fine, though. White supremacists? Holocaust deniers? Gays marriage supporters? Atheists? NAMBLA? Satanists? SJWs? “Trans-racial” what’s her name? Westobo Baptist Church?

            They’re all doing just fine.

            Mob censorship is a paper tiger.

            Moreover, how exactly is “mob-censorship” at all different from the proper operation of the marketplace?

          • Who wouldn't want to be Anonymous says:

            John:

            in any sphere of public life

            Bingo. Public fora are places where freedom of speech is actually a thing you can claim.

            Private fora–including things like “the editorial page of the NY Times,” “this website,” and “Madison Cube Garden”–are a completely different story.

          • stillnotking says:

            “Mob censorship is a paper tiger.”

            Yes, precisely because enough people in liberal societies are made annoyed or curious enough to deliberately signal-boost anything the mob tries to suppress. The norm that mob censorship is bad is what produces the Streisand Effect, so be careful arguing against it.

            Mob censorship is a very real tiger in societies that lack Enlightenment attitudes toward tolerance and free expression.

          • Matt M says:

            “They’re all doing just fine.”

            They’re “doing just fine” in the sense that a certain number of them still exist.

            Of course, a certain number of homosexuals still exist in Iran. Are they “doing just fine?”

            The fact that certain groups are able cling to an existence often in secret and entirely insular communities where they cannot openly discuss their beliefs with outsiders is probably not what anyone would consider as “just fine.”

            What would happen to you in your life, your job, and your personal relationships if, tomorrow, you started identifying yourself as a neonazi? Would you be “just fine”?

          • walpolo says:

            >>“Freedom of speech” is, and has always been, a right that is defined in relation to government restriction.

            Let’s ask the ideological grandfather of freedom of speech, JS Mill:

            “Our merely social intolerance kills no one, roots out no opinions, but induces men to disguise them, or to abstain from any active effort for their diffusion. With us, heretical opinions do not perceptibly gain, or even lose, ground in each decade or generation; they never blaze out far and wide, but continue to smoulder in the narrow circles of thinking and studious persons among whom they originate, without ever lighting up the general affairs of mankind with either a true or a deceptive light. And thus is kept up a state of things very satisfactory to some minds, because, without the unpleasant process of fining or imprisoning anybody, it maintains all prevailing opinions outwardly undisturbed, while it does not absolutely interdict the exercise of reason by dissentients afflicted with the malady of thought. A convenient plan for having peace in the intellectual world, and keeping all things going on therein very much as they do already. But the price paid for this sort of intellectual pacification, is the sacrifice of the entire moral courage of the human mind.” (On Liberty, chapter 2, paragraph 19)

          • Who wouldn't want to be Anonymous says:

            Negative ghostrider. The reason mob censorship doesn’t work is because they can only effect (some) private fora.

            No matter how many newspapers wont publish your racist op-eds, no matter how many conventions you get black listed from, no matter how many charity luncheons have you arrested for trespassing, no matter how many websites ban you, public fora are always open.

            And you can make your own private forum.

          • John Schilling says:

            Private fora–including things like “the editorial page of the NY Times,” “this website,” and “Madison Cube Garden”–are a completely different story

            No, not completely different. There is a well-founded tradition and expectation that the NYT will publish a representative sample of well-written articles and letters from all sides of an issue. That Madison Square Garden is available for rent to anyone who can pay and make reasonable assurances of security. Madison Cube Garden, you’ll have to ask the Earthicans 🙂

            Unlike government censorship, it would “merely” be a violation of strong social and political norms for e.g. the New York Times to only publish socialist letters and editorials. It would not be literally illegal for them to do this. That’s not “completely different” in my book.

            To quote a guy who used to be sort of respected around here, that’s the ultimate concession: you’re saying that the most compelling thing you can say for your position is that it’s not literally illegal.

          • onyomi says:

            “…is doing just fine” is getting added to “white dudes…” under the list of things behind which I expect to find some nasty sentiment hidden.

          • Who wouldn't want to be Anonymous says:

            What would happen to you in your life, your job, and your personal relationships if, tomorrow, you started identifying yourself as a neonazi? Would you be “just fine”?

            Certainly. I would very quickly find like minded individuals to form social/economic relationships with. I’m pretty handy, I’m sure I could bedazzle some swastikas on leather jackets for cash.

          • Matt M says:

            ” I would very quickly find like minded individuals to form social/economic relationships with.”

            And how would those relationships compare to the ones you enjoyed previously?

            How many neonazis are CEOs of fortune 500 companies? How many are in Congress? How many are in the prestigious local country club?

            I’m sure homosexuals in Iran are able to have some sort of employment and are able to socialize with other homosexuals too.

            Is it your assertion that this means they are “fine”?

          • Who wouldn't want to be Anonymous says:

            John, you have an impressively high opinion of the NYT Editorial Board. I can honestly say I have never seen them publish an op-ed that seriously contradicts their opinion. Or (I know, scoff if you want) Fox “News.”

            The social norms you speak of are very weak, and not nearly as widely practiced as the norm to claim they are. 😉

            Edit: More seriously. Norms very wildly based on the type of forum, and even the specific place in the forum. When reporting the news, anyone that wants to be seriously called a journalists tries pretty hard to be neutral. But on the next page in the same publication, it is generally permissible for the Op-eds, etc, to have a clear agenda. (You can occasionally find editorial bias seeping into the strictly news reporting, but AFAICT they try really hard to prevent it.) Letters to the editor will frequently contain counterpoints to the agenda, but due to the length restrictions they are generally aimed at very specific sub-topics, like specific factual inaccuracies.

            Pundits have no qualms screaming their bias from the rooftops, and there is no way anyone is going to get a word in edge wise. And this is perfectly acceptable. (Unless the pundit in question has contrary views to your own, in which case they are the devil.)

            Public accommodation type forums, like Madison Cube Garden, will take anybodies money because, damn it, its all green. Except for Devo, because they are green. Or there is a very compelling reason to believe that hosting an event will injure the venue somehow.

            If the Met threatened to stop having their charity luncheons at the Waldorf if the Waldorf hosts a particular event (Art Forging Made Easy, perhaps) you can bet your sweet bottom dollar the Waldorf would roll in a second. The Met is an extremely lucrative repeat customer, after all, and losing the revenue would be devastating to the Waldorf’s bottom line. (I’m making it up. I actually have no idea what venue the Met uses.) This might rub against the norm a little bit, but random internet commenter’s opinions matter less than the shareholders who would almost certainly be pissed at the lost revenue.

            Some forums, like this one, are very keen on lively debate as long as something something three gates.

            Making sweeping arguments about “but… NORMS!” is not a very compelling argument about widely divergent forums and their norms.

          • Who wouldn't want to be Anonymous says:

            Matt M:

            Considering I don’t enjoy any of those relationships now, not having them tomorrow wouldn’t be much of a bother.

            And, AFAIK, homosexuality is full blown probably-get-executed-for-it illegal in Iran. It is an apples to aardvarks comparison between that and mob censorship.

          • James Picone says:

            Is this just reinventing structural oppression? No, seriously, not just as take-that.

            I think we can agree that people should not, in general, be obliged by social norm to hang out with people they find distasteful. There is no social norm requiring me to be friends with Bob The Person Who Keeps Loudly Discussing His Strong Opinions That I Find Horrendous, there’s no social norm requiring you to not take into account character of people you’re interviewing for a job (which being, say, a neo-nazi is indicative of). The flip side of free association is free dis-association. All good.

            But AFAICT the argument here is that they should be strong social norms against that sort of social veto being applied to a group en-masse – if Xists can conclude that the average person is going to think they’re terrible and not want to listen to them/employ them/whatever if they know they’re an Xist, that’s a problem.

            That is, perfectly okay actions in aggregate can turn into something not-okay.

            Isn’t the social-justice contention that, say, black people have a mild case of being Xists, in that one white person not having a black friend is fine, or one white person getting a job instead of a black person is fine, but that across the whole of society black people are slightly excluded and that’s not fine?

            (One difference – SJ people would not be fine with an individual black person being refused a job just because they were black. Not sure if that’s substantive).

          • John Schilling says:

            @WwwtbAnonymous: Are not Ross Douthat and David Brooks still regular columnists for the New York Times? Because I’m pretty sure that their political views on major issues are somewhat at odds with the editorial board. And, beyond the regular columnists, I believe they have occasional essays from writers even farther to the right.

            The New York Times, while left-leaning, does still adhere to the modern journalistic tradition of covering all sides of major issues in a not-overtly-biased fashion, and making its editorial pages at least somewhat accessible to first-rate writers of any ideological leaning.

          • Who wouldn't want to be Anonymous says:

            John:

            I am having trouble conjuring a clear picture of their views right now. My impression, though, is that they still fall pretty much within the shot group, so to speak, even if they tend slightly the right. I don’t follow editorials that closely, NYT or otherwise, so it is entirely possible I overstated my case (at least w.r.t. the NYT).

          • HeelBearCub says:

            @James Picone:

            Isn’t there a real need to distinguish between (A) “class of people who share fairly non-predictive trait” and (B) “class of people who espouse and engage in a specific course of action”?

            The arguments against discriminating against (A) and against (B) are different. I think people tend to conflate them.

          • Who wouldn't want to be Anonymous says:

            James:

            That is an interesting line of reasoning, that I would like to consider sometime when I am not so sleep-dep incoherent.

            On that note, (a) good whatever-time-of-day-it-is and (b) don’t be entirely surprised if I moderate or recant any extreme positions at some future time. I’m not entirely sure what I have been saying anymore.

          • HeelBearCub says:

            @John Schilling:
            But Brooks and Krugman both fall within the acceptable range of opinions that the editorial board is willing to be allowed to express themselves on those pages.

            No matter how seductive the argument, the NYT is not going to publish the editorial opinion of a Holocaust denier.

            (Now that I have committed myself to this opinion, I expect someone to go out and find said editorial with probability greater than 0%. Not much of a prediction, I grant you.)

          • Cauê says:

            If I imagine someone with the power to silence opinions they dislike (i.e. find dangerous, harmful, offensive, heretical, blasphemous, or icky), I can think of a number of arguments I could try to use to convince them not to do that. I mean, to try to convince them that it would be better to live in the world in which they didn’t do that.

