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

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

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

The podiatrist seemed inadequately reassured.

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

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

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

II.

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

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

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

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

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

III.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sometimes I wonder if the concentration camp guards in Auschwitz ever had this problem. Like, the ones who weren’t especially sadistic, but who took it because it was a 9-5 job, and word around the water cooler was that it was an easy way to make Scharführer after a few years. And every night they would come home to their wives and be like “Gott in Himmel, Helga, you have no idea what I have to put up with every day, all of these prisoners won’t stop asking me for food and water and stuff, and I try to give them a couple of extra scraps when the regulations allow, but even after I do that they just want more food and they never stop, don’t they realize it makes me feel really guilty and there’s nothing I can do, and every day is more miserable and draining than the last, and I mean, seriously Helga, how entitled can people get?”

I know that’s a horrible metaphor, and our hospital is really good and run by some of the best staff and nurses and doctors I have ever met and tries 100% to help patients whenever it can. It’s just how I feel sometimes.

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

IV.

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

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

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

Still, if it’s a disaster, it will be a different type of disaster.

And the thing I love about psychiatry – other than, I am contractually obligated to say, The People You Meet and The Chance To Make A Difference – is the lore. If all science is either physics or stamp collecting, psychiatry is stamp collecting par excellence with the world’s most interesting postal system, hunting through this incredibly confused and unsystematic mass of work done by thousands of brilliant people and trying to drag some kind of meaning out of it. Sometimes that involves dredging up weird drugs that no one else thinks about or remembers but which are perfectly suited for the precise situation at hand. Sometimes it’s disentagling complicated claims about what does and doesn’t work so you can be sure to give your patients the former. Other times it’s something totally out of left field, like reading this study and massively increasing the amount my consult patients liked me pretty much overnight with zero work.

I think outpatient will be good for this. There’s more freedom, more focus on treatment rather than warehousing, and a little bit more of an academic bent to it.

In the meantime, I am now a third year resident. There are people beneath me, and sometimes they do what I say! I get enough of a raise that I can say, for the first time in my life, that I am making the US median household income! I mostly get weekends off, except when I don’t!

And in two years, I’ll be done in Michigan and maybe I can move somewhere else and hang out with some of you people full-time.

But recently I was thinking about this again, because I was rereading Byron’s “Growing Old”. Part of his Don Juan, it’s a series of reflections about turning thirty (really, Byron? Growing Old? Thirty?). I was reading it because I had read it when I was fifteen or so, and gotten some things out of it, and I’d resolved to reread it when I was older to see if I could get anything else:

But now at thirty years my hair is grey—
(I wonder what it will be like at forty ?
I thought of a peruke the other day—)
My heart is not much greener ; and, in short, I
Have squandered my whole summer while ’twas May,
And feel no more the spirit to retort ; I
Have spent my life, both interest and principal,
And deem not, what I deemed, my soul invincible.

And lo and behold, I do sympathize a lot more now. For example, what’s with my hair? It’s not turning grey. But it is falling out en masse. I haven’t thought about a peruke – which I think it one of those big white old-timey wigs George Washington used to wear – yet. But maybe I should.

But moving on:

No more—no more—Oh ! never more on me
The freshness of the heart can fall like dew,
Which out of all the lovely things we see
Extracts emotions beautiful and new ;
Hived in our bosoms like the bag o’ the bee.
Think’st thou the honey with those objects grew ?
Alas ! ’twas not in them, but in thy power
To double even the sweetness of a flower.

There’s something very raw about being young. I remember reading a psychotherapy book that, like most psychotherapy books, talks about childhood trauma. Their prescription was that it gets buried under lots of layers of unconscious baggage, and you need to bring it to the surface. Once it’s at the surface, the patient’s reaction should be something like “That? That was what bothered me all this time?” Because when you’re a child, everything is more intense. Yeah, some childhood trauma is getting beaten or abused. But other childhood trauma is getting called names on the playground, or being left alone without knowing where your parents were. I find a lot of the “inner child” school of psychology to be kind of bunk, but I find interesting the idea of your inner child as somebody who you’re much stronger than, somebody who they respect because you’ve developed really powerful psychological coping mechanisms they could never dream of, so that you’re a protector figure.

Ozy talks about this a lot in the context of their borderline personality disorder. I tend to think of a lot of symptoms of borderline as being associated with neoteny – a preservation of childlikeness into adulthood (I don’t know how orthodox this is). For Ozy, everything is still raw, maybe will always be raw. Every even slightly good thing that happens delights them. Every even slightly bad thing that happen traumatizes them.

