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The Case Of The Famous Physicist


Old news, but I only just heard about it: Long Island woman says psych ward doctors believed she was delusional for insisting Obama follows her on Twitter.

The story: a woman was brought in for psychiatric evaluation. During the evaluation, she said President Obama followed her on Twitter. The psychiatrists decided she was psychotic and forced medication on her. But in fact, President Obama does follow her on Twitter, just as he does six hundred thousand other people. So they committed a perfectly sane person for telling the truth, leading to what the article calls a “frightening eight-day ‘One Flew Over the Cuckoo’s Nest’ ordeal”.

I don’t know anything about this case or this person, and I definitely don’t want this to sound like I have anything to say one way or the other about this person I have never met. But I’ve been involved in enough similar cases to have a different perspective, and wonder whether it was quite as much of an outrage as the article makes it out to be.

Consider: the comment occurred when she was in a hospital for psychiatric evaluation; that is, she was brought in before the Obama comment. According to the article:

The bizarre experience began Sept. 12, when the NYPD seized her prized 2003 BMW 325Ci in Harlem because they suspected she was high on weed, her attorney, Michael Lamonsoff, said. Cops found no marijuana but confiscated her ride anyway, he said. The NYPD declined to comment.

The following day, Brock walked into the NYPD’s Public Service Area 6 stationhouse in Harlem to retrieve her car, her suit charges. Brock — an eccentric 32-year-old born in Jamaica with dreams of making it big in the entertainment business — admitted in an interview she was “emotional,” but insisted she in no way is an “emotionally disturbed person.” Nevertheless, cops cuffed her and put her in an ambulance bound for the hospital, her suit charges.

This sort of elides over everything in between “went into police station to ask for car back” and “cops put her in an ambulance bound for the hospital.”

I’ve had patients sent by ambulance from the police station. It’s almost always because they started screaming and yelling threats at the police. Now, screaming and yelling threats at the police, although not a very good idea, is not always evidence of psychiatric disorder. But it often is. If you’re manic or on drugs, you’re a lot more likely to have the particular type of bad judgment that makes screaming threats at the police a seem like a good idea.

I don’t know what happened with Ms. Brock, and the article doesn’t say. I did take a look at her Twitter account, which is mostly angry tweets about Trayvon Martin, Mike Brown, and police brutality. A typical example is “Police should NOT be allowed to Murder the Citizens of this Country!!! We are not Animals!!! @BarackObama fix it NOW!!! #BanGuns”. Other Tweets seem maybe a little threatening, like the ominous “@NRA you people deserve the wrath that will come on you in the very near future” and “#KillRacists”.

So – cops have just done something very unfair to a person who likes making threats and doesn’t like cops, and who herself admits to being “eccentric” and “emotional”. Again without knowing what went on, my guess was that her “discussion” with the police was sufficiently exciting that they thought calling an ambulance for a psych evaluation was in order.

So imagine you’re the psychiatrist, you’re receiving a patient from the police for evaluation after she got in some kind of screaming match with them. And now she tells you Barack Obama follows her on Twitter. The article says:

“I told (the doctor) Obama follows me on Twitter to show her the type of person I am. I’m a good person, a positive person. Obama follows positive people!”

This is weird. At best, it displays a surprising ignorance of how Twitter and/or the world works. Yes, Obama follows 600,000 people on Twitter, but this does not prove that each of them is “a positive person”. I would assume he has some program that auto-follows anyone who mentions him. When you think this is a good thing to bring up during, of all times, a psychiatric evaluation, then I start to wonder.

(I should also add here that, in my limited experience, social media is God’s gift to grandiose psychiatric patients. None of them are “a guy with a Facebook page”. They’re all “social media celebrities with hundreds of followers”. It’s always “YOU CAN’T DO THIS TO ME! DO YOU KNOW WHO I AM? I HAVE HUNDREDS OF FOLLOWERS ON TWITTER! EVEN [NAME OF TWITTER PERSON I HAVE NEVER HEARD OF] FOLLOWS ME! THIS IS GOING TO GO VIRAL!” One patient even told me, in a threatening manner, that his blog had over a thousand hits. “You mean a day?” I asked. “No, total,” he answered. Then he wondered why I was so utterly failing to look impressed.)

So I’ll be honest – if someone had just been brought in for a shouting match with police, and the first thing they told me was that President Obama follows them on Twitter, well – among the most common symptoms of mania are irritability, grandiosity, poor decision-making, and flamboyant dress/behavior. Getting in a fight with the police sounds like irritability and poor decision making, thinking the Obama follow is relevant sounds like grandiosity, and this woman’s Facebook photo certainly suggests a flair for the dramatic. I’m not saying I would commit her on these factors alone, and a lot would depend on the rest of the history. But she already would have started digging quite a hole for herself.

Remember, psychiatrists have to err on the side of admitting people. Even if this lady didn’t have bipolar disorder, admitting her for further evaluation seems like the sort of thing that could be an honest mistake.

(and remember, all we have here is her side of the story. Goodness only knows what other things she might have said or done that she didn’t leak to the news for their sympathetic article based entirely on her testimony.)

But then there’s the hospital’s subsequent conduct. They said that she was unemployed. She said she was employed and could prove it through her Internet presence. The hospital apparently didn’t check and continued to say she was psychotic for thinking she was employed. How could the hospital possibly be so incompetent as to not check the link to her employment documents that she was personally giving them?


Let me tell you about Professor T.

(this would be a good time to reiterate that every patient story I tell here is a composite of multiple different people with all of the details changed around to protect anonymity. The gist of the story points out a true thing, but the specifics are all twisted around so thoroughly that even the people involved couldn’t recognize themselves.)

Professor T came to me in handcuffs. The police had picked him up in response to a call at the local university, where he was trying to give a lecture to a class that wasn’t expecting him and didn’t want him. The class’s actual professor had asked what the heck he was doing, and he had explained that he was Professor T, world-famous physicist, and that the head of the college had invited him to give a lecture on his theories that day, and it was too bad she hadn’t communicated this with the rank-and-file teachers, but he was a very busy man and they should all be honored by his presence and stop what they were doing and listen to him. A quick call to the administration confirmed none of them had any idea who he was either, and when he refused to go away or stop trying to lecture, the police were called to remove him. He started yelling and screaming at the police and telling them they were fools who were too small-minded to recognize a great scientist when they saw one, and they’d get what was coming to them. The cops decided this was a job for a psychiatrist and brought him to me.

Professor T said he’d just been really angry that the bureaucracy had screwed up badly enough to make him miss his lecture and that no one was willing to accommodate him. He was, after all, a very important leading scientist with a busy schedule. He moved in elite circles! Famous people like Edward Witten knew him well, and I was welcome to call to confirm that! He was used to being shown more respect!

I got a weird vibe from Professor T during our discussion. I know that distinguishing between professors and hobos is a famously difficult problem, but he just struck me as a little too much towards the hobo end for comfort. So I asked him if I could see any proof that he was who he said that he was.

He was happy to comply, and once we got to a computer he showed me some scientific papers with his name on top, suitably peppered with complicated words like “tachyon” and “chromodynamics”. He showed me a picture of him winning some prestigious physics prize, dressed in a lab coat with a medal around his neck. He even showed me what looked like a press release: “Professor T comes up with new Theory Of Everything that may explain Higgs Boson”. It was pretty convincing.


A bunch of patients had cancelled on me that day, so I had way too much free time. I started looking into Professor T’s credentials a little more. His papers were hosted on a private site and didn’t show up on Google Scholar and didn’t seem to be affiliated with any journal. The press release was on the same website, and seemed suspiciously badly written. There was nobody else in his photograph, and it was impossible to see what was written on the medal. Was it possible that a crazy hobo had just written some things that looked like papers, written something that looked like a press release, and then bought a lab coat and medal and taken a picture with them? Do real theoretical physicists even wear lab coats?

So I asked him if I could talk to Dr. Witten, whom he said he knew well. Professor T agreed. I Googled his phone number and called him up.

(It wasn’t actually Dr. Witten whom I called, but the case I’m adapting this story from involved someone else about as famous)

His secretary answered the phone, and I said I was a psychiatrist, and I asked if I could speak to Dr. Witten. The secretary was reluctant, but when I said it was about Professor T, she immediately asked me to hold, and I got Dr. Witten himself. I asked him if he knew Professor T.

“Absolutely,” said Dr. Witten. “He’s a crazy guy who keeps calling me up and telling me he’s solved physics. I don’t think he’s actually a professor of anything. I read one of his papers once, just for kicks, and it’s just a bunch of science terms like ‘tachyon’ and ‘chromodynamics’ strung together without rhyme or reason. It might fool a layman, but trust me, it makes no sense. I told him to stop calling me, and he wouldn’t, and finally I had to block him on my phone, and now he’s sending me letters in the mail, and it’s always same ranting about tachyon chromodynamics, which isn’t even a real thing. Did you say you’re a psychiatrist? Perfect, I’m so glad he’s finally getting treatment.”

I told Professor T about this, and he nodded his head. “Yes,” he said “I told you that Dr. Witten knows me well. I didn’t say he liked me. He still doesn’t fully understand my theories. But I am sure he’ll come around.”

I kept Professor T in hospital for about a week, and I can’t count how many times he yelled at me and complained that I was being unfair to him by not doing whatever the heck he wanted me to do that day. Read another one of his papers that would convince me his theories were sound. Call up yet another famous physicist he “knew”. Look at yet another of his fake websites devoted to himself. Every day, he threatened to sue me and my boss and the entire hospital for keeping him there even though he’d “proven” to us he was who he said.

Remember, delusions are fixed false beliefs. People are quite sure they’re true, quite sure they have evidence for them, and nothing (except occasionally really good psychiatric treatment) will convince them otherwise. They’ll keep demanding you take time to investigate more and more bizarre “arguments” and “evidence”, and if you ever stop, even after days and days of everything they say being one hundred percent refuted, they’ll accuse you of acting in bad faith.

(it’s like Internet arguments, only more so)

In everyday life, we get by on an assumption of trust. If I tell my boss I’m sick, he probably believes me. If he doesn’t believe me, and I send him a doctor’s note, he probably believes that the doctor’s note isn’t forged. If he doesn’t believe that, and he asks me for a number to call the doctor at, he probably believes it’s a real doctor and not my brother pretending to be a doctor to help me out. Yes, there are a couple of people who abuse that trust, but few enough that the rest of us are usually able to get by.

In psychiatry, there are a bunch of delusional people, paranoid people, narcissists, compulsive liars, and others who deliberately or unknowingly stretch the truth past the breaking point. Worse, a lot of the cues we use to detect liars, like “Are they shifty-looking?” don’t work, either because the person involved really believes what they’re saying or because they’re too far from the neurotypical norm for our usual intuitions to apply. A lot of the assumptions of trust we usually use crash and burn. If the person sitting next to me on the train says he’s a physics professor, I believe him. If the person brought in by police for a psychiatric evaluation says he’s a physics professor, maybe I don’t, and “how much time do I spent assessing the evidence and how much do I believe?” is a really tough question.

I am not trained as a police officer, detective, or judge. I’m also not paid to do their jobs. I’m also stuck in a system where the primary incentive is that if I ever fail to commit someone, then if they do anything bad after that I can be sued for everything I own. So I am stuck drawing partial conclusions, from incomplete evidence, in time I don’t have, from people I can’t necessarily trust, without even the ability to err on the side of caution.

I don’t think the hospital in the article followed great practices – in particular I’m unclear on how they came to believe the person was unemployed. And sending her the bill for her own involuntary commitment is an obvious injustice (albeit a universally practiced one). But the mistakes in the admission process are all ones I can imagine any psychiatrist making. Including me.

And that means something. You can trust me. After all, four different Dalai Lama accounts follow me on Twitter.

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323 Responses to The Case Of The Famous Physicist

  1. Jasmine says:

    People on this blog tend to believe things which are generally considered strange (eg: transhumanism). Has anyone here had a medical professional tell them they were delusional (in the clinical sense) because of something like that?

    • This could be a problem for people who wear medical alert necklaces or bracelets for cryonics. I imagine if a doctor had to evaluate me to see if I should be involuntarily committed he would ask about my necklace and count it against my sanity. It would get really bad if I made the mistake of admitting that I thought my best chance of being brought back was by a super-intelligent AI, and my greatest fear is of an AI destroying the visible universe.

      Scott, just in case perhaps you could issue “belief in cryonics is not strong evidence of insanity” cards to your transhumanist followers.

      • Jasmine says:

        I would also like one of those cards, Scott. After all, I’m sure that every psychiatrist would trust you. You’re followed by so many Lamas on Twitter!

        • Pku says:

          I’m followed by three llamas on twitter. And seventeen camels.

        • Deiseach says:

          I have to agree; it shows poor or impeded judgement, at the very least, to claim the President is following you on Twitter even if he is following you on Twitter when you’ve been hauled in for a psychiatric evaluation.

          If you can’t make the simple connection “If I want to get out of here, I have to appear normal. Mentioning the President in this context for no reason – even if it’s to show that I’m a heavy hitter and an important person and they can’t treat me like this – is not ‘normal’ so I shouldn’t do it, not unless I really am a heavy hitter with lots of pull and influential friends who really can get me out of here”, then you probably do need to be at least observed to make sure you’re not going to think you’re a birdie and can fly out the window.

          As for the hospital not checking her employment, well, saying “I’m employed, go look at my Internet pages!” isn’t much help. They were probably looking for an employer’s name, health insurance through work, etc. If she’s self-employed (and trying to make it in the music industry), then how employed is that? Plus, if she has an Internet page going on about how she’s a pop/rock music star – that’s going to count against her as grandiosity, as Scott said. Be fair – the lady is maintaining she’s a big shot in the music industry and personally known to President Obama, and then refers you to the Internet as proof of her employment status, how careful are you going to be about fact-checking that this is all true? 🙂

          As for social media in general – you would not believe the self-incriminating things people are dumb enough to put up on Facebook and the likes. Applicants for social housing filling in forms and telling us that they’re living alone because they’ve split up with their partner, then posting photos on Facebook showing off their engagement ring. People telling us they’re no longer cohabiting, have no idea where their partner is, and certainly he’s not paying child maintenance, then having their pictures published in the local paper as “X, Y and their kid Z at the local farm show”. People swearing they’re homeless, down to their last penny, and desperate so please can we give them a house, and then going on Facebook with details about the foreign holiday they’ve booked and the great time they expect to have.

          I am honestly surprised how a generation that is so familiar with social media and so savvy about the various platforms, that I as an older person have no idea how to use, apparently have no idea that when you put something up in public, it’s public and anyone can see it.

      • Pku says:

        This reminds me of an episode of House where they find out the patient has a secret room full of guns and start debating if that counts as a symptom of insanity (which would affect their diagnosis), which quickly devolves into a debate about guns. That seems really weird to me – whatever you think about guns, there are a lot of people without medically caused (is that an actual term?) insanity who have personal armouries (though I guess this is probably more common in Texas than New Jersey). I’m curious how psychiatrists deal with this sort of issue IRL (someone making a decision or believing which seems insane to them but is often believed by otherwise sane people).

        • LTP says:

          I’m also curious. There are a lot of people who I think have false beliefs, and who are very fixed about those false beliefs. Beliefs that I think may even be insane. Some of these people I would even go so far as to call cranks or kooks. Yet, I’m not sure I’d say all of them are medically insane and require psychiatric treatment. So where is the line for the psychiatrist?

          • Unknowns says:

            Bryan Caplan has argued that we categorize some people as “mentally ill” in order to justify acting against their beliefs and preferences in a way that we normally wouldn’t consider justified. (

            If he’s right, then people “require psychiatric treatment” simply when we believe we are justified in changing their beliefs and preferences essentially by force. I think he is probably mostly right.

          • David Kinard says:

            This seems only to apply to the condition where we take a belief or behavior as a confirming sign of mental illness.
            The claim is made that the mentally ill can do things, but choose not to, which is often not the case.

          • Paul Torek says:

            I hate to agree with Bryan Caplan about anything 🙂 , but in this case I’ll make an exception.

            Scott writes:

            Remember, psychiatrists have to err on the side of admitting people.

            That needs to change.

          • Corwin says:

            Well they ARE crazy


            but psychiatrists have to evaluate if they’re clinically crazy.

          • LTP says:


            Remember that Scott works at a mental health hospital, where patients are involuntarily brought to him because they are considered dangerous or at least disruptive. The incentive to admit Scott talks about don’t exist for private psychiatrists working with voluntary patients, which is the vast vast majority of psychiatry that goes on. My understanding is that involuntarily committing somebody in those circumstances is extremely rare.

            ETA: I’m also *really* skeptical of Caplan’s claim that a large fraction of mental illness is just unusual preferences, unless he means preferences in such a broad way as for the term to lose meaning.

          • David Kinard says:

            Right. Clearly, a person who is severely depressed does not prefer to be so.

          • Paul Torek says:

            July 4th seems like a good day to remind ourselves that taking away someone’s freedom is serious business. That’s what my point of agreement with Caplan boils down to. The standard of evidence, that the person is a threat, needs to be high.

        • CJB says:

          “So where is the line for the psychiatrist?”

          Typically isn’t it either direct threat to themselves or others, or brought in from county because they were, EG, pissing on someones lawn, turned out to be mentally disturbed and country shipped them over to avoid the hassle?