            Not many of those (if any) would cease to apply just because we’re not talking about state action.

            Freedom of thought and speech is a good thing, it’s not just something you give people out of compassion.

          • “Moreover, how exactly is “mob-censorship” at all different from the proper operation of the marketplace?”

            I think there is an important distinction that is getting missed in parts of this long thread—the distinction between not listening to people and trying to prevent people from speaking by making it costly. It is entirely appropriate not to listen to some people, not to read some books—we have, after all, a limited amount of time and attention. But making it costly to express some ideas—for instance by persuading people not to hire those who express them, or boycotting firms that employ or are owned by people who express them—is not an appropriate action, even though it is, in many cases, also not a violation of rights. The argument for that view is the conventional argument for freedom of speech, often put as the “marketplace of ideas.”

          • HeelBearCub says:

            @David Friedman:

            Suppose I drive into the parking lot of my favorite coffeehouse, Cafe A, and I see behind the counter a person I recognize from the last KKK rally which marched past my church.

            They are wearing no paraphernalia, they are unfailing polite, etc. But I still do not feel comfortable shopping there. I stop going there unless I’m in a pinch and start going to the one across town, Cafe B.

            Have I done something immoral?

            An acquaintance asks me why I don’t go to Cafe A anymore, surely it’s more convenient. Am I honor bound not to answer?

            The owner, who notices his business has dropped off sharply, sends a survey to “Coffee of the Month Club” members who have not been in recently. Can I answer why I do not attend?

            When I stopped going originally, if I bumped into the owner, could I have mentioned in passing that I am not planning on being a customer anymore?

            Could I tell her why if asked?

            Could I have proactively provided this information without waiting for it to be asked for?

            At what point in there did I slip from moral good to moral bad?

          • Nornagest says:

            @HBC: There aren’t really any bright lines in this sort of question, only loose empirical clusters, but if I had to draw one I’d put it at giving out the information unsolicited. At that point I no longer think it’s reasonable to say you’re acting in anyone’s defense.

            I also think you’re kinda stacking the deck by using a KKK member, i.e. someone who, even if they may not personally want to do you violence, has chosen to affiliate with a group that stands for an explicit threat to your physical safety. That’s hardly true for any of the boycott proposals that’ve been thrown around in the last couple years.

            (Jesus Christ, the threading here is terrible.)

          • Jaskologist says:

            Far be from me to derail a thread on free speech which somehow spawned from a post about mental hospitals, but those of you who think Munroe is overly smug will probably feel greatly vindicated reading his 2008 endorsement of Obama

            (Content warning: a trigger warning follows.)
            (Trigger warning: If you are at all blue-tribe, you will probably just want to skip over this.)

          • houseboatonstyx says:

            ETA to everyone: I apologize for the telegraphic, staccato tone of my comment. I had not time to write a longer one.

            @ HeelBearCub
            [re boycotting a coffee shop because of a baristo’s private politics]At what point in there did I slip from moral good to moral bad?

            Pretty much at saying anything to anybody about it later. (Driving away instead of going in makes sense, if your personal reaction would have been a problem.) Talking about it later is promoting a boycott and or a firing. Bad opinion gets good opinion. Does not get bullet.

            Even if punishment were justified, still the baristo deserves due process. How would you feel if you lost your job because someone thought they had seen you in a parade they disapprove of, and had spread this around secretly. Maybe when the owner heard about it, she would inform you and ask your side of it? Even if you could prove yourself innocent (as with an alibi for the parade date), she might still have to say “Sorry, we’re losing too much business by keeping you.”

            In the US an accused person has the right to confront his accuser, find out exactly what he is charged with, and present evidence in his defense. And the judge should be an, er, Judge, who does not stand to lose income by acquitting you.

            Before initiating this much harm to the baristo, I’d arrange a private meeting and ask him where he was on the parade date; if he has an alibi, then you were wrong, and should drop the whole thing (without upsetting him by telling him what you suspected).

            Even if he is guilty, count up some utilons. He suffers, the owner and other employees suffer, the customers suffer by having to go across town to their less preferred coffee shop. There are sure, immediate consequences to people you know, who are not even being accused of anything wrong.

            If you keep quiet, what happens? The baristo keeps his membership, or maybe changes his mind. If he stays, the bad group gets a few more donations and volunteer work from him, which may or may not have some small effect on some project of theirs, which project may or may not actually have any effect on any real person.

            Nuff said; I won’t make this longer by summing up the odds and labeling the principles involved.

          • John Schilling says:

            [the KKK barista scenario]

            At what point in there did I slip from moral good to moral bad?

            At what point in there did you do anything that you have seen other people criticized for doing? Nobody is going to criticize you for any of that, because nobody is going to notice that you did anything at all, except for a couple of people who specifically asked you for information and received helpful, private replies.

            Where you would open yourself up to criticism, would be the step where you start going to neutral third parties and saying, “You need to boycott this coffee shop because they’ve got a Klansman working there!” If they haven’t already noticed that, then nobody is helped by your pointing it out.

            You have the right to do it anyway, if you really want, but in the same way that the Klansman has the right to call every black person he sees a ninja. It makes the world a meaner place every time someone does it, and if done on a large enough scale it can cause real harm. We probably won’t stop you; we can’t stop you without resorting to even greater levels of unpleasantness, but please don’t anyway.

          • Brad says:

            Private tolerance isn’t a moral issue, it is a pragmatic and aesthetic one. As such there’s no need for a blanket rule.*

            One need not treat disagreement over whether or not every gay person ought to be tortured and murdered as equivalent to a disagreement over whether people ought to pay a fixed percentage of their income in tax or an increasing percentage as they have higher income.

            Rawls has the concept of a reasonable comprehensive doctrine, and while I might not agree with his exact definition, it’s a pretty useful concept here.

            Actual Stalinists who wanted to overthrow the US government by force and impose a dictatorship of the proletariat fall on the far side of that line. So do members of the KKK. The balance of considerations weighs against private tolerance in those cases (government tolerance is a different story).

            *I say this despite being aware of the SSC political survey.

          • HeelBearCub says:

            @John Schilling:
            I’ll note that you, houseboatonstyx and Nornagest seem to be in a disagreement on where the line is. I think it then becomes clear that the list of questions isn’t a straw man.

            I recognize there is tension between competing principles. Free association and free speech pull on each other, and there is not an easy answer. Denying the right to a livelihood is an awful punishment. As an example, I find it odious that convicted sex offenders in many jurisdictions are so constrained by automatic movement restrictions (no closer than 1000 yards to a school, etc.) that in some places there is literally no place in the town they can be.

            But, are you really willing to promote the principle that it’s immoral to talk about who you have chosen NOT to associate with? Because that is the principle that seems to be advocated here. You can try and dress it up, but that is what a boycott is, simply a public statement about your free association choices.

          • Alraune says:

            I think there is an important distinction that is getting missed in parts of this long thread—the distinction between not listening to people and trying to prevent people from speaking by making it costly.

            I recognize there is tension between competing principles. Free association and free speech pull on each other, and there is not an easy answer.

            This tension wouldn’t necessarily be the case, and that distinction wouldn’t be relevant, except that we recognize only a very imperfect freedom of association. Where people are forbidden from withdrawing from society, they also must be forbidden from excluding others from society.

          • Nornagest says:

            that is what a boycott is, simply a public statement about your free association choices.

            You know perfectly well that it’s an attempt to coordinate a bunch of people’s free association choices. That often looks like a simple public statement about your own, but no one’s going to mistake the implied “…and if you don’t agree, I think you’re tainted, too”. We’re not perfectly rational agents! Our social statements have consequences outside ourselves, even if they take the form of pure personal preference, and our norms about making them quite rightly take this into account.

            Note that I don’t think boycotts are unethical in all cases. If the Klansman in your example wasn’t just a face in a march but had for example been trying to set fire to your church, then I’m perfectly happy with trying to screw him over by nonviolent means (and maybe some violent ones, under the right circumstances).

            (Note also that I said in the first sentence of my post that there isn’t a well-defined ethical line. We can make arguments for drawing it in a bunch of places. But there’s sure as hell an ethical gradient there.)

          • houseboatonstyx says:

            @ Nornagest
            (Note also that I said in the first sentence of my post that there isn’t a well-defined ethical line. We can make arguments for drawing it in a bunch of places. But there’s sure as hell an ethical gradient there.)

            Fwiw, as I first floated down his list, I was just feeling like, “Hm, I can imagine doing that, I probably would do that to save awkwardness with my friend, etc.” Toward the later items, my feeling was “Naw, that’s not something I’d do.” With his final question, I looked back in moralizing mode and saw that all of them were wrong; any one of them could have led to the same bullet.

            So, objectively/consequence-wise, there may not really be much gradient. But virtue-wise, confiding with a friend who asked, would not set off moral alarms with me, other than a vague feeling that this is not a gentlemanly thing to do. It’s initiating the subject that would sound my alarms, and make me think about the possible consequences, and about morality.

          • Jiro says:

            those of you who think Munroe is overly smug will probably feel greatly vindicated reading his 2008 endorsement of Obama

            I haven’t heard of him, but reading that, I *now* think he’s overly smug. He’s praising Obama for going to the good guys instead of the industry representatives for copyright policy? Really? Can you say TPP?

          • Nita says:

            Seems more naive and overexcited than smug to me. I bet Bush’s supporters didn’t expect him to start a war over imaginary WMDs, either.

            Also:
            1) “I want Jon Stewart to smile again.” — d’awww!
            2) bonus points for unironic use of “white knight”

          • John Schilling says:

            @HeelBearCub: But, are you really willing to promote the principle that it’s immoral to talk about who you have chosen NOT to associate with?

            If I were to promote that principle, I probably wouldn’t have started by pointing to two of your chosen examples of such talk and describing them as A: not subject to criticism and B: helpful.

            Are you willing to engage in the discussion that other people here are actually conducting, or do you just want to tilt at comfortable straw men? If the former, please go back and read more carefully.

          • LHN says:

            @Nita Every president is a disappointment compared with the hopes invested in them when they’re elected. But I don’t think there’s a President in my lifetime who inspired comparably millenarian hopes among his admirers. (The culmination was probably his getting the Nobel Peace Prize in the first year of his term for, apparently, not being George W. Bush.)