The flip side of childhood trauma is childhood wonder. When you’re young, and to a lesser degree when you’re a teenager and even in your early twenties, you have a great capacity to be amazed at the raw beauty of the world. As you grow older, you get less direct exposure to things as you have more and more schemas to put them in: “Oh, yeah, that’s a beautiful sunset, it looks a lot like the five thousand other sunsets I’ve seen. I’ll just tag it ‘sunset’ and move on.” There’s a big loss there, but there’s a compensatory gain:

No more–no more–Oh! never more, my heart,
Canst thou be my sole world, my universe!
Once all in all, but now a thing apart,
Thou canst not be my blessing or my curse:
The illusion’s gone for ever, and thou art
Insensible, I trust, but none the worse,
And in thy stead I’ve got a deal of judgment,
Though Heaven knows how it ever found a lodgment.

That last couplet really resonates with me. You tend to think of judgment and wisdom as something you gain by laborious cultivation. And here’s Byron, saying “Somehow I seem to have gotten some good qualities. God only knows how that happened. Seriously, of all people, me?”

A lot of the time we make fun of teenagers for having crazy high libido. And then they grow older, and their sex drive calms down a little bit. I actually haven’t checked whether anyone knows if this is due to objective reductions in hormone levels, or if maybe once you’ve gone on a couple of dates and been in a couple of relationships it’s no longer quite so exciting.

But it’s not just sex. There’s this entire complex of teenage and early-twenties things around sex and extreme politics and mysticism and fashion, and some of it is praiseworthy in the sense of being really excited about new things, and part of it is just not having any idea what you’re doing, so that realistic opportunities and insane opportunities look about the same. And so you end up on this roller coaster of grandiose plans, inevitable letdowns, gnawing horrible fears, and unexpected relief. And then eventually you kind of bottom out and stop doing this.

I don’t know if this is biological either. Michael Vassar (and as far as I know no one else) theorizes about a “second puberty” in the late teens/early twenties where the brain starts to take on an adult form. There’s some evidence for – for example, this is the age at which a lot of previously latent mental disorders like schizophrenia develop. And there’s some evidence against – nobody had a conception of teenagerdom until like 1940s America or so. But it’s certainly a useful concept. Just as after puberty dies down you kind of naturally stop being so concerned about sex and acne and whatever, so after second puberty get a deal of judgment. You stop being so concerned about…what?

What is the end of Fame ? ’tis but to fill
A certain portion of uncertain paper :
Some liken it to climbing up a hill,
Whose summit, like all hills, is lost in vapour ;
For this men write, speak, preach, and heroes kill,
And bards burn what they call their ‘midnight taper’,
To have, when the original is dust,
A name, a wretched picture and worse bust.

Erikson calls the psychological crisis of the teenage years “identity versus role confusion”, and Reb Wiki’s commentary on his work adds that:

Erikson does note that the time of identity crisis for persons of genius is frequently prolonged. He further notes that in our industrial society, identity formation tends to be long, because it takes us so long to gain the skills needed for adulthood’s tasks in our technological world. So… we do not have an exact time span in which to find ourselves. It doesn’t happen automatically at eighteen or at twenty-one. A very approximate rule of thumb for our society would put the end somewhere in one’s twenties.

Let me take a stab at that “persons of genius” exemption, since some of my friends whom I’ve gotten a chance to observe are probably smart enough to qualify.

Anyone even a little bit smarter than normal gets feted and celebrated as a kid. I remember my fourth grade teacher telling my parents during a conference that “your son needs to go into science so he can cure cancer.” This is dumb. In a school of a thousand people, you can be the smartest kid in the school, more than smart enough to impress your teachers – and still be only one of the 300,000 smartest people in the country. If those other 300,000 people didn’t cure cancer, there’s a pretty good chance your son won’t either. But when you’re a kid, all you have to do to look smart is read the occasional science book and cultivate an interest in quarks. You can just go around saying “Did you know there are six types of quarks?” and everyone will think you’re some kind of genius.

Then you grow older. You reach the point where nobody thinks you’re a genius unless you can prove some kind of new result, which is a lot harder. You go to a good college, and suddenly you’re in an environment preselected so that everybody else is about as smart as you are. If you’ve been coasting through life on being able to name all six types of quark (and who’s going to know if you get one wrong?) this is pretty disorienting.

And so part of Erikson’s “role confusion” is thinking “Wait, I was the guy who was going to cure cancer. I can feel my status slipping away from me as I become more and more mediocre. What am I going to do to prove that I really am that cool?”

I think a lot of the pathologies of adolescence are part of that urge, hollow promises of regaining lost status. The key is to provide a narrative in which you are great and which is impervious to external disconfirmation. Extremist politics, mysticism and fashion all fit the bill for different personalities.