          You can horde all day and they won’t haul you in. You can wander around in a tinfoil hat and you won’t have a problem until you cause a threat to yourself or others.

          A lot of the research into psychological treatment seems terrible. Like the “I faked symptoms, checked myself in and stopped faking symptoms and they still made me wait to leave!” No shit. Psychosis isn’t necessarily constant, nor does it go away and never come back.

          • Deiseach says:

            There is also the problem that being mentally ill means that you are not as able to be objective about your situation as you think you are. So people can sincerely write articles full of indignation that an oppressive society coercively hauled them in for unwanted ‘treatment’ simply because they were acting outside the parameters of what is considered socially and conventionally acceptable according to stifling bourgeois mores, and very seldom you’ll get the other side of the story, which is that the “unconventional behaviour” consisted of wandering naked down the middle of a busy road and making the traffic swerve to avoid you, while delivering a speech about how the aliens were poisoning your food and water so that is why you were living on canned beets and not eating or washing for the past fortnight.

          • galin says:

            No one is as objective about their situation as they think they are. The problem is that we don’t seem to be able to produce any principled standard for figuring out which deviations from norms constitute “insanity”. Like, on what basis are you declaring the person walking naked down the street and lecturing about aliens insane? Do you trust that you won’t catch (an unjust number of) false positives with that reasoning? And more importantly, do you have any sort of mechanism for self-correction, or does your belief come prepackaged with self-fulfilling or at least self-reinforcing properties? Remember that declaring someone insane reduces your available sources of information by one, which is a problem when your original total was about one to begin with.

          • Hyzenthlay says:

            No one is as objective about their situation as they think they are.

            This. I’d go so far as to say that delusions are a normal part of the human condition. Lots of people have beliefs that aren’t supported by evidence.

            It’s hard to know where to draw that line. Someone talking about aliens probably appears more crazy to us than someone talking about guardian angels (or maybe that’s changing?) or The Secret. But I think the reasons we regard some irrational beliefs as “crazier” than others are mostly cultural and arbitrary.

      • Jaskologist says:

        I assume that the important piece here is “causing problems for other people.” The lady got into some sort of altercation with the police. Professor T plopped himself down in a lecture hall and refused to leave. If they’d kept to themselves, they wouldn’t have been committed.

        Once you cross that threshold, though, I imagine talking about how the AI is going to save you/destroy us all would not help your chances.

        • David Kinard says:

          It seems clearly that the police were causing problems for her. “Causing problems for the people who stole your car” is quite different then barging into a lecture hall and insisting on giving a speech.

          • Deiseach says:

            But look at how the newspaper article describes her: “eccentric”, “emotional”. That’s “we can’t flat out call her cuckoo because our lawyers say that would leave us open for a libel case but this lady is away with the fairies” writing.

            If she’s from Jamaica, that’s probably a way of saying she’s black. And indeed, there are legitimate questions of “is this one more case of the cops pulling over a black person driving an expensive car and faking a charge of drug possession to justify baseless racial profiling?”, and she certainly may have had grounds to be legitimately upset, but on the other hand, that doesn’t mean she didn’t behave in a fashion to raise suspicions that she might have not been completely rational, either.

          • William O. B'Livion says:

            The picture that Scott links to clearly shows that she’s black. She’s also holding a pistol with her finger on the trigger pointed at the camera man, as well as a holy bible.

            To a east coast progressive there are two things right there indicating mental instability–the gun and the bible.

            That sentence is intended to be a joke.

          • Lambert says:

            if she was using a gun like that, the conservatives & libertarians would be concerned too. Cooper’s rules 2&3.

          • Who wouldn't want to be Anonymous says:

            Oh yeah, I forgot to come back to this.

            So, she was involuntarily committed where the doctors were pretty vocal about her being delusional, so she’s crazy.

            Her total disregard for firearm safety in that picture makes a strong case that she is dangerous.

            Since her car was confiscated in Harlem, she’s apparently a NYC resident. However, NYC and neighboring counties have a stringent de facto ban on firearm ownership. Unless she’s a police officer or a judge in disguise, it is incredibly unlikely that she has a license for that pistol. IIRC, NYS also recently passed a law that significantly strengthened the duty to report requirements for mental health professionals, so it is entirely possible–likely, even–that as a result of her commitment she is now a prohibited person (at least in NY) by reason of mental defect. So if she currently possesses (or maybe ever possessed) a firearm in NYC or its outlying areas, it is very likely to be unlawful. So she’s a criminal.

            That makes her a crazy, dangerous criminal.

            Gotta love how that works, right?

      • ozymandias says:

        Why would you tell your psychiatrist you think an AI might destroy the visible universe? I can’t imagine it would be relevant to your treatment. Literally the only outcome of that would be increasing the likelihood you get an inaccurate diagnosis as delusional.

        I guess that’s sort of a self-perpetuating system, actually. Non-delusional people with weird beliefs are self-aware enough to shut up about them to the psychiatrist, so mentioning a weird belief to your psychiatrist is good evidence you’re delusional.

        • Cristian says:

          I’ve told my therapist some very weird theories and beliefs, usually as part of telling other stories or explaining bits that may sound a little off. OTOH, I haven’t told those things to my psychiatrist, because, as you say those conversations usually center more around treatment. But I understand that some veins of psychiatry are closer to therapy and some people work with their psychiatrist as a therapist. In those cases I can totally see a case as James describes. But, maybe I’m getting this totally wrong.

        • Furrfu says:

          Why would you tell them? I believe that telling the truth is a valuable thing to do even when it isn’t in my interest. This sometime leads to problems; last time I was in a police station, they kind of tied themselves in knots to figure out how to not arrest me, because I told them I wouldn’t sign the false affidavit they were preparing for me.

        • David Kinard says:

          I think it my very well be in your interest to have a good term relationship with your psychiatrist. Part of that is understanding who you are and how you see the world. They need to now what the norms are for you, the way you react to things, your values, etc. Ideally, one shouldn’t see their psychiatrist as a judge or interrogator.

          • Jiro says:

            Someone who can involuntarily commit you (and cost you money and get you fired) is a judge or interrogator.

          • LTL says:

            I think reading Scott has given you a skewed view of psychiatrists. Remember that Scott works in a mental health hospital where his patients are often brought to him, and who are extreme cases by definiton. The incentives he talks about to commit people only exists because it is a hospital with extreme cases.

            A private psychiatrist does not have those incentives, and a private psychiatrist committing somebody is extremely rare.

          • ozymandias says:

            LTL: I’ve been in the mental health system myself a fair amount as a patient, and I *still* think it’s wise to conceal weird shit from the mental health system unless it’s necessary for my treatment. True, getting kidnapped is the worst-case scenario (but still a legitimate concern– although in my case mostly preventible by not talking about suicide). But there are other scenarios, like “therapist decides that my actual problem is hypersexuality because I’m polyamorous”, or “therapist decides that all my symptoms are the product of being transgender”, or even just “therapist decides that this is the time to Learn About A Minority Group and you are going to Educate Them.” All three of which have happened to me!

            Perhaps you are just less weird than I am?

          • David Kinard says:

            ozymandias, my experiences with p-docs (both psychologists and psychiatrists) were largely negative. It took me quite some time, but I eventually found someone I was comfortable with. I wasn’t suggesting the default position to be one of trust, rather that one should seek that as the ideal. Especially if you have long term issues, you need someone who will listen to your input. Too many docs do, as in your experience, just tell you “the way it is” or “the way it should be” and don’t pay attention to your feedback and input.

          • walpolo says:

            The flip side of this, though, is: how much are you in a position to know which of your unusual mental traits might play a part in your mental illnesses? I tend to tell my therapists most of the abnormal-seeming things about me that I can think of, on the grounds that they may be able to draw connections I couldn’t see myself.

            I’m not trans or poly or anything of that sort, though, so perhaps I’m relatively safe from being misjudged in that regard.

          • Deiseach says:

            (1) Person who is seeing me long-term, on a mutually agreed basis of voluntary attendance, for a discussed and identified range of problems, where we have the time and opportunity to explain, explore and discuss non-conventional beliefs or attitudes – tell them

            (2) Person who is seeing me on a time-limited, involuntary basis, for a quick’n’dirty assessment of “are they likely to self-harm/harm others?” – don’t tell them, because it’s not germane and will only muddy the waters and we haven’t got six weeks to debate the pros and cons of “can cryonics work, is the creation of a god-like AI not alone possible but attainable, and will all problems be solved by uploading human consciousness into machine-computation space?”

          • walpolo says:

            That seems like the right rule to follow.

          • galin says:

            Right, except that the people most likely to have this kind of good judgment (I think Deiseach called it “wisdom” elsewhere) are probably too well-adjusted to get on anyone’s radar. So your failure mode is… catching people who already have problems and adding at least one more, on the theory that having one problem implies a greater likelihood of having the particular problems (dangerousness, illucidity) that you’re worried about.

          • ozymandias says:

            David: I agree, but also I’m not sure that understanding various kinds of weirdness is as correlated as one would hope for. I have told my current therapist a lot of the weird things about me, but I’m not going to tell her that I have spiritual experiences, or that I’m pro-suicide, or about my kinks. Why would I? It’s all downside. I don’t have any conflict about those things, but there’s a chance (however small) that my therapist would set it as a treatment target, say uninformed and hurtful things that harm our therapeutic relationship, or (yes) send me to the hospital.

            And my therapist is someone I’ve selected for compatibility and built a relationship with; those concerns are a lot more pressing if I’m in a psychiatric hospital with J. Random Psychiatric Resident.

          • LTP says:


            Admittedly my experiences with psychiatry/psychology are much different than yours, it sounds like, for a number of reasons:

            1. I am a young, straight, white, man.

            2. I live in one of the most culturally liberal parts of the US, and the therapists and psychiatrists reflect this.

            3. I’ve never been a threat to harm myself or others. My issues revolve around anxiety where I tend to lock up and become docile and nonthreatening in a “freeze response”. Also, for this reason, I’ve never had to see a therapist or psychiatrist involuntarily.

            Just based on my experiences and those of others, as well as talking to my psychiatrists and therapists throughout the years, it just seems to me that a lot of the horror stories and fears people have around the risks of entering mental healthcare are much much rarer than they would seem.

      • I’d love one of those cards as well.

        As Jasmine points out you might need a credibility boost, so maybe you could mention how many Dalai Lamas follow you?

        (Speaking more seriously, I will accept that card no matter how you present it)

        • Sine Salvatorem says:

          For a moment there, I didn’t even realise you were referring to me. WordPress did some sort of name switch and decided I was a ‘Jasmine’. I’m probably more amused by this than a normal person should be.

          • Deiseach says:

            Ah, but how can we tell you’re the person wrongly identified as Jasmine and not someone piggy-backing on that identity of a real Jasmine who is not at the moment commenting? 🙂

          • Based on the fact that we have the same flair – which would require me to know her email address. This is generally unlikely but, if it were the case, it would imply that I at least knew her.

            Anyway, I’ll just prove it by replying to this as ‘Jasmine’.

          • Jasmine says:

            Can confirm: I am me.

      • CatCube says:

        I’m sorry, I’m not a participant in LessWrong or rationalism or any other community that discusses cryonics, so I ask this question out of ignorance: Since we haven’t cracked the nut on cryonics, what the hell are “medical alert necklaces or bracelets for cryonics” and what direction are they supposed to convey to medical practitioners?

        • Sine Salvatorem says:

          They mean “If you see this person and they look pretty dead, freeze (or at least chill) their head and call Alcor/CI ASAP”.

          Basically: Don’t stick this person in the morgue while warm so their brain can decay. If you know what cryo (basically) is, you know why that’s important.

          Needless to say, most medical personnel will find this kind of weird.

        • FeepingCreature says:

          The “freeze them” part of cryonics is functional, shows some good signs of preserving brain state, and is being implemented by several charitable organizations, such as Alcor and the Cryonics Institute.

          The “unthaw them” part is what’s being troublesome.

        • zz says:

          Fairly good introduction to why (some) rationalists are into cryonics and the raison d’etre for the cro paraphenalia.

          • CatCube says:

            OK, I skimmed over the Alcor page. I can kind of see where a psychiatrist evaluating someone might look sideways at them having signed paperwork with these guys. It’s one thing to, in principle, like the idea of cryonics. At the current level of technology, taking out a quarter of a million in life insurance and making one of these places the beneficiary seems a little…off to me. I mean, it’s your money, but I *really* think that it might be better left to your next of kin to cover the loss of your salary.

          • Murphy says:

            I agree and while I wouldn’t invest that much myself in a long shot I also wouldn’t make a lot of expensive choices many people make. I can understand though. 250k for a long shot chance at immortality is a not half bad deal.

          • CatCube

            I have life insurance both for Alcor, and for my family to cover the loss of my salary. Cryonics is cheap compared to lots of other medical expenses.

          • CatCube says:

            I understand it being a choice, but what I see is an awful lot of money going to an organization for a very slim hope. I fear it’s an organization *preying* on people grasping for a slim hope, which is what an awful lot of organizations promising slim hopes do. The Yudkowsky page linked above (about the death of the author’s brother) that I found the Alcor page through probably colored my reading, though, because it was quasi-religious about being nearby to immortality; it struck me as coming from the same place as Christians who think they’ve calculated the final date of the apocalypse and start throwing money at it.

            As I say, it’s your money, but I’d recommend putting the life insurance to your next of kin instead of betting a life-changing amount of money on the following: (1) That immortality will be discovered before the infrastructure keeping your body on ice fails or runs out of money; [logical] AND (2) If immortality is discovered in this timeframe, it’ll turn out that the process used to freeze you is compatible with those life-extension technologies.

            Edit to fix typo.

      • vV_Vv says:

        You could probably get away by saying that’s a religious belief.

        • Eli says:

          Psychiatrists aren’t actually required to let you hide your crazy under the label of religion.

      • Eli says:

        As apocalypses go, the nice thing about UFAI tiling our light-cone in paperclips is that I won’t have to suffer through it.

    • Memento says:

      I would hope not. No belief, however bizarre, should be defined as a delusion simply based on its content. It is the manner in which the belief is held– ie, that it is fixed, as Scott said– that defines it as a delusion. If I believe that electromagnetic fields have mystical healing powers, but I can rationally manipulate information that challenges my belief, that makes me eccentric. If I believe that it is impossible for me to contract HIV or pneumonia because of a magnetic bracelet that I am wearing, and no amount of scientific evidence can convince me otherwise, then I am delusional.

      • Protagoras says:

        Scientific evidence from who? Suppose I believe, correctly, that people’s ability to trick me with plausible sounding scientific arguments exceeds my ability to see through such deceptions, and I therefore adopt a policy of not listening to scientific arguments, since I can’t distinguish the tricks from the ones which should convince me. Does that sufficie to turn my contra-scientific belief into a delusion?

        • Tracy W says:

          @Protagoras If you’re not basing your beliefs on scientific evidence, and you refuse to listen to scientific arguments, what are you basing your beliefs on? Because while obviously there is the risk that a good stage magician could be manipulating your experimental results, every single other method I can think of is even more open to other people’s manipulations.

      • Jiro says:

        The trouble with that is that for any disputed idea, it’s possible for a person on one side to claim that a person on the other side “won’t let any evidence convince him otherwise”. Everyone thinks their own side is supported by evidence and that the other side is unable to be convinced by perfectly good evidence.

      • David Kinard says:

        That would make a great deal of people we know think of as “sane” mentally ill.

        Unfortunately, I think we do have to look at cultural context. A person who has cultural reinforcement or indoctrination of their delusions is a bit different then someone who comes up with them on their own.

        • CJB says:

          The TYPE of delusion helps too. Most of what gets classified as ‘delusion’ isn’t “I don’t believe in Anthropogenic Global Warming despite what Michael Mann said”.

          It’s “I’m being persecuted by the CIA for global warming denialism and you can’t convince me otherwise.”

          Normal people would be relatively easy to sway to the “probably not being persecuted” camp, or at least pretty open to considering it.

          Delusional people, iiuc, tend to double down, and get more ridiculous the more you talk to them.

          • David Kinard says:

            Have you ever tried talking to a hardcore conspiracy theorist?

          • Linch says:

            How will you be able to differentiate someone like Tyrone Hayes from a delusional conspiracy theorist? I mean, I’m sure his PhD helps but it’s not exactly like there’s a shortage of delusional people with PhDs.

            I suppose this could just be a case where the false positives aren’t large enough to over-ride the true positives, but it’s still alarming that the whistleblowers you absolutely should listen to because their (true) beliefs are simultaneously extremely beneficial to society and completely outside the mainstream can potentially be silenced by psychiatric treatment.


            “He told colleagues that he suspected that Syngenta held “focus groups” on how to mine his vulnerabilities. ”

            “He instructed the students in his lab… to hang up the phone if they heard a click, a signal that a third party might be on the line. Other scientists seemed to remember events differently, he noticed, so he started carrying an audio recorder to meetings.”

            “He worried that the company was orchestrating a campaign to destroy his reputation. He complained that whenever he gave public talks there was a stranger in the back of the room, taking notes. On a trip to Washington, D.C., in 2003, he stayed at a different hotel each night.”

          • Mary says:

            How about “I’m being persecuted by the IRS because I’m conservative, and you can’t convince me otherwise.”?