            Munroe’s endorsement implicitly acknowledges how unusual it is that Obama was “for once, someone I can vote for not because I dislike the other candidate, but because I’m proud of mine”.

            Reagan clearly had a strong base of admiration, but my impression is a lot of that developed while he was in office more than anticipating him. (Though to be fair, given where I grew up I was unlikely to have seen much of what his religious conservative supporters were saying, except insofar as it was reflected in the national news.) No other president I’ve seen has even come close.

            Kennedy may have had that sort of halo. But that’s before my lifetime, and I’m not sure how much of that impression is a matter of reading back his post-assassination idealization.

          • Jaskologist says:

            @Nita,

            To elaborate, I do find that post naive and sincere. The “smug” accusation comes not from that, but the larger context where he is still presuming to lecture the rest of us without any re-calibration/mea culpa given how he managed to be, to a first approximation, entirely wrong about such things in the past.

            (Personally, I still enjoy the comic. It may be more hit and miss than in the past, but there are enough hits to remain on my regular browsing list.)

          • Nornagest says:

            Kennedy may have had that sort of halo. But that’s before my lifetime, and I’m not sure how much of that impression is a matter of reading back his post-assassination idealization.

            Before my time too, but if back issues of MAD Magazine are anything to go by, he was known before his assassination for being a goofy rich boy from a political dynasty and for playing grab-ass in the White House. I probably shouldn’t read too much into satire, of course, but it reads like an odd combination of early Bush II and late Bill Clinton; although there’s an aspirational side to it that’s missing in the more cynical Nineties and Noughties.

          • CJB says:

            Holy crap…..the thread….

            So, my response to the “KKK Barista” situation is…

            The KKK is an excellent example of the triumph of free speech. They were very popular, pretty much right up until people started looking at them and what they were doing and saying.

            I mean, the American people had plenty of time to see the bestest, most popular, most famous, well spoken, etc. segregationists do their thing. We all could’ve chosen to agree with George Wallace.

            But instead, other ideas won. I’m not particularly willing to strip him of all consequences of his actions. And when people decided to curse William Garrison, they had the right to do that too.

            And I don’t think we leave enough room in these debates for the fact that it goes both ways. Flower Shop gets in trouble for not flowering a gay marriage= lawsuit but also = massive outpouring of support, including some from leftists.

            People blatently trying to game donations…didn’t really get any.

            People can be very stupid. People can also be much smarter than you think. Essentially, I think, we’re debating the question “how much should we react to the actions of a tiny minority of assholes.”

            Yes, tumblrites are assholes. But once you factor in the radicals who post on a topic fifty times….how many actual human beings are actually doing this?

            Honestly, it’s a bit like conservatives complaining about campus radicalism- on the one hand, yes. On the other hand, half the articles on the phenomenon cites the exact same incident.

            319 million people means that you can whip up large groups out of tiny populations.

          • HeelBearCub says:

            @John Schilling:
            Are you reading what other people besides you and I are writing? houseboatonstyx took the stand that even to stop giving business to Cafe A was a moral wrong. I’m certainly not intending to engage in straw manning. This is something I pointed out before but you seem to have missed.

            You and Nornagest seem to be drawing a line at publich speech (as opposed to private) about chosen non-association. I draw this from your mention of a “neutral third party” and Nornagest’s statement about organizing.

            So, is that where you want to draw the line? You should not, morally, make public statements about your choice’s in non-association? Or is that still too restrictive on speech about association?

            My gut says that if you are willing to engage in public speech about your principles, I should be allowed to make a public speech about my desire not to associate with you because of those principles. If I make a public speech about your private speech this seems much more problematic.

            @Nornagest, you also seem to be pointing at a principle of proportionality. I say this because you say my KKK example is “stacking the deck” because of what the KKK has advocated at various points in there history. Do you think proportionality matters?

          • Matt M says:

            I don’t think it’s at all rare to hear someone advance the theory that Kennedy’s positive legacy is what it is largely because he was killed while the hype stage was still active and before he really had the chance to disappoint his most loyal supporters.

            But if you look hard at his foreign policy and lukewarm at best support for civil rights, there’s plenty of reason to think he ultimately would have.

          • Nornagest says:

            So, is that where you want to draw the line? You should not, morally, make public statements about your choice’s in non-association?

            I want to draw the line at actively trying to screw people over for their own choices in speech or association. Because of the way we’re wired for socialization, making those public statements often qualifies, but it’s a contingently scummy thing to do, not an inherently. “Don’t go to that bar, the owner deliberately backed over my dog and spat on the corpse” is not a problematic thing to say, provided it’s true. “Don’t go to that bar, I hear its owner donated to Bernie Sanders” is.

            …“stacking the deck” because of what the KKK has advocated at various points in there history. Do you think proportionality matters?

            I’m tempted to say “yes”, but I suspect that what I see as proportional, and how it’s important, might not be what you see. This isn’t about the Klan being extra special hateful; it’s about the Klan having a history of violence, to the point where its marches were and are often seen as intimidation. That adds a dimension to your scenario that’s absent from — to draw an example of a recent boycott out of a hat — something like the recent Chick-Fil-A dispute.

            I don’t think my answers would have been substantially different if we were talking about, say, a member of NAMBLA whose photos you saw on WikiLeaks or something, but there’s a certain legitimacy to feeling threatened here that wouldn’t exist there. At least in the abstract; whether you’re black or white or green, I don’t think there are many Klansmen that are going to leap over the counter and throttle you if you run across them at work.

          • HeelBearCub says:

            @CJB:
            I think you are really misreading the civil rights era struggles. It was not some sober reflection wherein people dispassionately presented there ideas and the broad public decided. Black people had to sacrifice in blood to get people to even see their case at all. Businesses did not have to be told that they would lose white business if they served black customers. That was baked into the cake by then. They did need to see that there was enough pressure on the other side to show that it was at least zero sum, if not worse, to continue siding with segregation. Of course, this was only one tactic, among many.

            @Nornagest:
            I think in both KKK example and the dog/corpse example the salient difference you seem to be highlighting is action vs. speech. The KKK actually did physically violence as did the putative owner who runs over a dog.

            At any point does speech that advocates action become tantamount to action? If it was not an employee of Cafe A, but rather the owner of Cafe A, and they were not a member of the KKK, but merely advocates for government enforced race segregation. Suppose they give speeches about it, donated money to political candidates who favored returning to it, put up a billboard extolling its virtues, and even ran as a political candidate on a platform of returning to racial segregation, is it moral to organize a boycott of their business then?

          • CJB says:

            So, circling back to this again-

            Are we talking “boycott” or “protest” here?

            Because they have definately different means of action.

            Boycotts are purely economic. You send, say, Chik-fil-a a letter saying “You’re being boycotted until/because of X” and then don’t give them money. Boycotts are actually quite awesome- they’re extremely democratic, easy to enact AND counteract.

            Boycotts, in other words, only work when you’re able to convince lots and lots of people to join them. (Theoretically- a lot of companies are very gun shy)

            Protests- I think the problem with protests is we haven’t really internalized the population explosion and twitter. Back in the day, if you had two people marching in front of your place, you probably ignored them because they’re two cranky cranks. Today, it’s far easier to gin up dozens if not hundreds of protestors than it was to get two back in the day.

            So while before, we had a scaling mental map of “Two=cranks, 12=concern, 200=shit!” which again, allowed people to judge the actual level of community concern.

            Today, the greater numbers indicate the same percentage ofthe population being pissed at you, but we can’t really understand that at an emotional level.

          • HeelBearCub says:

            @CJB:
            The situation I am describing is clearly just a boycott, not a protest. And the position from many at SSC, including Scott, seems to be that a boycott is a bullet and should never, ever be used if someone is merely expresses an idea. “Argument gets counter argument, not a bullet.”

            I’m trying to explore whether folks have really thought this all the way through.

          • Jiro says:

            Boycotts are actually quite awesome- they’re extremely democratic, easy to enact AND counteract.

            That’s the theory. The practice is that boycotts work by taking advantage of the psychological tendencies of people to jump on bandwagons, to apply double standards between targets with bandwagons and without, be easily outraged at claims they don’t bother to research, etc. In an ideal world where only rational people joined boycotts, boycotts wouldn’t be much like bullets. In a world full of Twitter, Tumblir, and Facebook, a boycott is the equivalent of calling your enemy a “practicing Homo Sapiens”; you are using people’s ignorance as a weapon against a third party.

          • Nornagest says:

            At any point does speech that advocates action become tantamount to action?

            If speech credibly threatens action, then I think it’s justifiable to respond to it as action. But I don’t think trying to get the government to do something qualifies as a credible threat in most cases.

            On the other hand, while I’m still not sure I’d endorse a boycott, it feels less ethically questionable in the case of a business that itself endorsed e.g. racial segregation than in the case of one that just happened to employ a Klansman, especially if it’s a sole proprietorship. Part of this comes from the fact that it implies less collateral damage — the person shouldering the most direct financial burden is the same one making the speech. But part of it comes from the fact that a business is a social institution, and giving one money is a de-facto endorsement of its social role. Would this matter if its owner strictly separated their advocacy from their business practices? I’m honestly not sure, aside from noting that we’re looking at a shorter causal chain. But I think it’d be worth taking into account if there was e.g. a sign in the window saying “Restore Racial Segregation Now!”.

            And on the third hand, if you walk up to a coffee shop and find that sign in the window, you gotta expect that the owner’s losing some business from it, boycott or no boycott.

        • houseboatonstyx says:

          houseboatonstyx took the stand that even to stop giving business to Cafe A was a moral wrong.

          Not me. I said drink where you like, just don’t talk about why.

          • HeelBearCub says:

            @houseboat:

            Sorry, I think I read to much into this.

            “Driving away instead of going in makes sense, if your personal reaction would have been a problem

            I interpreted that as meaning the only reason to drive away was if you couldn’t stay silent while on the premises. Otherwise, I’m not exactly sure what you meant by that.

          • houseboatonstyx says:

            I meant if for any personal reason you would not have enjoyed having your coffee in Coffeehouse A, driving away was a right thing to do … even if you just wanted to do a one-person boycott to keep your own coffee money from going into their till. It’s telling other people about the baristo’s after-hours politics that I think would be wrong (though understandable).