Along with the pathologies there were the ill-advised adventures. “I’m going to be a great person by…um…exercising an hour a day, from now on, all the time, and eventually becoming really buff.” Lasted a month. Then “I’m going to be a great person by…um…learning to speak ten languages, one at a time.” Lasted until first encounter with the Finnish case system. “I’m going to become a great person by…” The problem with all of these were that none of these were things I actually wanted to do (cf Randall Munroe, “Never trust anyone who’s more excited about success than about doing the thing they want to be successful at.”)

Actually, forget Randall Munroe. The best related quote is a different Monroe, who said that “although you are ambitious, you have no ambition.” And so:

Ambition was my idol, which was broken
Before the shrines of Sorrow, and of Pleasure ;
And the two last have left me many a token
O’er which reflection may be made at leisure :
Now, like Friar Bacon’s Brazen Head, I’ve spoken,
‘Time is, Time was, Time’s past’ : a chymic treasure
Is glittering Youth, which I have spent betimes—
My heart in passion, and my head on rhymes.

One of the key points of the rationalist community is to learn to “optimize” rather than “satisfice” things, and it’s a useful lesson. But everyone sometimes needs reverse advice, and younger me – and younger lots of people – didn’t really understand satisficing.

When I was about ten, I decided to just optimize my entire life. I made a schedule of exactly what I would do every day – each minute filled with some sort of very productive character-building activity. Then I followed it for two days. Then I gave up and felt bad about it for a while.

That’s the sort of optimizing that only Young Scott could love. But I’ve been reading On The Road recently, and I wonder if the sort of Beat culture of authenticity is a different kind of optimizing, where you’re throwing everything at being different and more real, to the point of abandoning family and financial stability and whatever else.

There’s a place for this kind of optimization, if it’s what you want to do. But I eventually noticed that attempts to optimize my life and be maximally good were making me kind of miserable. I think that’s where the judgment part comes in. You learn when it’s okay to stop getting mad at yourself for not being perfect and take a little bit of time to relax and enjoy.

Byron is maybe a bad example of learning to overcome ambition, since he did kind of become super famous. But even that can be a kind of relaxing ambition. You learn what you’re good at, even if it’s something like poetry that might not be the most lucrative and world-changing thing around, and you focus on that. You’re not going to be Julius Caesar, but you might be Lord Byron. Or if not Lord Byron, you might at least have a career and be good at it. Role confusion gives way to identity.

(even MIRI, the most healthily ambitious people I know, have backed down from “we will save the world all by ourselves, right now” to “we will contribute an important part in an eventual effort to save the world”)

In fact, I think that’s the most important part of the solution, the part that makes it a little more dignified than abject surrender to being a cog in the machine. Vague formless ambition crystallizes into a couple of things that you’re good at and want to pursue, and then it doesn’t seem like ambition any longer. It just seems like the thing you’re doing.

Byron also got one other thing right, which was that he was able to sacrifice ambition to pleasure. This seems a better shrine to sacrifice at than “akrasia” or “conformity” or “vague feelings that I shouldn’t be doing this.”

But I, being fond of true philosophy,
Say very often to myself, ‘Alas!
All things that have been born were born to die,
And flesh (which Death mows down to hay) is grass ;
You’ve passed your youth not so unpleasantly,
And if you had it o’er again—’twould pass—
So thank your stars that matters are no worse,
And read your Bible, sir, and mind your purse.’

Seems like another riff on the same subject. Ambition and the raw energy of youth turning to a vague fondness that he got things mostly right, for a human.

I hate to change poets in midstream, but Chesterton says much the same:

…the doubts that drove us through the night as we two talked amain,
And day had broken on the streets e’er it broke upon the brain.
Between us, by the peace of God, such truth can now be told;
Yea, there is strength in striking root and good in growing old.
We have found common things at last and marriage and a creed,
And I may safely write it now, and you may safely read.

The theme to me seems the same. Youth is scary. Everything is important. Philosophy seems perilously close. Every tiny thing inspires doubts. Then “there is strength in striking root and good in growing old”. You get a base. You know where you are standing. Things feel calmer and safer. You go from role confusion to identity.

Byron talks of “reading your Bible and minding your purse”. Chesterton talks about “we have marriage and a creed”. I read these as kind of similar. It’s about finding an ideology – in contrast to the constant ideology-searching of youth where you get your Communists and your Daoist and your anarchists and whatever. And then it’s about turning to be more interested in the everyday world of things like marriage and family and relationships and balancing your checkbook.

If this were about suddenly ceasing to care about ideas, then it would be monstrous and I’d be trying to resist it every way I can. But neither Chesterton nor Byron became intellectual lightweights in their old age. I think of it as getting to participate in the world of ideas because you want to, rather than because you have to. In Jung’s words, “swimming rather than drowning”. Or since the ocean of thought is maybe too big for a swimming metaphor, you’re still out at sea, but you’ve got a nice sturdy ship instead of a Neurath’s boat where you have to build your vessel while you’re sailing on it.