          • David Kinard says:

            I was referring to the people who believe that every major tragedy is orchestrated by the government. There are a surprisingly large number of these people, who other then their conspiratorial worldview, seem relatively normal and functional.

      • David Kinard says:

        But a belief in say, the infallibility of Muhammed in a muslim culture is surely different right? It may be an inflexible delusion, but it is one that is culturally indoctrinated. Not everyone in say, Saudi Arabia who holds this view would be what we think of as mentally ill.

        • ento says:

          Yes. It doesn’t take an especially weak-minded person to be convinced of any religion’s correctness given total cultural indoctrination. (Converts are an interesting case, though.)

          • David Kinard says:

            From a certain point of view- if the result of stating those thoughts of doubt result in serious consequences, and the probability of stating them is increased by thinking them, it is one’s rational self interest not to entertain such thoughts. Scott gave the example of yelling at the police as a sign of instability. I assume questioning Muhammed amounts to the same thing (probably worse) in Saudi Arabia.

        • vV_Vv says:

          If I understand correctly the medical definition of delusion specifically excludes beliefs that are commonly accepted in the person’s culture or social group.
          This excludes all religious beliefs that some community of any relevant size believes, and arguably also most conspiracy theories on the Internet.

    • galin says:

      This isn’t quite what you’re asking, but I’ve gotten into a lot of trouble in general for not being able to convince people of anything unless they’re particularly well-attuned to my thought patterns and/or communication style. Said trouble has included:

      – two psychiatric hospitalizations, once for (not particularly severe) suicidal ideation and once for (not particularly dangerous) self-harm. In both cases I wasn’t exactly doing well, but I wasn’t doing any more badly than usual and should have had the presence of mind NOT TO TALK TO THE PO—er, psychiatry residents, but of course I have a very poor sense of context and so I ended up talking about existentialist philosophy at some length, which really didn’t help matters.

      – I was the defendant in some legal action once and the judge found my testimony “not credible” even though there were no real disputes of fact. We think that this was because I was saying some pretty strange and abstract things, like that I had a different concept of ethical concept X than most people, such that I sincerely acted in Y and Z ways. It was the sort of thing that less-wrongers would find very plausible but it really didn’t come off well in court.

      – I’ve been accused of being manipulative on many occasions where my subjective experience was that I was being direct and sincere. This has happened to me often enough that I’m forced to entertain the possibility that I might be delusional, which is really scary and destabilizing because how do you know whether you’re lying to yourself about whether you’re lying to other people?

      There is an interpretation of all these events other than that I’m a crazy manipulative person (that I have no sense of how most people think and am therefore unable to present information to them in a way that makes sense to them, and so they in turn can’t model my thought process and therefore assume I must be lying/insane), but it’s exactly the sort of abstract and counterintuitive claim that I can never get people to believe so I’m terrified of even posting it here.

      • Protagoras says:

        I’ve certainly had the experience of saying things because they seemed true and relevant to me, and getting a reaction as if I were being manipulative. I think it’s just difficult to avoid; there can’t be any simple, clear signal of “I am not just being manipulative,” because any simple, clear signal would just be adopted by manipulators to conceal their activity.

        • LTP says:

          I think signalling self-awareness that one’s thought patterns or conclusions come off as weird to others can really put people at ease, even if you believe it is true. Also, signalling a genuine openness that you could be wrong, even if you think it is unlikely, helps.

          I am not a psychiatrist–just spitballing here–but my intuition is that if one repeatedly doesn’t realize that their thought patterns or conclusions come off as weird and “out there” to others until explicitly told, or if they have no genuine openness to the idea that they’re wrong, I think that increases the probability one is perceived as delusional AND that they actually are delusional. It’s the lack of self-awareness about the strangeness of the views combined with a lack of willingness to consider one is wrong that makes one delusional.

          • galin says:

            Yeah, but how do you know how to do that if you don’t “get” people? I’ve gotten a lot better at this with time, but it’s really not obvious that repeating “I’m not lying!” or offering ever-more-sophisticated reasoning for your beliefs or describing exactly the kind of evidence it would take to change your mind will only dig you in deeper. So it’s *really dangerous* to use “ability to come off the right way” as a proxy for sanity!

          • David Kinard says:

            True. On the other hand, it could plant the suggestion in someone’s mind.

            “Just to let you know, I’m NOT trying to scam you.”

            In terms of convincing people, it’s more then just making well reasoned arguments. It’s anticipating their reasoning, and noticing social cues. When to make a joke to lighten the mood. Occasional questions of “how do you feel about that?” etc.

          • galin says:

            The thing is, while the ability to convince other people to agree with you is nice, the ability to convince them of your credibility (i.e. that you’re not crazy or lying) is absolutely essential, and persistent failure on that account is (1) disastrous on the practical level and (2) crazy-making. Which is why we bear some responsibility, in the absence of a legitimate way (epistemically and morally) to determine whether someone is sane and/or sincere, to err on the side of not completely delegitimizing people(‘s words and ideas).

          • Mary says:

            The fun thing is that ability to convince them easily and totally is a hallmark of such psychological problems as psychopaths and narcissist.

          • Holding weird beliefs is a sign of mental health issues. Being very good at convincing people of your beliefs is a sign of being neurotypical. Thus, cult leaders inhabit an interesting quantum state of being simultaneously normal and abnormal until you open the news paper and learn about the sex scandal.

          • Liz Calkins says:

            Galin: Oh man, you sound so much like me it’s scary. Where stuff makes perfect sense in my head but is hard to figure out how to explain in a way that other people will accept, or where I regularly get labelled as dumb, delusional, and/or ignorant, when I actually know darn well I’m intelligent, sure of what I experienced, and/or informed on the facts.

            Though in my case it’s more an issue of frequently brushing up against people’s narratives that don’t match what I observe of actual reality (whether in general or my own life situation), rather than my having weird beliefs per se.

            And it is indeed frustrating, crazy-making, and sometimes disastrous.

      • Cery says:

        In my experience, people can’t tell when others are lying/manipulative at a rate any better than chance. False positives and false negatives are just as common as true positives and true negatives.

      • yellowish fish says:

        when people tell me I am being manipulative, in my experience, they often mean that I have not been manipulative enough..through being too uninflected and sincere I have left them too much work to do, they want more (metaphorical) romance before sex, but, if I actually exert myself to manipulate them (and thus disrespect their rational agency) they are still keeping in play a mutually-agreeable happy-ending

    • Leif says:

      When I was a teenager, I had a therapist (which I realize is distinct from a psychiatrist, although therapists are part of the broader medical system in a sense) who told me I had problems because I believed logic can be applied to everything, and that there are absolute truths. He spent hours trying to convince me that “everyone has their own truth”, and he even told me that the existence of clairvoyants disproves rationality. My parents were forcing me to see him, so I couldn’t just stop. Luckily, they realized he was incompetent when he thought I had actual psychiatric issues and wanted to refer me to a psychiatrist.

      • Sine Salvatorem says:

        Wow. That’s worse than I expected. You didn’t even need to believe in the coming of the robot gods – believing in logic alone was enough. I’m honestly dumbfound.

        [Note: IDK why I was originally named “Jasmine” in this thread but w/e]

      • Mary says:

        “he even told me that the existence of clairvoyants disproves rationality.”

        Wow. If clairvoyance does exist, does it fail to distribute the middle term? Does it commit argumentum ad misericordiam? Or Tu quoque?

      • Deiseach says:

        Since “black and white thinking” is given as a symptom of borderline personality disorder, then I can see why a therapist might try to shift you from a “logic is all” mindset to an acceptance of “grey areas, people genuinely have different beliefs and it is acceptable to allow some ambiguity” (I have the “black and white” mindset myself, so I’d resist that line of attack, but I do see the reasoning for it).

        On the other hand, “clairvoyance destroys the concept of rationality” is nonsense. So you’re correct, that therapist was for the birds.

        • William O. B'Livion says:

          What to do when your therapist is crazy…

          • Of course the therapist is crazy – who else would become a therapist? The only people who can handle listening to mentally ill people every day for years are the people who got a lot of practice with the voices in their heads.

            [NB: Meant as a joke; not as callous ableism]

        • Leif says:

          Seems like “all thinking that is in any way black-and-white is bad” is a great example of the bad kind of black-and-white thinking. 🙂

          I haven’t studied psychology — I’ve just read a few Wikipedia articles — but isn’t borderline black-and-white thinking more specific than just believing in absolute truths? My understanding is that they tend to think specific people are either all-good or all-bad.

          Btw, in addition to the clairvoyants thing, this therapist also talked up the movie “What the Bleep Do We Know?” to me. If you’re not familiar, it’s a bunch of nonsense about quantum physics and the observer effect, which argues that there is no objective reality independent of the mind, and that you can actually change your reality with thought. It’s not a metaphor.

          • ozymandias says:

            Borderlines have a tendency to think that *everything* is either all-good or all-bad, it just happens to be really pressing in the case of people. A fair amount of dialectical behavioral therapy is guiding borderlines to the thought that shades of gray actually exist.

    • Acheman says:

      Well, I really am sometimes very depressed and also I think have problems with scrupulosity. However, I’ve also been treated as irrational for feeling very upset about (1) the likelihood of catastrophic global warming; (2) the fact that many of the clothes I wear were produced under unethical conditions that resulted in a great deal of suffering; (3) the same thing is true of the food I eat; (4) per the Drowning Child argument, every time I go to the cinema I am responsible for suffering and death; (5) a significant portion of the people who ever existed in the world were violated, hungry, worked to exhaustion, or simply died in infancy or early childhood.

      It was a massive relief to encounter a psychotherapist who said “All these sound like completely reasonable things to be upset about, let’s work on how you get that upset to a bearable level that doesn’t interfere with your daily functioning, and also how you make choices that make you feel more comfortable about your role in the world.

      I’ve also been told, a bit like Leif, that my attempt to reason about things was a defence mechanism, that I need to ‘stop thinking so much’, that I care too much about logic, etc. When people gave me psychiatric questionnaires and I asked questions about the premises for the questions, eg ‘what would you call “irrational” guilt?’, I was talked to as if I were avoiding the question rather than genuinely seeking clarification.

      I’ve been treated as if my belief that I’m to some extent responsible for all the predictably foreseeable results of my actions was obviously false and delusional.

      These weren’t things I was bringing up for no reason, they were attempts on my part to explain what seemed to be the proximate causes of my feeling bad, while not denying that I was depressed and that was influencing how I thought. I have learned it is not always a good idea to bring them up, but the result of that is that I haven’t always been able to talk about what’s really bothering me. And when I am stressed and unwell the work of figuring out what’s going to be OK to say vs not becomes that much more onerous.

      There are unspoken philosophical orthodoxies one is expected to adhere to as a good psychiatric patient. Any moral reasoning beyond Kohlberg’s Stage Four is pathologised. There are whole classes of things – communication theories, meta-ethics, anything that one has to reason ones way to – regarding which one is not supposed to have emotions. Emotion and belief, even evaluative belief, are assumed to be distinct entities. One may give rise to the other, but it is not acceptable to say, ‘my phenomenological experiences of belief and emotion are completely intertwined and I think they cannot be fully decomposed from one another.’

      And god forbid you start drawing attention to those orthodoxies or directly questioning which assumptions ground the discussion which is being had.

      • David Kinard says:

        Some psychiatrists/psychologists are better then others. It’s important to find a good one who understands you.

        Also, doesn’t Kohlberg’s stages seem like an oversimplification.

        • Acheman says:

          I agree, Kohlberg’s stages are a massive oversimplification – I used them as a shorthand to express what sorts of position are tabooed, but I’ve realised that there was a connotation of superiority there which I didn’t consciously intend. I don’t think a psychiatry that pathologised anything that Kohlberg would have classed as being below Stage Four would be a good idea either.

        • Acheman says:

          And I agree with you about psychologists and psychiatrists, but when one is in hospital one doesn’t always get to pick and choose, particularly with the former – I was in groups run by a variety of different therapists, most of whom thought my considered ethical positions were completely determined by (or possibly the cause of?) my illness.

      • TeMPOraL says:

        I sympathize. I’ve been in between therapy sessions so I didn’t have a chance to mention it to any therapist, but I had an almost half-year-long period of time when I was so emotionally upset about energy security and natural resources running out that I felt incredible guilt and stress over simply using the stove. Every time I started a fire under a pot I had this picture of the future before my eyes, when neither my family nor me can get anything warm to eat or drink, because we’ve run out of usable fuels and are trying to survive civilization breakdown.

        The stress was really unbearable and seriously interfered with my ability to do my job (I could spend hours at work panicked about the collapse of civilization; reading a survival book back then didn’t help at all). Fortunately, the problem slowly faded away and half a year later I was ok. What I recognize happened is that my mind pushed the issue to the backburner, refused to process it on a daily basis, to evaluate the probable consequences of problems we’re facing right now. I’ve reached the solution your therapist mentioned – “All these sound like completely reasonable things to be upset about, let’s work on how you get that upset to a bearable level that doesn’t interfere with your daily functioning, and also how you make choices that make you feel more comfortable about your role in the world.”.

        But I must say I feel guilty about it. All my life I wanted to bear the responsibility to help safeguard the fate of humanity, and in the end this (probably subconsciously) self-assumed responsibility crushed me. I got so overwhelmed that right now I find it incredibly hard to do anything actionable towards making this world a better place for everyone. I flinch.

        And all of this makes me wonder, maybe that’s why so many people seem to stop caring as they get older. There’s too many fires to fight in their personal life, and the burden of the whole world is too overwhelming to even think about.

        • David Kinard says:

          Funny when you think about, what’s emotionally healthy on the personal level may be suicidal on the societal level.

        • Furrfu says:

          You will probably be happy to know that natural resources don’t run out, except for uranium, helium, fossil fuels, and whatever we put on space probes, since everything else is still in the landfill; and that you can cook your food quite adequately with an aluminum solar reflector. Which is to say, your worries were in fact irrational. (Except for the one about civilization collapsing, which is surely a real possibility.)

          So there’s an interesting interplay here between your emotions, your beliefs, and your actions. Your emotional tendency toward scrupulosity caused you to believe irrational things, which amplified that emotional tendency, and that emotional spiral prevented you from taking actions that would actually be effective!

          There may well be cases where irrational beliefs are more conducive to your survival, but this is not one of them.

        • “but I had an almost half-year-long period of time when I was so emotionally upset about energy security and natural resources running out that I felt incredible guilt and stress over simply using the stove.”

          For most issues of this sort (overpopulation, global warming, humanity getting dumber because of dysgenic reproductive patterns, destruction of the family, catastrophic growth of government, surveillance, …) there are some reasonable people who believe in them, some who don’t. Perhaps one needs non-confrontational mechanisms for getting believers together with non-believers in order that the former can revise their priors from “this catastrophe is almost certainly happening” to “this catastrophe might be happening, but it might not be,” and thus reduce the sort of emotional problems you describe.

          • I wonder if this can be something LW meetups try. eg: “The theme of this meeting is updating your beliefs about various catastrophes. Let’s organise into groups to discuss the following civilisational failure modes…”

            Yes, it sounds weird, but if any group can pull that off, LW can.

            PS: Loved The Machinery of Freedom. It’s the book that converted me to libertarianism.

      • onyomi says:

        Not being able to put the horrible realities of the world out of your mind and get on with your life as if everything’s fine is a sign of mental illness.

        • Not being able to put horrible realities of the past out of your mind and get on with your life as if everything’s fine is, if not mental illness, at least unreasonable behavior. Believing that things are terrible now and currently getting worse isn’t insanity, merely error.

          The definition of absolute poverty on a global scale used to be a dollar a day. By that measure, c. 1970, almost 30% of the world’s population was poor. The current figure, by the same measure (inflation adjusted) is about 5%.

          • onyomi says:

            I definitely don’t think things are getting materially worse (and get annoyed when people glibly repeat things like “you know how it is–the rich get richer, the poor get poorer…”), but isn’t it also kind of depressing that so many people can still be so unhappy even when, as Louis CK points out, “everything is amazing”? That said, people are probably less miserable than they were when they had to contend with a high probability of famine, plague, etc., and I am broadly optimistic about the future.

            Still, I think it’s interesting that a healthy mind seems to be, to some extent, in denial, almost by definition. Haven’t they found, for example, that depressed people have more accurate self-perceptions than mentally healthy people? And no matter how much better our material circumstances get, most people have to put the thought of inevitable mortality out of our heads (or feel hopeful we can upload our consciousness into a computer, etc.) to get on with our day. I certainly do.

      • 27chaos says:

        I like this comment a lot, thank you.

    • I recently tried to explain the whole [LW thing that cannot be named] thing to an intelligent non-science-tech-literate friend of mine recently. They’re a health professional though not mental health. When I got to the bit about people freaking out over the [thing], my friend was so confronted by the whole thing that they basically said “I think people shouldn’t be allowed to believe that kind of thing”. My friend also seemed to intensely resent the community that had allowed that sort of thing to be believed. I got the sense that my friend thought for intelligent people to believe in such things they had to be severly mentally ill (probably requiring treatment).

      Needless to say I don’t think that, and this person doesn’t seem to react that way to other things. But it made me think that if you trigger enough of an average person’s weirdness heuristics and I think they will just go “click-wirr” and lash out at whatever ideas or people are nearby.

    • Eli says:

      Cause != effect. Crazy beliefs can crop up in people who do not technically have a mental illness, or who have a well-controlled mental illness. Crazy beliefs are actually a fairly normal part of life.