            Another comment is talking about the Chik-Fil-La boycott, which I supported, since the owners openly gave some of their profits to a cause I think evil. Since I don’t want any of my money to go to that cause, I wouldn’t give them any money. In the Hobby Lobby case, sfaik customers’ money was not going anywhere except to their lawyers; but imo the boycott (“voting with your money”) was reasonable.

            Both these boycotts were punching upwards, at companies big enough to stand some loss. No outing was involved; they both had deliberately made themselves test cases, with lawyers aforethought. The facts of both cases were clear, available, and well publicized; it wasn’t mob action on rumor.

            (The pizza and florist cases were the opposite: mob action on rumor, punching down against small businesses — who had not sought confrontation, and might be ruined just by the cost of getting lawyers to defend them.)

      • FullMetaRationalist says:

        Sounds like a Rain Dance.

      • BBA says:

        I’ve heard “kabuki” in reference to some particularly inane rituals – Supreme Court confirmation hearings, for instance – but that term may be doing a disservice to the actual art form of kabuki theater.

        “Going through the motions”? “Covering your ass”?

        • Nornagest says:

          I’ll bet all forms of highly stylized theater look about equally weird to outsiders. Imagine trying to explain the plot of Swan Lake to an 18th-century Japanese dude, if you had nothing to refer to but the score and the dancing.

        • onyomi says:

          I don’t think anyone who says this knows anything about Kabuki. I think it’s literally just a way of making something sound more emphatic by adding meaningless symbols. Like how some people have started saying *PEN*ultimate to mean “really, really ultimate.” *shudder*

        • FullMetaRationalist says:

          “Kayfabe”?

      • Sniffnoy says:

        You can just say “theater”. Or more commonly “X theater”, where X is the subject in question. So “psychiatry theater” here, probably. As BBA mentions “kabuki” also gets used.

      • Winter Shaker says:

        Ritual bureaucracy?

      • Rauwyn says:

        Cargo cult?

  46. Myself says:

    What I want to know is if I end up in psych care, what is the quickest way to get out of there, disregarding any morality?

    • CJB says:

      Wait, presumably. If you don’t bounce off the walls, you should be able to sell them on “not a danger to myself or others”.

      I mean, they don’t really WANT you there. Understaffed, underfunded, desperate need for beds.

      It’s like getting out of jail. If you’re careful, obedient, and play the system, you can get shoved out surprisingly early.

      • Matt M says:

        “I mean, they don’t really WANT you there. Understaffed, underfunded, desperate need for beds.”

        Well, the referring physician/EMT/whatever probably WANTS you to be there, so as to avoid being sued if you end up doing something bad.

        Edit – And under that same logic, they don’t want to release you TOO soon, in case you immediately do something bad and they get blamed for it.

  47. Kevin S. Van Horn says:

    Thanks for an interesting post. I have a question about this:

    “if someone comes in complaining of depression, then to a first approximation, after a few basic tests and questions to rule out some rarer causes, you give them an SSRI.”

    Really? Is that because it’s the easiest thing to do, or do you think it’s the most effective treatment for depression? Compared to, say, alternatives such as CBT.

    • Deiseach says:

      Anti-depressants take about six weeks to kick in, but so would counselling or therapies like CBT.

      And to get any good out of counselling, you have to be both willing and able to engage with it. Anti-depressants could help get your head in the space to be able to get benefit from counselling.

  48. Truekay says:

    Wow, this post reminded me of my own brief stay in an inpatient psych hospital. “Security theater” is the perfect descriptor. I had a bad reaction to the SSRI that was prescribed to me on the first night. To begin with I just had the usual side effects like racing thoughts, jitters, etc. But then I was struck with a bolt of pure terror out of nowhere, so I did the first thing I could think of: I leaped out of bed and ran to the front desk. I managed to tell the nurse how frightened I was before I passed out. My blood pressure was extremely low, and they ended up giving me IV fluids. Around this time I began to have a bunch of disturbing thoughts, mostly related to intense bodily harm or the idea that the horrible, inexplicable fear I felt in that moment would stay with me for the rest of my life. I told the nurse about these thoughts. He looked bored and told me to talk to the psychiatrist about it in the morning. At the time I felt like he wasn’t taking me seriously, but in retrospect I realized that, like Scott described, he was just accustomed to this stuff. Hell, he had probably dealt with something more worrisome earlier that same day.

    I met some interesting people in the hospital, and for that reason I don’t regret the experience. I still have some residual resentment towards the social worker who committed me, though. I know she made the best decision she could with the information she had, but it was disturbing to have my freedom taken away so quickly when I hadn’t done anything “wrong” to anyone but myself.

  49. walpolo says:

    Are the nurses at your hospital like The Nurses?

    https://www.youtube.com/watch?v=4u_Hyw80Yqo

  50. Anonymous says:

    Thanks so much for this post, Scott. It has, at least temporarily, lessened the hatred that I harbor for psychiatrists who were complicit in my little involuntary mental health incarcerations.

    I’ve had three of them since I turned 18. I’m in my mid-30s now and I’m happily married with a child, an ok job, etc. For as long as I can remember, I’ve suffered from what can accurately be called Major Depressive Disorder and when I was younger, I had a serious problem with alcohol.

    Major depression + alcohol + an enabling girlfriend that I lived with + guns + the occasional cocaine binge + a parental financial cushion coupled with mom and dad bailing me out when I got arrested caused the local cops in an affluent town in NJ to take a special interest in me.

    Getting arrested there when I was at my worst didn’t take much. The three times that I was involuntarily hospitalized were a result of noise complaints from my neighbors and an inappropriate response from me when the cops showed up. This was after I had a more serious, yet also alcohol related, gun arrest.

    The first two times that I was involuntarily hospitalized, the cops didn’t even bother arresting me. They simply took me into the local ER as a psych admission and were emphatic about how dangerous I was to the staff. I could go on here about the conversations I had, via video, with the shrinks who committed me, but I don’t have time to write a novella. I had health insurance and those two little vacations were in private hospitals, and in retrospect, they didn’t seem so bad. However, at the time I was OUTRAGED at the idea that THESE PEOPLE CAN TAKE A SINGLE DAY AWAY FROM ME! I wanted to sue when I got out. Mom and dad threw a ton of money my way, but they weren’t going to support a lawsuit and that was that.

    Then I got arrested again and rather than just take me to jail and let me dry out like most cops do with any other drunken criminal, I was once again taken to the emergency room and committed.

    I ended up spending 24 days in the criminal ward of Ancora, which is a notoriously nasty psych hospital in NJ. The patients there were really out of their minds. I was assaulted once (the security was actually good and not abusive), and that ended quickly. But the threat of violence there was constant.

    My psychiatrist, who wanted to keep me committed, was destroyed by my lawyer in front of the judge who was doing the hearing. He admitted that all of my behavior that he’d observed didn’t indicate any sort of psychosis, detachment from reality, potential harm to myself or others, or whatever. To his credit, he was more or less honest and told the judge that I should remain admitted because of how the police described my arrest, although my lawyer had to tease this out of him. When I wasn’t intoxicated, I didn’t seem crazy at all, and people like that deserve to be in jail or prison, not Ancora.

    I’m not sure what exactly turned me around, but serving close to half of a 4-year prison sentence after all of this probably had a lot to do with it.

    I don’t know why I’m bothering to write this. I guess I still have a lot of anger over my involuntary commitments, especially the one at Ancora, and your post reminded me of them and made the people who were part of this a little more human to me.

    • Anonymous says:

      I’m a big believer in the concept of “shock incarceration.” A nice long week in jail after my first serious arrest would probably have done the job well. Jail is really scary when you first get there. When they’re carting you off to prison, that’s really scary too. Once you’ve been in either one for a little while, you miss food and sex much more than you fear violence.

      We incarcerate so many people in America today that going to jail or prison is very much like being stuck in an annoying subway car for an extended period of time.

      • Anonymous says:

        >We incarcerate so many people in America today that going to jail or prison is very much like being stuck in an annoying subway car for an extended period of time.

        The side effects are significantly worse.

  51. as someone who has been hospitalized a few times, it’s good to see a psychiatrist seeing it the same way i did. i think you ARE doing some good. it kind of works like this:

    “The purpose of a mental hospital is not to help you recover. It’s to get you to keep the crazy inside long enough to function in every day civil society. The mental health professionals are not going to help you figure out what trauma has triggered your psychosis or depression or whatever. They are going to teach you to shut the fuck up about it, so you can get out of that horrible place, because if you don’t shut up, you’re going to be stuck in there indefinitely.”

    http://markpneyer.me/2015/06/18/thoughts-on-the-charleston-terrorist-from-someone-with-mental-illness/

  52. You probably won’t notice this post, because it’s so far down, but Scott, I want to try to reassure you (I hope this is reassuring) that for the people I know who visit shrinks a lot, one of most important things you can do is just listen to their problems. A lot of these people don’t really have a functioning social life or family structure. Some literally have no friends. They have no one to bounce ideas off of or say, “hey, this weird thing happened, what do you think about it?” So for a lot of people, the shrink steps into that role; the medicine is being heard and having a human being who expresses compassion and concern.

    The other important thing is medication follow up. Make sure the medication works and doesn’t have terrible side effects. So often I see something like, say, medication is causing patient to eat too much, so shrink recommends taking medication in the evening instead of the morning so the cravings happen while asleep. A week later, patient is calling up loved ones, crying and screaming. Finally someone remembers the recent medication alteration, patient goes back to taking medication in the morning, and life goes back to normal.

    While I’m at it, one thing that I wish shrinks would do is consult, in total confidence, with the patient’s family. There are things the family can tell you about the patient’s behavior, but they may not want to tell you if they think you’ll tell the patient. (“So, your brother says you’re kind of emotionally stunted, like you stopped maturing in middle school…”) I’m sure there are lots of practical reasons why that wouldn’t work.

    Good luck.

  53. F1E8E55F says:

    I am happy to give them reasonable doses of the non-addictive anti-anxiety drugs

    I’m curious, what are those? I mostly know about benzodiazepines, and I’m given to understand those are eventually addictive. What else is there?