In an unhealthy society, it can be dangerous to lose revolutionary fervor. But in a healthy society, it seems to be a natural and important process. I don’t know if our society is healthy enough for me to be entirely comfortable with it. There are a lot of people who can’t get a stable career, people who are trying as hard as they can. But even in a revolution you need a couple of people to keep things running and maybe donate money earned at a stable job to the people with more zeal (see: Engels), and in the spirit of satisficing rather than optimizing I’m pretty okay with this role.

…or maybe you stay an anarchist or a Daoist or a communist. But then it’s because you’re set in that philosophy and you like it and you’re making a stand there, rather than because it’s your Experiment Of The Month. It’s good to have Experiments Of The Month – high expected value of information, low transaction costs for changing your mind – but it’s also a relief to be done with that. Identity in place of role confusion. As for the adult world of relationships and checkbooks, it’s a different and lower-variance way of contributing to the community, and if you’re lucky you can have kids and start the whole cycle over again.

Yesterday I turned thirty years old. People keep asking me how I feel about it. I think I agree with Byron. I passed my youth not too unpleasantly. And if I had it over again, it’d pass. So thank the stars that matters are no worse.

I’ve been asked to give an impromptu speech. Specifically, I was asked six months ago, when Hannah messaged me and said “You need to give an impromptu speech at my wedding. You’ve got six months to get it sounding impromptu enough.”

But I’ve been thinking about this day for even longer than that. The first time Hannah and I talked about her wedding was…maybe three or four years ago. She was staying at my house in Southern California on her way to Anna and Carl’s wedding. And this was actually an Important Historic Occasion, because the next night when she stayed in San Diego, in order to save money she shared a hotel room with a certain Michael Blume and the rest is history. But at the time they weren’t together, and Hannah and I were – kind of half-dating, I don’t think we had actually started dating at the time, but we were flirting. And Hannah asked if I was going to go to the wedding the next day, and I said no, I couldn’t stand weddings, I hated weddings, I would do whatever I could to avoid them.

And she looked at me with big eyes and said “But…you’ll come to my wedding? Right?”

I said: “Mumble mumble maybe mumble try.”

Hannah wouldn’t take that as an answer and demanded to know my probability that I would come to her wedding.

I remember what I answered. It was something like “Fifty percent. Rising to ninety percent, if I’m the groom.”

And that didn’t work out, but I still find that now that the time is here I wouldn’t miss it for the world.

Hannah is still one of my favorite people. When I was out of a job and had no idea what I was going to do with my life, Hannah kind of saved me and gave me a place to live in Berkeley and threw me at her friend group so hard I have never been able to extract myself since. I have known her for five years now, I dated her for about three, I lived with her for one. And in the end, my only regret about attending her wedding was that it means I am visiting Berkeley on the ONE weekend that she’s not throwing a dinner party with her home cooking.

I’ve known Mike for a lot shorter, only about two years. Which is too bad, because it means that there were all these years of my life when I could have known Mike, but didn’t, which is a tragic waste. Mike is kind of like the Platonic ideal of the Good – to know him is to love him. I remember one Facebook thread where someone posted “Mike Blume is so nice and helpful and dreamy” to their wall, and it ended up ballooning to like a hundred likes and comments from people agreeing with the sentiment.

I was looking for that thread the other day so I could quote it, and I couldn’t find it. Part of the reason I couldn’t find it was that I kept asking people – “Do you remember who posted that Facebook thread praising Mike for being really nice and attractive and helpful?” – and they would say “Yeah, I think I was the one who posted that, it sounds like the sort of thing I would say.” And then they look and can’t find it, so I go to the next person, and they’re like “You know, I bet I was the one who posted that, it sounds like the sort of thing I would say…” annnnnnd I never did find the thread.

That is Mike.

So instead I hunted down something I once said about Mike once on my blog, which I would like to share with you today: “Hannah says Mike is her ‘happiness battery’, a source of emotional strength she can rely on to get her through difficult times. After living with him, I felt the same way, and he is at the center of so many social circles he might better be described as a giant happiness hydroelectric plant powering half of Northern California. The fact that flowers do not spring up everywhere he walks only proves that flowers are wrong.”

In fact, I took unfair advantage of this when I lived with Mike and Hannah to meet a steady stream of Mike groupies. That was how I met my current girlfriend Ozy – they dated Mike first. That was how I met my ex-girlfriend Kenzi, who officiated today – she dated Mike first. In fact, Mike and Kenzi were really good together. I used to wonder whether Hannah would marry Mike or Kenzi would marry Mike. I’m glad to see that they both married Mike, in different senses.