      Severe mental illness, however, is very likely to cause crazy beliefs.

  2. OldCrow says:

    7/10 on Professor or Hobo. Kinda disappointed in myself.

  3. Partisan says:

    At the end of section I, you have “The hospital apparently didn’t check and continued to say she was psychotic for thinking she was unemployed.” I think you mean “employed” based on what’s above?

  4. Alyssa Vance says:

    Amusingly related incident: In 1940, the Soviet Union invaded Estonia and overthrew the president, Konstantin Pats. The Soviets kept him in prison for a while, but after a few years, they sent him to a mental hospital:

    “On 24 March 1943, Päts was sent to forced treatment in psychoneurotic hospitals first in Kazan, then in Chistopol in Tatar ASSR. His forced psychiatric hospitalization was justified by his “persistent claiming of being the President of Estonia”.” –

    • LTP says:

      Wow, that’s some Orwellian shit there (I guess 1984 *was* meant as a critique of totalitarian communism, though, so the similarities make sense).

      • Mary says:

        The Gulag Archipelago actually describes one event it recounts as “straight out of Orwell.”

        • Nestor says:

          I read that book!

          And I have no idea what you’re talking about, a refresher would be merciful…

          It is hopelessly muddled in my brain with Cancer Ward, which I think was more memorable…

          • Mary says:

            It was one of the cases he recounted of how people ended up in the gulag. Namely, one of face crime. (Facial crime in my translation — ain’t translation grand?)

            IIRC, it was two teachers looking at a paper and smiling. The case was that they had been looking at a photo (of Stalin, I think) and their expressions showed contempt.

    • CJB says:

      It’s very simple. Do you know what the government does to people that dissent? You’d have to be crazy to dissent!

    • Tracy W says:

      In defence of the Soviets (second time this year I’ve written that, what is happening), it sounds like they first put a lot of effort into removing him from the presidency and trying to convince him he’d never get back in.

  5. Carl Shulman says:

    ” And sending her the bill for her own involuntary commitment is an obvious injustice (albeit a universally practiced one).”

    What stops the hospital from charging $10,000 per day? Has this been challenged in the courts?

    • Alraune says:

      I expect hospital rates have a Laffer Limit, where if a hospital’s prices go above a certain point, they start to recover less money from their patients, not more.

      • Cristian says:

        I’m pretty sure involuntary patients have a very inelastic demand. Same could be said for those who don’t pay the bill.

    • Scott Alexander says:

      Hospital rates are usually determined by the hospital charging a sticker price and insurance companies paying a certain (small) percent of it.

      So if the insurance company is going to pay 10% of what you charge them, and $1000 would be a fair rate, you charge $10000.

      I assume the rate for uninsured individuals is the sticker price, which is higher than the the real price but not infinitely or arbitrarily so. If they charged uninsured people $100,000, then the insurance company would have to pay $10,000, and they’d refuse.

      Also, I think hospitals usually can’t collect their full bills from uninsured people (especially poor psych patients) and that their rates are related to whatever’s likely to get them the best settlement when they inevitably have to negotiate.

      • Error says:

        I like how the price is exponentially higher for the people who are least able to pay. The cynical imp that occupies most of my skull thinks there’s a set of guys at the insurance companies who aimed for this result. That is, the people who are uninsured not only don’t have coverage, but also have 10x higher bills. That creates an implicit threat that anyone who doesn’t pay the insurance racket will be insta-bankrupted by the slightest thing.

        (I’ve been on the wrong end of this. Yes, I’m bitter, and I didn’t even go bankrupt.)

        • LHN says:

          The explicit plotting would be more plausible if the individual insurance market weren’t so clearly an afterthought for the industry. They’ve never exactly been marketing to the uninsured, and their primary customers are businesses who aren’t directly affected by those list prices. (There are indirect effects, of course, but I’m skeptical that they’re the primary driver of the dynamic.)

    • CJB says:

      Absofuckingloutely nothing. At all.

      Which is why surgeries at Rural West Virginia Hospital are much, much cheaper than those at Our Lady of the Bright Lights and Big City.

      Most of the problem boils down to “USA’s strange insurance payment plans.”

      See, Insurance companies work with hospitals to set prices. And thus, they get major kickbacks.

      So it works like this. You get a bill from the hospital for 100K (We’re assuming it’s only small stuff- minor surgery and a fairly short hospital stay)

      You pay your deductible (Say, 1K cuz good insurance) the other 99K goes to your insurance company. They cut various haggles and deals to actually transfer only probably 30K to the hospital.

      However, when you’re an ordinary joe, you don’t access to the kickback system, so you end up paying 100K. Or, more precisely, you end up paying 30K or so before bankruptcy, suicide, or death frees you from a daily burden.

  6. walpolo says:

    I get a lot of emails from science cranks, and I’ve always wondered what it is that’s typically wrong with these guys, mentally. What’s the diagnosis you give someone who has the delusion that he’s a great scientist who’s solved all of physics (it’s literally always a he in my experience)? It seems to be a very common problem for people to have.

    • Pku says:

      Last year someone (using the pseudonym “Ozymandias”) sent our department a 200-page book claiming to prove the Riemann hypothesis and five similar problems (I think it also included a couple of problems that were literally impossible, like the continuum hypothesis). I don’t understand how people can put that much effort into this.

      • LTP says:

        I imagine it would be easy for a very intelligent autodidact with an inflated ego, who probably hasn’t had their thoughts and ideas checked and challenged by experts as they learned the field, to legitimately believe they have made some great insight and therefore to put all that work into demonstrating that insight. In fact, they probably just suffer from a bad case of the Dunning-Krueger effect.

        But if you actually believed you had a great insight but were mistaken, wouldn’t you be tempted to put in all that work?

        • 27chaos says:

          It’s about confidence levels inside and outside an argument, as well.

          Personally, I’ve got a notebook with two dozen pages of me playing with the Collatz conjecture trying to reach some kind of proof. Inside the notebook, I think my arguments are pretty good, though not yet made rigorous. Outside the notebook, I know there’s less than a one in a million chance that my work is at all meaningful.

          Frustrating situation to be in, when your beliefs are flawed but you can’t point at any specifics showing why.

        • CJB says:

          Correct me if I’m wrong, but wasn’t Grigori Perelman largely an antodictat amateur? I mean, I’m sure it’s vanishingly rare, but you can’t simply discard it- particularly in stuff like mathmatics, where you really can make huge breakthroughs based only on pure brainpower.

          • LTP says:

            I’m not saying you can discard it, I’m just saying it seems far more likely that an autodidact will fall into crankish belief than somebody who learned the field at traditional institutions. Having one’s ideas and thoughts vetted and challenged is often important, and autodidacts often miss that. A few may use that independence to do great things, but I would imagine a lot would use that to succumb to the dunning-krueger effect and get sucked into working on unfruitful research.

            That doesn’t mean one should ignore these people. I’m more talking descriptively rather than prescriptively. I do think, if anything, there probably isn’t enough openness in the academy for ideas and research from autodidacts in fields like mathematics and philosophy where no lab or practical training is required. More openness to outsiders in the academy might even reduced the crankishness of autodidiacts as they will have more opportunities to engage with their peers.

          • Tom Womack says:

            My suspicion is that the academy is reasonably open to ideas and research from people in mathematics who, like Perelman, have a gold medal from the International Maths Olympiad.

            The IMO’s not perfect, but it’s been developed over fifty years to become about the best domain-specific test for incipient genius that I’ve encountered.

          • Douglas Knight says:

            No, Perelman was not an autodidact. For example, he acquired a PhD.

            Perhaps his education was more self-directed than most mathematicians (which is hardly exceptional among top mathematicians), but he had a community to bounce ideas off of, not to mention an advisor to check that he knew what he was talking about.

      • Winter Shaker says:

        Last year someone (using the pseudonym “Ozymandias”) sent our department a 200-page book claiming to prove the Riemann hypothesis

        I really hope you looked on their works and despaired 😛

      • I suspect the source of their energy is schizophrenia.

    • seladore says:

      I have a lot experience with science cranks — I’m a cosmologist at a (prestigious + well-known) University, which which makes me a magnet for this stuff.

      As LTP says below, the critical ingredients are (1) intelligence (2) egotism, and (3) lack of exposure to the wider scientific community.

      They are typically smart people, who were ‘interested in science’ as kids. Like Scott said in a post a while back, it doesn’t take much for a kid to be become known as a ‘science genius’… just get good grades, and talk about things like atoms and thermodynamics. So these people read a lot of popular science, become known as ‘the science genius’, and they get used to being the smartest person in the room.

      At this point, most real scientists go to college (and then onto a PhD programme), which will do a very good job of (a) making them aware of how smart working scientists actually are, and (b) how difficult it is to make scientific progress. But cranks don’t go this route — they never immerse themselves in the field, they never have their ideas challenged, and they get used to the feeling of being the most intelligent person around. This causes a bit of a feedback loop of delusion and ego-stroking… combine with a dash of egotism, and they can easily start to assume that they are among the smartest people in history.

      • Jaskologist says:

        Come to think of it, this explains a lot of atheists, too.

      • zz says:

        Can confirm. Right now I’m tutoring a 13-year-old who’s very smart. He’s also adopted (meaning his parents aren’t remotely capable of comprehending how smart their son is, much less give him any guidance), so I can say things like “every single trained mathematician is familiar with the proof that there exists no bijection between Q and R, there is no conceivable chance Cantor made a mistake, seeing as every trained mathematician has seen this argument and failed to find an error,” only to have him insist that he’ll come up with a bijection between Q and R. (So far he hasn’t.)

        We’re making progress. Next steps involve throwing GED:EGB and MIT video lectures at him, both of which should help correct the perception that just because he’s smarter than everyone he’s met doesn’t mean that he’s smarter than everyone. (There’s also a couple of math professors I know who live nearby I’m considering getting him in touch with. Given this comment and the content of Scott’s post, I’ve dramatically upgraded the risk of not encountering smart people and am much more likely to do so.)

        • houseboatonstyx says:

          There’s also a couple of math professors I know who live nearby I’m considering getting him in touch with.

          That could prove counterproductive if any of these apply to either or both professors:

          The professor has forgotten, or not kept up with, some issues the kid asks about.

          The prof is tired, drunk, under medication, etc.

          The prof is untactful.

          The prof is impatient to get back to zis own tasks.

          The prof has nothing to get back to because zie is retired for loss of ability. If zie was fired for misbehavior, zie may have plenty of time and talk a lot, but not about math.

          The prof is really dumber than the kid.

          Hm, looking over this, it occurs to me that you’ve got a litmus test right there. Any prof likely to be useful, will be smart enough to decline your invitation.

        • James Picone says:

          Suggestion: “The Art of Computer Programming”, by Knuth. Your local tertiary educational institution likely has a copy in its library. It’s more computer science than programming craft – very theory heavy – and it’s ludicrously dense. Excellent book for making you feel stupid.

          Also the games “Spacechem” and “Infinifactory” – they’re programming puzzle games with a roughly cliff-shaped difficulty curve. (Infinifactory is probably gentler than Spacechem, though).

        • Eli says:

          “every single trained mathematician is familiar with the proof that there exists no bijection between Q and R, there is no conceivable chance Cantor made a mistake, seeing as every trained mathematician has seen this argument and failed to find an error,” only to have him insist that he’ll come up with a bijection between Q and R. (So far he hasn’t.)

          Uhhhhh have you showed him Dedekind cuts? Because, like, the impossibility of a bijection is shown by the fact that you can cut Q but can’t cut R.

          This reminds me of the time I invented infinitesimals as a 12-year-old… except it was pure nonsense and I couldn’t get anything to work sensibly so I gave up and figured that the adults would tell me someday.

      • walpolo says:

        That might be some of them, but a lot of the time (more often?) the emails I get are from people who are mixing in numerology and random free association gibberish about JFK or something. Very few of them actually use any equations.

        I mean, the Time Cube guy is not just an intelligent autodidact. He’s got to be actually crazy.

      • J. Quinton says:

        This *almost* happened to me. I was the smart kid in my family. Luckily I wasn’t “smart kid in Podunk, Nowhereville” but “smart kid in NYC” so I went to Stuyvesant. There I felt a bit more normal; if I had any budding delusions of grandeur they certainly would have gotten quelled there since I was decidedly average in that school.

        Ironically, after I graduated high school I joined the Air Force, where the “wow you’re really smart” started to happen again. One of my fellow Airmen also grew up in NYC and when I told him what high school I went to he said “What are you doing in the Air Force? You should be at Yale or some shit”.

    • ShardPhoenix says:

      Crankiness might be related to a milder version of delusions of grandeur:

      My non-scientific diagnosis would be that it’s chuunibyou for intellectuals :).

  7. Alraune says:

    This “I agree that would be horrible but it’s not what happened in this particular case” form of argument is one I’m entirely too acquainted with making, and I’m increasingly getting fed up with having to do it. How do we convince people that the easy cases are solved by now, and if Outrage of the Week looks straightforward it should be assumed to be at least a distortion and has a good chance of being a flat lie?

    • David Kinard says:

      But your assumption there is based on people’s having a universal sense of what is outrageous, which they clearly don’t. A lot of the “outrage” stories will outrage some people, and have others being outraged at the fact that others are outraged. It’s a formula that has become hugely popular in the internet media age, as both allies and enemies will click on your story.

  8. hamiltonianurst says:

    I can’t seem to find the article, but that magician quote is Teller of Penn & Teller.

  9. Steve Johnson says:

    My gut tells me that the first person is way less mentally ill (although not necessarily more functional in society) while the second person is.

    When Obama addresses crowds he says “I” and “you” and “we” all the time. Some intern or some script follows people on twitter specifically so that people feel a personal connection to Obama. Various random people within that woman’s social circle probably get paid in various ways for vague community organization roles where the money is extorted in some way from giant corporations. The entertainment she watches is crafted specifically to give her the idea that she or someone like her could get famous so she’s an aspiring entertainer. She’s angry and short tempered with the police because she’s been encouraged to be by every piece of media she’s ever seen.

    She’s no more delusional (which is pretty delusional) than lots of other people similar to her.

    • houseboatonstyx says:

      Yes, you don’t have to be crazy to believe some crazy stuff.

    • Eggo says:

      Yeah, the same sort of thing was common with Elvis and The Beatles. It’s probably a disorder, but definitely a socially-inflicted one.

  10. R Flaum says:

    “Do real theoretical physicists even wear lab coats?”

    I was a physics major, and the head of the physics department at my college, who was a theoretical physicist, went around wearing a lab coat everywhere. She was the only one in the department who did that, though.

    • Seth says:

      I went to MIT. I saw many world-famous theoretical physicists walking in the halls (I wouldn’t say I knew any of them!). Why would anyone ever wear a lab coat as daily wear? I can’t remember *ever* seeing *anyone* wearing a lab coat in the physics department, except maybe sometimes in the area around where the student physics lab classes were located (and I think that was mostly the lab techs, who dealt with the grungy equipment). Physics isn’t chemistry.

      On the other hand, for a publicity photo, if it were real, it’s not utterly insane that the photographer would ask the guy to wear a lab coat because it looks “scientific”. That is, deliberate staging with a symbol. You couldn’t definitively conclude that someone was faking being a theoretical physicist because they appeared in a newsy photo wearing a lab coat. If you asked them, what’s up with that, they might say “The PR people thought I looked like a hobo in my normal clothes, so they grabbed a lab coat for me to wear as a Proper Scientist”.

      • Scott Alexander says:

        “Why would anyone ever wear a lab coat as daily wear?”

        I wear a lab coat somewhat more often than I have to, because it covers up being poorly dressed. If my shirt is wrinkled and I don’t have time to iron it – lab coat. Pants are stained and I just noticed before I have to leave? Lab coat. Don’t want to worry about a belt or about making sure stuff stays tucked in? Lab coat.

        • Protagoras says:

          I’ve often wished that professors still could go around wearing academic robes. Then nobody would mistake us for hobos.

          • Markus Ramikin says:

            Try it anyway and tell us how it goes.

            /maybe not 100% well intentioned advice, cough

          • This is why I wish more Orthodox clergy in America went around in cassocks. This makes them less likely to be mistaken for hobos and more likely to be taken for witches.

        • triclops says:

          I love these little insights almost as much as the deeper insights.

      • LHN says:

        My first thought re the department head was that since she was old enough to be in charge, she may have begun her career at a time when she needed (or at least believed it was useful to have) a clear visual signal that she was a scientist rather than a secretary, and just kept the habit going forward.

      • R Flaum says:

        This was a smaller school; IIRC there were four physics professors total, so even the department head was teaching lab classes. It might also have been a cultural difference (she was Croatian); I say this because I worked for her on a research project over the summer, and she wore the lab coat even when not teaching any classes at all (the project itself was running computer simulations; she probably wasn’t worried about getting bits splashed on her).

      • Publius Varinius says:

        I used to wear a labcoat when I was a lecturer back in the blackboard era: it prevented chalkdust from covering my regular clothes.

      • Luke Somers says:

        We generally didn’t wear lab coats unless we were doing chemical work at the time – nanophysics requires some chemistry, and sometimes moderately nasty stuff – and it wasn’t in the clean room. Like, if I was doing a KOH etch in the lab rather than the clean room, that was a good time for a lab coat.

        We certainly didn’t wander the halls that way.