    • Careless says:

      Well, there’s buspirone, which from my experience using it is useless/harmless to the point where I do not believe I could tell if I had taken it or not

  54. Shenpen says:

    Scott,

    what do you think about the recent Brain Derived Neurotrophic Factor craze? That you can boost this shit with intermittent fasting and exercise and it is not only gonna make you smarter, it will also fix your depression? E.g.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022308/
    http://news.discovery.com/human/health/exercise-plus-fasting-may-boost-brains-neurons-1411211.htm

  55. Anonymous says:

    Is there anything at all to be done for people with BPD? Someone that careens between suicidal thoughts, drug abuse, grandiosity, rage, mania, professions of undying love, and so on? Or just try to not be in the way when they crash and burn?

  56. BBA says:

    Splitting from the free speech thread above, because I don’t even know where to begin.

    It’s important to note that the First Amendment wasn’t meant to be a universal statement of enlightenment ideals; it was written solely regarding a federal government in a system where state governments were already in existence and many had their own bills of rights. The formulation of freedom of speech in my state constitution (similar to those in many others, and apparently ultimately derived from the French Declaration of Rights of 1789) seems more appropriate to me:

    “Every citizen may freely speak, write and publish his or her sentiments on all subjects, being responsible for the abuse of that right; and no law shall be passed to restrain or abridge the liberty of speech or of the press.”

    Emphasis mine.

    • Alraune says:

      The amendments were meant to simultaneously satisfy the demands of several different schools of enlightenment ideals. What other meaning would you give “universal”?

      As for the French declaration of rights, I’m typically glad their influence share in the Anglo-Franco-Germanic cultural alliance isn’t higher.

    • FullMetaRationalist says:

      I’ve always assumed that the 1st Amendment was a bunch of rules originally intended to restrain the Big Bad Government from bullying Alice, rather than to restrain Bob from bullying Charlie.

      At the point of original intent, those were equivalent concerns. The federal government didn’t yet have a community and mind of its own like it does now,

      By “Big Bad Government”, I was rather thinking of Great Britain. My impression of history is that the American Colonies were fed up with the way it was bullied by Great Britain. And that it didn’t want “The Great Experiment” to revert to a state where speaking ill of the government amounted to treason. I.e. the Bill of Rights precludes a corrupt government from exploiting the Principle-Agent Problem (by ignoring the criticisms of We The People).

      • Anonymous says:

        No, the Bill of Rights was to protect the States from each other. In particular, the people of Virginia were afraid of the people of Massachusetts.

    • FullMetaRationalist says:

      I think there is an important distinction that is getting missed in parts of this long thread—the distinction between not listening to people and trying to prevent people from speaking by making it costly.

      We need to make a further distinction. I didn’t follow the Phil Robertson controversy. But now I’m beginning to understand it. It appears there exist two types of markets: the Market of Ideas (MI); and the Market of Goods & Services (MGS).

      The MGS is a place where citizens are offered a variety of goods are services. Each citizen chooses to buy a good or service according to their preferences. Each business competes with rival businesses for the citizens’ patronage. The businesses which sell the most popular goods and services continue to thrive, while the businesses which sell the least popular goods or services are weeded out by natural selection.

      The MI is a place where citizens are exposed to various memes. Each citizen chooses to adopt memes into their belief system according to their preferences. Ideologies compete with incompatible ideologies for the citizens’ mental storage space. The ideologies which proselytize the most citizens continue to thrive, while the ideologies which fail to convert are weeded out by natural selection.

      Ideally, each market would not interfere with the other. This way, the market participants compete on their own merits. But this isn’t the case in reality.

      It’s possible for MGS to influence MI. E.g. it’s plausible that the reason A&E suspended Phil Robertson was to protect their bottom line. If A&E had allowed Robertson to freely express his negative opinion of homosexuality, Duck Dynasty’s ratings might have fallen because maybe viewers find homophobia distasteful. (I know that’s not what actually happened. Duck Dynasty is just a vehicle for a thought experiment.)

      Conversely, it’s possible for MI to influence MGS. E.g. the backlash A&E faced. It was a situation where a memeplex convinced a business to recant a suspension of employment.

      This scenario presents a dilemma. Should A&E suspend Robertson to protect their bottom line? Or should A&E continue to host & amplify an opinion they disagree with at the risk of their position in the market of goods and services. Does the right to life, liberty, and the pursuit of profit allow a company to silence someone? Or is the commitment to Free Speech allowed to bankrupt a company.

      Popehat:

      4. The marketplace of ideas assigns consequences to all participants. That means, for instance, that A&E might suffer market consequences for its behavior. That’s a feature, not a bug.

      Ken White implies that the lack of a clear divide between the markets was intentional. Is it a mistake for us to distinguish the MI from the MGS? I.e. maybe it’s better thought of as a single market. After all, does the U.S. not already allow super PACs to appropriate money towards political causes?

      (I’m still not sure what I think yet. And I haven’t read the most recent comments yet because I’ve been thinking about this one for several hours.)

      • FullMetaRationalist says:

        After wrangling with the coffee shop analogy, I’ve realized that cash (financial capital) and votes (political capital) are similar in certain respects.

        Every dollar spent represents a vote towards the surivival of a company. There happens to be a gas station near my residence. I find the proximity super convenient. When I’m driving around town, it’s not difficult to buy from an alternative station every once in a blue moon. But I make a commitment to buy from the station that’s near my residence. This is because I would hate to have the CEO decide the station near my residence isn’t making enough revenue and therefore close down shop. I bet environmentalists commit to buying organic products at more expensive prices for the similar reason that they would hate for the company go bankrupt and therefore fail to Change The World.

        Democratic elections more closely resembles communism, but the underlying mechanism is the similar. Each citizen is allotted a single vote, which they can then spend on their favored political candidate. Each vote represents the desire for the candidate to win the election.

        We’ve chosen to optimize each market such that citizens’ preferences accurately map to the success of businesses and politicians. For this to work, third parties can’t interfere. If someone takes MY money and spends it, that’s stealing. Not only do I lose out on resources, but the company from which I might have bought a product also loses profit. Similarly, if the mafia coerces me to spend MY vote on a certain political candidate, that’s voter fraud. Then suddenly government policy is being legislated by a sockpuppet.

        Unfortunately, money and votes are fungible (to a certain extent). Large corporations sometimes leverage their vast sums of money to bribe politicians. This distorts the political process because elections are now most influenced by whoever has the most money, rather than the will of the people. Large political factions sometimes leverage their credibility to convince politically neutral consumers to boycott a company (e.g. a pizzeria which refuses to serve gay weddings). This distorts the free market because the survival of the business now depends on how large the boycott is, rather than the quality of their product.

        But there exist mechanisms to combat these distortions. In more stable nations, there exist laws which deter political corruption (such as bribery). In healthy democracies, there exist cultural norms which deter memetic coercion (such as intimidation). Today I learned that those cultural norms are what’s actually meant by the phrase “Freedom of Speech”.

        Bad business gets out-competed. Does not get boycott. Never. Never ever never for ever.

        • houseboatonstyx says:

          In more stable nations, there exist laws which deter political corruption (such as bribery). In healthy democracies, there exist cultural norms which deter memetic coercion (such as intimidation). Today I learned that those cultural norms are what’s actually meant by the phrase “Freedom of Speech”.

          This sounds so good I’d like to see it considerably unpacked.

          On boycotting, I think it’s a legitimate quick way to express moral disapproval. But it should punch upward (or at least level); going after one small pizza shop or coffee shop would be punching down. And it is mob action, without due process; it may be based on rumour, not fact.

          Otoh, if you try to punch a target that’s too high/big, like Walmart, they’ll never notice.

          A target just the right size, sfaik, is something like Olive Garden, Applebees, etc. It’s a chain small enough to notice the boycott, but large enough that no individuals will be seriously injured.

          The Olive Garden situation was ideal for a boycott in several ways. A restaurant is a vulnerable target: very easy for boycotters to go to a different restaurant on the same day they hear about the boycott, and to go back to the target if/when it changes its policy. The boycott got publicity because it was tied to a national news story: those restaurants had announced that they were adjusting employees’ hours to avoid paying them benefits. All the boycotters acted within the same few days, making a sudden drop in Olive Garden’s business that was very noticeable. In contrast, scattered people boycotting Walmart on scattered dates will be lost in the noise, even if there are a lot of them.

          • CJB says:

            My grandfather had a saying: “Society is built on the twin pillars of rewards and retribution.”

            And I think we have a lot of retribution, but few reward mechanisms.

            If, for example, the goal of the chik-fil-a boycott was to stop a donation from a big company, they could’ve signed a pledge to eat one sandwich a month there, for one off the top of my head example.

          • FullMetaRationalist says:

            This sounds so good I’d like to see it considerably unpacked.

            As in “this sounds too good to be true”? And what specifically would you like unpacked? I’m afraid I don’t know understand. But I’ll give it a shot anyways.

            My comment attempted to convey a symmetry and follow it to its natural conclusions. In contrast, I felt that to continue the KKK/Coffee-shop train of thought (in the original thread) would be unproductive. It’s just too mired in subjectivity and minutia. Also, I’m not intimately familiar with the Civil Rights era.

            Upthread, “Who wouldn’t want to be Anonymous” cited public forums as a space to circumvent mob-censorship. “stillnotking” cited the Streisand Effect as a technique to contravene mob-censorship. Both of these are examples of the cultural pillars which I spoke of earlier.

            Another one is to quote “Freedom of Speech”. Even if the average Joe doesn’t understand the difference between Freedom of Speech (a la John Stuart Mill) and the 1st Amendment, the religious attitude surrounding the phrase bestows a sense of finality on the fact that the first speaker ought to be given a chance to make his or her case. I won’t attempt an exhaustive list, but I imagine there’s more I haven’t thought of.

            On boycotting, I think it’s a legitimate quick way to express moral disapproval.

            Had you asked me a week ago, I would have agreed. As of today, I’m on the fence. On one hand, I want to preserve the symmetry. In the ideal world where businesses survive by the popularity of their products, boycotts seem distortive. On the other hand, should not a common code of ethics constrain the behavior of a company?