I’m trying to avoid using the phrase “emergent property” in a wedding speech, but I’ll say it – there is an emergent property to their relationship that makes them even better together than either one is alone. Their interactions with each other show such amazing mutual respect and love and complementarity that it adds new plausibility to the idea of soulmates. They are my model of how a good relationship ought to work. And one day, I hope some ambitious linguist will study their ability to communicate with each other entirely in adorable high-pitched noises (“eeeeeeeeeee!” “EEEEEEEEEEE!”)

I like Mike, and I like Hannah. But beyond either of them, I have a huge, huge crush on their relationship.

I want to marry their marriage.

I know my conservative friends tell me that we’re on a slippery slope, and soon people will be marrying animals, and trees, and rocks. And I can only hope that, somewhere at the bottom of that slope, someone legalizes man-relationship unions.

And when that happens, the rest of you, stay away! I called it first!

My friends got MARRIED!

But I’m sorry to get into politics at a time like this. Let’s talk about something more relevant. Let’s talk about population genetics.

A Dr. Joseph Chang of Yale University, using sophisticated statistical techniques, determined that ancestry mixes surprisingly quickly across populations. I promise this will become relevant. He found that beyond a certain horizon anybody who’s the ancestor of anybody in a population is the ancestor of everybody. The exact length changes depending on some assumptions, but for a relatively mixed population like descendants of Eurasians, it’s probably around fifteen hundred years. Some tribes on remote islands way out in the Pacific might be longer. Anyone from Papua New Guinea here today? No?

Then everyone here today is a descendent of Socrates. Everyone here today is a descendent of Confucius. Everyone here today is a descendent of Mohammed. Even if you don’t look much like him. Queen Elizabeth’s official genealogy confirms a descent from Mohammed, and she doesn’t look Middle Eastern either.

We’re all descendants of Nefertiti. The patriarch Abraham. The Japanese imperial line. Charlemagne. Qin Shih Huang Di. And not just genetically. We learned values from our parents that they learned from their parents that they learned from their parents and so on to Socrates or Mohammed or Charlemagne sitting their kids down at the dinner table and trying to teach them right from wrong.

Mike and Hannah met through the Machine Intelligence Research Institute, through the Visiting Fellows program at Benton-that-was. A lot of people here today are involved with MIRI, or other organizations trying to ensure the survival of humanity a thousand or two thousand years from now. And there’s a lot of discussion, within those circles, about what such a future would be like.

And I was reading about this population genetics stuff six months ago, at the same time Hannah asked me to write an impromptu speech, and it made me think.

Whatever else we’re celebrating with the ritual of marriage, we’re also celebrating this. We’re marking this incredibly audacious act of taking a genetic and memetic payload and shooting it into the far future, where it will spread further and further with every generation and eventually rewrite humankind.

And if we make it another fifteen hundred years as a biological species, someday we will have a world where everybody alive is a descendent of Mike and Hannah. And where everyone has received their values from someone who received their values who received their values…from Mike and Hannah.

And that’s pretty high up there for me as a reason to be incredibly excited about the whole project.

So, a toast. To Hannah. To Mike. To their relationship. And to the future.

Congratulations, guys.

(No pressure.)

ADDED: Here is the text of the wedding ceremony itself, written by Hannah.

The Hospital Mission Statement. The descriptions of the long procedure, the countless doctor-hours of work, the innumerable committees, that went into drafting this mission statement. The firm assertion that this mission statement is a divinely inspired pipeline to the culture of this particular hospital, meditating upon which will tell us the sort of institution we have been hired by. The total indistinguishability from any other hospital or clinic mission statement I have ever heard, all of which go something like “We strive to provide comprehensive care to patients in a culture of excellence” and could have been devised by the average college student in three minutes.

The big Vietnamese guy from Internal Medicine sitting next to me with a nametag reading “Becca Silverman”. The halting attempt to be humorous – “That’s funny, you don’t look like a Becca”. The deadpan assertion “Becca is an ancient and traditional Vietnamese name.” The awkward, uncertain silence.

The discussion of the hospital’s Ethical Guidelines. The assurance that, although not all of us are Catholic, the hospital guidelines are rooted in Catholicism but not limited to them and we will all be able to appreciate their wisdom in a nice ecumenical way. The segue into the first of these guidelines, which is COMMUNION WITH THE CATHOLIC CHURCH.

The introduction to various executives and officers, a disproportionate number of whom used to work in the auto industry but left for the hospital industry when times got bad. The inspirational quotes from Henry Ford, who, if these executives and officers are to be believed, is some sort of credible expert in the art of hospital-running. The growing worry that someone is going to tell me my patients just need an oil change.

The educational movie about someone who drives drunk and then gets in an accident and dies. The explanation that the moral of the movie was “Don’t make bad decisions”. The feeling that this is probably one of those problems that could benefit from being taskified. The only good part of the movie, which was the totally unnecessary plot twist where the drunk driver turns out to (secretly!) be the son of the doctor who was supposed to treat him, leading the actor playing the doctor to shout “NOOOOOOOOOOOOOOOOO!” in a very Anakin-ish way for about five seconds straight.