    • James Picone says:

      My father has a PhD in physics and did some work on high-temperature superconductors and crystal growth, including some at MIT.

      He’s been known to rant about the way scientists are always depicted as wearing white labcoats – apparently he pretty much never wore one.

      • pthagnar says:

        every chemist and biologist i have known has worn lab coats at work

        okay some of the biologists were very dry informatics types and hardly ever went into a lab, but labs usually have some ill-fitting coats for guests which they wore when they went into labs

    • Tom Womack says:

      At least in the bits of the chemistry world I’ve encountered, ‘lab coat’ correlates to ‘potentially covered in poison’, and wearing lab coats outside the lab is Really Not Done – you certainly take the coat off and leave it on the lab hatstand when you go to the office space to write up what you’ve done.

  11. dlr says:

    Well, I for one am happy someone kept her off the streets, even if for only 8 days. That’s 8 fewer days when she has the opportunity to unilaterally decide someone is a racist and kill them.

    If I had been the psychiatrist making the admitting decision, the presence of #KillRacists and her facebook photo would have been enough to tip the balance to ‘hold for observation’. Better safe than sorry. The decision is supposed to be ‘a danger to themselves OR OTHER PEOPLE’ right?

    • Scott Alexander says:

      She’s a rapper and that was the cover of one of her albums. I feel like rappers are allowed to be arbitrarily weird-looking.

      If you commit people who say “kill racists”, half the country is going to be in psychiatric asylums.

      • galin says:

        Can we please admit that it’s *really scary* that people can be confined and medicated against their will based on whether the admitting psychiatrist “feels” like they’re “allowed to be arbitrarily weird” in one way or another?

        • CJB says:

          “Can we please admit that it’s *really scary* that people can be confined and medicated against their will based on whether the admitting psychiatrist “feels” like they’re “allowed to be arbitrarily weird” in one way or another?”

          But to get to that point, you have to be in a position to be involuntarily admitted, and this involves….well, actions that mean “view your actions negatively” is a reasonable starting point.

          Look, whatever TV tells you, most cops want what I or you want- to have a nice, quiet day at work. Hauling screaming rappers to the booby hatch is not super fun. Dealing with the undoubtedly vast amounts of paperwork is not fun.

          Bureaucracy- it doesn’t get abused much, because abusing it deliberately is a giant pain in the ass.

          Now, this isn’t universal, of course. I just read about several people at Depuy Synthes who went to federal PMITA prison for lying about a medical device.

          Now, I gotta say- I’m a loyal man- but the idea of endanging lives and my own freedom to keep Depuy Synthes from having to answer awkward questions?

          HELL with that. But apparently some people do think that way.

      • Mary says:

        Half the country could come down with the plague. Why couldn’t half the country be psychiatric cases?

        Anyway, if you think “kill racists” is that common, you perhaps should consider selection bias.

        • galin says:

          Because psychiatric illnesses are by definition those things which are (1) outside the norm and (2) interfere with functioning. (Part of the reason, of course, that those things interfere with functioning *is* that they’re outside the norm, so in a world where half the population were like that they would be less debilitating and therefore less likely to be considered illnesses. Isn’t pseudoscience fun?)

          • Furrfu says:

            It’s an interesting question as to whether kinds of madness become more or less debilitating as they become more widespread. On one hand, it becomes more important to make reasonable accommodations to them, and so maybe it would be more likely to happen. On the other hand, for many kinds of madness, making reasonable accommodations to the condition is much easier for people who aren’t themselves mad in that way.

            An easy category to point to here is conditions that make people more aggressive or impulsive, including, to circle back, mania. A violent outburst in a group of calm, courageous people is likely to be restrained with as little force as possible; a violent outburst in a group full of barely restrained violent people is likely to get the outburster killed.

          • Mary says:

            who defined them as out of the norm?

          • walpolo says:

            Yeah, I wouldn’t think “outside the norm” would be a necessary condition. If 55% of people became majorly depressed, depression wouldn’t cease to be a mental illness.

            I think the right definition is both (1) debilitating and something like (2) either caused by abnormalities or potentially responsive to psychiatric treatment.

            ETA: Or you could have some definition of “the norm” which appealed to what’s natural and healthy for humans rather than to what’s numerically average for humans. That is, a definition according to which if 60% of us had an arm amputated, that would not make it “normal” for humans to have one arm.

          • galin says:

            So, I did some research, and apparently the definition of mental illness as abnormality + dysfunction is not as standard as I thought (though it certainly exists). Mea culpa.

            I would still argue that e.g. the DSM smuggles in that assumption via vague concepts, but that’s a bit more involved of an argument than I bargained for.

        • Anonymous says:

          “Anyway, if you think “kill racists” is that common, you perhaps should consider selection bias.”

          Second. Most of America’s left is almost centrist. Tumblr isn’t representative of reality.

          • David Kinard says:

            There are certainly communities and subcultures where saying that “killallracists” is a bad thing will get you accused of being an apologist for racism.

      • Winter Shaker says:

        She’s a rapper and that was the cover of one of her albums. I feel like rappers are allowed to be arbitrarily weird-looking.

        Still a little difficult to square with the pro-gun-control sentiments she expressed, though.

        • CJB says:

          “Still a little difficult to square with the pro-gun-control sentiments she expressed, though.”

          Not particularly. Rappers do this ALL the time.

          Politically, I’d guess it boils down to serving two masters. They need to appeal to young angry inner city men- not for the money, but for the cred. Once angry young inner city young men bump your music, 18-35 year old whites will get into it, because “authenticity’ has value and “authentic”rap is what the homeboys listen to.

          At the same time, once you’re rich and famous, you find yourself burdened with expectation. Chris Brown discovered that the same cheerful liberal honky college students in daddy’s kia would sing along to lyrics about beating the shit out of women, but if you actually beat the shit out of women, there’s a serious backlash.

          (This is roughly a “po’ trash” v. “pearls and twinset” culture clash- po’ trash women tend to have different views of spousal violence than rich women- particularly when they experience it. Discuss amongst yourselves)

          So rappers have to appeal to the hood rats, by making songs about I’m super authentic and look how awesome I am anyone that disses me dies horribly.

          But then they have to turn around and placate their new liberal buddies and do you think Clooney invites you to your parties if you turn down anti-gun PSAs?

          Also there needs to be a lot of pretending that you’re deeply saddened by the violence, which, I’m given to understand, needs to “stop” because otherwise people might look at you and discussing what it means that your music actively, literally, and explicitly tells young teenagers how to and why to commit the acts of violence and criminality committed in just the way you rapped about.

      • In particular, if we commit people who ever say anything ridiculously hyperbolic things on the internet, the entire internet-using population needs to be locked up.

    • Oh my god! You’re infected!

      One of the awful things Social Justice has done is to convince people to take hyperbole seriously.

      I feel like I used to be a native speaker of English– I could understand low-intensity metaphor as having little emotional weight, but then I got sensitized. Tragically, it seems as though the rest of the country is catching up with me, so I guess I’ll get to be a native speaker again.

      • Randy M says:

        I blame lawyers. Firs thing to do is kill all lawyers.

        (I’m not sure how lawyers are to blame, I just wanted to allude to Shakespeare)

      • hawkice says:

        I am unable to tell whether calling overuse of hyperbole a tradegy is intentional irony, unintentional irony, or you submitting to the collective mind’s will.

        • Creutzer says:

          But Nancy isn’t talking about overuse of hyperbole. Rather, she’s talking about hyperbole being taken seriously, which is something that one would naively expect to decrease as use increases.

          • Thanks. That’s what I meant.

            I think what defeats the naive expectation that more hyperbole means that it will be taken less seriously is partly the belief that Our Hyperbole is just kidding and an effort to move the world in the right direction while Their Hyperbole is a collection of serious threats, and partly uncertainty about just how violent people might turn out to be.

  12. HeelBearCub says:


    What effect does fact that this is reported in the Daily News have on your assessment of whether this is reported in the most accurate way possible (with the other possibility being that its reported in the most shocking way possible)?

    • Scott Alexander says:

      I don’t know much about the Daily News, but if you Google it you’ll find the same story in a bunch of other places.

      • HeelBearCub says:

        Daily News is a tabloid. i don’t think it’s unfair to say they are one step above The Enquirer and should be treated as entertainment and not news.

        And I’m seeing one mention in the Washington Post which sources only right back to The Daily News, and then a bunch of other tabloids (including British ones that I believe are also owned by Rupert Murdoch).

        I have a feeling that if I go through all of the mentions, none of them will actually be secondarily sourced. My guess is they will all just be reporting what Daily News said.

        • HeelBearCub says:

          Sorry, meant to say none would be primarily sourced, all secondarily sourced.

        • Scott Alexander says:

          You can find much the same story on Ms. Brock’s Twitter feed and Facebook. I mean, that just proves that she thinks it happened, but that’s really all the story’s saying anyway.

          • HeelBearCub says:

            Isn’t it the case that just reporting the contents of a press release is generally frowned upon (in journalistic circles?)

            I’m not exactly sure, absent something else, why the presumed motivated reasoning in Ms. Brock’s version of events shouldn’t result in a fairly large discount in our assessment of likelihood of accuracy.

            No doubt the story is interesting, but it’s unclear to me, at all, why a psych hospital would take mere claims of employment status as evidence of delusion. You seem to point to this yourself. Why then should we be motivated to believe her version of events? Shouldn’t this claim, if anything, cause us to update the other way?

  13. Jiro says:

    People respond to incentives. If you lock patients up because most patients who claim to be X are delusional, you’ll encourage people to turn in their jilted ex to a psychatrist for involuntary commitment using their non-delusional claim to be X as evidence, thus reducing the usefulness of X as an indicator of delusion.

    In fact, it doesn’t even require malice; if you are too willing to accept X as evidence of delusion, that will lead you to not pay as much attention to whether X is actually true, and if you don’t pay as much attention, X becomes poorer evidence for delusion.

  14. Decius says:

    Sending a bill for involuntary treatment seems to break a core aspect of contracts as well as medicine. Is there some legal or moral basis for “You didn’t ask for or consent to the service we provided, but here’s the bill for it.”?

    • HeelBearCub says:

      No more so than treatment if you are brought in to the hospital unconscious after an injury of some sort.

      • galin says:

        Nonconsensual =/= involuntary. There is a big difference between “We didn’t get your consent because we couldn’t ask you” and “We didn’t get your consent because you actively refused to give it to us“.

        • Doug S. says:

          True, but if you’re involuntarily committed, it’s because you weren’t competent to act in your own best interests. At least, that’s the legal theory.

          • galin says:

            Right, which makes it extremely relevant whether or not we have a reliable mechanism for determining whether a given person is incompetent.

    • Liz Calkins says:

      Yeah, I feel extremely lucky that both times I got involuntarily and wrongfully/unnecessarily treated I happened to be on MassHealth. If it had happened during my long period of no health insurance I’d have been absolutely livid and trying to find every way possible to fight paying for it.

  15. Siah Sargus says:

    How many people have “solved physics”? Why is this a thing? Why does it have to involve quantum-something and never any new terms? Why don’t we have people trying to solve biology?

    • birdboy2000 says:

      I was of the understanding that Darwin already solved biology.

      • Corwin says:

        Not entirely. Darwin got Natural Selection, but iirc, the abstraction that the Inclusive Fitness criterion is, was due to someone named Hamilton in the 1960s.

        Not sure anything outside of pure math ever gets Really Solved.

    • MawBTS says:

      I think delusions exist in an ecosystem, and physics-related delusions are extremely competitive, memetically speaking.

      The average person finds physics to be largely incomprehensible, and can’t easily distinguish made-up bullshit from the genuine article. A crazy person rambling about Obama sabotaging his car will attract nearly universal incredulity. An equally crazy person rambling about gluons and muons might actually gain traction, at least with laypeople.

      You could say the same thing about biology. But physics has an aura of coolness that biology lacks, IMO.

    • Furrfu says:

      This is probably because physicists are trying to solve physics, but biologists are not trying to solve biology. As for “new terms”, if you take some time to browse through crank physics theories, I think you’ll find they’re full of neologisms, just like other crank theories. Or did you mean “terms” in the sense of “monomials”, and if so, in what?

    • zz says:

      It is said, “I think I’m going to solve psychology.”

      (Fun and slightly disturbing game: how many things rationalists LessWrongers say would work towards getting you committed?)

    • Tracy W says:

      Possibility: we already do but all the time that physicists have free to marvel at physics cranks biologists spend on creationists.

      Another possibility: solving the fundamental underlying nature of reality sounds grander.

      Third possibility: biology requires more experiments and this is harder work and more expensive so the cranks avoid it.

      • Siahsargus says:

        Now that I think about it, I think your first possibility is mostly correct. Geologists, biologists, paleontologists have creationists; chemists, pharmacists, and psychiatrists have varying breeds of alternative medicines; mechanical engineers have infinite motion machine crazies; it would seem just about every field of study has its dark memetic counterpart that refuses to die.

        As for your third possibility, lack of evidence never stopped anyone’s beliefs from being “proven”. I think most of the biology cranks are in diet and fitness mags.

      • CatCube says:

        I think most fields have cranks, that may or may not be known to outsiders. Physics and math have the ones everyone thinks of first, and biology has creationists as you mentioned. My field is structural engineering and we’ve got the “9/11 controlled demolition” conspiracy theorists.

        To other people on the board, what other kinds of cranks are out there for your field?

        • Alraune says:

          Electrical’s got both all the perpetual motion generators and the Secret Russian Transverse Wave Energy cranks.

        • Adam says:

          My wife’s an electrical engineer working on experimental radar development and has to deal with the HAARP folks who think the government causes hurricanes.

          I was a military officer, so maybe all the people that think they could command armies because they’ve read a bunch of history books?

  16. Alex Zavoluk says:

    Mostly not relevant, but this article reminded me of a play I acted in my second year of college: Die Physiker (The Physicists), by Swiss-German playright Friedrich Durrenmat. It centers on 3 physicists in an insane asylum, one who thinks he’s Newton, one Einstein, and one who thinks King Solomon talks to him, and it’s quite dark and wonderful, full of twists and turns. It might be of interest to anyone concerned with the power of scientific creations.

    Here’s the wikipedia article, but there are huge spoilers, so beware:

    • LHN says:

      My school’s student theater group put this on my first year in college– which came close to being fatal for me.

      I was sitting in the front row. At the end of a scene, at least as they staged it, one of the characters flies off the handle and knocks over a large, heavy, round table.

      Which then proceeded to roll, slowly, towards the edge of the stage. If I’d had any sense of self-preservation I’d have moved, but whether through unwillingness to draw attention to myself or sheer paralyzed disbelief, I didn’t. So the table rolled off the edge of the stage, and landed upended, with its heavy base right in the (fortunately empty) seat next to mine.

      (Perhaps not surprisingly, this is the only thing I remembered about the play till you reminded me of it. Though I also now recall that one of my friends played Moebius.)

  17. Kevin C. says:

    What, all these comments, and no mention of Martha Mitchell?

    • Scott Alexander says:

      I’d never heard of that effect under that name, but I have a feeling I’ll be referring to it often.

  18. Seth says:

    Here’s a link to her lawyer’s press release, which is probably the ur-source of the all the news story echoes:

    “Press Release: Woman Falsely Arrested and Committed to a Mental Facility by the NYPD and Harlem Hospital Staff After Telling Them She Was a Banker and Was Followed on Twitter by the President”

    • Deiseach says:

      Okay, looking at the press release, she did not help herself in any way. Refusing to tell her age meant that even if they did go online to check what she was saying was true, how were they to distinguish her from another black woman named Kamilah Brock?

      And that part about her being a banker? Well, if this is the same Kamilah Brock, she did work in the banking industry – for one year, 2007-2008.

      That’s not “proof of employment” and it certainly is not “I am a banker”. It’s so vague, she could have been anything from a teller to management (I’m betting she was not one of the higher levels of management, or whatever we are supposed to take from the self-description as “a banker”).

      When we are re-directed to her personal website, her name switches from “Kamilah” to “Akilah”; again, sure, probably changing it for publicity/career purposes, but it doesn’t help in establishing her identity.

      Sorry, but it does sound more like “grandiosity” and less like “professional woman stitched up by cops because she was black and stroppy”.

  19. Doug S. says:

    In order to be a delusion, a belief has to be unusual. For example, if you believe that Jesus was the Son of God, that’s not delusional, because lots of people believe it. If you believe that you’re the Son of God, then you’re delusional unless you can get enough other people to believe it too, in which case you’re a cult leader.

    • US says:

      Not only that, the DSM account of delusion (and the previous account – it goes for both DSM IV & V) even includes a special exemption for religious beliefs:

      “A false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not ordinarily accepted by other members of the persons’s culture or subculture (i.e., it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction can sometimes be inferred from an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion).” (DSM V)

      Note that that’s an ‘i.e.’, not an ‘e.g.’.