            But we do have a common code of ethics. It’s our legal code. Like you said, boycotts do not follow due process. I think the proper response to unethical business practices is to either change the law, or sue the company. If a significant enough fraction of the citizenry condemn the company’s behavior, I would (at least naively) not expect a problem in getting an ethical injunction passed into law.

            Though slower, due process also has the benefit of changing the company’s behavior without suddenly ruining their bottom line. Successful boycotts may (in theory) cause a company with an otherwise successful product to shut down, though it was possible to continue selling the same product in more ethical ways.

            (Do boycotts ever work like this in practice? E.g. wasn’t this kind of the case with the Donglegate thing, except with a person instead of a company? I can’t think of any actual boycotts to cite off the top of my head.) (The Nestle baby-formula controversy was pretty disappointing. Simultaneously, I’d rather live in a world with Crunch brand chocolate bars than not. Nestle may have been large enough to endure the boycott, but what about the small pizzeria?)

            But it should punch upward (or at least level);

            I don’t remember what the SSC commentariat collectively decided about punching up/down. But I feel like deciding whether something is up or down runs into the Heap Problem: as the size of the enemy party decreases, at what threshold does punching up become punching down?

            Another problem is subjectivity. How does one measure size in the first place? Olive Garden may have a net worth and a clear number of employees. But can we estimate the number of participants in [reproductively viable female worker ant] to any degree of accuracy? Keep in mind that all debates are bravery debates.

            I think these are some of the issues Due Process can more easily avoid.

            The Olive Garden situation was ideal for a boycott in several ways. A restaurant is a vulnerable target

            At first I was going to say this was a silly point. Earlier, I was making the case that maybe boycotts (as the dual of censorship) are a bad idea. Whether a boycott is permissible by the cultural standards which society has collectively decided upon ought not depend on the efficacy of the particular boycott.

            However — I recall a post where Scott discussed how San Francisco train employees were complaining about their loss in jobs to an automated system (I can’t find it. Am I imagining things?). The larger argument was that a Basic Income would solve the problem better than individuals complaining about their jobs. If McDonald’s hourly staff make a big public hoopla about their minimum wages and McDonald’s management raises their wages in response, this only affects the employees at McDonald’s. The employees at the Walmart next door are still stuck with minimum wages.

            I wish to draw a parallel again, this time between the McDonald’s scenario and the Olive Garden boycott. AFAIK, every major company is restructuring their hours to circumvent the Affordable Care Act. But the citizenry clearly aren’t boycotting every major company. It’s just that Olive Garden made this change conspicuously (I presume; I haven’t followed this boycott either).

            The problem is not Olive Garden; the problem is the implementation of the Affordable Care Act. If the citizenry decide denying healthcare benefits is unethical, then we ought to cement this into law to ensure all employees receive health care benefits, rather than enforce this standard solely on a single company.

          • HeelBearCub says:

            @FullMetalRationalist:

            I don’t want to derail this thread, so I am very specifically not attempting to continue that other debate, but, in regards to this statement: “It’s just too mired in subjectivity and minutia.” Allow me to attempt to clarify my intent.

            Less Wrong said there exists a very bright line: “Bad argument gets counterargument. Does not get bullet. Never. Never ever never for ever.” Scott then said that boycotts (and a number of other things) are very clearly on the wrong side of that bright line, essentially moving it.

            Some seem to think that the line remains just as bright and clear as the original. So I’m pointing out things that are clearly adjacent to the new line and asking “Is the line as bright and clear as you think it is?”

            Edit: And David Friedman, who I was directly replying to, was drawing the same line by distinguishing “preventing speech by making it costly” from simply “not listening.”

          • Winter Shaker says:

            FullMetaRationalist:

            I recall a post where Scott discussed how San Francisco train employees were complaining about their loss in jobs to an automated system (I can’t find it. Am I imagining things?)

            This one?

          • houseboatonstyx says:

            Working backwards up this thread.

            @ HeelBearCub
            David Friedman, who I was directly replying to, was drawing the same line by distinguishing “preventing speech by making it costly” from simply “not listening.”

            I’ll applaud David’s term here — while bouncing off his point by saying that expressing unpopular views is already, literally, costly. Starting and publicizing a website for a ‘crankish’ opinion does cost quite a lot of money and time — whereas if your opinion fits into a current echo chamber, many free forums welcome it, and if you start a website of your own they will link to you.

            My perhaps extreme regard for ‘free speech’ as one of the set of stand-alone moral rights from which the Bill of Rights draws much of its power, leads to something like this. No one should lack practical access to public fora. Where there is none practical, existing propriatory fora have a human courtesy obligation to allow zim at least a small space in their relevant discussions. At very least, a link to zis own low-traffic website.

            To update Mill — truth, or the optimal synthesis, requires that all positions have a seat at the table. (Within reasonable limits of course, civility and readability required, etc.)

          • houseboatonstyx says:

            Thank you for the long reply with the many examples (on most of which I disagree); I think now I’ve got what you meant with your earlier statement:

            In more stable nations, there exist laws which deter political corruption (such as bribery). In healthy democracies, there exist cultural norms which deter memetic coercion (such as intimidation). Today I learned that those cultural norms are what’s actually meant by the phrase “Freedom of Speech”.

            What sounds very good to me, is your approach to a definition of “Freedom of Speech/Free Speech/etc” as “cultural norms” when it’s used outside of law. Would ‘a set of cultural norms’ have the same meaning?

          • FullMetaRationalist says:

            @HeelBearCub

            David Friedman’s comment implicitly suggests a litmus test where the question “Is behavior_x in agreement with Freedom of Speech?” reduces to “does behavior_x increase the cost of speech to the other party?”. I specifically decided to fork from David Friedman’s comment because I liked the direction it was going, but felt dissatisfied because the litmus test wasn’t clear enough. Thus began what I see as a long and messy debate over coffee shops. But I think there’s a better way to resolve the disagreement.

            Logic has this concept called the “Principle of Charity”. I expect most everyone around SSC is familiar with it by now. But as review, the idea is to interpret an opponent’s argument in its strongest form. Well recently, I’ve been thinking about this other concept. For lack of a better name, I’ll call it the “Principle of Autonomy”.

            —————————————–

            A not so quick detour: The Principle of Autonomy

            Suppose I ask a friend for advice. Since this is a psychiatry blog, let’s say I ask my physician about what to do about my depression. Personally, I dislike when people give me a lackluster response like “Uh, you should try Prozac first.” “… ‘Should‘? Is that really all you have to say?”

            People have mental models of the world, which they use to evaluate experiences in real time. As a nerd, I’m the kind of person who wants to have as comprehensive and accurate a model as possible. And as I said way upthread, I don’t like doing things without knowing why.

            When I ask for advice, I don’t want the final-result which was predigested for me by YOUR black box of a mental model. I want you to share your model with me so that I may run my own {preferences, opinions, life-experiences} through the model and arrive at a conclusion that I have confidence in since I understand the reasoning from the ground up. Don’t just give me advice, give me the algorithm!

            It’s similar to the reasoning behind the phrase “No battle plan survives contact with the enemy.” According to wikipedia, Helmuth von Moltke the Elder ran his army “by means of directives stating his intentions, rather than detailed orders, and he was willing to accept deviations from a directive provided that it was within the general framework of the mission.” Your physician knows a lot about medicine, but does he know about your preferences and life circumstances as well as you do?

            You can tell the difference by the way the recipient reacts. It’s the difference between a student who says “… … … oh … … …” and the student who says “OH! I get it now! [starts scribbling furiously]”. Back to the doctor example. In an ideal world, I’d rather my physician explain to me “Your options are {SSRI’s, SNRI’s, TCS’s, MAOI’s, TeCA’s, NASSA’s, etc}. Let me explain how they generally work and the pros and cons of each.”

            (n.b. I’m explaining my preferences, not complaining about doctors. I realize doctors have more important things to do than play med school.)

            (n.b. I don’t actually know anything about antidepressants. I just ripped them off wikipedia.)

            There’s also usually an easy litmus test to tell one explanation from the other, without even looking at them semantically. The black box explanation usually includes a “should” (sometimes preceded by an “if”; e.g. “if you’re depressed, you should take Prozac”). In other words, the black box explanation is usually a normative statement. The white box explanation is usually a descriptive statement.

            The reason I call this the Principle of Autonomy is because I feel the black box explanation treats me like a dumb pleb who obviously isn’t smart or mature enough to make my own decisions. In the black box scenario, the Ministry of Truth makes my decisions in my stead. We might even call the black box explanation uncharitable because it doesn’t give me the credit of acting like an intelligent being with agency (except “uncharitability” already refers to a different concept — ho hum).

            (Incidentally. I think a common theme among the SSC’S “Comment of the Month” texts are the introduction of a novel model, rather than a bickering over parameters of an extant model.)

            (Also. I like how when people are strawmanning, the other party can say “that sounds uncharitable”. The “Principle of Autonomy” is comparatively kludgy, because it doesn’t make sense to say “that sounds unautonomous”.)

            ——————————————-

            And now for the featured film: The Coffee Shop.

            At what point in there did I slip from moral good to moral bad?

            The point where we’ve crossed the Bright Yellow Line is where the situation changed from [Coffee Patron Patrick tells Neighbor Nancy “Barista Bob is in the KKK”] to [Coffee Patron Patrick tells Neighbor Nancy “Barista Bob is in the KKK, and therefore you should stop buying coffee at Star Bucks“].

            Do you see the difference? I think the first instance was ethically permissible because it was just a neighbor sharing some information about the world. What Nancy thinks about it shouldn’t concern Patrick because she has preferences that aren’t identical to Patrick’s. I think the second instance was not ethically permissible because Patrick is trying to smuggle his unique preferences into Nancy’s opinions. This violates the Principle of Autonomy because Patrick implicitly assumes that Nancy isn’t smart enough to make her own decision about what to do regarding her newfound knowledge of Bob’s KKK membership.

            Come on. Let’s give Nancy a little more credit than that.

          • FullMetaRationalist says:

            @Winter Shaker

            Yep. That’s the one. In hindsight, I think my search terms were overly specific.