The presentation on work-life balance at the end of a long ten-hour day. The feeling that every time a company makes employees stay overtime to attend a mandatory seminar on work-life balance, an angel does a facepalm. The request for audience suggestions on how to fit a sixty to seventy hour work week in with sleep, study, errands, and family. The comment from Becca: “That thing with the hourglass Hermione used in the Harry Potter movie?”

The inspirational speech about how we should let Jesus guide us in our medical practice. The suppressed comment that as far as I know, Jesus only encountered one psychiatric case, which he diagnosed as a demon and treated by casting it into a herd of pigs who then fell off a cliff. The suspicion that this is no longer considered Best Practice. The doubt over whether Medicare would even reimburse him for the pigs.

My father came with me as far as Detroit, where he stopped to help me search for a new car in the Motor City. He is wise in the ways of the world, though sometimes a little too practical. I remember back when he came to visit me in Japan. Come dinner time, he asked “Is there anywhere you can get good Italian food in this country?”, and when I protested that he might want to try some sushi, or noodles, or dumplings, or tempura, he just shook his head and started looking through the index of his guidebook. I think we had Italian six of the seven nights he was there.

Admittedly, when Japan does Italian, it goes all out.

But I will give him credit where credit is due; he eventually made it up to the poor Japanese. After he perused all the cars that one of the world’s greatest automotive centers had to offer, he made me a final well-informed recommendation and I am now the proud owner of a new Subaru.

In much the same way, I used to think I disliked social interaction. I have since realized – and it blew my mind – that I only disliked social interaction with people who aren’t awesome.

I am leaving California tomorrow for the Midwest, where I have a four-year residency in one of the local hospitals. In a life that has seen more than its share of leaving places to go to other places, I don’t think I’ve ever been quite so reluctant to move on.

People in the Bay Area get it. You get a bunch of hippies throwing love into the pot, computer programmers adding brainpower, and entrepreneurs adding competence. Mix and stir and you get people who want to make the world better, know how to do it, and sometimes even get up off their armchair and do.

I’ve recently been thinking about two competing philosophies. The first, which seems to me very conservative, is that you maximize virtue and if you’re sufficiently virtue happiness follows on its own. The second, which seems very hippie, is that you maximize happiness and if you’re sufficiently happy then you naturally want to spread that happiness as far as possible. I have previously been sympathetic to the former view, but the Bay Area makes an impossible-to-ignore case for the latter. All the self-help and spirituality and wacky leftism seems founded in this base of “We’ve maxed out our own happiness meter just by living here! How can we help the rest of you?”

I was privileged to experience a bubble within a bubble, the meta-bubble being the Bay Area “rationalist community”, ie a bunch of people who met through Less Wrong, the Machine Intelligence Research Institute, and the Center for Applied Rationality. One of my thoughts in designing Raikoth and other constructed societies is that if you collect nice people beyond a certain concentration it has unexpected emergent effects based on everyone suddenly realizing they can trust everyone else and voluntarily abandoning some of their hang-ups and defense mechanisms. That is exactly what happened in the Bay Area sometime before I moved there.

I am still trying to work out what went right in the hopes of being able to bottle it and export it to other groups of people. There’s the old adage that there are three sides to every issue – your side, their side, and the truth – and the epistemic virtue that allows you to detach from your side in a philosophical debate is exactly the same virtue that allows you to see every side of a quarrel and work through it reasonably. I think a lot of the best self-help – cognitive-behavioral therapy, non-violent communication, that kind of thing – are basically trying to teach this skill that the Bay Area rationalist community has more of than any other group I’ve ever seen.

Beyond that, cynicism can be incredibly liberating. Things that no one would ever admit elsewhere – status motives, sex motives, weird cognitive biases and mental flinches – are all out in the open among Bay Area rationalists. People can say things like “I don’t know why, but that thing you do enrages me, can you please stop?” and instead of getting offended other people will just say “Sure”, because no one makes sense, and mindspace is deep and wide. Overt status contests are really hard to get into, because everyone knows exactly what a status contest is and it would be oddly tacky, the same way that saying “Oh, I like an obscure band, you’ve probably never heard of them” sounds tacky because everyone has absorbed it as a stereotypical example of something pretentious people do.

People seem to accept sex and romance (of all permutations and kinks) as a normal part of life, and can talk about it in a way that I would describe as “like reasonable adults” if reasonable adults showed any signs of being able to talk that way. For almost the first time, I was able to have close female friends without being confused and scared of getting classified as a “creep” or “Nice Guy (TM)”. People of any gender and sexual orientation can ask friends of any other gender or sexual orientation to cuddle, and be met with an enthusiastic “yes” or an immediately-accepted “no” but almost never an outraged “How dare you!”