      Here are a few related observations on the topic from the text Delusions and Self-deception by Bayne and Fernández:

      “Much […] can be said for and against the epistemic conception of delusion (and self-deception), but instead of going down that path we want to introduce another way in which to conceptualize pathologies of belief formation. Rather than think of doxastic pathology in terms of departures from the epistemic norms of belief formation, one can think of it in terms of departures from the procedural norms of belief formation, where a procedural norm is a norm that specifies how a psychological system ought to function. Just as agnosias involve departures from the procedural norms of visual perception, so too delusion and self-deception might involve departures from the procedural norms of belief formation. […]

      Do delusion and self-deception involve departures from the procedural norms of belief formation? Self-deception—at least, everyday self-deception—need involve no such departure from the procedural norms of belief formation. There is overwhelming evidence that normal human beings have a systematically distorted self-conception […] Drivers tend to believe that their driving abilities are above average […], teachers tend to believe that their teaching abilities are above average […], and most of us believe that we are less prone to self-serving biases than others are […]. Having an overly positive self-image seems to be part of the functional profile of the human doxastic system; indeed, one might even argue that having an accurate self-conception is an indication of doxastic malfunction […]

      What about delusions? On the face of things, it seems obvious that delusions involve departures—typically, quite radical departures—from the procedural norms of human belief formation. Delusions stand out as exotic specimens in the garden of belief, as examples of what happens precisely when the mechanisms of belief formation break down. In support of this point, it is of some note that the DSM characterization of delusion includes a special exemption for religious beliefs. This exemption appears to be ad hoc from the perspective of the epistemic account of delusions, but it is perfectly appropriate in the context of the procedural norms account, because—certain commentators to the contrary—there is no reason to suppose that religious belief as such is indicative of doxastic malfunction.2 Delusions, by contrast, do seem to be symptomatic of doxastic malfunction.”

    • Corwin says:

      Believing wrong things is what delusional means. Whether tons of people are deluded in the same way just make it a socially accepted delusion.

      Yes, the DSM ways that holding wrong beliefs is not delusional if people were exposed to it so much and seeing them accepted, that it’s … “reasonable insanity”… to hold them.

      ( i.e. the procedure by which humans acquire beliefs is mainly from other humans. If I got it right, the DSM defines delusion as a belief that is not arrived by through Normal Ways, i.e. From What The Majority Of Humans Around Them Believe, and From Personal Observation. (Also granting that humans can easily disregard their own observations if they conflict with locally majoritary beliefs even if those are wrong.))

      • In the context of psychiatry, though, surely there’s a critically important distinction between a wrong belief that is due to the limitations of the typical human mind and a wrong belief that is due to a malfunction in a particular human mind?

    • Pku says:

      I’m not sure it’s just that – I think most people who believe in religion are pretty garage-dragony about it (not a lot of people, for example, refuse to wear mixed weaves or follow most of the bible’s stranger commandments, and those who do are usually considered somewhat crazy). If someone believed they were the son of god in the same way the average christian believes Jesus it, but were still sane, they probably wouldn’t go around telling everyone.

  20. moridinamael says:

    I would just like to add that one of my undergrad chem professors was escorted off campus by police because they assumed he was a hobo. That is all.

  21. anonymous says:

    I’m not a psychiatrist so I’ve never faced the decision of whether to commit someone, but I do have someone in my family who I think may have NPD. Lately I’ve been trying to decide how much I should bother to maintain a relationship with this person. I’m not really sure.

    • Paul Torek says:

      According to my wife (a psychologist), The Wizard of Oz and Other Narcissists is a good book for friends/relatives/etc of narcissists.

  22. Why no capitalization at the beginning of the sentences in parenthesis? (Not complaining, just curious. I don’t recall ever noticing this particular form before.)

  23. Theo says:

    Scott- most of your psychiatry posts seem to be based around the many many ways in which psychiatry is terrible and unscientific and filled with perverse incentives and does harm to innocent people. Overall, do you feel that your career in psychiatry (thus far) has been a net positive or negative?
    potential future psychiatric student becoming increasingly concerned with my choices

    • Scott Alexander says:

      Positive or negative to me, or to the world?

      • Daniel Armak says:

        Of course we’d like you to answer both!

        • It occurs to me that one *could* hold that although mandatory in-patient psychiatry as a thing has a net negative effect on the world, Scott’s presence in it means that less harm occurs than would otherwise occur.

          I mean, I taught phil. classes as a grad student in a university. I think the “college is like tulips” analogy is pretty accurate, so I think that overall the cluster of organizations I was a part of were net-negative, or at least worse than many alternatives. But I like to think that my being a teacher was better for my students than someone else being a teacher.

      • Theo says:

        I had been referring to the world- or at the very least the part of the world encompassing your patients and their loved ones. That said, I’m now interested to see if you feel that psychiatry’s been a net personal negative.

  24. Sam says:

    Half-baked idea: in places where medical treatment is not free at the point of use but which do have cultures of suing for medical malpractice (e.g., America), making involuntary commitment not directly cost the patient(‘s insurance) would align incentives somewhat better.

    Justification: as Scott observes, there are very strong lawsuit-related reasons for hospitals to be eager to commit people who have even the slightest hint of mental illness. On top of that, they can then send the patient’s insurers an invoice, which covers the cost to them of commiting the patient, providing treatment, staffing, etc. Even in the case of uninsured patients, they can expect to wring *some* money out, even if it’s only, say, 10% of the sticker price—and, again, as Scott say, they set their prices accordingly. Committing people is, hence, at worst a ‘draw’ for the hospital (treatment costs passed on + profit margin) and often a ‘win’ (lawsuit liability avoided). The hospital makes the decisions more-or-less without the input of the patient, but (if committed) the patient bears significant costs—which the hospital does not if they’re able to just send the bill.

    (Obviously, individual psychiatrists make the decision to commit/not commit without reference to financial considerations—but they *will* make it with reference to hospital policy, which itself takes money matters into account.)

    • Scott Alexander says:

      Okay, but if the hospital has to pay for it (which in many cases they already do) they’ll just make up the difference by charging people with insurance more.

      Probably the fairest way to do it would be that the government has to pay for uninsured people (which is already how it mostly works here in Michigan). Then the government has some department dedicated to auditing psych hospitals and making sure they’re not committing people unless they meet criteria.

      • Sam says:

        Sure. But commitment is still a cost centre for the hospital, so it wouldn’t be a slam-dunk any more—if it’s already priced in to their general rates, less commitments means more profit; if it’s not priced in, that’s a competetive advantage for that particular hospital and the Market will work its magic.

        (I don’t actually believe that that will happen because the American healthcare market is all sorts of fucked up; in fact, I don’t believe it’s possible to construct a functional consumer healthcare market that doesn’t have really undesirable properties somewhere. It’s good to hear that, at least in some places in America, it’s not just being left up to the Market to decide these things and that there is state intervention to prevent absurdities.)

        Audits might work, but it faces the dual problems of regulatory capture and having a funding sword of Damocles hanging over it; many American regulatory departments (national and state-level) have been cut to the bone and beyond and simply can’t do their jobs any more.

  25. Goldblum says:

    One patient even told me, in a threatening manner, that his blog had over a thousand hits. “You mean a day?” I asked. “No, total,” he answered. Then he wondered why I was so utterly failing to look impressed.

    Damn son, your blog got owned by your psychiatrist’s.

  26. David Kinard says:

    Hello. I think this is my first time commenting on this site. I am usually a big fan of your blogging but this particular entry troubled me.

    First off, let’s start with the assumption that getting emotional or angry with the police is an inherent sign of mental illness. While such behavior certainly is risky, the risks one may be willing to take are often informed by their inherent ethics. If one views the police as the equivalent of a violent gang who has stolen their property, recognizes that society believes they have a license for their violence, and finds it imperative to actually express their personal moral outrage, this is not the result of a mental illness, but a conscious ethical choice. It may not be something you would personally do, but I would suggest you might be falling prey to the mind projection fallacy here.

    Secondly, I would think as a psychiatrist, there would be an additional scrutiny that would be required in such cases, to be sure you are not doing dirty work for the police so to speak. The police can bring someone in for mental evaluation on a much lower standard then they could arrest them for suspicion of committing a crime.

    When you mention the fact that she had anti-police tweets. While mentioning Barack Obama follows her may be a sign of delusionality or simply an ignorance of how social media works (I think you’d be quite surprised, there is an incredible gap of understanding between those who are fluent in social media and those who aren’t) Let’s say, however, that the police DID try to confirm this. They would see her anti-police tweets. Isn’t it possible this was a factor, that these police decided to give her a hard time because of this, but lacked an actual reason to arrest her?

    I think it is quite dangerous to conflate political views out of mainstream with mental illness, and I think erring in such cases on the side of not holding a person is a reasonable precautionary principle against the abuse of such power for such reasons.

    • Scott Alexander says:

      As I specifically said, getting in fights with the police does not prove mental illness, but it sure is good Bayesian evidence (that is, you’re more likely to do it if you’re mentally ill than not mentally ill). We don’t know any of the details here, and there are a lot of factors that could tip the scale to make someone fighting the police seem mentally ill.

      She didn’t mention the Obama tweet to the police, just the psychiatrist, and there’s no reason to think the police checked her Twitter account.

      • Jiro says:

        That falls under the category of creating incentives–if you use it as evidence, it creates incentives for the police to turn in troublemakers as mentally ill, causing it to be less good as evidence.

        Also, just “it’s bayseian evidence” isn’t enough. False positives have a cost, too, and in this case a particularly high one.

        • Scott Alexander says:

          This is what I was trying to get at with my last few paragraphs.

          If most people you meet are innocent, you can afford to have a presumption of innocence. If many people are guilty, but you’re able to hold long drawn-out trials to find the truth, you can also afford to have a presumption of innocence.

          But when many people are guilty, and you don’t have the resources to investigate thoroughly, you’re kind of out of luck.

          Suppose a patient gets brought in by a police officer. The officer says that he found the patient trying to hang herself, and when he tried to stop her, she screamed and attacked him. The patient says this totally didn’t happen and the police are liars.

          At this point it’s her word versus his. I can either never take any patients again (because a lot of them claim someone was lying/framing them, even the ones where this is obviously not true) or I can just accept that the police are trustworthy most of the time.

          • galin says:

            Or you could do the ethical thing and not commit people without dispositive evidence. It is extremely irresponsible to adopt a trustworthiness heuristic just so you can justify taking action where the evidence does not support it!

            ETA: I know that there are costs to inaction, but the only way you end up with zero risk tolerance is if you think there is no downside to depriving someone of literal liberty without due process. And before you say that you’re not the government, you are empowered by the government (which theoretically ought to have a monopoly on the legitimate use of force) to commit people against their will on the theory that you have some special science trick for figuring out whether someone is actually “insane”, over and above the abilities of a judge or jury. And you’re not producing any evidence whatsoever that that’s the case.

          • Jiro says:

            But when many people are guilty, and you don’t have the resources to investigate thoroughly, you’re kind of out of luck.

            The problem is that basing acts on “many people are guilty” creates incentives which weaken the “many people are guilty” part. Many people are guilty, until you actually assume that many people are guilty, in which case it stops being true. It vanishes if you pay attention to it. It’s like a reverse basilisk. I’m sure there’s a name for this sort of thing but I forget it.

            (Note that “many” doesn’t mean “greater than 50%, it means “so many that making the assumption is worth it”.)

          • Mary says:

            Reverse Tinkerbell. A belief that makes what is believed less probable, unlike Tinkerbell, which of course does the opposite.

          • J says:

            I think you guys are greatly overestimating the prospects for a medical resident to effect social change by taking bold ethical stands against the medical establishment.

            I mean, feel free to do premed, med school and then two years of residency if you’d like to have your own shot at making a bold statement while risking getting fired, sued for malpractice, and then barred from practicing medicine.

          • Liz Calkins says:

            “or I can just accept that the police are trustworthy most of the time.”

            The problem is that, as news events show, the police frequently are not trustworthy, and trusting them can result in serious harm or death that would be unjustified even if the person actually did have mental health issues.

            I know I’ve gone through traumatic experiences with police and mental health providers thanks to unnecessary and wrong involuntary treatment myself, had other instances of things like me and other kids I knew being punished for receiving abuse from our parents (because our parents successfully lied that it was us that was the problem), and of course heard horror stories of mentally ill people killed by the very police who were supposed to be helping them, your attitude that we should just trust the police all the time is not only arguably factually wrong, but really terrifying and increases the likelihood that people with mental issues will stay away from treatment they actually need out of justified fear.

            I think even if someone actually truly is fruitier than a moonbat, they still should have every right to refuse treatment, even if a legal waiver has to be placed in front of them before letting them do so. Because someone who doesn’t want treatment isn’t going to be cooperative to get any benefit from it anyway regardless of how much they may or may not need it, so what good would it actually do to force it on them? All it does is provide a CYA, and a legal waiver can do that just as effectively.

            I’m with David, usually I like your posting, but this one induced a big “No, no, no, no, no, no, no” reaction from me.

          • Mary says:

            News events show that no one is trustworthy. Because news events are those that are dramatic — and also rare.

        • Liz Calkins says:

          Mary: Alleged rarity is cold comfort to the thousands of people like me who’ve had to live through unjust and scary treatment by police. (And by bad mental health providers, for that matter.)

          And I’m one of the lucky ones: I got through it alive with no permanent injuries other than the mental trauma.

          • Liz Calkins says:

            And I misplaced my comment too far over. Blast it the commenting indentation here is hard to keep track of sometimes. Sigh.

      • Seth says:

        Isn’t this the reasoning problem/fallacy of “(Almost) All X are Y, but not all Y are X, possibly very few Y are X”. As in, say almost all people undergoing a heart attack have chest pain, but there are many many cases of people having chest pain which are not heart attacks. Or appendicitis almost always presents with abdominal pain, but many many cases of abdominal pain are not appendicitis. If you’re a cardiologist, you see a lot of patients with the chest pain/heart attack combination But if you go to a party, and someone says “Doc, I’ve got this pain in my chest today”, how justified would it be to reply “That’s good Bayesian evidence you’re having a heart attack”?

        [i.e. “The vast majority of mentally-ill people are confrontational with the police” isn’t the same as “The vast majority of people confrontational with the police are mentally-ill”]

        There’s also an issue that if the police are dealing day after day with let’s say unquestionably mentally-ill people, they basically have a supply of cheap true-positives they can use to statistically justify some deliberate false-positives if they’re so inclined. They can’t send everyone who hassles them for commitment, but it seems they could do a certain amount while keeping the statistical truth-value of “this person is mentally-ill” at a relatively high percentage.

        • CJB says:

          Occams razor- people likely to think that far ahead, keep that strategy in mind are much less likely to either A. be in jobs focused on physical confrontation or B. want to punish people in that fashion for that reason.

          So I suppose it’s possible that you have a Borderline cop cheerfully doing all this, but that strikes me as unlikely.

          • Seth says:

            Don’t be snobby – don’t think blue-collar workers are all dumb. Especially when it comes to clever ways to Work The System. Consider if you deal a lot with offenders who are evidently aggressively drunk, blatantly stoned out of their mind, or unarguably suffering drug withdrawal. Then if someone is just giving you lip, it’s hardly beyond your ability to claim on occasion “The individual was combative, agitated, disorderly – restrained and sent for psychiatric observation”. And presto, they’re essentially imprisoned for a week, no lawyer, no court case. Again, you can’t do this all the time, to everyone. But if you don’t go overboard, it’ll clearly be true that the statistical majority of cases you’ve sent for psych commitment are obviously correct calls.

    • Deiseach says:

      It’s a tricky distinction to try and make, because on the one hand, agreed, a person may have good grounds to react strongly in an emotional manner.

      On the other hand, there are often circumstances which mean we have to curb our expressions, and our judgement should be able to tell us to do so. Yelling abuse at your boss will probably get you fired, and unless you have another job lined up to walk right into, then biting your tongue and trying to stay calm is probably a better reaction.

      Saying “Well, I’m naturally emotional, I couldn’t keep it cool” may mean yes, you find it tough to keep from reacting emotionally. Or it may mean you have something like borderline personality disorder, one symptom of which is emotional lability and problems controlling anger.

      Maybe the police are abusing their powers. Or maybe you reacted in a manner that was out of proportion to the situation, or showed poor judgement. Unfortunately, we then dump it on psychiatrists/psychologists to decide which is the case.

      • Liz Calkins says:

        “It’s a tricky distinction to try and make, because on the one hand, agreed, a person may have good grounds to react strongly in an emotional manner.”

        Yes, being threatened with major bodily harm in a situation where you have no way to defend yourself, while having your completely factual and sincere account of your innocence in the situation dismissed as proof you’re crazy/guilty is in fact a very good reason to react strongly in an emotional manner.

        Because in order to get out of my own situation I actually would have been forced to not only fake calmness I didn’t feel and was justified in not feeling, but flat-out lie and admit to things I didn’t do, didn’t feel, and didn’t have problems with, because the doctors were stubbornly convinced their false assessment of the reasons I was upset was more correct then the actual true reasons I was very clearly stating to them.

        When the entire reason you’re upset is: “You’re threatening me with bodily harm, keeping me imprisoned here against my will, and subjecting me to treatment I don’t need,” and the doctor goes, “yeah sure, whatever, I know what’s really wrong with you is “, what are you supposed to do, exactly?

        Your assertion that I or anyone else has BPD or other issues if we don’t roll over and placidly accept everything that is done to us no matter how wrong or harmful it happens to be, is both factually wrong and offensive. Because that’s not being sane, that’s being a masochistic extreme doormat.

        I know what my actual issues are, and those issues are brought on in part by the constant expectation that I willingly and quietly submit like a good little girl to anyone’s lies and/or mistreatment.