          • FullMetaRationalist says:

            @houseboatonstyx

            expressing unpopular views is already, literally, costly. Starting and publicizing a website for a ‘crankish’ opinion does cost quite a lot of money and time

            If an opinion is fringe, that’s not an act of sabotage. That’s a lack of demand. It’s the difference between the cost of construction and the cost of vandalism. No one’s make the fringe opinion more costly to express, the cost is inherent in the amplification of the signal. Therefore, I see no violation of Free Speech.

            Starting and publishing a ‘crankish’ website is like starting your own business because you’re dissatisfied with the existing market. If the NY Times is willing to print your opinion, cool beans. If you start your own website because the NY Times rejected your opinion, that’s still fair because the NY Times had to pay a cost to start their own website too. I doubt anyone is going to sympathize when you say “but the free market should pay for my right to start a business”.

            Would ‘a set of cultural norms’ have the same meaning?

            I don’t see an extensional difference between “cultural norms” and “a set of cultural norms”. So I don’t know what you’re asking. Would it mean anything differently if “Free Speech” were defined as a tuple?

            I guess the way I now look at it is: Free Speech is an ideal which society should strive to uphold (for reasons previously discussed); the 1st Amendment guarantees the U.S. Government will follow that ideal; the 1st Amendment guarantees a mere subset of Free Speech because the the government is a mere subset of the entirety of the nation; the 1st Amendment is a strict subset of Free Speech because there are things the government does not guarantee, yet society should strive to uphold anyway.

          • HeelBearCub says:

            @FullMetaRationalist:

            Is their a difference between what you are saying and “Hey all my Facebook friends, I, Patrick, have decided to join a boycott of Cafe A because of [detail of value model]”?

            I have said not you should>/em> join the boycott. I have merely said I am.

            Is this OK in your framing? Or, are are you implying the black box, even though I gave a statement detailing my thinking, because I used the word boycott?

          • FullMetaRationalist says:

            @HeelBearCub

            I have the mindset of a child. I’m always asking “why?” and sometimes I say “don’t tell me what to do”.

            .............black....white.
            descriptive..[ n/a ]..[best]
            normative....[worst]..[fair]

            worst = (normative)(black box)
            This is equivalent to "Eat your vegetables." It's a command without explanation.

            fair = (normative)(white box)
            This is equivalent to "Eat your vegetables so you grow big and strong." It's a command, but with a dash of reasoning.

            best = (descriptive)(white box)
            This is equivalent to "You'll grow big and strong if you eat your vegetables." It offers me information while affording me the freedom to decide my own behavior.

            n/a = (descriptive)(black box)
            This is an oxymoron.

            The situation you describe sounds closest to (normative)(white box). I appreciate you sharing your knowledge of the world (in this case, regarding Barista Bob). I do not appreciate your implicit peer pressure.

            I think it’s one thing to mention to your friends in passing that you can’t attend the Saturday picnic because earlier you committed to attend a boycott. I think it’s another thing to deliberately post to facebook:

            I do not agree with the employment of Bob, the Starbucks Barista, on account of his membership in the KKK. Therefore I, Patrick the Starbucks Patron, hereby pledge to attend the Starbucks Boycott held this Saturday which you can find more information on if you click the link below [wink wink].

            What was the purpose of posting such a statement to facebook? Was it so Patrick and his friends could “keep in touch”? Was it to spread an interesting news story? Was it to garner popularity (since Che Guevara is all the rage)? Was it to recruit some greenhorns towards the cause?

            This is a grey area. The only person who knows why Patrick posted such a statement to facebook (and therefore if the statement was made in the spirit of Free Speech) is Patrick. But then again, maybe not even Patrick knows. Asches to Asches, must to must.

          • HeelBearCub says:

            @Full Metal Rationalist:

            It sounds like, in practice, you find it immoral to tell anyone you are boycotting some place, no matter how detailed the reason. You seem to regard the fact that I have decided to boycott, and I have decided to inform people I am boycotting, carries an implicit “should”.

            This seems to me to turn your previous thoughts on their head. I could give a 30 point discourse on why I find Perdue Farms chicken treatment immoral, and therefore I am no longer buying their product, and you would seem to say “there is an implied should, therefore they have not explained the box well enough.”

            Is that fair to your position?

          • brad says:

            FullMetaRationalist:

            I think you are confusing an aesthetic preference for a moral one. You don’t like when the doctor says “take prozac”, but that doesn’t mean he is acting immorally. Perhaps he isn’t the right doctor for you, but maybe are some people who want paternalism in a physician.

            Likewise, if you told me you don’t like people who try to peer pressure you into joining a boycott, I could totally understand that. But that’s not the same thing as saying those people are acting morally wrong.

            This isn’t to try to say that there isn’t some compelling moral argument against boycotts, maybe there is, but I don’t think the one you gave quite does it.

            Personally, though, having read through the responses here, I remain unconvinced. I don’t know why I shouldn’t use my words to try to convince others to use their buying choices to hurt economically people who are actively using their words to try to convince others to hurt me — including hurting me physically.

          • FullMetaRationalist says:

            @brad

            who are actively using their words to try to convince others to hurt me — including hurting me physically.

            In my describing my new mental model of Free Speech, I highlighted two distinct ecosystems: the market of ideas and the market of goods and services. By considering physical violence, we must now consider a third ecosystem: the gene pool.

            (Maybe the reason I dislike the KKK/coffeeshop thread was because I wanted to nail down the naive model before adjusting for complicating parameters. Like how Physics 101 asks students to solve trajectory problems without considering air resistance.)

            It would seem to me that the Market of Goods and Services supervenes the Market of Ideas, both of which in turn supervene the Gene Pool. If people don’t have the freedom to think for themselves, there cannot exist a free market of goods and services. If people are afraid of physical violence (or literally dead), people cannot have the freedom to think for themselves.

            galaxies
            ———————–
            useful products
            ———————–
            ideas
            ———————–
            people
            ———————–
            subatomic particles

            The general goal is to not let the power of one ecosystem affect the state of another ecosystem. Each ecosystem has its own way of promoting the most fit of the competition.

            But if Barista Bob (as a KKK member) wants to physically harm you or remove you from the gene pool, I think it’s entirely ethical to defend yourself in any way possible. I think your physical well-being is much more important than the well-being of some hoity-toity economic market. I think there’s a good reason why we as a society consider the right to self-defense as superseding almost all other arguments.

            You don’t like when the doctor says “take Prozac”, but that doesn’t mean he is acting immorally.

            I did not mean to imply the doctor was acting immorally. In the case of the doctor, I agree that it’s just a matter of aesthetics.

            A boycott is bad not because of some inherent property of the principle of autonomy. A boycott is bad because the violation in the principle of autonomy often signifies the influence of one ecosystem on another. And in an ideal society, I would not expect ecosystems to cross-pollinate. The previous sentence sounds like the thesis upon which all of my reasoning rests, so let me say it again for the sake of clarity.

            In an ideal society, I would not expect ecosystems to cross-pollinate.

            The badness is contingent on the cross-pollination. The Principle of Autonomy is a convenient (but perhaps not perfectly accurate) litmus-test of whether cross-pollination occurred. David Friedman’s litmus test has a lot of merit, but runs into edge cases because it’s possible for one party to increase the cost of speech/doing business of others by accident.

            In the facebook example. Suppose Nancy asks Patrick if he wants to attend a picnic among mutual friends. Patrick mentions in passing that he can’t because he’ll be attending a boycott against Starbucks. Also suppose that Nancy is aware of the boycott, and is in fact a KKK member (non-violent) communist herself. (can I stop using the KKK? I’d rather my thought experiments not include air resistance)

            This is an edge case where Patrick may have increased to the costs of expressing Nancy’s opinion. Nancy may experience peer pressure to hide her communist leanings for the sake of friend-group harmony. But I don’t think it was Patrick’s intention to exert peer pressure.

            Let’s run this through the two litmus tests and the model itself.

            Friedman test: Were Nancy’s costs of expression increased? Yes. [RED CARD]

            Autonomy test: Did Patrick tell Nancy how to live her life? No. [NO VIOLATION]

            Model: Did Patrick’s post affect Nancy’s future patronage to Starbucks (which would therefore be a case where the memetic sphere affected the business sphere)? Nancy may be afraid to be seen at Starbucks by Patrick, which would affect Starbucks business. But not necessarily because maybe Nancy and Patrick are good enough friends to mutually understand that people have different opinions, can agree to disagree, and therefore Nancy will continue to attend Starbucks without qualm.

            I’m tempted to evaluate this case as a [NO VIOLATION]. Except now that I think about it, the premises may be contaminated from the beginning.

            What’s the difference between a “boycott” and a humdrum situation were “people just don’t wanna buy from Starbucks anymore” (because the coffee sucks)? I think the word “boycott” smuggles in connotations which can affect whether or not we red card it. The word “boycott” may refer to a situation where people simply stop attending Starbucks because they don’t feel comfortable around a commie. The word “boycott” may alternatively refer to a situation where people organize a campaign to convince others to stop attending Starbucks.

            I feel bad in the first situation because (back to the thesis,) I don’t think people ought to discontinue patronage to a company based on their political affiliation to begin with. In practice, it can’t be helped. There’s really nothing we can do to make people drink Starbucks brand coffee if they personally feel uncomfortable around the commie. It’s not in the spirit of Free Speech, but I can’t really condemn it on ethical grounds. People can associate with who they want.

            The second situation feels like a clear cut case of tumblrina-style mob-rule. Not only does it disregard the notion of Free speech by trying to punish the commie, but it’s a phenomenon we can ethically condemn and do something about.

            So when Patrick says “I’m going to boycott Starbucks”, does he mistakenly mean he’s going to simply stop attending over the long-term? Or does he intend to recruit friends to protest the boycott and therefore cause a intense short-term dip in Starbuck’s revenue.

            (I suspect something involving “personal knowledge vs shared knowledge” is going on here, but I don’t understand exactly how yet.)

            (Do you guys see how this is beginning to resemble a trajectory problem where the degree of accuracy requires us to adjust for a butterfly flapping its wings in China? The Coffeeshop thread looked like it was busy computing butterfly-wing perturbations without first modeling an accurate equation of gravity.)

          • FullMetaRationalist says:

            @HeelBearCub

            “there is an implied should, therefore they have not explained the box well enough.”

            What? This is not my position. Something has gone terribly wrong. Increasing the length or resolution of the explanation doesn’t affect whether they conclude with paternalistic advice “therefore, you should perform action_x”. Like, you understand my punnet square, right?