I have actually used moral philosophy to settle problems, and it has worked – if only because people get much more interested in the arcana of the moral principles involved than on whatever the original point of contention was. I have seen libertarians, socialists, feminists, mens’ rights advocates, transhumanists, and pious Christians get together at the same table, debate their views, and have a totally reasonable discussion that ends with everyone more enlightened and appreciative than when they arrived. I’ve seen a bunch of guys live together with the one girl they are all dating and this situation produce zero conflict.

A long time ago, a discussion on the uses of technical rationality seemed to converge around it probably being more useful for communities than for individuals. I think the Bay Area is a shining and undeniable proof of this, and I’m incredibly grateful to have gotten to live there as long as I did.

…but I should add that it’s not just the rationality and that the people involved are, in fact, wonderful people, and would probably have been wonderful people no matter what memeplex they had been exposed to. I can hardly begin to thank all the great people I have interacted with and learned from over the past year. I probably shouldn’t even try, as I’m sure the jet lag I’m in the process of losing a fight against, not to mention the limitations of finite time and energy, will make me forget people who I love dearly. But I can’t help expressing gratitude to just a couple of the people I got the privilege of getting to know recently.

Mike, I told you before that I use you to ground morality. I have used “Mike Blume does X” in ethical debates as a knock-down argument that X is okay, and the argument always gets accepted. Alicorn says she uses you as a “happiness battery”, and I notice I started doing the same after a few months living with you, and given your central position in so many social circles a better metaphor might be a giant happiness hydroelectric plant powering half of Northern California. The fact that flowers do not spring up everywhere you walk only demonstrates that flowers are wrong

Alicorn, you claimed when we first met that you were “orthogonal to status”, which at the time I thought was ridiculous. I still would be reluctant to use exactly that description. But if you were to say you had solved life, you are practically the only person from whom I would take the claim remotely seriously. You have some mysterious ability to factor situations into simple parts, figure out what you want from them, and then just do that without any drama or self-questioning or hullabaloo. If I had that skill to a tenth of the degree you do, I would just dismiss the rest of the human race as so hopelessly confused as to be not worth your time, but you have somehow managed to stay really nice regardless. You also cook well and have amazing hair.

Luke, I remember getting some social skills advice from a friend in New York. He told me that if I met someone who was obviously amazing along one axis, I should compliment them along other axes, because they will more fully appreciate hearing compliments they didn’t already know. I think his exact words were “If there’s a really pretty girl, tell her she’s smart, and if there’s a really smart girl, tell her she’s pretty”. I remember asking “What if there’s a girl who’s both smart and pretty?” and being told to tell her that she was kind, or had a nice voice, or something. After continuing this several more iterations, we joked that if we ever found someone amazing along every axis, we would be reduced to horrible awkward compliments like “Hi! I’m Scott! You’re really tall! Mind if I sit down?” Well, you not only seem to exemplify this nightmare scenario, but I can’t even tell you that you’re really tall. YOU ALREADY KNOW!

Leah, there’s an old Jewish saying that “everyone wants to serve God, but only in an advisory position”. Probably meant as satire, but if by chance the job actually exists, I think it is a perfect match for you and I will happily write you a glowing letter of recommendation.

Anna, I am constantly amazed by the number of plans that contain or should contain a node saying “Get Anna Salamon’s advice, then do whatever she says”. When people raise irrelevant theoretical objections to thought experiments beginning “Imagine a perfect Bayesian reasoner claimed…”, I just switch to “Imagine Anna Salamon claimed…” and they shut up.

Kenzi, it was incredibly gratifying to be able to tell my parents “I’m dating someone who…” and then list off all your qualities. The only problem was that by the time I got to “…is amazing at pretty much every style of dance, and got accepted to a prestigious medical school but turned it down to pursue her dream job at a non-profit, and can identify all West Coast flora on sight…” I think they might have stopped believing me. But you’re not just a trophy. You’re also the person who can finish a hiking trip with me without giving up, breaking down, or feigning your own death to escape. That (among other things) earns you a permanent place in my heart.

Davis, I still have trouble believing you actually exist.

Vassar, before I came to Berkeley, someone warned me “Vassar is kind of crazy and it’s impossible to have a normal conversation with him”. As a result, I spent several months avoiding you. Then I finally got to meet you and I realized I had made a huge mistake. I mean, you are crazy, and it is is impossible to have a normal conversation with you. But normal conversation is incredibly over-rated compared to whatever the heck you call the thing that interaction with you involves. I regret that we didn’t get more of a chance to talk about stuff and I hope to solve that sometime in the future.

Elizabeth, this is you to a ‘T’. You are a good egg.