        • Deiseach says:

          Liz, I was actually talking about the way Kamilah reacted in the cop shop.

          Actually, I’m surprised people trust the police on here – you think you explain nicely to them what the situation is and they’ll let you go? No, that’s not how it works.

          So going in to the police and ranting and raving is not going to help you. Tellng them “Check my website” and refusing to give her age, when her website is full of anti-gun, anti-cop messages? Not very clever, whatever it has to do with her mental state.

          • Liz Calkins says:

            Says someone who thinks:

            One, that it’s easy to be calm when going through a scary and traumatizing experience that you don’t actually deserve to be receiving.

            Two, that being calm will do you any good when the truth itself is being dismissed as false.

            It’s like I said: You’re basically expecting people to be a good little extreme doormat in the face of severe mistreatment AND lie through their teeth to get out of a situation. And then you say it’s a sign of mental illness if you don’t do those things.

            To which absolutelolwhut is the nicest possible response I can come up with.

            I’ve actually lived through being subjected to police brutality I didn’t deserve. Have you?

    • Mary says:

      ” If one views the police as the equivalent of a violent gang who has stolen their property, recognizes that society believes they have a license for their violence, and finds it imperative to actually express their personal moral outrage, this is not the result of a mental illness, but a conscious ethical choice.”

      If you expect its being “a conscious ethical choice” to mean it has no consequences, you’re — how to put this? — crazy. If you find it imperative, you must be wiling to sacrifice other things to it.

      • CJB says:

        I’d argue that someone who believed the cops were a dangerous gang, liable to snap and murder black people for funsies, and then proceeded to antagonize them, was clearly mentally ill- specifically, they’re at least suicidal.

        I mean, if you came to me and said “hey, I’m going to go find the nearest crip and cuss him out” I’d assume your were suicidal.

        So either shes a consistant liar, or she’s trying to suicide by cop (BTW- a fairly common event that no one has brought up. Sometimes the nutjobs seek out the cops).

  27. Publius Varinius says:

    Remember, psychiatrists have to err on the side of admitting people.”

    Have to, or have an incentive to ?

    • Scott Alexander says:

      Is there a difference between “having to” and “having a very strong incentive to”? If I put a gun to your head and tell you to give me your money, you don’t have to give me the money, you just have a strong incentive to do so. What else could “have to” even mean, save “has literally been mind-controlled”?

      • Publius Varinius says:

        This is what I mean:

        Have to: Psychiatrists do it because it’s usually the best interest of the patient. A (reasonably ethical) psychiatrist would still decide to err on the side of admitting, even if she couldn’t be held liable for that decision.

        Have an incentive to: Psychiatrists err on the side of admitting people not because they think it will help the patient, but only because they fear the consequences if things go wrong. If a (reasonably ethical) psychiatrist had a guarantee that she won’t be held responsible for the consequences, she wouldn’t err on the side of admitting the patient.

        • J says:

          That’s an odd definition of “have to”. Sounds more like “should”. To me, “Have to” connotes the stuff you put under “Have an incentive to”, especially in this case where they can get sued to oblivion, fired and forbidden from practicing.

    • Moshe Zadka says:

      Someone is holding a gun to your head, and telling you to wave your arm.

      Do you “have to” wave your arm, or do you merely have a really good incentive to wave it? What if they’re holding a gun to your head, as well as the head of every single member of your family? Legal theory, in fact, recognizes that strong-enough incentives are indistinguishable from not being liable from actions.

    • anon says:

      You don’t technically have to do anything, but if you exercise that right too much, eventually you end up in prison or worse.

    • CatCube says:

      It’s like the saying in the military: “I can’t make you do something, but I can make you wish you had done it.”

  28. “One patient even told me, in a threatening manner, that his blog had over a thousand hits. “You mean a day?” I asked. “No, total,” he answered. Then he wondered why I was so utterly failing to look impressed.”

    Scott, it’s just as well that you don’t want to associate your blog with your actual name– no one would believe the amount of traffic you get.

    As for plausible beliefs, if MKUltra weren’t well-verified, I’d think it was a paranoid delusion.

    • Moshe Zadka says:

      Ummm…my blog is about fairly obscure things, and my post outlining best practices in starting a new Open Source Python project got 700 visits on the day it was published. 1000 hits total is not about “you got 0wned by your psychiatrist”, it really is a sign of some sort of disconnect from how blogs work… 🙂

  29. Deiseach says:

    Remember, delusions are fixed false beliefs. People are quite sure they’re true, quite sure they have evidence for them, and nothing (except occasionally really good psychiatric treatment) will convince them otherwise. They’ll keep demanding you take time to investigate more and more bizarre “arguments” and “evidence”, and if you ever stop, even after days and days of everything they say being one hundred percent refuted, they’ll accuse you of acting in bad faith.

    Time for a Chesterton quotation! I haven’t done one of these in a while, and here’s the perfect opportunity 🙂

    Once I remember walking with a prosperous publisher, who made a remark which I had often heard before; it is, indeed, almost a motto of the modern world. Yet I had heard it once too often, and I saw suddenly that there was nothing in it. The publisher said of somebody, “That man will get on; he believes in himself.” And I remember that as I lifted my head to listen, my eye caught an omnibus on which was written “Hanwell.” I said to him, “Shall I tell you where the men are who believe most in themselves? For I can tell you. I know of men who believe in themselves more colossally than Napoleon or Caesar. I know where flames the fixed star of certainty and success. I can guide you to the thrones of the Super-men. The men who really believe in themselves are all in lunatic asylums.” He said mildly that there were a good many men after all who believed in themselves and who were not in lunatic asylums. “Yes, there are,” I retorted, “and you of all men ought to know them. That drunken poet from whom you would not take a dreary tragedy, he believed in himself. That elderly minister with an epic from whom you were hiding in a back room, he believed in himself. If you consulted your business experience instead of your ugly individualistic philosophy, you would know that believing in himself is one of the commonest signs of a rotter. Actors who can’t act believe in themselves; and debtors who won’t pay. It would be much truer to say that a man will certainly fail, because he believes in himself. Complete self-confidence is not merely a sin; complete self-confidence is a weakness. Believing utterly in one’s self is a hysterical and superstitious belief like believing in Joanna Southcote: the man who has it has `Hanwell’ written on his face as plain as it is written on that omnibus.” And to all this my friend the publisher made this very deep and effective reply, “Well, if a man is not to believe in himself, in what is he to believe?” After a long pause I replied, “I will go home and write a book in answer to that question.”

    …Every one who has had the misfortune to talk with people in the heart or on the edge of mental disorder, knows that their most sinister quality is a horrible clarity of detail; a connecting of one thing with another in a map more elaborate than a maze. If you argue with a madman, it is extremely probable that you will get the worst of it; for in many ways his mind moves all the quicker for not being delayed by the things that go with good judgment. He is not hampered by a sense of humour or by charity, or by the dumb certainties of experience. He is the more logical for losing certain sane affections. Indeed, the common phrase for insanity is in this respect a misleading one. The madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason. The madman’s explanation of a thing is always complete, and often in a purely rational sense satisfactory. Or, to speak more strictly, the insane explanation, if not conclusive, is at least unanswerable; this may be observed specially in the two or three commonest kinds of madness. If a man says (for instance) that men have a conspiracy against him, you cannot dispute it except by saying that all the men deny that they are conspirators; which is exactly what conspirators would do. His explanation covers the facts as much as yours. Or if a man says that he is the rightful King of England, it is no complete answer to say that the existing authorities call him mad; for if he were King of England that might be the wisest thing for the existing authorities to do. Or if a man says that he is Jesus Christ, it is no answer to tell him that the world denies his divinity; for the world denied Christ’s.

    Nevertheless he is wrong. But if we attempt to trace his error in exact terms, we shall not find it quite so easy as we had supposed. Perhaps the nearest we can get to expressing it is to say this: that his mind moves in a perfect but narrow circle. A small circle is quite as infinite as a large circle; but, though it is quite as infinite, it is not so large. In the same way the insane explanation is quite as complete as the sane one, but it is not so large. A bullet is quite as round as the world, but it is not the world. There is such a thing as a narrow universality; there is such a thing as a small and cramped eternity; you may see it in many modern religions. Now, speaking quite externally and empirically, we may say that the strongest and most unmistakable mark of madness is this combination between a logical completeness and a spiritual contraction. The lunatic’s theory explains a large number of things, but it does not explain them in a large way. I mean that if you or I were dealing with a mind that was growing morbid, we should be chiefly concerned not so much to give it arguments as to give it air, to convince it that there was something cleaner and cooler outside the suffocation of a single argument.

  30. Ross Levatter says:

    Tom Szasz told the following story in his book Insanity: The Idea and Its Consequences. A staff psychiatrist is reviewing the previous night’s admissions. He notes a woman was admitted for schizophrenia but sees no documentation of why the resident, a foreign medical school graduate, thought the diagnosis applied. To the staff psychiatrist, she seemed to demonstrate only some anxiety. So he asked the foreign psych resident why he thought the patient was schizophrenic. The resident replied, “She said she had butterflies in her stomach.”

    Communication between patient and doctor is often challenging, even more so if the patient is aware that his or her answers will determine whether or not they are to be held against their will. Some are not smart, in the strategic sense. Some have little awareness of such things as the significance, or lack thereof, of being “followed” by the President of the United States on Twitter. Some, especially black patients, may show a touch more outrage at the police killings of blacks than some psychiatrists of a different race and social status feel appropriate. None of this strikes me as evidence of mental illness.

    • Scott Alexander says:

      I heard a similar story on a job interview – a doctor told the story of a foreign resident at her hospital who admitted a patient because the patient said he had “eaten a submarine” (ie a sub sandwich, but the foreigner apparently didn’t know this).

      I mentioned this to someone and they said it was a classic joke and very unlikely that it actually happened.

      • David Kinard says:

        There was a story I read, as I recall from a credible source although I can no longer find it via google, of an elderly woman who was diagnosed with schizophrenia because she answered “yes” to the question “do you sometimes hear voices and not know where they are coming from?”

        They apparently did figure out she wasn’t schizophrenic, as she answered that way because she was deaf in one ear.

      • Ross Levatter, MD says:

        Tom was a longtime friend of mine, Scott. I’m confident of the veracity of his anecdote. Also, being unilaterally deaf myself from an acoustic, I can appreciate David’s tale!

  31. Pku says:

    You’ve mentioned before that you see having to admit people when you’re not sure as a huge problem. This seems like a reasonable course of action to me though (at least if they’ve threatened suicide or something) – even if 99% of those suicide threats are false and stupid, that’s still 99 people being falsely imprisoned for a week vs one death, or about two years’ total imprisonment vs one life being cut short by, say, ~40 years. Even if you assume being in a psychiatric hospital is literally as bad a being dead, that’s still a 20 to 1 gain.

    • galin says:

      Are you willing to apply the same reasoning to the presumption of innocence in criminal proceedings?

      • Pku says:

        The math doesn’t really work out – Most murderers don’t become serial killers, and prison sentences for murder tend to last decades, not days, so the payoff would be massively negative.

    • Jiro says:

      False imprisonment for a week in a mental institution causes more harm than just the loss of one week, especially for low income patients who cannot afford to miss work or pay late fees on bills and have nobody to take care of their children while they are locked up.

      • Liz Calkins says:

        Not to mention the sheer mental trauma, as well as any possible physical trauma if you try to resist or escape and security reacts badly, or if you get subjected to harmful treatments during that week.

        Ask, say, Rosemary Kennedy how well her unnecessary and involuntary treatment worked out for her.

  32. creative username #1138 says:

    Two years ago the case of Gustl Mollath was a big story in Germany.

    Short version of the story: Men gets accused by wife of domestic violence.He claims that his wife is part of a big money-laundering conspiracy by the bank she works for. Court declares him innocent by reason off paranoid personality disorder after expert diagnoses. Court orders him to be committed. He spends the next 7 years there. Turns out the bank his wife worked for was involved in a conspiracy. He’s now free after a public outcry.

    • CJB says:

      That’s excellent news.

      Newspapers don’t report common things. The more rare, the bigger the story, generally speaking.

      Newspapers are great lists of things you don’t need to have any concern about.

      • Jiro says:

        Newspapers don’t report common things.

        That doesn’t mean “His story is true but they locked him up anyway” is rare.

        It means “His story is true, they locked him up anyway, and by pure coincidence evidence turned up independently that confirmed his story” is rare. I’d expect that in most cases like this nobody ever discovers evidence of the sane patient’s sanity.

  33. Lumiere says:

    I would be interested in a post on Ekman’s work, and applications to your work. Particularly around detecting truth, given the last part of this post.

  34. Liz Calkins says:

    The problem is that committing someone who actually doesn’t need it can be traumatic, cause them serious issues, AND deter them from getting any future help they might actually need.

    Basically, preface: I’m in a situation of trying to care for my very difficult and sometimes emotionally abusive disabled mother while in a position of financial insecurity (and thus dependence on her) on my part. But of course this violates the usual narrative of the innocent, vulnerable invalid patient with a financially independent caretaker, so I’m invariably ending up in a situation where her various doctors and social workers take her side on everything and subsequently treat me as if I’m a huge problem to be dealt with, that my own needs are completely irrelevant, and that things would be so much better if I wasn’t part of the equation even if I had difficulty taking care of myself on my own.

    So, on two separate occasions I’ve expressed my irritation and upset with this sentiment, telling them something along the lines of, “I hate that you people always treat me like you wish I didn’t exist.” And on both occasions they decided to interpret that as meaning I wish I didn’t exist, and decided to Section 12 me, after talking to doctors that I had never met before in my life who authorized it, leading the police to come to my house to drag me to the hospital as an alleged suicide risk.

    The first time I had no idea what was going on and was almost ready to leave for a work shift. All the police would tell me was that “someone at the hospital wanted to talk to me”. When I told them I had no idea what they were talking about, that I was fine, and that if they were unwilling to explain further I refused to go with them, they then proceeded to reach out to grab me, and when I shrank away and tried to get away, they tackled and manhandled me into cuffs, then dragged me into the car. I spent the whole time crying and asking why they were doing this, to which I got mockery and derision in return.

    When I got to the hospital, they dragged me into this room all the way back in the middle of nowhere, surrounded by orderlies and security guards. I continued crying and demanding to know what was going on and demanding to be allowed to leave to go to my job, which got me threatened with sedation and restraint and involuntary admission.

    Even when I finally got someone to tell me what had actually happened, my explanation of how they got things wrong went in one ear and out the other, though I did at least finally convince them to call my job for me and let them know what had happened.

    Eventually a doctor came in, and he then proceeded to be a complete condescending jerkass who refused to believe that the only thing wrong with me at the time was that I was completely scared out of my wits by what they were doing to me and that I wanted to be allowed to leave. He even asked me if I was autistic because I kept repeating, “I’m scared of what you’re doing to me and I want my stuff back so I can go to work!”, then got huffy at me when I told him he was a flipping moron for reaching that conclusion, and when I complained in general how dumb they were for not just LISTENING to me and accepting I was telling the damn truth.

    It took three hours before I finally managed to convince the flipping morons that I really really was really really not suicidal and really really just wanted to go to my damn job. I then had to walk to my job and work the rest of the shift while being completely frazzled and covered in welts and bruises and pulled muscles. (Fortunately it was a desk job, unfortunately one that required interacting with clients, though it still went reasonably OK.)

    I was out $36 from my wages, one ruined messenger bag that the cops ripped while grabbing me, and a whole lot of mental trauma, not to mention being bruised and aching all over for days. And not only did nobody give me an apology or any sort of compensation, but the PD fellow I filed a complaint with had the gall to tell me they were being nice for not charging me for “resisting arrest” (even though I specially asked and specifically was told I was not being arrested).

    The second time around, I begged and pleaded with the police to not take me in, but that didn’t work, so I resignedly went along. I remembered last time they had mentioned I could have called a patient advocate, so the very first thing I did was demand to speak to her right away. Unfortunately once she showed up, she just told me that I had no right to refuse treatment. Great.

    Once the doctor showed up, I interrupted his precanned speech to insist that, again, I was scared, I didn’t want or need the treatment, there was a big mixup, and I wanted to be let go immediately. He got huffy and pissy and told me he was going to leave and come back later when I was willing to be more cooperative, and ordered the nurses to shoot me full of a drug that would make me so. I initially resisted, but when they made it clear they were going to restrain me if I continued, I reluctantly let them shoot me full of whatever it was.

    I managed to sneak a cell phone call to my aunt in there, who thankfully was home and agreed to come bail me out somehow. Then I needed to use the restroom, and discovered while in there that I had started my period and bled all over myself. I begged for a change of clothes and some pads, but got a really noncommittal response.

    So, feeling rather desperate, I tried to make a run for it, which of course got me tackled and tied painfully to a bed. Fortunately my aunt showed up after not too long, and she convinced them to let me go with a little help from me continuing to insist I was not suicidal and that while I had issues, I wanted to discuss them on my own terms and not with jerkass doctors who didn’t want to listen to me, while I was shot full of drugs and tied to a bed.

    (I felt somewhat proud of myself when the doctor said he was surprised I was still awake and reasonably coherent after the amount of whatever it is they gave me.)