            I guess it’s kind of a weird square, because a white box (under my definition: revealing any relevant portion of your thought process regarding the objective facts of the universe) will by definition include a descriptive statement of how the world works. By (normative)(white box), I mean a statement which explains the reasoning, but draws conclusions for me anyway. So really, it’s both descriptive and normative.

            It sounds like, in practice, you find it immoral to tell anyone you are boycotting some place, no matter how detailed the reason

            Something has gone terribly wrong. My position is: an action was not made in the spirit of the Free Market (the dual of Free Speech) if: that action, for political reasons rather than economic reasons, deliberately affects the consumer habits of another person.

            Whether the boycott was mentioned in the spirit of the Free Market is contingent on: a) the context of the conversation; b) Patrick’s intentions; and c) the manner in which the boycott was mentioned. All three points derive from the question of “Is Patrick attempting to deny Starbucks even more patronage by trying to smuggle his political preferences into others?” If the KKK falls out of political fashion, why should Starbucks suffer collateral damage? The KKK should be allowed to wither away without sinking a popular coffee company with it.

            (As discussed in my comment to brad, the fact that the historical KKK was extremely violent changes the moral calculus considerably. In my thought experiments, I’ve been using it as a place holder for any old political faction.)

            (I should stop talking about boycotts as “immoral”. I don’t think it’s immoral so much as inoptimal given society’s commitment to a Free Market. We would all rather live in a world with coffee as high-quality as Starbucks’s, right? (I don’t actually drink coffee; it’s too bitter.) )

            [insert obligatory complaint about the threading]

        • HeelBearCub says:

          @Full Metal Rationalist:
          “What? This is not my position. Something has gone terribly wrong.”

          Are you sure I haven’t accurately characterized your position? After I posted that comment you said the following:

          “The word “boycott” may alternatively refer to a situation where people organize a campaign to convince others to stop attending Starbucks…[This] situation feels like a clear cut case of tumblrina-style mob-rule. ”

          Now, the ellipses hide a number of intervening sentences, but it’s pretty clear the situation you refer to is the fact of trying to convince others of trying to join a boycott.

          No matter how detailed the explanation for my behavior, the mere fact that I attempt to convince others of the desirability of this action seems to be out of bounds for you. It seems fairly clear in that framing that you care far more about the normative statement than you do about how clear the box is.

          And specifically you don’t like any normative statement made about the marketplace of goods that derive from the marketplace of ideas. You have set up a “non-overlapping magisteria” argument, it seems. So much so, that you even express regret that people privately decide where to take their business if it is not based on only the end product itself; concluding that it’s OK, but not optimal.

          Now, steel manning slightly, you might be referencing the actual effect on the behavior of others that a call for a boycott has. You may be concluding that most people, when deciding to join a boycott, don’t carefully consider a list of 30 points on why the actions of an economic actor are bad and simply “vote with the tribe”. That seems like a really, really different point though (and almost all boycotts do have extensive reasoning readily available, even if the normative statement comes first).

      • Alraune says:

        Ken White implies that the lack of a clear divide between the markets was intentional. Is it a mistake for us to distinguish the MI from the MGS? I.e. maybe it’s better thought of as a single market.

        The issue with Ken’s argument that all legal actions are “within the market” is that he wants them to cut only one direction, they don’t, and once you realize that they do no work. He has an argument against giving protection to the first speaker, but the only argument for giving protection to the first mob is that it’s very slightly more difficult to punish its members than it is to punish properly public figures.

        And that’s not a call for civility, it’s a call for the development of better retribution technologies.

      • Nita says:

        there exist two types of markets: the Market of Ideas (MI); and the Market of Goods & Services (MGS)

        Well, sort of. MGS is an actual market (actual markets?), while “the market of ideas” is a rather dubious metaphor, probably spawned by market-ethusiasts’ desire to call every phenomenon they approve of a “market”.

        Ideas in the MI are not bought, sold or traded (patents and such are clearly in the MGS territory), but shared — it’s more of an ecosystem, if anything.

        • Alraune says:

          “the market of ideas” is a rather dubious metaphor, probably spawned by market-ethusiasts’ desire to call every phenomenon they approve of a “market”.

          Nah, it developed from reference to those literal marketers of ideas, printers.

          • Nita says:

            I don’t see the contradiction?

            Here are the first uses, both by American judges:

            The ultimate good desired is better reached by free trade in ideas — that the best test of truth is the power of the thought to get itself accepted in the competition of the market.

            Like the publishers of newspapers, magazines, or books, this publisher bids for the minds of men in the market place of ideas.

            The line of reasoning seems to be “we all agree that markets are good, and free markets are the best, right? well, this is also a market of sorts, therefore it should be free.”

            Anyway, I don’t mind cute metaphors, but when they take on a life of their own, it gets a little weird.

            E.g., some people say “eyes are the mirrors of the soul”, but from that we can’t conclude there are two kinds of mirrors:
            1) eyes,
            2) other mirrors (previously known as “mirrors”).

          • Alraune says:

            The line of reasoning seems to be “we all agree that markets are good, and free markets are the best, right? well, this is also a market of sorts, therefore it should be free.”

            No, it’s “We all agree that free press is good, and inviolably free press is best, right? Well, this guy is also ‘press’ of sorts, and therefore should be inviolably free.”

            They analogized citizens to press, and therefore concluded that citizens needed Free Speech, not just freeish speech. If the functional term in “speech market” was “market” rather than “speech,” the end of the argument would be “therefore Congress can commerce clause the hell out of you” and we’d (or I’d, anyway) live in a very different country.

          • FullMeta_Rationalist says:

            We don’t need to think about the Market of Ideas as a literal market. The key was to quarantine the dissimilar mechanisms of competition to their respective arenas. Ideas should live and die by their own merit, rather than the headcount or wealth of a political faction. Like, we wouldn’t want basketball games to be decided by ice skating skill. But this is what happened in the Phil Robertson Case. “Ecosystem” may have been the better word.

        • Alraune says:

          We’ve got a good example of how blurry market of ideas vs. market of goods and services gets today in the so-called “Reddit Revolt.” It’s both a culture fight over the degree of autonomy given to the subdomains of one particular website, and a labor dispute over how the corporate arm relates to the moderators, and both elements are inextricable from the other.

    • A Definite Beta Guy says:

      Okay, so let’s ask the anti-federalists:
      “…in all the
      Constitutions of our own States; there is not one of them but what is either founded on a declaration or bill of rights, or has certain express reservation of rights interwoven in the body of them.”
      http://www.firearmsandliberty.com/antifederalist/theantifederalistpapers.pdf

      Every state already had a Bill of Rights. The Constitution did not. Their fear (correctly as it turns out) was that the federal government would overstep its bounds, and that if it did not also have a Bill of Rights then the federal government would be empowered to do literally anything it could get the army to enforce.

      I think it’s a very tough sell to suggest many of the Founding Fathers thought free speech no big deal.

    • houseboatonstyx says:

      It’s important to note that the First Amendment wasn’t meant to be a universal statement of enlightenment ideals; [….]

      It may be the closest thing we have, though. Can you suggest a better one, comparably well known?

    • houseboatonstyx says:

      On a very quick and lazy search for “being responsible for the abuse of that right”, I didn’t see anything promising to unpack ‘abuse’ and ‘responsible’ in that 18th Century context. My guess would be, that ‘abuse’ would include things like libel, and ‘responsible’ would include being responsible (via lawsuit) for paying for damage done by the libel, etc. Perhaps updatable as “No harm, no foul”?

  57. FullMetaRationalist says:

    Hi Scott, Imma derail again by pointing out that the Dutch are experimenting with Basic Incomes.

    http://qz.com/437088/utrecht-will-give-money-for-free-to-its-citizens-will-it-make-them-lazier/

    • Shenpen says:

      Just for information: The Netherlands and Sweden are seen by other Europeans really similar to how San Franscisco or Berkeley is seen by other Americans i.e. the ridiculously far-left places. Germany is so much in love with fiscal rigor, I cannot see this happening soon and probably right now they are pointing fingers at the Dutch and laughing.

  58. “You can adjust to having to treat someone having a seizure. You can adjust to somebody banging on the window and screaming. But it’s really hard to adjust to constant moral self-questioning.”

    This reminds me a lot of the job I had at a residential special school, except I became increasingly sure that it *was* net-negative.

    I find it really really reassuring that someone I admire and respect has had similar issues. I mean, obviously your work is a lot harder and you’ve been doing it for longer, but, well, I just assume that a Sufficiently Good Person swoops into a broken system and fixes everything. It is good (from a purely selfish perspective) to know that at least one Sufficiently Good Person just muddles through and does the best they can.

    I mean, from your descriptions of your work (which admittedly are an incomplete and biased source) it sounds like the best you can do is good even if it’s not perfect. The best I could do was kinda shit. But it is good to know I am not Irredeemably Evil Forever.

  59. Jon Lisle-Summers says:

    I am in the UK where mental health care, always the poor relation, is being deprived of yet more resources because, you know, the rich and greedy bet the farm on three-legged nag and lost. This is not the fault of the rich and greedy so they get the poor to pay for it.
    I have trained as Peer Support Worker with 19 others. We have the full spectrum of BPD, schizophrenia and anxiety/depression. I have learned so much it would fill a book the size of Joyce’s Ulysses.
    The top two things are: We are the ultimate survivors. It’s no fun when your internal analysers and assessors go haywire and become unreliable. Stepping back from the subjective is a massive step requiring serious mental and emotional skill.
    Second: All the trainees had a wicked sense of humour. In the end, it’s the tool of choice when facing life’s vicissitudes in a probabilistic universe which we prefer to think is logical and certain. E=MC².

  60. Liz says:

    I loved this post. Thanks for sharing your experience as a psych resident.

  61. 57dimensions says:

    Having just been in a residential psych ward (a step down from inpatient) for adolescents, I’d say this is a very on point description of what psych hospitals are like. Before I read this I tended to describe my experience there as a summer camp except with a lot more crying. The people I was there with turned out to be truly amazing people who were hilarious and kind, which made it even sadder that most of them were there because they had tried to kill themselves multiple times.