Zak, you are nice and helpful and friendly and never gave me any grief about my total failure to answer any of your emails. In case you were wondering, it was because I’m a bad person.

Carl, the last time you commented on my blog, I went around doing a little dance and singing “Carl Shulman reads my blog! This validates my existence!”

Shannon, I admire your fighting spirit and your ability to remain cheerful in the face of adversity and pretty much everywhen else. Thanks for your help explaining IFS to me and for your thoughts on psychiatry which I am going to try my best to learn from.

Kevin, I predict one day I will see your name and picture in a biochemistry textbook. I don’t know whether it will be as a bold pioneer or as a horrible warning. Either way, I’ll be like “Hey, I knew that guy!”

Julia, I am constantly surprised to see you in our community when you could so obviously fit into a much higher-status community where people have class and drink fancy wine and almost never wear shoes with individual toes. But I am delighted that you stick around with us. I remember seeing a video of your “straw Vulcan” speech and wondering who you were and how I had somehow missed knowing about you and how I could correct that. Every time we have talked you have given me really interesting things to think about. I am so glad you are one of us instead of wasting your life becoming Secretary of State or something.

Valentine, I am convinced that if an evil wizard ever tried to attack you with one of those artifacts that turns the target’s insecurities and negative emotions against them, he would end up looking baffled, kicking the artifact to see if it was broken, and eventually giving up in disgust. And then you would kick his ass. Compassionately. And I love the story behind your nickname.

Steven, your sense of humor needs to be declared either a wonder of the world or at least a UNESCO World Heritage Site. You are the only justification the existence of Twitter I will accept. And your explanation of your politics actually was quite helpful to me.

Will Newsome (are you a Berkelian these days? I’m just going to count you) even though you are sometimes irresistibly fun to tease (I still like telling the story of how after I read Breakdown of Will, three consecutive people to whom I mentioned the book title thought I was talking about you) I have a huge amount of respect for your originality as a thinker and for your Taking Ideas Seriously abilities. I continue to wish to subscribe to the newsletter you stubbornly refuse to write.

Paul and Katja, I didn’t really get to see you much or really at all, but I was really impressed by your work organizing the Berkeley altruist community. Even if I cannot yet count you as friends I definitely count you as inspirations. Katja, you are the second of three people I will accuse in this post of having awesome hair.

Nisan, likewise with your community organization work and you actually putting together and holding all those meetups. I am still impressed you tried that Hermeneutics game. Empiricism!

Jonah, there is a passage I remember from Name of the Wind: “Elodin proved a difficult man to find. When I visited Ledgers and Lists, I discovered he only taught one class: Unlikely Maths. However, this was less than helpful, as according to the ledger, the time of the class was ‘now’ and the location was ‘everywhere.'” I cannot think of a more elegant description of being in your social circle.

Will & Divia, if I were doing a meta-analysis of whether all those weird self-help things really make people better, you would be two really really big squares way on the right of the forest plot, and people would get angry and say that I should have dropped you as outliers.

Lindsey, I think I only think of you as a personification of the spirit of California because of that one California-themed party you put on, but the comparison stands.

Nick, of everything that happened that first time I visited Benton long ago, driving somewhere with you talking about ethics is the part I remember most. You are wise and calm and clear-thinking, and my attempts to visualize you getting angry at something fail about the same way my attempts to visualize a square circle do – this vague vision of a square with rounded corners followed by a “screw this, this is dumb” and giving up. You are the last of three people whom I will mention have awesome hair.

Louie, remember that time you came to the California-theme party as a bigshot high-powered studio executive? It took me several minutes of talking to you before I realized you were playing a role. You are so much larger than life at all times that I can pretty much believe anything of you, and so well-rounded you approximate a hypersphere. You’re another one of those people I can’t tell stories about because no one would believe me.

Qiaochu, I don’t know which I am more jealous of – your skill in and enthusiasm about math, or that you’re going to get to live with Mike and Alicorn next year. Whenever I am searching for math-related things on the Internet, I inevitably stumble across your name and things you have written with much greater regularity than the percent the world intellectual community you compose would suggest. There was a three minute window when you were talking to me when I sort of understood the idea of using probability to escape Lobian self-reference. You have a great name and an even better explanation of how to pronounce it, and you are fun.

Eliezer, I was thinking recently about the impact that ideas and people and communities traceable back directly to you have had on my life. I ended up giving you credit for most of my friends, all my relationships, one of my favorite books, the last place I lived, the job I’ve been working for the past year, quite a bit of my philosophy, and, via my work and prizes in MetaMed looking really good on my resume, quite possibly my career as well. If you ever succeed in your grand scheme to initiate a positive singularity and turn the world into a utopia, I’m going to be the one grumbling that I had my life radically improved by Eliezer Yudkowsky before it was cool.