    So yeah, once again I ended up with a lot of emotional and mental trauma. Even worse is that this all scared me off from getting therapy I actually needed for months, because I was absolutely petrified that a single wrong word that my therapist took the wrong way would send me back into that hellish experience for a third time. It took a few sessions of making it absolutely, positively, 100% clear that I wasn’t suicidal and didn’t want to go through that ever again to make me feel safe enough to try.

    And I was lucky. There’s plenty of horror stories of people who didn’t actually need certain harsh therapies or admission who got trapped for weeks or months or years, and underwent things it was much harder to recover from. Or how about family members who called police to come help them with their mentally ill loved ones, only to have the police end up killing them.

    And then we wonder why we have a mental health issues: Because that’s what happens when people who have or are suspected of having mental health issues have good reason to be scared witless of their utter lack of control over the proceedings and the sometimes horrific response they get from doctors and other responders. Even someone who actually does need help is still going to be justifiably resistant to cooperating with therapy when treated like that.

    • Liz Calkins says:

      I probably should addendum that I’m someone who spent a large chunk of their childhood being ganged up on and beat up by bullies, so putting me in a situation of feeling like I’m surrounded, have no control over what happens to me, and am unable to effectively defend myself against physical harm, is pretty much one of the worst things you could do to me. Yet the yahoos still wanted me to trust them enough to accept therapy from them.

      • galin says:

        This. I’m so, so sorry that this happened to you and kind of shocked (and incredibly grateful) that you somehow managed to get away so quickly both times. I and a bunch of other people I know weren’t so lucky: in one case I was held for a whole week because they interpreted “three days” to mean three court days, and I’d been admitted on the Friday of MLK weekend, over the objections of my psychiatrist sister.

        And yes, it’s absolutely traumatic and has prevented me from seeking treatment for my actually awful depression and self-harm. I specifically tell psychiatrists (whom I see for medication alone) that I will never tell them about anything to do with self-harm because they’ve completely disqualified themselves as a group from the business of trustworthiness.

        • John Schilling says:

          Is there a class of people with a professional understanding of mental health issues, but no incentive to forcibly incarcerate people? Or possibly the incentive but not the power, but it’s going to be hard to work around the de facto power to call the police and say “I am a Certified Mental Health Professional and, trust me on this, you need to lock up so-and-so”.

          The better sorts of Catholic priest might qualify, but there are obvious issues for non-Catholic “patients” there.

          • Liz Calkins says:

            I’d settle for there just at least being more protections. Some suggestions:

            1. Police and other security are not allowed to respond to psychiatric calls ever unless there’s an actual crime being committed. Only firefighters and medical personnel are allowed to take psychiatric calls.

            2. Only a doctor who’s had direct contact with the patient is allowed to make a suggestion of admission.

            3. And the suggestion is just that: A suggestion. Anyone over the age of majority should have the right to refuse any and all treatment at any time. Even if that requires a waiver being signed to absolve the medical provider from liability as a result of the refusal.

            4. Minors and other people not considered to be of sound enough mind are trickier, but I believe there should be at least two entities required to be involved: Their guardian AND some objective, impartial legally liable entity in charge of ensuring no harmful, unnecessary treatment is forced on the minor/invalid.

            Because otherwise it’s like, I don’t care how much help I need, I’m never voluntarily ceding control of my well-being over to someone I don’t fully trust, and the thought that I can be forcibly required to is absolutely terrifying.

            I’m fine with undergoing therapy so long as I have full control, where I know what’s being done and why and what are the risks, and at any time I can walk away. Not when I’m being tied up and shot full of mysterious substances in a situation where I’m completely trapped.

            (Because it’s like: What was in that shot? What are the side effects? Is it something I might be allergic to? Was it related to problems I actually had? I don’t know, because I wasn’t allowed to be informed and then make my own decision. That’s so incredibly not OK, there’s not enough superlatives for how not OK it is.)

        • Liz Calkins says:

          Yeah, I’ve heard plenty of horror stories to make me realize how lucky I was. I think it was because I was lucky enough to have external factors in both cases:

          For the first, the external factor that I had a job that obviously expected me to be there and I obviously had been fully intending to go to.

          For the second, that I had enough foresight to grab my cell phone and was allowed to keep and use it, and that my aunt was available to bail me out. I think that second time would have gone a lot, lot worse had that not been the case.

          And yeah, that’s the greatest tragedy of it. I suffer from depression, anxiety, and a lot of self-hatred and feelings like too many people in my life wish I didn’t exist. But I felt like even though those were issues I needed to be able to talk about, I couldn’t without having them misinterpreted yet again. These sorts of inappropriate tactics by medical doctors are very much scaring off people from treatment they actually need, because they don’t feel like they have a guarantee of being able to refuse treatment they don’t need.

          Plus, even if I was suicidal, I don’t see how the way I was treated would have helped me out one iota. What suicidal person is going to feel better, exactly, after being mocked, threatened, ignored, manhandled, and condescended to by the very people who are supposed to be helping them?

  35. John says:

    We’ve had the opposite issue, someone who claimed we were harassing them, based on us messaging their public LinkedIn profile. So therefore rationally decided to phone us a bunch of times stalk people on social media, looked up our office and refused to leave for 3 hours. Is that the same category as grandiose delusions or more like paranoia? Didn’t really know what to do about them.

  36. J says:

    This case was first discussed on SSC under this comment:

    My favorite part is this twist: @BarackObama really was following her on twitter, but @BarackObama isn’t actually the president of the United States. They should totally make a Twilight Zone episode out of that.

    But equally delightful is Larry Kestenbaum’s tale of paranoid schizophrenic Alfred Lawrence Patterson, who claimed that Sen. Edward Kennedy and the Secret Service had conspired to commit him to the Northville Regional Psychiatric Hospital to prevent him from getting elected to Congress. (Read his original comment in the link above to get the story).

  37. Who wouldn't want to be Anonymous says:

    Re: Professor v. Hobo

    (a) I am surprised, especially given the community, that I haven’t seen any mention of Kurt Gödel. Literally starved himself to death in the university hospital because of his delusions.

    (b) Or any mentions of how Hemingway’s delusions (supposedly) turned out to be true. I say supposedly because I am not entirely sure the evidence presented fully vindicate his beliefs.

    (c) I actually know a hobo frequently mistaken for a professor. Well, he isn’t really a hobo. He has perfectly adequate lodging. He is just paying for it under the table because he went off grid a few decades ago, as far as I can tell, to hide assets during some sort of “rich people problems.” You know, “What, that yacht? I am sure I don’t know to whom it belongs” sort of thing.

    And he has a worn appearance because he hasn’t bought any new clothes in 30 years. I mean, everything Barny’s carries now is apparently rubbish. And he has some sort of grudge against Brooks Brothers. And don’t even get him started about those hacks on Saville Row.

    And he never drives any of his antique cars or limousines because… why should he pay the DMV to use his property?? Its just extortion, damn it. And the FAA is a bunch of pencil pushing bureaucrats, so he never gets to fly his planes. And the berthing fees for the yacht are exorbitant. Good grief, those pricks at the club can go pound sand before he gives them a single dime. They should be paying him for the privilege of looking at his yacht. Its not like they do anything but look, anyway.

    It is a good thing he has his house staff to keep him company. Except the butler has been shtooping one of the maids, and isn’t being very discreet about it. It is getting downright scandalous. The cooks assistant is pregnant, too, and the gardener has been let go because he showed up for work drunk again. He’s had to take on a couple extra between boys this season to pick up the slack. The whole place is falling apart, and if things get any worse, you’d think he lived in a barn.

    Except… he does live in a barn.

    Albeit, on that has a fairly nice (all things considered) apartment built in it (but I don’t think the city knows that). I am not entirely sure were he would actually find room to fit a household staff, because the place is crammed to the rafters with the much more real fleet of antique cars, planes, and the yacht. I honestly can’t tell if the staff is some sort of 30 year running joke with the people he rents the barn/house from, or if he is delusional. Or… he does seem obstreperous enough to make it up just to mess with people.

    Having nothing better to do, he spends a lot of time hanging out at the local community college where everyone just assumes he teaches. Despite looking decidedly like a hobo.

    • Pku says:

      Half of my conversations with people I don’t know (when I’m in the mood, anyways) are me trying to convince them of ridiculous things, like Jesus turned the dead sea into jam or I got my scar from fighting a bear back in Canada.Now that you bring up something like this, I suspect if I keep this up, stay in academia, and let personal hygiene go a bit, people will be sure I’m a crank who actually believes all this stuff.
      OTOH, the only times it really gets awkward are the occasions when people actually believe my stories about having fought a bear with my bear hands (sorry). I just don’t have the heart to tell them.

    • Mary says:

      IIRC, the time when the feds were investigating Hemingway for his work for the Soviet Union and the time when he thought they were had zero overlap.

    • “Or any mentions of how Hemingway’s delusions (supposedly) turned out to be true.”

      I discuss the case of Hemingway and the FBI at:

      As best I can tell, the story is basically bogus. I have a link to the FBI file on which it purports to be based.

  38. “This is weird. At best, it displays a surprising ignorance of how Twitter and/or the world works” … “When you think this is a good thing to bring up during, of all times, a psychiatric evaluation, then I start to wonder.”

    For the record, if you work alongside computer support staff you realise there’s some pretty silly/crazy sounding stuff that people commonly come up with around PCs internet etc. 🙂

    I was also wondering what the normal baseline is for sane people answering those questions in this situation? My initial thought is that if someone went to the police station to pick up their car (even if they were silly enough to scream and shout etc) they would totally freak out if they were then forcably sent to a mental institution. Detainment is scarey for most folks I’m guessing that fear would probably severely affect the normality of any answer for a significant amount of such people. Perhaps this is already accounted for, and I totally get that an assessment is waaaay more difficult than lay people think, but I’m just wondering is the baseline a sane person or a sane scared person?

    Scott do you think the financial incentive structure around release/detain could be easily improved? Some insurance or caps on suing? Liability held by the institution?

  39. Eli says:

    Wow. Some of these stories are really unusual. My own “bad therapist” and “bad psychiatrist” stories are much more prosaic.

    When I was a kid, I was disobedient and angry, so obviously I had bipolar disorder. At one point, I started reading John Taylor Gatto about the origins of the school system, and mentioned these things to a psychiatrist, which was of course taken as further evidence that I have bipolar disorder. Years later, my parents broadly agree about the school system; they just wanted me to be able to function competently whether or not the school system was designed by capitalist ideologues.

    When I was older, I got busy having a depressive breakdown in the year after graduating from undergrad. I told a therapist that I really hated the notion that after finishing school you’re just supposed to focus on work and accomplishments and not enjoy yourself anymore. He told me I was immature.

  40. Anonymous says:

    I don’t know if this is your intention, but these articles about very delusional people remind me of some smaller delusions of myself when I was a teenager, as well as some from other people I know. When you have a whole system built around protecting your belief from being falsified, everything seems consistent, and it even grows from small attacks (invent more elaborate excuses to be able to refute the new objection). What you have to do is build a parallel narrative which you keep separate for a while so you don’t feel the need to refute its claims, in order for it to grow. And then, when nothing is left unexplained, you can compare the two narratives from a distance and make the switch.

  41. Loki says:

    When I was in psychiatric hospital, and not, at that time, delusional, the nurses refused to believe the following true things when I told them:

    * That some of the dry grass in the car park was smouldering in the sun in a kind of ‘I am low key on fire’ sort of way (I was allowed out on a walk with my non-crazy mother, she saw it too)
    * That there were bugs on the floor of a room in the hospital (they eventually looked closer, to shut me up, and saw that there were)
    * That I had heard an alarm (I have no proof on this one).

    I was in hospital – as I had told them when I was admitted, though I don’t know if the nurses knew this, I don’t know how well information was shared with them – voluntarily, due to some acute suicidal urges that, while almost definitely related to my Bipolar, were specifically triggered by being dismissed, not believed and threatened by the police when I tried to report a rape.

    People refusing to believe true things that I told them was, for obvious reasons, very bad for my mental health at that time.

    I feel like, if a psychiatric patient states something that is vaguely plausible, demonstrating immediate disbelief to their face is almost never going to be helpful. Finding out if it’s true, like Scott did – sure, that is a helpful response. That way you can figure out if the person is delusional, which is a useful thing to know. In the case of the fire in the car park, it’s useful for other reasons.

    But basically, I feel like immediate and obvious disbelief at what a patient is saying is just not a helpful thing. It feels like gaslighting, it can exacerbate depersonalisation and cause a person to question their perception of reality in a way that *really* isn’t helpful if you aren’t delusional, and most of all, it makes that patient think you are an asshole they can’t trust.

    • CatCube says:

      I think that you’re right that “immediate and obvious disbelief” is probably not the right way to do things, but I don’t know if it’s possible for the psychiatric system to end up functioning any other way. Even if they write rules that state that an admitting psychiatrist should investigate claims deeply, these rules must be executed by human beings, who will find after a little while that a huge fraction of the claims made to them are obvious bullshit. They’ll then tend to disregard all claims out of hand, because that’s how people are wired–after a while, you start to see what you expect to see based on experience, no matter what the rules are.

      Take rules written for safety reasons. There are plenty of people who were killed disobeying safety regulations, because their cutting corners had always worked before and it can be a pain in the ass to obey the rules strictly*. They literally had their lives on the line, and still let themselves slip. Expecting a psychiatrist to remain totally objective about every person brought before them, despite most of those people telling self-serving stories, doesn’t square with what we know about how people interact with the world around them.

      *I’m not referring to rules which are vexatious or unreasonable–and there are plenty of those. I’m thinking of rules like “use a ladder, and not a stack of chairs.”

  42. Simon says:

    I tried to do a good skim of the comments to make sure this is not a duplicate thought, but no promises.

    I am 100% sympathetic with Scott’s perspective when he says he has to err on the side of committing because that is just the system. And maybe I am 80% sympathetic when he says that the price psych hospitals charge to their involuntary “customers” is not totally arbitrary because blah blah blah the system.

    BUT: I do think this an example of the thing where you get inured to really awful shit you see every day and forget how to add utilities correctly.

    Like… from my perspective… if I am imprisoned against my will and forced to take psychoactive drugs for A WEEK away from my job and family, that is an act of violence. To get a bill for hundreds of thousands of dollars after that which will ruin my credit and possibly force me to declare bankruptcy and make my life much harder for many years is icing on the cake.

    To be the victim of this kind of violence and hear “well the system blah blah and you should have known better than to say something that sounds a little crazy”… like… this would literally maybe make me *become* crazy with justified rage.

    Like I said… I am sympathetic and understand that this is the fault of none of the individually well-meaning people involved, but… geeze…. What a world…..

    A parallel case is child protective services, which seems to often be extremely cavalier about the absolutely heart-rending violence of taking away peoples’ children. It is just ultra scary when “the system” can impose extreme disutility on you without forcing themselves to be very conservative and justified. It has Orwellian consequences because we all internalize that the “reasonable” thing to do is to avoid any interaction with the system and be terrified of coming to its attention for any reason.

  43. Dr M says:

    I wish to add my own experience. I was once a psychiatric intern on the West Coast. I also had a hobby of working at a local radio station as a volunteer.

    A patient was admitted to our hospital and part of the complaint against her was that she claimed to work with a radio station. She said she met many celebrities in her job. The psychiatrists all believed that these were delusions and were untrue. I realized that she was actually a volunteer at the same station I worked at and there were even pictures of her with some of the rock musicians at the station.

    I was naive. I pointed out to everyone that she was telling the truth. No one believed me. They were convinced that I had allowed myself to be pulled into her hallucinations. That was the beginning of the end of my career in psychiatry (by my own choice.)

  44. Anon says:

    I’m sorry that happened to you. If you don’t mind, your experience would be relevant to the post. If you’d rather not, I fully understand 🙂 .

    Edit: this was directed at Liz about her mistreatment.

  45. Leonard says:

    (it’s like Internet arguments, only more so)

    Haha! Thanks Scott. This made my day.

  46. Lauren says:


    I know I am immensely late to the party, but I’m hoping that you’re still monitoring this comment thread.

    After reading this and The Right to Waive Your Rights, I’m getting the impression that psychiatrists are only releasing people who they are exceedingly sure are not going to kill themselves. However, I have a friend who once attempted to check himself into a psychiatric hospital because he was feeling actively suicidal, but after psychiatric evaluation they turned him away. Can you tell me anything about why this might happen? He claims that they said it was because he didn’t have a precise, enactable suicide plan, and they needed the space for more serious patients. Can psychiatric hospitals be “full”, and does that absolve them of this liability, or would they be required to send the patient to another hospital? Couldn’t being turned away as “not suicidal enough” only fuel their depressive thoughts more (RE: Reverse Psychology post from 6/18)?


    • Scott Alexander says:

      I wouldn’t expect that to happen. Maybe to some people “person comes to hospital and says they are suicidal” might potentially be taken less seriously than “friend overhears them say they are suicidal” or “person makes suicide attempt” because it shows they’re still trying to avoid reaching that point and have decent judgment.

      I would expect the hospital to have a lot of legal liability in that case, and I agree the legally correct thing to do would be to send them another hospital. But I don’t know the law in any state other than Michigan.

      • Lauren says:

        Thanks for your response – I thought it was pretty strange as well. I wasn’t sure if there was some kind of “admit-seeking behavior” (similar to drug-seeking behavior perhaps?) that you might see in psychiatric hospitals, or some other indicators of which people are seeking some kind of validation/attention vs those who are a genuine threat to themselves.